Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial.

Autor:	Chen M; Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA., Joshi KC; Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA., Kolb B; Rush University Medical Center, Chicago, Illinois, USA., Sitton CW; Diagnostic & Interventional Imaging, UT Houston, Houston, Texas, USA., Pujara DK; Neurology, University of Texas McGovern Medical School, Houston, Texas, USA., Abraham MG; Neurology and Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA., Ortega-Gutierrez S; Neuroloy, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Kasner SE; Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Hussain SM; Cleveland Clinic Stroke Program, Cleveland Clinic, Cleveland Heights, Ohio, USA., Churilov L; University of Melbourne, Parkville, Victoria, Australia., Blackburn S; Neurosurgery, University of Texas Medical School at Houston Vivian L Smith Department of Neurosurgery, Houston, Texas, USA., Sundararajan S; University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA., Hu YC; Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA., Herial N; Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA., Arenillas JF; Stroke Unit, Neurology Department, Stroke Unit. Neurology Department. Universitary Hospital, Valladolid (Spain), Valladolid, Spain., Tsai JP; Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA., Budzik RF; Riverside Methodist Hospital, Columbus, Ohio, USA., Hicks W; OhioHealth Neurological Physicians, Riverside Methodist Hospital, Columbus, Ohio, USA., Kozak O; Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.; Abington Memorial Hospital, Abington, Pennsylvania, USA., Yan B; The Royal Melbourne Hospital, Parkville, Victoria, Australia., Cordato D; Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia.; Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia., Manning NW; Institute of Neurosciences, UNSW Prince of Wales Clinical School, Sydney, New South Wales, Australia.; Advanced Endovascular Therapy, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia., Parsons M; Liverpool Hospital, Liverpool, New South Wales, Australia., Hanel RA; Baptist Health, Jacksonville, Florida, USA., Aghaebrahim A; Neurological Institute, Lyerley Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA., Wu T; Neurology, Christchurch Hospital, Christchurch, Canterbury, New Zealand., Cardona Portela P; Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain., Gandhi CD; Neurosurgery, Westchester Medical Center, Valhalla, New York, USA., Al-Mufti F; Neurology and Neurosurgery, Westchester Medical Center, Valhalla, New York, USA., Perez de la Ossa N; Stroke Unit, Department of Neurology, Hospital Germans Trias i Pujol, Barcelona, Spain., Schaafsma J; Medicine - Div. Neurology, Toronto Western Hospital, Toronto, Ontario, Canada., Blasco J; Neurointerventional Department C.D.I, Hospital Clinic de Barcelona, Barcelona, Spain., Sangha N; Kaiser Permanente Southern California, Los Angeles, California, USA., Warach S; University of Texas at Austin Dell Seton Medical Center, Austin, Texas, USA., Kleinig TJ; Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Johns H; University of Melbourne, Parkville, Victoria, Australia., Shaker F; Neurology, University of Texas McGovern Medical School, Houston, Texas, USA., Abdulrazzak MA; Cleveland Clinic, Cleveland, Ohio, USA., Ray A; Neurological Surgery, University Hospitals, Cleveland, Ohio, USA., Sunshine J; Radiology, University Hospitals-Case Medical Center, Cleveland, Ohio, USA., Opaskar A; University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA., Duncan KR; University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA., Xiong W; University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA., Al-Shaibi FK; University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA., Samaniego EA; Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Nguyen TN; Neurology, Boston University School of Medicine, Boston, Massachusetts, USA., Fifi JT; Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Tjoumakaris SI; Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA., Jabbour P; Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Mendes Pereira V; Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada., Lansberg MG; Department of Neurology, Stanford Stroke Center, Stanford University, Stanford, California, USA., Sila C; Neurological Institute, University Hospitals- Case Medical Center, Cleveland, Ohio, USA.; Neurology, Case Western Reserve University School of Medicine., Bambakidis NC; Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA., Davis S; The Royal Melbourne Hospital, Parkville, Victoria, Australia., Wechsler L; University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA., Albers GW; Neurology & Neurological Sciences, Stanford University, Stanford, California, USA., Grotta JC; Neurology, Memorial Hermann Hospital/UT Houston, Houston, Texas, USA., Ribo M; Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Spain.; Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain., Hassan AE; Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA., Campbell B; The Royal Melbourne Hospital, Parkville, Victoria, Australia., Hill MD; Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada., Sarraj A; Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA Amrou.sarraj@uhhospitals.org.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2024 Mar 12. Date of Electronic Publication: 2024 Mar 12.
DOI:	10.1136/jnis-2023-021219
Abstrakt:	Background: The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized. Methods: SELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was examined. Results: Of 351 included patients, 194 (55%) and 189 (54%) demonstrated intracranial and intracerebral hemorrhage, respectively, with a higher incidence in EVT (134 (75%) and 130 (73%)) versus medical management (MM) (60 (35%) and 59 (34%), both P<0.001). Hemorrhagic infarction type 1 (HBC=1a) and type 2 (HBC=1b) accounted for 93% of all hemorrhages. Parenchymal hematoma (PH) type 1 (HBC=1c) and type 2 (HBC=2) were observed in 1 (0.6%) EVT-treated and 4 (2.2%) MM patients. Symptomatic ICH (sICH) (SITS-MOST definition) was seen in 0.6% EVT patients and 1.2% MM patients. No trend for ICH with core volumes (P=0.10) or Alberta Stroke Program Early CT Score (ASPECTS) (P=0.74) was observed. Among EVT patients, the presence of any ICH did not worsen clinical outcome (modified Rankin Scale (mRS) at 90 days: 4 (3-6) vs 4 (3-6); adjusted generalized OR 1.00, 95% CI 0.68 to 1.47, P>0.99) or modify EVT treatment effect (P interaction =0.77). Conclusions: ICH was present in 75% of the EVT population, but PH or sICH were infrequent. The presence of any ICH did not worsen functional outcomes or modify EVT treatment effect at 90-day follow-up. The high rate of hemorrhages overall still represents an opportunity for adjunctive therapies in EVT patients with a large ischemic core. Competing Interests: Competing interests: MC has received consulting fees from Medtronic and Microvention. AH has received grants from RESCUE - ICAD – Medtronic. He has also reported consulting fees from Medtronic, Microvention, Stryker, and Cerenovus. SO-G has received grants from Stryker Neurovascular and Microvention. He has also received modest consulting fees from Medtronic, Stryker Neurovascular, and Microvention. JB is a member of the speakers’ bureau for Stryker Neurovascular and Microvention, and holds leadership roles in Inspire S and A registries (Medtronics). TNN is a DSMB member for the SELECT2 trial and has received grants from Medtronic. SD is a DSMB member for the SELECT2 trial and on the advisory board for Medtronic. JF and LW are DSMB members for the SELECT2 trial. GA reports compensation from iSchemaView for consultant services; and stock holdings in iSchemaView. AS has received grant support from Stryker Neurovascular for the SELECT2 trial. He is also a member of the speaker’s bureau and advisory board for Stryker Neurovascular. The other authors have no competing interest relevant to this study. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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