Intracranial Calcification is Predictive for Hemorrhagic Transformation and Prognosis After Intravenous Thrombolysis in Non-Cardioembolic Stroke Patients

Abstract

Hemorrhagic transformation is the major complication of intravenous thrombolysis. Calcification is used widely as an imaging indicator of atherosclerotic burden and cerebrovascular function. The relationship between intracranial calcification and hemorrhagic transformation has not been explored fully. We aimed to identify and quantify calcification in the main cerebral vessels to investigate the correlations between quantitative calcification parameters, hemorrhagic transformation, and prognosis. Methods: Acute, non-cardiogenic, ischemic stroke patients with anterior circulation who received intravenous thrombolysis therapy in the First Hospital of Jilin University were retrospectively and consecutively included. All included patients underwent a baseline CT before intravenous thrombolysis and a follow-up CT at 24 hours. A third-party software, ITK-SNAP, was used to segment and measure the calcification volume. A vascular nonbone component with a CT value 130 HU was considered calcified. Hemorrhagic transformation was determined based on the ECASS II classification criteria. Results:The study included 242 patients, 214 of whom were identified as having calcification. Thirty-one patients developed hemorrhagic transformation. The calcification volume on the lesion side (0.1ml) was associated with hemorrhagic transformation (p 0.004, OR 1.504, 95% CI: 1.140-1.985). Ninety-six patients had poor prognoses. The poor prognosis group had more calcified vessels than the good prognosis group (p 0.014, OR 1.477, 95% CI: 1.083-2.015). Conclusions:The arterial calcification volume on the lesion side is associated with hemorrhagic transformation after thrombolysis. The higher the number of calcified vessels, the greater the risk of poor prognosis.for early reperfusion, significantly reducing disability and fatality in acute ischemic stroke patients 1,2) . However, it is still accompanied by a 2-7% risk of symp-

Carotid Siphon Calcification Predicts the Symptomatic Progression in Branch Artery Disease With Intracranial Artery Stenosis—Brief Report

“… 3 , 4 Intracranial calcification is associated with the early progression or recurrence of stroke, coronary events, vascular deaths, 5 and hemorrhagic transformation in patients with noncardioembolic stroke. 6 Vertebrobasilar calcification in patients with ischemic stroke is a valid predictor for stroke recurrence and acute vascular disease. 7 Coronary artery calcification in patients with atrial fibrillation has increased the independent risk of stroke, 3 but carotid calcification is not associated with incident stroke.…”

Comparison of symptomatic vertebrobasilar plaques between patients with and without Diabetes Mellitus using computed tomographic angiography and vessel wall magnetic resonance imaging

“…Two studies reported that calcification volumes of the intracranial carotid artery and vertebrobasilar artery were significantly associated with worse outcomes after intra-arterial revascularization therapies. 27 , 28 Yu et al 29 reported that calcification volume on the lesion side was associated with hemorrhagic transformation after intravenous thrombolysis. Therefore, the higher volume of vertebrobasilar artery calcification observed in DM patients may substantially influence the prognostication and treatment decision-making.…”

Silent brain infarction is associated with carotid siphon calcification in ischemic stroke patients

“…According to the histopathologically validated method using plain CT, calcification are of two types: intimal calcification and medial calcification ( Kockelkoren et al, 2017 ). This scoring model has been proved and used in many researches ( Compagne et al, 2018 , Kauw et al, 2021 , Yang et al, 2018 , Yu et al, 2021 ). The circularity, thickness, and morphology of calcification were recorded.…”