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Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial. Journal of neurointerventional surgery Chen, M., Joshi, K. C., Kolb, B., Sitton, C. W., Pujara, D. K., Abraham, M. G., Ortega-Gutierrez, S., Kasner, S. E., Hussain, S. M., Churilov, L., Blackburn, S., Sundararajan, S., Hu, Y. C., Herial, N., Arenillas, J. F., Tsai, J. P., Budzik, R. F., Hicks, W., Kozak, O., Yan, B., Cordato, D., Manning, N. W., Parsons, M., Hanel, R. A., Aghaebrahim, A., Wu, T., Cardona Portela, P., Gandhi, C. D., Al-Mufti, F., Perez de la Ossa, N., Schaafsma, J., Blasco, J., Sangha, N., Warach, S., Kleinig, T. J., Johns, H., Shaker, F., Abdulrazzak, M. A., Ray, A., Sunshine, J., Opaskar, A., Duncan, K. R., Xiong, W., Al-Shaibi, F. K., Samaniego, E. A., Nguyen, T. N., Fifi, J. T., Tjoumakaris, S. I., Jabbour, P., Mendes Pereira, V., Lansberg, M. G., Sila, C., Bambakidis, N. C., Davis, S., Wechsler, L., Albers, G. W., Grotta, J. C., Ribo, M., Hassan, A. E., Campbell, B., Hill, M. D., Sarraj, A. 2024

Abstract

The 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.SELECT2 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.Of 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).ICH 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.

View details for DOI 10.1136/jnis-2023-021219

View details for PubMedID 38471760