Predictors of Hemorrhage After Endovascular Therapy : Findings From the Interrsect Study

Abstract

Background: While recent endovascular therapy trials have had a minimal number of adverse events, intracerebral hemorrhage (ICH) still occurs. The predictors of ICH with endovascular therapy remain unclear. We assessed predictors of hemorrhage following endovascular thrombectomy using data from the prospectively collected, multicenter INTERRSeCT study.

Methods: Patients undergoing endovascular therapy +/- intravenous alteplase (tPA) were enrolled and received baseline CT/CTA, follow-up CTA/Angiogram and 24-hr CT or MRI images. Primary outcome was any ICH as per the ECASS classification of hemorrhage. Secondary outcome was PH1/PH2 hemorrhages. We assessed the relations between ICH and baseline ASPECTS scoring, thrombus location, residual flow, collateralization, tPA use, and final recanalization state. Multivariable regression with stepwise selection was used to adjust for relevant covariates.

Results: Of 242 patients who met inclusion criteria, 58 (24%) had an ICH at 24 hours (HI1 53%, HI2 19%, PH1 7%, PH2 21%). Post-procedure hemorrhage was associated with lower ASPECTS scores (p<0.001), ICA (p=0.004), proximal M1 (p=0.008), and mid-M1 (p=0.002) thrombus locations, and serum glucose (7.6 vs. 6.7; p=0.027). When adjusted for covariates, lower ASPECTS score (OR: 1.41 per point lost; 95% CI: 0.57-0.88; p=0.002), mid-M1 thrombus location (OR: 2.03; 95% CI: 1.03-4.01; p=0.041), and serum glucose (OR:1.15, 95% CI: 1.01-1.35, p=0.033) independently predicted the presence of post-procedure ICH. PH1/PH2 hemorrhages were associated with ICA thrombus (OR:2.96, 95% CI:1.05-8.33, p=0.04) after adjusting for relevant covariates.

Conclusion: Early ischemia defined by imaging, mid-M1 thrombus location, and increased serum glucose are associated with increased risk of hemorrhage in patients undergoing combination tPA and endovascular therapy.