Clinical Significance of Asymptomatic Intracranial Hemorrhage Following Thrombectomy for Large-Vessel Occlusion:...

The prognostic significance of asymptomatic intracranial hemorrhage (aICH) after endovascular thrombectomy (EVT) for acute ischemic stroke remains uncertain. We investigated the association between aICH and clinical outcomes using data from a large prospective registry.

We analyzed patients with anterior circulation large-vessel occlusion from the ANGEL-ACT registry (November 2017 to March 2019) who underwent EVT. Patients were categorized into aICH, symptomatic ICH (sICH), and no ICH groups. The primary endpoint was 90-day modified Rankin Scale (mRS) score 0-2, and the safety outcome was death within 90 days. Multivariable logistic regression was performed to identify independent predictors of aICH.

Among 1252 eligible patients, 221 (17.7%) developed aICH, 117 (9.3%) had sICH, and 914 had no ICH. Compared with patients without ICH, those with aICH had a lower rate of 90-day mRS 0-2 (13.6% vs 53.6%; OR 2.62, 95% CI 1.47 to 4.65; p = 0.001). No statistically significant difference was observed between the aICH and sICH groups despite a numerically lower rate of functional independence in the sICH group (13.6% vs 34.0%; OR 0.47, 95% CI 0.18 to 1.25; p = 0.131). Compared with patients with aICH, 90-day mortality was significantly higher in the sICH group (37.9% vs. 14.0%; OR 4.93, 95% CI 1.86 to 13.04; p = 0.001), but not significantly different in the no ICH group (9.0% vs. 14.0%; OR 0.77, 95% CI 0.37 to 1.64; p = 0.502). Valvular heart disease, more thrombectomy passes, higher admission blood glucose, and vascular perforation were independent predictors of aICH.

aICH after EVT was associated with worse functional outcomes than no ICH, while mortality was lower than in sICH.