Abstract T P1: Predictive Factors of Intracranial Hemorrhage in Patients With Acute Large Vessel Occlusion

Abstract

Objective: Recanalization therapy, such as intravenous tissue plasminogen activator (IVT) or endovascular treatment (EVT), is known to improve outcomes in acute ischemic stroke; however, such maneuver carries the risk of intracranial hemorrhage (ICH). The present study assessed the predictive factors of ICH in the patients with acute large vessel occlusion. Methods: The Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan registry prospectively registered 1,442 stroke patients with major vessel occlusion who were admitted to 84 Japanese stroke centers within 24 hours after onset from July 2010 to June 2011. We analyzed the incidence and predictive factor of ICH within 24 hours after onset among the 1,436 patients except 6 patients who underwent bypass surgery. Results: Any ICH was observed in 283 (19.7%) patients, and symptomatic (with neurological deterioration defined as National Institute of Health Stroke Scale score ≥4) ICH was observed in 47 (3.3%) patients. Comparing patients without ICH, we find statistical significance in the rate of favorable outcome (any ICH; 18.3% vs. 35.0%, p<0.001, symptomatic ICH; 4.3% vs. 32.6%, p<0.001). On multivariate analyses, any recanalization therapy (IVT and/or EVT)(OR, 1.94; 95% CI, 1.09-3.44)and reperfusion of the affected artery on MR angiography at 24 hours after onset (OR, 1.90; 95% CI, 1.31-2.75) significantly related to any ICH. Significant related factor of symptomatic ICH was only recanalization therapy (OR, 2.45; 95% CI; 1.30-4.16), but not EVT (OR; 1.26; 95% CI, 0.50-3.16). Moreover, warfarin-, antiplatelet-, heparin- or thrombolytic agents-use was not an independent predictor of ICH risk. Conclusions: Among the patients with acute large vessel occlusion, ICH was associated with recanalization therapy (IVT or EVT), but not the use of antithrombotic agents.