1. Timing of symptomatic intracranial hemorrhage after endovascular stroke treatment.
- Author
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van der Steen W, van der Ende NA, van Kranendonk KR, Chalos V, Brouwer J, van Oostenbrugge RJ, van Zwam WH, van Doormaal PJ, van Es AC, Majoie CB, van der Lugt A, Dippel DW, and Roozenbeek B
- Abstract
Introduction: Little is known about the timing of occurrence of symptomatic intracranial hemorrhage (sICH) after endovascular therapy (EVT) for acute ischemic stroke. A better understanding could optimize in-hospital surveillance time points and duration. The aim of this study was to delineate the probability of sICH over time and to identify factors associated with its timing., Patients and Methods: We retrospectively analyzed data from the Dutch MR CLEAN trial and MR CLEAN Registry. We included adult patients who underwent EVT for an anterior circulation large vessel occlusion within 6.5 h of stroke onset. In patients with sICH (defined as ICH causing an increase of ⩾4 points on the National Institutes of Health Stroke Scale [NIHSS]), univariable and multivariable linear regression analysis was used to identify factors associated with the timing of sICH. This was defined as the time between end of EVT and the time of first CT-scan on which ICH was seen as a proxy., Results: SICH occurred in 205 (6%) of 3391 included patients. Median time from end of EVT procedure to sICH detection on NCCT was 9.0 [IQR 2.9-22.5] hours, with a rapidly decreasing incidence after 24 h. None of the analyzed factors, including baseline NIHSS, intravenous alteplase treatment, and poor reperfusion at the end of the procedure were associated with the timing of sICH., Conclusion: SICHs primarily occur in the first hours after EVT, and less frequently beyond 24 h. Guidelines that recommend to perform frequent neurological assessments for at least 24 h after intravenous alteplase treatment can be applied to ischemic stroke patients treated with EVT., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DD and AvdL report funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution. CM: received funds from TWIN Foundation (related to this project, paid to institution); and from CVON/Dutch Heart Foundation, Stryker, European Commission, Health Evaluation Netherlands (unrelated; all paid to institution). CM is shareholder of Nicolab, a company that focuses on the use of artificial intelligence for medical imaging analysis. WvZ reports speaker fees from Stryker, Nicolab and Cerenovus, both paid to institution. BR reports funding from the Dutch Heart Foundation, and The Netherlands Organisation for Health Research and Development, all paid to institution., (© European Stroke Organisation 2022.)
- Published
- 2022
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