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

Author:

Alexandre Andrea MORCID,Scarcia LucaORCID,Brunetti ValerioORCID,Scala IreneORCID,Kalsoum Erwah,Valente IacopoORCID,Camilli Arianna,De Leoni Davide,Colò FrancescaORCID,Frisullo GiovanniORCID,Piano Mariangela,Rollo Claudia,Macera Antonio,Ruggiero MariaORCID,Lafe Elvis,Gabrieli Joseph D,Cester Giacomo,Limbucci Nicola,Arba FrancescoORCID,Ferretti Simone,Da Ros ValerioORCID,Bellini Luigi,Salsano Giancarlo,Mavilio Nicola,Russo RiccardoORCID,Bergui Mauro,Caragliano Antonio A,Vinci Sergio L,Romano Daniele G,Frauenfelder GiuliaORCID,Semeraro VittorioORCID,Ganimede Maria PORCID,Lozupone Emilio,Romi Andrea,Cavallini Anna,Milonia LucaORCID,Muto Massimo,Giordano Flavio,Cirillo Luigi,Calabresi PaoloORCID,Pedicelli AlessandroORCID,Broccolini AldobrandoORCID

Abstract

BackgroundThe 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.MethodsThe 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.ResultsIn 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.ConclusionIn 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.

Funder

Ricerca Corrente Reti IRCCS 2022 - Rete IRCCS delle Neuroscienze e della Neuroriabilitazione – RIN, Istituto Virtuale Nazionale Malattie Cerebrovascolari

Publisher

BMJ

Subject

Neurology (clinical),General Medicine,Surgery

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