Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Natasha Ironside; Ching Jen Chen; Reda M. Chalhoub; Peter Wludyka; Ryan T. Kellogg; Sami Al Kasab; Dale Ding; Ilko Maier; Ansaar Rai; Pascal Jabbour; Joon Tae Kim; Stacey Q. Wolfe; Robert M. Starke; Marios Nikos Psychogios; Amir Shaban; Adam S. Arthur; Shinichi Yoshimura; Jonathan A. Grossberg; Ali Alawieh; Isabel Fragata; Adam J. Polifka; Justin R. Mascitelli; Joshua W. Osbun; Charles Matouk; Michael R. Levitt; Travis M. Dumont; Hugo H. Cuellar-Saenz; Richard Williamson; Daniele G. Romano; Roberto Javier Crosa; Benjamin Gory; Maxim Mokin; Mark Moss; Kaustubh Limaye; Peter Kan; Alejandro M. Spiotta; Min S. Park

doi:10.1136/jnis-2022-019513

Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Natasha Ironside, Ching Jen Chen, Reda M. Chalhoub, Peter Wludyka, Ryan T. Kellogg, Sami Al Kasab, Dale Ding, Ilko Maier, Ansaar Rai, Pascal Jabbour, Joon Tae Kim, Stacey Q. Wolfe, Robert M. Starke, Marios Nikos Psychogios, Amir Shaban, Adam S. Arthur, Shinichi Yoshimura, Jonathan A. Grossberg, Ali Alawieh, Isabel FragataAdam J. Polifka, Justin R. Mascitelli, Joshua W. Osbun, Charles Matouk, Michael R. Levitt, Travis M. Dumont, Hugo H. Cuellar-Saenz, Richard Williamson, Daniele G. Romano, Roberto Javier Crosa, Benjamin Gory, Maxim Mokin, Mark Moss, Kaustubh Limaye, Peter Kan, Alejandro M. Spiotta, Min S. Park

Neurosurgery

Research output: Contribution to journal › Article › peer-review

Abstract

Background Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy. Methods This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade. Results The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference. Conclusions This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.

Original language	English (US)
Pages (from-to)	E312-E322
Journal	Journal of neurointerventional surgery
Volume	15
Issue number	e2
DOIs	https://doi.org/10.1136/jnis-2022-019513
State	Published - Nov 1 2023

Keywords

Hemorrhage
Stroke
Thrombectomy
Thrombolysis

ASJC Scopus subject areas

Surgery
Clinical Neurology

Access to Document

10.1136/jnis-2022-019513

Cite this

Ironside, N., Chen, C. J., Chalhoub, R. M., Wludyka, P., Kellogg, R. T., Al Kasab, S., Ding, D., Maier, I., Rai, A., Jabbour, P., Kim, J. T., Wolfe, S. Q., Starke, R. M., Psychogios, M. N., Shaban, A., Arthur, A. S., Yoshimura, S., Grossberg, J. A., Alawieh, A., ... Park, M. S. (2023). Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR). Journal of neurointerventional surgery, 15(e2), E312-E322. https://doi.org/10.1136/jnis-2022-019513

Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR). / Ironside, Natasha; Chen, Ching Jen; Chalhoub, Reda M. et al.
In: Journal of neurointerventional surgery, Vol. 15, No. e2, 01.11.2023, p. E312-E322.

Research output: Contribution to journal › Article › peer-review

Ironside, N, Chen, CJ, Chalhoub, RM, Wludyka, P, Kellogg, RT, Al Kasab, S, Ding, D, Maier, I, Rai, A, Jabbour, P, Kim, JT, Wolfe, SQ, Starke, RM, Psychogios, MN, Shaban, A, Arthur, AS, Yoshimura, S, Grossberg, JA, Alawieh, A, Fragata, I, Polifka, AJ, Mascitelli, JR, Osbun, JW, Matouk, C, Levitt, MR, Dumont, TM, Cuellar-Saenz, HH, Williamson, R, Romano, DG, Crosa, RJ, Gory, B, Mokin, M, Moss, M, Limaye, K, Kan, P, Spiotta, AM & Park, MS 2023, 'Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)', Journal of neurointerventional surgery, vol. 15, no. e2, pp. E312-E322. https://doi.org/10.1136/jnis-2022-019513

@article{75b8a28e40334936819fde31a7d2279f,

title = "Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)",

abstract = "Background Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy. Methods This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade. Results The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference. Conclusions This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.",

keywords = "Hemorrhage, Stroke, Thrombectomy, Thrombolysis",

author = "Natasha Ironside and Chen, {Ching Jen} and Chalhoub, {Reda M.} and Peter Wludyka and Kellogg, {Ryan T.} and {Al Kasab}, Sami and Dale Ding and Ilko Maier and Ansaar Rai and Pascal Jabbour and Kim, {Joon Tae} and Wolfe, {Stacey Q.} and Starke, {Robert M.} and Psychogios, {Marios Nikos} and Amir Shaban and Arthur, {Adam S.} and Shinichi Yoshimura and Grossberg, {Jonathan A.} and Ali Alawieh and Isabel Fragata and Polifka, {Adam J.} and Mascitelli, {Justin R.} and Osbun, {Joshua W.} and Charles Matouk and Levitt, {Michael R.} and Dumont, {Travis M.} and Cuellar-Saenz, {Hugo H.} and Richard Williamson and Romano, {Daniele G.} and Crosa, {Roberto Javier} and Benjamin Gory and Maxim Mokin and Mark Moss and Kaustubh Limaye and Peter Kan and Spiotta, {Alejandro M.} and Park, {Min S.}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2023",

month = nov,

day = "1",

doi = "10.1136/jnis-2022-019513",

language = "English (US)",

volume = "15",

pages = "E312--E322",

journal = "Journal of neurointerventional surgery",

issn = "1759-8478",

publisher = "BMJ Publishing Group",

number = "e2",

}

TY - JOUR

T1 - Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke

T2 - Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

AU - Ironside, Natasha

AU - Chen, Ching Jen

AU - Chalhoub, Reda M.

AU - Wludyka, Peter

AU - Kellogg, Ryan T.

AU - Al Kasab, Sami

AU - Ding, Dale

AU - Maier, Ilko

AU - Rai, Ansaar

AU - Jabbour, Pascal

AU - Kim, Joon Tae

AU - Wolfe, Stacey Q.

AU - Starke, Robert M.

AU - Psychogios, Marios Nikos

AU - Shaban, Amir

AU - Arthur, Adam S.

AU - Yoshimura, Shinichi

AU - Grossberg, Jonathan A.

AU - Alawieh, Ali

AU - Fragata, Isabel

AU - Polifka, Adam J.

AU - Mascitelli, Justin R.

AU - Osbun, Joshua W.

AU - Matouk, Charles

AU - Levitt, Michael R.

AU - Dumont, Travis M.

AU - Cuellar-Saenz, Hugo H.

AU - Williamson, Richard

AU - Romano, Daniele G.

AU - Crosa, Roberto Javier

AU - Gory, Benjamin

AU - Mokin, Maxim

AU - Moss, Mark

AU - Limaye, Kaustubh

AU - Kan, Peter

AU - Spiotta, Alejandro M.

AU - Park, Min S.

PY - 2023/11/1

Y1 - 2023/11/1

N2 - Background Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy. Methods This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade. Results The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference. Conclusions This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.

AB - Background Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy. Methods This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade. Results The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference. Conclusions This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.

KW - Hemorrhage

KW - Stroke

KW - Thrombectomy

KW - Thrombolysis

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U2 - 10.1136/jnis-2022-019513

DO - 10.1136/jnis-2022-019513

M3 - Article

C2 - 36725360

AN - SCOPUS:85148663397

SN - 1759-8478

VL - 15

SP - E312-E322

JO - Journal of neurointerventional surgery

JF - Journal of neurointerventional surgery

IS - e2

ER -

Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Abstract

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