Hemorrhages may not be as innocuous as previously thought, researchers say.
Asymptomatic intracranial hemorrhage (aSICH) after endovascular treatment for acute ischemic stroke reduces the likelihood of excellent functional outcomes, according to the results of a recent study published online in the Journal of NeuroInterventional Surgery.
“In Asian population, aSICH after thrombectomy may decrease the likelihood of an excellent functional outcome but does not influence favorable outcome and mortality at 90 days in patients with ischemic stroke due to large artery occlusion in the anterior circulation,” write researchers led by Yonggang Hao, MD (Jinling Hospital, Nanjing, China).
To date, research looking at aSICH has shown a variable effect on outcomes in this patient population. For the new study, Hao and colleagues sought to examine the effect of aSICH on 90-day functional outcomes in patients enrolled in the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry (ACTUAL), which includes 21 stroke centers in China. In all, 632 patients with endovascular treatment for acute ischemic stroke due to large artery occlusion were included.
Outcomes were compared between patients with aSICH (33.5%) and those without hemorrhage (50.5%) using CT scans performed within 72 hours of the endovascular procedure. Favorable outcomes were defined as an mRS score of 0, 1, or 2; and excellent outcomes was defined as a mRS score of 0 or 1.
The proportion of patients with excellent outcomes at 90 days was lower in patients with aSICH compared with those without hemorrhage (19.8% vs 37.9%; P < 0.001), as was the proportion with favorable outcomes (43.9% vs 56.1%; P = 0.006).
A multivariable analysis revealed that diabetes, atrial fibrillation, baseline serum glucose, baseline NIHSS, stroke etiology, and occlusion site were all associated with excellent outcomes.
Multivariable analysis also confirmed the lower ratio of excellent outcomes in patients with aSICH vs those with no hemorrhage (OR 0.53; 95% CI 0.33-0.84).
Worth Paying Attention
Prior research has shown that aSICH is more likely to occur in patients who undergo thrombectomy than those treated with medical management. According to the study, intracranial hemorrhage sometimes occurs because of mechanical damage to the vessel wall, a reperfusion lesion, or increased blood-brain barrier permeability, but is sometimes considered to be clinically innocuous.
However, according to the researchers, “considering the relatively higher incidence (33.5%) and negative impacts on functional outcomes in this study, aSICH after endovascular treatment may not be innocuous.”
“Although remaining asymptomatic at the time of detection, aSICH may undermine long-term neurological functions,” they conclude.
Sources:
Hao Y, Liu W, Wang H, et al. Prognosis of asymptomatic intracranial hemorrhage after endovascular treatment. J NeuroIntervent Surg. 2018;Epub ahead of print.
Disclosures:
Hao reports no relevant conflicts of interest.
