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Early recurrent ischemic events after mechanical thrombectomy: effect of post-treatment intracranial hemorrhage

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Abstract

Objective

Patients with intracranial hemorrhages (ICH) after mechanical thrombectomy (MT) may have a higher risk of early recurrent embolism (ERE) because of delayed initiation of anticoagulants. We assessed the rate of ischemic events in the early period after MT and the association with post-MT ICH.

Methods

Patients who underwent MT in our institute were retrospectively reviewed. ERE was defined as recurrent ischemic stroke and systemic embolism within 14 days after MT. The association between ERE and parenchymal hematoma (PH) was assessed. Multivariable regression analysis and inverse probability of treatment weighting was used to adjust for differences in baseline characteristics between patients with and without PH.

Results

A total of 307 patients (median age, 78 years; female, 47%; median baseline National Institutes of Health Stroke Scale score, 19) were included. ERE was observed in 12 of 307 patients (8 strokes, 4 systemic embolisms; 3.9%). Median time from MT to ERE was 6.5 days (IQR, 3–8 days). PH occurred in 21 patients (6.8%). Median time from MT to initiating oral anticoagulants was longer in patients with PH (8 days) than in those without (3 days) (p < 0.01). In both unweighted and weighted multivariable analysis, PH was significantly associated with an increased risk of ERE (unweighted odds ratio, 10.60; 95% CI, 2.66–42.23; weighted odds ratio, 12.34; 95% CI, 2.49–61.07).

Conclusions

ERE occurred in about 4% of patients after MT. PH after MT was associated with delayed initiation of oral anticoagulants and an increased risk of recurrent ischemic events.

Clinical trial registration

URL: https://www.clinicaltrials.gov. Unique identifier: NCT02251665.

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Availability of data and material

A part, not all, of patients’ data may be available upon reasonable request.

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Funding

This study was supported in part by a Grant-in-Aid for Scientific Research (20K16716).

Author information

Authors and Affiliations

  1. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan

    Junpei Koge, Masayuki Shiozawa, Masatoshi Koga & Kazunori Toyoda

  2. Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan

    Kanta Tanaka & Hiroshi Yamagami

  3. Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan

    Takeshi Yoshimoto & Masafumi Ihara

  4. Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan

    Tetsu Satow & Jun C. Takahashi

  5. Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan

    Jun-ichi Kira

Authors
  1. Junpei Koge
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  2. Kanta Tanaka
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  3. Takeshi Yoshimoto
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  4. Masayuki Shiozawa
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  5. Hiroshi Yamagami
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  6. Tetsu Satow
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  7. Jun C. Takahashi
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  8. Masafumi Ihara
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  9. Masatoshi Koga
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  10. Jun-ichi Kira
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  11. Kazunori Toyoda
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Corresponding author

Correspondence to Junpei Koge.

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Conflicts of interest

Dr. Koge reports no disclosures. Dr. Tanaka reports lecturer’s fees from Daiichi-Sankyo, Medico’s Hirata, and Stryker. Dr. Yoshimoto reports lecture’s fees from Takeda Pharmaceutical. Dr. Shiozawa reports no disclosures. Dr. Yamagami reports research grants from Bristol-Myers Squibb; lecturer’s fees from Stryker, Terumo, Medtronic, Medico’s Hirata, Johnson and Johnson, Bayer, Daiichi-Sankyo, Bristol-Myers Squibb, Boehringer Ingelheim, Takeda, and Otsuka Pharmaceutical; and membership of the advisory boards for Daiichi-Sankyo and Biomedical Solutions. Dr. Satow reports research funding from CANON Medical System, lecture’s fees from Medtronic and Stryker. Dr. Takahashi reports no disclosures. Dr. Ihara reports lecturer’s fees from Daiichi Sankyo, Eisai, and Bayer, and grant support from Panasonic, Bristol-Myers Squibb, and Otsuka Pharmaceutical. Dr. Koga reports honoraria from Bayer Yakuhin, Bristol-Myers-Squibb, Otsuka, Daiichi-Sankyo, Nippon Boehringer Ingelheim and Takeda, scientific advisory board from Ono, and research supports from Takeda, Daiichi-Sankyo, Nippon Boehringer Ingelheim, Astellas, Pfizer and Shionogi, outside the submitted work. Dr. Kira reports no disclosures. Dr. Toyoda reports lecturer’s fees from Daiichi Sankyo, Boehringer Ingelheim, Bayer, and Bristol-Myers Squibb.

Ethics approval

This study was approved by the ethics committee of the National Cerebral and Cardiovascular Center, Japan (M23-073-7).

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Supplementary file1 (DOCX 484 KB)

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Koge, J., Tanaka, K., Yoshimoto, T. et al. Early recurrent ischemic events after mechanical thrombectomy: effect of post-treatment intracranial hemorrhage. J Neurol 268, 2810–2820 (2021). https://doi.org/10.1007/s00415-021-10449-1

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  • DOI: https://doi.org/10.1007/s00415-021-10449-1

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