Asymptomatic parenchymal haemorrhage following endovascular treatment: Impact on functional outcome in patients with acute ischaemic stroke
Background and purpose In patients with acute ischaemic stroke (AIS), haemorrhagic transformation (HT) following endovascular treatment (EVT) is associated with poor functional outcome. However, the impact of asymptomatic HT, not linked to neurological deterioration in the acute phase, is unknown. W...
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| Veröffentlicht in: | European journal of neurology 2024-02, Vol.31 (2), p.e16112-n/a |
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| creator | Toscano‐Prat, Clara Martínez‐González, José Pablo Guasch‐Jiménez, Marina Ramos‐Pachón, Anna Martí‐Fàbregas, Joan Blanco‐Sanroman, Nerea Coronel‐Coronel, Melissa Fabiola Domine, María Constanza Martínez‐Domeño, Alejandro Prats‐Sánchez, Luis Marín‐Bueno, Rebeca Aguilera‐Simón, Ana Lambea‐Gil, Álvaro Ezcurra‐Díaz, Garbiñe Camps‐Renom, Pol |
| description | Background and purpose
In patients with acute ischaemic stroke (AIS), haemorrhagic transformation (HT) following endovascular treatment (EVT) is associated with poor functional outcome. However, the impact of asymptomatic HT, not linked to neurological deterioration in the acute phase, is unknown. We aimed to investigate the impact of asymptomatic PH1 (aPH1) and PH2 (aPH2) subtypes of HT on the functional outcome of patients treated with EVT.
Methods
We conducted a retrospective study of patients with AIS who were consecutively admitted to our comprehensive stroke centre between January 2019 and December 2022, and who underwent EVT. We collected clinical, radiological, and procedural data. HTs were categorized according to the Heidelberg classification. The primary outcome was the shift on the modified Rankin Scale (mRS) at 3 months of follow‐up. We performed bivariate and multivariable ordinal regression analyses to test the association between aPH1/aPH2 and the primary outcome.
Results
We included 314 patients (mean age = 72.5 years [SD = 13.6], 171 [54.5%] women). We detected 54 (17.2%) patients with HT; 23 (7.3%) were classified as PH2 (11 asymptomatic) and 17 (5.4%) as PH1 (16 asymptomatic). The adjusted common odds ratio for aPH2 of worsening 1 point on the 3‐month mRS was 3.32 (95% confidence interval = 1.16–9.57, p = 0.026). No association was observed for aPH1. aPH2 was also independently associated with lower odds of achieving a favourable outcome (mRS = 0–2). Neither aPH1 nor aPH2 was associated with mortality.
Conclusions
In patients with AIS treated with EVT, aPH2 is independently associated with unfavourable functional outcome. |
| doi_str_mv | 10.1111/ene.16112 |
| format | Article |
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In patients with acute ischaemic stroke (AIS), haemorrhagic transformation (HT) following endovascular treatment (EVT) is associated with poor functional outcome. However, the impact of asymptomatic HT, not linked to neurological deterioration in the acute phase, is unknown. We aimed to investigate the impact of asymptomatic PH1 (aPH1) and PH2 (aPH2) subtypes of HT on the functional outcome of patients treated with EVT.
Methods
We conducted a retrospective study of patients with AIS who were consecutively admitted to our comprehensive stroke centre between January 2019 and December 2022, and who underwent EVT. We collected clinical, radiological, and procedural data. HTs were categorized according to the Heidelberg classification. The primary outcome was the shift on the modified Rankin Scale (mRS) at 3 months of follow‐up. We performed bivariate and multivariable ordinal regression analyses to test the association between aPH1/aPH2 and the primary outcome.
Results
We included 314 patients (mean age = 72.5 years [SD = 13.6], 171 [54.5%] women). We detected 54 (17.2%) patients with HT; 23 (7.3%) were classified as PH2 (11 asymptomatic) and 17 (5.4%) as PH1 (16 asymptomatic). The adjusted common odds ratio for aPH2 of worsening 1 point on the 3‐month mRS was 3.32 (95% confidence interval = 1.16–9.57, p = 0.026). No association was observed for aPH1. aPH2 was also independently associated with lower odds of achieving a favourable outcome (mRS = 0–2). Neither aPH1 nor aPH2 was associated with mortality.
Conclusions
In patients with AIS treated with EVT, aPH2 is independently associated with unfavourable functional outcome.</description><identifier>ISSN: 1351-5101</identifier><identifier>ISSN: 1468-1331</identifier><identifier>EISSN: 1468-1331</identifier><identifier>DOI: 10.1111/ene.16112</identifier><identifier>PMID: 37909802</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Aged ; Asymptomatic ; Bivariate analysis ; Brain Ischemia - complications ; Brain Ischemia - surgery ; Cardiovascular system ; Endovascular Procedures - adverse effects ; endovascular treatment ; Female ; haemorrhagic transformation ; Hemorrhage ; Hemorrhage - etiology ; Humans ; Ischemia ; Ischemic Stroke - complications ; Male ; outcome ; Patients ; Regression analysis ; Retrospective Studies ; Statistical analysis ; Stroke ; Stroke - complications ; Stroke - surgery ; Thrombectomy ; Treatment Outcome</subject><ispartof>European journal of neurology, 2024-02, Vol.31 (2), p.e16112-n/a</ispartof><rights>2023 The Authors. published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2024. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3882-70fa8577b7f0692bebf440408e669bd4c9edf9cfb9e305c4743ff8ada2ee51953</citedby><cites>FETCH-LOGICAL-c3882-70fa8577b7f0692bebf440408e669bd4c9edf9cfb9e305c4743ff8ada2ee51953</cites><orcidid>0000-0001-9229-8649 ; 0000-0003-1428-8212 ; 0000-0001-6587-6271 ; 0000-0003-1785-9201 ; 0000-0002-3192-4631 ; 0009-0006-9385-6933 ; 0000-0002-9511-3117</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fene.16112$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fene.16112$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,11541,27901,27902,45550,45551,46027,46451</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37909802$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Toscano‐Prat, Clara</creatorcontrib><creatorcontrib>Martínez‐González, José Pablo</creatorcontrib><creatorcontrib>Guasch‐Jiménez, Marina</creatorcontrib><creatorcontrib>Ramos‐Pachón, Anna</creatorcontrib><creatorcontrib>Martí‐Fàbregas, Joan</creatorcontrib><creatorcontrib>Blanco‐Sanroman, Nerea</creatorcontrib><creatorcontrib>Coronel‐Coronel, Melissa Fabiola</creatorcontrib><creatorcontrib>Domine, María Constanza</creatorcontrib><creatorcontrib>Martínez‐Domeño, Alejandro</creatorcontrib><creatorcontrib>Prats‐Sánchez, Luis</creatorcontrib><creatorcontrib>Marín‐Bueno, Rebeca</creatorcontrib><creatorcontrib>Aguilera‐Simón, Ana</creatorcontrib><creatorcontrib>Lambea‐Gil, Álvaro</creatorcontrib><creatorcontrib>Ezcurra‐Díaz, Garbiñe</creatorcontrib><creatorcontrib>Camps‐Renom, Pol</creatorcontrib><title>Asymptomatic parenchymal haemorrhage following endovascular treatment: Impact on functional outcome in patients with acute ischaemic stroke</title><title>European journal of neurology</title><addtitle>Eur J Neurol</addtitle><description>Background and purpose
In patients with acute ischaemic stroke (AIS), haemorrhagic transformation (HT) following endovascular treatment (EVT) is associated with poor functional outcome. However, the impact of asymptomatic HT, not linked to neurological deterioration in the acute phase, is unknown. We aimed to investigate the impact of asymptomatic PH1 (aPH1) and PH2 (aPH2) subtypes of HT on the functional outcome of patients treated with EVT.
Methods
We conducted a retrospective study of patients with AIS who were consecutively admitted to our comprehensive stroke centre between January 2019 and December 2022, and who underwent EVT. We collected clinical, radiological, and procedural data. HTs were categorized according to the Heidelberg classification. The primary outcome was the shift on the modified Rankin Scale (mRS) at 3 months of follow‐up. We performed bivariate and multivariable ordinal regression analyses to test the association between aPH1/aPH2 and the primary outcome.
Results
We included 314 patients (mean age = 72.5 years [SD = 13.6], 171 [54.5%] women). We detected 54 (17.2%) patients with HT; 23 (7.3%) were classified as PH2 (11 asymptomatic) and 17 (5.4%) as PH1 (16 asymptomatic). The adjusted common odds ratio for aPH2 of worsening 1 point on the 3‐month mRS was 3.32 (95% confidence interval = 1.16–9.57, p = 0.026). No association was observed for aPH1. aPH2 was also independently associated with lower odds of achieving a favourable outcome (mRS = 0–2). Neither aPH1 nor aPH2 was associated with mortality.
Conclusions
In patients with AIS treated with EVT, aPH2 is independently associated with unfavourable functional outcome.</description><subject>Aged</subject><subject>Asymptomatic</subject><subject>Bivariate analysis</subject><subject>Brain Ischemia - complications</subject><subject>Brain Ischemia - surgery</subject><subject>Cardiovascular system</subject><subject>Endovascular Procedures - adverse effects</subject><subject>endovascular treatment</subject><subject>Female</subject><subject>haemorrhagic transformation</subject><subject>Hemorrhage</subject><subject>Hemorrhage - etiology</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Ischemic Stroke - complications</subject><subject>Male</subject><subject>outcome</subject><subject>Patients</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Statistical analysis</subject><subject>Stroke</subject><subject>Stroke - complications</subject><subject>Stroke - surgery</subject><subject>Thrombectomy</subject><subject>Treatment Outcome</subject><issn>1351-5101</issn><issn>1468-1331</issn><issn>1468-1331</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kctO3DAUhi3Uisu0i75AZakbWITxJRe7uxEaWiTUbso6cpxjJjS2U9thNM_AS2MYygIJL-wj69N3ztGP0BdKzmk-S3BwTmtK2QE6pmUtCso5_ZBrXtGiooQeoZMY7wghrGHkEB3xRhIpCDtGD6u4s1PyVqVB40kFcHqzs2rEGwXWh7BRt4CNH0e_HdwtBtf7exX1PKqAUwCVLLj0HV_ZSemEvcNmdjoN3mWFn5P2FvDgsjkNGYx4O6QNVnpO-Tvqpya5b0zB_4VP6KNRY4TPL-8C3Vyu_1z8LK5__7i6WF0XmgvBioYYJaqm6RpDask66ExZkpIIqGvZ9aWW0BupTSeBk0qXTcmNEapXDKCisuILdLr3TsH_myGm1uZRYByVAz_HlglRMZLvMqPf3qB3fg55t0xJSmspKk4ydbandPAxBjDtFAarwq6lpH1KqM0Jtc8JZfbri3HuLPSv5P9IMrDcA9thhN37pnb9a71XPgLj8p3J</recordid><startdate>202402</startdate><enddate>202402</enddate><creator>Toscano‐Prat, Clara</creator><creator>Martínez‐González, José Pablo</creator><creator>Guasch‐Jiménez, Marina</creator><creator>Ramos‐Pachón, Anna</creator><creator>Martí‐Fàbregas, Joan</creator><creator>Blanco‐Sanroman, Nerea</creator><creator>Coronel‐Coronel, Melissa Fabiola</creator><creator>Domine, María Constanza</creator><creator>Martínez‐Domeño, Alejandro</creator><creator>Prats‐Sánchez, Luis</creator><creator>Marín‐Bueno, Rebeca</creator><creator>Aguilera‐Simón, Ana</creator><creator>Lambea‐Gil, Álvaro</creator><creator>Ezcurra‐Díaz, Garbiñe</creator><creator>Camps‐Renom, Pol</creator><general>John Wiley & Sons, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9229-8649</orcidid><orcidid>https://orcid.org/0000-0003-1428-8212</orcidid><orcidid>https://orcid.org/0000-0001-6587-6271</orcidid><orcidid>https://orcid.org/0000-0003-1785-9201</orcidid><orcidid>https://orcid.org/0000-0002-3192-4631</orcidid><orcidid>https://orcid.org/0009-0006-9385-6933</orcidid><orcidid>https://orcid.org/0000-0002-9511-3117</orcidid></search><sort><creationdate>202402</creationdate><title>Asymptomatic parenchymal haemorrhage following endovascular treatment: Impact on functional outcome in patients with acute ischaemic stroke</title><author>Toscano‐Prat, Clara ; Martínez‐González, José Pablo ; Guasch‐Jiménez, Marina ; Ramos‐Pachón, Anna ; Martí‐Fàbregas, Joan ; Blanco‐Sanroman, Nerea ; Coronel‐Coronel, Melissa Fabiola ; Domine, María Constanza ; Martínez‐Domeño, Alejandro ; Prats‐Sánchez, Luis ; Marín‐Bueno, Rebeca ; Aguilera‐Simón, Ana ; Lambea‐Gil, Álvaro ; Ezcurra‐Díaz, Garbiñe ; Camps‐Renom, Pol</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3882-70fa8577b7f0692bebf440408e669bd4c9edf9cfb9e305c4743ff8ada2ee51953</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Asymptomatic</topic><topic>Bivariate analysis</topic><topic>Brain Ischemia - complications</topic><topic>Brain Ischemia - surgery</topic><topic>Cardiovascular system</topic><topic>Endovascular Procedures - adverse effects</topic><topic>endovascular treatment</topic><topic>Female</topic><topic>haemorrhagic transformation</topic><topic>Hemorrhage</topic><topic>Hemorrhage - etiology</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Ischemic Stroke - complications</topic><topic>Male</topic><topic>outcome</topic><topic>Patients</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Statistical analysis</topic><topic>Stroke</topic><topic>Stroke - complications</topic><topic>Stroke - surgery</topic><topic>Thrombectomy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Toscano‐Prat, Clara</creatorcontrib><creatorcontrib>Martínez‐González, José Pablo</creatorcontrib><creatorcontrib>Guasch‐Jiménez, Marina</creatorcontrib><creatorcontrib>Ramos‐Pachón, Anna</creatorcontrib><creatorcontrib>Martí‐Fàbregas, Joan</creatorcontrib><creatorcontrib>Blanco‐Sanroman, Nerea</creatorcontrib><creatorcontrib>Coronel‐Coronel, Melissa Fabiola</creatorcontrib><creatorcontrib>Domine, María Constanza</creatorcontrib><creatorcontrib>Martínez‐Domeño, Alejandro</creatorcontrib><creatorcontrib>Prats‐Sánchez, Luis</creatorcontrib><creatorcontrib>Marín‐Bueno, Rebeca</creatorcontrib><creatorcontrib>Aguilera‐Simón, Ana</creatorcontrib><creatorcontrib>Lambea‐Gil, Álvaro</creatorcontrib><creatorcontrib>Ezcurra‐Díaz, Garbiñe</creatorcontrib><creatorcontrib>Camps‐Renom, Pol</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Toscano‐Prat, Clara</au><au>Martínez‐González, José Pablo</au><au>Guasch‐Jiménez, Marina</au><au>Ramos‐Pachón, Anna</au><au>Martí‐Fàbregas, Joan</au><au>Blanco‐Sanroman, Nerea</au><au>Coronel‐Coronel, Melissa Fabiola</au><au>Domine, María Constanza</au><au>Martínez‐Domeño, Alejandro</au><au>Prats‐Sánchez, Luis</au><au>Marín‐Bueno, Rebeca</au><au>Aguilera‐Simón, Ana</au><au>Lambea‐Gil, Álvaro</au><au>Ezcurra‐Díaz, Garbiñe</au><au>Camps‐Renom, Pol</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Asymptomatic parenchymal haemorrhage following endovascular treatment: Impact on functional outcome in patients with acute ischaemic stroke</atitle><jtitle>European journal of neurology</jtitle><addtitle>Eur J Neurol</addtitle><date>2024-02</date><risdate>2024</risdate><volume>31</volume><issue>2</issue><spage>e16112</spage><epage>n/a</epage><pages>e16112-n/a</pages><issn>1351-5101</issn><issn>1468-1331</issn><eissn>1468-1331</eissn><abstract>Background and purpose
In patients with acute ischaemic stroke (AIS), haemorrhagic transformation (HT) following endovascular treatment (EVT) is associated with poor functional outcome. However, the impact of asymptomatic HT, not linked to neurological deterioration in the acute phase, is unknown. We aimed to investigate the impact of asymptomatic PH1 (aPH1) and PH2 (aPH2) subtypes of HT on the functional outcome of patients treated with EVT.
Methods
We conducted a retrospective study of patients with AIS who were consecutively admitted to our comprehensive stroke centre between January 2019 and December 2022, and who underwent EVT. We collected clinical, radiological, and procedural data. HTs were categorized according to the Heidelberg classification. The primary outcome was the shift on the modified Rankin Scale (mRS) at 3 months of follow‐up. We performed bivariate and multivariable ordinal regression analyses to test the association between aPH1/aPH2 and the primary outcome.
Results
We included 314 patients (mean age = 72.5 years [SD = 13.6], 171 [54.5%] women). We detected 54 (17.2%) patients with HT; 23 (7.3%) were classified as PH2 (11 asymptomatic) and 17 (5.4%) as PH1 (16 asymptomatic). The adjusted common odds ratio for aPH2 of worsening 1 point on the 3‐month mRS was 3.32 (95% confidence interval = 1.16–9.57, p = 0.026). No association was observed for aPH1. aPH2 was also independently associated with lower odds of achieving a favourable outcome (mRS = 0–2). Neither aPH1 nor aPH2 was associated with mortality.
Conclusions
In patients with AIS treated with EVT, aPH2 is independently associated with unfavourable functional outcome.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>37909802</pmid><doi>10.1111/ene.16112</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-9229-8649</orcidid><orcidid>https://orcid.org/0000-0003-1428-8212</orcidid><orcidid>https://orcid.org/0000-0001-6587-6271</orcidid><orcidid>https://orcid.org/0000-0003-1785-9201</orcidid><orcidid>https://orcid.org/0000-0002-3192-4631</orcidid><orcidid>https://orcid.org/0009-0006-9385-6933</orcidid><orcidid>https://orcid.org/0000-0002-9511-3117</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Asymptomatic Bivariate analysis Brain Ischemia - complications Brain Ischemia - surgery Cardiovascular system Endovascular Procedures - adverse effects endovascular treatment Female haemorrhagic transformation Hemorrhage Hemorrhage - etiology Humans Ischemia Ischemic Stroke - complications Male outcome Patients Regression analysis Retrospective Studies Statistical analysis Stroke Stroke - complications Stroke - surgery Thrombectomy Treatment Outcome |
| title | Asymptomatic parenchymal haemorrhage following endovascular treatment: Impact on functional outcome in patients with acute ischaemic stroke |
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