Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Natasha Ironside; Ching Jen Chen; Reda M. Chalhoub; Ryan T. Kellogg; Dale Ding; Ilko Maier; Sami Al Kasab; Pascal Jabbour; Joon Tae Kim; Stacey Q. Wolfe; Ansaar Rai; Robert M. Starke; Marios Nikos Psychogios; Amir Shaban; Adam S. Arthur; Shinichi Yoshimura; Jonathan A. Grossberg; Ali Alawieh; Isabel Fragata; Adam J. Polifka; Justin R. Mascitelli; Joshua W. Osbun; Charles Matouk; Michael R. Levitt; Travis M. Dumont; Hugo H. Cuellar-Saenz; Richard Williamson; Daniele G. Romano; Roberto Javier Crosa; Benjamin Gory; Maxim Mokin; Mark Moss; Kaustubh Limaye; Peter Kan; Alejandro M. Spiotta; Min S. Park

doi:10.1136/jnis-2022-019513

Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Natasha Ironside, Ching Jen Chen, Reda M. Chalhoub, Ryan T. Kellogg, Dale Ding, Ilko Maier, Sami Al Kasab, Pascal Jabbour, Joon Tae Kim, Stacey Q. Wolfe, Ansaar Rai, Robert M. Starke, Marios Nikos Psychogios, Amir Shaban, Adam S. Arthur, Shinichi Yoshimura, Jonathan A. Grossberg, Ali Alawieh, Isabel Fragata, Adam J. PolifkaJustin R. Mascitelli, Joshua W. Osbun, Charles Matouk, Michael R. Levitt, Travis M. Dumont, Hugo H. Cuellar-Saenz, Richard Williamson, Daniele G. Romano, Roberto Javier Crosa, Benjamin Gory, Maxim Mokin, Mark Moss, Kaustubh Limaye, Peter Kan, Alejandro M. Spiotta, Min S. Park

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy. Methods: This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade. Results: The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference. Conclusions: This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.

Original language	English (US)
Article number	019513
Journal	Journal of neurointerventional surgery
DOIs	https://doi.org/10.1136/jnis-2022-019513
State	Accepted/In press - 2023
Externally published	Yes

Keywords

Hemorrhage
Stroke
Thrombectomy
Thrombolysis

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1136/jnis-2022-019513

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Ironside, N., Chen, C. J., Chalhoub, R. M., Kellogg, R. T., Ding, D., Maier, I., Al Kasab, S., Jabbour, P., Kim, J. T., Wolfe, S. Q., Rai, A., Starke, R. M., Psychogios, M. N., Shaban, A., Arthur, A. S., Yoshimura, S., Grossberg, J. A., Alawieh, A., Fragata, I., ... Park, M. S. (Accepted/In press). Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR). Journal of neurointerventional surgery, [019513]. https://doi.org/10.1136/jnis-2022-019513

Ironside, N, Chen, CJ, Chalhoub, RM, Kellogg, RT, Ding, D, Maier, I, Al Kasab, S, Jabbour, P, Kim, JT, Wolfe, SQ, Rai, A, Starke, RM, Psychogios, MN, Shaban, A, Arthur, AS, Yoshimura, S, Grossberg, JA, Alawieh, A, Fragata, I, Polifka, AJ, Mascitelli, JR, Osbun, JW, Matouk, C, Levitt, MR, Dumont, TM, Cuellar-Saenz, HH, Williamson, R, Romano, DG, Crosa, RJ, Gory, B, Mokin, M, Moss, M, Limaye, K, Kan, P, Spiotta, AM & Park, MS 2023, 'Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)', Journal of neurointerventional surgery. https://doi.org/10.1136/jnis-2022-019513

@article{e30730442c3a453a8d88004f35f900a7,

title = "Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)",

abstract = "Background: Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy. Methods: This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade. Results: The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference. Conclusions: This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.",

keywords = "Hemorrhage, Stroke, Thrombectomy, Thrombolysis",

author = "Natasha Ironside and Chen, {Ching Jen} and Chalhoub, {Reda M.} and Kellogg, {Ryan T.} and Dale Ding and Ilko Maier and {Al Kasab}, Sami and Pascal Jabbour and Kim, {Joon Tae} and Wolfe, {Stacey Q.} and Ansaar Rai and Starke, {Robert M.} and Psychogios, {Marios Nikos} and Amir Shaban and Arthur, {Adam S.} and Shinichi Yoshimura and Grossberg, {Jonathan A.} and Ali Alawieh and Isabel Fragata and Polifka, {Adam J.} and Mascitelli, {Justin R.} and Osbun, {Joshua W.} and Charles Matouk and Levitt, {Michael R.} and Dumont, {Travis M.} and Cuellar-Saenz, {Hugo H.} and Richard Williamson and Romano, {Daniele G.} and Crosa, {Roberto Javier} and Benjamin Gory and Maxim Mokin and Mark Moss and Kaustubh Limaye and Peter Kan and Spiotta, {Alejandro M.} and Park, {Min S.}",

note = "Funding Information: The STAR registry currently receives funding from Penumbra, Stryker and Medtronic. MRL: Grants from the NIH (R01NS105692, R01NS088072, U24NS100654, UL1TR002319, R25NS079200) and the American Heart Association (18CDA34110295). Unrestricted educational grants from Medtronic, Stryker and Philips Volcano. Consultant for Medtronic. Minor equity/ownership interest in Proprio, Cerebrotech, Synchron. Adviser to Metis Innovative. JAG: Grants from the Georgia Research Alliance. Consultant for Cognition Medical. AMS: Research support from Penumbra, Stryker, Medtronic, and Siemens. Consultant for Penumbra, Stryker, Terumo, and Arsenal. MM: Consultant for Medtronic, and Cerenovus. Stock ownership in Serenity Medical, Synchron, and Endostream. RMS: Grants from the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, the NIH (R01NS111119-01A1, UL1TR002736, KL2TR002737), the National Center for Advancing Translational Sciences, the National Institute on Minority Health and Health Disparities, and Medtronic. Consultant for Penumbra, Abbott, Medtronic, InNeuroCo and Cerenovus. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2023",

doi = "10.1136/jnis-2022-019513",

language = "English (US)",

journal = "Journal of NeuroInterventional Surgery",

issn = "1759-8478",

publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke

T2 - Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

AU - Ironside, Natasha

AU - Chen, Ching Jen

AU - Chalhoub, Reda M.

AU - Kellogg, Ryan T.

AU - Ding, Dale

AU - Maier, Ilko

AU - Al Kasab, Sami

AU - Jabbour, Pascal

AU - Kim, Joon Tae

AU - Wolfe, Stacey Q.

AU - Rai, Ansaar

AU - Starke, Robert M.

AU - Psychogios, Marios Nikos

AU - Shaban, Amir

AU - Arthur, Adam S.

AU - Yoshimura, Shinichi

AU - Grossberg, Jonathan A.

AU - Alawieh, Ali

AU - Fragata, Isabel

AU - Polifka, Adam J.

AU - Mascitelli, Justin R.

AU - Osbun, Joshua W.

AU - Matouk, Charles

AU - Levitt, Michael R.

AU - Dumont, Travis M.

AU - Cuellar-Saenz, Hugo H.

AU - Williamson, Richard

AU - Romano, Daniele G.

AU - Crosa, Roberto Javier

AU - Gory, Benjamin

AU - Mokin, Maxim

AU - Moss, Mark

AU - Limaye, Kaustubh

AU - Kan, Peter

AU - Spiotta, Alejandro M.

AU - Park, Min S.

N1 - Funding Information: The STAR registry currently receives funding from Penumbra, Stryker and Medtronic. MRL: Grants from the NIH (R01NS105692, R01NS088072, U24NS100654, UL1TR002319, R25NS079200) and the American Heart Association (18CDA34110295). Unrestricted educational grants from Medtronic, Stryker and Philips Volcano. Consultant for Medtronic. Minor equity/ownership interest in Proprio, Cerebrotech, Synchron. Adviser to Metis Innovative. JAG: Grants from the Georgia Research Alliance. Consultant for Cognition Medical. AMS: Research support from Penumbra, Stryker, Medtronic, and Siemens. Consultant for Penumbra, Stryker, Terumo, and Arsenal. MM: Consultant for Medtronic, and Cerenovus. Stock ownership in Serenity Medical, Synchron, and Endostream. RMS: Grants from the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, the NIH (R01NS111119-01A1, UL1TR002736, KL2TR002737), the National Center for Advancing Translational Sciences, the National Institute on Minority Health and Health Disparities, and Medtronic. Consultant for Penumbra, Abbott, Medtronic, InNeuroCo and Cerenovus. Publisher Copyright: © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2023

Y1 - 2023

N2 - Background: Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy. Methods: This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade. Results: The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference. Conclusions: This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.

AB - Background: Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy. Methods: This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade. Results: The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference. Conclusions: This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.

KW - Hemorrhage

KW - Stroke

KW - Thrombectomy

KW - Thrombolysis

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UR - http://www.scopus.com/inward/citedby.url?scp=85148663397&partnerID=8YFLogxK

U2 - 10.1136/jnis-2022-019513

DO - 10.1136/jnis-2022-019513

M3 - Article

C2 - 36725360

AN - SCOPUS:85148663397

SN - 1759-8478

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

M1 - 019513

ER -

Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: Insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

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