Abstract
Background: Intracranial hemorrhage (ICH) is a frequent complication after endovascular stroke treatment. Objective: To assess the association of the occurrence and type of ICH after endovascular treatment (EVT) with functional outcome. Methods: We analyzed data from the MR CLEAN-NO IV and MR CLEAN-MED trials. Both trials included adult patients with ischemic stroke with a large vessel occlusion in the anterior circulation, who were eligible for EVT. ICH was classified (1) as asymptomatic or symptomatic (concomitant neurological deterioration of ≥4 points on the NIHSS, or ≥2 points on 1 NIHSS item), and (2) according to the Heidelberg Bleeding Classification. We used multivariable ordinal logistic regression analyses to assess the association of the occurrence and type of ICH with the modified Rankin Scale score at 90 days. Results: Of 1017 included patients, 331 (33%) had an asymptomatic ICH, and 90 (9%) had a symptomatic ICH. Compared with no ICH, both asymptomatic (adjusted common OR (acOR)=0.76; 95% CI 0.58 to 0.98) and symptomatic (acOR=0.07; 95% CI 0.04 to 0.14) ICH were associated with worse functional outcome. In particular, isolated parenchymal hematoma type 2 (acOR=0.37; 95% CI 0.14 to 0.95), combined parenchymal hematoma with hemorrhage outside infarcted brain tissue (acOR=0.17; 95% CI 0.10 to 0.30), and combined hemorrhages outside infarcted brain tissue (acOR=0.14; 95% CI 0.03 to 0.74) were associated with worse functional outcome than no ICH. Strength of the association of ICH with functional outcome depends on the type of ICH. Although the association is stronger for symptomatic ICH, asymptomatic ICH after EVT is also associated with worse functional outcome.
| Original language | English |
|---|---|
| Article number | jnis-2022-019474 |
| Pages (from-to) | 971-976 |
| Number of pages | 6 |
| Journal | Journal of NeuroInterventional Surgery |
| Volume | 15 |
| Issue number | 10 |
| Early online date | 19 Oct 2022 |
| DOIs | |
| Publication status | Published - 1 Oct 2023 |
Bibliographical note
Funding Information:The MR CLEAN-NO IV and MR CLEAN-MED trials were both funded through the Collaboration for New Treatments of Acute Stroke (CONTRAST) consortium, which acknowledges the support from the Netherlands Cardiovascular Research Initiative, an initiative of the Dutch Heart Foundation (CVON2015-01: CONTRAST); and from the Brain Foundation Netherlands (HA2015.01.06). The collaboration project is additionally financed by the Ministry of Economic Affairs by means of the PPP Allowance made available by Top Sector Life Sciences & Health to stimulate public–private partnerships (LSHM17016). This work was funded in part through unrestricted funding by Stryker, Medtronic, and Cerenovus.
Funding Information:
DWJD and AvdL report unrestricted grants from Stryker, Penumbra, Medtronic, Cerenovus, Thrombolytic Science, LLC, Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organization for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and Thrombolytic Science, LLC for research, paid to the institution. BR reports funding from the Dutch Heart Foundation and the Netherlands Organisation of Health Research and Development, paid to the institution. BJE reports unrestricted grants from The Netherlands Organization for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and Nicolab b.v. all paid to the institution. CM received funds from, CVON/Dutch Heart Foundation and Stryker, (related to this project, paid to institution) and from the European Commission, Healthcare Evaluation Netherlands TWIN Foundation (unrelated to this project; all paid to the institution) and is a shareholder of Nicolab.
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