Predictors of subarachnoid hemorrhage in acute ischemic stroke with endovascular therapy.
OBJECTIVE
Subarachnoid hemorrhage (SAH) is a potential hemorrhagic complication after endovascular intracranial recanalization. The purpose of this study was to describe the frequency and predictors of SAH in acute ischemic stroke patients treated endovascularly and its impact on clinical outcome.


METHODS
Acute ischemic stroke patients treated with primary mechanical thrombectomy, intra-arterial thrombolysis, or both were analyzed. Postprocedural computed tomography and magnetic resonance images were reviewed to identify the presence of SAH. We assessed any decline in the National Institutes of Health Stroke Scale score 3 hours after intervention and in the outcomes at discharge.


RESULTS
One hundred twenty-eight patients were treated by primary thrombectomy with MERCI Retriever devices, whereas 31 were treated by primary intra-arterial thrombolysis. Twenty patients experienced SAH, 8 with pure SAH and 12 with coexisting parenchymal hemorrhages. SAH was numerically more frequent with primary thrombectomy than in the intra-arterial thrombolysis groups (14.1% vs 6.5%, P = 0.37). On multivariate analysis, independent predictors of SAH were hypertension (odds ratio = 5.39, P = 0.035), distal middle cerebral artery occlusion (odds ratio = 3.53, P = 0.027), use of rescue angioplasty after thrombectomy (odds ratio = 12.49, P = 0.004), and procedure-related vessel perforation (odds ratio = 30.72, P < 0.001). Patients with extensive SAH or coexisting parenchymal hematomas tended to have more neurologic deterioration at 3 hours (28.6% vs 0%, P = 0.11), to be less independent at discharge (modified Rankin Scale ≤ 2; 0% vs 15.4%, P = 0.5), and to experience higher mortality during hospitalization (42.9% vs 15.4%, P = 0.29).


CONCLUSIONS
Procedure-related vessel perforation, rescue angioplasty after thrombectomy with MERCI devices, distal middle cerebral artery occlusion, and hypertension were independent predictors of SAH after endovascular therapy for acute ischemic stroke. Only extensive SAH or SAH accompanied by severe parenchymal hematomas may worsen clinical outcome at discharge.
Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095-7437, USA.
Zhong-Song
ZS
Shi
David S
DS
Liebeskind
Yince
Y
Loh
Jeffrey L
JL
Saver
Sidney
S
Starkman
Paul M
PM
Vespa
Nestor R
NR
Gonzalez
Satoshi
S
Tateshima
Reza
R
Jahan
Lei
L
Feng
Chad
C
Miller
Latisha K
LK
Ali
Bruce
B
Ovbiagele
Doojin
D
Kim
Gary R
GR
Duckwiler
Fernando
F
Viñuela
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017130:Angioplasty; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000009:adverse effects; D005006:Ethnicity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D007090:Image Interpretation, Computer-Assisted; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D017131:Thrombectomy / Q000009:adverse effects*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome