The impact of general anesthesia, baseline ASPECTS, time to treatment, and IV tPA on intracranial hemorrhage after neurothrombectomy: pooled analysis of the SWIFT PRIME, SWIFT, and STAR trials.

Raychev, Radoslav; Saver, Jeffrey L; Jahan, Reza; Nogueira, Raul G; Goyal, Mayank; Pereira, Vitor M; Gralla, Jan; Levy, Elad I; Yavagal, Dileep R; Cognard, Christophe; Liebeskind, David S (2019). The impact of general anesthesia, baseline ASPECTS, time to treatment, and IV tPA on intracranial hemorrhage after neurothrombectomy: pooled analysis of the SWIFT PRIME, SWIFT, and STAR trials. (In Press). Journal of neurointerventional surgery BMJ Publishing Group 10.1136/neurintsurg-2019-014898

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BACKGROUND Despite the proven benefit of neurothrombectomy, intracranial hemorrhage (ICH) remains the most serious procedural complication. The aim of this analysis was to identify predictors of different hemorrhage subtypes and evaluate their individual impact on clinical outcome. METHODS Pooled individual patient-level data from three large prospective multicenter studies were analyzed for the incidence of different ICH subtypes, including any ICH, hemorrhagic transformation (HT), parenchymal hematoma (PH), subarachnoid hemorrhage (SAH), and symptomatic intracranial hemorrhage (sICH). All patients (n=389) treated with the Solitaire device were included in the analysis. A multivariate stepwise logistic regression model was used to identify predictors of each hemorrhage subtype. RESULTS General anesthesia and higher baseline Alberta Stroke Program Early CT score (ASPECTS) were associated with a lower probability of any ICH (OR 0.36, p0.003), (OR 0.80, p0.032) and HT (OR 0.54, p0.023), (OR 0.78, p=0.001), respectively. Longer time from onset to treatment was associated with a higher likelihood of HT (OR 1.08, p0.001) and PH (OR 1.11, p0.015). Intravenous tissue plasminogen activator (IV-tPA) was also a strong predictor of PH (OR 7.63, p0.013). Functional independence at 90 days (modified Rankin Scale (mRS) 0-2) was observed significantly less frequently in all hemorrhage subtypes except SAH. None of the patients who achieved functional independence at 90 days had sICH. CONCLUSIONS General anesthesia and larger baseline ischemic core are associated with a lower probability of HT whereas IV-tPA and prolonged time to treatment increase the risk of PH after neurothrombectomy.# TRIAL REGISTRATION NUMBERS: SWIFT-NCT01054560; post results, SWIFT PRIME-NCT01657461; post results, STAR-NCT01327989; post results.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Gralla, Jan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1759-8486

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

05 Aug 2019 17:24

Last Modified:

05 Aug 2019 17:24

Publisher DOI:

10.1136/neurintsurg-2019-014898

PubMed ID:

31239326

Uncontrolled Keywords:

IV TPA acute stroke anesthesia intracranial hemorrhage thrombectomy

BORIS DOI:

10.7892/boris.131667

URI:

https://boris.unibe.ch/id/eprint/131667

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