# Relationship between early venous filling after thrombectomy and intracranial hemorrhage and prognosis in patients with acute ischemic stroke: a systematic review and meta-analysis

## TL;DR

This study finds that early venous filling during stroke treatment is linked to worse outcomes, including higher bleeding risk and poorer recovery.

## Contribution

The study identifies early venous filling as a potential marker for predicting poor outcomes after stroke thrombectomy.

## Key findings

- Early venous filling is associated with reduced functional recovery after stroke.
- Early venous filling increases the risk of postoperative intracranial hemorrhage.
- Early venous filling is linked to higher rates of symptomatic intracranial hemorrhage.

## Abstract

This study aims to assess the relationship between early venous filling (EVF) observed during mechanical thrombectomy and 90-day functional independence (mRS ≤ 2) as well as postoperative intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (SICH), in patients with acute ischemic stroke.

We conducted a systematic search of the PubMed, EMBASE, Web of Science, and Cochrane Library databases up to September 26, 2024, following the PRISMA 2020 guidelines. The primary clinical outcomes were defined as 90-day functional independence (mRS ≤ 2) and SICH, while the secondary clinical outcome was ICH. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using a random-effects model.

A total of six studies that met the inclusion criteria were analyzed. Meta-analysis demonstrated that patients with EVF had a significantly reduced likelihood of achieving 90-day functional independence compared to patients without EVF (OR 0.42, 95% CI 0.18–0.99, P = 0.05). Moreover, patients with EVF exhibited a markedly higher risk of post-procedural SICH than patients without EVF (OR 4.68, 95% CI 2.20–9.96, P < 0.001). Additionally, EVF was strongly linked to an increased incidence of post-procedural ICH (OR 5.73, 95% CI 2.57–12.82, P < 0.0001).

EVF may serve as an intraoperative angiographic marker associated with a higher incidence of postoperative ICH, SICH, and poorer 90-day functional independence.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024595410.