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Predictors of subarachnoid hemorrhage in acute ischemic stroke with endovascular therapy.
- Source :
-
Stroke [Stroke] 2010 Dec; Vol. 41 (12), pp. 2775-81. Date of Electronic Publication: 2010 Nov 04. - Publication Year :
- 2010
-
Abstract
- Background and Purpose: Subarachnoid hemorrhage (SAH) is a potential hemorrhagic complication after endovascular intracranial recanalization. The purpose of this study was to describe the frequency and predictors of SAH in acute ischemic stroke patients treated endovascularly and its impact on clinical outcome.<br />Methods: Acute ischemic stroke patients treated with primary mechanical thrombectomy, intra-arterial thrombolysis, or both were analyzed. Postprocedural computed tomography and magnetic resonance images were reviewed to identify the presence of SAH. We assessed any decline in the National Institutes of Health Stroke Scale score 3 hours after intervention and in the outcomes at discharge.<br />Results: One hundred twenty-eight patients were treated by primary thrombectomy with MERCI Retriever devices, whereas 31 were treated by primary intra-arterial thrombolysis. Twenty patients experienced SAH, 8 with pure SAH and 12 with coexisting parenchymal hemorrhages. SAH was numerically more frequent with primary thrombectomy than in the intra-arterial thrombolysis groups (14.1% vs 6.5%, P = 0.37). On multivariate analysis, independent predictors of SAH were hypertension (odds ratio = 5.39, P = 0.035), distal middle cerebral artery occlusion (odds ratio = 3.53, P = 0.027), use of rescue angioplasty after thrombectomy (odds ratio = 12.49, P = 0.004), and procedure-related vessel perforation (odds ratio = 30.72, P < 0.001). Patients with extensive SAH or coexisting parenchymal hematomas tended to have more neurologic deterioration at 3 hours (28.6% vs 0%, P = 0.11), to be less independent at discharge (modified Rankin Scale ≤ 2; 0% vs 15.4%, P = 0.5), and to experience higher mortality during hospitalization (42.9% vs 15.4%, P = 0.29).<br />Conclusions: Procedure-related vessel perforation, rescue angioplasty after thrombectomy with MERCI devices, distal middle cerebral artery occlusion, and hypertension were independent predictors of SAH after endovascular therapy for acute ischemic stroke. Only extensive SAH or SAH accompanied by severe parenchymal hematomas may worsen clinical outcome at discharge.
- Subjects :
- Adult
Aged
Aged, 80 and over
Analysis of Variance
Angioplasty
Cerebral Angiography
Cerebral Revascularization adverse effects
Ethnicity
Female
Humans
Hypertension complications
Hypertension epidemiology
Image Interpretation, Computer-Assisted
Infarction, Middle Cerebral Artery complications
Infarction, Middle Cerebral Artery epidemiology
Magnetic Resonance Imaging
Male
Middle Aged
Risk Factors
Stents
Stroke epidemiology
Stroke surgery
Subarachnoid Hemorrhage epidemiology
Subarachnoid Hemorrhage surgery
Tomography, X-Ray Computed
Treatment Outcome
Stroke complications
Subarachnoid Hemorrhage etiology
Thrombectomy adverse effects
Thrombolytic Therapy adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4628
- Volume :
- 41
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Stroke
- Publication Type :
- Academic Journal
- Accession number :
- 21051673
- Full Text :
- https://doi.org/10.1161/STROKEAHA.110.587063