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Original research
Intraprocedural predictors of post-stent retriever thrombectomy subarachnoid hemorrhage in middle cerebral artery stroke
  1. Perry P Ng1,2,
  2. Theodore C Larson1,
  3. Christopher W Nichols1,
  4. Mark M Murray1,
  5. Karen L Salzman2,
  6. Richard H Smith1
  1. 1 Centura Health Neurosciences and Spine, Lakewood, Colorado, USA
  2. 2 University of Utah Health Sciences Center, Salt Lake City, Utah, USA
  1. Correspondence to Dr Perry P Ng, CHPG Neurosciences and Spine, St Anthony Hospital, Lakewood, CO 80228-1726, USA; perryng{at}


Background Stent retriever thrombectomy (SRT) in acute thromboembolic stroke can result in post-thrombectomy subarachnoid hemorrhage (PTSAH). Intraprocedural findings associated with PTSAH are not well defined.

Objective To identify angiographic findings and procedural factors during SRT that are associated with PTSAH.

Materials and methods This was a retrospective, observational cohort study of consecutive patients with middle cerebral artery (MCA) acute ischemic stroke treated with SRT. Inclusion criteria were: (1) age ≥18 years; (2) thromboembolic occlusion of the MCA; (3) at least one stent retriever pass beginning in an M2 branch; (4) postprocedural CT or MRI scan within 24 hours; (5) non-enhanced CT Alberta Stroke Program Early CT Score >5. Exclusion criteria included multi-territory stroke before SRT.

Results Eighty-five patients were enrolled; eight patients had PTSAH (group 1) and 77 did not (group 2). Baseline demographic and clinical characteristics were comparable between the two groups. In group 1, a significantly greater proportion of patients had more than two stent retriever passes (62.5% vs 18.2%, P=0.01), a stent retriever positioned ≥2 cm along an M2 branch (100% vs 30.2%, P=0.002), and the presence of severe iatrogenic vasospasm before SRT pass (37.5% vs 5.2%, P=0.02). One patient with PTSAH and associated mass effect deteriorated clinically.

Conclusions An increased number of stent retriever passes, distal device positioning, and presence of severe vasospasm were associated with PTSAH. Neurological deterioration with PTSAH can occur.

  • angiography
  • complication
  • hemorrhage
  • stroke
  • subarachnoid

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  • Contributors PPN: database creation, data mining, project planning, writing of first manuscript draft, guarantor. TCL, project planning, literature search, review of angiograms, proofreading of manuscript. CWN: met statisticians for data analysis, literature search, data mining. MMM: data mining, proofreading of manuscript. KLS: literature search, imaging CT and MRI review, proofreading of manuscript. RHS: institutional review board application and reviews, coordination of project with all authors, data mining, proofreading of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The research protocol was reviewed and approved by the Catholic Health Initiatives institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.