Symptomatic intracerebral hemorrhage in proximal and distal medium middle cerebral artery occlusion patients treated with mechanical thrombectomy
Authors: Yedavalli Vivek S , Salim Hamza Adel , Musmar Basel , Adeeb Nimer , Essibayi Muhammed Amir , ElNaamani Kareem , Henninger Nils , Sundararajan Sri Hari , Kuhn Anna Luisa , Khalife Jane , Ghozy Sherief , Scarcia Luca , Tan Benjamin YQ , Heit Jeremy Josef , Regenhardt Robert W , Cancelliere Nicole M , Bernstock Joshua D , Rouchaud Aymeric , Fiehler Jens , Sheth Sunil A , Puri Ajit S , Dyzmann Christian , Colasurdo Marco , Barreau Xavier , Renieri Leonardo , Filipe João Pedro , Harker Pablo , Radu Răzvan Alexandru , Marotta Thomas R , Spears Julian , Ota Takahiro , Mowla Ashkan , Jabbour Pascal , Biswas Arundhati , Clarençon Frédéric , Siegler James E , Nguyen Thanh N , Varela Ricardo , Baker Amanda , Altschul David , Gonzalez Nestor , Möhlenbruch Markus A , Costalat Vincent , Gory Benjamin , Stracke Paul , Aziz-Sultan Mohammad Ali , Hecker Constantin , Shaikh Hamza , Liebeskind David S , Pedicelli Alessandro , Alexandre Andrea M , Tancredi Illario , Faizy Tobias D , Kalsoum Erwah , Lubicz Boris , Patel Aman B , Mendes Pereira Vitor , Guenego Adrien , Dmytriw Adam A 
Published: July 2024

Background

Acute ischemic stroke (AIS) caused by distal medium vessel occlusions (DMVOs) represents a significant proportion of overall stroke cases. While intravenous thrombolysis (IVT) has been a primary treatment, advancements in endovascular procedures have led to increased use of mechanical thrombectomy (MT) in DMVO stroke patients. However, symptomatic intracerebral hemorrhage (sICH) remains a critical complication of AIS, particularly after undergoing intervention. This study aims to identify factors associated with sICH in DMVO stroke patients undergoing MT.

Methods

This retrospective analysis utilized data from the Multicenter Analysis of Distal Medium Vessel Occlusions: Effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. Middle cerebral artery (MCA) DMVO stroke patients were included. The primary outcome measured was sICH, as defined per the Heidelberg Bleeding Classification. Univariable and multivariable logistic regression were used to identify factors independently associated with sICH.

Results

Among 1708 DMVO stroke patients, 148 (8.7%) developed sICH. Factors associated with sICH in DMVO patients treated with MT included older age (adjusted odds ratio (aOR) 1.01, 95% confidence interval (95% CI) 1.00 to 1.03, P=0.048), distal occlusion site (M3, M4) compared with medium occlusions (M2) (aOR 1.71, 95% CI 1.07 to 2.74, P=0.026), prior use of antiplatelet drugs (aOR 2.06, 95% CI 1.41 to 2.99, P<0.001), lower Alberta Stroke Program Early CT Scores (ASPECTS) (aOR 0.75, 95% CI 0.66 to 0.84, P<0.001), higher preoperative blood glucose level (aOR 1.00, 95% CI 1.00 to 1.01, P=0.012), number of passes (aOR 1.27, 95% CI 1.15 to 1.39, P<0.001), and successful recanalization (Thrombolysis In Cerebral Infarction (TICI) 2b-3) (aOR 0.43, 95% CI 0.28 to 0.66, P<0.001).

Conclusion

This study provides novel insight into factors associated with sICH in patients undergoing MT for DMVO, emphasizing the importance of age, distal occlusion site, prior use of antiplatelet drugs, lower ASPECTS, higher preoperative blood glucose level, and procedural factors such as the number of passes and successful recanalization. Pending confirmation, consideration of these factors may improve personalized treatment strategies.