Supplementary Material for: Risk of Intracranial Hemorrhage after Endovascular Treatment for Acute Ischemic Stroke: Systematic Review and Meta-Analysis

Background: Intracranial hemorrhage is a major
complication of endovascular treatment in patients with acute ischemic
stroke. Controlled clinical trials reported varied incidences of
intracranial hemorrhage after endovascular treatment. This meta-analysis
aimed to estimate whether endovascular treatment, compared with medical
treatment, increases the risk of intracranial hemorrhage in patients
with acute ischemic stroke. Methods: The current
publications on endovascular treatment for acute ischemic stroke were
systematically reviewed. Rates of intracranial hemorrhage after
endovascular treatment for acute ischemic stroke reported in controlled
clinical trials were pooled and analyzed. Random and fixed-effect models
were used to pool the outcomes. For analyzing their individual risks,
intracranial hemorrhages after endovascular treatment were classified as
symptomatic and asymptomatic. Results: Eleven studies
involving 1,499 patients with endovascular treatment and 1,320 patients
with medical treatment were included. After pooling the data, the risk
of any intracranial hemorrhage was significantly higher in patients with
endovascular treatment than in patients with medical treatment (35.0
vs. 19.0%, OR = 2.55, 95% CI: 1.64-3.97, p < 0.00001). The
risk of asymptomatic intracranial hemorrhage was also significantly
higher in patients with endovascular treatment than in those with
medical treatment (28 vs. 12%, OR = 3.16, 95% CI: 1.62-6.16, p <
0.001). However, the risks of symptomatic intracranial hemorrhage were
similar in patients with endovascular treatment and in those with
medical treatment (5.6 vs. 5.2%, OR = 1.09, 95% CI: 0.79-1.50, p = 0.61). Conclusion:
Although the risk of any intracranial hemorrhage may increase after
endovascular treatment, the risk of symptomatic intracranial hemorrhage
may remain similar as compared with medical treatment.