Predictors and impact of hemorrhagic transformations after endovascular thrombectomy in patients with acute large vessel occlusions

Abstract

BackgroundPredictors and impact of hemorrhagic transformation (HT) after thrombectomy remain to be elucidated.ObjectiveTo investigate the independent predictors and impact of each hemorrhagic infarction (HI) and parenchymal hematoma (PH) after thrombectomy in patients with acute stroke due to intracranial large vessel occlusion (LVO).Materials and methodsWe retrospectively reviewed data from 400 patients with acute LVO who underwent thrombectomy. Logistic regression analyses were performed to determine independent predictors of HI and PH on post-treatment CT scans. Associations between HT and poor outcome (modified Rankin Scalescore ≥3) at 90 days were analyzed.ResultsHT was observed in 98 patients (62 HIs (15.5%) and 36 PHs (9%)). Independent predictors of HI were male sex, atrial fibrillation, and time from symptom onset to groin puncture. Hyperlipidemia (OR=0.221, 95% CI 0.064 to 0.767, P=0.017) and successful reperfusion (OR=0.246, 95% CI 0.093 to 0.651, P=0.005) were independently associated with a lower chance of PH, while hypertension (OR=2.260, 95% CI 1.014 to 5.035, P=0.046) and longer procedure duration (OR=1.046, 95% CI 1.016 to 1.077, P=0.003) were independently associated with a higher chance of PH. Only PH (OR=10.154, 95% CI 3.260 to 31.632, P<0.001) was an independent predictor of poor outcome.ConclusionsPH is independently associated with poor outcome, whereas HI does not predict outcome after thrombectomy in patients with acute LVO. Our findings suggest that rapid and successful reperfusion is essential to prevent PH in patients undergoing thrombectomy for acute LVO. In addition, our study suggests that hyperlipidemia is associated with a lower risk of PH in such patients.

Predicting parenchymal hematoma associated with endovascular thrombectomy for acute occlusion of anterior circulation large vessel: the GuEss-MALiGn scale

“…PH2, whose size was defined as more than 30% of the infarcted area, occurred in 5.2% of enrolled patients in our study. The occurrence rate of PH2 was less than that of PH in the two previous studies [6,7]. The two previous studies did not report the occurrence rates of PH2.…”

“…Another single-center study also presented a 9.0% prevalence of posttreatment PH after EVT for an ACLVO. In that study, hyperlipidemia and successful reperfusion reduced the occurrence of PH, while hypertension and longer procedure duration increased the occurrence of PH [7].…”

“…Hyperlipidemia is a beneficial factor for the prevention of posttreatment PH [7,17]. A low level of serum cholesterol can enhance the necrosis of smooth muscle cells in the medial layer of the artery.…”

“…The rate of PH associated with EVT was 8.5% among the enrolled patients [6]. Lee et al [7] also recruited patients with EVT for ACLVO in a single-center study, and the rate for PH was 9.0% in their collection. In our study, PH occurred in 18.0% of enrolled patients.…”

“…quently by MRI. Nogueira et al [6] evaluated the PH associated with EVT with CT as well as MRI, and Lee et al [7] used only CT. Meanwhile, we defined the occurrence of PH using MRI in all enrolled cases.…”