Early Hemorrhagic Transformation after Reperfusion Therapy in Patients with Acute Ischemic Stroke: Analysis of Risk Factors and Predictors

Abstract

Background: The standard reperfusion therapy for acute ischemic stroke (AIS) is considered to be thrombolysis, but its application is limited by the high risk of hemorrhagic transformation (HT). This study aimed to analyze risk factors and predictors of early HT after reperfusion therapy (intravenous thrombolysis or mechanical thrombectomy). Material and methods: Patients with acute ischemic stroke who developed HT in the first 24 h after receiving rtPA thrombolysis or performing mechanical thrombectomy were retrospectively reviewed. They were divided into two groups, respectively, the early-HT group and the without-early-HT group based on cranial computed tomography performed at 24 h, regardless of the type of hemorrhagic transformation. Results: A total of 211 consecutive patients were enrolled in this study. Among these patients, 20.37% (n = 43; age: median 70.00 years; 51.2% males) had early HT. Multivariate analysis of independent risk factors associated with early HT found that male gender increased the risk by 2.7-fold, the presence of baseline high blood pressure by 2.4-fold, and high glycemic values by 1.2-fold. Higher values of NIHSS at 24 h increased the risk of hemorrhagic transformation by 1.18-fold, while higher values of ASPECTS at 24 h decreased the risk of hemorrhagic transformation by 0.6-fold. Conclusions: In our study, male gender, baseline high blood pressure, and high glycemic values, along with higher values of NIHSS were associated with the increased risk of early HT. Furthermore, the identification of early-HT predictors is critical in patients with AIS for the clinical outcome after reperfusion therapy. Predictive models to be used in the future to select more careful patients with a low risk of early HT need to be developed in order to minimize the impact of HT associated with reperfusion techniques.

Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma

“…Lastly, our study revealed insignificant associations between the presenting NIHSS, NCCT-based ASPECTS, and CTP-derived infarct core volume with an increased risk of delayed PH following thrombectomy, which is in contrast with previous literature [ 3 , 27 ]. Nonetheless, our analysis identified a trend toward an increased risk of delayed PH in patients with higher presenting NIHSS, lower NCCT-based ASPECTS, and larger CTP-derived infarct core volumes, although statistical significance was not attained within our cohort.…”

Hemorrhagic Coagulation Disorders and Ischemic Stroke: How to Reconcile Both?

“…Another interesting study found a correlation between an increased NIHSS score and the concomitant presence of atrial fibrillation and tumors [85]. These data regarding the concomitant presence of atrial fibrillation have not been confirmed in other studies [81], while, with regard to the diagnosis of a concomitant neoplasm, it is difficult to find case series that evaluate patients also for the purposes of researching a neoplasm occult. To conclude, a review demonstrated that the occurrence of hemorrhage in the context of an ischemic area depends on many factors, including the location and size of the infarct and poor collateral vascularization, confirming what has been said previously [86].…”

“…In the case of a cardioembolic stroke, the numerousness of the clots was predictive of the overlap of a hemorrhagic complication considering the possibility that, in this case, there could be a greater extension and a multiplicity of the infarcted brain areas [72,80]. Iancu et al [81] looked for risk factors and hemorrhagic transformation in patients with an initial diagnosis of ischemic stroke. Among these, the presence of male sex, high glycemic values of arterial hypertension at baseline, and high values of NIHSS and ASPECTS scores were all associated with a significantly elevated risk of hemorrhagic transformation [81].…”

“…Iancu et al [81] looked for risk factors and hemorrhagic transformation in patients with an initial diagnosis of ischemic stroke. Among these, the presence of male sex, high glycemic values of arterial hypertension at baseline, and high values of NIHSS and ASPECTS scores were all associated with a significantly elevated risk of hemorrhagic transformation [81]. In this study as in others, the assessment of stroke severity and early detection of tomographic characteristics of the infarcted ischemic lesion were the main predictive factors of hemorrhagic transformation [82,83].…”

Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations

“…These symptoms persist for a duration exceeding 24 h or may even culminate in the patient's death. Notably, the only discernible causative factor for these symptoms should be of vascular origin, unless there are specific interventions like surgery or medication that might interrupt this course" [176]. This clearcut definition, along with the combined insights from imaging and clinical examinations, solidifies the diagnostic accuracy, ensuring patients receive the most appropriate and timely care.…”