Predictors of Parenchymal Hematoma After Mechanical Thrombectomy
Author:
Boisseau William1, Fahed Robert1, Lapergue Bertrand2, Desilles Jean-Philippe134, Zuber Kevin1, Khoury Naim5, Garcia Jeanne2, Maïer Benjamin1, Redjem Hocine1, Ciccio Gabriele1, Smajda Stanislas1, Escalard Simon1, Taylor Guillaume6, Mazighi Mikael134, Piotin Michel134, Gory Benjamin78, Blanc Raphaël134, Decroix Jean-Pierre, Wang Adrien, Evrard Serge, Tchikviladzé Maya, Bourdain Frederic, Afanasiev Vadim, Majhadi Loubna, Consoli Arthuro, Di Maria Federico, Coskun Oguzhan, Rodesch Georges, Lopez Delphine, Redjem Hocine, Obadia Mickael, Sabben Candice, Ben Maacha Malek, Pico Fernando, Rakotoharinandrasana Haja, Tassan Philippe, Poll Roxanna, Corabianu Ovide, De Broucker Thomas, Smadja Didier, Alamowitch Sonia, Obadia Mickael, Ille Olivier, Manchon Eric, Garcia Pierre-Yves, Riva Roberto, Labeyrie Paul-Emile, Nighoghossian Norbert, Philippeau Frédéric, Cakmak Serkan, Blanc-Lasserre Karine, Vallet Anne-Evelyne,
Affiliation:
1. From the Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France (W.B., R.F., J.-P.D., K.Z., B.M., H.R., G.C., S.S., S.E., M.M., M.P., R.B.) 2. Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., J.G.) 3. Université Paris Denis Diderot, Sorbonne Paris Cite, France (J.-P.D., M.M., M.P., R.B.) 4. Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., M.M., M.P., R.B.) 5. HSHS Neuroscience Center, HSHS St John's Hospital, Springfield, IL (N.K.) 6. Department of Intensive Care, Rothschild Foundation Hospital, Paris, France (G.T.) 7. Department of Diagnostic and Therapeutic Neuroradiology, Nancy Hospital, France (B.G.) 8. University of Lorraine, INSERM U1254, IADI, Nancy, France (B.G.).
Abstract
Background and Purpose—
Parenchymal hematoma (PH) is a rare but dreadful complication of acute ischemic stroke with unclear underlying mechanisms. We aimed to study the incidence and predictors of PH after mechanical thrombectomy.
Methods—
Data from a prospective observational multicenter registry was screened to identify acute ischemic stroke patients with an anterior circulation large vessel occlusion who underwent mechanical thrombectomy. Clinical, imaging, and procedural characteristics were used for the analysis, including brain imaging systematically performed at 24 hours. PH occurrence was assessed according to ECASS (European Collaborative Acute Stroke Study) criteria. Univariate and multivariable analyses were performed to identify predictors of PH.
Results—
A total of 1316 patients were included in the study. PH occurred in 153 out of 1316 patients (11.6%) and was associated with a lower rate of favorable outcome and increased mortality. On multivariable analysis, age (per 1 year increase, odds ratio [OR], 1.01; 95% CI, 1.00–1.03;
P
=0.05), current smoking (OR, 2.02; 95% CI, 1.32–3.09;
P
<0.01), admission Alberta Stroke Program Early CT Score (per a decrease of 1 point, OR, 1.70; 95% CI, 1.18–2.44;
P
<0.01), general anesthesia (OR, 1.98; 95% CI, 1.36–2.90;
P
<0.001), angiographic poor collaterals (OR, 2.13; 95% CI, 1.36–3.33;
P
<0.001) and embolization in new territory (OR, 2.94; 95% CI, 1.70–5.10;
P
<0.001) were identified as independent predictors of PH.
Conclusions—
PH occurred at a rate of 11.6% after mechanical thrombectomy, with high morbidity and mortality. Our study identified clinical, radiological, and procedural predictors of PH occurrence that can serve as the focus of future periprocedural management studies with the aim of reducing its occurrence.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03776877.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)
Cited by
57 articles.
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