BACKGROUND AND PURPOSE: Intracranial hemorrhage is a known complication following endovascular thrombectomy. The radiologic characteristics of a CT scan may assist with hemorrhage risk stratification. We assessed the radiologic predictors of intracranial hemorrhage following endovascular therapy using data from the INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) study. MATERIALS AND METHODS: Patients undergoing endovascular therapy underwent baseline imaging, postprocedural angiography, and 24-hour follow-up imaging. The primary outcome was any intracranial hemorrhage observed on follow-up imaging. The secondary outcome was symptomatic hemorrhage. We assessed the relationship between hemorrhage occurrence and baseline patient characteristics, clinical course, and imaging factors: baseline ASPECTS, thrombus location, residual flow grade, collateralization, and clot burden score. Multivariable logistic regression with backward selection was used to adjust for relevant covariates. RESULTS: Of the 199 enrolled patients who met the inclusion criteria, 46 (23%) had an intracranial hemorrhage at 24 hours. On multivariable analysis, postprocedural hemorrhage was associated with pretreatment ASPECTS (OR, 1.56 per point lost; 95% CI, 1.12-2.15), clot burden score (OR, 1.19 per point lost; 95% CI, 1.03-1.38), and ICA thrombus location (OR, 3.10; 95% CI, 1.07-8.91). In post hoc analysis, clot burden scores of ≤3 (sensitivity, 41%; specificity, 82%; OR, 3.12; 95% CI, 1.36-7.15) and pretreatment ASPECTS ≤ 7 (sensitivity, 48%; specificity, 82%; OR, 3.17; 95% CI, 1.35-7.45) robustly predicted hemorrhage. Residual flow grade and collateralization were not associated with hemorrhage occurrence. Symptomatic hemorrhage was observed in 4 patients. CONCLUSIONS: Radiologic factors, early ischemia on CT, and increased CTA clot burden are associated with an increased risk of intracranial hemorrhage in patients undergoing endovascular therapy.

Bezmialem Vakif Üniversitesi Nöroloji Istanbul Turkey

Calgary Stroke Program Department of Clinical Neurosciences University of Calgary Calgary Canada

Department of Medicine Charles LeMoyne Hospital Greenfield Park Canada

Department of Neurology Chosun University School of Medicine and Hospital Gwangju Republic of Korea

Department of Neurology Keimyung University Daegu Republic of Korea

Department of Neurology Miller School of Medicine University of Miami Miami Florida

Department of Neurology Stroke Unit Hospital Clínico Universitario de Valladolid Universidad de Valladolid Valladolid Spain

Department of Neurosciences King Faisal Specialist Hospital and Research Center Riyadh Saudi Arabia

Division of Neurology Queen's University Kingston Canada

Division of Neurology Vancouver Stroke Program University of British Columbia Vancouver Canada

From the Department of Medicine University of Ottawa and Ottawa Hospital Research Institute Ottawa Canada

Institut de Diagnostic per la Imatge Girona Biomedical Research Institute University Hospital Dr Josep Trueta Girona Spain

International Clinical Research Center St Anne's University Hospital Brno Czech Republic

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