Determinants of Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: A Retrospective Cohort Study.

Wouter Van Der Steen ,Kilian M Treurniet ,Martin Sterrenberg ,Karin Bodde ,Annet Geerling ,Bart J Emmer ,Anouk Van Der Hoorn ,Emilie M M Santos ,Wouter J Schonewille ,Ewoud J Van Dijk ,Julie Staals ,Naziha El Ghannouti ,Imke Hooijenga ,Vicky Chalos ,Lonneke S.f Yo ,Hanneke Droste ,Marc P Van Proosdij ,Erna Bos ,Stefan D Roosendaal ,Stefanie Schipperen ,René Van Den Berg ,G Menno Krietemeijer ,Nicoline Aaldering ,Jeannette Hofmeijer ,Roel J.j Heijboer ,Thomas Liebig ,Marjolein Vossers ,Bas F.w Van Der Kallen ,René J Dallinga ,Silvan Licher ,Saliha Ergezen ,Kirsten Janssen ,Roger R.m Harmsma ,Robert‐ Jan B Goldhoorn ,Haryadi Prasetya ,Nadine Fleitour ,J F Huguet ,Jo P Peluso ,Jose De Bont- Stikkelbroeck ,Diederik W.j Dippel ,Wim H Van Zwam ,Paut Greebe ,Ludo F M Beenen ,Anton Meijer ,Hester F Lingsma ,Heitor Alves ,Adriaan Ros ,Anouk De Jong ,Joost De Vries ,Annick J Weterings ,Jan Albert Vos ,Paul L.m De Kort ,Esther Van Der Heijden ,P J A M Brouwers ,Elyas Ghariq ,Ans De Ridder ,Bob Roozenbeek ,Sebastiaan F De Bruijn ,Geert J Lycklama ,Adrien E Groot ,Omid Eschgi ,Eleonora L.f Kirkels ,Marianne A.a Van Walderveen ,Puck Fransen ,Pieter‐Jan Van Doormaal ,Maureen Wollaert ,Hester Bongenaar ,Jordi Borst ,Jelis Boiten ,Nadinda A.m Van Der Ende ,Raymie-Jayce Ganpat ,Saman Vinke ,Charles B L M Majoie ,Gina Van Vemde ,Sandra Kleijn ,Marit Lucas ,Hieronymus D Boogaarts ,Marieke J.h Wermer ,Geert J Lycklama À Nijeholt ,Marieke E.s Sprengers ,Koos Keizer ,Rob H Lo ,Albert J Yoo ,D Jeurrissen ,Tamara Vermeulen ,Tiny Simons ,Olvert A Berkhemer ,Wouter Dinkelaar ,Daan Muijres ,Marjan Elfrink ,Eva J.h.f Voogd ,Sabine L Collette ,Ivo G H Jansen ,Katinka R Van Kranendonk ,Boudewijn A.a.m Van Hasselt ,H Bart Van Der Worp ,Kars C.j Compagne ,Gert Messchendorp ,Joost Bot ,Jonathan M Coutinho ,Merel Boers ,Praneeta Konduri ,Natalie E Lecouffe ,Jan S.p Van Den Berg ,Nikki Boodt ,Lukas C Van Dijk ,Karin Kanselaar ,Leo A.m Aerden ,Corina Puppels ,Robert J Van Oostenbrugge ,Lieve M Schupp ,Ralph R Geuskens ,Maarten Uyttenboogaart ,Eva Ponjee ,Tiemen Van Boxtel ,P.a Auke ,Berber Zweedijk ,Bas Hammer ,Wilma Pellikaan ,Esmée Venema ,Sjoert Pegge ,Sanne J Den Hartog ,Joke De Meris ,Michelle Simons ,Alis Heshmatollah ,Yvo B.w.e.m Roos ,Rita Sprengers ,Reinoud P H Bokkers ,Marieke A Mens ,Maxim J.h.l Mulder ,Josje Brouwer ,Sjoerd F.m Jenniskens ,Jasper M Martens ,Annemieke Lindl-Velema ,Denn Barning ,Anna M M Boers ,Nerea Arrarte Terreros ,Michelle Sandiman ,Tomas Bulut ,Martin M Brown ,Ido R Van Den Wijngaard ,Sharon Romviel ,Nawid Saiedie ,Annet Geerlings ,Adriaan C.g.m Van Es ,Stefan Vinken ,Tobien H.c.m.l Schreuder ,Heleen M Den Hertog ,Lucas A Ramos ,Manon Kappelhof ,H Zwenneke Flach ,Tim Van Straaten ,Paul F C Groot ,Jeroen Koets ,Alida A Postma ,Manon L Tolhuisen ,Nynke Nicolaij ,Julia Van Tuijl ,Jasmijn Lodico ,Yvonne Drabbe ,Jocova Vervoort ,Sabrina Verheesen ,Mc Haaglanden ,Ilse Slokkers ,Aad Van Der Lugt ,Roeland Sales Barros

doi:10.1161/strokeaha.121.036195

Abstract

Background:Symptomatic intracranial hemorrhage (sICH) is a serious complication after endovascular treatment for ischemic stroke. We aimed to identify determinants of its occurrence and location.Methods:We retrospectively analyzed data from the Dutch MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) and MR CLEAN registry. We included adult patients with a large vessel occlusion in the anterior circulation who underwent endovascular treatment within 6.5 hours of stroke onset. We used univariable and multivariable logistic regression analyses to identify determinants of overall sICH occurrence, sICH within infarcted brain tissue, and sICH outside infarcted brain tissue.Results:SICH occurred in 203 (6%) of 3313 included patients and was located within infarcted brain tissue in 50 (25%), outside infarcted brain tissue in 23 (11%), and both within and outside infarcted brain tissue in 116 (57%) patients. In 14 patients (7%), data on location were missing. Prior antiplatelet use, baseline systolic blood pressure, baseline plasma glucose levels, post-endovascular treatment modified treatment in cerebral ischemia score, and duration of procedure were associated with all outcome parameters. In addition, determinants of sICH within infarcted brain tissue included history of myocardial infarction (adjusted odds ratio, 1.65 [95% CI, 1.06–2.56]) and poor collateral score (adjusted odds ratio, 1.42 [95% CI, 1.02–1.95]), whereas determinants of sICH outside infarcted brain tissue included level of occlusion on computed tomography angiography (internal carotid artery or internal carotid artery terminus compared with M1: adjusted odds ratio, 1.79 [95% CI, 1.16–2.78]).Conclusions:Several factors, some potentially modifiable, are associated with sICH occurrence. Further studies should investigate whether modification of baseline systolic blood pressure or plasma glucose level could reduce the risk of sICH. In addition, determinants differ per location of sICH, supporting the hypothesis of varying underlying mechanisms.Registration:URL: https://www.isrctn.com/; Unique identifier: ISRCTN10888758.

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