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Hemorrhagic Transformation After Thrombectomy for Tandem Occlusions
François Zhu1, Julien Labreuche2, Diogo C Haussen3
1From the Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254 (F.Z., S.B., B.G.), University Hospital of Nancy, France.
Stroke
|December 25, 2018
Summary
Hemorrhagic transformation after stroke thrombectomy for tandem large vessel occlusions is common, but parenchymal hematoma, not hemorrhagic infarction, impacts mortality. Aggressive endovascular treatment may be safe.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Tandem large vessel occlusion strokes involving the carotid artery present treatment challenges.
- Intracranial hemorrhage risk from antiplatelet therapy during thrombectomy is a concern.
Purpose of the Study:
- To evaluate hemorrhagic transformation incidence after thrombectomy in tandem large vessel occlusion strokes.
- To identify associated factors and clinical relevance of hemorrhagic transformation.
- To assess the safety of aggressive endovascular treatment for tandem occlusions.
Main Methods:
- Pooled data from the TITAN (Thrombectomy in Tandem Lesions) collaboration.
- Analysis of consecutive anterior circulation tandem large vessel occlusion strokes patients undergoing thrombectomy.
- Assessment of hemorrhagic infarction (HI) and parenchymal hematoma (PH) within 24 hours.
Main Results:
- Among 289 patients, 24.7% developed HI and 14.2% developed PH.
- Independent predictors for HI and PH included intracranial carotid occlusion, diabetes, no prior IV thrombolysis, and complete extracranial occlusion.
- Parenchymal hematoma (PH) was linked to increased mortality, while hemorrhagic infarction (HI) did not affect 90-day outcomes.
Conclusions:
- Incidence of PH in tandem occlusions is comparable to isolated occlusions.
- Predictors for PH and HI are similar, and acute carotid stenting/antiplatelet therapy were not significant predictors.
- Findings support considering aggressive endovascular treatment for tandem occlusions.
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