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TOPLINE:

Asymptomatic hemorrhagic infarction (HI) and subarachnoid hemorrhage (SAH) after endovascular thrombectomy (EVT) for acute ischemic stroke were associated with more than double the risk for worse functional outcomes at 90 days, a new trial showed.

METHODOLOGY:

• This secondary analysis of the DIRECT-MT randomized clinical trial included 490 patients (median age, 70 years; 57% men) treated with EVT at tertiary hospitals in China between 2016 and 2019.
• Patients with asymptomatic HI and SAH detected on 90-day follow-up imaging were included in the hemorrhage group (n = 133), and those without any hemorrhage were included in the control group (n = 357).
• The primary outcome was the functional outcome at 90 days, as measured on the modified Rankin Scale (mRS). Scores were further categorized into thresholds of 0-1, 0-2, and 0-3, indicating excellent, good, and favorable outcomes, respectively.

TAKEAWAY:

• The hemorrhage group had significantly higher odds of worse mRS scores at 90 days than the control group (odds ratio [OR], 2.6; P = .001).
• In the propensity score matching model, asymptomatic HI and SAH were significantly associated with worse recovery across mRS score thresholds of 0-1 (OR, 0.4; P = .03) and 0-2 (OR, 0.3; P = .002).
• Men vs women and patients with single thrombectomy attempts vs multiple attempts were more negatively affected by asymptomatic HI and SAH (P for interaction = .01).

IN PRACTICE:

“Clinicians often regard asymptomatic HI and SAH, particularly those without overt clinical symptoms, as inconsequential. As a result, these asymptomatic hemorrhages are frequently overlooked in both acute management and long-term follow-up, under the assumption that they do not negatively impact patient recovery,” the investigators wrote. 

However, in the current study, the conditions were negatively associated with stroke recovery, “suggesting a need for closer monitoring and proactive management to improve outcomes,” they added.

SOURCE:

The study was led by Rundong Chen, MD, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China. It was published online on March 28 in JAMA Network Open.

LIMITATIONS:

The retrospective design introduced potential bias. The findings were not generalizable beyond Chinese tertiary hospitals, especially in regions with different stroke management protocols. Additionally, the small sample size may have limited the subgroup analysis power.

DISCLOSURES:

The study was funded by the National Natural Science Foundation of China, Changfeng Talent Development Program, Basic Experiment Funding of Naval Medical University (NMU) in Shanghai, and China Postdoctoral Science Foundation. One investigator reported receiving grants from the China Postdoctoral Science Foundation and Basic Experiment Funding of NMU during the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.