{"id":"753ab21d9fe2","type":"article","url":"https://hartvaat.nl/2026/05/19/vertraagde-intracraniele-bloeding-na-trombectomie-geassocieerd-met-slechtere-fun/","title":"Vertraagde intracraniële bloeding na trombectomie geassocieerd met slechtere functionele uitkomst en SBP >150 mmHg","title_en":"","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","dubbele-trombocytenremming"],"journal":"Journal of the American Heart Association","doi":"10.1161/JAHA.125.048272","source_url":"https://doi.org/10.1161/JAHA.125.048272","authors":["Jae Wook Jung","Byungjae Kim","Eun Lee Ko","JoonNyung Heo","Hyungwoo Lee","Young Dae Kim","Haram Joo","Byung Moon Kim","Dong Joon Kim","Hyo Suk Nam"],"significance":7,"published":"2026-06-14","source_date":"2026-05-19","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/"],"congress":"","summary_en":"Retrospective study of 268 patients undergoing endovascular thrombectomy, with dual-energy CT immediately post-procedure and follow-up imaging. Early intracranial haemorrhage (ICH) occurred in 11.9%, delayed ICH in 36.9%, and no ICH in 51.1%. Delayed ICH was associated with lower 90-day functional independence (mRS 0-2; aOR 0.49; 95% CI 0.25-0.94), without elevated mortality. Within delayed ICH, haemorrhagic infarction was mainly associated with functional dependence, while parenchymal haematoma was also linked to death. Higher postprocedural systolic blood pressure predicted delayed ICH, with thresholds at mean >150 mm Hg and peak >166 mm Hg. Optimised BP management may help prevent delayed ICH.","created":"2026-07-03T10:33:03Z","updated":"2026-07-03T13:31:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Retrospectieve studie van 268 patiënten die endovasculaire trombectomie ondergingen, met dual-energy CT direct na de procedure en follow-up beeldvorming. Vroege intracraniële bloeding (ICH) trad op bij 11,9%, vertraagde ICH bij 36,9%, en bij 51,1% geen ICH. Vertraagde ICH was geassocieerd met lagere kans op functionele onafhankelijkheid (mRS 0-2) na 90 dagen (aOR 0,49; 95%-BI 0,25-0,94), zonder verhoogde mortaliteit. Binnen vertraagde ICH was hemorragisch infarct vooral geassocieerd met functionele afhankelijkheid, terwijl parenchymateus hematoom ook met sterfte was verbonden. Hogere postprocedurele systolische bloeddruk voorspelde vertraagde ICH, met drempels bij gemiddelde >150 mmHg en piek >166 mmHg. Geoptimaliseerd BP-management kan vertraagde ICH potentieel voorkomen.","abstract_original":"BACKGROUND: Hemorrhagic transformation after endovascular thrombectomy can occur either immediately (early intracranial hemorrhage [ICH]) or on follow-up imaging (delayed ICH), possibly reflecting distinct mechanisms and outcomes. This study aim to investigate the incidence and prognosis of early and delayed ICH and to examine how postprocedural blood pressure (BP) relates to delayed ICH. METHODS: We analyzed consecutive patients undergoing endovascular thrombectomy (May 2019 through December 2024) who underwent post-endovascular thrombectomy dual energy computed tomography and follow-up imaging. Early ICH was defined as high attenuation on virtual noncontrast of dual energy computed tomography; delayed ICH was defined as new hemorrhage on follow-up after a negative virtual noncontrast. Hourly BP between dual energy computed tomography and follow-up was collected. Outcomes were 90-day functional independence (modified Rankin Scale score of 0-2) and 90-day death. RESULTS: Among 268 patients, early ICH occurred in 32 (11.9%) patients, delayed ICH in 99 (36.9%), and no ICH in 137 (51.1%). Versus no ICH, delayed ICH was associated with lower odds of functional independence (adjusted odds ratio, 0.49 [95% CI, 0.25-0.94]) without a higher mortality rate (adjusted odds ratio, 1.48 [95% CI, 0.70-3.18]). Within delayed ICH, type of hemorrhagic infarction related to less functional independence, whereas type of parenchymal hematoma related to both functional dependence and death. Higher postprocedural systolic BP was associated with delayed ICH, with thresholds at mean >150 mm Hg and peak >166 mm Hg. CONCLUSIONS: Delayed ICH was more common than early ICH and independently associated with worse outcomes. Dual energy computed tomography facilitated temporal distinction of hemorrhage and revealed BP-related risks for delayed ICH, suggesting that delayed ICH may be preventable through optimized BP management."}