Clot Burden Score and Early Ischemia Predict Intracranial Hemorrhage following Endovascular Therapy
| Autor: | Andrew M. Demchuk, Seong Hwan Ahn, Thalia S. Field, Mohamed Najm, Sung Il Sohn, Josep Puig, Robert Mikulik, Fahad S. Al-Ajlan, Negar Asdaghi, Ana Calleja, Albert Y. Jin, J.-M. Boulanger, Talip Asil, Vignan Yogendrakumar, Michael D. Hill, Bijoy K Menon, Dar Dowlatshahi |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Ischemia Logistic regression Endovascular therapy 030218 nuclear medicine & medical imaging Brain Ischemia 03 medical and health sciences 0302 clinical medicine Residual flow Risk Factors Post-hoc analysis medicine Humans Radiology Nuclear Medicine and imaging cardiovascular diseases Thrombus 10. No inequality Aged Thrombectomy medicine.diagnostic_test Interventional business.industry Endovascular Procedures Thrombosis Middle Aged medicine.disease 3. Good health Stroke Yogendrakumar V. Al-Ajlan F. Najm M. Puig J. Calleja A. Sohn S. Ahn S. H. Mikulik R. Asdaghi N. Field T. S. et al. -Clot Burden Score and Early Ischemia Predict Intracranial Hemorrhage following Endovascular Therapy- AMERICAN JOURNAL OF NEURORADIOLOGY cilt.40 ss.655-660 2019 Angiography Female Neurology (clinical) Radiology Complication business Intracranial Hemorrhages 030217 neurology & neurosurgery |
| Zdroj: | AJNR. American journal of neuroradiology. 40(4) |
| ISSN: | 1936-959X |
| Popis: | BACKGROUND AND PURPOSE: Intracranial hemorrhage is a known complication following endovascular thrombectomy. The radiologic characteristics of a CT scan may assist with hemorrhage risk stratification. We assessed the radiologic predictors of intracranial hemorrhage following endovascular therapy using data from the INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) study. MATERIALS AND METHODS: Patients undergoing endovascular therapy underwent baseline imaging, postprocedural angiography, and 24-hour follow-up imaging. The primary outcome was any intracranial hemorrhage observed on follow-up imaging. The secondary outcome was symptomatic hemorrhage. We assessed the relationship between hemorrhage occurrence and baseline patient characteristics, clinical course, and imaging factors: baseline ASPECTS, thrombus location, residual flow grade, collateralization, and clot burden score. Multivariable logistic regression with backward selection was used to adjust for relevant covariates. RESULTS: Of the 199 enrolled patients who met the inclusion criteria, 46 (23%) had an intracranial hemorrhage at 24 hours. On multivariable analysis, postprocedural hemorrhage was associated with pretreatment ASPECTS (OR, 1.56 per point lost; 95% CI, 1.12–2.15), clot burden score (OR, 1.19 per point lost; 95% CI, 1.03–1.38), and ICA thrombus location (OR, 3.10; 95% CI, 1.07–8.91). In post hoc analysis, clot burden scores of ≤3 (sensitivity, 41%; specificity, 82%; OR, 3.12; 95% CI, 1.36–7.15) and pretreatment ASPECTS ≤ 7 (sensitivity, 48%; specificity, 82%; OR, 3.17; 95% CI, 1.35–7.45) robustly predicted hemorrhage. Residual flow grade and collateralization were not associated with hemorrhage occurrence. Symptomatic hemorrhage was observed in 4 patients. CONCLUSIONS: Radiologic factors, early ischemia on CT, and increased CTA clot burden are associated with an increased risk of intracranial hemorrhage in patients undergoing endovascular therapy. |
| Databáze: | OpenAIRE |
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