Introduction Intracranial hemorrhage (ICH) remains a major complication of endovascular thrombectomy for stroke. Both symptomatic ICH and asymptomatic ICH have been shown to portend a worse prognosis after thrombectomy in patients with ASPECTS >6. Incidence of ICH and its effect on the outcomes after endovascular thrombectomy for patients with large cores remains unknown. This study evaluated the incidence and effect of ICH in a subset analysis of the SELECT2 trial.
Methods SELECT2 was a prospective, randomized, controlled, open-label, adaptive, international trial to assess endovascular thrombectomy vs medical management in patients with a large core stroke (CT ASPECTS 3-5 and/or ischemic core volume ≥ 50ml) due to occlusion of the internal carotid artery or the first segment of the middle cerebral artery, who presented within 24 hours of last known well. We performed a subgroup analysis of SELECT2 data to understand baseline characteristics and outcomes associated with subjects experiencing any ICH, defined by the Heidelberg bleeding criteria (HBC).
Results A total of 352 patients were included– 172 received medical management (MM) and 180 received endovascular thrombectomy (EVT) plus medical management (EVT + MM). Any intracranial hemorrhage was observed in 34.9% (60/172) in the MM group versus 74.9% (134/180) of patients in the EVT + MM group (p<0.001). Hemorrhagic transformation (HBC 1a or 1b) accounted for 93% of the intracranial hemorrhages in both the MM group (56/60) and the EVT + MM group (125/134). Among those receiving EVT + MM, successful reperfusion was achieved in 75.6% (34/45) of patients without intracranial hemorrhage versus 81.3% (109/134) of patients with intracranial hemorrhage (p=0.40). Early neurological worsening occurred in 8.9% (4/45) of EVT + MM patients without intracranial hemorrhage versus 29.9% (40/134) with any intracranial hemorrhage (adj. RR: 2.67, 95% CI: 1.01-7.08, p=0.049). This; however, did not result in statistically significant differences in 90-day mRS scores (adj. GenOR: 0.88, 95% CI: 0.68-1.13, p=0.32), functional independence (adj RR: 1.10, 95% CI: 0.61-1.96, p=0.57), independent ambulation (adj. RR: 0.85, 95% CI: 0.61-1.20,p=0.36), or 90-day all-cause mortality (adj. RR: 1.09, 95% CI: 0.84-1.41, p=0.52) between patients with any intracranial hemorrhage versus those without, after adjusting for treatment modality, age, NIHSS, time from last known well to randomization, ASPECTS and ischemic core volume estimates.
Conclusion In a subset analysis of SELECT2 trial, patients receiving EVT had a higher rate of any intracranial hemorrhage when compared with those receiving medical management. Although EVT patients with ICH had a higher incidence of early neurological worsening, there was no difference in 90-day mRS, mortality and discharge dispositions between those with or without ICH.
Disclosures M. Chen: None. K. Joshi: None. B. Kolb: None. M. Hill: None. M. Abraham: None. A. Hassan: None. S. Ortega-Gutiérrez: None. M. Hussain: None. D. Pujara: None. C. Sitton: None. V. Pereira: None. M. Ribo: None. G. Albers: None. B. Campbell: None. A. Sarraj: None.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.