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Risk factors of intracranial hemorrhage after mechanical thrombectomy of anterior circulation ischemic stroke

PurposeIntracranial hemorrhage (ICH) is a potentially severe complication after mechanical thrombectomy (MT). Here, we investigated risk factors for the occurrence of any and symptomatic ICH after MT due to large-vessel occlusion of the anterior circulation.MethodsConsecutive patients with acute isc...

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Hauptverfasser: Neuberger, Ulf (VerfasserIn) , Vollmuth, Philipp (VerfasserIn) , Schönenberger, Silvia (VerfasserIn) , Schieber, Simon (VerfasserIn) , Ringleb, Peter A. (VerfasserIn) , Bendszus, Martin (VerfasserIn) , Pfaff, Johannes (VerfasserIn) , Möhlenbruch, Markus Alfred (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: [April 2019]
In: Neuroradiology
Year: 2019, Jahrgang: 61, Heft: 4, Pages: 461-469
ISSN:1432-1920
DOI:10.1007/s00234-019-02180-6
Online-Zugang:Verlag, Volltext: https://doi.org/10.1007/s00234-019-02180-6
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Verfasserangaben:Ulf Neuberger, Philipp Kickingereder, Silvia Schönenberger, Simon Schieber, Peter A. Ringleb, Martin Bendszus, Johannes Pfaff, Markus A. Möhlenbruch
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Zusammenfassung:PurposeIntracranial hemorrhage (ICH) is a potentially severe complication after mechanical thrombectomy (MT). Here, we investigated risk factors for the occurrence of any and symptomatic ICH after MT due to large-vessel occlusion of the anterior circulation.MethodsConsecutive patients with acute ischemic anterior circulation stroke with large-vessel occlusion undergoing MT were analyzed. ICH was categorized according to the Heidelberg Bleeding Classification. Forty-three procedural and clinical parameters were analyzed using univariate tests and multivariate logistic regressions.ResultsOf 612 patients, any ICH was detected in 195 (31.9%), while 27 (4.4%) developed a symptomatic ICH. Infarct size > 1/3 of vascular territory in control imaging (OR 2.18, 95% CI 1.45-3.21), higher serum glucose levels (OR 1.23 for change of 15 units mg/dL, 95% CI 1.10-1.39), and higher thrombectomy maneuver count (OR 1.21, 95% CI 1.11-1.32) were significantly associated with a higher risk of developing any ICH compared to no ICH. Wake-up strokes (OR 3.99, 95% CI 1.38-11.60), transfer from an external clinic (OR 3.04, 95% CI 1.24-7.48), and higher serum glucose levels (OR 1.22 for change of 15 units mg/dL, 95% CI 1.05-1.42) were revealed as independent risk factors for development of symptomatic ICH compared to no symptomatic ICH. Patients with no infarct demarcation (OR 0.10, 95% CI 0.01-0.80) and complete recanalization (OR 0.57, 95% CI 0.37-0.86) showed a lower risk of developing any ICH.ConclusionWake-up strokes and patients who are treated within a drip-and-ship concept are especially vulnerable for symptomatic ICH, while complete recanalization, contrary to subtotal recanalization only, was revealed as a protective factor against ICH.
Beschreibung:Published online: 18 February 2019
Gesehen am 08.05.2019
Beschreibung:Online Resource
ISSN:1432-1920
DOI:10.1007/s00234-019-02180-6

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