High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke

Abstract

ObjectiveBlood-brain barrier (BBB) permeability has been proposed as a predictor of hemorrhagic transformation (HT) after tissue plasminogen activator (tPA) administration; however, the reliability of perfusion computed tomography (PCT) permeability imaging for predicting HT is uncertain.We aimed to determine the performance of high-permeability region size on PCT (HPrs-PCT) in predicting HT after intravenous tPA administration in patients with acute stroke.MethodsWe performed a multimodal CT protocol (non-contrast CT, PCT, CT angiography) to prospectively study patients with middle cerebral artery occlusion treated with tPA within 4.5 hours of symptom onset. HT was graded at 24 hours using the European-Australasian Acute Stroke Study II criteria. ROC curves selected optimal volume threshold, and multivariate logistic regression analysis identified predictors of HT.ResultsThe study included 156 patients (50% male, median age 75.5 years). Thirty-seven (23,7%) developed HT [12 (7,7%), parenchymal hematoma type 2 (PH-2)]. At admission, patients with HT had lower platelet values, higher NIHSS scores, increased ischemic lesion volumes, larger HPrs-PCT, and poorer collateral status. The negative predictive value of HPrs-PCT at a threshold of 7mL/100g/min was 0.84 for HT and 0.93 for PH-2. The multiple regression analysis selected HPrs-PCT at 7mL/100g/min combined with platelets and baseline NIHSS score as the best model for predicting HT (AUC 0.77). HPrs-PCT at 7mL/100g/min was the only independent predictor of PH-2 (OR 1, AUC 0.68, p = 0.045).ConclusionsHPrs-PCT can help predict HT after tPA, and is particularly useful in identifying patients at low risk of developing HT.

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

“…Perfusion CT can also generate BBBP maps that can help in the identification of patients at risk of HT ( 65 , 171 , 172 ), but its relevance compared to other predictors has been contested ( 173 ).…”

Blood–Brain Barrier Disruption and Hemorrhagic Transformation in Acute Ischemic Stroke: Systematic Review and Meta-Analysis

“…Five studies were found as having a low risk of bias ( 15 , 21 , 23 , 24 , 26 ), seven a high risk ( 13 , 17 – 20 , 22 , 25 ), and two an unclear risk ( 14 , 16 ) ( Supplemental Table 1 ). The general clinical characteristics of the included studies evaluating BBB with CT are summarized in the Supplemental Table 2 .…”

Increased microvascular permeability and low level of low-density lipoprotein cholesterol predict symptomatic intracerebral hemorrhage in acute ischemic stroke

“…2 mL/100 g for the penumbra). [16][17][18] CTA original images were analyzed by AVA software to reveal the presence, etiology, and site of occlusion, and we obtain vascular volume rendering (VR), maximum intensity projection (MIP), multiplanar reformation (MPR), and collateral filling data. We reported the number of patients with large artery occlusion in sICH group and non-sICH group, and classified patients in four types according to occlusion site: ACA, MCA, posterior cerebral artery (PCA), and other intracranial arteries (Others).…”