Background To date, there have not been any studies to evaluate the extent of blood loss and its significance in the hospital course of acute ischemic stroke (AIS) patients undergoing endovascular revascularization.

Objective The aim of this study was to evaluate the extent of peri-procedural blood loss measured by hemoglobin (Hb) and hematocrit (HCT), in AIS patients undergoing endovascular revascularization.

Design/methods Consecutive AIS patients in Grady Memorial Hospital were retrospectively analyzed. The AIS transfers from outside hospitals were excluded from this study given lack of available data about pre-procedure Hb/HCT levels. The HCT and Hb right before (PRE-HCT and PRE-Hb) and within 24 h after the endovascular procedure (POST-HCT and POST Hb) were recorded. Patients' demographic information, baseline NIHSS, site of occlusion, revascularization modalities, and the need for transfusion early after the procedure were documented. Descriptive statistics are provided.

Results Forty-one patients (age 68±14; 46% male) with large vessel occlusions were included (26 patients with M1 occlusion, nine patients with M2/3 occlusion, seven patients with ICA occlusion and two patients with basilar/PCA occlusions). The mean NIHSS was 18. Patients had PRE and POST HCT/Hb of 39.3±5.3/ 13.1±1.8 and 34.5±5.3/ 11.5±1.8, respectively. The extent of drop from PRE to POST HCT/Hb (4.7±3.6/1.5±1.2) was statistically significant (paired t-test, p<0.0001). Six patients (14.6%) had HCT/Hb drop >9.0/3.0. The type of device (Merci vs Penumbra) and use of IV or IA-tPA was not associated with any differences in HCT/Hb drop. Only one patient (PRE HCT/Hb:34.9/11.9; POST HCT/Hb:24.6/8.3) required blood transfusion.

Conclusions Our results suggest some extent of blood loss in endovascular management of acute stroke. However, clinically significant blood loss and blood transfusion requirement are uncommon. Future studies with higher number of patients are needed to further delineate this potential complication.

Competing interests A Noorian: None. S Rangaraju: None. K Owada: None. B Glenn: None. S Belagaje: None. A Anderson: None. M Frankel: None. R Gupta: Concentric Medical, Codman Neurovascular, CoAxia, and Rapid Medical. R Nogueira: Concentric Medical, ev3 Neurovascular, CoAxia, and Rapid Me.