Prognosis associated with asymptomatic intracranial hemorrhage after acute ischemic stroke: a systematic review and meta-analysis

Tang, Guo‐Yi; Cao, Zhixin; Luo, Yuting; Wu, Shaohua; Sun, Xunsha

doi:10.1007/s00415-022-11046-6

Cited by 13 publications

(9 citation statements)

References 37 publications

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“…Traditionally, sHT, which is usually termed as parenchymal hemorrhage, is the main type of HT that has a detrimental impact on clinical outcome [4,5]. However, recent studies showed that patients who developed aHT after EVT also had a worse functional outcome than those without HT [6][7][8]. Our study supports the view that both aHT and sHT have an adverse effect on the functional outcome of patients who received EVT.…”

Section: Discussionsupporting

confidence: 82%

“…Hemorrhagic transformation (HT) is a common complication of this treatment, which has a variety of impacts on patients. Symptomatic HT (sHT) causes severe disability and even death [3][4][5], while asymptomatic HT (aHT) may also influence the 90-day functional outcome in patients who received EVT for LVO [6][7][8]. The incidence rate of HT frequently serves as a safety index in clinical studies of EVT because of its devastating impact on clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Proximal hyperdense middle cerebral artery sign is associated with increased risk of asymptomatic hemorrhagic transformation after endovascular thrombectomy: a multicenter retrospective study

Kang

Sun

et al. 2022

J Neurol

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Objective To investigate whether hyperdense middle cerebral artery sign (HMCAS) on pretreatment no-contrast CT (NCCT) is associated with hemorrhagic transformation (HT) after endovascular thrombectomy (EVT). Methods Patients with acute middle cerebral artery (MCA) occlusion who received EVT in three comprehensive hospitals were retrospectively evaluated. They were divided into four groups based on the presence or absence of HMCAS and corresponding CTA findings, among whom differences were compared. Univariate and multivariate logistic regression analyses were performed to investigate the association between HMCAS and HT and its subtypes. Results 318 patients were included, among whom 149 (46.9%) had HMCAS. Patients in the proximal positive HMCAS group had higher National Institute of Health Stroke Scale scores and lower Alberta Stroke Program Early CT Scores (ASPECTS) than those in the proximal negative HMCAS group. The rate of HT was higher in the proximal positive HMCAS group than that in the proximal negative HMCAS group. In multivariate logistic regression analysis, the proximal HMCAS were independently associated with HT (adjusted OR = 2.073, 95% CI 1.211–3.551, p = 0.008) and aHT (adjusted OR = 2.271, 95% CI 1.294–3.986, p = 0.004), but not with sHT. Patients who developed HT, including aHT and sHT, had a lower rate of good outcome. Conclusion Proximal HMCAS on initial NCCT was independently associated with aHT in patients who received EVT for acute MCA occlusion. Both aHT and sHT had a detrimental effect on clinical outcome.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Proximal hyperdense middle cerebral artery sign is associated with increased risk of asymptomatic hemorrhagic transformation after endovascular thrombectomy: a multicenter retrospective study

Kang

Sun

et al. 2022

J Neurol

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“…Our observation of a technique-associated difference in risk of sICH did not translate into a difference in 90-day neurological outcomes between ADAPT and stent retriever. Although the effects of ICH after MT on clinical outcomes were not within the scope of the present study, a recent meta-analysis by Tang et al found asymptomatic ICH to be associated with worse 3-month clinical outcome among patients who underwent MT (adjusted OR 1.89, P=0.007) 16. This suggests that efforts to reduce any ICH, asymptomatic or otherwise, are important in the neurological recovery of AIS patients after MT.…”

Section: Discussionmentioning

confidence: 55%

Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Ironside

Chen

Chalhoub

et al. 2023

J NeuroIntervent Surg

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BackgroundReducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy.MethodsThis is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade.ResultsThe study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference.ConclusionsThis study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.

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“…HT is a common complication of EVT with a high incidence rate of up to 46.1-55.9% in randomized controlled trials [18,19], which has a variety of impacts on patients from asymptomatic HT to severe disability even death [3][4][5]. Moreover, Recent studies showed that patients who developed asymptomatic HT after endovascular treatment also had a worse functional outcome than those without HT [20,21].…”

Section: Discussionmentioning

confidence: 99%

Proximal Hyperdense Middle Cerebral Artery Sign is Associated with Increased Risk of Hemorrhagic Transformation after Endovascular Thrombectomy: A Multi-center Retrospective Study

Kang

Sun

et al. 2022

Preprint

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Objective: To investigate whether hyperdense middle cerebral artery sign (HMCAS) on pretreatment no-contrast CT (NCCT) is associated with hemorrhagic transformation (HT) after endovascular thrombectomy (EVT). Methods: Patients with acute middle cerebral artery (MCA) occlusion who received EVT between January 2018 and December 2021 in three comprehensive hospitals were retrospectively evaluated. They were divided into negative HMCAS, proximal HMCAS, and distal HMCAS groups, among whom differences were compared. Univariate and multivariate logistic regression analysis were performed to investigate the association between HMCAS and HT. Results: 318 patients were included, among whom 149 (46.9%) had HMCAS with 107 (71.8%) in the proximal HMCAS group and 42 (28.2%) in the distal HMCAS group. Patients with proximal HMCAS had higher National Institute of Health Stroke Scale scores (p = 0.006) and lower Alberta Stroke Program Early CT Scores (p < 0.001). Large artery atherosclerosis was more frequent in the negative HMCAS group while cardioembolism was more common in the positive HMCAS groups (p = 0.007). The rate of HT was higher in the proximal HMCAS group than that in the negative HMCAS group (61.7% vs 43.2%, p < 0.05). Proximal HMCAS was associated with HT in univariate analysis (unadjusted OR = 2.117, 95%CI: 1.291–3.471, p = 0.003) and remained an independent risk factor of HT in multivariate logistic regression analysis (adjusted OR = 1.989, 95%CI: 1.170–3.380, p = 0.011). Conclusion: Proximal HMCAS on initial NCCT was independently associated with HT in patients who received EVT for acute MCA occlusion.

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Prognosis associated with asymptomatic intracranial hemorrhage after acute ischemic stroke: a systematic review and meta-analysis

Cited by 13 publications

References 37 publications

Proximal hyperdense middle cerebral artery sign is associated with increased risk of asymptomatic hemorrhagic transformation after endovascular thrombectomy: a multicenter retrospective study

Proximal hyperdense middle cerebral artery sign is associated with increased risk of asymptomatic hemorrhagic transformation after endovascular thrombectomy: a multicenter retrospective study

Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Proximal Hyperdense Middle Cerebral Artery Sign is Associated with Increased Risk of Hemorrhagic Transformation after Endovascular Thrombectomy: A Multi-center Retrospective Study

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