Predictors of Symptomatic Hemorrhage After Endovascular Treatment for Anterior Circulation Occlusions: Turkish Endovascular Stroke Registry

Abstract

We evaluated the predictive factors of symptomatic intracranial hemorrhage (SICH) in endovascular treatment of stroke. We included 975 ischemic stroke patients with anterior circulation occlusion. Patients that had hemorrhage and an increase of ≥4 points in their National Institutes of Health Stroke Scale (NIHSS) after the treatment were considered as SICH. The mean age of patients was 65.2±13.1 years and 469 (48.1%) were women. The median NIHSS was 16 (13–18) and Alberta Stroke Program Early CT 9 (8–10). In 420 patients (43.1%), modified Rankin Scale was favorable (0–2) and mortality was observed in 234 (24%) patients at the end of the third month. Patients with high diastolic blood pressure ( P<.05) had significantly higher SICH. SICH was significantly higher in those with high NIHSS scores ( P<.001), high blood glucose ( P<.001), and leukocyte count at admission ( P<.05). Diabetes mellitus (DM) (OR 1.90; P<.001), NIHSS (OR 1.07; P<.05), adjuvant intra-arterial thrombolytic therapy (IA-rtPA) (OR, 1.60; P<.05), and puncture-recanalization time (OR 1.01; P<.05) were independent factors of SICH. Higher baseline NIHSS score, longer procedure time, multiple thrombectomy maneuvers, administration of IA-rtPA, and the history of DM are independent predictors of SICH in anterior circulation occlusion.

Acute stroke management in Turkey: Current situation and future projection

“…15 In the recently published Turkish Endovascular Stroke Registry, where 975 patients were analyzed, the mean age was 65 years, the mean NIHSS 16, the good prognosis at 3 months (mRS ⩽ 2) was 43%, the mortality was 24%, and symptomatic bleeding was 13.6%. 16 In order to increase the use of IV tPA by neurologists in acute ischemic stroke, 19 certified courses were held in 17 provinces in 3 years between 2017 and 2019 in cooperation with the Turkish Society of Neurology and the Turkish Society of Cerebrovascular Diseases. Nearly 500 neurologists completed this training program where more than 50 trainers took a role.…”

“…15 In the recently published Turkish Endovascular Stroke Registry, where 975 patients were analyzed, the mean age was 65 years, the mean NIHSS 16, the good prognosis at 3 months (mRS ⩽ 2) was 43%, the mortality was 24%, and symptomatic bleeding was 13.6%. 16…”

Cold Case of Thrombolysis: Cold Recombinant Tissue Plasminogen Activator Confers Enhanced Neuroprotection in Experimental Stroke

“… 2 However, rtPA could not avoid the adverse effects, such as vascular edema and hemorrhagic transformation, caused by vascular recanalization. 3 …”