Document Detail


Predictors of subarachnoid hemorrhage in acute ischemic stroke with endovascular therapy.
MedLine Citation:
PMID:  21051673     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) is a potential hemorrhagic complication after endovascular intracranial recanalization. The purpose of this study was to describe the frequency and predictors of SAH in acute ischemic stroke patients treated endovascularly and its impact on clinical outcome.
METHODS: Acute ischemic stroke patients treated with primary mechanical thrombectomy, intra-arterial thrombolysis, or both were analyzed. Postprocedural computed tomography and magnetic resonance images were reviewed to identify the presence of SAH. We assessed any decline in the National Institutes of Health Stroke Scale score 3 hours after intervention and in the outcomes at discharge.
RESULTS: One hundred twenty-eight patients were treated by primary thrombectomy with MERCI Retriever devices, whereas 31 were treated by primary intra-arterial thrombolysis. Twenty patients experienced SAH, 8 with pure SAH and 12 with coexisting parenchymal hemorrhages. SAH was numerically more frequent with primary thrombectomy than in the intra-arterial thrombolysis groups (14.1% vs 6.5%, P = 0.37). On multivariate analysis, independent predictors of SAH were hypertension (odds ratio = 5.39, P = 0.035), distal middle cerebral artery occlusion (odds ratio = 3.53, P = 0.027), use of rescue angioplasty after thrombectomy (odds ratio = 12.49, P = 0.004), and procedure-related vessel perforation (odds ratio = 30.72, P < 0.001). Patients with extensive SAH or coexisting parenchymal hematomas tended to have more neurologic deterioration at 3 hours (28.6% vs 0%, P = 0.11), to be less independent at discharge (modified Rankin Scale ≤ 2; 0% vs 15.4%, P = 0.5), and to experience higher mortality during hospitalization (42.9% vs 15.4%, P = 0.29).
CONCLUSIONS: Procedure-related vessel perforation, rescue angioplasty after thrombectomy with MERCI devices, distal middle cerebral artery occlusion, and hypertension were independent predictors of SAH after endovascular therapy for acute ischemic stroke. Only extensive SAH or SAH accompanied by severe parenchymal hematomas may worsen clinical outcome at discharge.
Authors:
Zhong-Song Shi; David S Liebeskind; Yince Loh; Jeffrey L Saver; Sidney Starkman; Paul M Vespa; Nestor R Gonzalez; Satoshi Tateshima; Reza Jahan; Lei Feng; Chad Miller; Latisha K Ali; Bruce Ovbiagele; Doojin Kim; Gary R Duckwiler; Fernando Viñuela;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-11-04
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  41     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-30     Completed Date:  2010-12-22     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2775-81     Citation Subset:  IM    
Affiliation:
Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095-7437, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Analysis of Variance
Angioplasty
Cerebral Angiography
Cerebral Revascularization / adverse effects
Ethnic Groups
Female
Humans
Hypertension / complications,  epidemiology
Image Interpretation, Computer-Assisted
Infarction, Middle Cerebral Artery / complications,  epidemiology
Magnetic Resonance Imaging
Male
Middle Aged
Risk Factors
Stents
Stroke / complications*,  epidemiology,  surgery
Subarachnoid Hemorrhage / epidemiology,  etiology*,  surgery
Thrombectomy / adverse effects*
Thrombolytic Therapy / adverse effects*
Tomography, X-Ray Computed
Treatment Outcome
Grant Support
ID/Acronym/Agency:
K23 NS054084-01A1/NS/NINDS NIH HHS
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