Correlation between ECASS Defined Intracranial Bleed and 90 Days Outcome after Endovascular Treatment for Acute Stroke (P05.264)

Abstract

Objective: To evaluate correlation between ECASS defined hemorrhage and clinical outcome in acute ischemic stroke after endovascular therapy. Background Post thrombolytic hemorrhagic transformation (HT) of acute ischemic strokes can be characterized radiologically by European Cooperative Acute Stroke Study (ECASS) criteria and clinically by NINDS criteria. Despite a previous analysis of ECASS I and II demonstrating early neurologic deterioration and increased 90 day mortality associated with parenchymal hemorrhage, the correlation between ECASS radiologic classification and 90 day clinical outcome in patients undergoing endovascular therapy remains unclear. Design/Methods: Retrospective review of 34 acute stroke patients enrolled in clinical trials at our institute. Data was collected prospectively for all patients. CT head was performed 18-36 hours post procedure. intracranial bleeding was graded as follows based on ECASS definition: Grade: 0=no hemorrhage, 1=H1(petechial hemorrhage), 2=H2 (petechial hemorrhage), 3=PH1(parenchymal hemorrhage), 4=PH2(parenchymal hemorrhage), 5=symptomatic ICH (sICH). MRS>2 was defined as poor outcome, while mRS≤2 was defined as good outcome. Multivariate analysis was performed using the following variables: initial NIHSS, discharge and 3 month MRS, ECASS hemorrhage score. Results: 24/34 (71%) received IV thrombolysis, and all patients underwent endovascular treatment with either mechanical thrombectomy and/or intra-arterial thrombolysis. 21 (62%) were female. Mean patient age was 63. No hemorrhage occurred in 16 (47%) of patients, while HT was detected in 18 (53%): 11 (32%) with HI1, 0 (0%) with HI2, 5 (15%) with PH1, 2 (6%) with PH2 and 0 (0%) with sICH. All 34 patients had baseline mRS≤2. At 3 months, 21/34 patients (62%) had mRS>2, while 13 (38%) had mRS≤2. Multivariate analysis did not reveal ECASS defines hemorrhage as an independent predictor of outcome. Conclusions: In our cohort of patients post endovascular therapy, ECASS hemorrhage score did not correlate with functional outcome at 3 months after controlling for severity of stroke. Disclosure: Dr. Sweis has nothing to disclose. Dr. Malaiyandi has nothing to disclose. Dr. Issa has nothing to disclose. Dr. Jani has nothing to disclose. Dr. Taqi has nothing to disclose. Dr. Zaidat has received personal compensation for activities with Boston Scientific Corporation and Micrus Inc.