Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Concomitant Intracranial Hemorrhage.

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Tytuł:: Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Concomitant Intracranial Hemorrhage.
Autorzy:: Weller JM; Section for Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
Meissner JN; Section for Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
Stösser S; Section for Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
Dorn F; Department of Neuroradiology, University Hospital Bonn, Bonn, Germany.
Petzold GC; Section for Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany.; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
Bode FJ; Section for Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany. .
Corporate Authors:: GSR-ET investigators
Źródło:: Clinical neuroradiology [Clin Neuroradiol] 2022 Sep; Vol. 32 (3), pp. 809-816. Date of Electronic Publication: 2022 Jan 06.
Typ publikacji:: Journal Article; Multicenter Study
Język:: English
Imprint Name(s):: Publication: 2011- : Heidelberg : Springer Heidelberg
Original Publication: 2010 : Munich : Springer Medizin
MeSH Terms:: Intracranial Hemorrhages*
Ischemic Stroke*
Thrombectomy*
Brain Ischemia ; Endovascular Procedures ; Humans ; Retrospective Studies ; Stroke ; Treatment Outcome
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Contributed Indexing:: Investigator: A Reich; O Nikoubashman; J Röther; B Eckert; M Braun; GF Hamann; E Siebert; CH Nolte; G Bohner; RM Eckert; J Borggrefe; P Schellinger; J Berrouschot; A Bormann; C Kraemer; H Leischner; M Petersen; F Stögbauer; T Boeck-Behrens; S Wunderlich; A Ludolph; KH Henn; C Gerloff; J Fiehler; G Thomalla; A Alegiani; JH Schäfer; F Keil; S Tiedt; L Kellert; C Trumm; U Ernemann; S Poli; J Liman; M Ernst; K Gröschel; T Uphaus
Keywords: Endovascular therapy; Intravenous thrombolysis; Large vessel occlusion; Mechanical thrombectomy; Stroke
Entry Date(s):: Date Created: 20220106 Date Completed: 20220830 Latest Revision: 20231103
Update Code:: 20240104
PubMed Central ID:: PMC9424164
DOI:: 10.1007/s00062-021-01128-9
PMID:: 34989816
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Purpose: Intravenous thrombolysis and mechanical thrombectomy (MT) are standard of care in patients with acute ischemic stroke due to large vessel occlusion. Data on MT in patients with intracranial hemorrhage prior to intervention is limited to anecdotal reports, as these patients were excluded from thrombectomy trials.
Methods: We analyzed patients from an observational multicenter cohort with acute ischemic stroke and endovascular treatment, the German Stroke Registry-Endovascular Treatment trial, with intracranial hemorrhage before MT. Baseline characteristics, procedural parameters and functional outcome at 90 days were analyzed and compared to a propensity score matched cohort.
Results: Out of 6635 patients, we identified 32 patients (0.5%) with acute ischemic stroke due to large vessel occlusion and preinterventional intracranial hemorrhage who underwent MT. Risk factors of intracranial hemorrhage were head trauma, oral anticoagulation and intravenous thrombolysis. Overall mortality was high (50%) but among patients with a premorbid modified Rankin scale (mRS) of 0-2 (n = 15), good clinical outcome (mRS 0-2) at 90 days was achieved in 40% of patients. Periprocedural and outcome results did not differ between patients with and without preinterventional intracranial hemorrhage.
Conclusion: Preinterventional intracranial hemorrhage in acute ischemic stroke patients with large vessel occlusion is rare. The use of MT is technically feasible and a substantial number of patients achieve good clinical outcome, indicating that MT should not be withheld in patients with preinterventional intracranial hemorrhage.
(© 2022. The Author(s).)

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