Abstract Number ‐ 30: Predictors of Intracranial Hemorrhage and Successful Reperfusion After Mechanical Thrombectomy in Acute Ischemic Stroke
Authors: Luo Anqi , Birnbaum Lee 
Published: April 2023

Introduction

Mechanical thrombectomy (MT) has become the current standard of care for large vessel occlusion stroke but is associated with an increased risk of intracranial hemorrhage (ICH). Recent study showed that even asymptomatic ICH may decrease the likelihood of an excellent functional outcome at 90 days. This study aims to identify predictors for ICH in patients with acute ischemic stroke undergoing MT. Also, we try to identify the predictors for successful reperfusion TICI 2b/3.

Methods

We retrospectively reviewed all MT patients who were treated at a single comprehensive stroke center from 12/2016 to 09/2021. Variables included Ethnicity, age, gender, time from last know well to arrival, medical history, antithrombotic use, initial NIHSS, blood glucose, blood pressure, IV tPA, time from door to puncture, time from puncture to first pass, type of LVO, MT devices and TICI score. Primary Outcome was any ICH within 36 hours after MT. Secondary outcome was successful reperfusion, TICI 2b/3.

Results

Among 273 patients (68.8±14, Male 51.6%), 41.7% was Hispanic. 75 patients (27.5%) experienced any ICH after thrombectomy.Although ICH is common post MT and most of the researchers believe that only symptomatic ICH negatively impacts outcome, it is challenging to get an accurate post MT evaluation. Our patient cohort confirmed that ICH after MT may decrease the likelihood of excellent and favorable outcome upon discharge. Patients with history of drugs or ETOH abuse had higher risk of ICH post MT. TICI 2b/3 was associated with higher chance of favorable mRS (0‐3) upon discharge but paradoxically associated with higher chance of ICH post MT. (OR 3.01).Among all the variables, time from LKW to arrival was significantly shorter in patients achieved TICI 2b/3, 223min VS 414min. Door to puncture time was significantly faster in patients with TICI2b/3, 95min VS 121min. Puncture to first pass time was also significantly faster in patients with TICI2b/3, 19min VS 26min.Multiple logistic regression model showed that lower initial BG and NIHSS, ICA or M1 LVO and shorter door to first pass time were associated with favorable outcomes.

Conclusions

Compared to other clinical studies (usually only had 5–8% Hispanic patients), our study has significantly better representation of Hispanic population in which 41.7% of our patients are Hispanic. This emphasized the uniqueness and meaning of our study.Our patient cohort confirmed that it is important to avoid any ICH post MT, since it may decrease favorable and excellent outcome upon discharge. Extra attention is needed for patients with history of drugs or ETOH abuse because it is associated with significantly higher risk of ICH post MT in our patient cohort.ICH was commonly seen in TICI 2b/3 patients and may be due to successful reperfusion. Therefore, aggressive BP management (SBP<140) after MT is recommended if TICI 2b/3 achieved to avoid ICH expanding and worsening outcome. Also, angio‐CT scan after TICI 2b/3 may be necessary in the future. Favorable outcomes were reached more often if patients had lower initial BG and NIHSS, ICA or M1 LVO, shorter door to first pass time and can achieve TICI 2b/3 after MT.