Mechanical thrombectomy in acute ischaemic stroke patients with pre-interventional intracranial haemorrhage following intravenous thrombolysis

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Hanna Styczen - , University of Duisburg-Essen (Author)
  • Matthias Gawlitza - , University Hospital Carl Gustav Carus Dresden (Author)
  • Nuran Abdullayev - , University of Cologne (Author)
  • Alex Brehm - , University of Basel (Author)
  • Carmen Serna-Candel - , Klinikum Stuttgart (Author)
  • Sebastian Fischer - , Ruhr University Bochum (Author)
  • Johannes Gerber - , Institute and Polyclinic of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus Dresden (Author)
  • Christoph Kabbasch - , University of Cologne (Author)
  • Marios Nikos Psychogios - , University of Basel (Author)
  • Michael Forsting - , University of Duisburg-Essen (Author)
  • Hans Henkes - , Klinikum Stuttgart (Author)
  • Volker Maus - , Ruhr University Bochum (Author)

Abstract

Background: Data on outcome of endovascular treatment in patients with acute ischaemic stroke due to large vessel occlusion suffering from intravenous thrombolysis-associated intracranial haemorrhage prior to mechanical thrombectomy remain scarce. Addressing this subject, we report our multicentre experience. Methods: A retrospective analysis of consecutive acute ischaemic stroke patients treated with mechanical thrombectomy due to large vessel occlusion despite the pre-interventional occurrence of intravenous thrombolysis-associated intracranial haemorrhage was performed at five tertiary care centres between January 2010–September 2020. Baseline demographics, aetiology of stroke and intracranial haemorrhage, angiographic outcome assessed by the Thrombolysis in Cerebral Infarction score and clinical outcome evaluated by the modified Rankin Scale at 90 days were recorded. Results: In total, six patients were included in the study. Five individuals demonstrated cerebral intraparenchymal haemorrhage on pre-interventional imaging; in one patient additional subdural haematoma was observed and one patient suffered from isolated subarachnoid haemorrhage. All patients except one were treated by the ‘drip-and-ship’ paradigm. Successful reperfusion was achieved in 4/6 (67%) individuals. In 5/6 (83%) patients, the pre-interventional intracranial haemorrhage had aggravated in post-interventional computed tomography with space-occupying effect. Overall, five patients had died during the hospital stay. The clinical outcome of the survivor was modified Rankin Scale=4 at 90 days follow-up. Conclusion: Mechanical thrombectomy in patients with intravenous thrombolysis-associated intracranial haemorrhage is technically feasible. The clinical outcome of this subgroup of stroke patients, however, appears to be devastating with high mortality and only carefully selected patients might benefit from endovascular treatment.

Details

Original languageEnglish
Pages (from-to)456-461
Number of pages6
JournalNeuroradiology Journal
Volume34
Issue number5
Publication statusPublished - Oct 2021
Peer-reviewedYes

External IDs

PubMed 33840277
ORCID /0000-0001-7465-8700/work/150883605

Keywords

Keywords

  • Acute ischaemic stroke, intracranial haemorrhage, intravenous thrombolysis, large vessel occlusion, mechanical thrombectomy