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Updated: Feb 5, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Predictors of symptomatic intracranial hemorrhage after endovascular thrombectomy in acute ischemic stroke: A
Wei Hong1, Xiaoyu Wang2, Shanshan Hu2
1Department of Neurology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, Jiangsu 225300, China.
Background:
Intracranial hemorrhage (ICH) is a serious potential complication of stroke mechanical thrombectomy (MT). We evaluated the predictors of symptomatic ICH (sICH) after MT for patients with acute ischemic stroke (AIS).
Methods:
This retrospective study analyzed 170 consecutive patients with anterior circulation large vessel occlusion (LVO) undergoing MT. Outcomes were stratified as no hemorrhagic transformation (HT), asymptomatic ICH (aICH) and sICH. RAPID-processed perfusion parameters included ischemic core volume (rCBF<30 %), hypoperfusion volume (Tmax>6 s), mismatch volume, and hypoperfusion intensity ratio (HIR). Multivariable logistic regression with backward stepwise selection identified independent sICH predictors from ten candidate variables spanning clinical, laboratory, imaging and procedural domains.
Results:
Among 170 patients, any ICH occurred in 67 (39.4 %), of whom 22 met sICH criteria. Platelet counts, balloon dilatation, ischemic core volume, Tmax> 6 s volume and HIR differed significantly across groups (all p < 0.05). Door-to-puncture time was longer for aICH group than no HT group (159.82 ± 64.05 vs. 131.99 ± 68.47; p < 0.05). Compared with the aICH group, the sICH group had lower platelet counts (141.82 ± 43.56 vs. 176.98 ± 72.36; p < 0.05), a larger ischemic core volume (77.50 ± 61.71 vs. 31.88 ± 34.87; p < 0.05) and higher HIR (0.64(0.45, 0.80) vs. 0.40(0.15, 0.57); p < 0.05). Multivariable analysis identified ischemic core volume (OR 3.62, 95 %CI 2.16-6.67, p < 0.001) and thrombocytopenia (OR 6.53, 95 %CI 2.03-25.41, p = 0.003) as independent sICH predictors. The integrated model achieved robust discrimination (AUC 0.874, accuracy 85.6 %).
Conclusions:
Ischemic core volume and thrombocytopenia independently predict sICH following MT.
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