Determinants of Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: A Retrospective Cohort Study

Wouter Van Der Steen*, Nadinda A.M. Van Der Ende, Katinka R. Van Kranendonk, Vicky Chalos, Robert J. Van Oostenbrugge, Wim H. Van Zwam, Yvo B.W.E.M. Roos, Pieter J. Van Doormaal, Adriaan C.G.M. Van Es, Hester F. Lingsma, Charles B.L.M. Majoie, Aad Van Der Lugt, Diederik W.J. Dippel, Bob Roozenbeek

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: Symptomatic intracranial hemorrhage (sICH) is a serious complication after endovascular treatment for ischemic stroke. We aimed to identify determinants of its occurrence and location. Methods: We retrospectively analyzed data from the Dutch MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) and MR CLEAN registry. We included adult patients with a large vessel occlusion in the anterior circulation who underwent endovascular treatment within 6.5 hours of stroke onset. We used univariable and multivariable logistic regression analyses to identify determinants of overall sICH occurrence, sICH within infarcted brain tissue, and sICH outside infarcted brain tissue. Results: SICH occurred in 203 (6%) of 3313 included patients and was located within infarcted brain tissue in 50 (25%), outside infarcted brain tissue in 23 (11%), and both within and outside infarcted brain tissue in 116 (57%) patients. In 14 patients (7%), data on location were missing. Prior antiplatelet use, baseline systolic blood pressure, baseline plasma glucose levels, post-endovascular treatment modified treatment in cerebral ischemia score, and duration of procedure were associated with all outcome parameters. In addition, determinants of sICH within infarcted brain tissue included history of myocardial infarction (adjusted odds ratio, 1.65 [95% CI, 1.06-2.56]) and poor collateral score (adjusted odds ratio, 1.42 [95% CI, 1.02-1.95]), whereas determinants of sICH outside infarcted brain tissue included level of occlusion on computed tomography angiography (internal carotid artery or internal carotid artery terminus compared with M1: adjusted odds ratio, 1.79 [95% CI, 1.16-2.78]). Conclusions: Several factors, some potentially modifiable, are associated with sICH occurrence. Further studies should investigate whether modification of baseline systolic blood pressure or plasma glucose level could reduce the risk of sICH. In addition, determinants differ per location of sICH, supporting the hypothesis of varying underlying mechanisms. Registration: URL:; Unique identifier: ISRCTN10888758.

Original languageEnglish
Pages (from-to)2818-2827
Number of pages10
Issue number9
Publication statusPublished - 1 Sept 2022

Bibliographical note

Funding Information:
Drs Dippel and van der Lugt report funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences and Health, and unrestricted grants from Penumbra, Inc, Stryker, Medtronic, Thrombolytic Science, LLC, and Cerenovus for research, all paid to institution. Dr Majoie received funds from the TWIN Foundation (related to this project, paid to institution) and from CVON/Dutch Heart Foundation, Stryker, European Commission, and Health Evaluation Netherlands (unrelated; all paid to institution). Drs Majoie and Roos are minor shareholders of Nico.lab—a company that focuses on the use of artificial intelligence for medical imaging analysis. Dr van Zwam reports speaker fees from Stryker and Cerenovus, both paid to the institution, compensation from Philips for data and safety monitoring services, and grants from Johnson and Johnson International. Dr van Doormaal reports compensation from Stryker for consultant services.

Funding Information:
The MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) was supported by the Dutch Heart Foundation and by unrestricted grants from AngioCare Covidien/ev3, Medac/Lamepro, Stryker, and Penumbra. The MR CLEAN registry was partly funded by the TWIN Foundation and by the Erasmus MC University Medical Center, Maastricht UMC, and Amsterdam UMC.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.


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