Literature DB >> 31239326

The impact of general anesthesia, baseline ASPECTS, time to treatment, and IV tPA on intracranial hemorrhage after neurothrombectomy: pooled analysis of the SWIFT PRIME, SWIFT, and STAR trials.

Radoslav Raychev1, Jeffrey L Saver2, Reza Jahan3, Raul G Nogueira4, Mayank Goyal5, Vitor M Pereira6, Jan Gralla7, Elad I Levy8, Dileep R Yavagal9, Christophe Cognard10, David S Liebeskind11.   

Abstract

BACKGROUND: Despite the proven benefit of neurothrombectomy, intracranial hemorrhage (ICH) remains the most serious procedural complication. The aim of this analysis was to identify predictors of different hemorrhage subtypes and evaluate their individual impact on clinical outcome.
METHODS: Pooled individual patient-level data from three large prospective multicenter studies were analyzed for the incidence of different ICH subtypes, including any ICH, hemorrhagic transformation (HT), parenchymal hematoma (PH), subarachnoid hemorrhage (SAH), and symptomatic intracranial hemorrhage (sICH). All patients (n=389) treated with the Solitaire device were included in the analysis. A multivariate stepwise logistic regression model was used to identify predictors of each hemorrhage subtype.
RESULTS: General anesthesia and higher baseline Alberta Stroke Program Early CT score (ASPECTS) were associated with a lower probability of any ICH (OR 0.36, p=0.003), (OR 0.80, p=0.032) and HT (OR 0.54, p=0.023), (OR 0.78, p=0.001), respectively. Longer time from onset to treatment was associated with a higher likelihood of HT (OR 1.08, p=0.001) and PH (OR 1.11, p=0.015). Intravenous tissue plasminogen activator (IV-tPA) was also a strong predictor of PH (OR 7.63, p=0.013). Functional independence at 90 days (modified Rankin Scale (mRS) 0-2) was observed significantly less frequently in all hemorrhage subtypes except SAH. None of the patients who achieved functional independence at 90 days had sICH.
CONCLUSIONS: General anesthesia and smaller baseline ischemic core are associated with a lower probability of HT whereas IV-tPA and prolonged time to treatment increase the risk of PH after neurothrombectomy. TRIAL REGISTRATION NUMBERS: SWIFT-NCT01054560; post results, SWIFT PRIME-NCT01657461; post results, STAR-NCT01327989; post results. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Entities:  

Keywords:  IV TPA; acute stroke; anesthesia; intracranial hemorrhage; thrombectomy

Mesh:

Substances:

Year:  2019        PMID: 31239326     DOI: 10.1136/neurintsurg-2019-014898

Source DB:  PubMed          Journal:  J Neurointerv Surg        ISSN: 1759-8478            Impact factor:   5.836


  4 in total

1.  Matrix Metalloproteinase-9 Expression is Enhanced by Ischemia and Tissue Plasminogen Activator and Induces Hemorrhage, Disability and Mortality in Experimental Stroke.

Authors:  Sofiyan Saleem; Dong Wang; Tieqiang Zhao; Ryan D Sullivan; Guy L Reed
Journal:  Neuroscience       Date:  2021-01-17       Impact factor: 3.590

2.  Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit-A Prospective Cohort Study.

Authors:  Fabio Pilato; Serena Silva; Iacopo Valente; Marisa Distefano; Aldobrando Broccolini; Valerio Brunetti; Pietro Caliandro; Giacomo Della Marca; Riccardo Di Iorio; Giovanni Frisullo; Mauro Monforte; Roberta Morosetti; Carla Piano; Rosalinda Calandrelli; Fioravante Capone; Andrea Alexandre; Alessandro Pedicelli; Cesare Colosimo; Anselmo Caricato
Journal:  Brain Sci       Date:  2020-11-26

3.  Predictive accuracy of an ADC map for hemorrhagic transformation in acute ischemic stroke patients after successful recanalization with endovascular therapy.

Authors:  Huan Liu; Tianxiao Li; Yonghong Ding; Liangfu Zhu; Ferdinand K Hui; Tengfei Zhou; Juha Antero Hernesniemi; Yanyan He; Yingkun He
Journal:  Ann Transl Med       Date:  2022-05

4.  Aortic and supra-aortic arterial tortuosity and access technique: Impact on time to device deployment in stroke thrombectomy.

Authors:  Joao Alves Rosa; Rachel Roberts; James Wareham; Robert Crossley; Anthony Cox; Alex Mortimer
Journal:  Interv Neuroradiol       Date:  2020-11-20       Impact factor: 1.764

  4 in total

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