TY - JOUR
T1 - Clinically Asymptomatic Hemorrhagic Conversion Is Associated with Need for Inpatient Rehabilitation After Mechanical Thrombectomy for Anterior Circulation Ischemic Stroke
AU - Hung, Alice
AU - Ejimogu, Emeka
AU - Ran, Kathleen
AU - Nair, Sumil
AU - Yang, Wuyang
AU - Lee, Ryan
AU - Yedavalli, Vivek
AU - Hillis, Argye
AU - Gailloud, Philippe
AU - Caplan, Justin
AU - Gonzalez, Fernando
AU - Xu, Risheng
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/6
Y1 - 2024/6
N2 - Background: Hemorrhagic conversion (HC) is a known complication after acute ischemic stroke (AIS) in patients undergoing mechanical thrombectomy (MT). Although symptomatic HC has been shown to lead to poor neurologic outcomes, the effect of asymptomatic HC (aHC) is unclear. This study aims to identify predictors of aHC and to determine the short-term outcomes. Methods: This is a single-institution retrospective study of patients with anterior circulation stroke (AIS) who underwent MT between January 2016 and September 2022. Radiographic HC was identified on postoperative imaging. Asymptomatic hemorrhage was defined as no acute neurologic decline attributable to imaging findings. Baseline characteristics, technical aspects, and outcomes were compared between aHC and no-HC groups. Logistic regression and multivariate analysis were performed. Results: A total of 615 patients underwent MT for AIS, of whom 496 met the inclusion criteria. A total of 235 patients (47.4%) had evidence of aHC. Diabetes mellitus (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.06–2.41; P = 0.03), hyperglycemia (OR, 1.01; 95% CI, 1.00–1.01; P = 0.002), greater number of passes (OR, 1.14; 95% CI, 1.00–1.31; P = 0.05), and longer time to reperfusion (OR, 1.02; 95% CI, 1.00–1.05; P = 0.05) were associated with aHC. Patients with aHC were significantly more likely to require rehabilitation, whereas those without HC were more likely to be discharged home (P < 0.001). There were no significant differences in long-term outcomes. Conclusions: HC occurred in up to half of patients who underwent MT for AIS, most of whom were clinically asymptomatic. Despite clinical stability, aHC was significantly associated with a greater need for inpatient rehabilitation. Predictors of aHC included hyperglycemia and a longer time to reperfusion.
AB - Background: Hemorrhagic conversion (HC) is a known complication after acute ischemic stroke (AIS) in patients undergoing mechanical thrombectomy (MT). Although symptomatic HC has been shown to lead to poor neurologic outcomes, the effect of asymptomatic HC (aHC) is unclear. This study aims to identify predictors of aHC and to determine the short-term outcomes. Methods: This is a single-institution retrospective study of patients with anterior circulation stroke (AIS) who underwent MT between January 2016 and September 2022. Radiographic HC was identified on postoperative imaging. Asymptomatic hemorrhage was defined as no acute neurologic decline attributable to imaging findings. Baseline characteristics, technical aspects, and outcomes were compared between aHC and no-HC groups. Logistic regression and multivariate analysis were performed. Results: A total of 615 patients underwent MT for AIS, of whom 496 met the inclusion criteria. A total of 235 patients (47.4%) had evidence of aHC. Diabetes mellitus (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.06–2.41; P = 0.03), hyperglycemia (OR, 1.01; 95% CI, 1.00–1.01; P = 0.002), greater number of passes (OR, 1.14; 95% CI, 1.00–1.31; P = 0.05), and longer time to reperfusion (OR, 1.02; 95% CI, 1.00–1.05; P = 0.05) were associated with aHC. Patients with aHC were significantly more likely to require rehabilitation, whereas those without HC were more likely to be discharged home (P < 0.001). There were no significant differences in long-term outcomes. Conclusions: HC occurred in up to half of patients who underwent MT for AIS, most of whom were clinically asymptomatic. Despite clinical stability, aHC was significantly associated with a greater need for inpatient rehabilitation. Predictors of aHC included hyperglycemia and a longer time to reperfusion.
KW - Hemorrhagic conversion
KW - Ischemic stroke
KW - Mechanical thrombectomy
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U2 - 10.1016/j.wneu.2024.03.102
DO - 10.1016/j.wneu.2024.03.102
M3 - Article
C2 - 38537791
AN - SCOPUS:85190723658
SN - 1878-8750
VL - 186
SP - e181-e190
JO - World neurosurgery
JF - World neurosurgery
ER -