title: Subarachnoid hemorrhage in a multimodal approach heavily weighted toward mechanical thrombectomy with solitaire stent in acute stroke.
abstract: OBJECTIVE
  Subarachnoid hemorrhage (SAH) may appear on computerized tomography scans after mechanical thrombectomy for acute ischemic stroke. The incidence and prognosis of this observation remain unknown. We investigated the frequency and clinical consequences of SAH after treating acute ischemic stroke with a multimodal approach heavily weighted toward mechanical thrombectomy with Solitaire stent.
  
  
  METHODS
  Seventy-four consecutive patients with acute ischemic stroke underwent mechanical thrombectomy with a Solitaire stent as a first-line treatment. Nonenhanced computerized tomography scans were performed before, immediately after, and 24 hours after treatment to detect SAH. Clinical outcome was assessed after treatment, on day 1, at discharge, and at 3 months. Clinical and radiological data were compared between patients with and without SAH.
  
  
  RESULTS
  Twelve patients (16.2%) exhibited SAH associated with pure SAH (n=4) or mixed SAH and contrast extravasation (n=8). The SAH was located in the ipsilateral Sylvian fissure (n=11) or bilateral parietooccipital sulci (n=1). Patients with SAH had no periprocedural vessel perforations or arterial dissections and no postprocedural neurological deteriorations. Rescue angioplasty was performed more frequently in SAH group than in control group (33.3% vs 9.7%; P=0.05). Patients with SAH and those without had similar recanalization rates and clinical outcomes.
  
  
  CONCLUSIONS
  SAH on post-therapeutic computerized tomography scans were not uncommon after primary mechanical thrombectomy with a Solitaire stent, but they seemed to be benign. Rescue angioplasty and unidentified, small vessel ruptures due to mechanical stretch during stent retrieval might give rise to these lesions.
authors.affiliation: Department of Radiology, Chonnam National University Hospital, 671 Jebong-Ro, Dong-gu, Gwangju, 501-757, South Korea. radyoon@jnu.ac.kr
authors.forename: Woong
authors.initials: W
authors.lastname: Yoon
authors.forename: Min Young
authors.initials: MY
authors.lastname: Jung
authors.forename: Se Hee
authors.initials: SH
authors.lastname: Jung
authors.forename: Man Seok
authors.initials: MS
authors.lastname: Park
authors.forename: Joon Tae
authors.initials: JT
authors.lastname: Kim
authors.forename: Heoung Keun
authors.initials: HK
authors.lastname: Kang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome