RT Journal Article
SR Electronic
T1 Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 120
OP 127
DO 10.1136/jnis-2023-021219
VO 17
IS 2
A1 Chen, Michael
A1 Joshi, Krishna C
A1 Kolb, Bradley
A1 Sitton, Clark W
A1 Pujara, Deep Kiritbhai
A1 Abraham, Michael G
A1 Ortega-Gutierrez, Santiago
A1 Kasner, Scott E
A1 Hussain, Shazam M
A1 Churilov, Leonid
A1 Blackburn, Spiros
A1 Sundararajan, Sophia
A1 Hu, Yin C
A1 Herial, Nabeel
A1 Arenillas, Juan F
A1 Tsai, Jenny P
A1 Budzik, Ronald F
A1 Hicks, William
A1 Kozak, Osman
A1 Yan, Bernard
A1 Cordato, Dennis
A1 Manning, Nathan W
A1 Parsons, Mark
A1 Hanel, Ricardo A
A1 Aghaebrahim, Amin
A1 Wu, Teddy
A1 Cardona Portela, Pere
A1 Gandhi, Chirag D
A1 Al-Mufti, Fawaz
A1 Perez de la Ossa, Natalia
A1 Schaafsma, Joanna
A1 Blasco, Jordi
A1 Sangha, Navdeep
A1 Warach, Steven
A1 Kleinig, Timothy J
A1 Johns, Hannah
A1 Shaker, Faris
A1 Abdulrazzak, Mohammad A
A1 Ray, Abhishek
A1 Sunshine, Jeffery
A1 Opaskar, Amanda
A1 Duncan, Kelsey R
A1 Xiong, Wei
A1 Al-Shaibi, Faisal K
A1 Samaniego, Edgar A
A1 Nguyen, Thanh N
A1 Fifi, Johanna T
A1 Tjoumakaris, Stavropoula I
A1 Jabbour, Pascal
A1 Mendes Pereira, Vitor
A1 Lansberg, Maarten G
A1 Sila, Cathy
A1 Bambakidis, Nicholas C
A1 Davis, Stephen
A1 Wechsler, Lawrence
A1 Albers, Gregory W
A1 Grotta, James C
A1 Ribo, Marc
A1 Hassan, Ameer E
A1 Campbell, Bruce
A1 Hill, Michael D
A1 Sarraj, Amrou
YR 2025
UL http://jnis.bmj.com/content/17/2/120.abstract
AB Background The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized.Methods SELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was examined.Results Of 351 included patients, 194 (55%) and 189 (54%) demonstrated intracranial and intracerebral hemorrhage, respectively, with a higher incidence in EVT (134 (75%) and 130 (73%)) versus medical management (MM) (60 (35%) and 59 (34%), both P<0.001). Hemorrhagic infarction type 1 (HBC=1a) and type 2 (HBC=1b) accounted for 93% of all hemorrhages. Parenchymal hematoma (PH) type 1 (HBC=1c) and type 2 (HBC=2) were observed in 1 (0.6%) EVT-treated and 4 (2.2%) MM patients. Symptomatic ICH (sICH) (SITS-MOST definition) was seen in 0.6% EVT patients and 1.2% MM patients. No trend for ICH with core volumes (P=0.10) or Alberta Stroke Program Early CT Score (ASPECTS) (P=0.74) was observed. Among EVT patients, the presence of any ICH did not worsen clinical outcome (modified Rankin Scale (mRS) at 90 days: 4 (3–6) vs 4 (3–6); adjusted generalized OR 1.00, 95% CI 0.68 to 1.47, P>0.99) or modify EVT treatment effect (Pinteraction=0.77).Conclusions ICH was present in 75% of the EVT population, but PH or sICH were infrequent. The presence of any ICH did not worsen functional outcomes or modify EVT treatment effect at 90-day follow-up. The high rate of hemorrhages overall still represents an opportunity for adjunctive therapies in EVT patients with a large ischemic core.The individual patient data will not be made available. After a written request to the corresponding author is reviewed and approved by the steering committee, statistical codes and outputs will be made available for the purpose of reproducing results.