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Risk analysis of post-procedural intracranial hemorrhage based on STAY ALIVE Acute Stroke Registry
Department of Neurology, University of Pecs, Medical School, Pecs, Hungary.
Department of Neurology, University of Pecs, Medical School, Pecs, Hungary.
Department of Neurology, University of Pecs, Medical School, Pecs, Hungary.
Department of Neurology, University of Pecs, Medical School, Pecs, Hungary.
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2020 (English)In: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 29, no 7, article id 104851Article in journal (Refereed) Published
Abstract [en]

Background: Intracranial hemorrhages (ICH) are classified as symptomatic or asymptomatic according to the presence of clinical deterioration. Here, we aimed to find predictive factors of symptomatic intracranial bleeding in a registry-based stroke research.

Methods: Data of consecutive patients with acute ischemic stroke (AIS) were extracted from the prospective STAY ALIVE stroke registry. Analysis of the total population and treatment sugroups such as endovascular thrombectomy (EVT), intravenous thrombolysis (IVT), or their combination (IVT+EVT) were also done. Outcome measures were ICH, 30- and 90-day clinical outcome based on the modified Rankin Scale (mRS:0-2 as favorable outcome). The hemorrhage was captured by a non-enhanced CT of the skull within 24 h after procedure.

Results: A total of 355 patients (mean age: 68 +/- 11; female N=177 (49.9%); EVT n=131 (36.9%); IVT n=157 (44.2%); IVT+EVT n=67 (18.9%) were included in the analysis. The total number of ICH was 47 (13%), symptomatic (sICH) 12 (3.4%) and asymptomatic (aICH) 35 (9.9%) in the whole population. NIHSS >= 15.5 at 24 post stroke hours predicted sICH with a sensitivity of 100% and a specificity of 92% (p<0.001). Furthermore, lower age, good collateral circulation on initial CT angiography and lower NIHSS score measured at 24 h independently associated with a favorable 90-day outcome, whereas baseline NIHSS and ASPECT score were not.

Conclusion: Although partial recanalization, ASPECT< 6, and poor collaterals were significantly associated with sICH, the only independent predictor was NIHSS >= 15.5 at 24 post stroke hours. This suggests a careful evaluation of patients with worsening NIHSS despite an adequate therapy.

Place, publisher, year, edition, pages
New York: Demos Publishing , 2020. Vol. 29, no 7, article id 104851
Keywords [en]
Collateral circulation, endovascular treatment, intracranial haemorrhage, ischemic stroke
National Category
Neurology
Identifiers
URN: urn:nbn:se:oru:diva-113268DOI: 10.1016/j.jstrokecerebrovasdis.2020.104851ISI: 000539258500003PubMedID: 32402722Scopus ID: 2-s2.0-85084480226OAI: oai:DiVA.org:oru-113268DiVA, id: diva2:1852403
Note

This study was supported by an Economic Development and Innovation Operative Programme Grant (GINOP-2.3.2-15-2016-00048).

Available from: 2024-04-18 Created: 2024-04-18 Last updated: 2024-04-18Bibliographically approved

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