title: Determinants of Intracranial Hemorrhage Occurrence and Outcome after Neurothrombectomy Therapy: Insights from the Solitaire FR With Intention For Thrombectomy Randomized Trial.
abstract: OBJECTIVE
  Intracranial hemorrhage is the most dreaded complication of neurothrombectomy therapy for acute ischemic stroke. The determinants of intracranial hemorrhage and its impact on clinical course remain incompletely delineated. The purpose of this study is to further investigate the clinical and procedural factors leading to intracranial hemorrhage and to define the clinical impact of different hemorrhagic subtypes.
  
  
  METHODS
  We analyzed data prospectively collected in the Solitaire FR With Intention for Thrombectomy randomized clinical trial. A multivariable logistic regression model was used to identify independent clinical, imaging, and procedural predictors of any intracranial hemorrhage and of 7 intracranial hemorrhage subtypes. Univariate analysis was used to determine the impact of each of the intracranial hemorrhage subtypes on clinical outcome.
  
  
  RESULTS
  Among the 144 enrolled patients, any radiologic intracranial hemorrhage (21.3% versus 38.2%, P = .035), symptomatic intracranial hemorrhage (1.1% versus 10.9%, P = .012), and subarachnoid hemorrhage (2.2% versus 12.7%, P = .027) occurred less frequently in the Solitaire FR than in the Merci retriever arms. The most common independent determinant of hemorrhage occurrence was rescue therapy with intra-arterial rtPA, which was associated with any intracranial hemorrhage and 4 subtypes and tended to be used more frequently in the Merci group (10.9% versus 3.4%; P = .09). Among the hemorrhage subtypes, basal ganglionic hemorrhage had the strongest impact on good clinical outcome at 90 days (OR, 0.30; P = .025) and was associated with higher reperfusion, prolonged time to treatment, and rescue therapy with intra-arterial rtPA.
  
  
  CONCLUSIONS
  Intracranial hemorrhage, especially subarachnoid and symptomatic intracerebral hemorrhage, occurs less frequently with the Solitaire FR than the Merci retriever, in part due to less frequent use of rescue therapy with intra-arterial rtPA. Basal ganglionic hemorrhage strongly affects clinical outcome and is distinctively related to late reperfusion.
authors: From the Department of Neurology (R.R., D.L., J.S.) Stroke Center (R.R., R.J., D.L., J.S.), University of California, Los Angeles, Los Angeles, California rudoray@gmail.com rraychev@mednet.ucla.edu.
authors: R
authors: R
authors: Raychev
authors: Division of Interventional Neuroradiology (R.J.) Stroke Center (R.R., R.J., D.L., J.S.), University of California, Los Angeles, Los Angeles, California.
authors: R
authors: R
authors: Jahan
authors: From the Department of Neurology (R.R., D.L., J.S.) Stroke Center (R.R., R.J., D.L., J.S.), University of California, Los Angeles, Los Angeles, California.
authors: D
authors: http://orcid.org/0000-0002-5109-8736
authors: D
authors: Liebeskind
authors: Oregon Stroke Center (W.C.), Oregon Health and Sciences University, Portland, Oregon.
authors: W
authors: W
authors: Clark
authors: Department of Neurology (R.G.N.), Emory University, Atlanta, Georgia.
authors: R G
authors: http://orcid.org/0000-0003-4532-153X
authors: RG
authors: Nogueira
authors: From the Department of Neurology (R.R., D.L., J.S.) Stroke Center (R.R., R.J., D.L., J.S.), University of California, Los Angeles, Los Angeles, California.
authors: J
authors: J
authors: Saver
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator