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. 2022 Dec 15;11(24):7433.
doi: 10.3390/jcm11247433.

Predictors of Symptomatic Intracranial Hemorrhage after Endovascular Thrombectomy in Acute Ischemic Stroke Patients with Anterior Large Vessel Occlusion-Procedure Time and Reperfusion Quality Determine

Yan Li  1 , Natalie van Landeghem  1 , Aydin Demircioglu  1 , Martin Köhrmann  2 , Philipp Dammann  3 , Marvin Darkwah Oppong  3 , Ramazan Jabbarli  3 , Jens Matthias Theysohn  1 , Jens-Christian Altenbernd  1   4 , Hanna Styczen  1 , Michael Forsting  1 , Isabel Wanke  1   5 , Benedikt Frank  2 , Cornelius Deuschl  1
Affiliations

Predictors of Symptomatic Intracranial Hemorrhage after Endovascular Thrombectomy in Acute Ischemic Stroke Patients with Anterior Large Vessel Occlusion-Procedure Time and Reperfusion Quality Determine

Yan Li et al. J Clin Med. .

Abstract

Purpose: We aimed to evaluate predictors of symptomatic intracranial hemorrhage (sICH) in acute ischemic stroke (AIS) patients following thrombectomy due to anterior large vessel occlusion (LVO).

Methods: Data on stroke patients from January 2018 to December 2020 in a tertiary care centre were retrospectively analysed. sICH was defined as intracranial hemorrhage associated with a deterioration of at least four points in the National Institutes of Health Stroke Scale (NIHSS) score or hemorrhage leading to death. A smoothed ridge regression model was run to analyse the impact of 15 variables on their association with sICH.

Results: Of the 174 patients (median age 77, 41.4% male), sICH was present in 18 patients. Short procedure time from groin puncture to reperfusion (per 10 min OR 1.24; 95% CI 1.071-1.435; p = 0.004) and complete reperfusion (TICI 3) (OR 0.035; 95% CI 0.003-0.378; p = 0.005) were significantly associated with a lower risk of sICH. On the contrary, successful reperfusion (TICI 3 and TICI 2b) was not associated with a lower risk of sICH (OR 0.508; 95% CI 0.131-1.975, p = 0.325). Neither the total time from symptom onset to reperfusion nor the intravenous thrombolysis was a predictor of sICH (per 10 min OR 1.0; 95% CI 0.998-1.001, p = 0.745) (OR 1.305; 95% CI 0.338-5.041, p = 0.697).

Conclusion: Our findings addressed the paramount importance of short procedure time and complete reperfusion to minimize sICH risk. The total ischemic time from onset to reperfusion was not a predictor of sICH.

Keywords: EVT; LVO; brain; brain hemorrhage; sICH; stroke; thrombectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patient’s selection. Declaration of Abbreviations: IVT = intravenous thrombolysis; EVT = endovascular thrombectomy; LVO = large vessel occlusion.
Figure 2
Figure 2
Reperfusion grade and presence of symptomatic intracranial hemorrhage. TICI = thrombolysis in cerebral infarction scale; sICH = symptomatic intracranial hemorrhage.
See this image and copyright information in PMC

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