Association Between Asymptomatic Intracranial Hemorrhage and Outcomes After Thrombectomy: A Pooled Analysis of the RESCUE BT and DEVT Trials.

Association Between Asymptomatic Intracranial Hemorrhage and Outcomes After Thrombectomy: A Pooled Analysis of the RESCUE BT and DEVT Trials. Neurology. Clinical practice Cai, L., Yan, Z., Abdalkader, M., Li, T., Sang, H., Tian, Y., Xie, D., Li, M., Jin, W., Albers, G. W., Qiu, Z., Nguyen, T. N., Yang, Q., Zhao, H., Jiang, S. 2025; 15 (4): e200500

Abstract

Hemorrhagic transformation is a prevalent and serious complication that frequently occurs after endovascular recanalization in acute large vessel occlusion stroke. The impact of asymptomatic intracranial hemorrhage (aICH) on outcomes after endovascular thrombectomy (EVT) remains to be elucidated.This was a pooled analysis of individual patient data of 2 randomized trials in China, the RESCUE BT trial from October 2018 to October 2021 and the Direct Endovascular Treatment for Large Vessel Occlusion Stroke trial from May 2018 to May 2020. Patients with acute anterior circulation large vessel occlusion were categorized into 3 groups based on CT or MRI examination within 48 hours after thrombectomy: no intracranial hemorrhage (no-ICH), aICH, and symptomatic ICH (sICH). The primary outcome was functional independence (defined as modified Rankin Scale score of 0-2) at 90 days. Secondary outcomes were the change in NIH Stroke Scale score from baseline to 5-7 days and 3-month mortality.A total of 1,177 patients (median age, 68 years; 58.4% male) were included in this study, comprising 818 patients without ICH, 268 patients with aICH, and 91 patients with sICH. The proportion of functional independence was 57.3% in the no-ICH group, 34.7% in the aICH group, and 3.3% in the sICH group. Compared with the no-ICH group, there was a lower proportion of functional independence in the aICH group (adjusted odds ratio [aOR], 0.40; 95% CI 0.29-0.55; p < 0.001) and the sICH group (aOR, 0.02; 95% CI 0.01-0.07; p < 0.001). Both aICH and sICH were associated with less improvement of neurologic disability at 5-7 days from baseline and higher mortality at 90 days.Among patients with large vessel occlusion stroke who underwent EVT, the presence of aICH was associated with less early neurologic improvement and greater disability at 90 days. Asymptomatic ICH should be assessed in EVT trials, and strategies to reduce asymptomatic hemorrhage should be investigated.

View details for DOI 10.1212/CPJ.0000000000200500

View details for PubMedID 40687960

View details for PubMedCentralID PMC12270459