Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct : a secondary analysis of the SELECT2 randomized trial
© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ..
BACKGROUND: The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized.
METHODS: SELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was examined.
RESULTS: Of 351 included patients, 194 (55%) and 189 (54%) demonstrated intracranial and intracerebral hemorrhage, respectively, with a higher incidence in EVT (134 (75%) and 130 (73%)) versus medical management (MM) (60 (35%) and 59 (34%), both P<0.001). Hemorrhagic infarction type 1 (HBC=1a) and type 2 (HBC=1b) accounted for 93% of all hemorrhages. Parenchymal hematoma (PH) type 1 (HBC=1c) and type 2 (HBC=2) were observed in 1 (0.6%) EVT-treated and 4 (2.2%) MM patients. Symptomatic ICH (sICH) (SITS-MOST definition) was seen in 0.6% EVT patients and 1.2% MM patients. No trend for ICH with core volumes (P=0.10) or Alberta Stroke Program Early CT Score (ASPECTS) (P=0.74) was observed. Among EVT patients, the presence of any ICH did not worsen clinical outcome (modified Rankin Scale (mRS) at 90 days: 4 (3-6) vs 4 (3-6); adjusted generalized OR 1.00, 95% CI 0.68 to 1.47, P>0.99) or modify EVT treatment effect (Pinteraction=0.77).
CONCLUSIONS: ICH was present in 75% of the EVT population, but PH or sICH were infrequent. The presence of any ICH did not worsen functional outcomes or modify EVT treatment effect at 90-day follow-up. The high rate of hemorrhages overall still represents an opportunity for adjunctive therapies in EVT patients with a large ischemic core.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Journal of neurointerventional surgery - (2024) vom: 12. März |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
Complication |
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Date Revised 12.03.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1136/jnis-2023-021219 |
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| PPN (Katalog-ID): |
NLM369614828 |
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| 100 | 1 | |a Chen, Michael |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct |b a secondary analysis of the SELECT2 randomized trial |
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| 500 | |a Date Revised 12.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a BACKGROUND: The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized | ||
| 520 | |a METHODS: SELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was examined | ||
| 520 | |a RESULTS: Of 351 included patients, 194 (55%) and 189 (54%) demonstrated intracranial and intracerebral hemorrhage, respectively, with a higher incidence in EVT (134 (75%) and 130 (73%)) versus medical management (MM) (60 (35%) and 59 (34%), both P<0.001). Hemorrhagic infarction type 1 (HBC=1a) and type 2 (HBC=1b) accounted for 93% of all hemorrhages. Parenchymal hematoma (PH) type 1 (HBC=1c) and type 2 (HBC=2) were observed in 1 (0.6%) EVT-treated and 4 (2.2%) MM patients. Symptomatic ICH (sICH) (SITS-MOST definition) was seen in 0.6% EVT patients and 1.2% MM patients. No trend for ICH with core volumes (P=0.10) or Alberta Stroke Program Early CT Score (ASPECTS) (P=0.74) was observed. Among EVT patients, the presence of any ICH did not worsen clinical outcome (modified Rankin Scale (mRS) at 90 days: 4 (3-6) vs 4 (3-6); adjusted generalized OR 1.00, 95% CI 0.68 to 1.47, P>0.99) or modify EVT treatment effect (Pinteraction=0.77) | ||
| 520 | |a CONCLUSIONS: ICH was present in 75% of the EVT population, but PH or sICH were infrequent. The presence of any ICH did not worsen functional outcomes or modify EVT treatment effect at 90-day follow-up. The high rate of hemorrhages overall still represents an opportunity for adjunctive therapies in EVT patients with a large ischemic core | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Complication | |
| 650 | 4 | |a Hemorrhage | |
| 650 | 4 | |a Stroke | |
| 650 | 4 | |a Thrombectomy | |
| 650 | 4 | |a Thrombolysis | |
| 700 | 1 | |a Joshi, Krishna C |e verfasserin |4 aut | |
| 700 | 1 | |a Kolb, Bradley |e verfasserin |4 aut | |
| 700 | 1 | |a Sitton, Clark W |e verfasserin |4 aut | |
| 700 | 1 | |a Pujara, Deep Kiritbhai |e verfasserin |4 aut | |
| 700 | 1 | |a Abraham, Michael G |e verfasserin |4 aut | |
| 700 | 1 | |a Ortega-Gutierrez, Santiago |e verfasserin |4 aut | |
| 700 | 1 | |a Kasner, Scott E |e verfasserin |4 aut | |
| 700 | 1 | |a Hussain, Shazam M |e verfasserin |4 aut | |
| 700 | 1 | |a Churilov, Leonid |e verfasserin |4 aut | |
| 700 | 1 | |a Blackburn, Spiros |e verfasserin |4 aut | |
| 700 | 1 | |a Sundararajan, Sophia |e verfasserin |4 aut | |
| 700 | 1 | |a Hu, Yin C |e verfasserin |4 aut | |
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| 700 | 1 | |a Arenillas, Juan F |e verfasserin |4 aut | |
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| 700 | 1 | |a Budzik, Ronald F |e verfasserin |4 aut | |
| 700 | 1 | |a Hicks, William |e verfasserin |4 aut | |
| 700 | 1 | |a Kozak, Osman |e verfasserin |4 aut | |
| 700 | 1 | |a Yan, Bernard |e verfasserin |4 aut | |
| 700 | 1 | |a Cordato, Dennis |e verfasserin |4 aut | |
| 700 | 1 | |a Manning, Nathan W |e verfasserin |4 aut | |
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| 700 | 1 | |a Kleinig, Timothy J |e verfasserin |4 aut | |
| 700 | 1 | |a Johns, Hannah |e verfasserin |4 aut | |
| 700 | 1 | |a Shaker, Faris |e verfasserin |4 aut | |
| 700 | 1 | |a Abdulrazzak, Mohammad A |e verfasserin |4 aut | |
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| 700 | 1 | |a Fifi, Johanna T |e verfasserin |4 aut | |
| 700 | 1 | |a Tjoumakaris, Stavropoula I |e verfasserin |4 aut | |
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