Abstract
Background: Previous research has focused on the association between hemorrhagic transformation (HT) incidence and pre-procedural variables (i.e., baseline variables) rather than the association between HT incidence and endovascular treatment (EVT) procedural variables (e.g., stent retriever passes).Objective: To assess the association, if any, that exists between the number of stent retriever passes per procedure and the incidence of HT for patients undergoing mechanical thrombectomy.Methods: An endovascular database from a comprehensive stroke center was used to collect data on EVT patients treated with Trevo, Solitaire, or Penumbra stent retrievers from the years 2012 to 2017. Statistical analyses were conducted on the stent retriever passes, demographics, morbidities, medication usage, and outcomes and their association with HT.Results: Of the 329 total patients, 46 (14%) had HT. The HT group had an average [SD] of 1.65 [0.67] and range of [1–3] passes per procedure while the non-HT group had an average [SD] of 1.63 [0.86] and range of [1–5] passes per procedure. Admission NIHSS score (p = 0.0003) and the incidence of diabetes mellitus (DM) (p = 0.05) were significantly higher in the HT group. Subdividing HT into symptomatic and asymptomatic ICH groups failed to display significant differences in the distribution of the stent retriever passes (p = 0.969). The number of passes failed to show any association with HT (p = 0.804) while admission NIHSS score was found to have an OR of 1.07 (95%CI: 1.029–1.121, p = 0.001) with HT incidence.Conclusion: No significant association was found between HT incidence and the stent retriever passes. Further multicenter studies are warranted to corroborate our results.
Highlights
Hemorrhagic transformation (HT) presents as a prolific complication to any patient undergoing reperfusion therapies such as IV thrombolysis and/or endovascular treatment (EVT)
Previous research has focused on the association between hemorrhagic transformation (HT) incidence and pre-procedural variables rather than the association between HT incidence and endovascular treatment (EVT) procedural variables
The number of passes failed to show any association with HT (p = 0.804) while admission NIHSS score was found to have an OR of 1.07 (95%CI: 1.029–1.121, p = 0.001) with HT incidence
Summary
Hemorrhagic transformation (HT) presents as a prolific complication to any patient undergoing reperfusion therapies such as IV thrombolysis and/or endovascular treatment (EVT). Previous research has identified several pre-procedural risk factors of HT for acute ischemic stroke patients including preexisting morbidities such as “atrial fibrillation (AF), diabetes mellitus (DM), and congestive heart failure (CHF)” [2,3,4], radiographic biomarkers such as “relative CBV values, relative CBF values, and collateral flow” [5], laboratory values such as “platelet count, glucose levels, and levels of total cholesterol” [2] and clinical variables such as admission NIHSS score [6]. Previous research has focused on the association between hemorrhagic transformation (HT) incidence and pre-procedural variables (i.e., baseline variables) rather than the association between HT incidence and endovascular treatment (EVT) procedural variables (e.g., stent retriever passes)
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