Haemorrhagic transformation following ischaemic stroke: A retrospective study

Pande, Shrikant D; Win, May Myat; Khine, Aye Aye; Zaw, Ei Mon; Manoharraj, N.; Lolong, Lorecar; Tin, Aung Soe

doi:10.1038/s41598-020-62230-5

Cited by 32 publications

(32 citation statements)

References 33 publications

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“…This is supported by the fact that a BBB disruption measured in the first hours of stroke does not predict the appearance of HT occurring later than 3 days ( 129 ). It is thought that late HT occurs due to increased BBB permeability and blood flow after cerebral edema reduction ( 130 , 131 ). The hemorrhage appearance differs according to the stage it occurs.…”

Section: Hemorrhagic Transformation: the Role Of Bbb Permeabilitymentioning

confidence: 99%

“…Of the patients presenting with HT in the acute phase, 25% have had received reperfusion therapy, while only 16.7% of the late HT patients did ( 131 ). In another cohort of 527 patients, 86.3% of patients with HT developed it in the first 48 h ( 130 ). Montaner et al showed that 68.75% of patients with HT presented it in the first 48 h. Interestingly, seven of the 11 patients developing HT in the first 48 h had recanalization in the first 12 h, while none of the patients with HT beyond 48 h had early recanalization ( 110 ).…”

Section: Hemorrhagic Transformation: the Role Of Bbb Permeabilitymentioning

confidence: 99%

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Pathophysiology of Blood–Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery

et al. 2020

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The blood–brain barrier (BBB) is a dynamic interface responsible for maintaining the central nervous system homeostasis. Its unique characteristics allow protecting the brain from unwanted compounds, but its impairment is involved in a vast number of pathological conditions. Disruption of the BBB and increase in its permeability are key in the development of several neurological diseases and have been extensively studied in stroke. Ischemic stroke is the most prevalent type of stroke and is characterized by a myriad of pathological events triggered by an arterial occlusion that can eventually lead to fatal outcomes such as hemorrhagic transformation (HT). BBB permeability seems to follow a multiphasic pattern throughout the different stroke stages that have been associated with distinct biological substrates. In the hyperacute stage, sudden hypoxia damages the BBB, leading to cytotoxic edema and increased permeability; in the acute stage, the neuroinflammatory response aggravates the BBB injury, leading to higher permeability and a consequent risk of HT that can be motivated by reperfusion therapy; in the subacute stage (1–3 weeks), repair mechanisms take place, especially neoangiogenesis. Immature vessels show leaky BBB, but this permeability has been associated with improved clinical recovery. In the chronic stage (>6 weeks), an increase of BBB restoration factors leads the barrier to start decreasing its permeability. Nonetheless, permeability will persist to some degree several weeks after injury. Understanding the mechanisms behind BBB dysregulation and HT pathophysiology could potentially help guide acute stroke care decisions and the development of new therapeutic targets; however, effective translation into clinical practice is still lacking. In this review, we will address the different pathological and physiological repair mechanisms involved in BBB permeability through the different stages of ischemic stroke and their role in the development of HT and stroke recovery.

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Section: Hemorrhagic Transformation: the Role Of Bbb Permeabilitymentioning

confidence: 99%

Section: Hemorrhagic Transformation: the Role Of Bbb Permeabilitymentioning

confidence: 99%

Pathophysiology of Blood–Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery

et al. 2020

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“…Despite HT is a serious complication commonly following reperfusion therapy and, sometimes as a result of the natural evolution of the disease [13], the current treatment recommendations include anticoagulants, thrombolysis, and intravascular procedures [14]. Thus, available and routine clinical prediction tools of HT based on pathophysiological mechanisms are necessary to decide the best management options according to the patient's system response to stroke.…”

Section: Discussionmentioning

confidence: 99%

Sterile Leukocytosis Predicts Hemorrhagic Transformation in Arterial Ischemic Stroke: A National Inpatient Sample Study

Antoniazzi

Unda

Klyde

et al. 2021

Cureus

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Objective: Hemorrhage transformation (HT) is a known complication of arterial ischemic stroke (AIS). In addition, it is known that the increase of proinflammatory immune cells in the brain tissue after AIS predict worse outcomes. However, it is not clear whether inflammation due to preceding or post-stroke infections affect outcomes and moreover, if systemic inflammatory markers could be useful as a clinical prediction tool for HT post-stroke. Therefore, our objective was to assess the association between systemic proinflammatory profile in AIS patients with HT and in-hospital mortality that did not course with acute infections during hospitalization.Methods: This study was conducted using the 2016 and 2017 National Inpatient Sample (NIS) with International Classification of Diseases (ICD-10) codes. Multivariate logistic regression was used to examine the association between HT and in-hospital mortality with pro-inflammatory anomalies of white blood cells (WBCs) in AIS patients. Exclusion criteria comprised patients with under 18 years old, and with a diagnosis of gastrointestinal, urogenital, respiratory infection, bacteremia, viral infection, sepsis, or fever.Results: A total of 212,356 patients with AIS were included in the analysis. 422 (0.2%) patients had a HT and 10,230 (4.8%) patients died during hospitalization. The most common WBC pro-inflammatory marker was leukocytosis with 6.9% (n=29/422) of HT and 5.5% (n=560/10,230) of patients that died during hospitalization. After adjusting for socio-demographic, comorbidities and treatment factors, leukocytosis was found to be an independent risk factor for both outcomes, HT [OR = 1.5, 95% CI: 1-2.3, p=0.024] and, inhospital mortality [OR = 1.5, 95% CI: 1.3-1.6, p < 0.001]. Conclusion:Sterile leukocytosis is a potential clinical prediction tool to determine which patients are at higher risk of developing HT and die during hospitalization.

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“…HT is divided into hemorrhagic infarction (HI) and parenchymal hematoma (PH) types [ 2 ]. Patients with HI-type HT have no significantly higher risk of neurological deterioration than patients without HT, but patients with PH-type HT have symptomatic clinical deterioration [ 1 , 2 , 3 , 4 ]. According to a previous study, only PH-type HT in ischemic stroke is associated with early or late symptomatic neurological deterioration; we therefore wanted to focus on the risk factors associated with the occurrence of PH-type HT [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Possible Osteoporosis on Parenchymal-Type Hemorrhagic Transformation in Patients with Cardioembolic Stroke

Won

Kim

Cheong

et al. 2021

JCM

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Background: hemorrhagic transformation (HT) is a frequent complication of ischemic stroke, and parenchymal hematoma (PH)-type HT has been shown to correlate with symptomatic deterioration. Because both bone and vascular smooth muscle cells are composed of type 1 collagen, we hypothesized that the integrity of blood vessels around the infarction area might be more damaged in osteoporotic conditions after a cardioembolic stroke. Methods: we measured frontal skull Hounsfield unit (HU) values on brain CT images from cardioembolic stroke patients. We conducted a receiver operating characteristic curve analysis in a large sample registry to identify the optimal HU threshold for predicting osteopenia and osteoporosis. Hazard ratios were estimated using a Cox regression analysis to identify whether osteoporotic conditions were an independent predictor of PH-type HT in patients with cardioembolic stroke. Results: altogether, 600 consecutive patients (>18 years old) with cardioembolic stroke were enrolled over a 12-year period at our hospital. The infarction volume and hypothetical osteoporosis were independent predictive factors for PH-type HT development in patients with cardioembolic stroke. In the male group, hypothetical osteoporosis was an independent predictor for PH-type HT development after cardioembolic stroke (hazard ratio, 4.12; 95% confidence interval, 1.40–12.10; p = 0.010). Conclusions: our study suggests an association between possible osteoporosis and the development of PH-type HT in patients with cardioembolic stroke. Our findings could help to predict PH-type HT by providing a convenient method for measuring the HU value using brain CT images.

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Haemorrhagic transformation following ischaemic stroke: A retrospective study

Cited by 32 publications

References 33 publications

Pathophysiology of Blood–Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery

Pathophysiology of Blood–Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery

Sterile Leukocytosis Predicts Hemorrhagic Transformation in Arterial Ischemic Stroke: A National Inpatient Sample Study

Effect of Possible Osteoporosis on Parenchymal-Type Hemorrhagic Transformation in Patients with Cardioembolic Stroke

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