Influence of intracranial hemorrhage on clinical outcome in acute vertebrobasilar artery occlusion undergoing endovascular treatment

N Li; M Hong; X Chen; W Sun; Z Chen; L Chen; S Li; H Ge; F Peng

doi:10.1016/j.neurol.2024.01.003

Influence of intracranial hemorrhage on clinical outcome in acute vertebrobasilar artery occlusion undergoing endovascular treatment

Rev Neurol (Paris). 2024 Mar 6:S0035-3787(24)00420-X. doi: 10.1016/j.neurol.2024.01.003. Online ahead of print.

Authors

N Li¹, M Hong², X Chen³, W Sun⁴, Z Chen², L Chen², S Li⁵, H Ge³, F Peng⁶

Affiliations

¹ The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China.
² Department of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
³ The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China; Department of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
⁴ Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
⁵ Department of Encephalopathy, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China.
⁶ The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China; Department of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. Electronic address: ppfeng@xmu.edu.cn.

PMID: 38453601
DOI: 10.1016/j.neurol.2024.01.003

Abstract

Background and purpose: The effect of intracranial hemorrhage (ICH) on the outcome of patients with large-vessel occlusion undergoing endovascular treatment (EVT) has mainly focused on the anterior circulation. Knowledge of the relationship between ICH and outcomes in patients with acute vertebrobasilar artery occlusion (VBAO) receiving EVT is limited. We aimed to assess whether ICH is a prognostic marker for acute VBAO following EVT.

Methods: Patients who underwent EVT for acute VBAO in the acute posterior circulation ischemic stroke (PERSIST) registry were included. All patients were classified as having no or any-ICH. Any-ICH was subdivided into asymptomatic and symptomatic ICH. A multivariate regression analysis was performed to evaluate the association between ICH and functional outcomes in patients with acute VBAO after receiving EVT.

Results: Five hundred and forty-seven patients, including 107 patients with ICH (19.6%): 38 (7.0%) and 69 (12.6%) with symptomatic and asymptomatic ICH, respectively. After adjustment for potential confounders, any-ICH was independently associated with reduced chance of favorable outcome (OR 0.39, 95% CI 0.21-0.72, P=0.003), functional independence (OR 0.24, 95% CI 0.16-0.52, P<0.001), and excellent outcome (OR 0.34, 95% CI 0.15-0.75, P=0.008), and increased mortality risk (OR 2.14, 95% CI 1.30-3.51, P=0.003). Symptomatic ICH had a similar association. Moreover, asymptomatic ICH was a negative predictor of functional independence (OR 0.39, 95% CI 0.17-0.88, P=0.024).

Conclusion: Any- and symptomatic ICH were strongly associated with worse clinical outcomes and increased mortality in patients with acute VBAO who underwent EVT. Asymptomatic ICH was an inverse predictor of functional independence.

Keywords: Endovascular treatment; Intracranial hemorrhages; Outcome; Vertebrobasilar artery occlusion.