Parenchymal Hemorrhage Rate Is Associated with Time to Reperfusion and Outcome

Olivot, Jean Marc; Finitsis, Stephanos; Lapergue, Bertrand; Marnat, Gaultier; Sibon, Igor; Richard, Sébastien; Viguier, Alain; Cognard, Christophe; Mazighi, Mikaël; Gory, Benjamin

doi:10.1002/ana.26478

Cited by 8 publications

(4 citation statements)

References 21 publications

(44 reference statements)

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“…The limited statistical power of their analysis might have influenced the non-significance (study population in this publication: n=285 including 85 patients in the fast progressors subgroup). In previous publications, extended time from stroke onset to reperfusion and lower initial ASPECTS has been separately reported associated with parenchymal hemorrhage occurrence 17 18. Studying stroke progression velocity actually allows regrouping of these two characteristics into a unique indicator that might be a more sensitive and individualized feature for ICH risk prediction.…”

Section: Discussionmentioning

confidence: 99%

Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial

Marnat¹,

Kaesmacher

Buetikofer

et al. 2023

J NeuroIntervent Surg

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BackgroundIn proximal occlusions, the effect of reperfusion therapies may differ between slow or fast progressors. We investigated the effect of intravenous thrombolysis (IVT) (with alteplase) plus mechanical thrombectomy (MT) versus thrombectomy alone among slow versus fast stroke progressors.MethodsThe SWIFT-DIRECT trial data were analyzed: 408 patients randomized to IVT+MT or MT alone. Infarct growth speed was defined by the number of points of decay in the initial Alberta Stroke Program Early CT Score (ASPECTS) divided by the onset-to-imaging time. The primary endpoint was 3-month functional independence (modified Rankin scale 0–2). In the primary analysis, the study population was dichotomized into slow and fast progressors using median infarct growth velocity. Secondary analysis was also conducted using quartiles of ASPECTS decay.ResultsWe included 376 patients: 191 IVT+MT, 185 MT alone; median age 73 years (IQR 65–81); median initial National Institutes of Health Stroke Scale (NIHSS) 17 (IQR 13–20). The median infarct growth velocity was 1.2 points/hour. Overall, we did not observe a significant interaction between the infarct growth speed and the allocation to either randomization group on the odds of favourable outcome (P=0.68). In the IVT+MT group, odds of any intracranial hemorrhage (ICH) were significantly lower in slow progressors (22.8% vs 36.4%; OR 0.52, 95% CI 0.27 to 0.98) and higher among fast progressors (49.4% vs 26.8%; OR 2.62, 95% CI 1.42 to 4.82) (P value for interaction <0.001). Similar results were observed in secondary analyses.ConclusionIn this SWIFT-DIRECT subanalysis, we did not find evidence for a significant interaction of the velocity of infarct growth on the odds of favourable outcome according to treatment by MT alone or combined IVT+MT. However, prior IVT was associated with significantly reduced occurrence of any ICH among slow progressors whereas this was increased in fast progressors.

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Section: Discussionmentioning

confidence: 99%

Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial

Marnat¹,

Kaesmacher

Buetikofer

et al. 2023

J NeuroIntervent Surg

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“…To date, there are only limited and discrepant data regarding the impact of EVT time metrics on sICH occurrence. In a recently published prospective observational study, the rate of parenchymal hematoma increased by 2.5% (95% CI 1.5-3.6%, p < 0.001) for every additional hour of onset to reperfusion delay in patients with successful reperfusion (TICI2b-3) [29]. On the contrary, in two studies that compared the neurological outcomes of patient groups treated with drip-and-ship paradigm and in mothership site, the longer onset to reperfusion time of the drip-andship group was not associated with higher risk of overall intracranial hemorrhage or sICH [30,31].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Symptomatic Intracranial Hemorrhage after Endovascular Thrombectomy in Acute Ischemic Stroke Patients with Anterior Large Vessel Occlusion—Procedure Time and Reperfusion Quality Determine

Landeghem

Demircioğlu

et al. 2022

JCM

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Purpose: We aimed to evaluate predictors of symptomatic intracranial hemorrhage (sICH) in acute ischemic stroke (AIS) patients following thrombectomy due to anterior large vessel occlusion (LVO). Methods: Data on stroke patients from January 2018 to December 2020 in a tertiary care centre were retrospectively analysed. sICH was defined as intracranial hemorrhage associated with a deterioration of at least four points in the National Institutes of Health Stroke Scale (NIHSS) score or hemorrhage leading to death. A smoothed ridge regression model was run to analyse the impact of 15 variables on their association with sICH. Results: Of the 174 patients (median age 77, 41.4% male), sICH was present in 18 patients. Short procedure time from groin puncture to reperfusion (per 10 min OR 1.24; 95% CI 1.071–1.435; p = 0.004) and complete reperfusion (TICI 3) (OR 0.035; 95% CI 0.003–0.378; p = 0.005) were significantly associated with a lower risk of sICH. On the contrary, successful reperfusion (TICI 3 and TICI 2b) was not associated with a lower risk of sICH (OR 0.508; 95% CI 0.131–1.975, p = 0.325). Neither the total time from symptom onset to reperfusion nor the intravenous thrombolysis was a predictor of sICH (per 10 min OR 1.0; 95% CI 0.998–1.001, p = 0.745) (OR 1.305; 95% CI 0.338–5.041, p = 0.697). Conclusion: Our findings addressed the paramount importance of short procedure time and complete reperfusion to minimize sICH risk. The total ischemic time from onset to reperfusion was not a predictor of sICH.

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“…Differences with the present study include a larger population, allowing subgroup analyses, particularly in the TICI 2b subgroup (239 patients vs 1,071 patients in the present analysis). Recently, Olivot et al evaluated the relationship between TSOR and the occurrence of PH with functional outcome, and found that parenchymal hemorrhage (PH) rate is strongly associated with TSOR and affects functional outcome (ie, “time is bleeding”) 30 . It is therefore possible that the relationship between TSOR and functional outcome according to the reperfusion status is also mediated by PH occurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Olivot et al evaluated the relationship between TSOR and the occurrence of PH with functional outcome, and found that parenchymal hemorrhage (PH) rate is strongly associated with TSOR and affects functional outcome (ie, "time is bleeding"). 30 It is therefore possible that the relationship between TSOR and functional outcome according to the reperfusion status is also mediated by PH occurrence. Further studies will be needed to confirm these findings.…”

Section: Discussionmentioning

confidence: 99%

The Benefit of a Complete over a Successful Reperfusion Decreases with Time

Maïer

Finitsis

Mazighi

et al. 2023

Annals of Neurology

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Objective Time from stroke onset to reperfusion (TSOR) is strongly associated with outcomes after endovascular treatment. A near‐to‐complete or complete reperfusion (modified Treatment in Cerebral Ischemia [mTICI] 2c–3) is associated with improved outcomes compared with a successful reperfusion (mTICI 2b). However, it is unknown whether this association remains stable as TSOR increases. Therefore, we sought to investigate the association between TSOR and outcomes according to the reperfusion status. Methods We analyzed data from the Endovascular Treatment in Ischemic Stroke registry, a prospective, observational, multicentric study of acute ischemic stroke patients treated with endovascular treatment in 21 centers in France. We included patients with anterior occlusions (M1, internal carotid artery, tandem), with a known time of symptom onset. Outcomes were early neurological improvement at 24 hours and favorable outcome (modified Rankin Scale between 0 and 2) at 90 days. Results Overall, 4,444 patients were analyzed. Compared with a mTICI 2b, a mTICI 2c‐3 at 1 hour was associated with higher mean marginal probabilities of early neurological improvement (25.6%, 95% CI 11.7–39.5, p = 0.0003) and favorable outcome (15.2%, 95% CI 3.0–27.4, p = 0.0143), and progressively declined with TSOR. The benefit of a mTICI 2c‐3 over a mTICI 2b was no longer significant regarding the rates of early neurological improvement and favorable outcome after a TSOR of 414 and 344 minutes, respectively. Interpretation The prognostic value of a complete over a successful reperfusion progressively declined with time, and no difference regarding the rates of favorable outcome was observed between a complete and successful reperfusion beyond 5.7 hours. ANN NEUROL 2023;93:934–941

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Parenchymal Hemorrhage Rate Is Associated with Time to Reperfusion and Outcome

Cited by 8 publications

References 21 publications

Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial

Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial

Predictors of Symptomatic Intracranial Hemorrhage after Endovascular Thrombectomy in Acute Ischemic Stroke Patients with Anterior Large Vessel Occlusion—Procedure Time and Reperfusion Quality Determine

The Benefit of a Complete over a Successful Reperfusion Decreases with Time

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