PT  - JOURNAL ARTICLE
AU  - Wouter van der Steen
AU  - Nadinda A M van der Ende
AU  - Sven P R Luijten
AU  - Leon A Rinkel
AU  - Katinka R van Kranendonk
AU  - Henk van Voorst
AU  - Stefan D Roosendaal
AU  - Ludo F M Beenen
AU  - Jonathan M Coutinho
AU  - Bart J Emmer
AU  - Robert J van Oostenbrugge
AU  - Charles B L.M Majoie
AU  - Hester F Lingsma
AU  - Aad van der Lugt
AU  - Diederik W J Dippel
AU  - Bob Roozenbeek
ED  - ,
TI  - Type of intracranial hemorrhage after endovascular stroke treatment: association with functional outcome
AID  - 10.1136/jnis-2022-019474
DP  - 2022 Oct 19
TA  - Journal of NeuroInterventional Surgery
PG  - jnis-2022-019474
4099  - http://jnis.bmj.com/content/early/2022/10/19/jnis-2022-019474.short
4100  - http://jnis.bmj.com/content/early/2022/10/19/jnis-2022-019474.full
AB  - Background Intracranial hemorrhage (ICH) is a frequent complication after endovascular stroke treatment.Objective To assess the association of the occurrence and type of ICH after endovascular treatment (EVT) with functional outcome.Methods We analyzed data from the MR CLEAN-NO IV and MR CLEAN-MED trials. Both trials included adult patients with ischemic stroke with a large vessel occlusion in the anterior circulation, who were eligible for EVT. ICH was classified (1) as asymptomatic or symptomatic (concomitant neurological deterioration of ≥4 points on the NIHSS, or ≥2 points on 1 NIHSS item), and (2) according to the Heidelberg Bleeding Classification. We used multivariable ordinal logistic regression analyses to assess the association of the occurrence and type of ICH with the modified Rankin Scale score at 90 days.Results Of 1017 included patients, 331 (33%) had an asymptomatic ICH, and 90 (9%) had a symptomatic ICH. Compared with no ICH, both asymptomatic (adjusted common OR (acOR)=0.76; 95% CI 0.58 to 0.98) and symptomatic (acOR=0.07; 95% CI 0.04 to 0.14) ICH were associated with worse functional outcome. In particular, isolated parenchymal hematoma type 2 (acOR=0.37; 95% CI 0.14 to 0.95), combined parenchymal hematoma with hemorrhage outside infarcted brain tissue (acOR=0.17; 95% CI 0.10 to 0.30), and combined hemorrhages outside infarcted brain tissue (acOR=0.14; 95% CI 0.03 to 0.74) were associated with worse functional outcome than no ICH.Strength of the association of ICH with functional outcome depends on the type of ICH. Although the association is stronger for symptomatic ICH, asymptomatic ICH after EVT is also associated with worse functional outcome.Data are available upon reasonable request. De-identified data collected for the studies will be made available to others upon reasonable request. Data can be requested with a proposal at the website of the CONTRAST consortium (www.contrast-consortium.nl), or by sending an email to the corresponding author.