Incidence and Prognostic Impact of Intracranial Hemorrhage after Endovascular Treatment for Acute Large Vessel Occlusion

Cerebrovasc Dis. 2020;49(5):540-549. doi: 10.1159/000510970. Epub 2020 Oct 20.

Abstract

Introduction: Endovascular treatment (EVT) is effective against acute cerebral large vessel occlusion (LVO). However, it has been associated with a high incidence of intracranial hemorrhage (ICH). Because the incidence of ICH and prognostic impact of ICH were not scrutinized in general patients, we investigated the impact of ICH after EVT on functional outcome at 90 days in patients with acute LVO.

Methods: RESCUE-Japan Registry 2 was a multicenter registry that enrolled 2,420 consecutive patients with acute LVO within 24 h of onset. We analyzed 1,281 patients who received EVT and compared the functional outcomes between those with and without ICH (ICH and no-ICH groups, respectively) within 24 h after EVT. We explored the factors associated with ICH and prognostic impact of symptomatic ICH (SICH) among patients with ICH. We estimated the adjusted odds ratios (ORs) for good functional outcome as modified Rankin Scale scores 0-2 and mortality. We also explored the prognostic impact of symptomatic ICH (SICH) among patients with ICH.

Results: ICH occurred in 333 patients (26.0%). Several factors such as perioperative edaravone, stent retriever, and baseline glucose were associated with development of ICH within 24 h. A good outcome was observed in 80 (24.0%) and 454 (47.9%) patients in the ICH and no-ICH groups, respectively, and the adjusted OR was 0.3 (95% confidence interval [CI] = 0.2-0.5, p < 0.0001). Incidence of mortality within 90 days was not significantly different between the groups (adjusted OR 1.2; 95% CI: 0.7-1.9, p = 0.5). SICH was observed in 36 (10.8%) of 333 patients with ICH, and the good outcomes were 8.3 and 25.9% in patients with SICH and asymptomatic ICH (AICH), respectively (p = 0.02). Mortality at 90 days was 30.6 and 7.1% in patients with SICH and AICH, respectively (p < 0.0001).

Conclusions: The functional outcomes at 90 days were significantly worse in patients who developed ICH after receiving EVT for acute LVO, but the mortality was generally similar.

Keywords: Endovascular treatment; Intracranial hemorrhage; Ischemic stroke; Large vessel occlusion; Modified Rankin Scale.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Ischemia / diagnosis
  • Brain Ischemia / mortality
  • Brain Ischemia / therapy*
  • Endovascular Procedures / adverse effects*
  • Endovascular Procedures / mortality
  • Female
  • Humans
  • Incidence
  • Intracranial Hemorrhages / diagnostic imaging
  • Intracranial Hemorrhages / epidemiology*
  • Intracranial Hemorrhages / mortality
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Prospective Studies
  • Recovery of Function
  • Registries
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / mortality
  • Stroke / therapy*
  • Time Factors
  • Treatment Outcome