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.