Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR).

Abstract

BACKGROUND:

Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy.

METHODS:

This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade.

RESULTS:

The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference.

CONCLUSIONS:

This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.

• Authors: Natasha Ironside, Ching-Jen Chen, Reda M Chalhoub, Peter Wludyka, Ryan T Kellogg, Sami Al Kasab, Dale Ding, Ilko Maier, Ansaar Rai, Pascal Jabbour, Joon-Tae Kim, Stacey Q Wolfe, Robert M Starke, Marios-Nikos Psychogios, Amir Shaban, Adam S Arthur, Shinichi Yoshimura, Jonathan A Grossberg, Ali Alawieh, Isabel Fragata, Adam J Polifka, Justin R Mascitelli, Joshua W Osbun, Charles Matouk, Michael R Levitt, Travis M Dumont, Hugo H Cuellar-Saenz, Richard Williamson, Daniele G Romano, Roberto Javier Crosa, Benjamin Gory, Maxim Mokin, Mark Moss, Kaustubh Limaye, Peter Kan, Alejandro M Spiotta, Min S Park, STAR collaborators
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 15 Issue e2 Pg. e312-e322 (Nov 2023) ISSN: 1759-8486 [Electronic] England
• PMID: 36725360 (Publication Type: Journal Article)
• Copyright: © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Humans
• Ischemic Stroke (etiology)
• Brain Ischemia (diagnostic imaging, surgery, complications)
• Treatment Outcome
• Stroke (diagnosis)
• Intracranial Hemorrhages (etiology)
• Thrombectomy (adverse effects, methods)
• Risk Factors
• Retrospective Studies
• Aneurysm (complications)
• Registries