The impact of SAH finding on CT to the clinical outcome after mechanical thrombectomy for large vessel occlusion

Kentaro Suzuki; Yuji Matsumaru; Masataka Takeuchi; Masafumi Morimoto; Ryuzaburo Kanazawa; Yohei Takayama; Yuki Kamiya; Keigo Shigeta; Seiji Okubo; Mikito Hayakawa; Norihiro Ishii; Yorio Koguchi; Tomoji Takigawa; Masato Inoue; Hiromichi Naito; Takahiro Ota; Teruyuki Hirano; Noriyuki Kato; Toshihiro Ueda; Yasuyuki Iguchi; Kazunori Akaji; Wataro Tsuruta; Kazunori Miki; Shigeru Fujimoto; Tetsuhiro Higashida; Mitsuhiro Iwasaki; Junya Aoki; Yasuhiro Nishiyama; Toshiaki Otsuka; Kazumi Kimura; SKIP study Investigators

doi:10.1016/j.jns.2023.120797

The impact of SAH finding on CT to the clinical outcome after mechanical thrombectomy for large vessel occlusion

J Neurol Sci. 2023 Oct 15:453:120797. doi: 10.1016/j.jns.2023.120797. Epub 2023 Sep 7.

Authors

Kentaro Suzuki¹, Yuji Matsumaru², Masataka Takeuchi³, Masafumi Morimoto⁴, Ryuzaburo Kanazawa⁵, Yohei Takayama⁶, Yuki Kamiya⁷, Keigo Shigeta⁸, Seiji Okubo⁷, Mikito Hayakawa², Norihiro Ishii⁹, Yorio Koguchi¹⁰, Tomoji Takigawa¹¹, Masato Inoue¹², Hiromichi Naito¹³, Takahiro Ota¹⁴, Teruyuki Hirano¹⁵, Noriyuki Kato¹⁶, Toshihiro Ueda¹⁷, Yasuyuki Iguchi¹⁸, Kazunori Akaji¹⁹, Wataro Tsuruta²⁰, Kazunori Miki²¹, Shigeru Fujimoto²², Tetsuhiro Higashida⁵, Mitsuhiro Iwasaki⁴, Junya Aoki²³, Yasuhiro Nishiyama²³, Toshiaki Otsuka²⁴, Kazumi Kimura²³; SKIP study Investigators

Affiliations

¹ Department of Neurology, Nippon Medical School, Tokyo, Japan. Electronic address: kentarow@nms.ac.jp.
² Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
³ Department of Neurosurgery, Seisho Hospital, Kanagawa, Japan.
⁴ Department of Neurosurgery, Yokohama Shintoshi Neurosurgery Hospital, Kanagawa, Japan.
⁵ Department of Neurosurgery, Nagareyama Central Hospital, Chiba, Japan.
⁶ Department of Neurology, Akiyama Neurosurgical Hospital, Kanagawa, Japan.
⁷ Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan.
⁸ Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
⁹ Department of Neurosurgery, New Tokyo Hospital, Chiba, Japan.
¹⁰ Department of Neurology and Neurosurgery, Chiba Emergency Medical Center, Chiba, Japan.
¹¹ Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
¹² Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan.
¹³ Department of Neurosurgery, Funabashi Municipal Medical Center, Chiba, Japan.
¹⁴ Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
¹⁵ Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan.
¹⁶ Department of Neurosurgery, Mito Medical Center, Ibaraki, Japan.
¹⁷ Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kanagawa, Japan.
¹⁸ Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan.
¹⁹ Department of Neurosurgery, Mihara Memorial Hospital, Gunma, Japan.
²⁰ Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan.
²¹ Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
²² Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
²³ Department of Neurology, Nippon Medical School, Tokyo, Japan.
²⁴ Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan.

PMID: 37703704
DOI: 10.1016/j.jns.2023.120797

Abstract

Background and purpose: Whether subarachnoid haemorrhage (SAH) after mechanical thrombectomy affects the clinical outcomes of patients with acute large-vessel occlusion remains unclear. This study aimed to investigate the clinical impact of SAH on computed tomography (CT) after mechanical thrombectomy.

Methods: The SKIP study was an investigator-initiated, multicentre, randomised, open-label clinical trial. This study was performed in 23 hospital networks in Japan from January 1, 2017, to July 31, 2019. Among the 204 patients, seven were excluded because they did not undergo mechanical thrombectomy (MT) and had a modified Rankin scale (mRS) score > 2. The main outcome was the association between SAH within 36 h after mechanical thrombectomy and the clinical outcome at 90 days.

Results: Among 197 patients, the median age was 74 (67-79) years, 62.9% were male. Moreover, 26 (13.2%) patients had SAH (seven isolated SAH) on CT within 36 h. The SAH rate did not differ according to IV rt-PA administration (p = 0.4). The rate of favourable clinical outcomes tended to be lower in patients with SAH rather than patients without SAH (11 [42%] vs. 106 [62%], p = 0.08). Among the seven patients with isolated SAH, 6 showed favourable outcomes at 90 days. In the multivariate regression analysis, the presence of SAH within 36 h from onset was not associated with clinical outcome (Odd ratio, 0.59; 95% confidence interval, 0.18-1.95; p = 0.38).

Conclusions: Among patients with acute stroke treated with MT, SAH, especially isolated SAH findings on CT, were not associated with poor clinical outcomes after 90 days.

Trial registration number: UMIN000021488.

Keywords: Clinical outcome; Ischemic stroke; Mechanical thrombectomy; Subarachnoid haemorrhage.