Journal article
Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)
Journal of neurointerventional surgery, Vol.15(e2), pp.e312-e322
11/2023
DOI: 10.1136/jnis-2022-019513
PMCID: PMC10962911
PMID: 36725360
Abstract
Background Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy.MethodsThis is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade.ResultsThe study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference.ConclusionsThis study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.
Details
- Title: Subtitle
- Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)
- Creators
- Natasha Ironside - University of VirginiaChing-Jen Chen - Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USAReda M Chalhoub - Medical University of South CarolinaRyan T Kellogg - University of VirginiaDale Ding - University of LouisvilleIlko Maier - Neurology, University Medicine Goettingen, Goettingen, NS, GermanySami Al Kasab - Medical University of South CarolinaPascal Jabbour - Thomas Jefferson UniversityJoon-tae Kim - Chonnam National University HospitalStacey Q Wolfe - Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USAAnsaar Rai - West Virginia University HospitalsRobert M Starke - University of MiamiMarios-Nikos Psychogios - University Hospital of BaselAmir Shaban - University of IowaAdam S Arthur - The Spine InstituteShinichi Yoshimura - Hyogo Medical UniversityJonathan A Grossberg - Emory University School of MedicineAli Alawieh - Emory UniversityIsabel Fragata - Unidade Local de Saúde de São JoséAdam J Polifka - Department of Neurosurgery, University of Florida, Gainesville, Florida, USAJustin R Mascitelli - The University of Texas Health Science Center at San AntonioJoshua W Osbun - Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USACharles Matouk - University of New HavenMichael R Levitt - University of Washington School of MedicineTravis M Dumont - Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USAHugo H Cuellar-Saenz - Neurosurgery, LSUHSC, Shreveport, Louisiana, USARichard Williamson - Allegheny Health NetworkDaniele G Romano - Neurordiology, University Hospital 'San Giovanni di Dio e Ruggi d’Aragona', Salerno, ItalyRoberto Javier Crosa - Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, UruguayBenjamin Gory - Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, FranceMaxim Mokin - Neurosurgery, University of South Florida College of Medicine, Tampa, Florida, USAMark Moss - Washington Regional Medical CenterKaustubh Limaye - Indiana University BloomingtonPeter Kan - The University of Texas Medical Branch at GalvestonAlejandro M Spiotta - Medical University of South CarolinaMin S Park - University of VirginiaMarielle ErnstStavropoula TjoumakarisM Reid GoochNabeel HerialKyle FargenDileep R YavagalEric C PetersonAlex BrehmEdgar SamaniegoNitin GoyalDaniel Alan HoitVioliza Inoa-AcostaMichael CawleyGustavo PradillaBrian HowardJoão ReisJaime PamplonaRui CarvalhoBrian HohRyan HebertLouis J KimMelanie WalkerRussell CerejoGiulia FrauenfelderFrancesco DianaFernanda Rodriguez-ErazúWaldo GuerreroMehmet AkdolSTAR collaborators
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.15(e2), pp.e312-e322
- DOI
- 10.1136/jnis-2022-019513
- PMID
- 36725360
- PMCID
- PMC10962911
- NLM abbreviation
- J Neurointerv Surg
- ISSN
- 1759-8478
- eISSN
- 1759-8486
- Publisher
- BMJ Publishing Group Ltd
- Grant note
- N/A / Medtronic (http://dx.doi.org/10.13039/100004374) N/A / Penumbra N/A / Stryker (http://dx.doi.org/10.13039/100008894)
- Language
- English
- Electronic publication date
- 02/01/2023
- Date published
- 11/2023
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984364633002771
Metrics
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