Intracranial Hemorrhage after Endovascular Revascularization for Acute Ischemic Stroke

Abstract

Objective: Intracranial hemorrhage (ICH) after endovascular revascularization (ER) for acute ischemic stroke is associated with poor outcome. In this study, we examined the risk factors for postoperative ICH in patients who underwent ER in our hospital.

Methods: We investigated the incidence/type of postoperative ICH and risk factors in 157 patients who underwent ER in our hospital from July 2011 to June 2015.

Results: Postoperative ICH, including asymptomatic ICH, was observed in 57 (36.3%) patients. Symptomatic ICH occurred in seven patients (4.5%). According to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study classification, hemorrhagic infarction type 2 and parenchymal hematoma type 2 were observed in 27 (47.4%) and 4 (7.0%) patients, respectively, of all patients with ICH. The frequency of patients with functional independence (score of 0–2 on the modified Rankin scale) 90 days after ER was significantly lower in patients with than without ICH (p <0.01). We performed a multivariate analysis of factors associated with postoperative ICH. The oral administration of anticoagulants prior to onset (p = 0.019; odds ratio [OR], 3.17; 95% confidence interval [CI], 1.22–8.54) and a prolonged onset-to-recanalization time (p = 0.043; OR, 1.11; 95% CI, 1.01–1.24) were associated with poor outcome.

Conclusion: ICH after ER may lead to an unfavorable outcome. Risk factors for ICH after ER included the oral administration of anticoagulants prior to onset and a prolonged onset-to-recanalization time.