Abstract WP45: Subarachnoid Hemorrhage After Mechanical Thrombectomy With a Direct Aspiration First Pass Technique

Abstract

Introduction: The incidence and clinical significance of subarachnoid hemorrhage post mechanical thrombectomy (MT) has been evaluated after stent retriever use in limited studies. The goal of this study is to report the incidence, identify predictors of SAH, and explore the effect of SAH on outcome after MT with ADAPT technique. Method: We interrogated our prospectively collected ADAPT database to identify patients who developed SAH post MT. All patients were treated using ADAPT technique. Collected variables included demographics, comorbidities, admission NIHSS, procedural variables and outcome variables. Post procedural CT scans were reviewed by independent Neuroneuro-surgeon to identify SAH. Successful recanalization was defined as mTICI≥ 2b. Outcome measures included 90 days modified Rankin scale (mRS) and mortality. Logistic regression was used to identify the predictors of SAH and explore the effect of SAH on outcome. Results: A total of 510 patients were included in the study. Thirty-three patients (6.4%) had evidence of SAH on the post thrombectomy CT scan. There were more patients with HTN in the SAH group (90.9% vs 73.2%; p=0.024). Adjunctive stent retriever was used more in SAH group (57.6% vs 29.6%; p=0.001). More patients in SAH group required two or more attempts to achieve recanalization (93.9% vs 62.8%; p<0.001). Successful recanalization was achieved in higher proportion of patients in the non-SAH group (93.5% vs 81.8% p=0.012). On multivariate analysis, only HTN (OR 0.29: 95% CI 0.086-0.983) and higher number of aspiration attempts (OR 6.124: 95% CI 1.32-28.25) were associated with SAH .With respect to functional outcome, patients with SAH had worse outcome (mRS 3-6) comparing to non SAH (75.8% vs 55.6%; p= 0.023). However, SAH did not predict poor functional outcome on multivariate analysis. Conclusion: SAH after mechanical thrombectomy is not uncommon. HTN and higher number of attempts were associated with SAH when ADAPT technique was used. The presence of SAH does not appear to predict worse outcome.