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Original research
Association of asymptomatic hemorrhage after endovascular stroke treatment with outcomes
  1. Michael J Feldman1,
  2. Steven Roth1,
  3. Matthew R Fusco1,
  4. Tapan Mehta2,
  5. Niraj Arora3,
  6. James E Siegler4,
  7. Matthew Schrag5,
  8. Shilpi Mittal5,
  9. Howard Kirshner5,
  10. Akshitkumar M. Mistry1,
  11. Shadi Yaghi6,
  12. Rohan V Chitale1,
  13. Pooja Khatri7,
  14. Eva A Mistry5
  1. 1 Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  2. 2 Interventional Neuroradiology and Neurology, Hartford Hospital, Hartford, Connecticut, USA
  3. 3 Neurology, University of Missouri, Columbia, Missouri, USA
  4. 4 Cooper Neurologic Institute, Cooper University Health Care, Camden, New Jersey, USA
  5. 5 Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  6. 6 Neurology, New York University Medical Center, New York, New York, USA
  7. 7 Neurology, University of Cincinnati, Cincinnati, Ohio, USA
  1. Correspondence to Dr Michael J Feldman, Neurosurgery, Vanderbilt University Medical Center, Nashville, TN 37232-2102, USA; michael.j.feldman{at}; Dr Eva A Mistry, Department of Neurology, Vanderbilt University, 2525 West End Ave, St 612, Nashville, Tennessee, USA; eva.a.mistry{at}


Background Intracerebral hemorrhage (ICH) occurs in ~20%–30% of stroke patients undergoing endovascular therapy (EVT). However, there is conflicting evidence regarding the effect of asymptomatic ICH (aICH) on post-EVT outcomes. We sought to evaluate the effect of aICH on immediate and 90-day post-EVT neurological outcomes.

Methods In this post-hoc analysis of the multicenter, prospective Blood Pressure after Endovascular Therapy (BEST) study we identified subjects with ICH following EVT. This population was divided into no ICH, aICH, and symptomatic ICH (sICH). Associations with 90-day modified Rankin Scale (mRS) dichotomized by functional independence (0–2 vs 3–6) and early neurological recovery (ENR) were determined using univariate/multivariate logistic regression models.

Results Of 485 patients enrolled in BEST, 446 had 90-day follow-up data available. 92 (20.6%) developed aICH, and 18 (4%) developed sICH. Compared with those without ICH, aICH was not associated with worse 90-day outcome or lower ENR (OR 0.84 [0.53–1.35], P=0.55, aOR 0.84 [0.48–1.44], P=0.53 for 90-day mRS 0–2; OR 0.77 [0.48–1.23], P=0.34, aOR 0.72 [0.43–1.22] for ENR). aICH was not associated with 90-day outcome or ENR in patients with mTICI ≥2 b (OR 0.78 [0.48–1.26], P=0.33 for 90-day mRS 0–2; OR 0.89 [0.69–1.12], P=0.15 for ENR). A higher proportion of patients with aICH had mTICI ≥2 b than those without ICH (97%vs 87%, P=0.01).

Conclusions aICH was not associated with worse outcomes in patients with large-vessel stroke treated with EVT. aICH was more frequent in patients with successful recanalization. Further validation of our findings in large cohort studies of EVT-treated patients is warranted.

  • stroke
  • thrombectomy
  • hemorrhage

Data availability statement

Data are available upon reasonable request to the corresponding authors.

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Data availability statement

Data are available upon reasonable request to the corresponding authors.

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  • Contributors All listed authors' contributions include the conception and design, acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, and final approval of the version published. Lead author MJF and senior author EAM take overall responsibility for the manuscript.

  • Funding This study was supported by the Society of Vascular and Interventional Neurology, University of Cincinnati Gardner Neuroscience Institute, National Institutes of Health/National Institute of Neurological Disorders and Stroke (U01 NS086872 and U10 NS086512), and National Center for Advancing Translational Sciences/Clinical and Translational Science Awards Program (UL1 TR002243).

  • Competing interests RVC receives research grants from Medtronic and Cerenovus. PK receives research grant support from Cerenovus. EAM reports grant support from NIH/NINDS (K23NS113858). Remaining authors have no disclosures.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.