TY - JOUR
T1 - Type of intracranial hemorrhage after endovascular stroke treatment
T2 - association with functional outcome
AU - van der Steen, Wouter
AU - van der Ende, Nadinda A M
AU - Luijten, Sven P R
AU - Rinkel, Leon A
AU - van Kranendonk, Katinka R
AU - van Voorst, Henk
AU - Roosendaal, Stefan D
AU - Beenen, Ludo F M
AU - Coutinho, Jonathan M
AU - Emmer, Bart J
AU - van Oostenbrugge, Robert J
AU - Majoie, Charles B L M
AU - Lingsma, Hester F
AU - van der Lugt, Aad
AU - Dippel, Diederik W J
AU - Roozenbeek, Bob
AU - MR CLEAN-NO IV Investigators
AU - MR CLEAN-MED investigators
AU - CONTRAST Investigators
N1 - © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
PY - 2023/10
Y1 - 2023/10
N2 - BACKGROUND: Intracranial hemorrhage (ICH) is a frequent complication after endovascular stroke treatment.OBJECTIVE: To assess the association of the occurrence and type of ICH after endovascular treatment (EVT) with functional outcome.METHODS: We analyzed data from the MR CLEAN-NO IV and MR CLEAN-MED trials. Both trials included adult patients with ischemic stroke with a large vessel occlusion in the anterior circulation, who were eligible for EVT. ICH was classified (1) as asymptomatic or symptomatic (concomitant neurological deterioration of ≥4 points on the NIHSS, or ≥2 points on 1 NIHSS item), and (2) according to the Heidelberg Bleeding Classification. We used multivariable ordinal logistic regression analyses to assess the association of the occurrence and type of ICH with the modified Rankin Scale score at 90 days.RESULTS: Of 1017 included patients, 331 (33%) had an asymptomatic ICH, and 90 (9%) had a symptomatic ICH. Compared with no ICH, both asymptomatic (adjusted common OR (acOR)=0.76; 95% CI 0.58 to 0.98) and symptomatic (acOR=0.07; 95% CI 0.04 to 0.14) ICH were associated with worse functional outcome. In particular, isolated parenchymal hematoma type 2 (acOR=0.37; 95% CI 0.14 to 0.95), combined parenchymal hematoma with hemorrhage outside infarcted brain tissue (acOR=0.17; 95% CI 0.10 to 0.30), and combined hemorrhages outside infarcted brain tissue (acOR=0.14; 95% CI 0.03 to 0.74) were associated with worse functional outcome than no ICH.Strength of the association of ICH with functional outcome depends on the type of ICH. Although the association is stronger for symptomatic ICH, asymptomatic ICH after EVT is also associated with worse functional outcome.
AB - BACKGROUND: Intracranial hemorrhage (ICH) is a frequent complication after endovascular stroke treatment.OBJECTIVE: To assess the association of the occurrence and type of ICH after endovascular treatment (EVT) with functional outcome.METHODS: We analyzed data from the MR CLEAN-NO IV and MR CLEAN-MED trials. Both trials included adult patients with ischemic stroke with a large vessel occlusion in the anterior circulation, who were eligible for EVT. ICH was classified (1) as asymptomatic or symptomatic (concomitant neurological deterioration of ≥4 points on the NIHSS, or ≥2 points on 1 NIHSS item), and (2) according to the Heidelberg Bleeding Classification. We used multivariable ordinal logistic regression analyses to assess the association of the occurrence and type of ICH with the modified Rankin Scale score at 90 days.RESULTS: Of 1017 included patients, 331 (33%) had an asymptomatic ICH, and 90 (9%) had a symptomatic ICH. Compared with no ICH, both asymptomatic (adjusted common OR (acOR)=0.76; 95% CI 0.58 to 0.98) and symptomatic (acOR=0.07; 95% CI 0.04 to 0.14) ICH were associated with worse functional outcome. In particular, isolated parenchymal hematoma type 2 (acOR=0.37; 95% CI 0.14 to 0.95), combined parenchymal hematoma with hemorrhage outside infarcted brain tissue (acOR=0.17; 95% CI 0.10 to 0.30), and combined hemorrhages outside infarcted brain tissue (acOR=0.14; 95% CI 0.03 to 0.74) were associated with worse functional outcome than no ICH.Strength of the association of ICH with functional outcome depends on the type of ICH. Although the association is stronger for symptomatic ICH, asymptomatic ICH after EVT is also associated with worse functional outcome.
U2 - 10.1136/jnis-2022-019474
DO - 10.1136/jnis-2022-019474
M3 - Article
C2 - 36261280
SN - 1759-8478
VL - 15
SP - 971
EP - 976
JO - Journal of Neurointerventional Surgery
JF - Journal of Neurointerventional Surgery
IS - 10
ER -