Article
Author: Tsai, Jenny P ; Kolb, Bradley ; Wechsler, Lawrence ; Lansberg, Maarten G ; Sitton, Clark W ; Campbell, Bruce ; Perez de la Ossa, Natalia ; Sarraj, Amrou ; Sangha, Navdeep ; Al-Mufti, Fawaz ; Cordato, Dennis ; Hu, Yin C ; Johns, Hannah ; Joshi, Krishna C ; Blackburn, Spiros ; Sundararajan, Sophia ; Aghaebrahim, Amin ; Gandhi, Chirag D ; Parsons, Mark ; Hill, Michael D ; Samaniego, Edgar A ; Grotta, James C ; Abraham, Michael G ; Chen, Michael ; Cardona Portela, Pere ; Davis, Stephen ; Bambakidis, Nicholas C ; Kleinig, Timothy J ; Arenillas, Juan F ; Xiong, Wei ; Ribo, Marc ; Pujara, Deep Kiritbhai ; Blasco, Jordi ; Sunshine, Jeffery ; Churilov, Leonid ; Hassan, Ameer E ; Ray, Abhishek ; Schaafsma, Joanna ; Ortega-Gutierrez, Santiago ; Fifi, Johanna T ; Abdulrazzak, Mohammad A ; Sila, Cathy ; Kasner, Scott E ; Al-Shaibi, Faisal K ; Hussain, Shazam M ; Budzik, Ronald F ; Hanel, Ricardo A ; Opaskar, Amanda ; Mendes Pereira, Vitor ; Albers, Gregory W ; Tjoumakaris, Stavropoula I ; Nguyen, Thanh N ; Shaker, Faris ; Wu, Teddy ; Hicks, William ; Duncan, Kelsey R ; Kozak, Osman ; Warach, Steven ; Jabbour, Pascal ; Yan, Bernard ; Manning, Nathan W ; Herial, Nabeel
BackgroundThe incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized.MethodsSELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was examined.ResultsOf 351 included patients, 194 (55%) and 189 (54%) demonstrated intracranial and intracerebral hemorrhage, respectively, with a higher incidence in EVT (134 (75%) and 130 (73%)) versus medical management (MM) (60 (35%) and 59 (34%), both P<0.001). Hemorrhagic infarction type 1 (HBC=1a) and type 2 (HBC=1b) accounted for 93% of all hemorrhages. Parenchymal hematoma (PH) type 1 (HBC=1c) and type 2 (HBC=2) were observed in 1 (0.6%) EVT-treated and 4 (2.2%) MM patients. Symptomatic ICH (sICH) (SITS-MOST definition) was seen in 0.6% EVT patients and 1.2% MM patients. No trend for ICH with core volumes (P=0.10) or Alberta Stroke Program Early CT Score (ASPECTS) (P=0.74) was observed. Among EVT patients, the presence of any ICH did not worsen clinical outcome (modified Rankin Scale (mRS) at 90 days: 4 (3–6) vs 4 (3–6); adjusted generalized OR 1.00, 95% CI 0.68 to 1.47, P>0.99) or modify EVT treatment effect (Pinteraction=0.77).ConclusionsICH was present in 75% of the EVT population, but PH or sICH were infrequent. The presence of any ICH did not worsen functional outcomes or modify EVT treatment effect at 90-day follow-up. The high rate of hemorrhages overall still represents an opportunity for adjunctive therapies in EVT patients with a large ischemic core.