Association between Infarct Location and Hemorrhagic Transformation of Acute Ischemic Stroke following Successful Recanalization after Mechanical Thrombectomy

Ni, Heng; Lu, G-D; Hang, Yu; Jia, Z-Y; Cao, Y-Z; Shi, Hai‐Bin; Liu, S; Zhao, L-B

doi:10.3174/ajnr.a7742

Cited by 12 publications

(3 citation statements)

References 28 publications

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“…In 1 study, the topography of the core appeared to affect the risk of post-EVT ICH, with infarcts involving the deep areas being at much higher risk of any ICH as compared with purely cortical infarcts. 33 More severe hypoperfusion is usually observed in deep brain regions and can lead to BBB disruption, which may explain this association. 36 Further validation in larger independent data sets is warranted.…”

Section: Pretreatment Imaging Biomarkers Of Post-evt Ichmentioning

confidence: 99%

Role of Brain Imaging in the Prediction of Intracerebral Hemorrhage Following Endovascular Therapy for Acute Stroke

Seners

Wouters

Maïer

et al. 2023

Stroke

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Currently most acute ischemic stroke patients presenting with a large vessel occlusion are treated with endovascular therapy (EVT), which results in high rates of successful recanalization. Despite this success, more than half of EVT-treated patients are significantly disabled 3 months later partly due to the occurrence of post-EVT intracerebral hemorrhage. Predicting post-EVT intracerebral hemorrhage is important for individualizing treatment strategies in clinical practice (eg, safe initiation of early antithrombotic therapies), as well as in selecting the optimal candidates for clinical trials that aim to reduce this deleterious outcome. Emerging data suggest that brain and vascular imaging biomarkers may be particularly relevant since they provide insights into the ongoing acute stroke pathophysiology. In this review/perspective, we summarize the accumulating literature on the role of cerebrovascular imaging biomarkers in predicting post-EVT–associated intracerebral hemorrhage. We focus on imaging acquired before EVT, during the EVT procedure, and in the early post-EVT time frames when new therapeutic therapies could be tested. Accounting for the complex pathophysiology of post-EVT–associated intracerebral hemorrhage, this review may provide some guidance for future prospective observational or therapeutic studies.

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Section: Pretreatment Imaging Biomarkers Of Post-evt Ichmentioning

confidence: 99%

Role of Brain Imaging in the Prediction of Intracerebral Hemorrhage Following Endovascular Therapy for Acute Stroke

Seners

Wouters

Maïer

et al. 2023

Stroke

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“…Hemorrhagic transformation (HT) of variable severity is reported in up to a half of patients with acute large vessel occlusion (LVO) treated with endovascular thrombectomy (EVT), and has been independently associated with worse functional outcomes. 1,2 HT following acute revascularization has been suggested to be the result of postischemic hyperperfusion injury. [3][4][5] Identifying individuals at risk for HT due to hyperperfusion after EVT could provide invaluable information for the development of novel prognostication and treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transcranial Doppler ultrasound to evaluate the risk of hyperperfusion after endovascular stroke thrombectomy

Katsanos,

Srivastava,

Sahlas

et al. 2023

Journal of Neuroimaging

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Background and PurposeHemorrhagic transformation (HT) has been reported in up to 50% of acute ischemic stroke (AIS) patients with a large vessel occlusion (LVO) treated with endovascular thrombectomy (EVT). HT may be driven by postrecanalization hyperperfusion injury and is independently associated with worse functional outcomes. Strategies to identify patients at risk for HT may assist in developing preventive therapies.MethodsWe prospectively included adult AIS patients with an anterior circulation LVO achieving successful recanalization after EVT. Consenting participants received transcranial Doppler ultrasound (TCD) within 18 hours of procedure completion. We compared flow velocities according to the presence of HT on the computed tomography scan performed within the first 24±12 hours from the end of EVT. We also evaluated the association of flow velocities with systemic blood pressure (BP) readings at the time of insonation.ResultsA total of 48 patients consented to participate in the study. Six (12%) were excluded due to the absence of temporal windows. HT was detected in 20 participants (48%). Those with HT had higher peak systolic velocities on the middle cerebral arteries compared to those without HT for both the symptomatic (107±42 vs. 82±25 cm/second, p = .024) and asymptomatic (97±21 vs. 81±25 cm/second, p = .040) sides. No correlation of flow velocities on either the symptomatic or asymptomatic side and BP measurements at the time of insonation was detected.ConclusionTCD can identify patients at risk of HT following successful EVT. TCD could serve as an inexpensive ancillary test to guide participant selection for clinical trials targeting postprocedural reperfusion injury.

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Endovascular thrombectomy for DAWN- and DEFUSE-3 ineligible acute ischemic stroke patients: a systematic review and meta-analysis

Morsi,

Ghozy,

Elfil

et al. 2024

J Neurol

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Association between Infarct Location and Hemorrhagic Transformation of Acute Ischemic Stroke following Successful Recanalization after Mechanical Thrombectomy

Cited by 12 publications

References 28 publications

Role of Brain Imaging in the Prediction of Intracerebral Hemorrhage Following Endovascular Therapy for Acute Stroke

Role of Brain Imaging in the Prediction of Intracerebral Hemorrhage Following Endovascular Therapy for Acute Stroke

Transcranial Doppler ultrasound to evaluate the risk of hyperperfusion after endovascular stroke thrombectomy

Endovascular thrombectomy for DAWN- and DEFUSE-3 ineligible acute ischemic stroke patients: a systematic review and meta-analysis

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