Multicenter Study

. 2025 Jul 14;17(8):803-810.

doi: 10.1136/jnis-2024-021879.

Symptomatic intracerebral hemorrhage in proximal and distal medium middle cerebral artery occlusion patients treated with mechanical thrombectomy

Vivek S Yedavalli^#¹, Hamza Adel Salim^#^{2

3}, Basel Musmar⁴, Nimer Adeeb⁴, Muhammed Amir Essibayi⁵, Kareem ElNaamani⁵, Nils Henninger^{6

7}, Sri Hari Sundararajan⁸, Anna Luisa Kuhn⁹, Jane Khalife¹⁰, Sherief Ghozy¹¹, Luca Scarcia¹², Benjamin Yq Tan^{13

14}, Jeremy Josef Heit¹⁵, Robert W Regenhardt³, Nicole M Cancelliere¹⁶, Joshua D Bernstock¹⁷, Aymeric Rouchaud¹⁸, Jens Fiehler¹⁹, Sunil A Sheth²⁰, Ajit S Puri⁹, Christian Dyzmann²¹, Marco Colasurdo²², Xavier Barreau²³, Leonardo Renieri²⁴, João Pedro Filipe²⁵, Pablo Harker²⁶, Răzvan Alexandru Radu²⁷, Thomas R Marotta¹⁶, Julian Spears¹⁶, Takahiro Ota²⁸, Ashkan Mowla²⁹, Pascal Jabbour⁶, Arundhati Biswas³⁰, Frédéric Clarençon^{31

32}, James E Siegler¹⁰, Thanh N Nguyen³³, Ricardo Varela³⁴, Amanda Baker⁵, David Altschul⁵, Nestor Gonzalez³⁵, Markus A Möhlenbruch³⁶, Vincent Costalat²⁷, Benjamin Gory^{37

38}, Paul Stracke³⁹, Mohammad Ali Aziz-Sultan¹⁷, Constantin Hecker⁴⁰, Hamza Shaikh¹⁰, David S Liebeskind⁴¹, Alessandro Pedicelli⁴², Andrea M Alexandre⁴², Illario Tancredi⁴³, Tobias D Faizy¹⁹, Erwah Kalsoum¹², Boris Lubicz⁴⁴, Aman B Patel³, Vitor Mendes Pereira¹⁶, Adrien Guenego⁴⁴, Adam A Dmytriw^{3

16}; MAD MT Investigators

Collaborators, Affiliations

Collaborators

MAD MT Investigators:
Abdelaziz Amllay, Achala Vagal, Adrien Ter Schiphorst, Ajith J Thomas, Anil Gopinathan, Anne Dusart, Carolina Capirossi, Charbel Mounayer, Charlotte Weyland, Cheng-Yang Hsieh, Christoph J Griessenauer, Christopher J Stapleton, Erwah Kalsoum, Flavio Bellante, Gaultier Marnat, Géraud Forestier, Hamza Shaikh, Hugo H Cuellar-Saenz, Iacopo Valente, Igor Sibon, James D Rabinov, Jérôme Berge, Jessica Jesser, Juan Carlos Martinez-Gutierrez, Kevin Premat, Leonard Ll Yeo, Lina Chervak, Lukas Meyer, Mahmoud Elhorany, Miguel Quintero-Consuegra, Mohamad Abdalkader, Mohammad Ali Aziz-Sultan, Monika Killer-Oberpfalzer, Peter T Kan, Piers Klein, Priyank Khandelwal, Ramanathan Kadirvel, Robert Fahed, Sergio Salazar-Marioni, Shogo Dofuku, Simona Nedelcu, Stavropoula I Tjoumakaris, Suzana Saleme, Yasmin Aziz

Affiliations

¹ Department of Radiology, Division of Neuroradiology, Johns Hopkins Medicine, Baltimore, Maryland, USA vyedava1@jhmi.edu.
² Department of Radiology, Division of Neuroradiology, Johns Hopkins Medicine, Baltimore, Maryland, USA.
³ Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA.
⁴ Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, Louisiana, USA.
⁵ Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
⁶ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁷ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
⁸ Department of Endovascular Neurosurgery and Neuroradiology, NJMS, Newark, New Jersey, USA.
⁹ Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
¹⁰ Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, New Jersey, USA.
¹¹ Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, Minnesota, USA.
¹² Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.
¹³ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹⁴ Division of Neurology, Department of Medicine, National University Hospital, Singapore.
¹⁵ Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA.
¹⁶ Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada.
¹⁷ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹⁸ University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
¹⁹ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
²⁰ Department of Neurology, UTHealth McGovern Medical School, Houston, Texas, USA.
²¹ Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Schleswig-Holstein, Germany.
²² Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA.
²³ Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
²⁴ Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
²⁵ Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
²⁶ Department of Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
²⁷ Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
²⁸ Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
²⁹ Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine University of Southern California (USC), Los Angeles, California, USA.
³⁰ Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
³¹ GRC BioFast, Sorbonne Université, Paris, France.
³² Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
³³ Departments of Radiology & Neurology, Boston Medical Center, Boston, Massachusetts, USA.
³⁴ Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
³⁵ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
³⁶ Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
³⁷ Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.
³⁸ INSERM U1254, IADI, Université de Lorraine, Vandœuvre-lès-Nancy, France.
³⁹ Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany.
⁴⁰ Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.
⁴¹ UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, California, USA.
⁴² UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁴³ Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
⁴⁴ Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.

^# Contributed equally.

PMID: 38977305
DOI: 10.1136/jnis-2024-021879

Multicenter Study

Symptomatic intracerebral hemorrhage in proximal and distal medium middle cerebral artery occlusion patients treated with mechanical thrombectomy

Vivek S Yedavalli et al. J Neurointerv Surg. 2025.

. 2025 Jul 14;17(8):803-810.

doi: 10.1136/jnis-2024-021879.

Authors

Collaborators

MAD MT Investigators:
Abdelaziz Amllay, Achala Vagal, Adrien Ter Schiphorst, Ajith J Thomas, Anil Gopinathan, Anne Dusart, Carolina Capirossi, Charbel Mounayer, Charlotte Weyland, Cheng-Yang Hsieh, Christoph J Griessenauer, Christopher J Stapleton, Erwah Kalsoum, Flavio Bellante, Gaultier Marnat, Géraud Forestier, Hamza Shaikh, Hugo H Cuellar-Saenz, Iacopo Valente, Igor Sibon, James D Rabinov, Jérôme Berge, Jessica Jesser, Juan Carlos Martinez-Gutierrez, Kevin Premat, Leonard Ll Yeo, Lina Chervak, Lukas Meyer, Mahmoud Elhorany, Miguel Quintero-Consuegra, Mohamad Abdalkader, Mohammad Ali Aziz-Sultan, Monika Killer-Oberpfalzer, Peter T Kan, Piers Klein, Priyank Khandelwal, Ramanathan Kadirvel, Robert Fahed, Sergio Salazar-Marioni, Shogo Dofuku, Simona Nedelcu, Stavropoula I Tjoumakaris, Suzana Saleme, Yasmin Aziz

Affiliations

¹ Department of Radiology, Division of Neuroradiology, Johns Hopkins Medicine, Baltimore, Maryland, USA vyedava1@jhmi.edu.
² Department of Radiology, Division of Neuroradiology, Johns Hopkins Medicine, Baltimore, Maryland, USA.
³ Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA.
⁴ Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, Louisiana, USA.
⁵ Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
⁶ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁷ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
⁸ Department of Endovascular Neurosurgery and Neuroradiology, NJMS, Newark, New Jersey, USA.
⁹ Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
¹⁰ Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, New Jersey, USA.
¹¹ Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, Minnesota, USA.
¹² Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.
¹³ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹⁴ Division of Neurology, Department of Medicine, National University Hospital, Singapore.
¹⁵ Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA.
¹⁶ Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada.
¹⁷ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹⁸ University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
¹⁹ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
²⁰ Department of Neurology, UTHealth McGovern Medical School, Houston, Texas, USA.
²¹ Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Schleswig-Holstein, Germany.
²² Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA.
²³ Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
²⁴ Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
²⁵ Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
²⁶ Department of Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
²⁷ Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
²⁸ Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
²⁹ Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine University of Southern California (USC), Los Angeles, California, USA.
³⁰ Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
³¹ GRC BioFast, Sorbonne Université, Paris, France.
³² Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
³³ Departments of Radiology & Neurology, Boston Medical Center, Boston, Massachusetts, USA.
³⁴ Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
³⁵ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
³⁶ Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
³⁷ Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.
³⁸ INSERM U1254, IADI, Université de Lorraine, Vandœuvre-lès-Nancy, France.
³⁹ Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany.
⁴⁰ Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.
⁴¹ UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, California, USA.
⁴² UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁴³ Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
⁴⁴ Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.

^# Contributed equally.

PMID: 38977305
DOI: 10.1136/jnis-2024-021879

Abstract

Background: Acute ischemic stroke (AIS) caused by distal medium vessel occlusions (DMVOs) represents a significant proportion of overall stroke cases. While intravenous thrombolysis (IVT) has been a primary treatment, advancements in endovascular procedures have led to increased use of mechanical thrombectomy (MT) in DMVO stroke patients. However, symptomatic intracerebral hemorrhage (sICH) remains a critical complication of AIS, particularly after undergoing intervention. This study aims to identify factors associated with sICH in DMVO stroke patients undergoing MT.

Methods: This retrospective analysis utilized data from the Multicenter Analysis of Distal Medium Vessel Occlusions: Effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. Middle cerebral artery (MCA) DMVO stroke patients were included. The primary outcome measured was sICH, as defined per the Heidelberg Bleeding Classification. Univariable and multivariable logistic regression were used to identify factors independently associated with sICH.

Results: Among 1708 DMVO stroke patients, 148 (8.7%) developed sICH. Factors associated with sICH in DMVO patients treated with MT included older age (adjusted odds ratio (aOR) 1.01, 95% confidence interval (95% CI) 1.00 to 1.03, P=0.048), distal occlusion site (M3, M4) compared with medium occlusions (M2) (aOR 1.71, 95% CI 1.07 to 2.74, P=0.026), prior use of antiplatelet drugs (aOR 2.06, 95% CI 1.41 to 2.99, P<0.001), lower Alberta Stroke Program Early CT Scores (ASPECTS) (aOR 0.75, 95% CI 0.66 to 0.84, P<0.001), higher preoperative blood glucose level (aOR 1.00, 95% CI 1.00 to 1.01, P=0.012), number of passes (aOR 1.27, 95% CI 1.15 to 1.39, P<0.001), and successful recanalization (Thrombolysis In Cerebral Infarction (TICI) 2b-3) (aOR 0.43, 95% CI 0.28 to 0.66, P<0.001).

Conclusion: This study provides novel insight into factors associated with sICH in patients undergoing MT for DMVO, emphasizing the importance of age, distal occlusion site, prior use of antiplatelet drugs, lower ASPECTS, higher preoperative blood glucose level, and procedural factors such as the number of passes and successful recanalization. Pending confirmation, consideration of these factors may improve personalized treatment strategies.

Keywords: Stroke.

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Conflict of interest statement

Competing interests: Dr Regenhardt serves on a DSMB for a trial sponsored by Rapid Medical, serves as site PI for studies sponsored by Penumbra and Microvention, and receives stroke research grant funding from the National Institutes of Health, Society of Vascular and Interventional Neurology, and Heitman Stroke Foundation. Dr Guenego reports consultancy for Rapid Medical and Phenox, not directly related to the present work. Dr Clarençon reports conflicts of interest with Medtronic, Balt Extrusion (consultant), ClinSearch (core lab), Penumbra, Stryker (payment for reading) and Artedrone (Board); all not directly related to the present work. Dr Henninger received support from W81XWH-19-PRARP-RPA from the CDMRP/DoD, NS131756 and U24NS113844 from the NINDS, and NR020231 from the NINR and received compensation from Myrobalan, Inc and General Dynamics during the conduct of this study unrelated to this work. Dr Liebeskind is consultant as Imaging Core Lab to Cerenovus, Genentech, Medtronic, Stryker, Rapid Medical. Dr Yeo reports Advisory work for AstraZeneca, substantial support from NMRC Singapore and is a medical advisor for See-mode, Cortiro and Sunbird Bio, with equity in Ceroflo; all unrelated to the present work. Dr Griessenauer reports a proctoring agreement with Medtronic and research funding by Penumbra. Dr Marnat reports conflicts of interest with Microvention Europe, Stryker Neurovascular, Balt (consulting), Medtronic, Johnson & Johnson and Phenox (paid lectures), all not directly related to the present work. Dr Puri is a consultant for Medtronic Neurovascular, Stryker Neurovascular, Balt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc and Arsenal Medical, he received research grants from NIH, Microvention, Cerenovus, Medtronic Neurovascular and Stryker Neurovascular, and holds stocks in InNeuroCo, Agile, Perfuze, Galaxy and NTI. Dr Tjoumakaris is a consultant for Medtronic and Microvention (funds paid to institution, not personally). Dr Jabbour is a consultant for Medtronic, Microvention and Cerus. HS and VY are guarantors of the study.

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Symptomatic intracerebral hemorrhage in proximal and distal medium middle cerebral artery occlusion patients treated with mechanical thrombectomy

Collaborators

Affiliations

Symptomatic intracerebral hemorrhage in proximal and distal medium middle cerebral artery occlusion patients treated with mechanical thrombectomy

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources