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Pre-procedural predictive factors of symptomatic intracranial hemorrhage after thrombectomy in stroke

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Abstract

Objective

Symptomatic intracerebral hemorrhage (sICH) is a common complication of acute ischemic stroke (AIS) associated with limited treatments and poor outcomes. We aimed to identify predictive factors of sICH in patients with AIS following mechanical thrombectomy (MT) in a real-world setting.

Methods

Patients with large vessel occlusion of the anterior circulation treated with MT were consecutively included in a prospective monocentric cohort. Clinical, biological, and radiological parameters were collected to identify pre-procedural predictors for sICH.

Results

637 patients were included in our study. Magnetic resonance imaging was performed on most patients (86.7%). sICH occurred in 55 patients (8.6%). 428 patients (67.2%) were treated with intravenous thrombolysis. After multivariate analysis, prior use of antiplatelet therapies (odd ratio (OR) 1.84, 95% confidence interval (CI) 1.01–3.32), high C-reactive protein (OR per standard deviation (SD) increase 1.28, 95% 1.01–1.63), elevated mean arterial blood pressure (OR per 10 mmHg increase 1.22, 95% CI 1.03–1.44), hyperglycemia (OR per one SD-log increase 1.38, 95% CI 1.02–1.87), and low ASPECTS (OR per 1-point decrease 1.42, 95% CI 1.12–1.80) were found to be independent predictive factors of sICH. The pre-procedural predictors did not change when the absence of successful recanalization was considered as a covariate. Patients with strokes of unknown onset time were not especially vulnerable for sICH.

Conclusion

sICH after MT was associated with several pre-procedural risk factors: prior use of antiplatelet therapies, high C-reactive protein and hyperglycemia at baseline, elevated mean arterial blood pressure, and low ASPECTS.

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Author notes

  1. Laura Venditti, Olivier Chassin, Claire Ancelet, and Nicolas Legris have contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Neurology, Hôpital Bicêtre, Stroke Center, 78 rue du General Leclerc, 94270, Le Kremlin Bicêtre, France

    Laura Venditti, Olivier Chassin, Nicolas Legris, Mariana Sarov & Christian Denier

  2. Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France

    Claire Ancelet, Cristian Mihalea, Augustin Ozanne, Sophie Gallas, Jonathan Cortese, Vanessa Chalumeau, Leon Ikka, Jildaz Caroff & Laurent Spelle

  3. Department of Neurology, Hopital Foch, Suresnes, France

    Bertrand Lapergue

  4. Épidémiologie et Qualité des Soins, CHU Lille, Université de Lille, EA2694, Santé Publique, Statistiques, Lille, France

    Julien Labreuche

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  1. Laura Venditti
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Venditti, L., Chassin, O., Ancelet, C. et al. Pre-procedural predictive factors of symptomatic intracranial hemorrhage after thrombectomy in stroke. J Neurol 268, 1867–1875 (2021). https://doi.org/10.1007/s00415-020-10364-x

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