Determinants of Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: A Retrospective Cohort Study
Authors: van der Steen Wouter , van der Ende Nadinda A.M. , van Kranendonk Katinka R. , Chalos Vicky , van Oostenbrugge Robert J. , van Zwam Wim H. , Roos Yvo B.W.E.M. , van Doormaal Pieter J. , van Es Adriaan C.G.M. , Lingsma Hester F. , Majoie Charles B.L.M. , van der Lugt Aad , Dippel Diederik W.J. , Roozenbeek Bob , Boiten Jelis , Albert Vos Jan , Jansen Ivo G.H. , Mulder Maxim J.H.L. , Goldhoorn Robert- Jan B. , Compagne Kars C.J. , Kappelhof Manon , Brouwer Josje , den Hartog Sanne J. , Emmer Bart J. , Coutinho Jonathan M. , Schonewille Wouter J. , Albert Vos Jan , Wermer Marieke J.H. , van Walderveen Marianne A.A. , Staals Julie , Hofmeijer Jeannette , Martens Jasper M. , Lycklama à Nijeholt Geert J. , Boiten Jelis , de Bruijn Sebastiaan F. , van Dijk Lukas C. , van der Worp H. Bart , Lo Rob H. , van Dijk Ewoud J. , Boogaarts Hieronymus D. , de Vries J. , de Kort Paul L.M. , van Tuijl Julia , Peluso Jo P. , Fransen Puck , van den Berg Jan S.P. , van Hasselt Boudewijn A.A.M. , Aerden Leo A.M. , Dallinga René J. , Uyttenboogaart Maarten , Eschgi Omid , Bokkers Reinoud P.H. , Schreuder Tobien H.C.M.L. , Heijboer Roel J.J. , Keizer Koos , Yo Lonneke S.F. , den Hertog Heleen M. , Bulut Tomas , Brouwers Paul J.A.M. , Lycklama Geert J. , van Walderveen Marianne A.A. , Sprengers Marieke E.S. , Jenniskens Sjoerd F.M. , van den Berg René , Yoo Albert J. , Beenen Ludo F.M. , Postma Alida A. , Roosendaal Stefan D. , van der Kallen Bas F.W. , van den Wijngaard Ido R. , Emmer Bart J. , Martens Jasper M. , Yo Lonneke S.F. , Vos Jan Albert , Bot Joost , Meijer Anton , Ghariq Elyas , Bokkers Reinoud P.H. , van Proosdij Marc P. , Krietemeijer G. Menno , Peluso Jo P. , Boogaarts Hieronymus D. , Lo Rob , Dinkelaar Wouter , Auke P.A. , Hammer Bas , Pegge Sjoert , van der Hoorn Anouk , Vinke Saman , Lycklama à Nijeholt Geert J. , Boiten Jelis , Vos Jan Albert , Hofmeijer Jeannette , Martens Jasper M. , van der Worp H. Bart , Hofmeijer Jeannette , Flach H. Zwenneke , el Ghannouti Naziha , Sterrenberg Martin , Pellikaan Wilma , Sprengers Rita , Elfrink Marjan , Simons Michelle , Vossers Marjolein , de Meris Joke , Vermeulen Tamara , Geerlings Annet , van Vemde Gina , Simons Tiny , Messchendorp Gert , Nicolaij Nynke , Bongenaar Hester , Bodde Karin , Kleijn Sandra , Lodico Jasmijn , Droste Hanneke , Wollaert Maureen , Verheesen Sabrina , Jeurrissen D. , Bos Erna , Drabbe Yvonne , Sandiman Michelle , Aaldering Nicoline , Zweedijk Berber , Vervoort Jocova , Ponjee Eva , Romviel Sharon , Kanselaar Karin , Barning Denn , Venema Esmee , Geuskens Ralph R. , van Straaten Tim , Ergezen Saliha , Harmsma Roger R.M. , Muijres Daan , de Jong Anouk , Berkhemer Olvert A. , Boers Anna M.M. , Huguet J. , Groot P.F.C. , Mens Marieke A. , Treurniet Kilian M. , Tolhuisen Manon L. , Alves Heitor , Weterings Annick J. , Kirkels Eleonora L.F. , Voogd Eva J.H.F. , Schupp Lieve M. , Collette Sabine L. , Groot Adrien E.D. , LeCouffe Natalie E. , Konduri Praneeta R. , Prasetya Haryadi , Arrarte- Terreros Nerea , Ramos Lucas A. , Brown Martin M. , Liebig Thomas , van der Heijden Esther , Ghannouti Naziha , Fleitour Nadine , Hooijenga Imke , Puppels Corina , Pellikaan Wilma , Geerling Annet , Lindl-Velema Annemieke , van Vemde Gina , de Ridder Ans , Greebe Paut , de Bont- Stikkelbroeck Jose , de Meris Joke , Haaglanden MC , Janssen Kirsten , Licher Silvan , Boodt Nikki , Ros Adriaan , Venema Esmee , Slokkers Ilse , Ganpat Raymie-Jayce , Mulder Maxim , Saiedie Nawid , Heshmatollah Alis , Schipperen Stefanie , Vinken Stefan , van Boxtel Tiemen , Koets Jeroen , Boers Merel , Santos Emilie , Borst Jordi , Jansen Ivo , Kappelhof Manon , Lucas Marit , Geuskens Ralph Renan , Sales Barros Roeland 
Published: June 2022

Background:
Symptomatic intracranial hemorrhage (sICH) is a serious complication after endovascular treatment for ischemic stroke. We aimed to identify determinants of its occurrence and location.

Methods:
We retrospectively analyzed data from the Dutch MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) and MR CLEAN registry. We included adult patients with a large vessel occlusion in the anterior circulation who underwent endovascular treatment within 6.5 hours of stroke onset. We used univariable and multivariable logistic regression analyses to identify determinants of overall sICH occurrence, sICH within infarcted brain tissue, and sICH outside infarcted brain tissue.

Results:
SICH occurred in 203 (6%) of 3313 included patients and was located within infarcted brain tissue in 50 (25%), outside infarcted brain tissue in 23 (11%), and both within and outside infarcted brain tissue in 116 (57%) patients. In 14 patients (7%), data on location were missing. Prior antiplatelet use, baseline systolic blood pressure, baseline plasma glucose levels, post-endovascular treatment modified treatment in cerebral ischemia score, and duration of procedure were associated with all outcome parameters. In addition, determinants of sICH within infarcted brain tissue included history of myocardial infarction (adjusted odds ratio, 1.65 [95% CI, 1.06–2.56]) and poor collateral score (adjusted odds ratio, 1.42 [95% CI, 1.02–1.95]), whereas determinants of sICH outside infarcted brain tissue included level of occlusion on computed tomography angiography (internal carotid artery or internal carotid artery terminus compared with M1: adjusted odds ratio, 1.79 [95% CI, 1.16–2.78]).

Conclusions:
Several factors, some potentially modifiable, are associated with sICH occurrence. Further studies should investigate whether modification of baseline systolic blood pressure or plasma glucose level could reduce the risk of sICH. In addition, determinants differ per location of sICH, supporting the hypothesis of varying underlying mechanisms.

Registration:

URL:
https://www.isrctn.com/
; Unique identifier: ISRCTN10888758.