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

Ironside, Natasha; Chen, Ching-Jen; Chalhoub, Reda M; Kellogg, Ryan T; Ding, Dale; Maier, Ilko; Kasab, Sami Al; Jabbour, Pascal; Kim, Joon‐Tae; Wolfe, Stacey Quintero; Rai, Ansaar; Starke, Robert M.; Psychogios, Marios‐Nikos; Shaban, Amir; Arthur, Adam S; Yoshimura, Shinichi; Grossberg, Jonathan A; Alawieh, Ali; Fragata, Isabel; Polifka, Adam; Osbun, Joshua W.; Matouk, Charles; Levitt, Michael R.; Dumont, Travis M.; Cuellar‐Saenz, Hugo; Williamson, Richard; Romano, Daniele; Crosa, Roberto; Gory, Benjamin; Mokin, Maxim; Moss, Mark; Limaye, Kaustubh; Kan, Peter; Spiotta, Alejandro M; Park, Min S

doi:10.1136/jnis-2022-019513

Cited by 7 publications

(4 citation statements)

References 32 publications

(51 reference statements)

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“…Further, we cannot exclude some degree of confounding by unmeasured center-specific care parameters or population differences. However, our findings on HT rates and on predictors for the occurrence of post-revascularization HT are consistent with previous studies [3][4][5]14,15]. Furthermore, merging data from two large centers in different countries reduces the influence of specific geographical and national factors.…”

Section: Discussionsupporting

confidence: 92%

Timing of Antithrombotic Secondary Prevention in Patients with Intracranial Hemorrhage after Stroke Thrombolysis and Thrombectomy

Reale

Caliandro

Moreira

et al. 2023

JCM

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In patients with acute ischemic stroke, hemorrhagic transformation (HT) of infarcted tissue frequently occurs after reperfusion treatment. We aimed to assess whether HT and its severity influences the start of secondary prevention therapy and increases the risk of stroke recurrence. In this retrospective dual-center study, we recruited ischemic stroke patients treated with thrombolysis, thrombectomy or both. Our primary outcome was the time between revascularization and the start of any secondary prevention therapy. The secondary outcome was ischemic stroke recurrence within three months. We compared patients with vs. without HT and no (n = 653), minor (n = 158) and major (n = 51) HT patients using propensity score matching. The delay in the start of antithrombotics or anticoagulants was median 24 h in no HT, 26 h in minor HT and 39 h in major HT. No and minor HT patients had similar rates of any stroke recurrence (3.4% (all ischemic) vs. 2.5% (1.6% ischemic plus 0.9% hemorrhagic)). Major HT patients had a higher stroke recurrence at 7.8% (3.9% ischemic, 3.9% hemorrhagic), but this difference did not reach significance. A total of 22% of major HT patients did not start any antithrombotic treatment during the three-month follow-up. In conclusion, the presence of HT influences the timing of secondary prevention in ischemic stroke patients undergoing reperfusion treatments. Minor HT did not delay the start of antithrombotics or anticoagulants compared to no HT, with no significant difference in safety outcomes. Major HT patients remain a clinical challenge with both a delayed or lacking start of treatment. In this group, we did not see a higher rate of ischemic recurrence; however, this may have been censored by elevated early mortality. While not reaching statistical significance, hemorrhagic recurrence was somewhat more common in this group, warranting further study using larger datasets.

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Section: Discussionsupporting

confidence: 92%

Timing of Antithrombotic Secondary Prevention in Patients with Intracranial Hemorrhage after Stroke Thrombolysis and Thrombectomy

Reale

Caliandro

Moreira

et al. 2023

JCM

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“…The results of these studies are consistent with our findings; however, the mechanisms underlying how hyperglycemia enhances ICH remain unclear. The possible causes of ICH are as follows: (1) hyperglycemia exacerbates vascular wall dystrophy and hypoxia, resulting in more susceptible degeneration and necrosis of the vascular wall ( 29 , 30 ); (2) hyperglycemia leads to disruption of cellular metabolism, resulting in increased plasma osmolality and intracellular lactic acid buildup, ultimately leading to endothelial cell injury and acidosis ( 31 ); and (3) hyperglycemia can reportedly increase the activity of the matrix metalloproteinases (MMP-9 and MMP-3) in ischemic areas and aggravate blood–brain barrier dysfunction and post-reperfusion ICH ( 32 – 34 ). While it is hypothesized that maintaining stable blood glucose levels post-successful EVT may be crucial in preventing sICH ( 35 ), further studies are needed to confirm this.…”

Section: Discussionmentioning

confidence: 99%

Blood glucose to predict symptomatic intracranial hemorrhage after endovascular treatment of acute ischemic stroke with large infarct core: a prospective observational study

Yang,

Shi

et al. 2024

Front. Neurol.

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IntroductionSymptomatic intracranial hemorrhage (sICH) is a serious complication of acute ischemic stroke (AIS) after endovascular treatment (EVT). Limited data exist regarding predictors and clinical implications of sICH after EVT, underscoring the significance of identifying risk factors to enhance prevention strategies. Therefore, the main objective of this study was to evaluate the incidence of sICH and identify its predictors after EVT in patients with large infarct core-AIS in the pre-circulation stage.MethodsUsing data from the EVT for the Pre-circulation Large Infarct Core-AIS Study, we enrolled patients who were treated with EVT from the Prospective Multicenter Cohort Study of Early Treatment in Acute Stroke (MAGIC) registry. Baseline demographics, medical history, vascular risk factors, blood pressure, stroke severity, radiographic features, and EVT details were collected. The patients were classified into three groups: without intracranial hemorrhage (ICH), with asymptomatic intracranial hemorrhage (aICH), and sICH, based upon the occurrence of sICH. The main outcomes were the occurrence of sICH according to the Heidelberg Bleeding Classification and functional condition at 90 days. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curves were used to identify independent predictors of sICH after EVT.ResultsThe study recruited a total of 490 patients, of whom 13.3% (n = 65) developed sICH. Patients with sICH had less favorable outcomes than those without intracranial hemorrhage (ICH) and those with aICH (13.8% vs. 43.5% vs. 32.2%, respectively; p < 0.001). The overall mortality was 41.8% (n = 205) at 90 days post-EVT. The univariate analysis revealed significant differences among the three groups in terms of blood glucose levels at admission, probability of favorable outcomes, incidence of brain herniation, and 90-day mortality. The multifactorial logistic regression analysis revealed that the blood glucose level at admission [odds ratio (OR) 1.169, p < 0.001, confidence interval (CI) 1.076–1.269] was an independent predictor of sICH. A blood glucose level of 6.95 mmol/L at admission was the best predictor of sICH, with an area under the ROC curve (AUC) of 0.685 (95% CI: 0.616–0.754).DiscussionThe study findings demonstrated that the probability of sICH after EVT was 13.3% in patients with pre-circulation large infarct core-AIS, and sICH increased the risk of an unfavorable prognosis. Higher blood glucose levels at admission were associated with sICH after EVT in patients with pre-circulation large infarct core AIS. These findings underscore the importance of early management strategies to mitigate this risk.

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“…Michael Chen , 1 Thabele M Leslie-Mazwi, 2 Joshua A Hirsch , 3 Felipe C Albuquerque 4 Predicting treatment effect is a popular topic among recent Journal of Neurointerventional Surgery stroke thrombectomy publications. [1][2][3] The primary outcome measure is often functional independence, that is, a modified Rankin Scale (mRS) score of 0-2, which may lead practitioners to ruminate on the probability of this outcome during stroke triage, instead of treating patients with thrombectomy. The authors of this comment believe that the most current data no longer support that approach.…”

mentioning

confidence: 99%

“…Predicting treatment effect is a popular topic among recent Journal of Neurointerventional Surgery stroke thrombectomy publications 1–3. The primary outcome measure is often functional independence, that is, a modified Rankin Scale (mRS) score of 0–2, which may lead practitioners to ruminate on the probability of this outcome during stroke triage, instead of treating patients with thrombectomy.…”

mentioning

confidence: 99%

Large core stroke thrombectomy: paradigm shift or futile exercise?

Chen

Leslie‐Mazwi

Hirsch

et al. 2023

J NeuroIntervent Surg

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

Cited by 7 publications

References 32 publications

Timing of Antithrombotic Secondary Prevention in Patients with Intracranial Hemorrhage after Stroke Thrombolysis and Thrombectomy

Timing of Antithrombotic Secondary Prevention in Patients with Intracranial Hemorrhage after Stroke Thrombolysis and Thrombectomy

Blood glucose to predict symptomatic intracranial hemorrhage after endovascular treatment of acute ischemic stroke with large infarct core: a prospective observational study

Large core stroke thrombectomy: paradigm shift or futile exercise?

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