TY - JOUR
T1 - Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke
T2 - insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)
AU - Ironside, Natasha
AU - Chen, Ching Jen
AU - Chalhoub, Reda M.
AU - Kellogg, Ryan T.
AU - Ding, Dale
AU - Maier, Ilko
AU - Al Kasab, Sami
AU - Jabbour, Pascal
AU - Kim, Joon Tae
AU - Wolfe, Stacey Q.
AU - Rai, Ansaar
AU - Starke, Robert M.
AU - Psychogios, Marios Nikos
AU - Shaban, Amir
AU - Arthur, Adam S.
AU - Yoshimura, Shinichi
AU - Grossberg, Jonathan A.
AU - Alawieh, Ali
AU - Fragata, Isabel
AU - Polifka, Adam J.
AU - Mascitelli, Justin R.
AU - Osbun, Joshua W.
AU - Matouk, Charles
AU - Levitt, Michael R.
AU - Dumont, Travis M.
AU - Cuellar-Saenz, Hugo H.
AU - Williamson, Richard
AU - Romano, Daniele G.
AU - Crosa, Roberto Javier
AU - Gory, Benjamin
AU - Mokin, Maxim
AU - Moss, Mark
AU - Limaye, Kaustubh
AU - Kan, Peter
AU - Spiotta, Alejandro M.
AU - Park, Min S.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Background: Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy. Methods: This 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. Results: The 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. Conclusions: This 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.
AB - Background: Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy. Methods: This 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. Results: The 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. Conclusions: This 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.
KW - Hemorrhage
KW - Stroke
KW - Thrombectomy
KW - Thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=85148663397&partnerID=8YFLogxK
U2 - 10.1136/jnis-2022-019513
DO - 10.1136/jnis-2022-019513
M3 - Article
C2 - 36725360
AN - SCOPUS:85148663397
SN - 1759-8478
VL - 15
SP - E312-E322
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
IS - e2
M1 - 019513
ER -
