Introduction: Hemorrhagic transformation is a serious complication after endovascular therapy for acute ischemic stroke (AIS). Compared to the number of patients who have hemorrhage on follow-up neuroimaging, a fraction of patients develop symptoms related to the hemorrhage.
Hypothesis: We sought to identify risk factors for developing symptomatic intracerebral hemorrhage (sICH) following endovascular therapy for AIS, as opposed to hemorrhage incidentally discovered on neuroimaging.
Methods: We retrospectively reviewed AIS patients from 2005 to 2013 treated with endovascular therapy and identified those with any intracranial hemorrhage on imaging obtained 24 hours after treatment. We identified univariate associations with sICH that had a p<0.2 and fitted a multivariable logistic regression to the outcome of sICH.
Results: Sixty-five patients had intracranial hemorrhage on imaging, 58% male, mean age 65 ± 13 years, mean admission NIHSS 17 ± 8, and 22/65 (34%) had sICH. In the univariate analysis, post-procedural TICI score, SBP standard deviation (SD) in the first 24 hours, and procedure length achieved significance, but only TICI score and SBP SD retained significance in the multivariable model (Table 1). Several univariates that were presumed to impact sICH proved uninformative (Table 2).
Conclusions: In AIS patients who undergo endovascular treatment and have subsequent intracranial hemorrhage, recanalization status and SBP variability are associated with sICH. The later association is novel and warrants further investigation.