P Constant Dit Beaufils1, C Preterre1, S De Gaalon1, J Labreuche2, M Mazighi3, F Di Maria4, I Sibon5, G Marnat6, F Gariel6, R Blanc3, B Gory7,8, A Consoli4, F Zhu7,8, S Richard9,10, R Fahed11,12, H Desal11,12, B Lapergue13, B Guillon1, R Bourcier11,12. 1. Neurovascular Stroke Unit, University Hospital of Nantes, Nantes, France. 2. CHU Lille, EA 2694 - Santé Publique: Epidémiologie et Qualité des Soins, University of Lille, Lille, France. 3. Department of Interventional Neuroradiology Fondation Ophtalmologique A. De Rothschild, Unité INSERM 1148, Université de Paris, Paris, France. 4. Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France. 5. Department of Neurology, CHU Bordeaux, Stroke Unit, Université de Bordeaux, Bordeaux, France. 6. Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France. 7. Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, Nancy, France. 8. IADI, INSERM U1254, Université de Lorraine, Nancy, France. 9. CHRU-Nancy, Department of Neurology, Stroke Unit, Université de Lorraine (S.R.), Nancy, France. 10. INSERM U1116, CHRU-Nancy, Nancy, France. 11. Department of Diagnostic and Therapeutic Neuroradiology, L'institut du Thorax, Inserm 1087, CNRS, University Hospital of Nantes, UNIV Nantes, Nantes, France. 12. Department of Medicine - Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada. 13. Department of Neurology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France.
Abstract
BACKGROUND AND PURPOSE: Asymptomatic intracranial hemorrhage (aICH) is a common occurrence after endovascular treatment (EVT) for acute ischemic stroke (AIS). The aims of this study were to address its impact on 3-month functional outcome and to identify risk factors for aICH after EVT. METHODS: Patients with AIS attributable to anterior circulation large vessel occlusion who underwent EVT were enrolled in a multicenter prospective registry. Based on imaging performed 22-36 h post-EVT, we included patients with no intracranial hemorrhage (ICH) or aICH. Poor outcome defined as a 3-month modified Rankin Scale (mRS) score 4-6 and overall 3-month mRS score distribution were compared according to presence/absence of aICH, and aICH subtype using logistic regression. We assessed the risk factors of aICH using a multivariate logistic regression model. RESULTS: Of the 1526 patients included in the study, 653 (42.7%) had aICH. Patients with aICH had a higher rate of poor outcome: odds ratio (OR) 1.88 (95% confidence interval [CI] 1.44-2.44). Shift analysis of mRS score found a fully adjusted OR of 1.79 (95% CI 1.47-2.18). Hemorrhagic infarction (OR 1.63 [95% CI 1.22-2.18]) and parenchymal hematoma (OR 2.99 [95% CI 1.77-5.02]) were associated with higher risk of poor outcome. Male sex, diabetes, coronary artery disease, baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score, number of passes and onset to groin puncture time were independently associated with aICH. CONCLUSIONS: Patients with aICH, irrespective of the radiological pattern, have a worse functional outcome at 3 months compared with those without ICH after EVT for AIS. The number of EVT passes and the time from onset to groin puncture are factors that could be modified to reduce deleterious ICH.
BACKGROUND AND PURPOSE: Asymptomatic intracranial hemorrhage (aICH) is a common occurrence after endovascular treatment (EVT) for acute ischemic stroke (AIS). The aims of this study were to address its impact on 3-month functional outcome and to identify risk factors for aICH after EVT. METHODS:Patients with AIS attributable to anterior circulation large vessel occlusion who underwent EVT were enrolled in a multicenter prospective registry. Based on imaging performed 22-36 h post-EVT, we included patients with no intracranial hemorrhage (ICH) or aICH. Poor outcome defined as a 3-month modified Rankin Scale (mRS) score 4-6 and overall 3-month mRS score distribution were compared according to presence/absence of aICH, and aICH subtype using logistic regression. We assessed the risk factors of aICH using a multivariate logistic regression model. RESULTS: Of the 1526 patients included in the study, 653 (42.7%) had aICH. Patients with aICH had a higher rate of poor outcome: odds ratio (OR) 1.88 (95% confidence interval [CI] 1.44-2.44). Shift analysis of mRS score found a fully adjusted OR of 1.79 (95% CI 1.47-2.18). Hemorrhagic infarction (OR 1.63 [95% CI 1.22-2.18]) and parenchymal hematoma (OR 2.99 [95% CI 1.77-5.02]) were associated with higher risk of poor outcome. Male sex, diabetes, coronary artery disease, baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score, number of passes and onset to groin puncture time were independently associated with aICH. CONCLUSIONS:Patients with aICH, irrespective of the radiological pattern, have a worse functional outcome at 3 months compared with those without ICH after EVT for AIS. The number of EVT passes and the time from onset to groin puncture are factors that could be modified to reduce deleterious ICH.
Authors: Nadinda A M van der Ende; Bob Roozenbeek; Lucas E M Smagge; Sven P R Luijten; Leo A M Aerden; Petra Kraayeveld; Ido R van den Wijngaard; Geert J Lycklama À Nijeholt; Heleen M den Hertog; H Zwenneke Flach; Alexis C Wallace; Victor Gurewich; Gregory J Del Zoppo; William J Meurer; Hester F Lingsma; Aad van der Lugt; Diederik W J Dippel Journal: Trials Date: 2022-08-09 Impact factor: 2.728