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  • The impact of general anesthesia, baseline ASPECTS, time to treatment, and IV tPA on intracranial hemorrhage after neurothrombectomy: pooled analysis of the SWIFT PRIME, SWIFT, and STAR trials

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Ischemic Stroke
Original research
The impact of general anesthesia, baseline ASPECTS, time to treatment, and IV tPA on intracranial hemorrhage after neurothrombectomy: pooled analysis of the SWIFT PRIME, SWIFT, and STAR trials
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  1. Radoslav Raychev1,
  2. Jeffrey L Saver2,
  3. Reza Jahan3,
  4. Raul G Nogueira4,
  5. Mayank Goyal5,
  6. Vitor M Pereira6,
  7. Jan Gralla7,
  8. Elad I Levy8,
  9. Dileep R Yavagal9,
  10. Christophe Cognard10,
  11. David S Liebeskind11
  1. 1 Department of Neurology and Comprehensive Stroke Center, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  2. 2 Division of Interventional Neuroradiology, University of California Los Angeles Medical Center, Los Angeles, California, USA
  3. 3 Grady Memorial Hospital Marcus Stroke & Neuroscience Center, Atlanta, Georgia, USA
  4. 4 Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  5. 5 Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  6. 6 Division of Neuroradiology, Medical Imaging, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
  7. 7 Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
  8. 8 Department of Neurosurgery, State University of New York, Buffalo, New York, USA
  9. 9 University of Miami and Jackson Memorial Hospitals, Miami, Florida, USA
  10. 10 Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France
  11. 11 Department of Neurology, University of California Los Angeles, Neurovascular Imaging Research Core, Los Angeles, California, USA
  1. Correspondence to Dr. Radoslav Raychev, Department of Neurology and Comprehensive Stroke Center, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA; rudoray{at}gmail.com

Abstract

Background Despite the proven benefit of neurothrombectomy, intracranial hemorrhage (ICH) remains the most serious procedural complication. The aim of this analysis was to identify predictors of different hemorrhage subtypes and evaluate their individual impact on clinical outcome.

Methods Pooled individual patient-level data from three large prospective multicenter studies were analyzed for the incidence of different ICH subtypes, including any ICH, hemorrhagic transformation (HT), parenchymal hematoma (PH), subarachnoid hemorrhage (SAH), and symptomatic intracranial hemorrhage (sICH). All patients (n=389) treated with the Solitaire device were included in the analysis. A multivariate stepwise logistic regression model was used to identify predictors of each hemorrhage subtype.

Results General anesthesia and higher baseline Alberta Stroke Program Early CT score (ASPECTS) were associated with a lower probability of any ICH (OR 0.36, p=0.003), (OR 0.80, p=0.032) and HT (OR 0.54, p=0.023), (OR 0.78, p=0.001), respectively. Longer time from onset to treatment was associated with a higher likelihood of HT (OR 1.08, p=0.001) and PH (OR 1.11, p=0.015). Intravenous tissue plasminogen activator (IV-tPA) was also a strong predictor of PH (OR 7.63, p=0.013). Functional independence at 90 days (modified Rankin Scale (mRS) 0–2) was observed significantly less frequently in all hemorrhage subtypes except SAH. None of the patients who achieved functional independence at 90 days had sICH.

Conclusions General anesthesia and smaller baseline ischemic core are associated with a lower probability of HT whereas IV-tPA and prolonged time to treatment increase the risk of PH after neurothrombectomy.

Trial registration numbers SWIFT-NCT01054560; post results, SWIFT PRIME-NCT01657461; post results, STAR-NCT01327989; post results.

  • acute stroke
  • anesthesia
  • intracranial hemorrhage
  • thrombectomy
  • IV TPA

https://doi.org/10.1136/neurintsurg-2019-014898

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    Footnotes

    • Contributors The main author interpreted the data, drafted the original manuscript version, reviewed all suggestions provided by all co-authors, approved the final version, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All co-authors provided substantial contribution to the interpretation of the provided data. All co-authors also contributed with revisions to the original draft, approved the final version of the manuscript, and agreed to be accountable for all aspects of the work.

    • Funding All three trials (STAR, SWIFT, and SWIFT PRIME) were funded by Medtronic Neurovascular.

    • Competing interests All co-authors are consultants for Medtronic Neurovascular.

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

    • Correction notice Since this article was first published online first, a change has been made to the conclusion section of the abstract.

    • Patient consent for publication Not required.

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