{Reference Type}: Journal Article
{Title}: Impact of post-thrombectomy isolated subarachnoid hemorrhage on neurological outcomes in patients with anterior ischemic stroke - a retrospective single-center observational study.
{Author}: van Landeghem N;Ziegenfuß C;Demircioglu A;Dammann P;Jabbarli R;Haubold J;Forsting M;Wanke I;Köhrmann M;Frank B;Deuschl C;Li Y;
{Journal}: Neuroradiology
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jul 9
{Factor}: 2.995
{DOI}: 10.1007/s00234-024-03424-w
{Abstract}: <B>OBJECTIVE: </B>We aimed to investigate the impact of post-thrombectomy isolated subarachnoid hemorrhage (i-SAH) and other types of intracranial hemorrhage (o-ICH) on patient's neurological outcomes.<BR><B>METHODS: </B>Stroke data from 2018 to 2022 in a tertiary care center were retrospectively analyzed. Patients with large vessel occlusion from ICA to M2 branch were included. Post-thrombectomy intracranial hemorrhages at 24 h were categorized with Heidelberg Bleeding Classification. Neurological impairment of patients was continuously assessed at admission, at 24 h, 48 h and 72 h, and at discharge. Predictors of i-SAH and o-ICH were assessed.<BR><B>RESULTS: </B>297 patients were included. i-SAH and o-ICH were found in 12.1% (36/297) and 11.4% (34/297) of patients. Overall, NIHSS of i-SAH patients at discharge were comparable to o-ICH patients (median 22 vs. 21, p = 0.889) and were significantly higher than in non-ICH patients (22 vs. 7, p < 0.001). i-SAH often resulted in abrupt deterioration of patient's neurological symptoms at 24 h after thrombectomy. Compared to non-ICH patients, the occurrence of i-SAH was frequently associated with worse neurological outcome at discharge (median NIHSS increase of 4 vs. decrease of 4, p < 0.001) and higher in-hospital mortality (41.7% vs. 23.8%, p = 0.022). Regardless of successful reperfusion (TICI 2b/3), the beneficial impact of thrombectomy appeared to be outweighed by the adverse effect of i-SAH. Incomplete reperfusion and shorter time from symptom onset to admission were associated with higher probability of i-SAH, whereas longer procedure time and lower baseline ASPECTS were predictive for o-ICH occurrence.<BR><B>CONCLUSIONS: </B>Post-thrombectomy isolated subarachnoid hemorrhage is a common complication with significant negative impact on neurological outcome.