Association of Stroke Subtype With Hemorrhagic Transformation Mediated by Thrombectomy Pass: Data From the ANGEL-ACT Registry
Authors: Tong Xu , Burgin W. Scott , Ren Zeguang , Jia Baixue , Zhang Xuelei , Huo Xiaochuan , Luo Gang , Wang Anxin , Zhang Yijun , Ma Ning , Gao Feng , Song Ligang , Sun Xuan , Liu Lian , Deng Yiming , Li Xiaoqing , Wang Bo , Ma Gaoting , Wang Yilong , Wang Yongjun , Miao Zhongrong , Mo Dapeng , Gui Liqiang , Song Cunfeng , Peng Ya , Wu Jin , Zhao Shijun , Zhao Junfeng , Zhou Zhiming , Li Yongli , Jing Ping , Yang Lei , Liu Yajie , Zhao Qingshi , Liu Yan , Peng Xiaoxiang , Gao Qingchun , Guo Zaiyu , Chen Wenhuo , Li Weirong , Cheng Xiaojiang , Xu Yun , Zhang Yongqiang , Zhang Guilian , Lu Yijiu , Lu Xinyu , Wang Dengxiang , Wang Yan , Li Hao , Hua Yang , Geng Deqin , Yuan Haicheng , Wang Hongwei , Yang Haihua , Wang Zengwu , Wei Liping , Liufu Xuancong , Shi Xiangqun , Li Juntao , Yang Wenwu , Jing Wenji , Yong Xiang , Wang Leyuan , Li Chunlei , Cao Yibin , Zhu Qingfeng , Zhang Peng , Luo Xiang , Chen Shengli , Peng WenWu , Wang Lixin , Wen Xue , Shi Shugui , Wang Wanming , Bo Wang , Yuan Pu , Wang Dong , Guan Haitao , Liang Wenbao , Ma Daliang , Chen Long , Xiao Yan , Xie Xiangdong , Shi Zhonghua , Zeng Xiangjun , Su Fanfan , Chang MingZe , Yin Jijun , Sun Hongxia , Li Chong , Bi Yong , Xie Gang , Zhao Yuwu , Wang Chao , Zhang Peng , Wang Xianjun , Li Dongqun , Liang Hui , Chen Zhonglun , Wang Yan , Wang Yuxin , Yin Lin , Qiu HongKai , Wei Jun , Sun Yaxuan , Feng Xiaoya , Wu Weihua , Gao Lianbo , Ai Zhibing , Tan Lan , Ding Li , Liang Qilong , Wang Zhimin , Yang Jianwen , Xu Ping , Dong Wei , Zheng Quanle , Zhu Zhenyun , Zhao Liyue , Meng Qingbo , Wei Yuqing , Chen Xianglin , Wang Wei , Sun Dong , Yan Yongxing , Yuan Guangxiong , Yang Yadong , Zhou Jianfeng , Yang Zhi , Zhang Zhenzhong , Guan Ning , Wang Huihong 
Published: March 2022

Background:
The role of stroke etiology subtype in patients with acute large vessel occlusion on the occurrence of hemorrhagic transformation (HT) after endovascular treatment is poorly studied, and which factors mediate their relationship remains largely unknown. We utilized nationwide registry data to explore the association of stroke subtype (cardioembolism versus large artery atherosclerosis) with HT and to identify the possible mediators.

Methods:
A total of 1015 subjects were selected from the ANGEL-ACT registry (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke)—a prospective consecutive cohort of acute large vessel occlusion patients undergoing endovascular treatment at 111 hospitals in China between November 2017 and March 2019—and divided into large artery atherosclerosis (n=538) and cardioembolism (n=477) according to the Trial of ORG 10172 in Acute Stroke Treatment criteria. The types of HT included any intracerebral hemorrhage (ICH), parenchymal hematoma, and symptomatic ICH within 24 hours after endovascular treatment. The association between stroke subtype and HT was analyzed using a logistic regression model. Mediation analysis was done to assess how much of the effect of stroke subtype on HT was mediated through the identified mediators.

Results:
Stroke subtype (cardioembolism versus large artery atherosclerosis) was associated with increased risk of any ICH (29.8% versus 16.5%; odds ratio, 2.03 [95% CI, 1.22–3.36]), parenchymal hematoma (14.3% versus 5.4%; odds ratio, 2.90 [95% CI, 1.38–6.13]), and symptomatic ICH (9.9% versus 4.7%; odds ratio, 2.59 [95% CI, 1.09–6.16]) after adjustment for potential confounders. The more thrombectomy passes in cardioembolism patients had a significant mediation effect on the association of stroke subtype with increased risk of HT (any ICH, 15.9%; parenchymal hematoma, 13.4%; symptomatic ICH, 14.2%, respectively).

Conclusions:
Stroke subtype is an independent risk factor for HT within 24 hours following endovascular treatment among acute large vessel occlusion patients. Mediation analyses propose that stroke subtype contributes to HT partly through thrombectomy pass, suggesting a possible pathomechanistic link.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03370939.