Timing of symptomatic intracranial hemorrhage after endovascular stroke treatment

Steen, Wouter van der; Ende, Nadinda A.M. van der; Kranendonk, Katinka R. van; Chalos, Vicky; Brouwer, Josje; Oostenbrugge, Robert J. van; Zwam, Wim H van; Doormaal, Pieter Jan van; Es, Adriaan Cgm van; Majoie, Charles B. L. M.; Lugt, Aad van der; Dippel, Diederik W.J.; Roozenbeek, Bob

doi:10.1177/23969873221112279

Cited by 9 publications

(6 citation statements)

References 29 publications

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“…A previous study found no difference in the rates of sICH between primarily utilized stent retriever devices and non-stent retriever devices and the incidence of symptomatic intracranial hemorrhage in care-dependent stroke patients was similar to care-independent patients [23]. Our data suggested that the incidence of sICH was higher compared to the previously reported data [24] (10% vs 6%) and the type PH2 occurred are more in the poor outcome group than the favorable outcome group.…”

Section: Discussioncontrasting

confidence: 48%

Clinical predictors of stroke prognosis after endovascular therapy

Wang¹,

Yuan²,

Kang³

et al. 2023

Preprint

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Background and Aims Endovascular therapy (EVT) has been shown to be effective in the treatment of large vascular occlusive stroke, but many factors are correlated with the outcome for acute ischemic stroke (AIS) patients after EVT[1]. There are so many factors such as baseline admitting NIHSS score, smoking, last known normal (LKN) time to puncture and so on impacted functional outcome of AIS[2]. This study aims to find the main factors that influence the poor prognosis of AIS patients after EVT by analyzing the clinical data of AIS patients. Methods We analyzed the clinical data of AIS patients in the First People’s Hospital of Xian Yang city in Sha’anXi province from June 2017 to August 2021 following treatment with EVT. The data included the patient blood pressure upon admission, blood glucose, National Institutes of Health Stroke Scale (NIHSS) score, and 90-day modified Rankin scale (mRs) score follow-up data, last known normal (LKN) time to puncture, LKN time to puncture was defined as the time from the patient's last normal time to the successful groin puncture (GP), calculated in minutes. A good outcome was defined as a 90-day mRs score of 0 to 3, and a poor outcome was defined as a 90-day mRs score of 4 to 6. Results A total of 144 patients were included in the study, baseline admitting NIHSS score, smoking, and LKN time to puncture, After NIHSS stratification, an NIHSS score of 6–12 was found to be relevant to the prognosis from the results of the univariate analysis. The baseline NIHSS were (odds ratio = 3.02; 95% confidence interval, 2.878–4.252; P < 0.001), LKN time to GP (odds ratio = 2.17; 95% confidence interval, 1.341–2.625; P < 0.01), and time stratification (6–12h) (odds ratio = 4.22; 95% confidence interval, 2.519–5.561; P < 0.001).The result showed higher baseline NIHSS, LKN time to puncture, and time were associated with poorer prognosis of stroke patients after EVT in a multivariate analysis. Conclusions Our study indicated that smoking, the baseline NIHSS score, and LKN time to puncture were the risk factors for a poor outcome of stroke patients following an EVT. Quitting smoking, shortening LKN time to puncture should improve the outcome of AIS after EVT.

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Section: Discussioncontrasting

confidence: 48%

Clinical predictors of stroke prognosis after endovascular therapy

Wang¹,

Yuan²,

Kang³

et al. 2023

Preprint

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“…Nonetheless, the bleeding event outcomes remained consistent. Regarding bleeding risk, both alteplase and argatroban can increase the risk, but our study did not observe a significant increase in bleeding risk [ 33 , 34 ]. This may be because physicians adequately considered the risk of bleeding during patient screening and management and used these drugs only in patients with a low bleeding risk.…”

Section: Resultsmentioning

confidence: 74%

Can the combination of antiplatelet or alteplase thrombolytic therapy with argatroban benefit patients suffering from acute stroke? a systematic review, meta-analysis, and meta-regression

Xie,

Chen,

et al. 2024

PLoS ONE

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Background The effectiveness of administering argatroban as a treatment approach following antiplatelet therapy or alteplase thrombolytic therapy in patients with acute stroke is presently uncertain. However, it is important to highlight the potential benefits of combining this medication with known thrombolytics or antiplatelet therapy. One notable advantage of argatroban is its short half-life, which helps minimize excessive anticoagulation and risk of bleeding complications in inadvertent cases of hemorrhagic stroke. By conducting a meticulous review and meta-analysis, we aim to further explore the common use of argatroban and examine the plausible advantages of combining this medication with established thrombolytic and antiplatelet therapies. Method In this study, we performed a rigorous and methodical search for both randomized controlled trials and retrospective analyses. Our main objective was to analyze the impact of argatroban on the occurrence of hemorrhagic events and the mRS scores of 0–2. We utilized a meta-analysis to assess the relative risk (RR) associated with using argatroban versus not using it. Results In this study, we analyzed data from 11 different studies, encompassing a total of 8,635 patients. Out of these patients, 3999(46.3%) received argatroban treatment while the remaining 4636(53.7%)did not. The primary outcome of 90-day functional independence (modified Rankin scale (mRS) score≤2) showed that the risk ratio (RR) for patients using argatroban after alteplase thrombolytic therapy compared to those not using argatroban was(RR, 1.00 ([95% CI, 0.92–1.09]; P = 0.97), indicating no statistical significance. However, for patients using argatroban after antiplatelet therapy, was (RR,1.09 [95% CI, 1.04–1.14]; P = 0.0001), which was statistically significant. In terms of hemorrhagic events, the RR for patients using argatroban compared to those not using argatroban was (RR,1.08 [95% CI, 0.88–1.33]; P = 0.46), indicating no statistical significance. Conclusion The results of this study suggest that further research into combination therapy with argatroban and antiplatelet agents may be warranted, however more rigorous RCTs are needed to definitively evaluate the effects of combination treatment.

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“…For example, endovascular-procedure–related factors, such as number of passes or reperfusion at the end of the procedure, are important predictors of sICH. 19,20 Moreover, generalizability of the models might be limited due to different selection criteria for treatment with IVT and/or EVT. Also, the use of antihypertensive medication or antithrombotics could influence the risk of sICH.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: External Validation of Prediction Models

Ende

Kremers

Steen

et al. 2023

Stroke

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Background: Symptomatic intracranial hemorrhage (sICH) is a severe complication of reperfusion therapy for ischemic stroke. Multiple models have been developed to predict sICH or intracranial hemorrhage (ICH) after reperfusion therapy. We provide an overview of published models and validate their ability to predict sICH in patients treated with endovascular treatment in daily clinical practice. Methods: We conducted a systematic search to identify models either developed or validated to predict sICH or ICH after reperfusion therapy (intravenous thrombolysis and/or endovascular treatment) for ischemic stroke. Models were externally validated in the MR CLEAN Registry (n=3180; Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). The primary outcome was sICH according to the Heidelberg Bleeding Classification. Model performance was evaluated with discrimination (c-statistic, ideally 1; a c-statistic below 0.7 is considered poor in discrimination) and calibration (slope, ideally 1, and intercept, ideally 0). Results: We included 39 studies describing 40 models. The most frequently used predictors were baseline National Institutes of Health Stroke Scale (NIHSS; n=35), age (n=22), and glucose level (n=22). In the MR CLEAN Registry, sICH occurred in 188/3180 (5.9%) patients. Discrimination ranged from 0.51 (SPAN-100 [Stroke Prognostication Using Age and National Institutes of Health Stroke Scale]) to 0.61 (SITS-SICH [Safe Implementation of Treatments in Stroke Symptomatic Intracerebral Hemorrhage] and STARTING-SICH [STARTING Symptomatic Intracerebral Hemorrhage]). Best calibrated models were IST-3 (intercept, −0.15 [95% CI, −0.01 to −0.31]; slope, 0.80 [95% CI, 0.50−1.09]), SITS−SICH (intercept, 0.15 [95% CI, −0.01 to 0.30]; slope, 0.62 [95% CI, 0.38−0.87]), and STARTING−SICH (intercept, −0.03 [95% CI, −0.19 to 0.12]; slope, 0.56 [95% CI, 0.35−0.76]). Conclusions: The investigated models to predict sICH or ICH discriminate poorly between patients with a low and high risk of sICH after endovascular treatment in daily clinical practice and are, therefore, not clinically useful for this patient population.

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Timing of symptomatic intracranial hemorrhage after endovascular stroke treatment

Cited by 9 publications

References 29 publications

Clinical predictors of stroke prognosis after endovascular therapy

Clinical predictors of stroke prognosis after endovascular therapy

Can the combination of antiplatelet or alteplase thrombolytic therapy with argatroban benefit patients suffering from acute stroke? a systematic review, meta-analysis, and meta-regression

Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: External Validation of Prediction Models

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