{
  "abstract": "Background Patients with large vessel occlusion (LVO) and concurrent intracranial hemorrhage are systematically excluded from thrombectomy trials, leaving a critical evidence gap. We examined the association between endovascular thrombectomy (EVT) and clinical outcomes in this population, and derived a preliminary hemorrhage volume threshold to inform treatment selection.Methods This multicenter, retrospective cohort study included 85 patients with acute LVO and intracranial hemorrhage (EVT: n=49; best medical management (BMM): n=36) across 18 stroke centers. The primary endpoint was 90 day functional independence (modified Rankin Scale score of 0–2). Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were applied to partially mitigate selection bias in these two groups. A receiver operating characteristic derived hemorrhage threshold was internally validated via bootstrap iterations.Results Baseline groups (EVT vs BMM) differed in hemorrhage volume (median 5.0 vs 3.0 mL; P=0.019), reflecting confounding by treatment preference. Despite this, EVT was consistently associated with greater 90 day functional independence across all analytical approaches (53.1% vs 19.4%; IPTW adjusted OR 4.2, 95% CI 1.49 to 11.85; P=0.007). Mortality difference did not reach significance after adjustment (IPTW OR 0.51; P=0.219). Hemorrhage expansion and symptomatic intracranial hemorrhage rates were comparable. A preliminary threshold of 4.5 mL (AUC 0.70) identified patients with higher functional independence (66.7% vs 25.0%; P=0.015) and lower mortality (3.0% vs 31.2%; P=0.011).Conclusions In this hypothesis generating cohort, EVT was associated with favorable outcomes in patients with LVO and concurrent intracranial hemorrhage, particularly those with hemorrhage ≤4.5 mL. The non-randomized design and modest sample preclude definitive conclusions. Prospective validation is needed.",
  "authors": [
    {
      "affiliations": [
        "Department of Cerebrovascular Disease, Fujian Medical University Union Hospital, Fuzhou, China"
      ],
      "name": "Shujuan Gan"
    },
    {
      "affiliations": [
        "Neurology, Melbourne Brain Centre at Royal Melbourne Hospital, Parkville, Victoria, Australia"
      ],
      "name": "Mikiya Beppu"
    },
    {
      "affiliations": [
        "Department of Cerebrovascular Disease, Fujian Medical University Union Hospital, Fuzhou, China"
      ],
      "name": "Ming-Zhu Huang"
    },
    {
      "affiliations": [
        "Department of Neurology, Fujian Provincial Hospital, Fuzhou, China"
      ],
      "name": "Yingchao He"
    },
    {
      "affiliations": [
        "Department of Neurology, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China"
      ],
      "name": "Quanlong Hong"
    },
    {
      "affiliations": [
        "Department of Cerebrovascular Disease, Fujian Medical University Union Hospital, Fuzhou, China"
      ],
      "name": "Weifeng Huang"
    },
    {
      "affiliations": [
        "Cerebrovascular and Neuro-Intervention Department, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, China"
      ],
      "name": "Yining Yang"
    },
    {
      "affiliations": [
        "Department of Neurology, Yingkou Central Hospital, Liaoning, China"
      ],
      "name": "Hui Jiang"
    },
    {
      "affiliations": [
        "Neurology, Jinan University First Affiliated Hospital, Guangzhou, China"
      ],
      "name": "Hongyu Qiao"
    },
    {
      "affiliations": [
        "Department of Neurology, Fujian Medical University affiliated Mindong Hospital, Ningde, China"
      ],
      "name": "Xiaohua Sun"
    },
    {
      "affiliations": [
        "Department of Neurology, Fuzhou First General Hospital, Fuzhou, China"
      ],
      "name": "Hongye Wang"
    },
    {
      "affiliations": [
        "Department of Neurology, Jiujang NO.1 People's Hospital, Jiujiang, China"
      ],
      "name": "Tuanyuan Zheng"
    },
    {
      "affiliations": [
        "Neurovascular Center, Changhai Hospital, Shanghai, Shanghai, China"
      ],
      "name": "Jianmin Liu"
    },
    {
      "affiliations": [
        "Department of Cerebrovascular Disease, Fujian Medical University Union Hospital, Fuzhou, China"
      ],
      "name": "Zhiting Chen"
    },
    {
      "affiliations": [
        "Department of Cerebrovascular Disease, Fujian Medical University Union Hospital, Fuzhou, China"
      ],
      "name": "Wenhuo Chen"
    },
    {
      "affiliations": [
        "Neurology, Melbourne Brain Centre at Royal Melbourne Hospital, Parkville, Victoria, Australia"
      ],
      "name": "Bernard Yan"
    },
    {
      "affiliations": [
        "Cerebrovascular and Neuro-Intervention Department, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, China"
      ],
      "name": "Tingyu Yi"
    }
  ],
  "title": "Outcomes of endovascular thrombectomy for acute ischemic stroke with concurrent intracranial hemorrhage: multicenter registry study",
  "uid": "5b28e5c1-81bb-5ef1-b10f-be0debe12d50"
}