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Predictors and Impact of Sulcal SAH after Mechanical Thrombectomy in Patients with Isolated M2 Occlusion
Background And Purpose:
Data on SAH after M2 mechanical thrombectomy are limited. We aimed to determine the prevalence of sulcal SAH after mechanical thrombectomy for M2 occlusion, its associated predictors, and the resulting clinical outcome.
Materials And Methods:
The study retrospectively reviewed the data of patients with acute ischemic stroke who underwent mechanical thrombectomy for isolated M2 occlusion. The patients were divided into 2 groups according to the presence of sulcal SAH after M2 mechanical thrombectomy. Angiographic and clinical outcomes were compared. Multivariable analysis was performed to identify independent predictors of sulcal SAH and unfavorable outcome (90-day mRS, 3-6).
Results:
Of the 209 enrolled patients, sulcal SAH was observed in 33 (15.8%) patients. The sulcal SAH group showed a higher rate of distal M2 occlusion (69.7% versus 22.7%), a higher of rate of superior division occlusion (63.6% versus 43.8%), and a higher M2 angulation (median, 128° versus 106°) than the non-sulcal SAH group. Of the 33 sulcal SAH cases, 23 (66.7%) were covert without visible intraprocedural contrast extravasation. Distal M2 occlusion (OR, 12.04; 95% CI, 4.56-35.67; P < .001), superior division (OR, 3.83; 95% CI, 1.43-11.26; P = .010), M2 angulation (OR, 1.02; 95% CI, 1.01-1.04; P < .001), and the number of passes (OR, 1.58; 95% CI, 1.22-2.09; P < .001) were independent predictors of sulcal SAH. However, covert sulcal SAH was not associated with an unfavorable outcome (P = .830).
Conclusions:
After mechanical thrombectomy for M2 occlusion, sulcal SAH was not uncommon and occurred more frequently with distal M2 occlusion, superior division, acute M2 angulation, and multiple thrombectomy passes (≥3). The impact of covert sulcal SAH was mostly benign and was not associated with an unfavorable outcome.
Insights
Sulcal subarachnoid hemorrhage (SAH) occurred in 15.8% of patients after M2 mechanical thrombectomy, particularly with distal occlusions. Covert SAH did not worsen clinical outcomes.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Limited data exists on subarachnoid hemorrhage (SAH) following mechanical thrombectomy for M2 occlusions.
- Understanding SAH prevalence, predictors, and outcomes after M2 intervention is crucial.
Purpose of the Study:
- To determine the prevalence of sulcal SAH after M2 mechanical thrombectomy.
- To identify predictors associated with sulcal SAH.
- To evaluate the clinical outcome of patients with sulcal SAH.
Main Methods:
- Retrospective review of acute ischemic stroke patients undergoing M2 mechanical thrombectomy.
- Division into groups based on presence or absence of sulcal SAH.
- Multivariable analysis to identify predictors of SAH and unfavorable outcomes (90-day modified Rankin Scale 3-6).
Main Results:
- Sulcal SAH was observed in 15.8% of 209 patients.
- Predictors included distal M2 occlusion, superior division occlusion, increased M2 angulation, and multiple thrombectomy passes.
- Covert SAH (without visible extravasation) was common (66.7%) and not linked to unfavorable outcomes.
Conclusions:
- Sulcal SAH is a notable complication of M2 mechanical thrombectomy, associated with specific anatomical and procedural factors.
- The presence of covert sulcal SAH does not appear to negatively impact clinical outcomes.
