Abstract
BACKGROUND AND PURPOSE: Intracranial hemorrhage is a known complication following endovascular thrombectomy. The radiologic characteristics of a CT scan may assist with hemorrhage risk stratification. We assessed the radiologic predictors of intracranial hemorrhage following endovascular therapy using data from the INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) study. MATERIALS AND METHODS: Patients undergoing endovascular therapy underwent baseline imaging, postprocedural angiography, and 24-hour follow-up imaging. The primary outcome was any intracranial hemorrhage observed on follow-up imaging. The secondary outcome was symptomatic hemorrhage. We assessed the relationship between hemorrhage occurrence and baseline patient characteristics, clinical course, and imaging factors: baseline ASPECTS, thrombus location, residual flow grade, collateralization, and clot burden score. Multivariable logistic regression with backward selection was used to adjust for relevant covariates. RESULTS: Of the 199 enrolled patients who met the inclusion criteria, 46 (23%) had an intracranial hemorrhage at 24 hours. On multivariable analysis, postprocedural hemorrhage was associated with pretreatment ASPECTS (OR, 1.56 per point lost; 95% CI, 1.12–2.15), clot burden score (OR, 1.19 per point lost; 95% CI, 1.03–1.38), and ICA thrombus location (OR, 3.10; 95% CI, 1.07–8.91). In post hoc analysis, clot burden scores of 3 (sensitivity, 41%; specificity, 82%; OR, 3.12; 95% CI, 1.36–7.15) and pretreatment ASPECTS 7 (sensitivity, 48%; specificity, 82%; OR, 3.17; 95% CI, 1.35–7.45) robustly predicted hemorrhage. Residual flow grade and collateralization were not associated with hemorrhage occurrence. Symptomatic hemorrhage was observed in 4 patients. CONCLUSIONS: Radiologic factors, early ischemia on CT, and increased CTA clot burden are associated with an increased risk of intracranial hemorrhage in patients undergoing endovascular therapy.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 655-660 |
| Number of pages | 6 |
| Journal | American Journal of Neuroradiology |
| Volume | 40 |
| Issue number | 4 |
| DOIs | |
| State | Published - Jan 1 2019 |
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ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Clinical Neurology
Cite this
Clot burden score and early ischemia predict intracranial hemorrhage following endovascular therapy. / INTERRSeCT Investigators.
In: American Journal of Neuroradiology, Vol. 40, No. 4, 01.01.2019, p. 655-660.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Clot burden score and early ischemia predict intracranial hemorrhage following endovascular therapy
AU - INTERRSeCT Investigators
AU - Yogendrakumar, V.
AU - Al-Ajlan, F.
AU - Najm, M.
AU - Puig, J.
AU - Calleja, A.
AU - Sohn, S. I.
AU - Ahn, S. H.
AU - Mikulik, R.
AU - Asdaghi, Negar
AU - Field, T. S.
AU - Jin, A.
AU - Asil, T.
AU - Boulanger, J. M.
AU - Hill, M. D.
AU - Demchuk, A. M.
AU - Menon, B. K.
AU - Dowlatshahi, D.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - BACKGROUND AND PURPOSE: Intracranial hemorrhage is a known complication following endovascular thrombectomy. The radiologic characteristics of a CT scan may assist with hemorrhage risk stratification. We assessed the radiologic predictors of intracranial hemorrhage following endovascular therapy using data from the INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) study. MATERIALS AND METHODS: Patients undergoing endovascular therapy underwent baseline imaging, postprocedural angiography, and 24-hour follow-up imaging. The primary outcome was any intracranial hemorrhage observed on follow-up imaging. The secondary outcome was symptomatic hemorrhage. We assessed the relationship between hemorrhage occurrence and baseline patient characteristics, clinical course, and imaging factors: baseline ASPECTS, thrombus location, residual flow grade, collateralization, and clot burden score. Multivariable logistic regression with backward selection was used to adjust for relevant covariates. RESULTS: Of the 199 enrolled patients who met the inclusion criteria, 46 (23%) had an intracranial hemorrhage at 24 hours. On multivariable analysis, postprocedural hemorrhage was associated with pretreatment ASPECTS (OR, 1.56 per point lost; 95% CI, 1.12–2.15), clot burden score (OR, 1.19 per point lost; 95% CI, 1.03–1.38), and ICA thrombus location (OR, 3.10; 95% CI, 1.07–8.91). In post hoc analysis, clot burden scores of 3 (sensitivity, 41%; specificity, 82%; OR, 3.12; 95% CI, 1.36–7.15) and pretreatment ASPECTS 7 (sensitivity, 48%; specificity, 82%; OR, 3.17; 95% CI, 1.35–7.45) robustly predicted hemorrhage. Residual flow grade and collateralization were not associated with hemorrhage occurrence. Symptomatic hemorrhage was observed in 4 patients. CONCLUSIONS: Radiologic factors, early ischemia on CT, and increased CTA clot burden are associated with an increased risk of intracranial hemorrhage in patients undergoing endovascular therapy.
AB - BACKGROUND AND PURPOSE: Intracranial hemorrhage is a known complication following endovascular thrombectomy. The radiologic characteristics of a CT scan may assist with hemorrhage risk stratification. We assessed the radiologic predictors of intracranial hemorrhage following endovascular therapy using data from the INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) study. MATERIALS AND METHODS: Patients undergoing endovascular therapy underwent baseline imaging, postprocedural angiography, and 24-hour follow-up imaging. The primary outcome was any intracranial hemorrhage observed on follow-up imaging. The secondary outcome was symptomatic hemorrhage. We assessed the relationship between hemorrhage occurrence and baseline patient characteristics, clinical course, and imaging factors: baseline ASPECTS, thrombus location, residual flow grade, collateralization, and clot burden score. Multivariable logistic regression with backward selection was used to adjust for relevant covariates. RESULTS: Of the 199 enrolled patients who met the inclusion criteria, 46 (23%) had an intracranial hemorrhage at 24 hours. On multivariable analysis, postprocedural hemorrhage was associated with pretreatment ASPECTS (OR, 1.56 per point lost; 95% CI, 1.12–2.15), clot burden score (OR, 1.19 per point lost; 95% CI, 1.03–1.38), and ICA thrombus location (OR, 3.10; 95% CI, 1.07–8.91). In post hoc analysis, clot burden scores of 3 (sensitivity, 41%; specificity, 82%; OR, 3.12; 95% CI, 1.36–7.15) and pretreatment ASPECTS 7 (sensitivity, 48%; specificity, 82%; OR, 3.17; 95% CI, 1.35–7.45) robustly predicted hemorrhage. Residual flow grade and collateralization were not associated with hemorrhage occurrence. Symptomatic hemorrhage was observed in 4 patients. CONCLUSIONS: Radiologic factors, early ischemia on CT, and increased CTA clot burden are associated with an increased risk of intracranial hemorrhage in patients undergoing endovascular therapy.
UR - http://www.scopus.com/inward/record.url?scp=85064543051&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064543051&partnerID=8YFLogxK
U2 - 10.3174/ajnr.A6009
DO - 10.3174/ajnr.A6009
M3 - Article
C2 - 30872416
AN - SCOPUS:85064543051
VL - 40
SP - 655
EP - 660
JO - American Journal of Neuroradiology
JF - American Journal of Neuroradiology
SN - 0195-6108
IS - 4
ER -