Predictors of acute post-thrombectomy intracranial hemorrhage expansion in anterior circulation infarcts.

Autor: Bhamidipati A; Vanderbilt University School of Medicine, Nashville, TN, USA., Mummareddy N; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.; Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USA., Ahn S; Vanderbilt University School of Medicine, Nashville, TN, USA., Bendfeldt G; Vanderbilt University School of Medicine, Nashville, TN, USA., Lyons AT; Vanderbilt University School of Medicine, Nashville, TN, USA., Gangavarapu S; Vanderbilt University School of Medicine, Nashville, TN, USA., Chen J; Vanderbilt University School of Medicine, Nashville, TN, USA., Jo J; Vanderbilt University School of Medicine, Nashville, TN, USA., Kamal N; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.; Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USA., Roth SG; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.; Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USA., Froehler MT; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.; Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USA., Chitale RV; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.; Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USA., Fusco MR; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.; Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USA.
Jazyk: angličtina
Zdroj: Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences [Interv Neuroradiol] 2024 Apr 17, pp. 15910199241247884. Date of Electronic Publication: 2024 Apr 17.
DOI: 10.1177/15910199241247884
Abstrakt: Background: Post-mechanical thrombectomy (MT) intracranial hemorrhage (ICH) is a major source of morbidity in treated acute ischemic stroke patients with large vessel occlusion. ICH expansion may further contribute to morbidity. We sought to identify factors associated with ICH expansion on imaging evaluation post-MT.
Methods: We performed a retrospective cohort study of patients undergoing MT at a single comprehensive stroke center. Per protocol, patients underwent dual-energy head CT (DEHCT) post-MT followed by a 24-h interval non-contrast enhanced MRI. ICH expansion was defined as any increase in blood volume between the two studies if identified on the DEHCT. Univariate and multivariable analyses were performed to identify risk factors for ICH expansion.
Results: ICH was identified on DEHCT in 13% of patients ( n  = 35/262), with 20% (7/35) demonstrating expansion on interval MRI. The average increase in blood volume was 11.4 ml (SD 6.9). Univariate analysis identified anticoagulant usage (57% vs 14%, p  = 0.03), petechial hemorrhage inside the infarct margins or intraparenchymal hematoma on DEHCT (ECASS-II HI2/PH1/PH2) (71% vs 14%, p  < 0.01), basal ganglia hemorrhage (71% vs 21%, p  = 0.02), and basal ganglia infarction (86% vs 32%, p  = 0.03) as factors associated with ICH expansion. Multivariate regression demonstrated that anticoagulant usage (OR 20.3, 95% C.I. 2.43-446, p  < 0.05) and ECASS II scores of HI2/PH1/PH2 (OR 11.7, 95% C.I. 1.24-264, p  < 0.05) were significantly predictive of ICH expansion.
Conclusion: Expansion of post-MT ICH on 24-h interval MRI relative to immediate post-thrombectomy DEHCT is significantly associated with baseline anticoagulant usage and petechial hemorrhage inside the infarct margins or presence of intraparenchymal hematoma (ECASS-II HI2/PH1/PH2).
Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze: MEDLINE
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