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

• Verfasst von: Neuberger, Ulf [VerfasserIn]
• Verfasst von: Vollmuth, Philipp [VerfasserIn]
• Verfasst von: Schönenberger, Silvia [VerfasserIn]
• Verfasst von: Schieber, Simon [VerfasserIn]
• Verfasst von: Ringleb, Peter A. [VerfasserIn]
• Verfasst von: Bendszus, Martin [VerfasserIn]
• Verfasst von: Pfaff, Johannes [VerfasserIn]
• Verfasst von: Möhlenbruch, Markus Alfred [VerfasserIn]
• Titel: Risk factors of intracranial hemorrhage after mechanical thrombectomy of anterior circulation ischemic stroke
• Verf.angabe: Ulf Neuberger, Philipp Kickingereder, Silvia Schönenberger, Simon Schieber, Peter A. Ringleb, Martin Bendszus, Johannes Pfaff, Markus A. Möhlenbruch
• E-Jahr: 2019
• Jahr: [April 2019]
• Umfang: 9 S.
• Fussnoten: Published online: 18 February 2019 ; Gesehen am 08.05.2019
• Titel Quelle: Enthalten in: Neuroradiology
• Ort Quelle: Berlin : Springer, 1970
• Jahr Quelle: 2019
• Band/Heft Quelle: 61(2019), 4, Seite 461-469
• ISSN Quelle: 1432-1920
• DOI: doi:10.1007/s00234-019-02180-6
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Hemorrhagic transformation
• Sach-SW: Intracranial hemorrhage
• Sach-SW: Ischemic stroke
• Sach-SW: Mechanical thrombectomy
• Sach-SW: Risk factors
• K10plus-PPN: 1664973400

Abstract

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.