Background and Purpose—
The
high prevalence of hyperintense acute reperfusion marker (HARM) seen
after endovascular therapy is suggestive of blood-brain barrier
disruption and hemorrhage risk and
may be attributable to multiple
thrombectomy passes needed to achieve recanalization.
Methods—
Patients
with acute stroke were included if they were screened from January 2015
through February 2019, received an acute ischemic stroke diagnosis
involving the anterior circulation, treated with or without IV tPA
(intravenous tissue-type plasminogen activator), consented to the NINDS
Natural History Study, and imaged with a baseline magnetic resonance
imaging before receiving endovascular therapy. Consensus image reads for
HARM and hemorrhagic transformation were performed. Good clinical
outcome was defined as 0–2 using the latest available modified Rankin
Scale score.
Results—
Eighty
patients met all study criteria and were included in the analyses.
Median age was 65 years, 64% female, 51% black/African American, median
admit National Institutes of Health Stroke Scale=19, 56% treated with IV
tPA, and 84% achieved Thrombolysis in Cerebral Infarction score of
2b/3. Multiple-pass patients had significantly higher rates of severe
HARM at 24 hours (67% versus 29%;
P=0.001), any hemorrhagic transformation (60% versus 36%;
P=0.04) and poor clinical outcome (67% versus 36%;
P=0.008). Only age (odds ratio, 1.1; 95% CI, 1.01–1.12;
P=0.022)
and severe HARM at 24 hours post-endovascular therapy were
significantly associated with multiple passes (odds ratio, 7.2; 95% CI,
1.93–26.92;
P=0.003).
Conclusions—
In
this exploratory study, multiple thrombectomy passes are independently
associated with a significant increase in blood-brain barrier disruption
detected at 24 hours. Patients with HARM post-endovascular therapy had a
>7-fold increase in the odds of having multiple- versus single-pass
thrombectomy.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov. Unique identifier: NCT00009243.
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