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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 28:1391-1394, August 2007
DOI 10.3174/ajnr.A0575
© 2007 American Society of Neuroradiology

INTERVENTIONAL

Factors Predicting Hemorrhagic Complications after Multimodal Reperfusion Therapy for Acute Ischemic Stroke

N.A. Vora^a, R. Gupta^a,c, A.J. Thomas^b, M.B. Horowitz^b, A.H. Tayal^a, M.D. Hammer^a, K. Uchino^a, L.R. Wechsler^a and T.G. Jovin^a

^a Department of Neurology, Stroke Institute, University of Pittsburgh, Medical Center, Pittsburgh, Pa
^b Departments of Neurosurgery and Radiology, University of Pittsburgh, Medical Center, Pittsburgh, Pa
^c Department of Neurology, Michigan State University, East Lansing, Mich

Please address correspondence to Tudor G. Jovin, MD, Stroke Institute, 200 Lothrop St, Suite C-400, Pittsburgh, PA 15213; e-mail: jovintg{at}upmc.edu

BACKGROUND AND PURPOSE: We sought to find predictors for hemorrhagic complications in patients with acute ischemic stroke treated with multimodal endovascular therapy.

MATERIALS AND METHODS: We retrospectively reviewed patients with acute ischemic stroke treated with multimodal endovascular therapy from May 1999 to March 2006. We reviewed clinical and angiographic data, admission CT Alberta Stroke Programme Early CT Score (ASPECTS), and the therapeutic endovascular interventions used. Posttreatment CT scans were reviewed for the presence of a parenchymal hematoma or hemorrhagic infarction based on defined criteria. Predictors for these types of hemorrhages were determined by logistic regression analysis.

RESULTS: We identified 185 patients with a mean age of 65 ± 13 years and mean National Institutes of Health Stroke Scale score of 17 ± 4. Sixty-nine patients (37%) developed postprocedural hemorrhages: 24 (13%) parenchymal hematomas and 45 (24%) hemorrhagic infarctions. Patients with tandem occlusions (odds ratio [OR] 4.6 [1.4–6.5], P < .016), hyperglycemia (OR 2.8 [1.1–7.7], P < .043), or treated concomitantly with intravenous (IV) tissue plasminogen activator (tPA) and intra-arterial (IA) urokinase (OR 5.1 [1.1–25.0], P < .041) were at a significant risk for a parenchymal hematoma. Hemorrhagic infarction occurred significantly more in patients presenting with an ASPECTS 7 (OR 1.9 [1.3–2.7], P < .01).

CONCLUSIONS: Hemorrhagic infarctions are related to the extent of infarct based on presentation CT, whereas parenchymal hematomas are associated with the presence of tandem occlusions, hyperglycemia, and treatment with both IV tPA and IA urokinase in patients with acute stroke treated with multimodal endovascular therapy.