Predictors of acute post-thrombectomy intracranial hemorrhage expansion in anterior circulation infarcts

• Published in: Interventional neuroradiology 2024-04, p.15910199241247884
• Main Authors: Bhamidipati, Akshay, Mummareddy, Nishit, Ahn, Seoiyoung, Bendfeldt, Gabriel, Lyons, Alexander T, Gangavarapu, Surya, Chen, Jeffrey, Jo, Jacob, Kamal, Naveed, Roth, Steven G, Froehler, Michael T, Chitale, Rohan V, Fusco, Matthew R
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 1591-0199; 2385-2011; 2385-2011
• DOI: 10.1177/15910199241247884

Post-mechanical thrombectomy (MT) intracranial hemorrhage (ICH) is a major source of morbidity in treated acute ischemic stroke patients with large vessel occlusion. ICH expansion may further contribute to morbidity. We sought to identify factors associated with ICH expansion on imaging evaluation post-MT. We performed a retrospective cohort study of patients undergoing MT at a single comprehensive stroke center. Per protocol, patients underwent dual-energy head CT (DEHCT) post-MT followed by a 24-h interval non-contrast enhanced MRI. ICH expansion was defined as any increase in blood volume between the two studies if identified on the DEHCT. Univariate and multivariable analyses were performed to identify risk factors for ICH expansion. ICH was identified on DEHCT in 13% of patients (  = 35/262), with 20% (7/35) demonstrating expansion on interval MRI. The average increase in blood volume was 11.4 ml (SD 6.9). Univariate analysis identified anticoagulant usage (57% vs 14%,  = 0.03), petechial hemorrhage inside the infarct margins or intraparenchymal hematoma on DEHCT (ECASS-II HI2/PH1/PH2) (71% vs 14%,