Ultrasound Identification of Patients at Increased Risk of Intracranial Hemorrhage After Successful Endovascular Recanalization for Acute Ischemic Stroke.

Abstract

Intracranial hemorrhage (ICH) is the most feared complication of endovascular treatment (EVT) for acute ischemic stroke because of anterior circulation large vessel occlusion (LVO). The purpose of this study was to identify cerebral hemodynamic predictors of ICH and poor outcome in patients with successful recanalization. Serial transcranial color-coded sonography (TCCS) examinations assessed vessel status and cerebral hemodynamics of 226 (mean age, 69.8 ± 12.5 years; 130 men [57.5%]) consecutive patients with acute anterior circulation LVO at 48 hours and 1 week after EVT. Middle cerebral artery peak systolic velocity (PSV_MCA) and PSV_MCA ratio (recanalized PSV_MCA/contralateral PSV_MCA) were recorded. Out of 180 successfully recanalized patients (79.6%), 28 patients (15.5%) had ICH. They more often had arterial hypertension (25/28 [89.3%] vs. 106/152 [69.7%], P = 0.04), a more severe stroke syndrome (18 [range, 10-23] vs. 16 [range, 5-26], P = 0.01), a worse clinical outcome (90-day modified Rankin Scale [mRS] score 3-5: 16/28 [57.1%] vs. 42/152 [27.6%], P = 0.004), and soon after EVT showed a significantly higher mean PSV_MCA ratio (3.4 ± 0.1 vs. 2.4 ± 0.1, P < 0.0001) than patients without ICH, respectively. In multivariate analysis, early PSV_MCA ratio was independently associated with postinterventional ICH (odds ratio, 13.379; 95% confidence interval, 2.466-50.372; P < 0.01). The patients with ICH (19/28 [67.9%]) who resumed normal PSV_MCA values at 1 week after EVT had a better outcome (90-day mRS score 0-2: 8/19 [42.1%] vs. 0/9 [0%], respectively). Early TCCS detection of a high PSV_MCA ratio in successfully recanalized stroke patients indicates an increased risk of ICH, whereas cerebral hemodynamics normalization at 1 week in patients with postinterventional ICH predicts a relatively better 3-month outcome.