Endovascular Thrombectomy, Platelet Count, and Intracranial Hemorrhage

Intracranial hemorrhage can be a devastating complication of endovascular thrombectomy (ET) after acute ischemic stroke increasing disability and mortality. Patients with low platelet count were excluded from major ET trials. This study explores the association between platelet count and intracranial hemorrhage after ET.

A retrospective review of patients undergoing ET for anterior circulation large vessel occlusions at a single comprehensive stroke center between January 2015 and February 2018 was performed. Demographic and clinical information including National Institutes of Health Stroke Scale score, intravenous tissue plasminogen activator administration, ASPECTS, platelet count, international normalized ratio, time from symptom onset to recanalization, and modified thrombolysis in cerebral infarction score were analyzed. Radiological imaging and clinical course in the hospital was evaluated to identify parenchymal hemorrhage and symptomatic intracranial hemorrhage (sICH). Univariable and multivariable analyses were conducted.

A total of 555 patients underwent ET and 43% were male. The mean age and National Institutes of Health Stroke Scale score were 71 ± 14 years and 17 ± 6, respectively. Parenchymal hemorrhage-2 and sICH (European-Australian Cooperative Acute Stroke Study-III criteria) were noted in 9.7% and 5.8% patients, respectively. Rates of sICH in patients with platelet count <100,000 (n = 15), 100,000 to <150,000 (n = 59), and ≥150,000 (n = 481) were 6.7% (n = 1), 10.1% (n = 6), and 5.2% (n = 25), respectively (P = 0.25), and rates of modified Rankin Scale 0-2 at 90 days were 26.7%, 23.7%, and 36.4%, respectively (P = 0.12). Low ASPECTS was a significant predictor of sICH per European-Australian Cooperative Acute Stroke Study-III definition (P value = 0.046). Platelet count was not a predictor (P = 0.386) of sICH.

Risk of sICH after ET is low and comparable in patients with low and normal platelet counts. Low platelets should not exclude patients from undergoing intra-arterial therapy.