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1. Inter‐hospital transfer for thrombectomy: transfer time is brain.

Author

Seners, Pierre, Khyheng, Maeva, Labreuche, Julien, Lapergue, Bertrand, Pico, Fernando, Wang, Adrien, Consoli, Arturo, Coskun, Oguzhan, Di Maria, Federico, Pizzuto, Silvia, Sgreccia, Alessandro, Benoit, Charline, Gorza, Lucas, Weisenburger‐Lile, David, Jabeur, Waliyde, Tchikviladze, Maia, Evrard, Serge, Rodesch, Georges, Blanc, Raphaël, and Obadia, Michel

Subjects
THROMBECTOMY, ISCHEMIC stroke, PUBLIC hospitals, ENDOVASCULAR surgery, STROKE
Abstract

Background and purpose: Patients with acute ischaemic stroke and a large vessel occlusion who present to a non‐endovascular‐capable centre often require inter‐hospital transfer for thrombectomy. Whether the inter‐hospital transfer time is associated with 3‐month functional outcome is poorly known. Methods: Acute stroke patients enrolled between January 2015 and December 2022 in the prospective French multicentre Endovascular Treatment of Ischaemic Stroke registry were retrospectively analysed. Patients with an anterior circulation large vessel occlusion transferred from a non‐endovascular to a comprehensive stroke centre for thrombectomy were eligible. Inter‐hospital transfer time was defined as the time between imaging in the referring hospital and groin puncture for thrombectomy. The relationship between transfer time and favourable 3‐month functional outcome (modified Rankin Scale 0–2) was assessed through a mixed logistic regression model adjusting for centre and symptom‐onset‐to‐referring‐hospital imaging time, age, sex, diabetes, referring hospital National Institutes of Health Stroke Scale score, Alberta Stroke Programme Early Computed Tomography Score, occlusion site and intravenous thrombolysis use. Results: Overall, 3769 patients were included (median inter‐hospital transfer time 161 min, interquartile range 128–195; 46% with favourable outcome). A longer transfer time was independently associated with lower rates of favourable outcome (p < 0.001). Compared to patients with transfer time below 120 min, there was a 15% reduction in the odds of achieving favourable outcome for transfer times between 120 and 180 min (adjusted odds ratio 0.85; 95% confidence interval 0.67–1.07), and a 36% reduction for transfer times beyond 180 min (adjusted odds ratio 0.64; 95% confidence interval 0.50–0.81). Conclusions: A shorter inter‐hospital transfer time is strongly associated with favourable 3‐month functional outcome. A speedier inter‐hospital transfer is of critical importance to improve outcome. [ABSTRACT FROM AUTHOR]

Published
2024
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2. Endovascular therapy with or without intravenous thrombolysis in acute stroke with tandem occlusion

Author

Anadani, Mohammad, Marnat, Gaultier, Consoli, Arturo, Papanagiotou, Panagiotis, Nogueira, Raul, Spiotta, Alejandro, Bourcier, Romain, Kyheng, Maeva, Labreuche, Julien, Siddiqui, Adnan, Ribo, Marc, de Havenon, Adam, Fischer, Urs, Sibon, Igor, Dargazanli, Cyril, Arquizan, Caroline, Cognard, Christophe, Olivot, Jean Marc, Anxionnat, René, Audibert, Gérard, Mazighi, Mikael, Blanc, Raphaël, Lapergue, Bertrand, Richard, Sébastien, Gory, Benjamin, Turjman, Francis, Piotin, Michel, Steglich-Arnholm, Henrik, Holtmannspötter, Markus, Taschner, Christian, Eiden, Sebastian, Haussen, Diogo C., Muhammad, Waqas, Boutchakova, Maria, Dorn, Franziska, Killer-Oberpfalzer, Monika, Mangiafico, Salvatore, Psychogios, Marios-Nikos, Labeyrie, Marc-Antoine, Biondi, Alessandra, Bracard, Serge, Andrew Grossberg, Jonathan, Guenego, Adrien, Darcourt, Julien, Vukasinovic, Isabelle, Pomero, Elisa, Davies, Jason, Renieri, Leonardo, Hecker, Corentin, Muchada Muchada, Maria, Rodesch, Georges, Houdart, Emmanuel, Lockau, Johanna, Kastrup, Andreas, Redjem, Hocine, Behme, Daniel, Shallwani, Hussain, Christopher, Maurer, Mione, Gioia, Humbertjean, Lisa, Riou-Comte, Nolwenn, Zhu, François, Borderelle, Anne-Laure, Liao, Liang, Escalard, Simon, Desilles, Jean-Philippes, Ciccio, Gabriele, Smajda, Stanislas, Obadia, Mikael, Sabben, Candice, Corabianu, Ovide, de Broucker, Thomas, Smadja, Didier, Alamowitch, Sonia, Ille, Olivier, Manchon, Éric, Garcia, Pierre-Yves, Taylor, Guillaume, Ben Maacha, Malek, Wang, Adrien, Evrard, Serge, Tchikviladze, Maya, Ajili, Nadia, Weisenburger, David, Gorza, Lucas, Coskun, Oguzhan, Di Maria, Federico, Rodesh, Georges, Leguen, Morgan, Gratieux, Julie, Pico, Fernando, Rakotoharinandrasana, Haja, Tassan, Philippe, Poll, Roxanna, Marinier, Sylvie, Gariel, Florent, Barreau, Xavier, Berge, Jérôme, Veunac, Louis, Menegon, Patrice, Lucas, Ludovic, Olindo, Stéphane, Renou, Pauline, Sagnier, Sharmila, Poli, Mathilde, Debruxelles, Sabrina, Tourdias, Thomas, Liegey, Jean-Sébastien, Daumas-Duport, Benjamin, Alexandre, Pierre-Louis, Roy, Monica, Lenoble, Cédric, L'Allinec, Vincent, Girot, Jean-Baptiste, Desal, Hubert, Braun, Marc, Derelle, Anne-Laure, Tonnelet, Romain, Schmitt, Emmanuelle, Planel, Sophie, Lacour, Jean-Christophe, Hossu, Gabriela, Beaumont, Marine, Bailang, Mitchelle, Reitter, Marie, Masson, Agnès, Alb, Lionel, Tabarna, Adriana, Voicu, Marcela, Podar, Iona, Brezeanu, Madalina, Costalat, Vincent, Gascou, Gregory, Lefevre, Pierre-Henri, Derraz, Imad, Riquelme, Carlos, Gaillard, Nicolas, Mourand, Isabelle, Corti, Lucas, Washington University School of Medicine in St. Louis, Washington University in Saint Louis (WUSTL), Medical University of South Carolina [Charleston] (MUSC), Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), CHU Bordeaux [Bordeaux], Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Hôpital Foch [Suresnes], National and Kapodistrian University of Athens (NKUA), Emory University School of Medicine, Emory University [Atlanta, GA], Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, University at Buffalo [SUNY] (SUNY Buffalo), State University of New York (SUNY), Vall d'Hebron University Hospital [Barcelona], University of Utah, Inselspital Bern, Service de neurologie [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Neuroradiologie [Hôpital Gui de Chauliac], Hôpital Gui de Chauliac [Montpellier], Neurochirurgie [Hôpital Gui de Chauliac], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], Neuroradiologie Diagnostique et Thérapeutique [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de neurologie [CHRU Nancy], Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch], Nantes Université - pôle Santé, Nantes Université (Nantes Univ), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse], Pôle imagerie médicale [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Département de Neurologie [Toulouse], Institut des Neurosciences [Toulouse], Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT), CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Institut de Génomique Fonctionnelle (IGF), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
medicine.medical_specialty, medicine.medical_treatment, Hemorrhage, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, Endovascular therapy, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Modified Rankin Scale, medicine.artery, Internal medicine, Occlusion, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, medicine, Humans, Thrombolytic Therapy, Stroke, Ischemic Stroke, Thrombectomy, business.industry, Cerebral infarction, Endovascular Procedures, General Medicine, Thrombolysis, medicine.disease, 3. Good health, Treatment Outcome, Propensity score matching, Cardiology, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Surgery, Neurology (clinical), Internal carotid artery, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, 030217 neurology & neurosurgery
Abstract

BackgroundEndovascular therapy (EVT) is effective and safe in patients with tandem occlusion. The benefit of intravenous thrombolysis (IVT) prior to EVT in acute tandem occlusion is debatable.ObjectiveTo compare EVT alone with EVT plus IVT in patients with acute ischemic stroke due to anterior circulation tandem occlusions.MethodsThis is an individual patient pooled analysis of the Thrombectomy In TANdem lesions (TITAN) and Endovascular Treatment in Ischemic Stroke (ETIS) Registries. Patients were divided into two groups based on prior IVT treatment: (1) IVT+ group, which included patients who received IVT prior to EVT, (2) IVT− group, which included patients who did not receive IVT prior to EVT. Propensity score (inverse probability of treatment weighting (IPTW)) was used to reduce baseline between-group differences. The primary outcome was favorable outcome—that is, modified Rankin Scale (mRS) score 0 to 2 at 90 days.ResultsOverall, 602 consecutive patients with an acute stroke with tandem occlusion were included (380 and 222 in the bridging therapy and EVT alone groups, respectively). Onset to imaging time was shorter in the IVT+ group (median 103 vs 140 min). In contrast, imaging to puncture time was longer in the IVT+ group (median 107 vs 91 min). In IPTW analysis, the IVT+ group had higher odds of favorable outcome, excellent outcome (90-day mRS score 0–1), and successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2b/3 at the end of EVT). There was no difference in the risk of significant hemorrhagic complications between groups. In secondary analysis of patients treated with acute cervical internal carotid artery stenting, bridging therapy was associated with higher odds of favorable outcome and lower odds of mortality at 90 days.ConclusionsOur results suggest that bridging therapy in patients with acute ischemic stroke due to anterior tandem occlusion is safe and may improve functional outcome, even in the setting of acute cervical internal carotid artery stenting during EVT.

Published
2021
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3. Effect of Operator's Experience on Proficiency in Mechanical Thrombectomy: A Multicenter Study

Author

François Zhu, Wagih Ben Hassen, Nicolas Bricout, Basile Kerleroux, Kevin Janot, Benjamin Gory, René Anxionnat, Sébastien Richard, Adrien Marchal, Raphael Blanc, Michel Piotin, Arturo Consoli, Denis Trystram, Christine Rodriguez Regent, Jean-Philippe Desilles, David Weisenburger-Lile, Simon Escalard, Denis Herbreteau, Heloise Ifergan, Igor Lima Maldonado, Julien Labreuche, Hilde Henon, Olivier Naggara, Bertrand Lapergue, Grégoire Boulouis, Redjem Hocine, Ciccio Gabriele, Smajda Stanislas, Maier Benjamin, Mazighi Mikael, Obadia Mikael, Sabben Candice, Peres Roxanne, Corabianu Ovide, De Broucker Thomas, Smadja Didier, Alamowitch Sonia, Ille Olivier, Manchon Eric, Garcia Pierre-Yves, Taylor Guillaume, Ben Maacha Malek, Wang Adrien, Evrard Serge, Tchikviladze Maya, Ajili Nadia, Gorza Lucas, Buard Géraldine, Coskun Oguzhan, Di Maria Federico, Rodesh Georges, Zimatore Sergio, Leguen Morgan, Gratieux Julie, Pico Fernando, Rakotoharinandrasana Haja, Tassan Philippe, Poll Roxanna, Marinier Sylvie, Nighoghossian Norbert, Riva Roberto, Eker Omer, Turjman Francis, Derex Laurent, Cho Tae-Hee, Mechtouff Laura, Claire Lukaszewicz Anne, Philippeau Frédéric, Cakmak Serkan, Blanc-Lasserre Karine, Vallet Anne-Evelyne, Marnat Gaultier, Gariel Florent, Barreau Xavier, Berge Jérôme, Menegon Patrice, Sibon Igor, Liegey Sebastien, Olindo Stéphane, Renou Pauline, Sagnier Sharmila, Poli Mathilde, Debruxelles Sabrina, Pangon Nicolas, Bourcier Romain, Detraz Lili, Daumas-Duport Benjamin, Alexandre Pierre-Louis, Roy Monica, Lenoble Cédric, L’allinec Vincent, Girot Jean-Baptiste, Desal Hubert, Bracard Serge, Braun Marc, Derelle Anne-Laure, Tonnelet Romain, Liao Liang, Muszynski Patricio, Schmitt Emmanuelle, Planel Sophie, Humbertjean Lisa, Mione Gioia, Lacour Jean-Christophe, Riou-Comte Nolwenn, Audibert Gérard, Voicu Marcela, Alb Ionel, Reitter Marie, Brezeanu Madalina, Masson Agnès, Tabarna Adriana, Podar Ioana, Macian-Montoro Francisco, Saleme Suzanna, Mounayer Charbel, Rouchaud Aymeric, Costalat Vincent, Arquizan Caroline, Dargazanli Cyril, Gascou Grégory, Lefèvre Pierre-Henri, Derraz Imad, Riquelme Carlos, Gaillard Nicolas, Mourand Isabelle, Corti Lucas, Francois Eugene, Vannier Stéphane, Ferre Jean-Christophe, Raoult Helene, Ronziere Thomas, Lassale Maria, Paya Christophe, Gauvrit Jean-Yves, Tracol Clément, Langnier-Lemercier Sophie, Samson Yves, Rosso Charlotte, Leger Anne, Deltour Sandrine, Clarencon Frederic, Shotar Eimad, Spelle Laurent, Denier Christian, Chassin Olivier, Chalumeau Vanessa, Caroff Jildaz, Venditti Laura, Turc Guillaume, Seners Pierre, Domigo Valérie, Lamy Catherine, Birchenall Julia, Isabel Clothilde, Viguier Alain, Cognard Christophe, Christine Januel Anne, Olivot Jean-Marc, Raposo Nicolas, Bonneville Fabrice, François Albucher Jean, Calviere Lionel, Touze Emmanuel, Barbier Charlotte, Schneckenburger Romain, Boulanger Marion, Cogez Julien, Guettier Sophie, Timsit Serge, Gentric Jean-Christophe, Ognard Julien, Mathias Merrien Francois, Ozkul Wermester Ozlem, Massardier Evelyne, Papagiannaki Chrysanthi, Bourdain Frédéric, Patricia Bernady, Lagoarde-Segot Laurent, Cailliez Hélène, Veunac Louis, Higue David, Wolff Valérie, Pop Raoul, Beaujeux Rémi, Mihoc Dan-Sorin, Manisor Monica, Le Bras Anthony, Evain Sarah, Le Guen Arnaud, Richter Sebastian, Hubrecht Regis, Demasles Stéphanie, Barroso Bruno, Zuber Mathieu, Farhat Wassim, Alias Quentin, Lun François, Stenvenoot Delphine, Heinzlef Olivier, Godon Hardy Sylvie, Bohotin Valentin, and Grimaud Jérôme

Subjects
medicine.medical_specialty, Standard of care, Time Factors, Neuroradiologist, 030204 cardiovascular system & hematology, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Operator (computer programming), Medicine, Humans, Registries, Thrombectomy, Advanced and Specialized Nursing, Surgeons, business.industry, Cerebral infarction, Endovascular Procedures, Cerebral Infarction, medicine.disease, Mechanical thrombectomy, Stroke, Multicenter study, Ischemic stroke, Reperfusion, Physical therapy, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract

Background and Purpose: We aimed to evaluate among trained interventional neuroradiologist, whether increasing individual experience was associated with an improvement in mechanical thrombectomy (MT) procedural performance metrics. Methods: Individual MT procedural data from 5 centers of the Endovascular Treatment in Ischemic Stroke registry and 2 additional high-volume stroke centers were pooled. Operator experience was defined for each operator as a continuous variable, cumulating the number of MT procedures performed since January 2015, as MT became standard of care or, if later than this date, since the operator started performing mechanical thrombectomies in autonomy. We tested the associations between operator’s experience and procedural metrics. Results: A total of 4516 procedures were included, performed by 36 operators at 7 distinct centers, with a median of 97.5 endovascular treatment procedures per operator (interquartile range, 57–170.2) over the study period. Higher operator’s experience, analyzed as a continuous variable, was associated with a significantly shorter procedural duration (β estimate, −3.98 [95% CI, −5.1 to −2.8]; P P =0.013). Conclusions: In trained interventional neuroradiologists, increasing experience in MT is associated with significantly shorter procedural duration and better reperfusion rates, with a theoretical ceiling effect observed after around 100 procedures. These results may inform future training and practice guidelines to set minimal experience standards before autonomization, and to set-up operators’ recertification processes tailored to individual case volume and prior experience.

Published
2021

4. Prognosis and risk factors associated with asymptomatic intracranial hemorrhage after endovascular treatment of large vessel occlusion stroke: a prospective multicenter cohort study

Author

Constant Dit Beaufils, Pacôme, Labreuche, Julien, Richard, Śebastien, Fahed, Robert, Desal, Hubert Armand, Piotin, Michel P., Blanc, Raphaël, Redjem, Hocine, Escalard, Simon, Desilles, Jean Philippe, Ciccio, Gabriele, Smajda, Stanislas, Maier, Benjamin, Mazighi, Mikael, Obadia, Mikael, Sabben, Candice, Peres, Roxanne, Corabianu, Ovide, De Broucker, Thomas, Smadja, Didier, Alamowitch, Sonia, Ille, Olivier, Manchon, Eric, Garcia, Pierre Yves, Taylor, Guillaume, Ben Maacha, Malek, Wang, Adrien, Evrard, Serge, Tchikviladze, Maya, Ajili, Nadia, Lapergue, Bertrand, Weisenburger, David, Gorza, Lucas, Buard, Géraldine, Coskun, Oguzhan, Consoli, Arturo, Di Maria, Federico, Rodesh, Georges, Zimatore, Sergio, Leguen, Morgan, Gratieux, Julie D., Pico, Fernando, Rakotoharinandrasana, Haja, Tassan, Philippe, Poll, Roxanna, Marinier, Sylvie, Nighoghossian, Norbert, Riva, Roberto, Eker, Omer faruk, Turjman, Francis, Derex, Laurent, Cho, Tae-Hee, Mechtouff, Laura, Lukaszewicz, Anne Claire, Philippeau, Frédéric, Cakmak, Serkan, Blanc-Lasserre, Karine, Vallet, Anne Evelyne, Marnat, Gaultier, Gariel, Florent, Barreau, Xavier, Berge, Jerome, Veunac, Louis, Menegon, Patrice, Sibon, Igor, Lucas, Ludovic, Olindo, Stéphane, Renou, Pauline, Sagnier, Sharmila, Poli, Mathilde, Debruxelles, Sabrina, Tourdias, Thomas, Liegey, Jean Sebastien, Bourcier, Romain, Detraz, Lili, Daumas-Duport, Benjamin, Alexandre, Pierre Louis, Roy, Monica, Lenoble, Cédric, L’Allinec, Vincent, Girot, Jean Baptiste, Desal, Hubert, Guillon, Benoît, De Gaalon, Solène, Preterre, Cécile, Gory, Benjamin, Bracard, Serge R., Anxionnat, René, Braun, Marc, Derelle, Anne Laure, Tonnelet, Romain, Liao, Liang, Zhu, François, Schmitt, Emmanuelle, Planel, Sophie, Richard, Sébastien, Humbertjean, Lisa, Mione, Gioia, Lacour, Jean Christophe, Bonnerot, Mathieu, Riou-Comte, Nolwenn, Macian-Montoro, Francisco, Saleme, Suzanna, Mounayer, Charbel, Rouchaud, Aymeric M., Costalat, Vincent, Arquizan, Caroline, Dargazanli, Cyril, Gascou, Grégory, Lefèvre, Pierre Henri, Derraz, Imad, Riquelme, Carlos, Gaillard, Nicolas, Mourand, Isabelle, Corti, Lucas, Francois, Eugene, Vannier, Stéphane, Ferré, Jean-Christophe, Raoult, Hélène, Ronziere, Thomas, Lassale, Maria, Paya, Christophe, Gauvrit, Jean Yves, Tracol, Clément, Langnier-Lemercier, Sophie, Samson, Yves, Rosso, Charlotte, Leger, Anne, Deltour, Sandrine, Clarencon, Frédéric, Shotar, Eimad, Spelle, Laurent, Denier, Christian, Chalumeau, Vanessa, Caroff, Jildaz, Chassin, Olivier, Venditti, Laura, Turc, G., Naggara, Olivier N., Boulouis, Grégoire, Ben Hassen, Wagih, Seners, Pierre, Viguier, Alain, Cognard, Christophe H., Januel, Anne Christine, Olivot, Jean Marc, Raposo, Nicolas, Bonneville, Fabrice, Touze, Emmanuel, Barbier, Charlotte N., Schneckenburger, Romain, Boulanger, Marion, Cogez, Julien, Guettier, Sophie, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch], Hôpital Foch [Suresnes], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), P.C.D.B. and J.L. have nothing to disclose. R. Blanc, R. Bourcier, A.C., H.D., F.D.M., R.F., F.G., B. Gory, G.M., C.P., S.R., I.S. and F.Z. have nothing to disclose. M.M. reports personal fees from Amgen, personal fees from Boerhinger, personal fees from Acticor, and personal fees from Air Liquide, outside the submitted work. B.L. reports grants from Stryker, Penumbra and Microventino, outside the submitted work. S.D.G. reports personal fees and non‐financial support from Boerhinger, outside the submitted work. B. Guillon reports personal fees from Boerhinger‐Ingelheim France and Bristol‐Myers‐Squibb, outside the submitted work., Centre hospitalier universitaire de Nantes (CHU Nantes), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Service de neuroradiologie [Suresnes], Service de neurologie [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), CHU Bordeaux [Bordeaux], Service de neurologie [CHRU Nancy], Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), and The Ottawa Hospital

Subjects
Male, endovascular treatment, medicine.medical_specialty, Asymptomatic, Brain Ischemia, Cohort Studies, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Modified Rankin Scale, Internal medicine, Humans, Medicine, asymptomatic, Registries, 030212 general & internal medicine, Stroke, Thrombectomy, Intracerebral hemorrhage, business.industry, Endovascular Procedures, Odds ratio, medicine.disease, intracerebral hemorrhage, stroke, Confidence interval, 3. Good health, Treatment Outcome, Neurology, Cardiology, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Neurology (clinical), prognosis, medicine.symptom, business, Intracranial Hemorrhages, 030217 neurology & neurosurgery, Cohort study
Abstract

International audience; 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.

Published
2021
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