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. 2024 Aug 25;14(17):1856.
doi: 10.3390/diagnostics14171856.

Post-Thrombectomy Subarachnoid Hemorrhage: Incidence, Predictors, Clinical Relevance, and Effect Modulators

Huanwen Chen  1   2 , Marco Colasurdo  3 , Mihir Khunte  4   5 , Ajay Malhotra  5 , Dheeraj Gandhi  6
Affiliations

Post-Thrombectomy Subarachnoid Hemorrhage: Incidence, Predictors, Clinical Relevance, and Effect Modulators

Huanwen Chen et al. Diagnostics (Basel). .

Abstract

Background: Subarachnoid hemorrhage (SAH) following endovascular thrombectomy (EVT) is a poorly understood phenomenon, and whether it is associated with clinical detriment is unclear.

Methods: This was an explorative analysis of a national database of real-world hospitalizations in the United States. Patients who underwent EVT were included. Patients were divided into SAH and non-SAH groups, and hospitalization outcomes were compared using multivariable logistic regression models. Regression models were also used to identify significant predictors for post-EVT SAH, and significant modulators of SAH's association with hospitalization outcomes were also assessed.

Results: A total of 99,219 EVT patients were identified; 6174 (6.2%) had SAH. Overall, SAH was independently associated with increased odds of in-hospital mortality (21.5% vs. 10.6%, adjusted OR 2.53 [95%CI 2.23-2.87], p < 0.001) and lower odds of routine discharge to home with self-care (18.2% vs. 28.0%, aOR 0.58 [95%CI 0.52-0.65], p < 0.001). Distal/medium vessel occlusion (DMVO), coagulopathy, angioplasty or stenting, concurrent intraparenchymal hemorrhage (IPH), and female sex were associated with higher odds of SAH. DMVO was associated with particularly heightened risk of death (31.8% vs. 7.9%, aOR 6.99 [95%CI 2.99 to 16.3], p < 0.001), which was an effect size significantly larger than other sites of vascular occlusion (interaction p > 0.05).

Conclusion: SAH is an uncommon but likely clinically detrimental post-EVT complication. DMVO, coagulopathy, angioplasty or stenting, concurrent IPH, and female sex were independently associated with higher odds of post-EVT SAH. SAH associated with DMVO-EVT may be particularly harmful.

Keywords: distal; endovascular; intracranial hemorrhage; medium; stroke; subarachnoid hemorrhage; thrombectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Hospitalization outcomes of patients with or without subarachnoid hemorrhage following endovascular thrombectomy for acute ischemic stroke. Routine discharge was defined as discharge to home to self-care. Multivariable adjustments were made for patient age, sex, site of vascular occlusion, stroke severity, stroke risk factors, antithrombotic medication use, and medical comorbidities. p-values less than 0.05 were deemed statistically significant.
Figure 2
Figure 2
Hospitalization outcomes of patients with or without subarachnoid hemorrhage following endovascular thrombectomy for acute ischemic stroke stratified by patient subgroups. Adjusted odds ratios (aOR) accounted for patient age, sex, site of vascular occlusion, stroke severity, stroke risk factors, antithrombotic medication use, and medical comorbidities. p-values less than 0.05 were deemed statistically significant.
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