Asymptomatic stroke subtypes linked to worse 90-day recovery outcomes

Key takeaways:

• The odds ratio of a worse modified Rankin score in the asymptomatic hemorrhagic infarction and subarachnoid hemorrhage group vs. no hemorrhage group was 2.59.

• The data support the need for close monitoring. 

Individuals with asymptomatic hemorrhaging infarction or subarachnoid hemorrhage after receiving endovascular treatment for acute ischemic stroke recorded worse 90-day recovery outcomes compared with those without, data show.

“Although research comparing outcomes between patients with symptomatic [intracerebral hemorrhage] and those with no hemorrhage exists, studies specifically addressing the prognostic significance of asymptomatic [hemorrhaging infarction (HI)] and [subarachnoid hemorrhage (SAH)] are limited,” Rundong Chen, MD, from the School of Health Science and Engineering, University of Shanghai in China, and colleagues wrote.

Chen and colleagues conducted a secondary analysis of the DIRECT-MT clinical trial to determine whether asymptomatic HI and SAH affect functional recovery for those with acute ischemic stroke given endovascular treatment (EVT) compared with those without hemorrhage.

DIRECT-MT was a multicenter, randomized study conducted at tertiary hospitals in China between 2016 and 2019. It compared the efficacy of IV thrombolysis plus EVT vs. EVT alone in 490 individuals (median age, 70 years; 43% female) with acute ischemic stroke due to large-vessel occlusion. At baseline, researchers collected clinical and demographic data, along with stroke severity measurements based on the NIH Stroke Scale (NIHSS) and modified Rankin scale score (mRS).

The primary outcome of the current analysis was mRS score measured at 90-day follow up, with secondary analyses focused on three subtypes of recovery based on 90-day mRS score (0 to 1, excellent; 0 to 2, good; 0 to 3, favorable).

The analysis included 133 patients with asymptomatic HI or SAH and 357 patients who had no recorded hemorrhage.

The researchers reported that the odds ratio of having a worse mRS score at 90 days in the asymptomatic HI and SAH group compared with those who had no hemorrhage was 2.59 (95% CI, 1.45-4.63).

Data further showed strong associations in the asymptomatic HI and SAH group, with worse 90-day recovery across mRS scores of 0 to 1 and 0 to 2.

Chen and colleagues additionally reported that asymptomatic patients with HI and SAH recorded higher median NIHSS scores (18 vs. 16) as well as a longer median time from stroke onset to reperfusion (300 minutes vs. 264 minutes), while also undergoing more median overall thrombectomy attempts (2 vs. 1).

“Asymptomatic HI and SAH were associated with significantly worse long-term outcomes in patients undergoing mechanical thrombectomy for acute ischemic stroke,” Chen and colleagues wrote. “Although traditionally considered low risk, these hemorrhages were shown to negatively affect recovery.”