Intracranial hemorrhage after mechanical thrombectomy

Despite the risk of symptomatic intracerebral hemorrhage, successful recanalization via mechanical thrombectomy 6 hours after stroke may improve clinical outcomes in patients with large vessel occlusion 1).

Intracranial hemorrhage (ICH) can be a devastating complication of mechanical thrombectomy following acute ischemic stroke increasing disability and mortality. Patients with low platelet count were excluded from major trials.

A study of Desai et al., explored the association between platelet count and ICH after MT.

A retrospective review of patients undergoing MT for anterior circulation large vessel occlusions at a single comprehensive stroke center (CSC) between January 2015 and February 2018 was performed. Demographic and clinical information including NIHSS score, IV-tPA administration, ASPECTS, platelet count, INR, time from symptom onset to recanalization and mTICI score were analyzed. Radiological imaging and clinical course in the hospital was evaluated to identify parenchymal hemorrhage (PH) and symptomatic intracranial hemorrhage (sICH). Univariable and multivariable analysis was conducted.

555 patients underwent ET and 43% were male. Mean age and NIHSS score were 71 ±14 years and 17 ±6. PH-2 and sICH (ECASS-III criteria) was noted in 9.7% and 5.8% patients respectively. Rate of sICH in patients with platelet count <100,000 (n=15), 100,000-<150,000 (n=59) and ≥150,000 (n=481) were 6.7% (n=1), 10.1% (n=6) and 5.2% (n=25), respectively (p=0.25) and rates of mRS 0-2 at 90 days were 26.7%, 23.7% and 36.4%, respectively (p=0.12). Low ASPECTS was a significant predictor of sICH per ECASS III definition (p value=0.046). Platelet count was not a predictor (p=0.386) of sICH.

Risk of sICH after ET is low and comparable in patients with low and normal platelet counts. Low platelets should not exclude patients from undergoing intra-arterial therapy 2).

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Cho YH, Choi JH. Outcomes of Mechanical Thrombectomy in Patients with Large Diffusion-Weighted Imaging Lesions. J Korean Neurosurg Soc. 2021 Nov 26. doi: 10.3340/jkns.2021.0064. Epub ahead of print. PMID: 34823275.
Desai SM, Mehta A, Morrison AA, Gross BA, Jankowitz BT, Jovin TG, Jadhav AP. Endovascular Thrombectomy, Platelet Count and Intracranial Hemorrhage. World Neurosurg. 2019 Apr 10. pii: S1878-8750(19)31028-9. doi: 10.1016/j.wneu.2019.04.036. [Epub ahead of print] PubMed PMID: 30980980.
  • intracranial_hemorrhage_after_mechanical_thrombectomy.txt
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