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Abstract
Introduction The main aim of this study is to investigate the mechanistic and clinical factors contributing to the beneficial effect of Solitaire over Merci in lowering symptomatic intracranial haemorrhage (SICH) in the SWIFT trial. We also sought to determine which radiographic ICH subtype affects clinical outcome.
Methods The SWIFT trial database was analysed for incidence of different ICH subtypes in all 144 enrolled patients. Each ICH subtype was correlated with baseline clinical and imaging characteristics, procedural factors, and clinical outcome. Multivariate logistic regression model was used to identify the most significant predictors of the individual ICH subtypes.
Results Table
Among all analysed clinical and procedural factors for each ICH subtype, rescue therapy with TPA was the most common ICH predictor and occurred more frequently in the Merci group, although this difference was not statistically significant (10.9% vs 3.4%; p=0.085). Basal ganglia ICH was the only radiographic subtype associated with worsened outcome at 90 days (OR 3.33; p=0.025). SICH was associated with higher mortality (OR 5.73; p=0.048), mRS shift (OR 2.41; p=0.011), and high NIHSS (mean effect 22.35 points; p=0.004) at 90 days.
Conclusions
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The higher rate of ICH in the Merci arm was mainly related to increased occurrence of SAH, and to a lesser degree of IVH, PH2, and cortical ICH. Each one of these ICH subtypes was strongly associated with TPA rescue therapy. In comparison to Merci device, Solitaire likely offsets SICH due to lower incidence of vascular injury and decreased need for additional TPA administration.
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Other predictors of PH2, SAH, and SICH were high baseline INR, ASPECTS, and NIHSS, respectively, none of which differed between the two treatment arms.
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Basal ganglia ICH was the only radiographic subtype affecting clinical outcome. This type of haemorrhage was associated with higher reperfusion, prolonged time to treatment, and was also influenced by rescue therapy with TPA.
Disclosures R. Raychev: None. R. Jahan: 2; C; Stryker Neurovascular. D. Liebesekind: 2; C; Stryker Neurovascular. J. Saver: 2; C; Stryker Neurovascular.