Hemoglobin decline within 24 h post-mechanical thrombectomy as an indicator of poor clinical outcomes

Mechanical thrombectomy (MT) for acute large vessel occlusion (LVO) significantly improves patient prognosis. However, despite successful recanalization achieved through MT, some patients still have unfavorable outcomes. Although anemia in the context of ischemic stroke is recognized as a detrimental prognostic factor, its impact on patients undergoing MT remains inconclusive. Post-MT anemia is frequently a target of intervention, but its prevention is of greater importance. We investigated the extent of hemoglobin (Hb) reduction after MT for acute LVO, its impact on prognosis, and potential preventive strategies.

The study included 102 patients who underwent MT between January 2016 and December 2022. Hb levels were monitored from admission until day 10 post-MT. We collected data on age, sex, weight, cause of ischemic stroke, location of vessel occlusion, and details regarding MT. The administration of recombinant tissue plasminogen activator, pre-stroke antithrombotic therapy, National Institutes of Health Stroke Scale (NIHSS) score, and presence of chronic kidney disease or chronic heart failure were also recorded. The modified Rankin Scale (mRS) score was assessed on admission and at 3 months follow-up. Factors associated with mRS scores of 3-6 at 3 months were identified.

The highest Hb decrease was noted from admission to 24 h post-MT, with the median Hb level reaching its lowest point on day 4. Poor prognosis was associated with mRS score on admission (odds ratio [OR], 6.94; 95% confidence interval [CI], 1.28-37.60), NIHSS score (OR, 1.14; 95% CI, 1.04-1.25), modified thrombolysis in cerebral infarction 2c-3 recanalization (OR, 0.16; 95% CI, 0.03-0.73), and Hb decrease 24 h post-MT (OR, 2.17; 95% CI, 1.07-4.43). Hb decrease 24 h post-MT was significantly associated with more than two device passes (p-value, 0.037).

A decrease in Hb 24 h post-MT was associated with a negative prognosis, with a decrease in Hb being linked to more than two device passes. Efforts should be directed toward optimizing the first-pass effect in MT to enhance procedural efficacy and clinical outcomes.