Risk factors for intracranial hemorrhage after mechanical thrombectomy: a systematic review and meta-analysis

Area of Science:

• Neurology
• Interventional Neurology
• Stroke Medicine

Background:

• Intracerebral hemorrhage (ICH) is a critical complication following mechanical thrombectomy (MT).
• Understanding ICH risk factors is crucial for patient management and improving outcomes.
• This meta-analysis synthesizes current evidence on predictors of ICH post-MT.

Purpose of the Study:

• To systematically identify and evaluate independent predictors of various types of ICH after MT.
• To provide a comprehensive overview of risk factors associated with symptomatic ICH (sICH), parenchymal hematoma (PH), hemorrhagic infarction (HI), and any ICH.

Main Methods:

• Systematic literature search of Pubmed and Embase databases (inception to November 2018).
• Inclusion of 42 studies comprising 10,001 patients.
• Meta-analysis to identify independent predictors for different ICH classifications.

Main Results:

• Overall rates: sICH 8%, PH 13%, HI 25%, any ICH 35%.
• Predictors of sICH: female sex, longer treatment interval, tirofiban use, lower ASPECTS score.
• Predictors of any ICH: diabetes mellitus, deep white matter changes on DWI, intravenous rt-PA administration.

Conclusions:

• Multiple predictors for ICH following MT have been identified.
• Further large-scale cohort studies are recommended to validate these findings due to current evidence limitations.
• These identified predictors can inform risk stratification and clinical decision-making in MT procedures.