Intracerebral hemorrhage risk after adjunct intraarterial thrombolysis in thrombectomy-treated acute ischemic stroke

Adnan I Qureshi; Yilun Huang; Ibrahim A Bhatti; Camilo R Gomez; Daniel F Hanley; Daniel E Ford; Ameer E Hassan; Thanh N Nguyen; Alejandro M Spiotta; Erol Veznedaroglu; Ronald F Budzik; Rishi Gupta; Raul G Nogueira; Antonin Krajina; Bruno Bartolini; Joey English; Blaise Baxter; David S Liebeskind

doi:10.1111/jon.13238

Intracerebral hemorrhage risk after adjunct intraarterial thrombolysis in thrombectomy-treated acute ischemic stroke

J Neuroimaging. 2024 Sep 22. doi: 10.1111/jon.13238. Online ahead of print.

Authors

Adnan I Qureshi^{1

2}, Yilun Huang¹, Ibrahim A Bhatti^{1

2}, Camilo R Gomez², Daniel F Hanley³, Daniel E Ford⁴, Ameer E Hassan⁵, Thanh N Nguyen⁶, Alejandro M Spiotta⁷, Erol Veznedaroglu⁸, Ronald F Budzik⁹, Rishi Gupta¹⁰, Raul G Nogueira¹¹, Antonin Krajina¹², Bruno Bartolini¹³, Joey English¹⁴, Blaise Baxter¹⁵, David S Liebeskind¹⁶

Affiliations

¹ Zeenat Qureshi Stroke Institutes, St Cloud, Minnesota, USA.
² Department of Neurology, University of Missouri, Columbia, Missouri, USA.
³ Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.
⁴ Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
⁵ Department of Neurology, Valley Baptist Medical Center Harlingen, Harlingen, Texas, USA.
⁶ Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
⁷ Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
⁸ Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
⁹ Department of Neuroradiology, Riverside Methodist Hospital, Columbus, Ohio, USA.
¹⁰ Department of Neurology, Wellstar Health System, Marietta, Georgia, USA.
¹¹ Department of Neurology, University of Pittsburgh Medical Center Stroke Institute, Pittsburgh, Pennsylvania, USA.
¹² Department of Radiology, Charles University, Hradec Králové, Czech Republic.
¹³ Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.
¹⁴ Department of Neurology, Sutter California Pacific Medical Center, San Francisco, California, USA.
¹⁵ Department of Radiology, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
¹⁶ Department of Neurology, UCLA Health, Los Angeles, California, USA.

PMID: 39307964
DOI: 10.1111/jon.13238

Abstract

Background and purpose: Intraarterial thrombolysis as an adjunct to mechanical thrombectomy is increasingly being considered to enhance reperfusion in acute ischemic stroke patients. Intraarterial thrombolysis may increase the risk of post-thrombectomy intracerebral hemorrhage (ICH) in certain patient subgroups.

Methods: We analyzed acute ischemic stroke patients treated with mechanical thrombectomy in a multicenter registry. The occurrence of any (asymptomatic and symptomatic) post-thrombectomy ICH was ascertained using standard definition requiring serial neurological examinations and computed tomographic scans acquired within 48 hours of the thrombectomy. We determined the risk of ICH in subgroups defined by clinical characteristics and the use of intravenous (IV) thrombolysis.

Results: A total of 146 (7.5%) patients received intraarterial thrombolysis among 1953 acute ischemic stroke patients who underwent mechanical thrombectomy. The proportion of patients who developed any ICH was 26 (17.8%) and 510 (28.2%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .006). The proportion of patients who developed symptomatic ICH was 4 (2.7%) and 30 (1.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .34). Among patients who received IV thrombolysis (n = 1042), the proportion of patients who developed any ICH was 9 (16.7%) and 294 (30.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .028). The risk was not different in strata defined by age, gender, location of occlusion, preprocedure National Institutes of Health Stroke Scale score, time interval between symptom onset and thrombectomy, Alberta Stroke Program Early CT Score, systolic blood pressure, and serum glucose concentrations.

Conclusions: In patients undergoing mechanical thrombectomy, the risk of any ICH and symptomatic ICH was not increased with intraarterial thrombolysis, including in those who had already received IV thrombolytics.

Keywords: intraarterial thrombolysis; intravenous thrombolysis; ischemic stroke; mechanical thrombectomy; multicenter registry.

Grants and funding

Stryker Neurovascular