Background and Purpose: Intracranial hemorrhage (ICH) presents as a major complication for patients undergoing endovascular treatment (EVT) for acute ischemic stroke (AIS). Our study aims to assess the risk and correlation with the number of passes with a stentriver involved in EVT and hemorrhagic transformation.
Methods: We utilized our endovascular database and analyzed all the patients admitted from 2012-2017, who underwent EVT with stentrievers. We collected baseline demographics, clinical characteristics, admission NIHSS, and modified Rankin Scale (mRS) at discharge, as well as groin puncture and recanalization times. The number of stentriver passes during each procedure as well as presence of ICH post procedure were recorded. A logistic regression analysis was done to determine the association between hemorrhagic transformation and number of passes.
Results: 277 patients (mean age 71.6 ± 12.6 years; 52% female) with AIS underwent EVT with stentrievers. There was no difference in baseline demographics. (Table 1) Of the 277 patients, 47 (17.0%) were diagnosed with ICH after EVT. Ninety-day mortality was higher in patients with ICH than in patients without ICH (15.7% vs 42.6%; P=.001). On multivariate analysis, the number of passes with a stentriever were not significantly associated with ICH after EVT (OR, 1.3; 95% CI, 0.89-1.9). There was no significant difference in rates of intracranial hemorrhage occurrence with ≥5 passes (OR, 5.0; 95% CI, 0.31-82.4).
Conclusions: Our study shows that endovascular treatment with multiple passes of a stentreiver does not increase the incidence of symptomatic hemorrhage in AIS, even up to 5 passes. Large prospective studies are warranted to study the factors that lead to hemorrhagic transformation in AIS.