Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial.

Journal: Journal of neurointerventional surgery

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Affiliated Institutions:  Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA. Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA. Rush University Medical Center, Chicago, Illinois, USA. Diagnostic & Interventional Imaging, UT Houston, Houston, Texas, USA. Neurology, University of Texas McGovern Medical School, Houston, Texas, USA. Neurology and Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA. Neuroloy, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. Cleveland Clinic Stroke Program, Cleveland Clinic, Cleveland Heights, Ohio, USA. University of Melbourne, Parkville, Victoria, Australia. Neurosurgery, University of Texas Medical School at Houston Vivian L Smith Department of Neurosurgery, Houston, Texas, USA. University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA. Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA. Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA. Stroke Unit, Neurology Department, Stroke Unit. Neurology Department. Universitary Hospital, Valladolid (Spain), Valladolid, Spain. Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA. Riverside Methodist Hospital, Columbus, Ohio, USA. OhioHealth Neurological Physicians, Riverside Methodist Hospital, Columbus, Ohio, USA. Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. The Royal Melbourne Hospital, Parkville, Victoria, Australia. Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia. Institute of Neurosciences, UNSW Prince of Wales Clinical School, Sydney, New South Wales, Australia. Liverpool Hospital, Liverpool, New South Wales, Australia. Baptist Health, Jacksonville, Florida, USA. Neurological Institute, Lyerley Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA. Neurology, Christchurch Hospital, Christchurch, Canterbury, New Zealand. Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain. Neurosurgery, Westchester Medical Center, Valhalla, New York, USA. Neurology and Neurosurgery, Westchester Medical Center, Valhalla, New York, USA. Stroke Unit, Department of Neurology, Hospital Germans Trias i Pujol, Barcelona, Spain. Medicine - Div. Neurology, Toronto Western Hospital, Toronto, Ontario, Canada. Neurointerventional Department C.D.I, Hospital Clinic de Barcelona, Barcelona, Spain. Kaiser Permanente Southern California, Los Angeles, California, USA. University of Texas at Austin Dell Seton Medical Center, Austin, Texas, USA. Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia. Cleveland Clinic, Cleveland, Ohio, USA. Neurological Surgery, University Hospitals, Cleveland, Ohio, USA. Radiology, University Hospitals-Case Medical Center, Cleveland, Ohio, USA. Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. Neurology, Boston University School of Medicine, Boston, Massachusetts, USA. Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada. Department of Neurology, Stanford Stroke Center, Stanford University, Stanford, California, USA. Neurological Institute, University Hospitals- Case Medical Center, Cleveland, Ohio, USA. Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA. University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA. Neurology & Neurological Sciences, Stanford University, Stanford, California, USA. Neurology, Memorial Hermann Hospital/UT Houston, Houston, Texas, USA. Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Spain. Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA. Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada. Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA Amrou.sarraj@uhhospitals.org.

Abstract summary 

The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized.SELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was examined.Of 351 included patients, 194 (55%) and 189 (54%) demonstrated intracranial and intracerebral hemorrhage, respectively, with a higher incidence in EVT (134 (75%) and 130 (73%)) versus medical management (MM) (60 (35%) and 59 (34%), both P<0.001). Hemorrhagic infarction type 1 (HBC=1a) and type 2 (HBC=1b) accounted for 93% of all hemorrhages. Parenchymal hematoma (PH) type 1 (HBC=1c) and type 2 (HBC=2) were observed in 1 (0.6%) EVT-treated and 4 (2.2%) MM patients. Symptomatic ICH (sICH) (SITS-MOST definition) was seen in 0.6% EVT patients and 1.2% MM patients. No trend for ICH with core volumes (P=0.10) or Alberta Stroke Program Early CT Score (ASPECTS) (P=0.74) was observed. Among EVT patients, the presence of any ICH did not worsen clinical outcome (modified Rankin Scale (mRS) at 90 days: 4 (3-6) vs 4 (3-6); adjusted generalized OR 1.00, 95% CI 0.68 to 1.47, P>0.99) or modify EVT treatment effect (P=0.77).ICH was present in 75% of the EVT population, but PH or sICH were infrequent. The presence of any ICH did not worsen functional outcomes or modify EVT treatment effect at 90-day follow-up. The high rate of hemorrhages overall still represents an opportunity for adjunctive therapies in EVT patients with a large ischemic core.

Authors & Co-authors:  Chen Joshi Kolb Sitton Pujara Abraham Ortega-Gutierrez Kasner Hussain Churilov Blackburn Sundararajan Hu Herial Arenillas Tsai Budzik Hicks Kozak Yan Cordato Manning Parsons Hanel Aghaebrahim Wu Cardona Portela Gandhi Al-Mufti Perez de la Ossa Schaafsma Blasco Sangha Warach Kleinig Johns Shaker Abdulrazzak Ray Sunshine Opaskar Duncan Xiong Al-Shaibi Samaniego Nguyen Fifi Tjoumakaris Jabbour Mendes Pereira Lansberg Sila Bambakidis Davis Wechsler Albers Grotta Ribo Hassan Campbell Hill Sarraj

Study Outcome 

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Statistics
Citations : 
Authors :  62
Identifiers
Doi : jnis-2023-021219
SSN : 1759-8486
Study Population
Male,Female
Mesh Terms
Other Terms
Complication;Hemorrhage;Stroke;Thrombectomy;Thrombolysis
Study Design
Study Approach
Country of Study
Publication Country
England