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  • Predictors of parenchymal hematoma and clinical outcome after mechanical thrombectomy in patients with large ischemic core due to large vessel occlusion: a retrospective multicenter study

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Ischemic stroke
Original research
Predictors of parenchymal hematoma and clinical outcome after mechanical thrombectomy in patients with large ischemic core due to large vessel occlusion: a retrospective multicenter study
  1. Andrea M Alexandre1,
  2. Luca Scarcia2,
  3. Valerio Brunetti3,
  4. Irene Scala4,
  5. Erwah Kalsoum2,
  6. Iacopo Valente1,
  7. Arianna Camilli4,
  8. Davide De Leoni4,
  9. Francesca Colò4,
  10. Giovanni Frisullo3,
  11. Mariangela Piano5,
  12. Claudia Rollo5,
  13. Antonio Macera5,
  14. Maria Ruggiero6,
  15. Elvis Lafe6,
  16. Joseph D Gabrieli7,
  17. Giacomo Cester7,
  18. Nicola Limbucci8,
  19. Francesco Arba9,
  20. Simone Ferretti10,
  21. Valerio Da Ros11,
  22. Luigi Bellini11,
  23. Giancarlo Salsano12,
  24. Nicola Mavilio12,
  25. Riccardo Russo13,
  26. Mauro Bergui13,
  27. Antonio A Caragliano14,
  28. Sergio L Vinci14,
  29. Daniele G Romano15,
  30. Giulia Frauenfelder15,
  31. Vittorio Semeraro16,
  32. Maria P Ganimede17,
  33. Emilio Lozupone18,
  34. Andrea Romi19,
  35. Anna Cavallini20,
  36. Luca Milonia21,
  37. Massimo Muto22,
  38. Flavio Giordano22,
  39. Luigi Cirillo23,24,
  40. Paolo Calabresi3,4,
  41. Alessandro Pedicelli1,4,
  42. Aldobrando Broccolini3,4
  1. 1Interventional Neuroradiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  2. 2Neuroradiology Unit, Henri Mondor Hospital, Creteil, France
  3. 3Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  4. 4Catholic University School of Medicine, Rome, Italy
  5. 5Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
  6. 6Neuroradiology Unit, Maurizio Bufalini Hospital, Cesena, Italy
  7. 7Neuroradiology Unit, Policlinico Universitario di Padova, Padua, Italy
  8. 8Interventional Neurovascular Unit, A.O.U. Careggi, Florence, Italy
  9. 9Stroke Unit, A.O.U. Careggi, Florence, Italy
  10. 10NEUROFARBA Department, University of Florence, Florence, Italy
  11. 11Department of Biomedicine and Prevention, University Hospital of Rome “Tor Vergata”, Rome, Italy
  12. 12Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genua, Italy
  13. 13Neuroradiology Unit, A.O. Città della Salute e della Scienza, Turin, Italy
  14. 14Neuroradiology Unit, A.O.U. Policlinico G. Martino, Messina, Italy
  15. 15Neuroradiology Unit, A.O.U. S. Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
  16. 16Interventional Radiology Unit, "SS Annunziata" Hospital, Taranto, Italy
  17. 17Neuroradiology Unit, "SS Annunziata" Hospital, Taranto, Italy
  18. 18Neuroradiology Unit, Vito Fazzi Hospital, Lecce, Italy
  19. 19Neuroradiology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
  20. 20Department of Emergency Neurology and Stroke Unit, IRCCS Fondazione Mondino, Rome, Italy
  21. 21Interventional Neuroradiology, University Hospital Policlinico Umberto I, Rome, Italy
  22. 22Neuroradiology Unit, Azienda Ospedaliera di Rilievo Nazionale "A. Cardarelli", Naples, Italy
  23. 23Neurology and Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna - Maggiore Hospital, Bolona, Italy
  24. 24Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, Bologna, Italy
  1. Correspondence to Dr Aldobrando Broccolini, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy; aldobrando.broccolini{at}policlinicogemelli.it

Abstract

Background The aim of our study was to find predictors of parenchymal hematoma (PH) and clinical outcome after mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO) and baseline large infarct.

Methods The databases of 16 stroke centers were retrospectively screened for patients with anterior circulation LVO and baseline Alberta Stroke Program Early CT Score (ASPECTS) ≤5 that received MT. Procedural parameters, including the number of passes during first and second technique of MT, were recorded. Outcome measures were occurrence of PH type 2 and any type of PH after MT, and the 90-day modified Rankin Scale (mRS) score of 0–3 and 0–2.

Results In total, 408 patients were available for analysis. A higher number of passes in the second technique was predictive of PH type 2 (odds ratio (OR) - 3.204, 95% confidence interval (CI) 1.140 to 9.005), whereas procedure conducted under general anesthesia was associated with lower risk (OR 0.127, 95% CI 0.002 to 0.808). The modified thrombolysis in cerebral infarction grade 2c-3 was associated with the mRS score 0–3 (OR 3.373, 95% CI 1.891 to 6.017), whereas occurrence of PH type 2 was predictive of unfavorable outcome (OR 0.221, 95% CI 0.063 to 0.773). Similar results were found for the mRS score 0–2 outcome measure.

Conclusion In patients with large ischemic core, a higher number of passes during MT and procedure not conducted under general anesthesia are associated with increased rate of PH type 2, that negatively impact the clinical outcome. Our data outline a delicate balance between the need of a complete recanalization and the risk of PH following MT.

  • Stroke
  • Intervention

Data availability statement

Data are available upon reasonable request. The anonymized data that support the results of this study are available on request from the corresponding author.

https://doi.org/10.1136/jnis-2023-021146

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    Data availability statement

    Data are available upon reasonable request. The anonymized data that support the results of this study are available on request from the corresponding author.

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    Footnotes

    • Twitter @abroccolini1

    • AMA and LS contributed equally.

    • Contributors AMA, LS, VB, IS, EK and AB contributed to the study concept or design, acquisition, analysis and interpretation of data and drafting/revision of the manuscript for content. IV, AC, DDL, GF, FC, MP, CR, AM, MR, EL, JDG, GC, NL, FA, SF, VDR, LB, GS, NM, RR, MB, AAC, SLV, DGR, GFra, VS, MPG, ELo, AR, ACav, LM, MM, FG, LC, contributed to the acquisition, analysis and interpretation of data and revision of the manuscript for content. AP and PC contributed to the study concept or design and to drafting/revision of the manuscript for content. AB is the guarantor.

    • Funding This work was supported by Ricerca Corrente Reti IRCCS 2022, RCR‐2022‐23682294, Rete IRCCS delle Neuroscienze e della Neuroriabilitazione – RIN, Istituto Virtuale Nazionale Malattie Cerebrovascolari.

    • Competing interests None declared.

    • 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.