Abstract Background and aims Endovascular therapy (EVT) is standard for acute ischaemic stroke (AIS) due to large- or medium-vessel occlusion, but symptomatic intracranial haemorrhage (sICH) remains a severe complication associated with early neurological deterioration and poor recovery. We aimed to identify predictors of sICH to improve risk stratification and post-procedural surveillance. Methods We retrospectively included consecutive AIS patients treated with EVT at University Hospital Giessen, Germany, between October 2021 and December 2023. Demographic, clinical, laboratory, imaging and procedural variables (including pre-stroke modified Rankin Scale mRS, admission NIHSS, TOAST aetiology, ASPECTS and mTICI) were obtained from the institutional stroke registry and records; imaging was reviewed by an experienced radiologist and neurologist. sICH on follow-up neuroimaging was defined according to ECASS III and classified using the Heidelberg Bleeding Classification. Multivariable logistic regression assessed predictors of intracranial haemorrhage and sICH, adjusting for age, pre-stroke mRS and admission NIHSS. Results Among 379 EVT-treated patients, 40 (10.6%) developed sICH and had markedly worse outcomes (discharge NIHSS 22 vs 4; in-hospital mortality 70.0% vs 34.2%; both p0.001). Higher admission glucose (OR 1.01; 95% CI 1.00–1.01) and creatinine (OR 1.43; 95% CI 1.01–2.03) were independently associated with sICH. Successful recanalisation was protective (OR 0.34; 95% CI 0.14–0.81), whereas lower ASPECTS was strongly associated with increased sICH risk (OR 0.77; 95% CI 0.66–0.91). Conclusions Admission metabolic markers and baseline infarct extent may help identify patients at elevated sICH risk after EVT. Conflict of interest All authors have nothing to disclose
Omar et al. (2026) studied this question.