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

被引：14

作者：

Ironside, Natasha ^{[1
]}

Chen, Ching-Jen ^{[2
]}

Chalhoub, Reda M. ^{[3
]}

Kellogg, Ryan T. ^{[1
]}

Ding, Dale ^{[4
]}

Maier, Ilko ^{[5
]}

Al Kasab, Sami ^{[6
]}

Jabbour, Pascal ^{[7
]}

Kim, Joon-tae ^{[8
]}

Wolfe, Stacey Q. ^{[9
]}

Rai, Ansaar ^{[10
]}

Starke, Robert M. ^{[11
]}

Psychogios, Marios-Nikos ^{[12
]}

Shaban, Amir ^{[13
]}

Arthur, Adam S. ^{[14
]}

Yoshimura, Shinichi ^{[15
]}

Grossberg, Jonathan A. ^{[16
]}

Alawieh, Ali ^{[17
]}

Fragata, Isabel ^{[18
]}

Polifka, Adam J. ^{[19
]}

Mascitelli, Justin R. ^{[20
]}

Osbun, Joshua W. ^{[21
]}

Matouk, Charles ^{[22
]}

Levitt, Michael R. ^{[23
]}

Dumont, Travis M. ^{[24
]}

Cuellar-Saenz, Hugo H. ^{[25
]}

Williamson, Richard ^{[26
]}

Romano, Daniele G. ^{[27
]}

Crosa, Roberto Javier ^{[28
]}

Gory, Benjamin ^{[29
]}

Mokin, Maxim ^{[30
]}

Moss, Mark ^{[31
]}

Limaye, Kaustubh ^{[32
]}

Kan, Peter ^{[33
]}

Spiotta, Alejandro M. ^{[3
]}

Park, Min S. ^{[1
]}

STAR Collaborators

机构：

[1] Univ Virginia, Neurosurg, Charlottesville, VA 22903 USA

[2] Univ Texas McGovern Med Sch, Neurosurg, Houston, TX USA

[3] Med Univ South Carolina, Neurosurg, Charleston, SC USA

[4] Univ Louisville, Neurosurg, Louisville, KY USA

[5] Univ Med Goettingen, Neurol, Gottingen, NS, Germany

[6] Med Univ South Carolina, Neurol, Charleston, SC USA

[7] Thomas Jefferson Univ, Neurol Surg, Philadelphia, PA USA

[8] Chonnam Natl Univ Hosp, Gwangju, Gwangju, South Korea

[9] Wake Forest Sch Med, Neurosurg, Winston Salem, NC USA

[10] West Virginia Univ Hosp, Radiol, Morgantown, WV USA

[11] Univ Miami, Neurol Surg, Miller Sch Med, Miami, FL USA

[12] Univ Hosp Basel, Dept Neuroradiol, Clin Radiol & Nucl Med, Basel, Switzerland

[13] Univ Iowa, Roy J & Lucille A Carver Coll Med, Neurol, Iowa City, IA USA

[14] Semmes Murphey Neurol & Spine Inst, Memphis, TN USA

[15] Hyogo Coll Med, Dept Neurosurg, Nishinomiya, Hyogo, Japan

[16] Emory Univ, Neurosurg & Radiol, Sch Med, Atlanta, GA USA

[17] Emory Univ, Neurosurg, Atlanta, GA USA

[18] Ctr Hosp Lisboa Cent, Neuroradiol, Lisbon, Portugal

[19] Univ Florida, Dept Neurosurg, Gainesville, FL USA

[20] Univ Texas Hlth Sci Ctr San Antonio, Dept Neurosurg, San Antonio, TX USA

[21] Washington Univ St Louis, Neurosurg, Sch Med, St Louis, MO USA

[22] Yale Univ, Neurosurg, New Haven, CT USA

[23] Univ Washington, Neurol Surg, Sch Med, Seattle, WA USA

[24] Univ Arizona, Arizona Hlth Sci Ctr, Dept Surg, Div Neurosurg, Tucson, AZ USA

[25] LSUHSC, Neurosurgery, Shreveport, LA USA

[26] Allegheny Hlth Network, Neurol, Pittsburgh, PA USA

[27] Univ Hosp San Giovanni di Dio & Ruggi dAragona, Neurordiol, Salerno, Italy

[28] Med Uruguaya, Endovasc Neurosurg, Montevideo, Montevideo, Uruguay

[29] CHRU Nancy, Dept Diagnost & Intervent Neuroradiol, Nancy, Lorraine, France

[30] Univ S Florida, Neurosurg, Coll Med, Tampa, FL USA

[31] Washington Reg Med Ctr, Fayetteville, AR USA

[32] Indiana Univ, Bloomington, IN USA

[33] Univ Texas Med Branch Galveston, Neurosurg, Galveston, TX USA

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2023年 / 15卷 / E2期

关键词：

Thrombolysis; Thrombectomy; Stroke; Hemorrhage; TISSUE-PLASMINOGEN-ACTIVATOR; HEALTH-CARE PROFESSIONALS; LARGE VESSEL OCCLUSION; EARLY MANAGEMENT; STENT RETRIEVER; TRANSFORMATION; GUIDELINES; REVASCULARIZATION; HYPERGLYCEMIA; ASPIRATION;

D O I：

10.1136/jnis-2022-019513

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

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

引用

页码：E312 / E322

页数：11

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