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Ischemic stroke
Original research
Acute ischemic stroke with or without asymptomatic intracranial hemorrhage after endovascular treatment: a propensity-score matching study
  1. Xiaoxi Zhang1,2,
  2. Fang Shen1,
  3. Luo Rui2,
  4. Liu Hanchen1,
  5. Hongjian Shen1,
  6. Xu Hongye1,
  7. Ge Manyue3,
  8. Weilong Hua1,
  9. Lei Zhang1,
  10. Yongxin Zhang1,
  11. Pengfei Xing1,
  12. Zifu Li1,
  13. Jianmin Liu1,
  14. Pengfei Yang1
    1. 1Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
    2. 2Institutes of Brain Science, Fudan University, Shanghai, China
    3. 3Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
    1. Correspondence to Dr Pengfei Yang; p.yang{at}vip.163.com; Professor Jianmin Liu; chstroke{at}163.com

    Abstract

    Background The long-term follow-up of asymptomatic intracranial hemorrhage (aICH) in patients with acute ischemic stroke after endovascular treatment (EVT) remains controversial.

    Objective

    To evaluate the potential effect of aICH in a real-world practice setting using a matched prospective database.

    Methods This observational cohort study enrolled patients between January 2015 and December 2022 in a prospective database. Eligible patients with occlusions in the anterior circulation were given endovascular treatment and achieved successful reperfusion. The primary outcome was functional independence (modified Rankin Scale (mRS) score 0–2). Propensity score (PS)-weighted multivariable logistic regression analyses were adjusted and were repeated in subsequent 1:1 PS-matched cohorts.

    Results 732 patients, 516 without any ICH and 216 with aICH, were included. 418 and 348 patients were identified after matching in the aICH substudy and hemorrhagic infarction type aICH substudy, respectively. In the postmatched population, patients with aICH had worse functional outcomes (mRS score 0–2) at 90 days than patients without any ICH (37.8% vs 55.5%: P<0.001). Worse functional outcomes were seen in patients with aICH who were older (OR=5.59 (95% CI 2.91 to 10.74)), had higher baseline National Institutes of Health Stroke Scale score (OR=6.80 (95% CI 3.72 to 12.43)), lower baseline Alberta Stroke Program Early CT Score (OR=2.08 (95% CI 1.23 to 3.51)), and who received general anesthesia (OR=3.37 (95% CI 1.92 to 5.90)).

    Conclusions This matched-control study largely confirmed that asymptomatic ICH after EVT is associated with worse functional outcomes, and the harmful effect is more significant in older patients and those with severe baseline clinical and radiological features.

    • Hemorrhage
    • Thrombectomy
    • CT

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/jnis-2024-022048

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • Contributors XZ, LR: study design, manuscript drafting, funding acquisition; FS: original data collection, methodology and software; LH, HS, XH, and GM: validation, resources; WH, LZ, YZ, PX, and LZ: sata curation; JL and PY: conceptualization, writing - review and editing, supervision and guarantee.

      • Funding This work was supported by Basic Experiment Funding of NMU grant number 2022QN052 and China Postdoctoral Science Foundation grant number 2023M740708.

      • 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.