title: Predictors of Symptomatic Intracranial Hemorrhage after Endovascular Therapy in Acute Ischemic Stroke with Large Vessel Occlusion.
abstract: BACKGROUND
  The symptomatic intracranial hemorrhage (SICH) is a serious complication of endovascular therapy (EVT) in acute ischemic stroke (AIS) with large vessel occlusion. We aimed to clarify the predictors of SICH after EVT in patients with internal carotid artery (ICA) or proximal M1 segment of middle cerebral artery occlusions.
  
  
  METHODS
  Among 1442 AIS patients with large vessel occlusion admitted within 24 hours after onset between July 2010 and June 2011, 226 patients with ICA or proximal M1 occlusions were treated with EVT. SICH was defined as any type of intracranial hemorrhage with a decline in the National Institutes of Health Stroke Scale (NIHSS) score ≥4.
  
  
  RESULTS
  Of the 226 patients, 204 with sufficient data were analyzed. SICH was observed in 10 patients (4.9%). Baseline NIHSS score (22 versus 17), serum glucose level (206 mg/dL versus 140 mg/dL), and prior antiplatelet therapy (60.0% versus 21.7%) were significantly higher in patients with SICH than in those without (all P < .01). With receiver operating characteristic analyses, the optimal cutoff values for predicting SICH were NIHSS score ≥19 and serum glucose ≥160 mg/dL. In multivariate analysis, glucose level ≥160 mg/dL (odds ratio: 11.89; 95% confidence interval [CI]: 2.79-65.08), prior antiplatelet therapy (odds ratio: 8.03; 95% CI: 1.83-41.70), and NIHSS score ≥19 (odds ratio: 7.78; 95% CI: 1.63-59.44) were independent predictors of SICH.
  
  
  CONCLUSIONS
  Hyperglycemia, prior antiplatelet therapy, and high baseline NIHSS score were associated with SICH after EVT in AIS patients with ICA or proximal M1 occlusions.
authors.affiliation: Department of Neurology, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Sugiura
authors.affiliation: Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: yamagami-brain@umin.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamagami
authors.affiliation: Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Sakai
authors.affiliation: Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yoshimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D002545:Brain Ischemia / Q000150:complications; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications*; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D018709:Statistics, Nonparametric; D020521:Stroke / Q000209:etiology*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; antiplatelet therapy; endovascular therapy; hyperglycemia; large vessel occlusion; symptomatic intracranial hemorrhage