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Stroke. 2017 May;48(5):1203-1209. doi: 10.1161/STROKEAHA.116.016368. Epub 2017 Apr 3.

Predictors for Symptomatic Intracranial Hemorrhage After Endovascular Treatment of Acute Ischemic Stroke.

Author information

1
From the Department of Neurology, Jinling Hospital, Southern Medical University (Guangzhou), Nanjing, China (Y.H., X.L., G.X.); Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China (Y.H.); Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, China (D.Y., H.W., X.L., G.X.); Department of Neurology, The 89th Hospital of the People's Liberation Army, Weifang, Shandong Province, China (H.W.); Department of Neurology (W.Z., Y.X., X.L., G.X.) and Department of Medical Statistics (Y.L.), Jinling Hospital, Medical School of Nanjing University, China; Department of Neurology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China (M.Z.); Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, China (Y.G.); Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, China (Z.Z.); Department of Radiology, The First People's Hospital of Yangzhou, Yangzhou University, Jiangsu Province, China (W.W.); Department of Neurology, The First Affiliated Hospital of Zhengzhou University, China (H.X.); Department of Neurology, The Chinese Armed Police Force Guangdong Armed Police Corps Hospital, Guangzhou, China (X.T.); and Department of Interventional Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China (P.L.).
2
From the Department of Neurology, Jinling Hospital, Southern Medical University (Guangzhou), Nanjing, China (Y.H., X.L., G.X.); Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China (Y.H.); Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, China (D.Y., H.W., X.L., G.X.); Department of Neurology, The 89th Hospital of the People's Liberation Army, Weifang, Shandong Province, China (H.W.); Department of Neurology (W.Z., Y.X., X.L., G.X.) and Department of Medical Statistics (Y.L.), Jinling Hospital, Medical School of Nanjing University, China; Department of Neurology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China (M.Z.); Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, China (Y.G.); Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, China (Z.Z.); Department of Radiology, The First People's Hospital of Yangzhou, Yangzhou University, Jiangsu Province, China (W.W.); Department of Neurology, The First Affiliated Hospital of Zhengzhou University, China (H.X.); Department of Neurology, The Chinese Armed Police Force Guangdong Armed Police Corps Hospital, Guangzhou, China (X.T.); and Department of Interventional Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China (P.L.). gelinxu@nju.edu.cn xfliu2@vip.163.com.

Abstract

BACKGROUND AND PURPOSE:

Symptomatic intracranial hemorrhage (SICH) pose a major safety concern for endovascular treatment of acute ischemic stroke. This study aimed to evaluate the risk and related factors of SICH after endovascular treatment in a real-world practice.

METHODS:

Patients with stroke treated with stent-like retrievers for recanalizing a blocked artery in anterior circulation were enrolled from 21 stroke centers in China. Intracranial hemorrhage was classified as symptomatic and asymptomatic ones according to Heidelberg Bleeding Classification. Logistic regression was used to identify predictors for SICH.

RESULTS:

Of the 632 enrolled patients, 101 (16.0%) were diagnosed with SICH within 72 hours after endovascular treatment. Ninety-day mortality was higher in patients with SICH than in patients without SICH (65.3% versus 18.8%; P<0.001). On multivariate analysis, baseline neutrophil ratio >0.83 (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.24-3.46), pretreatment Alberta Stroke Program Early Computed Tomography Score of <6 (OR, 2.27; 95% CI, 1.24-4.14), stroke of cardioembolism type (OR, 1.91; 95% CI, 1.13-3.25), poor collateral circulation (OR, 1.97; 95% CI, 1.16-3.36), delay from symptoms onset to groin puncture >270 minutes (OR, 1.70; 95% CI, 1.03-2.80), >3 passes with retriever (OR, 2.55; 95% CI, 1.40-4.65) were associated with SICH after endovascular treatment.

CONCLUSIONS:

Incidence of SICH after thrombectomy is higher in Asian patients with acute ischemic stroke. Cardioembolic stroke, poor collateral circulation, delayed endovascular treatment, multiple passes with stent retriever device, lower pretreatment Alberta Stroke Program Early Computed Tomography Score, higher baseline neutrophil ratio may increase the risk of SICH.

KEYWORDS:

collateral circulation; groin; intracranial hemorrhages; stroke; thrombectomy

PMID:
28373302
DOI:
10.1161/STROKEAHA.116.016368
[Indexed for MEDLINE]

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