Edgar R Lopez-Navarro1, Christofer Delfs2, Andrea Jarre2, Vivian Sanio2, Götz Greif3, Jose Gutierrez4, E Bernd Ringelstein5, Sven G Meuth6, Carl-Albrecht Haensch3,7, Adrian Ringelstein8, Marius Ringelstein6,9. 1. Department of Neurology, Johanna Etienne Krankenhaus, Neuss, Germany. 2. Department of Radiology and Neuroradiology, Kliniken Maria Hilf, Viersener Str. 450, 41063, Mönchengladbach, NRW, Germany. 3. Department of Neurology, Kliniken Maria Hilf, Mönchengladbach, Germany. 4. Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA. 5. Department of Neurology, University of Münster, Münster, Germany. 6. Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. 7. Faculty of Health, University of Witten/Herdecke, Witten, Germany. 8. Department of Radiology and Neuroradiology, Kliniken Maria Hilf, Viersener Str. 450, 41063, Mönchengladbach, NRW, Germany. adrian.ringelstein@mariahilf.de. 9. Department of Neurology, Center of Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Abstract
PURPOSE: Despite improved techniques and sophisticated postinterventional care, symptomatic intracranial hemorrhage (sICH) remains the most feared complication of mechanical thrombectomy (MT). Based on peri-interventional parameters, we aimed to discover which patients have a higher risk of sICH. METHODS: From March 2017 until March 2020 consecutive patients with acute ischemic stroke (AIS) and confirmed large-vessel occlusion who underwent MT were analyzed retrospectively. Demographic, clinical, and radiological variables and parameters specific to thrombectomy were reviewed. A univariate analysis was performed and statistically significant variables were included in a logistic regression model to identify independent factors predictive of sICH. RESULTS: A total of 236 patients with confirmed large-vessel occlusion were included and 22 (9.3%) had sICH. Univariate predictors of sICH included diabetes mellitus, glucose > 11.1 mmol/L, creatinine clearance (CrCl) ≤ 30 ml/min/1.73, ASPECTS indicating pretreatment infarct size, acute internal carotid artery (ICA) occlusion, stent implantation, tirofiban use, time from symptom onset to groin puncture > 4.5 h and high contrast medium consumption. In the adjusted analysis, ASPECTS < 6 (OR 3.673, p = 0.041), and amount of contrast injected ≥ 140 ml (OR 5.412, p = 0.003) were independent predictors of sICH, but not any more baseline glucose > 11.1 mmol/L (OR 1.467, p = 0.584), CrCl ≤ 30 ml/min/1.73 (OR 4.177, p = 0.069), acute ICA occlusion (OR 2.079, p = 0.181), stent implantation (OR 0.465, p = 0.512), tirofiban use (OR 5.164, p = 0.167), and time from onset-to-groin puncture (OR 1.453, p = 0.514). CONCLUSION: The amount of contrast medium used is a modifiable factor associated with sICH. This association is novel and may be related to the neurotoxicity of the contrast medium disrupting the blood-brain barrier.
PURPOSE: Despite improved techniques and sophisticated postinterventional care, symptomatic intracranial hemorrhage (sICH) remains the most feared complication of mechanical thrombectomy (MT). Based on peri-interventional parameters, we aimed to discover which patients have a higher risk of sICH. METHODS: From March 2017 until March 2020 consecutive patients with acute ischemic stroke (AIS) and confirmed large-vessel occlusion who underwent MT were analyzed retrospectively. Demographic, clinical, and radiological variables and parameters specific to thrombectomy were reviewed. A univariate analysis was performed and statistically significant variables were included in a logistic regression model to identify independent factors predictive of sICH. RESULTS: A total of 236 patients with confirmed large-vessel occlusion were included and 22 (9.3%) had sICH. Univariate predictors of sICH included diabetes mellitus, glucose > 11.1 mmol/L, creatinine clearance (CrCl) ≤ 30 ml/min/1.73, ASPECTS indicating pretreatment infarct size, acute internal carotid artery (ICA) occlusion, stent implantation, tirofiban use, time from symptom onset to groin puncture > 4.5 h and high contrast medium consumption. In the adjusted analysis, ASPECTS < 6 (OR 3.673, p = 0.041), and amount of contrast injected ≥ 140 ml (OR 5.412, p = 0.003) were independent predictors of sICH, but not any more baseline glucose > 11.1 mmol/L (OR 1.467, p = 0.584), CrCl ≤ 30 ml/min/1.73 (OR 4.177, p = 0.069), acute ICA occlusion (OR 2.079, p = 0.181), stent implantation (OR 0.465, p = 0.512), tirofiban use (OR 5.164, p = 0.167), and time from onset-to-groin puncture (OR 1.453, p = 0.514). CONCLUSION: The amount of contrast medium used is a modifiable factor associated with sICH. This association is novel and may be related to the neurotoxicity of the contrast medium disrupting the blood-brain barrier.
Authors: Mayra Montalvo; Eva Mistry; Andrew Davey Chang; Aleksandra Yakhkind; Katarina Dakay; Idrees Azher; Ashutosh Kaushal; Akshitkumar Mistry; Rohan Chitale; Shawna Cutting; Tina Burton; Brian Mac Grory; Michael Reznik; Ali Mahta; Bradford B Thompson; Koto Ishida; Jennifer Frontera; Howard A Riina; David Gordon; David Parella; Erica Scher; Jeffrey Farkas; Ryan McTaggart; Pooja Khatri; Karen L Furie; Mahesh Jayaraman; Shadi Yaghi Journal: J Neurol Neurosurg Psychiatry Date: 2019-08-19 Impact factor: 10.154