Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Natasha Ironside; Ching-Jen Chen; Reda M Chalhoub; Peter Wludyka; Ryan T Kellogg; Sami Al Kasab; Dale Ding; Ilko Maier; Ansaar Rai; Pascal Jabbour; Joon-Tae Kim; Stacey Q Wolfe; Robert M Starke; Marios-Nikos Psychogios; Amir Shaban; Adam S Arthur; Shinichi Yoshimura; Jonathan A Grossberg; Ali Alawieh; Isabel Fragata; Adam J Polifka; Justin R Mascitelli; Joshua W Osbun; Charles Matouk; Michael R Levitt; Travis M Dumont; Hugo H Cuellar-Saenz; Richard Williamson; Daniele G Romano; Roberto Javier Crosa; Benjamin Gory; Maxim Mokin; Mark Moss; Kaustubh Limaye; Peter Kan; Alejandro M Spiotta; Min S Park; STAR collaborators

doi:10.1136/jnis-2022-019513

Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

J Neurointerv Surg. 2023 Nov;15(e2):e312-e322. doi: 10.1136/jnis-2022-019513. Epub 2023 Feb 1.

Authors

Natasha Ironside¹, Ching-Jen Chen², Reda M Chalhoub³, Peter Wludyka⁴, Ryan T Kellogg⁵, Sami Al Kasab⁶, Dale Ding⁷, Ilko Maier⁸, Ansaar Rai⁹, Pascal Jabbour¹⁰, Joon-Tae Kim¹¹, Stacey Q Wolfe¹², Robert M Starke¹³, Marios-Nikos Psychogios¹⁴, Amir Shaban¹⁵, Adam S Arthur¹⁶, Shinichi Yoshimura¹⁷, Jonathan A Grossberg¹⁸, Ali Alawieh¹⁹, Isabel Fragata²⁰, Adam J Polifka⁴, Justin R Mascitelli²¹, Joshua W Osbun²², Charles Matouk²³, Michael R Levitt²⁴, Travis M Dumont²⁵, Hugo H Cuellar-Saenz²⁶, Richard Williamson²⁷, Daniele G Romano²⁸, Roberto Javier Crosa²⁹, Benjamin Gory³⁰, Maxim Mokin³¹, Mark Moss³², Kaustubh Limaye³³, Peter Kan³⁴, Alejandro M Spiotta³, Min S Park⁵; STAR collaborators

Affiliations

¹ Neurosurgery, University of Virginia, Charlottesville, Virginia, USA [email protected].
² Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USA.
³ Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
⁴ Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
⁵ Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
⁶ Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
⁷ Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
⁸ Neurology, University Medicine Goettingen, Goettingen, NS, Germany.
⁹ Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA.
¹⁰ Neurological surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
¹¹ Chonnam National University Hospital, Gwangju, Gwangju, Korea (the Republic of).
¹² Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
¹³ Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁴ Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
¹⁵ Neurology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA.
¹⁶ Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
¹⁷ Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
¹⁸ Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁹ Neurosurgery, Emory University, Atlanta, Georgia, USA.
²⁰ Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
²¹ Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
²² Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA.
²³ Neurosurgery, Yale University, New Haven, Connecticut, USA.
²⁴ Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
²⁵ Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA.
²⁶ Neurosurgery, LSUHSC, Shreveport, Louisiana, USA.
²⁷ Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
²⁸ Neurordiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.
²⁹ Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay.
³⁰ Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France.
³¹ Neurosurgery, University of South Florida College of Medicine, Tampa, Florida, USA.
³² Washington Regional Medical Center, Fayetteville, Arkansas, USA.
³³ Indiana University, Bloomington, Indiana, USA.
³⁴ Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA.

Abstract

Background: Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy.

Methods: This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade.

Results: The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference.

Conclusions: This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.

Keywords: Hemorrhage; Stroke; Thrombectomy; Thrombolysis.

MeSH terms

Aneurysm* / complications
Brain Ischemia* / complications
Brain Ischemia* / diagnostic imaging
Brain Ischemia* / surgery
Humans
Intracranial Hemorrhages / etiology
Ischemic Stroke* / etiology
Registries
Retrospective Studies
Risk Factors
Stroke* / diagnosis
Thrombectomy / adverse effects
Thrombectomy / methods
Treatment Outcome

Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Authors

Collaborators

Affiliations

Abstract

MeSH terms

Grants and funding