MRI predictors of intracranial hemorrhage in acute ischemic stroke after endovascular thrombectomy therapy.

OBJECTIVES: To investigate the predictors for the occurrence of intracranial hemorrhage (ICH) after endovascular thrombectomy (EVT) therapy in acute ischemic stroke (AIS) patients.

METHODS: Patients with AIS who underwent EVT and bridging therapy were enrolled retrospectively. ICH was evaluated on follow-up noncontrast CT or MRI. Diffusion weighted imaging (DWI) volume, perfusion weighted imaging (PWI) volume, DWI-PWI mismatch (DPM) volume and other clinical data were collected for 135 AIS patients. Multivariate logistic regression analysis was used to predict ICH after therapy in AIS patients.

RESULTS: The DWI volume in patients undergoing EVT with ICH was significantly larger than that in patients without ICH (50.61±47.43 vs 26.65±29.51; t =-2.416, P =0.020). For patients treated with bridging therapy, patients with ICH had larger DWI volume (26.32±29.66 vs 13.04±20.14; t =-2.013, P =0.037) and PWI volume (174.21±75.12 vs 129.87±60.29; t =-2.618, P =0.011) than patients without ICH. More patients with ICH were attempted for >3 passes with retriever during EVT than patients without ICH (EVT: 51.72% vs 26.19%; χ2 =5.131, P =0.028; bridging therapy: 48.15% vs 21.62%; χ2 =4.982, P =0.033). Multivariable logistic regression analysis demonstrated that DWI volume (OR, 1.017 (95% CI, 1.002-1.033); P =0.022) and >3 passes with the retriever (OR, 0.327 (95% CI, 0.114-0.936); P =0.037) were independently associated with ICH after EVT in AIS patients. DWI volume (OR, 1.024 (95% CI, 1.011-1.048); P =0.046), PWI volume (OR, 1.010 (95% CI, 1.002-1.018); P =0.016) and >3 passes with the retriever (OR, 0.281 (95% CI, 0.089-0.887); P =0.030) were independently associated with ICH after bridging therapy in AIS patients.

CONCLUSIONS: DWI volume, PWI volume and >3 passes with the retriever were able to predict the ICH in patients with AIS after EVT therapy.