Incidence and Prognostic Impact of Intracranial Hemorrhage after Endovascular Treatment for Acute Large Vessel Occlusion

Kinjo, Norito; Yoshimura, Shinichi; Sakai, Nobuyuki; Yamagami, Hiroshi; Morimoto, Takeshi; Investigators, RESCUE-Japan Registry

doi:10.1159/000510970

Cited by 18 publications

(3 citation statements)

References 31 publications

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“…AICH including asymptomatic ICH and SICH has been reported to worsen clinical outcomes. 28,29 Therefore, the increase in AICH after 2 passes should be considered important.…”

Section: Discussionmentioning

confidence: 99%

Number of Passes of Endovascular Therapy for Stroke With a Large Ischemic Core: Secondary Analysis of RESCUE-Japan LIMIT

Namitome

Uchida

Shindo

et al. 2023

Stroke

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BACKGROUND: The increased risk of intracranial hemorrhage with multiple passes in endovascular therapy (EVT) for large vessel occlusion with a large ischemic core is a concern. We explored the effect of the number of EVT passes on patients in a randomized clinical trial. METHODS: This post hoc study was the secondary analysis of RESCUE-Japan LIMIT, which was a randomized clinical trial comparing EVT and medical treatment alone for large vessel occlusion with large ischemic core. We grouped patients according to the number of passes with successful reperfusion (modified Thrombolysis in Cerebral Infarction score, ≥2b) in 1, 2, and 3 to 7 passes and failed reperfusion (modified Thrombolysis in Cerebral Infarction score, 0–2a) after any pass in the EVT group, and these groups were compared with medical treatment group. The primary outcome was modified Rankin Scale score of 0 to 3 at 90 days. Secondary outcomes were improvement in National Institutes of Health Stroke Scale score of ≥8 at 48 hours, mortality at 90 days, symptomatic intracranial hemorrhage, and any intracranial hemorrhage within 48 hours. RESULTS: The number of patients who received EVT with successful reperfusion after 1, 2, and 3 to 7 passes and failed reperfusion were 44, 23, 19, and 14, respectively, and 102 received medical treatment alone. The adjusted odds ratios (95% CIs) for the primary outcome relative to medical treatment were 5.52 (2.23–14.28) after 1 pass, 6.45 (2.22–19.30) after 2 passes, 1.03 (0.15–4.48) after 3 to 7 passes, and 1.17 (0.16–5.37) if reperfusion failed. The adjusted odds ratios (95% CIs) for any intracranial hemorrhage within 48 hours relative to medical treatment were 1.88 (0.90–3.93) after 1 pass, 5.14 (1.97–14.72) after 2 passes, 3.00 (1.09–8.58) after 3 to 7 passes, and 6.16 (1.87–24.27) if reperfusion failed. CONCLUSIONS: The successful reperfusion within 2 passes was associated with better clinical outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03702413.

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“…AICH including asymptomatic ICH and SICH has been reported to worsen clinical outcomes. 28,29 Therefore, the increase in AICH after 2 passes should be considered important.…”

Section: Discussionmentioning

confidence: 99%

Number of Passes of Endovascular Therapy for Stroke With a Large Ischemic Core: Secondary Analysis of RESCUE-Japan LIMIT

Namitome

Uchida

Shindo

et al. 2023

Stroke

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“…Furthermore, a previous registry study showed that both asymptomatic and symptomatic ICH after EVT in patients with acute LVO were associated with worse functional outcomes. 34 The meta-analysis from HERMES (the Highly Effective Reperfusion evaluated in Multiple Endovascular Stroke Trials) showed a higher rate of symptomatic ICH after EVT in patients with low ASPECTS, but it did not report the association between symptomatic ICH and functional outcomes. 35 MRI with susceptibility-weighted imaging or T2* weighted imaging could provide more accurate qualitative information of cerebral microbleeds, which were reported to increase ICH after EVT.…”

Section: Discussionmentioning

confidence: 99%

Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT

Sakakibara,

Uchida,

Yoshimura

et al. 2023

J Stroke

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Background and Purpose Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core.Methods The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3–5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum.Results Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65–2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46–16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008).Conclusion Patients with ASPECTS of 3–5 on MRI benefitted more from EVT than those with ASPECTS of 3–5 on CT.

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“…The timing and causes of death after EVT in routine clinical practice have remained largely unknown. Registry-based studies focusing on hemorrhagic complications, 9 – 12 space-occupying edema formation 13 – 15 or infectious complications as pneumonia 16 , 17 have suggested that these are frequent causes of death after EVT, but the relative frequencies of the complications and the timing of their occurrence are unknown. A better understanding of the causes of death after EVT may inform future studies aiming to improve outcomes and increase the chance of survival.…”

Section: Introductionmentioning

confidence: 99%

Timing and causes of death after endovascular thrombectomy in patients with acute ischemic stroke

Sluis

Hinsenveld

Goldhoorn

et al. 2022

European Stroke Journal

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Introduction: Endovascular thrombectomy (EVT) increases the chance of good functional outcome after ischemic stroke caused by a large vessel occlusion, but the risk of death in the first 90 days is still considerable. We assessed the causes, timing and risk factors of death after EVT to aid future studies aiming to reduce mortality. Patients and methods: We used data from the MR CLEAN Registry, a prospective, multicenter, observational cohort study of patients treated with EVT in the Netherlands between March 2014, and November 2017. We assessed causes and timing of death and risk factors for death in the first 90 days after treatment. Causes and timing of death were determined by reviewing serious adverse event forms, discharge letters, or other written clinical information. Risk factors for death were determined with multivariable logistic regression. Results: Of 3180 patients treated with EVT, 863 (27.1%) died in the first 90 days. The most common causes of death were pneumonia (215 patients, 26.2%), intracranial hemorrhage (142 patients, 17.3%), withdrawal of life-sustaining treatment because of the initial stroke (110 patients, 13.4%) and space-occupying edema (101 patients, 12.3%). In total, 448 patients (52% of all deaths) died in the first week, with intracranial hemorrhage as most frequent cause. The strongest risk factors for death were hyperglycemia and functional dependency before the stroke and severe neurological deficit at 24–48 h after treatment. Discussion and conclusion: When EVT fails to decrease the initial neurological deficit, strategies to prevent complications like pneumonia and intracranial hemorrhage after EVT could improve survival, as these are often the cause of death.

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Incidence and Prognostic Impact of Intracranial Hemorrhage after Endovascular Treatment for Acute Large Vessel Occlusion

Cited by 18 publications

References 31 publications

Number of Passes of Endovascular Therapy for Stroke With a Large Ischemic Core: Secondary Analysis of RESCUE-Japan LIMIT

Number of Passes of Endovascular Therapy for Stroke With a Large Ischemic Core: Secondary Analysis of RESCUE-Japan LIMIT

Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT

Timing and causes of death after endovascular thrombectomy in patients with acute ischemic stroke

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