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Treatment-Related Factors Associated with Hemorrhagic Transformation and Hemorrhagic Subtypes after Mechanical
Marie K Luff1, Nicole Khezri1, Salvador Miralbés1
1From the Department of Neurology and Comprehensive Stroke Center (M.K.L., N. K., D.S.L.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Neuroradiology (S.M.), Hospital Son Espases, Mallorca, Spain; Interventional Neurology (B.N.), McLaren Regional Medical Center, Flint, Michigan, USA; Interventional Neurology (B.N.), McLaren Regional Medical Center, Macomb, Michigan, USA; Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston, SC, USA; Radiology and Neuroradiology (C.L.), Klinikum Vest Recklinghausen, Recklinghausen, Germany; Interventional Neuroradiology/ Endovascular Neurosurgery (M.M.-G.), Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Interventional Neuroradiology (R.A.M.), Rhode Island Hospital, Providence, Rhode Island, USA; Vascular and Interventional Radiology (L.D.), Ghent University Hospital, Ghent, Belgium; Radiology (P.V.), Hospital Universitario Central de Asturias-HUCA, Oviedo, Spain; Neuroscience Department (O.O.Z.), Bon Secours Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA; Stryker Neurovascular (L.L.P.), Fremont, California, USA; Wellstar Medical Group (R.G.), Neurosurgery, WellStar Health System, Marietta, Georgia, USA and Neuroradiology (M.A.M.), Uniklinik Heidelberg, Heidelberg, Germany.
Background And Purpose:
Clinical studies rarely examine associations between acute ischemic stroke (AIS) treatment factors and the development of radiographic intracranial hemorrhage (ICH) that is independent of symptomatic change. Additionally, few studies perform detailed analysis of subtypes of ICH after mechanical thrombectomy (MT). The objective of this study was to examine the associations between participants and treatment-related interventions, radiographic ICH, and hemorrhagic subtypes in a large cohort of patients treated with MT for AIS.
Materials And Methods:
A participant cohort across 71 global sites (n=1453) was analyzed using a multivariable imputed regression models to examine participant and treatment-related variables associated with ICH and with hemorrhagic subtypes.
Results:
581/1453 (40.0%) participants developed ICH at the 24-hour timepoint after MT. HI-1, HI-2, and SAH subtypes were most common. In a multivariable model, M2 occlusions (when compared with ICA occlusions) and achieving final pass eTICI of 2c or greater were protective against any ICH (OR = 0.68, CI [0.48, 0.96], p=0.03; OR = 0.79, CI [0.64, 0.97], p=0.02). M2 occlusions were significantly associated with SAH when compared to ICA occlusions (OR = 1.93, CI [1.11, 3.36], p=0.02).
Conclusions:
The treatment-related variables of treating a M2 occlusion and obtaining a final pass eTICI of 2c or greater were protective against ICH after adjusting for patient variables. More investigation is needed in determining the relationship between M2-segment occlusions and SAH.
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