Bridging May Increase the Risk of Symptomatic Intracranial Hemorrhage in Thrombectomy Patients With Low Alberta Stroke Program Early Computed Tomography Score.

Kaesmacher, Johannes; Meinel, Thomas R.; Nannoni, Stefania; Olivé-Gadea, Marta; Piechowiak, Eike I.; Maegerlein, Christian; Goeldlin, Martina; Pierot, Laurent; Seiffge, David J.; Mendes Pereira, Vitor; Heldner, Mirjam R.; Grunder, Lorenz; Costalat, Vincent; Arnold, Marcel; Dobrocky, Tomas; Gralla, Jan; Mordasini, Pasquale; Fischer, Urs (2021). Bridging May Increase the Risk of Symptomatic Intracranial Hemorrhage in Thrombectomy Patients With Low Alberta Stroke Program Early Computed Tomography Score. Stroke, 52(3), pp. 1098-1104. American Heart Association 10.1161/STROKEAHA.120.030508

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BACKGROUND AND PURPOSE

Whether intravenous thrombolysis (IVT) increases the risk for symptomatic intracranial hemorrhage (sICH) in patients treated with mechanical thrombectomy (MT) is a matter of debate. Purpose of this study was to evaluate the extent of early ischemia as a possible factor influencing the risk for sICH after IVT+MT versus direct MT.

METHODS

An explorative analysis of the BEYOND-SWIFT (Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy) multicenter cohort was performed. We hypothesized that the sICH risk between IVT+MT versus direct MT differs across the strata of Alberta Stroke Program Early Computed Tomography Scores (ASPECTS). For this purpose, all patients with ICA, M1, and M2 vessel occlusions and available noncontrast computed tomography or diffusion-weighed imaging ASPECTS (n=2002) were analyzed. We used logistic regression analysis in subgroups, as well as interaction terms, to address the risk of sICH in IVT+MT versus direct MT patients across the ASPECTS strata.

RESULTS

In 2002 patients (median age, 73.7 years; 50.7% women; median National Institutes of Health Stroke Scale score, 16), the overall rate of sICH was 6.5% (95% CI, 5.5%-7.7%). Risk of sICH differed across ASPECTS groups (9-10: 6.3%; 6-8: 5.6% and ≤5 9.8%; P=0.042). With decreasing ASPECTS, the risks of sICH in the IVT+MT versus the direct MT group increased from adjusted odds ratio of 0.61 ([95% CI, 0.24-1.60] ASPECTS 9-10), to 1.72 ([95% CI, 0.69-4.24] ASPECTS 6-8) and 6.31 ([95% CI, 1.87-21.29] ASPECTS ≤5), yielding a positive interaction term (1.91 [95% CI, 1.01-3.63]). Sensitivity analyses regarding diffusion-weighed imaging versus noncontrast computed tomography ASPECTS did not alter the primary observations.

CONCLUSIONS

The extent of early ischemia may influence relative risks of sICH in IVT+MT versus direct MT patients, with an excess sICH risk in IVT+MT patients with low ASPECTS. If confirmed in post hoc analyses of randomized controlled trial data, IVT may be administered more carefully in patients with low ASPECTS eligible for and with direct access to MT.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Kaesmacher, Johannes; Meinel, Thomas Raphael; Piechowiak, Eike Immo; Seiffge, David Julian; Heldner, Mirjam Rachel; Grunder, Lorenz Nicolas; Arnold, Marcel; Dobrocky, Tomas; Gralla, Jan; Mordasini, Pasquale and Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1524-4628

Publisher:

American Heart Association

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

16 Feb 2021 08:35

Last Modified:

24 Feb 2021 09:55

Publisher DOI:

10.1161/STROKEAHA.120.030508

PubMed ID:

33504188

Uncontrolled Keywords:

brain infarction hemorrhage ischemic stroke thrombectomy tissue-type plasminogen activator

BORIS DOI:

10.48350/151737

URI:

https://boris.unibe.ch/id/eprint/151737

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