1. Pre-procedural predictive factors of symptomatic intracranial hemorrhage after thrombectomy in stroke
- Author
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Cristian Mihalea, Bertrand Lapergue, Jonathan Cortese, Laura Venditti, Léon Ikka, Augustin Ozanne, Sophie Gallas, Claire Ancelet, Olivier Chassin, Mariana Sarov, Vanessa Chalumeau, Nicolas Legris, Julien Labreuche, Laurent Spelle, Christian Denier, and Jildaz Caroff
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Stroke ,Thrombectomy ,Neuroradiology ,Intracerebral hemorrhage ,business.industry ,Thrombolysis ,medicine.disease ,Confidence interval ,Treatment Outcome ,Blood pressure ,Neurology ,Cohort ,Cardiology ,Neurology (clinical) ,Complication ,business ,Intracranial Hemorrhages ,030217 neurology & neurosurgery - Abstract
Symptomatic intracerebral hemorrhage (sICH) is a common complication of acute ischemic stroke (AIS) associated with limited treatments and poor outcomes. We aimed to identify predictive factors of sICH in patients with AIS following mechanical thrombectomy (MT) in a real-world setting. Patients with large vessel occlusion of the anterior circulation treated with MT were consecutively included in a prospective monocentric cohort. Clinical, biological, and radiological parameters were collected to identify pre-procedural predictors for sICH. 637 patients were included in our study. Magnetic resonance imaging was performed on most patients (86.7%). sICH occurred in 55 patients (8.6%). 428 patients (67.2%) were treated with intravenous thrombolysis. After multivariate analysis, prior use of antiplatelet therapies (odd ratio (OR) 1.84, 95% confidence interval (CI) 1.01–3.32), high C-reactive protein (OR per standard deviation (SD) increase 1.28, 95% 1.01–1.63), elevated mean arterial blood pressure (OR per 10 mmHg increase 1.22, 95% CI 1.03–1.44), hyperglycemia (OR per one SD-log increase 1.38, 95% CI 1.02–1.87), and low ASPECTS (OR per 1-point decrease 1.42, 95% CI 1.12–1.80) were found to be independent predictive factors of sICH. The pre-procedural predictors did not change when the absence of successful recanalization was considered as a covariate. Patients with strokes of unknown onset time were not especially vulnerable for sICH. sICH after MT was associated with several pre-procedural risk factors: prior use of antiplatelet therapies, high C-reactive protein and hyperglycemia at baseline, elevated mean arterial blood pressure, and low ASPECTS.
- Published
- 2021