RT Journal Article SR Electronic T1 Clot Burden Score and Early Ischemia Predict Intracranial Hemorrhage following Endovascular Therapy JF American Journal of Neuroradiology JO Am. J. Neuroradiol. FD American Society of Neuroradiology DO 10.3174/ajnr.A6009 A1 V. Yogendrakumar A1 F. Al-Ajlan A1 M. Najm A1 J. Puig A1 A. Calleja A1 S.-I. Sohn A1 S.H. Ahn A1 R. Mikulik A1 N. Asdaghi A1 T.S. Field A1 A. Jin A1 T. Asil A1 J.-M. Boulanger A1 M.D. Hill A1 A.M. Demchuk A1 B.K. Menon A1 D. Dowlatshahi A1 , YR 2019 UL http://www.ajnr.org/content/early/2019/03/14/ajnr.A6009.abstract AB 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.aORadjusted ORCBSclot burden scoreEVTendovascular therapyICHintracranial hemorrhage