Thrombectomy Technique Predicts Hemorrhagic Transformation Risk after Thrombectomy in Basilar artery Stroke

Background: Hemorrhagic transformation (HT) is a classical complication after thrombectomy for ischemic stroke and is often associated with clinical deterioration and poor clinical outcome. Few studies analyzed its impact and prevalence after basilar artery occlusion (BAO) treated by thrombectomy. We determined HT predictors, incidence, and clinical impact in a large multicenter cohort of BAO treated by thrombectomy.

Materials and Methods: We performed a retrospective analysis of a multicenter prospective cohort of consecutive patients treated by thrombectomy for BAO. We evaluated the incidence of HT, its impact on 90-day favorable outcome (modified Rankin's scale of 0–3) and performed multivariate analyses to determine factors predicting HT.

Results: A total of 244 patients were included, HT incidence was 25% (61/244). Only 20% of END+ patients achieved a favorable outcome (vs. 54% for HT patients, p < 0.0001). HT+ was identified as an independent predictive factor negatively associated with favorable outcome in multivariate analysis (odds ratio = 0.266 [0.109–0.649, p = 0.004]. The only significant predictor of HT was the use of the combined technique as first-line during thrombectomy (odds ratio = 2.36 [1.05–5.34], p = 0.039) compared with contact aspiration only.

Conclusion: HT at day 1 following MT for BAO is an independent predictor of poor 3-month clinical outcome, use of a combined technique during thrombectomy as first-line may increase its odds, contact aspiration should be preferred first.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
14 December 2021