Types of intraparenchymal hematoma as a predictor after revascularization in patients with anterior circulation acute ischemic stroke

Yusuke Morinaga; Kouhei Nii; Yusuke Takemura; Hayatsura Hanada; Kimiya Sakamoto; Yoko Hirata; Ritsurou Inoue; Jun Tsugawa; Satoshi Kimura; Kanako Kurihara; Yuji Tateishi; Toshio Higashi

doi:10.25259/SNI_792_2020

Types of intraparenchymal hematoma as a predictor after revascularization in patients with anterior circulation acute ischemic stroke

Surg Neurol Int. 2021 Mar 17:12:102. doi: 10.25259/SNI_792_2020. eCollection 2021.

Affiliations

¹ Department of Neurosurgery, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan.
² Stroke Center, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan.

Abstract

Background: Intracranial hemorrhage after revascularization for acute ischemic stroke is associated with poor outcomes. Few reports have examined the relationship between parenchymal hematoma after revascularization and clinical outcomes. This retrospective study aimed to investigate the risk factors and clinical outcomes of parenchymal hematoma after revascularization for acute ischemic stroke.

Methods: Ninety-three patients underwent revascularization for anterior circulation acute ischemic stroke. Patient characteristics and clinical outcomes were compared between patients with and without post procedural parenchymal hematoma using the following parameters: age, sex, occlusion location, presence of atrial fibrillation, diffusion-weighted imaging-Alberta stroke program early computed tomography score (DWI-ASPECTS), National Institute of Health Stroke Scale (NIHSS) score, recombinant tissue plasminogen activator, thrombolysis in cerebral infarction > 2b, door-to-puncture time, onset-to-recanalization time, number of passes, and modified Rankin Scale scores.

Results: Parenchymal hematomas were not significantly correlated with age, sex, occlusion location, atrial fibrillation, DWI-ASPECTS, NIHSS score, recombinant tissue plasminogen activator, thrombolysis in cerebral infarction > 2b, door-to-puncture time, onset-to-recanalization time, and number of passes, but were significantly correlated with poor clinical outcomes (P = 0.001) and absence of the anterior communicating artery evaluated using pre procedural time-of-flight magnetic resonance angiography (P = 0.03).

Conclusion: Parenchymal hematoma was a predictor of poor outcomes. In particular, the absence of the anterior communicating artery on pre procedural time-of-flight magnetic resonance angiography is a potential risk factor for parenchymal hematoma after revascularization for anterior circulation acute ischemic stroke.

Keywords: Cerebral hemorrhage; Cerebral revascularization; Cerebrovascular accident; Stroke; Thrombectomy.