Prognosis and Predictors of Symptomatic Intracranial Hemorrhage After Endovascular Treatment of Large Vessel Occlusion Stroke

Huixin Shen; Qingfeng Ma; Liqun Jiao; Fei Chen; Sufang Xue; Jingya Li; Zhengping Li; Haiqing Song; Xiaoqin Huang

doi:10.3389/fneur.2021.730940

Prognosis and Predictors of Symptomatic Intracranial Hemorrhage After Endovascular Treatment of Large Vessel Occlusion Stroke

Front Neurol. 2022 Jan 21:12:730940. doi: 10.3389/fneur.2021.730940. eCollection 2021.

Authors

Huixin Shen¹, Qingfeng Ma¹, Liqun Jiao², Fei Chen¹, Sufang Xue¹, Jingya Li¹, Zhengping Li¹, Haiqing Song¹, Xiaoqin Huang¹

Affiliations

¹ Departments of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
² Departments of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Abstract

Background: Symptomatic intracranial hemorrhage (sICH) is a devastating complication of endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) and is associated with high risk of disability and mortality. This study intended to evaluate the predictors of sICH after EVT in patients with large vessel occlusion (LVO)-induced AIS.

Methods: We conducted a retrospective review on consecutive AIS patients who underwent EVT in our University hospital between January 2019 and August 2020. The patients were classified into two groups based upon the occurrence of sICH. The main outcomes were the occurrence of sICH using the Heidelberg Bleeding Classification and functional condition at 90 days. Multivariate logistic regression analysis and receiver operating characteristics (ROC) curves were used to identify independent predictors of sICH after EVT.

Results: Three hundred and 69 patients were enrolled in the study, of which 16.8% (n = 62) developed sICH. Favorable neurological outcome was lower in patients with sICH than in patients without sICH (6.5 vs. 43.3%; P < 0.001), with the overall mortality being 112 (30.4%) at 90 days post- EVT. Results from univariate analysis showed significant differences between the two groups in the prevalence of diabetes, initial Alberta Stroke Program Early CT Score (ASPECTS) score, National Institutes of Health Stroke Scale (NIHSS) score after operation, the levels of fasting blood glucose (FBG), neutrophil to lymphocyte ratio (NLR), platelets (PLT), and thrombin time (TT) at admission. Multivariate logistic regression analysis showed that FBG ≥ 7.54 mmol/L (OR: 2.765; 95% confidence interval [CI]: 1.513-5.054), NLR ≥ 5.48 (OR: 2.711; 95% CI: 1.433-5.128), TT at admission ≥ 16.25 s (OR: 2.022; 95% CI: 1.115-3.667), and NIHSS score within 24 h after the operation ≥ 10 (OR: 3.728; 95% CI: 1.516-9.170) were independent predictors of sICH. The combination of NLR ≥ 5.48, FBG ≥ 7.54 mmol/L, TT at admission ≥ 16.25 s, and NIHSS score within 24 h after the operation ≥ 10 generated an optimal prediction model (AUC: 0.723).

Conclusion: Higher levels of FDG, NLR, TT at admission, and NIHSS score after operation were associated with sICH after EVT in patients with LVO-induced AIS.

Keywords: acute ischemic stroke; endovascular treatment; large vessel occlusion; predictors; symptomatic intracranial hemorrhage.