Predictors for intracerebral hemorrhage after intravenous or intraarterial recanalization in acute major cerebral artery occlusion in Korean patients.

OBJECTIVE

To evaluate predictors for intracerebral hemorrhage (ICH) and 1-month mortality after intravenous (IV) or intraarterial (IA) recanalization therapy for major cerebral artery occlusion in Korean patients.

METHODS

From 2011 to 2015, we prospectively gathered data from consecutive patients treated with IV/IA recanalization within 8 h of symptoms in a single center. The effects of demographic, clinical, laboratory, and radiological factors on ICH within 2 weeks were assessed, as well as 1-month mortality.

RESULTS

From a total of 183 patients, symptomatic intracerebral hemorrhage (SICH) occurred in 32 patients (17.5%), and asymptomatic ICH occurred in 37 patients (20.2%). The mortality rate at 1 month in ICH patients was 37.7%. The international normalized ratio (INR) (OR, 4.9; 95% CI, 1.03-23.4;  = 0.046), glucose (OR, 1.119 per mmol/L; 95% CI, 1.015-1.233;  = 0.023), medium-volume infarct (15-69.9 mL) (OR, 2.62; 95% CI, 1.1-6.26;  = 0.03), large-volume infarct (≥70 mL) (OR, 5.54; 95% CI, 2.1-14.6;  = 0.001), and angioplasty or stenting (OR, 6.29; 95% CI, 1.71-23.22;  = 0.006) were predictors of any ICH. Hyperlipidemia or statin medication (OR, 4.17; 95% CI, 1.38-12.59;  = 0.011), INR (OR, 7.13; 95% CI, 0.94-54.22  = 0.058), and large-volume infarct (≥70 mL) (OR, 7.96; 95% CI, 2.31-27.39;  = 0.001) were predictors of SICH. Hypertension (OR, 5.77; 95% CI, 1.43-23.3;  = 0.014), initial NIHSS score (OR, 1.09; 95% CI, 1.01-1.18;  = 0.27), and SICH (OR, 15.7; 95% CI, 4.04-61.08;  < 0.001) were predictors of 1-month mortality.

CONCLUSION

INR and glucose may be strong modifiable predictors of critical ICH leading to death after IV/IA recanalization therapy in acute cerebral artery occlusion.