Predictors of Parenchymal Hematoma After Mechanical Thrombectomy

Abstract

Background and Purpose— Parenchymal hematoma (PH) is a rare but dreadful complication of acute ischemic stroke with unclear underlying mechanisms. We aimed to study the incidence and predictors of PH after mechanical thrombectomy. Methods— Data from a prospective observational multicenter registry was screened to identify acute ischemic stroke patients with an anterior circulation large vessel occlusion who underwent mechanical thrombectomy. Clinical, imaging, and procedural characteristics were used for the analysis, including brain imaging systematically performed at 24 hours. PH occurrence was assessed according to ECASS (European Collaborative Acute Stroke Study) criteria. Univariate and multivariable analyses were performed to identify predictors of PH. Results— A total of 1316 patients were included in the study. PH occurred in 153 out of 1316 patients (11.6%) and was associated with a lower rate of favorable outcome and increased mortality. On multivariable analysis, age (per 1 year increase, odds ratio [OR], 1.01; 95% CI, 1.00–1.03; P =0.05), current smoking (OR, 2.02; 95% CI, 1.32–3.09; P <0.01), admission Alberta Stroke Program Early CT Score (per a decrease of 1 point, OR, 1.70; 95% CI, 1.18–2.44; P <0.01), general anesthesia (OR, 1.98; 95% CI, 1.36–2.90; P <0.001), angiographic poor collaterals (OR, 2.13; 95% CI, 1.36–3.33; P <0.001) and embolization in new territory (OR, 2.94; 95% CI, 1.70–5.10; P <0.001) were identified as independent predictors of PH. Conclusions— PH occurred at a rate of 11.6% after mechanical thrombectomy, with high morbidity and mortality. Our study identified clinical, radiological, and procedural predictors of PH occurrence that can serve as the focus of future periprocedural management studies with the aim of reducing its occurrence. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT03776877.

Intracranial Hemorrhage After Reperfusion Therapies in Acute Ischemic Stroke Patients

“…Observational studies, reflecting real-life practice, have confirmed these data. In a large observational study from the Endovascular Treatment for Ischemic Stroke (ETIS) registry, independent predictors of PHs after EVT included age (per 1 year increase), current smoking, admission ASPECTS (per 1-point decrease), general anesthesia, angiographic poor collaterals, and embolization in a new territory (9). The Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MRCLEAN) investigators performed a similar study and found only increased systolic blood pressure and atrial fibrillation associated with PH occurrence (82).…”

“…Hemorrhagic complications after reperfusion therapies include a broad spectrum of severity between small petechial hemorrhagic infarcts (HIs) to parenchymal hematomas (PHs) (6)(7)(8). ICH, especially with PH, is associated with increased morbidity and mortality (9,10). This explains in part why ICH and especially symptomatic ICH (sICH) are mandatory safety outcomes of most AIS RCTs.…”

Time from I.V. Thrombolysis to Thrombectomy and Outcome in Acute Ischemic Stroke

“…Detailed materials have been previously described 8 . All patients who underwent EVT for acute ischemic stroke in the anterior or posterior circulation in these 9 comprehensive stroke centers have been registered in the ETIS Registry.…”

Pathophysiology of Blood–Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery

“…Several predictors of HT after EVT have been identified so far. At time to the procedure, low ASPECTS score and poor collateral status are among them (143)(144)(145). These have also been associated with edema formation (146).…”