Hemorrhagic transformation in acute ischemic stroke: hemorrhagic subtypes and symptomatic intracranial hemorrhage

BACKGROUND: Few clinical studies perform detailed analyses of subtypes of intracranial hemorrhage (ICH) after mechanical thrombectomy (MT) used to treat acute ischemic stroke. Symptomatic intracranial hemorrhage (sICH) is a formidable complication of MT and is widely used in clinical trials as a saf...

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Autores: Luff, Marie K, Khezri, Nicole, Miralbes, Salvador, Naravetla, Bharath, Spiotta, Alejandro M, Loehr, Christian, Martínez-Galdámez, Mario, McTaggart, Ryan A, Defreyne, Luc, Vega, Pedro, Zaidat, Osama O, Price, Lori Lyn, Gupta, Rishi, Möhlenbruch, Markus A, Liebeskind, David S
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Conselleria de Salut i Consum del Govern de les Illes Balears
Repositorio:Docusalut
Idioma:inglés
OAI Identifier:oai:docusalut.com:20.500.13003/25448
Acceso en línea:https://hdl.handle.net/20.500.13003/25448
Access Level:acceso abierto
Palabra clave:Hemorrhage
Stroke
Thrombectomy
Hemorragia
Accidente Cerebrovascular
Trombectomía
Device
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spelling Hemorrhagic transformation in acute ischemic stroke: hemorrhagic subtypes and symptomatic intracranial hemorrhageLuff, Marie KKhezri, NicoleMiralbes, SalvadorNaravetla, BharathSpiotta, Alejandro MLoehr, ChristianMartínez-Galdámez, MarioMcTaggart, Ryan ADefreyne, LucVega, PedroZaidat, Osama OPrice, Lori LynGupta, RishiMöhlenbruch, Markus ALiebeskind, David SHemorrhageStrokeThrombectomyHemorragiaAccidente CerebrovascularTrombectomíaDeviceHemorrhageStrokeThrombectomyBACKGROUND: Few clinical studies perform detailed analyses of subtypes of intracranial hemorrhage (ICH) after mechanical thrombectomy (MT) used to treat acute ischemic stroke. Symptomatic intracranial hemorrhage (sICH) is a formidable complication of MT and is widely used in clinical trials as a safety outcome. However, variable definitions of sICH are used across clinical studies. OBJECTIVE: To radiographically subcategorize post-MT ICH development within this large cohort and examine overlap with sICH. Second, to examine the agreement of this definition of sICH with local site-reported occurrences of sICH to see how sICH rates change with modifications of the definitions used. METHODS: A large cohort of patients treated with MT for acute ischemic stroke (n=1395) was analyzed to (1) radiographically characterize hemorrhagic subtypes of intracranial hemorrhage (ICH) occurring after MT; (2) examine associations of hemorrhagic subtypes with sICH; and (3) compare core laboratory-adjudicated occurrences of sICH with site-reported sICH. RESULTS: The overall rate of ICH was 552/1395 patients (39.6%), and the overall rate of sICH was 47/1395 (3.4%). The most common type of ICH was hemorrhagic infarction type 1 (HI1), which represented 45.3% of all ICH cases- followed by HI2 (31.5%) and subarachnoid hemorrhage (SAH, 29.2%). Parenchymal hematoma 2 (PH2) represented only 3.3% of all ICH cases. Of the PH2 hemorrhages, only 33.3% were determined to be symptomatic. Of sICH cases, the most common ICH subtypes were HI2 (48.9%) and SAH (38.3%). Comparison of sICH rates as determined by core laboratory adjudication versus local site-reported results showed that only 14 patients were identified as having sICH with both definitions, with 47 patients total with sICH according to one definition, but not the other. CONCLUSIONS: Results of this analysis demonstrate the radiographic subtypes of ICH and also highlight the limitations of variable criteria used to define sICH, suggesting that it might be appropriate to revisit how sICH is defined post-MT. TRIAL REGISTRATION NUMBER: Clinical trial NCT03845491.BMJ Journals20252025-06-1620252025-06-16research articlehttp://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/20.500.13003/25448reponame:Docusalutinstname:Conselleria de Salut i Consum del Govern de les Illes BalearsInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution-NonCommercial 4.0 Internationalhttp://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccessoai:docusalut.com:20.500.13003/254482026-06-22T12:44:07Z
dc.title.none.fl_str_mv Hemorrhagic transformation in acute ischemic stroke: hemorrhagic subtypes and symptomatic intracranial hemorrhage
title Hemorrhagic transformation in acute ischemic stroke: hemorrhagic subtypes and symptomatic intracranial hemorrhage
spellingShingle Hemorrhagic transformation in acute ischemic stroke: hemorrhagic subtypes and symptomatic intracranial hemorrhage
Luff, Marie K
Hemorrhage
Stroke
Thrombectomy
Hemorragia
Accidente Cerebrovascular
Trombectomía
Device
Hemorrhage
Stroke
Thrombectomy
title_short Hemorrhagic transformation in acute ischemic stroke: hemorrhagic subtypes and symptomatic intracranial hemorrhage
title_full Hemorrhagic transformation in acute ischemic stroke: hemorrhagic subtypes and symptomatic intracranial hemorrhage
title_fullStr Hemorrhagic transformation in acute ischemic stroke: hemorrhagic subtypes and symptomatic intracranial hemorrhage
title_full_unstemmed Hemorrhagic transformation in acute ischemic stroke: hemorrhagic subtypes and symptomatic intracranial hemorrhage
title_sort Hemorrhagic transformation in acute ischemic stroke: hemorrhagic subtypes and symptomatic intracranial hemorrhage
dc.creator.none.fl_str_mv Luff, Marie K
Khezri, Nicole
Miralbes, Salvador
Naravetla, Bharath
Spiotta, Alejandro M
Loehr, Christian
Martínez-Galdámez, Mario
McTaggart, Ryan A
Defreyne, Luc
Vega, Pedro
Zaidat, Osama O
Price, Lori Lyn
Gupta, Rishi
Möhlenbruch, Markus A
Liebeskind, David S
author Luff, Marie K
author_facet Luff, Marie K
Khezri, Nicole
Miralbes, Salvador
Naravetla, Bharath
Spiotta, Alejandro M
Loehr, Christian
Martínez-Galdámez, Mario
McTaggart, Ryan A
Defreyne, Luc
Vega, Pedro
Zaidat, Osama O
Price, Lori Lyn
Gupta, Rishi
Möhlenbruch, Markus A
Liebeskind, David S
author_role author
author2 Khezri, Nicole
Miralbes, Salvador
Naravetla, Bharath
Spiotta, Alejandro M
Loehr, Christian
Martínez-Galdámez, Mario
McTaggart, Ryan A
Defreyne, Luc
Vega, Pedro
Zaidat, Osama O
Price, Lori Lyn
Gupta, Rishi
Möhlenbruch, Markus A
Liebeskind, David S
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv
dc.subject.none.fl_str_mv Hemorrhage
Stroke
Thrombectomy
Hemorragia
Accidente Cerebrovascular
Trombectomía
Device
Hemorrhage
Stroke
Thrombectomy
topic Hemorrhage
Stroke
Thrombectomy
Hemorragia
Accidente Cerebrovascular
Trombectomía
Device
Hemorrhage
Stroke
Thrombectomy
description BACKGROUND: Few clinical studies perform detailed analyses of subtypes of intracranial hemorrhage (ICH) after mechanical thrombectomy (MT) used to treat acute ischemic stroke. Symptomatic intracranial hemorrhage (sICH) is a formidable complication of MT and is widely used in clinical trials as a safety outcome. However, variable definitions of sICH are used across clinical studies. OBJECTIVE: To radiographically subcategorize post-MT ICH development within this large cohort and examine overlap with sICH. Second, to examine the agreement of this definition of sICH with local site-reported occurrences of sICH to see how sICH rates change with modifications of the definitions used. METHODS: A large cohort of patients treated with MT for acute ischemic stroke (n=1395) was analyzed to (1) radiographically characterize hemorrhagic subtypes of intracranial hemorrhage (ICH) occurring after MT; (2) examine associations of hemorrhagic subtypes with sICH; and (3) compare core laboratory-adjudicated occurrences of sICH with site-reported sICH. RESULTS: The overall rate of ICH was 552/1395 patients (39.6%), and the overall rate of sICH was 47/1395 (3.4%). The most common type of ICH was hemorrhagic infarction type 1 (HI1), which represented 45.3% of all ICH cases- followed by HI2 (31.5%) and subarachnoid hemorrhage (SAH, 29.2%). Parenchymal hematoma 2 (PH2) represented only 3.3% of all ICH cases. Of the PH2 hemorrhages, only 33.3% were determined to be symptomatic. Of sICH cases, the most common ICH subtypes were HI2 (48.9%) and SAH (38.3%). Comparison of sICH rates as determined by core laboratory adjudication versus local site-reported results showed that only 14 patients were identified as having sICH with both definitions, with 47 patients total with sICH according to one definition, but not the other. CONCLUSIONS: Results of this analysis demonstrate the radiographic subtypes of ICH and also highlight the limitations of variable criteria used to define sICH, suggesting that it might be appropriate to revisit how sICH is defined post-MT. TRIAL REGISTRATION NUMBER: Clinical trial NCT03845491.
publishDate 2025
dc.date.none.fl_str_mv 2025
2025-06-16
2025
2025-06-16
dc.type.none.fl_str_mv research article
http://purl.org/coar/resource_type/c_2df8fbb1
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/20.500.13003/25448
url https://hdl.handle.net/20.500.13003/25448
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial 4.0 International
http://creativecommons.org/licenses/by-nc/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial 4.0 International
http://creativecommons.org/licenses/by-nc/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BMJ Journals
publisher.none.fl_str_mv BMJ Journals
dc.source.none.fl_str_mv reponame:Docusalut
instname:Conselleria de Salut i Consum del Govern de les Illes Balears
instname_str Conselleria de Salut i Consum del Govern de les Illes Balears
reponame_str Docusalut
collection Docusalut
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.811543

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