Abstract
Background and Purpose: Intracerebral hemorrhage (ICH) after mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remains a major complication and its early prediction is of high relevance. Baseline serum glucose (BGL) is a known predictor of ICH, but its interaction with early ischemic changes remains uncertain. We hypothesized that BGL interacts with the effect of tissue water uptake on the occurrence of ICH.Methods: Three hundred and thirty-six patients with acute ischemic stroke treated with MT were retrospectively analyzed. ICH was diagnosed within 24 h on non-enhanced CT (NECT) and classified according to the Heidelberg Bleeding Classification. Early tissue water homeostasis has been assessed using quantitative lesion net water uptake (NWU) on admission CT. Multivariate logistic regression was used to identify predictors of ICH.Results: One hundred and seven patients fulfilled the inclusion criteria of which 37 (34.6%) were diagnosed with ICH. Patients with ICH had a significant higher BGL on admission (median 177 mg/dl, IQR: 127–221.75, P < 0.001). In patients with low BGL (<120 mg/dl), higher NWU was associated with 1.34-fold increased likelihood of ICH, while higher NWU was associated with a 2.08-fold increased likelihood of ICH in patients with a high BGL (>200 mg/dl). In multivariable logistic regression analysis, BGL (OR: 1.02, 95% CI: 1.00–1.04, P = 0.01) and NWU (OR: 2.32, 95% CI: 1.44–3.73, P < 0.001) were significantly and independently associated with ICH, showing a significant interaction (P = 0.04).Conclusion: A higher degree of early tissue water uptake and high admission BGL were both independent predictors of ICH. Higher BGL was significantly associated with accelerated effects of NWU on the likelihood of ICH. Although a clear causal relationship remains speculative, stricter BGL control and monitoring may be tested to reduce the risk of ICH in patients undergoing thrombectomy.
Highlights
Large randomized controlled trials provide efficacy of mechanical thrombectomy (MT) over medical treatment in patients with acute ischemic stroke (AIS) [1, 2]
Out of 336 patients, 107 consecutive patients were included according to the inclusion criteria [median age 76 years (IQR: 65.0–81.0) and 51.4% females] with 63 patients (58.9%) having received intravenous thrombolysis before MT
Thirty-seven patients (34.6%) had an intracerebral hemorrhage (ICH) within 24 h after MT according to the Heidelberg Bleeding Classification with symptomatic intracerebral hemorrhage (sICH) identified in 19 patients (17.8%)
Summary
Large randomized controlled trials provide efficacy of mechanical thrombectomy (MT) over medical treatment in patients with acute ischemic stroke (AIS) [1, 2]. Irrespective of this success, intracerebral hemorrhage (ICH) remains a common and challenging complication with a negative impact on functional outcome. The current state of literature provides no sufficient data for the mutual impact of serum glucose and early ischemic brain edema on the risk of ICH in patients with AIS [12,13,14].
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