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Impact of Intracranial Hemorrhage After Endovascular Treatment for Medium Vessel Occlusion

Satoru Fujiwara1, Kazutaka Uchida2, Tsuyoshi Ohta3

  • 1Department of Neurology, Kobe City Medical Center General Hospital, Kobe , Japan.

Neurosurgery
|March 14, 2025
PubMed
Abstract

Insights

Intracranial hemorrhage (ICH) after endovascular treatment (EVT) for medium vessel occlusion (MeVO) is linked to poorer functional outcomes. Minimizing ICH during EVT for MeVO is essential for improving patient results.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Stroke Medicine

Background:

  • Endovascular treatment (EVT) is used for acute ischemic stroke due to medium vessel occlusion (MeVO).
  • Hemorrhagic complications, specifically intracranial hemorrhage (ICH), are a concern following EVT for MeVO.
  • The clinical impact of ICH on functional outcomes after EVT for MeVO requires elucidation.

Purpose of the Study:

  • To investigate the association between intracranial hemorrhage (ICH) after EVT for MeVO and functional outcomes.
  • To compare functional outcomes based on the presence and severity of ICH post-EVT for MeVO.

Main Methods:

  • A post hoc analysis of the Japan Registry of NeuroEndovascular Therapy 4 (JRNT4) was performed.
  • Included 2465 patients with MeVO who underwent EVT for acute ischemic stroke between 2015 and 2019.
  • Patients were categorized by ICH occurrence (none, asymptomatic, symptomatic) and functional outcomes (mRS, mortality) were assessed.

Main Results:

  • 12.6% of analyzed patients developed ICH, with 31.5% of those being symptomatic.
  • Both asymptomatic and symptomatic ICH were associated with a lower likelihood of favorable functional outcomes (mRS 0-2 at 30 days).
  • Adjusted odds ratios indicated significantly worse outcomes with symptomatic ICH (aOR 0.12) and a trend towards worse outcomes with asymptomatic ICH (aOR 0.77).

Conclusions:

  • Intracranial hemorrhage following EVT for MeVO is associated with worse functional outcomes, regardless of symptom presentation.
  • Developing optimal devices and techniques to minimize ICH during EVT for MeVO is critical.
  • Further research into reducing hemorrhagic complications is warranted to improve stroke treatment efficacy.

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