Abstract WP34: The Relationship Between Reperfusion and Intracranial Hemorrhage After Thrombectomy

Abstract

Introduction: Symptomatic intracerebral hemorrhage (sICH) is a devastating complication after endovascular thrombectomy (EVT). Prior reports have demonstrated that TICI ≥2b reperfusion is protective against sICH. We aimed to further examine the relationship between reperfusion grade and sICH, to elucidate whether a difference between TICI 2b and 3 exists, and to determine whether this relationship holds true for patients undergoing delayed thrombectomy (6-24 hours). Methods: We performed a single-center retrospective review of prospectively-recorded data for patients undergoing EVT for large vessel occlusion (LVO) between January 2015 and February 2018. Multivariable logistic regression analyses were performed to identify predictors of PH and sICH (NINDS, SITS-MOST, ECASS III criteria) and to identify the role of reperfusion grade. This analysis was repeated for delayed thrombectomy patients. Results: Five-hundred-and-twenty-eight patients were included. Mean age was 71.5 and 43% were male. Median NIHSS and TLSW to treatment were 17 and 4.8 hours, respectively. Successful recanalization was achieved in 94%. On multivariable analyses, ASPECTS was a predictor of PH [p=0.002, OR-0.7 (0.57-0.87)] for patients achieving any reperfusion grade. For patients achieving successful reperfusion, lower ASPECTS was a predictor of PH [p=0.005, OR-0.72 (0.58-0.89)]) and of sICH (ECASS III) [p=0.04, OR-0.67 (0.45-0.98)]; in addition, TICI 2b as compared to TICI 3 was a predictor of PH [p=0.04, OR-2.1 (1-4.4)] and of sICH (NINDS) [p=0.05, OR-7.5 (1-57)]. TLSW to treatment was not an independent predictor of PH or sICH. Conclusion: Higher baseline ASPECTS and higher degree of reperfusion following EVT is associated with reduced likelihood of PH and sICH.