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

Autor:	Ironside N; Neurosurgery, University of Virginia, Charlottesville, Virginia, USA ironsidenatasha@gmail.com., Chen CJ; Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USA., Chalhoub RM; Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA., Wludyka P; Department of Neurosurgery, University of Florida, Gainesville, Florida, USA., Kellogg RT; Neurosurgery, University of Virginia, Charlottesville, Virginia, USA., Al Kasab S; Neurology, Medical University of South Carolina, Charleston, South Carolina, USA., Ding D; Neurosurgery, University of Louisville, Louisville, Kentucky, USA., Maier I; Neurology, University Medicine Goettingen, Goettingen, NS, Germany., Rai A; Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA., Jabbour P; Neurological surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Kim JT; Chonnam National University Hospital, Gwangju, Gwangju, Korea (the Republic of)., Wolfe SQ; Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA., Starke RM; Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA., Psychogios MN; Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland., Shaban A; Neurology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA., Arthur AS; Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA., Yoshimura S; Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan., Grossberg JA; Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA., Alawieh A; Neurosurgery, Emory University, Atlanta, Georgia, USA., Fragata I; Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal., Polifka AJ; Department of Neurosurgery, University of Florida, Gainesville, Florida, USA., Mascitelli JR; Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA., Osbun JW; Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA., Matouk C; Neurosurgery, Yale University, New Haven, Connecticut, USA., Levitt MR; Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA., Dumont TM; Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA., Cuellar-Saenz HH; Neurosurgery, LSUHSC, Shreveport, Louisiana, USA., Williamson R; Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA., Romano DG; Neurordiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy., Crosa RJ; Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay., Gory B; Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France., Mokin M; Neurosurgery, University of South Florida College of Medicine, Tampa, Florida, USA., Moss M; Washington Regional Medical Center, Fayetteville, Arkansas, USA., Limaye K; Indiana University, Bloomington, Indiana, USA., Kan P; Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA., Spiotta AM; Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA., Park MS; Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2023 Nov; Vol. 15 (e2), pp. e312-e322. Date of Electronic Publication: 2023 Feb 01.
DOI:	10.1136/jnis-2022-019513
Abstrakt:	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. Competing Interests: Competing interests: PK, JRM, MM and MRL are members of the editorial board of JNIS. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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