Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Concomitant Intracranial Hemorrhage.
Research article published in Clinical neuroradiology (2022)
Abstract
PURPOSE: Intravenous thrombolysis and mechanical thrombectomy (MT) are standard of care in patients with acute ischemic stroke due to large vessel occlusion. Data on MT in patients with intracranial hemorrhage prior to intervention is limited to anecdotal reports, as these patients were excluded from thrombectomy trials. METHODS: We analyzed patients from an observational multicenter cohort with acute ischemic stroke and endovascular treatment, the German Stroke Registry-Endovascular Treatment trial, with intracranial hemorrhage before MT. Baseline characteristics, procedural parameters and functional outcome at 90 days were analyzed and compared to a propensity score matched cohort. RESULTS: Out of 6635 patients, we identified 32 patients (0.5%) with acute ischemic stroke due to large vessel occlusion and preinterventional intracranial hemorrhage who underwent MT. Risk factors of intracranial hemorrhage were head trauma, oral anticoagulation and intravenous thrombolysis. Overall mortality was high (50%) but among patients with a premorbid modified Rankin scale (mRS) of 0-2 (n = 15), good clinical outcome (mRS 0-2) at 90 days was achieved in 40% of patients. Periprocedural and outcome results did not differ between patients with and without preinterventional intracranial hemorrhage. CONCLUSION: Preinterventional intracranial hemorrhage in acute ischemic stroke patients with large vessel occlusion is rare. The use of MT is technically feasible and a substantial number of patients achieve good clinical outcome, indicating that MT should not be withheld in patients with preinterventional intracranial hemorrhage.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Intravenous thrombolysis and mechanical thrombectomy (MT) are standard of care in patients with acute ischemic stroke due to large vessel occlusion. Data on MT in patients with intracranial hemorrhage prior to intervention is limited to anecdotal reports, as these patients were excluded from thrombectomy trials.
Why This Matters for Hirudotherapy
This multicenter observational study analyzed the German Stroke Registry-Endovascular Treatment cohort and identified 32 of 6,635 patients (0.5%) who had acute ischemic stroke from large-vessel occlusion together with intracranial hemorrhage before mechanical thrombectomy; overall mortality was high (50%), yet among those with a premorbid modified Rankin scale of 0-2, 40% achieved a good outcome, and periprocedural and outcome results did not differ from a propensity-matched comparison group, leading the authors to conclude thrombectomy should not be withheld in this setting. For ASH it illustrates the real-world clinical stakes of the clotting/bleeding axis the leech secretome research relates to, underscoring how thrombosis and hemorrhage frequently coexist and complicate management. This is a small, rare-subgroup cohort study in interventional stroke care with no connection to leeches or hirudotherapy; it is descriptive context, not evidence for any leech-based therapy.
Citation
Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Concomitant Intracranial Hemorrhage.
Weller et al. · Clinical neuroradiology, 2022
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