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Ischemic Stroke
Original research
Prediction of intracranial hemorrhages after mechanical thrombectomy of basilar artery occlusion
  1. Ulf Neuberger1,
  2. Fatih Seker1,
  3. Silvia Schönenberger2,
  4. Simon Nagel2,
  5. Peter Arthur Ringleb2,
  6. Martin Bendszus1,
  7. Johannes Alex Rolf Pfaff1,
  8. Markus Alfred Möhlenbruch1
  1. 1Neuroradiology, University of Heidelberg, Heidelberg, Germany
  2. 2Neurology, University of Heidelberg, Heidelberg, Germany
  1. Correspondence to Dr. Markus Alfred Möhlenbruch, Neuroradiology, University of Heidelberg, Heidelberg 69120, Germany; markus.moehlenbruch{at}med.uni-heidelberg.de

Abstract

Background Mechanical thrombectomy (MT) achieves high recanalization rates in basilar artery occlusion (BAO). A severe complication of MT in BAO is intracranial hemorrhage (ICH). Yet, knowledge of risk factors for ICH after MT in BAO is limited.

Objective To evaluate clinical and procedural parameters of patients treated with MT owing to BAO to identify potential risk factors for ICH—in particular, symptomatic ICH (sICH), and assess their clinical relevance.

Methods We conducted a retrospective analysis of 101 consecutive patients presenting with BAO, who were treated with MT in our centre. Important clinical and procedural parameters were analysed as possible predictors for any ICH and sICH according to the Heidelberg Bleeding Classification using univariate tests and multivariate logistic regressions.

Results ICH occurred in 25 (24.8%) patients, with a total of 7 (6.9%) developing sICH. Treatment with glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors was independently associated with any ICH (OR=24.67, 95% CI 4.90 to 124.03) and sICH (OR=7.08, 95% CI 1.36 to 36.78). Also, a longer onset-to-recanalization time increased the risk of both any ICH (OR=1.17, 95% CI 1.07 to 1.31) and sICH (OR=1.22, 95% CI 1.08 to 1.42). Higher serum glucose levels were associated with a higher incidence of any ICH (OR=1.39, 95% CI 1.06 to 1.85) and a higher risk of a fatal outcome (OR=1.03, 95% CI 1.01 to 1.05).

Conclusion Administration of GPIIb/IIIa inhibitor during the course of MT of BAO was identified as an important risk factor in the development of any ICH and sICH.

  • basilar artery occlusion
  • intracranial hemorrhage
  • mechanical thrombectomy
  • endovascular recanalization
  • risk factors

https://doi.org/10.1136/neurintsurg-2019-014939

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    Footnotes

    • Contributors UN, JARP, and MAM conceived and designed the research. UN, FS, JARP, and MAM acquired and analyzed the data. UN performed the statistical analysis and prepared the first draft of the report. All authors made critical revisions of the manuscript for important intellectual content and approved the final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval The stroke database was approved by the local ethics committee. As this was a retrospective analysis, additional written informed consent was waived.

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

    • Data sharing statement Data are available upon reasonable request from the corresponding author.

    • Patient consent for publication Not required.