Contrast Enhancement and Contrast Extravasation on Computed Tomography After Intra-Arterial Thrombolysis in Patients With Acute Ischemic Stroke

Abstract

Background and Purpose-The goal of this study was to determine the CT findings and clinical consequences of contrast enhancement and contrast extravasation on CT scans obtained after intra-arterial thrombolytic therapy for treatment of acute ischemic stroke. Methods-Sixty-two patients were treated with intra-arterial thrombolysis. All patients underwent nonenhanced CT scans immediately and 24 hours after thrombolytic therapy. Contrast enhancement was defined as a hyperdense lesion that disappeared on a 24-hour follow-up CT scan. Contrast extravasation was defined as a hyperdense lesion with maximum Hounsfield unit Ͼ90 that persisted on a follow-up CT scan. We evaluated the differences in the clinical and radiological data between 3 groups: contrast enhancement, contrast extravasation, and control groups. Results-Contrast enhancement was found in 14 of 62 patients (22.6%); contrast extravasation was seen in 7 (11.3%).Compared with the control group, the contrast enhancement group had a lower recanalization grade (64.3% versus 34.1%, Pϭ0.048) and a lower incidence of hemorrhagic transformation (14.3% versus 43.9%, Pϭ0.047). The contrast extravasation group had a higher incidence of both hemorrhage (100% versus 43.9%, Pϭ0.006) and symptomatic hemorrhage (100% versus 14.6%, PϽ0.001) than the control group. Poor outcomes were more frequent in the contrast extravasation group (100% versus 38.9%, Pϭ0.003) than the control group. Conclusions-Contrast enhancement on CT scans obtained after intra-arterial thrombolysis is usually not associated with hemorrhagic complications. However, contrast extravasation is highly associated with parenchymatous hematoma and should be considered a negative prognostic sign.

Hemorrhagic Transformation of Ischemic Stroke: Prediction with CT Perfusion

“…Occlusion site and perfusion defect size are important considerations in determining the outcome of revascularization procedures and defining a target population for treatment (47)(48)(49). Surrogate radiologic markers of BBB breakdown, including intraprocedural early venous filling (50) and postprocedural contrast enhancement and extravasation, have been described previously (51). These markers usually are associated with larger volumes of contrast material injected over a prolonged period.…”

Reperfusion Rates Following Intra-Arterial Thrombolysis for Acute Ischemic Stroke: The Influence of the Method for Alteplase Delivery

“…Repeated microcatheter contrast injection may cause the extravasation of contrast to the surrounding tissue and thus result in toxic damage with resultant hemorrhage. 15 As a result, operators repeating microcatheter injections should take care to reduce injection pressure and volume. Microwire maceration of the clot also carries the risk of penetration into perforator branches with resultant hemorrhage.…”

Contrast Extravasation into an Acute Spontaneous Intracerebral Hematoma: Multidetector CT Angiographic Findings and Clinical Implications

“…Contrast extravasation has been described as a hyperdense area that disappears on a follow-up CT scan (14). Mericle et al (15) have suggested that extravasation of contrast medium could be defined as a hyperdense area with a maximal HU measurement over 90 and/or disappearance of the hyperdensity on a repeated CT obtained within 24 hours.…”