Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial

Michael Chen; Krishna C Joshi; Bradley Kolb; Clark W Sitton; Deep Kiritbhai Pujara; Michael G Abraham; Santiago Ortega-Gutierrez; Scott E Kasner; Shazam M Hussain; Leonid Churilov; Spiros Blackburn; Sophia Sundararajan; Yin C Hu; Nabeel Herial; Juan F Arenillas; Jenny P Tsai; Ronald F Budzik; William Hicks; Osman Kozak; Bernard Yan; Dennis Cordato; Nathan W Manning; Mark Parsons; Ricardo A Hanel; Amin Aghaebrahim; Teddy Wu; Pere Cardona Portela; Chirag D Gandhi; Fawaz Al-Mufti; Natalia Perez de la Ossa; Joanna Schaafsma; Jordi Blasco; Navdeep Sangha; Steven Warach; Timothy J Kleinig; Hannah Johns; Faris Shaker; Mohammad A Abdulrazzak; Abhishek Ray; Jeffery Sunshine; Amanda Opaskar; Kelsey R Duncan; Wei Xiong; Faisal K Al-Shaibi; Edgar A Samaniego; Thanh N Nguyen; Johanna T Fifi; Stavropoula I Tjoumakaris; Pascal Jabbour; Vitor Mendes Pereira; Maarten G Lansberg; Cathy Sila; Nicholas C Bambakidis; Stephen Davis; Lawrence Wechsler; Gregory W Albers; James C Grotta; Marc Ribo; Ameer E Hassan; Bruce Campbell; Michael D Hill; Amrou Sarraj

doi:10.1136/jnis-2023-021219

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Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial

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Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial

Michael Chen, Krishna C Joshi, Bradley Kolb, Clark W Sitton, Deep Kiritbhai Pujara, Michael G Abraham, Santiago Ortega-Gutierrez, Scott E Kasner, Shazam M Hussain, Leonid Churilov, …

Journal of neurointerventional surgery, Vol.17(2), pp.120-127

02/2025

DOI: 10.1136/jnis-2023-021219

PMID: 38471760

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Abstract

Background The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized.MethodsSELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was examined. Results Of 351 included patients, 194 (55%) and 189 (54%) demonstrated intracranial and intracerebral hemorrhage, respectively, with a higher incidence in EVT (134 (75%) and 130 (73%)) versus medical management (MM) (60 (35%) and 59 (34%), both P<0.001). Hemorrhagic infarction type 1 (HBC=1a) and type 2 (HBC=1b) accounted for 93% of all hemorrhages. Parenchymal hematoma (PH) type 1 (HBC=1c) and type 2 (HBC=2) were observed in 1 (0.6%) EVT-treated and 4 (2.2%) MM patients. Symptomatic ICH (sICH) (SITS-MOST definition) was seen in 0.6% EVT patients and 1.2% MM patients. No trend for ICH with core volumes (P=0.10) or Alberta Stroke Program Early CT Score (ASPECTS) (P=0.74) was observed. Among EVT patients, the presence of any ICH did not worsen clinical outcome (modified Rankin Scale (mRS) at 90 days: 4 (3–6) vs 4 (3–6); adjusted generalized OR 1.00, 95% CI 0.68 to 1.47, P>0.99) or modify EVT treatment effect (Pinteraction=0.77).Conclusions ICH was present in 75% of the EVT population, but PH or sICH were infrequent. The presence of any ICH did not worsen functional outcomes or modify EVT treatment effect at 90-day follow-up. The high rate of hemorrhages overall still represents an opportunity for adjunctive therapies in EVT patients with a large ischemic core.

Stroke

Complication

Hemorrhage

Thrombectomy

Thrombolysis

Vascular neurology

Details

Title: Subtitle: Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial
Creators: Michael Chen - Rush University Medical Center
Krishna C Joshi - Rush University Medical Center
Bradley Kolb - Rush University Medical Center
Clark W Sitton - Society of Interventional Radiology
Deep Kiritbhai Pujara - The University of Texas Health Science Center at Houston
Michael G Abraham - University of Kansas Medical Center
Santiago Ortega-Gutierrez - Neuroloy, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Scott E Kasner - Hospital of the University of Pennsylvania
Shazam M Hussain - Cleveland Clinic
Leonid Churilov - The University of Melbourne
Spiros Blackburn - The University of Texas Health Science Center at Houston
Sophia Sundararajan - University Hospitals of Cleveland
Yin C Hu - University Hospitals Cleveland Medical Center
Nabeel Herial - Thomas Jefferson University Hospital
Juan F Arenillas - Hospital Clínico Universitario de Valladolid
Jenny P Tsai - Cleveland Clinic
Ronald F Budzik - Riverside Methodist Hospital
William Hicks - Riverside Methodist Hospital
Osman Kozak - Abington Memorial Hospital
Bernard Yan - The Royal Melbourne Hospital
Dennis Cordato - Liverpool Hospital
Nathan W Manning - UNSW Sydney
Mark Parsons - Liverpool Hospital
Ricardo A Hanel - New England Baptist Hospital
Amin Aghaebrahim - Baptist Medical Center Jacksonville
Teddy Wu - Christchurch Hospital
Pere Cardona Portela - Bellvitge University Hospital
Chirag D Gandhi - Westchester Medical Center
Fawaz Al-Mufti - Westchester Medical Center
Natalia Perez de la Ossa - Trias (Greece)
Joanna Schaafsma - Toronto Western Hospital
Jordi Blasco - Hospital Clínic de Barcelona
Navdeep Sangha - Kaiser Permanente
Steven Warach - Seton Medical Center
Timothy J Kleinig - Royal Adelaide Hospital
Hannah Johns - The University of Melbourne
Faris Shaker - The University of Texas Health Science Center at Houston
Mohammad A Abdulrazzak - Cleveland Clinic
Abhishek Ray - University Hospitals of Cleveland
Jeffery Sunshine - University Hospitals Cleveland Medical Center
Amanda Opaskar - University Hospitals of Cleveland
Kelsey R Duncan - University Hospitals of Cleveland
Wei Xiong - University Hospitals of Cleveland
Faisal K Al-Shaibi - University Hospitals of Cleveland
Edgar A Samaniego - University of Iowa Hospitals and Clinics
Thanh N Nguyen - Boston University
Johanna T Fifi - Icahn School of Medicine at Mount Sinai
Stavropoula I Tjoumakaris - Jefferson University Hospitals
Pascal Jabbour - Thomas Jefferson University
Vitor Mendes Pereira - Toronto Western Hospital
Maarten G Lansberg - Stanford Medicine
Cathy Sila - Case Western Reserve University
Nicholas C Bambakidis - University Hospitals Cleveland Medical Center
Stephen Davis - The Royal Melbourne Hospital
Lawrence Wechsler - UPMC Health System
Gregory W Albers - Stanford University
James C Grotta - Memorial Hermann
Marc Ribo - Vall d'Hebron Hospital Universitari
Ameer E Hassan - The University of Texas Rio Grande Valley
Bruce Campbell - The Royal Melbourne Hospital
Michael D Hill - Center for Neurosciences
Amrou Sarraj - University Hospitals of Cleveland
Resource Type: Journal article
Publication Details: Journal of neurointerventional surgery, Vol.17(2), pp.120-127
DOI: 10.1136/jnis-2023-021219
PMID: 38471760
NLM abbreviation: J Neurointerv Surg
ISSN: 1759-8478
eISSN: 1759-8486
Publisher: BMJ Publishing Group Ltd
Grant note: NA / Stryker (http://dx.doi.org/10.13039/100008894)
Language: English
Electronic publication date: 03/12/2024
Date published: 02/2025
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984572559802771

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