Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Natasha Ironside¹, Ching-Jen Chen², Reda M Chalhoub³, Peter Wludyka⁴, Ryan T Kellogg⁵, Sami Al Kasab⁶, Dale Ding⁷, Ilko Maier⁸, Ansaar Rai⁹, Pascal Jabbour¹⁰, Joon-Tae Kim¹¹, Stacey Q Wolfe¹², Robert M Starke¹³, Marios-Nikos Psychogios¹⁴, Amir Shaban¹⁵, Adam S Arthur¹⁶, Shinichi Yoshimura¹⁷, Jonathan A Grossberg¹⁸, Ali Alawieh¹⁹, Isabel Fragata²⁰, Adam J Polifka⁴, Justin R Mascitelli²¹, Joshua W Osbun²², Charles Matouk²³, Michael R Levitt²⁴, Travis M Dumont²⁵, Hugo H Cuellar-Saenz²⁶, Richard Williamson²⁷, Daniele G Romano²⁸, Roberto Javier Crosa²⁹, Benjamin Gory³⁰, Maxim Mokin³¹, Mark Moss³², Kaustubh Limaye³³, Peter Kan³⁴, Alejandro M Spiotta³, Min S Park⁵; STAR collaborators

Collaborators, Affiliations

Affiliations

¹ Neurosurgery, University of Virginia, Charlottesville, Virginia, USA ironsidenatasha@gmail.com.
² Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USA.
³ Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
⁴ Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
⁵ Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
⁶ Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
⁷ Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
⁸ Neurology, University Medicine Goettingen, Goettingen, NS, Germany.
⁹ Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA.
¹⁰ Neurological surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
¹¹ Chonnam National University Hospital, Gwangju, Gwangju, Korea (the Republic of).
¹² Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
¹³ Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁴ Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
¹⁵ Neurology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA.
¹⁶ Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
¹⁷ Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
¹⁸ Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁹ Neurosurgery, Emory University, Atlanta, Georgia, USA.
²⁰ Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
²¹ Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
²² Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA.
²³ Neurosurgery, Yale University, New Haven, Connecticut, USA.
²⁴ Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
²⁵ Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA.
²⁶ Neurosurgery, LSUHSC, Shreveport, Louisiana, USA.
²⁷ Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
²⁸ Neurordiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.
²⁹ Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay.
³⁰ Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France.
³¹ Neurosurgery, University of South Florida College of Medicine, Tampa, Florida, USA.
³² Washington Regional Medical Center, Fayetteville, Arkansas, USA.
³³ Indiana University, Bloomington, Indiana, USA.
³⁴ Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA.

PMID: 36725360
PMCID: PMC10962911
DOI: 10.1136/jnis-2022-019513

Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Natasha Ironside et al. J Neurointerv Surg. 2023 Nov.

. 2023 Nov;15(e2):e312-e322.

doi: 10.1136/jnis-2022-019513. Epub 2023 Feb 1.

Authors

Affiliations

¹ Neurosurgery, University of Virginia, Charlottesville, Virginia, USA ironsidenatasha@gmail.com.
² Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USA.
³ Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
⁴ Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
⁵ Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
⁶ Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
⁷ Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
⁸ Neurology, University Medicine Goettingen, Goettingen, NS, Germany.
⁹ Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA.
¹⁰ Neurological surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
¹¹ Chonnam National University Hospital, Gwangju, Gwangju, Korea (the Republic of).
¹² Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
¹³ Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁴ Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
¹⁵ Neurology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA.
¹⁶ Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
¹⁷ Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
¹⁸ Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁹ Neurosurgery, Emory University, Atlanta, Georgia, USA.
²⁰ Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
²¹ Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
²² Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA.
²³ Neurosurgery, Yale University, New Haven, Connecticut, USA.
²⁴ Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
²⁵ Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA.
²⁶ Neurosurgery, LSUHSC, Shreveport, Louisiana, USA.
²⁷ Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
²⁸ Neurordiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.
²⁹ Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay.
³⁰ Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France.
³¹ Neurosurgery, University of South Florida College of Medicine, Tampa, Florida, USA.
³² Washington Regional Medical Center, Fayetteville, Arkansas, USA.
³³ Indiana University, Bloomington, Indiana, USA.
³⁴ Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA.

PMID: 36725360
PMCID: PMC10962911
DOI: 10.1136/jnis-2022-019513

Abstract

Background: Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy.

Methods: This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade.

Results: The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference.

Conclusions: This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.

Keywords: Hemorrhage; Stroke; Thrombectomy; Thrombolysis.

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Conflict of interest statement

Competing interests: PK, JRM, MM and MRL are members of the editorial board of JNIS.

References

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1. Turk AS, Siddiqui A, Fifi JT, et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet 2019;393:998–1008. - PubMed
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Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Collaborators

Affiliations

Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical