Prognosis and risk factors associated with asymptomatic intracranial hemorrhage after endovascular treatment of large vessel occlusion stroke: a prospective multicenter cohort study.
asymptomatic
endovascular treatment
intracerebral hemorrhage
prognosis
stroke
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
25
08
2020
accepted:
05
09
2020
pubmed:
17
9
2020
medline:
12
8
2021
entrez:
16
9
2020
Statut:
ppublish
Résumé
Asymptomatic intracranial hemorrhage (aICH) is a common occurrence after endovascular treatment (EVT) for acute ischemic stroke (AIS). The aims of this study were to address its impact on 3-month functional outcome and to identify risk factors for aICH after EVT. Patients with AIS attributable to anterior circulation large vessel occlusion who underwent EVT were enrolled in a multicenter prospective registry. Based on imaging performed 22-36 h post-EVT, we included patients with no intracranial hemorrhage (ICH) or aICH. Poor outcome defined as a 3-month modified Rankin Scale (mRS) score 4-6 and overall 3-month mRS score distribution were compared according to presence/absence of aICH, and aICH subtype using logistic regression. We assessed the risk factors of aICH using a multivariate logistic regression model. Of the 1526 patients included in the study, 653 (42.7%) had aICH. Patients with aICH had a higher rate of poor outcome: odds ratio (OR) 1.88 (95% confidence interval [CI] 1.44-2.44). Shift analysis of mRS score found a fully adjusted OR of 1.79 (95% CI 1.47-2.18). Hemorrhagic infarction (OR 1.63 [95% CI 1.22-2.18]) and parenchymal hematoma (OR 2.99 [95% CI 1.77-5.02]) were associated with higher risk of poor outcome. Male sex, diabetes, coronary artery disease, baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score, number of passes and onset to groin puncture time were independently associated with aICH. Patients with aICH, irrespective of the radiological pattern, have a worse functional outcome at 3 months compared with those without ICH after EVT for AIS. The number of EVT passes and the time from onset to groin puncture are factors that could be modified to reduce deleterious ICH.
Sections du résumé
BACKGROUND AND PURPOSE
Asymptomatic intracranial hemorrhage (aICH) is a common occurrence after endovascular treatment (EVT) for acute ischemic stroke (AIS). The aims of this study were to address its impact on 3-month functional outcome and to identify risk factors for aICH after EVT.
METHODS
Patients with AIS attributable to anterior circulation large vessel occlusion who underwent EVT were enrolled in a multicenter prospective registry. Based on imaging performed 22-36 h post-EVT, we included patients with no intracranial hemorrhage (ICH) or aICH. Poor outcome defined as a 3-month modified Rankin Scale (mRS) score 4-6 and overall 3-month mRS score distribution were compared according to presence/absence of aICH, and aICH subtype using logistic regression. We assessed the risk factors of aICH using a multivariate logistic regression model.
RESULTS
Of the 1526 patients included in the study, 653 (42.7%) had aICH. Patients with aICH had a higher rate of poor outcome: odds ratio (OR) 1.88 (95% confidence interval [CI] 1.44-2.44). Shift analysis of mRS score found a fully adjusted OR of 1.79 (95% CI 1.47-2.18). Hemorrhagic infarction (OR 1.63 [95% CI 1.22-2.18]) and parenchymal hematoma (OR 2.99 [95% CI 1.77-5.02]) were associated with higher risk of poor outcome. Male sex, diabetes, coronary artery disease, baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score, number of passes and onset to groin puncture time were independently associated with aICH.
CONCLUSIONS
Patients with aICH, irrespective of the radiological pattern, have a worse functional outcome at 3 months compared with those without ICH after EVT for AIS. The number of EVT passes and the time from onset to groin puncture are factors that could be modified to reduce deleterious ICH.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
229-237Investigateurs
Michel Piotin
(M)
Raphael Blanc
(R)
Hocine Redjem
(H)
Simon Escalard
(S)
Jean-Philippe Desilles
(JP)
Gabriele Ciccio
(G)
Stanislas Smajda
(S)
Benjamin Maier
(B)
Mikael Mazighi
(M)
Mikael Obadia
(M)
Candice Sabben
(C)
Roxanne Peres
(R)
Ovide Corabianu
(O)
Thomas de Broucker
(T)
Didier Smadja
(D)
Sonia Alamowitch
(S)
Olivier Ille
(O)
Eric Manchon
(E)
Pierre-Yves Garcia
(PY)
Guillaume Taylor
(G)
Malek Ben Maacha
(M)
Adrien Wang
(A)
Serge Evrard
(S)
Maya Tchikviladze
(M)
Nadia Ajili
(N)
Bertrand Lapergue
(B)
David Weisenburger
(D)
Lucas Gorza
(L)
Géraldine Buard
(G)
Oguzhan Coskun
(O)
Arturo Consoli
(A)
Federico Di Maria
(F)
Georges Rodesh
(G)
Sergio Zimatore
(S)
Morgan Leguen
(M)
Julie Gratieux
(J)
Fernando Pico
(F)
Haja Rakotoharinandrasana
(H)
Philippe Tassan
(P)
Roxanna Poll
(R)
Sylvie Marinier
(S)
Norbert Nighoghossian
(N)
Roberto Riva
(R)
Omer Eker
(O)
Francis Turjman
(F)
Laurent Derex
(L)
Tae-Hee Cho
(TH)
Laura Mechtouff
(L)
Anne-Claire Lukaszewicz
(AC)
Frédéric Philippeau
(F)
Serkan Cakmak
(S)
Karine Blanc-Lasserre
(K)
Anne-Evelyne Vallet
(AE)
Gaultier Marnat
(G)
Florent Gariel
(F)
Xavier Barreau
(X)
Jérôme Berge
(J)
Louis Veunac
(L)
Patrice Menegon
(P)
Igor Sibon
(I)
Ludovic Lucas
(L)
Stéphane Olindo
(S)
Pauline Renou
(P)
Sharmila Sagnier
(S)
Mathilde Poli
(M)
Sabrina Debruxelles
(S)
Thomas Tourdias
(T)
Jean-Sebastien Liegey
(JS)
Romain Bourcier
(R)
Lili Detraz
(L)
Benjamin Daumas-Duport
(B)
Pierre-Louis Alexandre
(PL)
Monica Roy
(M)
Cédric Lenoble
(C)
Vincent L'allinec
(V)
Jean-Baptiste Girot
(JB)
Hubert Desal
(H)
Benoît Guillon
(B)
Solène de Gaalon
(S)
Cécile Preterre
(C)
Benjamin Gory
(B)
Serge Bracard
(S)
René Anxionnat
(R)
Marc Braun
(M)
Anne-Laure Derelle
(AL)
Romain Tonnelet
(R)
Liang Liao
(L)
François Zhu
(F)
Emmanuelle Schmitt
(E)
Sophie Planel
(S)
Sébastien Richard
(S)
Lisa Humbertjean
(L)
Gioia Mione
(G)
Jean-Christophe Lacour
(JC)
Mathieu Bonnerot
(M)
Nolwenn Riou-Comte
(N)
Francisco Macian-Montoro
(F)
Suzanna Saleme
(S)
Charbel Mounayer
(C)
Aymeric Rouchaud
(A)
Vincent Costalat
(V)
Caroline Arquizan
(C)
Cyril Dargazanli
(C)
Grégory Gascou
(G)
Pierre-Henri Lefèvre
(PH)
Imad Derraz
(I)
Carlos Riquelme
(C)
Nicolas Gaillard
(N)
Isabelle Mourand
(I)
Lucas Corti
(L)
Eugene Francois
(E)
Stéphane Vannier
(S)
Jean-Christophe Ferre
(JC)
Helene Raoult
(H)
Thomas Ronziere
(T)
Maria Lassale
(M)
Christophe Paya
(C)
Jean-Yves Gauvrit
(JY)
Clément Tracol
(C)
Sophie Langnier-Lemercier
(S)
Yves Samson
(Y)
Charlotte Rosso
(C)
Anne Leger
(A)
Sandrine Deltour
(S)
Frederic Clarencon
(F)
Eimad Shotar
(E)
Laurent Spelle
(L)
Christian Denier
(C)
Olivier Chassin
(O)
Vanessa Chalumeau
(V)
Jildaz Caroff
(J)
Olivier Chassin
(O)
Laura Venditti
(L)
Guillaume Turc
(G)
Olivier Naggara
(O)
Gregoire Boulouis
(G)
Waghih Ben Hassen
(W)
Pierre Seners
(P)
Alain Viguier
(A)
Christophe Cognard
(C)
Anne Christine Januel
(AC)
Jean-Marc Olivot
(JM)
Nicolas Raposo
(N)
Fabrice Bonneville
(F)
Emmanuel Touze
(E)
Charlotte Barbier
(C)
Romain Schneckenburger
(R)
Marion Boulanger
(M)
Julien Cogez
(J)
Sophie Guettier
(S)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 European Academy of Neurology.
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