Neuroradiology

, Volume 56, Issue 12, pp 1087–1096 | Cite as

Postinterventional subarachnoid haemorrhage after endovascular stroke treatment with stent retrievers

  • Omid Nikoubashman
  • Arno Reich
  • Rastislav Pjontek
  • Michael Jungbluth
  • Martin Wiesmann
Interventional Neuroradiology

Abstract

Introduction

The purpose of this paper is to investigate the clinical significance of postinterventional subarachnoid hyperdensities (PSH) after endovascular mechanical thrombectomy in acute ischemic stroke.

Methods

We analysed clinical and radiological data of 113 consecutive patients who received postinterventional CT scans within 4.5 h after mechanical thrombectomy.

Results

PSH was present in 27 of 113 patients (24 %). Extravasation of contrast agent was observed during intervention in only 6 of 27 cases (22 %). There was consecutive haemorrhagic transformation in four patients with PSH (p = 0.209, Fisher’s exact test). Preinterventional predictors for the occurrence of PSH in our series were a long interval between clinical onset and recanalization (p = 0.028), a long procedure time (p = 0.010), and a high number of recanalization attempts (p = 0.001). PSH had no significant impact on clinical outcome (modified Rankin Scale) at discharge (p = 0.419) or at 3 months (p = 0.396). There were no significant correlations between PSH and thrombectomy devices (Solitaire: p = 0.433, Trevo Pro: p = 0.124).

Conclusion

PSH after endovascular mechanical thrombectomy in acute ischemic stroke are likely to occur in complicated cases in which more than one revascularisation attempt is performed. PSH per se do not appear to be associated with an impaired clinical outcome or an elevated risk for consecutive haemorrhage.

Keywords

Stroke Postinterventional CT Hyperdensity Subarachnoid haemorrhage Mechanical recanalization 

References

  1. 1.
    Yilmaz U, Walter S, Körner H, Papanagiotou P, Roth C, Simgen A, Behnke S, Ragoschke-Schumm A, Fassbender K, Reith W (2014) Peri-interventional subarachnoid hemorrhage during mechanical thrombectomy with stent retrievers in acute stroke: a retrospective case–control study. Clin NeuroradiolGoogle Scholar
  2. 2.
    Kurre W, Aguilar-Pérez M, Schmid E, Sperber W, Bäzner H, Henkes H (2014) Clinical experience with the pREset stent retriever for the treatment of acute ischemic stroke-a review of 271 consecutive cases. NeuroradiologyGoogle Scholar
  3. 3.
    Yoon W, Jung MY, Jung SH, Park MS, Kim JT, Kang HK (2013) Subarachnoid haemorrage in a multimodal approach heavily weighted toward mechanical thrombectomy with solitaire stent in acute stroke. Stroke 44(2):414–419PubMedCrossRefGoogle Scholar
  4. 4.
    Parrilla G, García-Villalba B, Espinosa de Rueda M, Zamarro J, Carrión E, Hernández-Fernández F, Martín J, Hernández-Clares R, Morales A, Moreno A (2012) Haemorrage/contrast staining areas after mechanical intra-arterial thrombectomy in acute ischemic stroke: imaging findings and clinical significance. AJNR Am J Neuroradiol 33(9):1791–1796PubMedCrossRefGoogle Scholar
  5. 5.
    Dorn F, Stehle S, Lockau H, Zimmer C, Liebig T (2012) Endovascular treatment of acute intracerebral artery occlusions with the solitaire stent: single-centre experience with 108 recanalization procedures. Cerebrovasc Dis 34(1):70–77PubMedCrossRefGoogle Scholar
  6. 6.
    Machi P, Costalat V, Lobotesis K, Maldonado IL, Vendrell JF, Riquelme C, Bonafé A (2012) Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients. J Neurointerv Surg 4(1):62–66PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Shi ZS, Liebeskind DS, Loh Y, Saver JL, Starkman S, Vespa PM, Gonzalez NR, Tateshima S, Jahan R, Feng L, Miller C, Ali LK, Ovbiagele B, Kim D, Duckwiler GR, Viñuela F, UCLA Endovascular Stroke Therapy Investigators (2010) Predictors of subarachnoid hemorrhage in acute ischemic stroke with endovascular therapy. Stroke 41(12):2775–2781PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Smith WS (2006) Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I. AJNR Am J Neuroradiol 27:1177–1182PubMedGoogle Scholar
  9. 9.
    Pexman JH, Barber PA, Hill MD, Sevick RJ, Demchuk AM, Hudon ME, Hu WY, Buchan AM (2001) Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 22(8):1534–1542PubMedGoogle Scholar
  10. 10.
    Nikoubashman O, Reich A, Gindullis M, Frohnhofen K, Pjontek R, Brockmann MA, Schulz JB, Wiesmann M (2014) Clinical significance of post-interventional cerebral hyperdensities after endovascular mechanical thrombectomy in acute ischaemic stroke. Neuroradiology 56(1):41–50PubMedCrossRefGoogle Scholar
  11. 11.
    Trouillas P, von Kummer R (2006) Classification and pathogenesis of cerebral haemorrages after thrombolysis in ischemic stroke. Stroke 37(2):556–561PubMedCrossRefGoogle Scholar
  12. 12.
    Harnek J, Zoucas E, Carlemalm E, Cwikiel W (1999) Differences in endothelial injury after balloon angioplasty, insertion of balloon-expanded stents or release of self-expanding stents: an electron microscopic experimental study. Cardiovasc Intervent Radiol 22(1):56–61PubMedCrossRefGoogle Scholar
  13. 13.
    Banks WA (2009) Characteristics of compounds that cross the blood–brain barrier. BMC 9(Suppl 1):S3CrossRefGoogle Scholar
  14. 14.
    Niego B, Freeman R, Puschmann TB, Turnley AM, Medcalf RL (2012) t-PA-specific modulation of a human blood–brain barrier model involves plasmin-mediated activation of the Rho kinase pathway in astrocytes. Blood 119(20):4752–4761PubMedCrossRefGoogle Scholar
  15. 15.
    Lummel N, Schulte-Altedorneburg G, Bernau C, Pfefferkorn T, Patzig M, Janssen H, Opherk C, Brückmann H, Linn J (2014) Hyperattenuated intracerebral lesions after mechanical recanalization in acute stroke. AJNR 35(2):345–351PubMedCrossRefGoogle Scholar
  16. 16.
    Khan SM, Ho DW, Lazar JM, Marmur JD (2014) Cerebral contrast retention after difficult cardiac catheterization: Case report. SAGE Open Medical Case Reports 2:2050313X14530283Google Scholar
  17. 17.
    Stone JA, Sharp S, Castillo M (1999) Subarachnoid contrast enhancement mimicking subarachnoid hemorrhage after coronary angiography. AJR 172:831–832PubMedCrossRefGoogle Scholar
  18. 18.
    Velden J, Milz P, Winkler F, Seelos K, Hamann GF (2003) Nonionic contrast neurotoxicity after coronary angiography mimicking subarachnoid hemorrhage. Eur Neurol 49:249–251PubMedCrossRefGoogle Scholar
  19. 19.
    Brockmann C, Scharf J, Nölte IS, Seiz M, Groden C, Brockmann MA (2010) Dual-energy CT after peri-interventional subarachnoid haemorrhage: a feasibility study. Clin Neuroradiol 20(4):231–235PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Omid Nikoubashman
    • 1
    • 2
  • Arno Reich
    • 3
  • Rastislav Pjontek
    • 1
  • Michael Jungbluth
    • 3
  • Martin Wiesmann
    • 1
  1. 1.Klinik für Diagnostische und Interventionelle NeuroradiologieUniklinik AachenAachenGermany
  2. 2.Institute for Neuroscience and Medicine 4JülichGermany
  3. 3.Klinik für NeurologieUniklinik AachenAachenGermany

Personalised recommendations