Asymptomatic Intracranial Hemorrhage Is Associated With Poor Outcomes After Mechanical Thrombectomy for Large Vessel Occlusion

Suzuki, Kentaro; Matsumaru, Yuji; Takeuchi, Masataka; Morimoto, Masafumi; Kanazawa, Ryuzaburo; Takayama, Yoshiaki; Kamiya, Yuki; Shigeta, Keigo; Okubo, Seiji; Hayakawa, Masayuki; Ishii, Norihiro; Koguchi, Yorio; Takigawa, Tomohiro; Inoue, Masatoshi; Naito, Hiromichi; Ota, Takahiro; Hirano, Teruyuki; Kato, Noriyuki; Ueda, Toshihiro; Iguchi, Yasuyuki; Akaji, Kazunori; Tsuruta, Wataro; Miki, Kazunori; Fujimoto, Shigeru; Higashida, Tetsuhiro; Iwasaki, Mitsuhiro; Aoki, Junya; Nishiyama, Yasuhiro; Otsuka, Toshiaki; Kimura, Kazumi

doi:10.1161/svin.121.000366

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…In our analysis, 76.9% of patients with active malignancy have a successful recanalization after EVT, which is higher than that observed in a previous meta-analysis (71%) 37. Nevertheless, even after successful reperfusion, there may be a fear of hemorrhage, which is associated with poor functional outcomes 38. The rate of post-procedural hemorrhage, except sICH, was higher in patients with active malignancy than in those without it.…”

Section: Discussioncontrasting

confidence: 60%

“…In previous studies, sICH and any ICH did not differ between patients with and without active malignancy 34. Given the good reperfusion rates and asymptomatic cases, EVT for AIS appears to be a reasonable therapeutic option for patients with active malignancy, but there is also a need to develop a post-procedural protocol to improve prognosis 38…”

Section: Discussionmentioning

confidence: 90%

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Endovascular therapy for acute ischemic stroke in patients with active malignancy: a meta-analysis with trial sequential analysis

Jhou

Yang

Chen

et al. 2022

J NeuroIntervent Surg

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BackgroundActive malignancy has a poorer prognosis and more deaths in patients with acute ischemic stroke (AIS). The outcomes of endovascular therapy (EVT) remain controversial in patients with AIS and active malignancy.MethodsWe searched PubMed, Cochrane, and Embase for articles published up to June 1, 2022. The primary outcome was good functional outcome at 3 months and successful reperfusion between patients with cancer and AIS and control patients. The secondary and safety outcomes included mortality at 3 months, in-hospital mortality, symptomatic intracerebral hemorrhage (sICH), any ICH, and subarachnoid hemorrhage (SAH).ResultsTwelve studies involving 5944 patients with AIS secondary to EVT were included (389 patients having active malignancy). The OR of good functional outcome at 3 months was 0.53 (95% CI 0.41 to 0.67) between the two groups. The OR of successful reperfusion between the two groups was 0.90 (95% CI 0.63 to 1.30). Compared with patients without cancers, those with cancers had a higher risk of mortality at 3 months (OR 3.64; 95% CI 2.35 to 6.27) and in-hospital mortality (OR 3.46; 95% CI 1.71 to 7.01). Despite a higher point estimate regarding any ICH (OR 1.41; 95% CI 1.01 to 1.96) and SAH (OR 2.53; 95% CI 1.10 to 5.81), sICH (OR 0.85; 95% CI 0.51 to 1.42) was not significant.ConclusionAlthough a quarter of patients with active malignancy and AIS regained functional independence, physicians and patients should consider whether to apply EVT in patients with active malignancy.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 90%

Endovascular therapy for acute ischemic stroke in patients with active malignancy: a meta-analysis with trial sequential analysis

Jhou

Yang

Chen

et al. 2022

J NeuroIntervent Surg

View full text Add to dashboard Cite

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“…Touching the safety concern, although EVT put BAO patients at higher risk of symptomatic ICH, EVT, in contrast, reduced the mortality rates. Although it may be understood that the symptomatic ICH following EVT was not deadly, it is important to remember that ICH, despite being asymptomatic, was linked to a poor functional result at three months [ 53 ]. However, several factors could be taken into consideration to reduce such hemorrhagic complications following reperfusion by EVT, including strict tissue-based patient selection using perfusion imaging in posterior circulation [ 54 , 55 ], direct EVT strategy [ 56 ], and optimal blood pressure control [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

Endovascular thrombectomy for basilar-artery occlusion: A meta-analysis with trial sequential analysis

Wang,

Chiu,

Chen

et al. 2023

Heliyon

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Asymptomatic Intracerebral Hemorrhage Following Endovascular Stroke Therapy Is Not Benign: A Systematic Review and Meta‐Analysis

Harker,

Aziz,

Vranic

et al. 2024

JAHA

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Background Asymptomatic intracerebral hemorrhage (aICH) occurs in approximately 35% of patients with acute ischemic stroke after endovascular thrombectomy. Unlike symptomatic ICH, studies evaluating the effect of aICH on outcomes have been inconclusive. We performed a systematic review and meta‐analysis to evaluate the long‐term effects of postendovascular thrombectomy aICH. Methods and Results The meta‐analysis protocol was submitted to the International Prospective Register of Systematic Reviews a priori. PubMed, Scopus, and Web of Science were searched from inception through September 2023, yielding 312 studies. Two authors independently reviewed all abstracts. Included studies contained adult patients with ischemic stroke undergoing endovascular thrombectomy with follow‐up imaging assessment of ICH reporting comparative outcomes according to aICH versus no ICH. After screening, 60 papers were fully reviewed, and 10 studies fulfilled inclusion criteria (n=5723 patients total, 1932 with aICH). Meta‐analysis was performed using Cochrane RevMan v5.4. Effects were estimated by a random‐effects model to estimate summary odds ratio (OR) of the effect of aICH versus no ICH on primary outcomes of 90‐day modified Rankin Scale 3 to 6 and mortality. The presence of aICH was associated with a higher odds of 90‐day mRS 3 to 6 (OR, 2.17 [95% CI, 1.81–2.60], P <0.0001, I 2 46% Q 19.15) and mortality (OR, 1.72 [95% CI, 1.17–2.53], P :0.005, I 2 79% Q 27.59) compared with no ICH. This difference was maintained following subgroup analysis according to hemorrhage classification and recanalization status. Conclusions The presence of aICH is associated with worse 90‐day functional outcomes and higher mortality. Further studies to evaluate the factors predicting aICH and treatments aimed at reducing its occurrence are warranted.

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Asymptomatic Intracranial Hemorrhage Is Associated With Poor Outcomes After Mechanical Thrombectomy for Large Vessel Occlusion

Cited by 4 publications

References 4 publications

Endovascular therapy for acute ischemic stroke in patients with active malignancy: a meta-analysis with trial sequential analysis

Endovascular therapy for acute ischemic stroke in patients with active malignancy: a meta-analysis with trial sequential analysis

Endovascular thrombectomy for basilar-artery occlusion: A meta-analysis with trial sequential analysis

Asymptomatic Intracerebral Hemorrhage Following Endovascular Stroke Therapy Is Not Benign: A Systematic Review and Meta‐Analysis

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