William Boisseau1, Robert Fahed1, Bertrand Lapergue2, Jean-Philippe Desilles1,3,4, Kevin Zuber1, Naim Khoury5, Jeanne Garcia2, Benjamin Maïer1, Hocine Redjem1, Gabriele Ciccio1, Stanislas Smajda1, Simon Escalard1, Guillaume Taylor6, Mikael Mazighi1,3,4, Piotin Michel1,3,4, Benjamin Gory7,8, Raphaël Blanc1,3,4. 1. Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France (W.B., R.F., J.-P.D., K.Z., B.M., H.R., G.C., S.S., S.E., M.M., M.P., R.B.). 2. Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., J.G.). 3. Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., M.M., M.P., R.B.). 4. Université Paris Denis Diderot, Sorbonne Paris Cite, France (J.-P.D., M.M., M.P., R.B.). 5. HSHS Neuroscience Center, HSHS St John's Hospital, Springfield, IL (N.K.). 6. Department of Intensive Care, Rothschild Foundation Hospital, Paris, France (G.T.). 7. Department of Diagnostic and Therapeutic Neuroradiology, Nancy Hospital, France (B.G.). 8. University of Lorraine, INSERM U1254, IADI, Nancy, France (B.G.).
Abstract
Background and Purpose: Parenchymal hematoma (PH) is a rare but dreadful complication of acute ischemic stroke with unclear underlying mechanisms. We aimed to study the incidence and predictors of PH after mechanical thrombectomy. Methods: Data from a prospective observational multicenter registry was screened to identify acute ischemic stroke patients with an anterior circulation large vessel occlusion who underwent mechanical thrombectomy. Clinical, imaging, and procedural characteristics were used for the analysis, including brain imaging systematically performed at 24 hours. PH occurrence was assessed according to ECASS (European Collaborative Acute Stroke Study) criteria. Univariate and multivariable analyses were performed to identify predictors of PH. Results: A total of 1316 patients were included in the study. PH occurred in 153 out of 1316 patients (11.6%) and was associated with a lower rate of favorable outcome and increased mortality. On multivariable analysis, age (per 1 year increase, odds ratio [OR], 1.01; 95% CI, 1.00–1.03; P=0.05), current smoking (OR, 2.02; 95% CI, 1.32–3.09; P<0.01), admission Alberta Stroke Program Early CT Score (per a decrease of 1 point, OR, 1.70; 95% CI, 1.18–2.44; P<0.01), general anesthesia (OR, 1.98; 95% CI, 1.36–2.90; P<0.001), angiographic poor collaterals (OR, 2.13; 95% CI, 1.36–3.33; P<0.001) and embolization in new territory (OR, 2.94; 95% CI, 1.70–5.10; P<0.001) were identified as independent predictors of PH. Conclusions: PH occurred at a rate of 11.6% after mechanical thrombectomy, with high morbidity and mortality. Our study identified clinical, radiological, and procedural predictors of PH occurrence that can serve as the focus of future periprocedural management studies with the aim of reducing its occurrence.
Background and Purpose: Parenchymal hematoma (PH) is a rare but dreadful complication of acute ischemic stroke with unclear underlying mechanisms. We aimed to study the incidence and predictors of PH after mechanical thrombectomy. Methods: Data from a prospective observational multicenter registry was screened to identify acute ischemic strokepatients with an anterior circulation large vessel occlusion who underwent mechanical thrombectomy. Clinical, imaging, and procedural characteristics were used for the analysis, including brain imaging systematically performed at 24 hours. PH occurrence was assessed according to ECASS (European Collaborative Acute Stroke Study) criteria. Univariate and multivariable analyses were performed to identify predictors of PH. Results: A total of 1316 patients were included in the study. PH occurred in 153 out of 1316 patients (11.6%) and was associated with a lower rate of favorable outcome and increased mortality. On multivariable analysis, age (per 1 year increase, odds ratio [OR], 1.01; 95% CI, 1.00–1.03; P=0.05), current smoking (OR, 2.02; 95% CI, 1.32–3.09; P<0.01), admission Alberta Stroke Program Early CT Score (per a decrease of 1 point, OR, 1.70; 95% CI, 1.18–2.44; P<0.01), general anesthesia (OR, 1.98; 95% CI, 1.36–2.90; P<0.001), angiographic poor collaterals (OR, 2.13; 95% CI, 1.36–3.33; P<0.001) and embolization in new territory (OR, 2.94; 95% CI, 1.70–5.10; P<0.001) were identified as independent predictors of PH. Conclusions: PH occurred at a rate of 11.6% after mechanical thrombectomy, with high morbidity and mortality. Our study identified clinical, radiological, and procedural predictors of PH occurrence that can serve as the focus of future periprocedural management studies with the aim of reducing its occurrence.
Authors: G Marnat; S Finistis; F Delvoye; I Sibon; J-P Desilles; M Mazighi; F Gariel; A Consoli; C Rosso; F Clarençon; M Elhorany; C Denier; V Chalumeau; J Caroff; L Veunac; F Bourdain; J Darcourt; J-M Olivot; R Bourcier; C Dargazanli; C Arquizan; S Richard; B Lapergue; B Gory Journal: AJNR Am J Neuroradiol Date: 2022-03-03 Impact factor: 3.825
Authors: E Shotar; G Pouliquen; K Premat; A Pouvelle; S Mouyal; L Meyblum; S Lenck; V Degos; S Abi Jaoude; N Sourour; B Mathon; F Clarençon Journal: AJNR Am J Neuroradiol Date: 2021-02-04 Impact factor: 3.825
Authors: Sara Bernardo-Castro; João André Sousa; Ana Brás; Carla Cecília; Bruno Rodrigues; Luciano Almendra; Cristina Machado; Gustavo Santo; Fernando Silva; Lino Ferreira; Isabel Santana; João Sargento-Freitas Journal: Front Neurol Date: 2020-12-09 Impact factor: 4.003
Authors: Ronda Lun; Gregory B Walker; Adrien Guenego; Mohammed Kassab; Eduardo Portela; Vignan Yogendrakumar; George Medvedev; Ken Wong; Michel Shamy; Dar Dowlatshahi; Robert Fahed Journal: Front Neurol Date: 2020-12-22 Impact factor: 4.003