Prediction of hemorrhagic transformation after acute thrombolysis following major artery occlusion using relative ADC ratio: A retrospective study

Shinoda, Narihide; Hori, Shinya; Mikami, Kazuyuki; Bando, Toshiaki; Shimo, Daisuke; Kuroyama, Takahiro; Kuramoto, Yoji; Matsumoto, Masato; Hirai, Osamu; Ueno, Yasushi

doi:10.1016/j.neurad.2017.07.003

Cited by 15 publications

(26 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results conflict with the reported association between END due to ischemia and lower baseline NIHSS scores, which were suggestive of good collateral flow at baseline [3,7]. Imaging studies have demonstrated that lower residual cerebral blood flow and lower apparent diffusion coefficient value in ischemic lesions were predictive of sICH [25,26]. Taken together, a higher NIHSS score rather than a lower ASPECTS might be suggestive of a greater depth of ischemia with irreversible tissue damage, which leads an increased risk of hemorrhage on reperfusion.…”

Section: Discussionmentioning

confidence: 83%

“…Univariate analyses of clinical characteristics between non-END patients and patients with END h and END i are shown in Table 1. Compared with non-END patients, the extensive EIC and large artery occlusions were more common in patients with both END subtypes; the pretreatment NIHSS score was higher (20.5 [16][17][18][19][20][21][22][23][24][25][26] vs. 14 [8][9][10][11][12][13][14][15][16][17][18][19][20], p = 0.001) and pretreatment with antiplatelets was more common (50.0% vs. 27.7%, p = 0.022) in patients with END h , and AF was more common in patients with END i (64.9% vs. 49.3%, p = 0.027). The multivariate analyses revealed that a higher pretreatment NIHSS score (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00-1.13) and pretreatment with antiplatelets (OR 2.84, 95% CI 1.08-7.72) were associated with END h .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator

Tanaka

Matsumoto

Furuta

et al. 2019

J Thromb Thrombolysis

View full text Add to dashboard Cite

Early neurological deterioration (END) following intravenous recombinant tissue plasminogen activator (rt-PA) treatment is a serious clinical event that can be caused by hemorrhagic or ischemic insult. We investigated the differences in predictive factors for END due to hemorrhagic and END due to ischemic insults. Consecutive patients from four hospitals who received 0.6 mg/kg intravenous rt-PA for acute ischemic stroke were retrospectively recruited. END was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points within 24 h compared with baseline. END was classified into those due to hemorrhagic (END h) or ischemic (END i) insult based on computed tomography (CT) or magnetic resonance imaging. Risk factors associated with END h and END i were investigated by comparison with non-END cases. A total of 744 patients (452 men, median 75 years old) were included. END was observed in 79 patients (10.6%), including 22 END h (3.0%) and 57 END i (7.7%), which occurred within a median of 7 h after treatment. Multivariate analyses showed that higher pretreatment NIHSS score (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00-1.13) and pretreatment with antiplatelets (OR 2.84, 95% CI 1.08-7.72) were associated with END h. Extensive early ischemic change (Alberta Stroke Program Early CT Score ≤ 7 on CT or ≤ 6 on diffusion-weighted imaging; OR 2.80, 95% CI 1.36-5.64) and large artery occlusions (OR 3.09, 95% CI 1.53-6.57) were associated with END i. Distinct factors were predictive for the END subtypes. These findings could help develop preventative measures for END in patients with the identified risk factors.

show abstract

Section: Discussionmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 99%

Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator

Tanaka

Matsumoto

Furuta

et al. 2019

J Thromb Thrombolysis

View full text Add to dashboard Cite

show abstract

“…The demographic characteristics are listed in Table 1. One study was a randomized controlled trial (91 patients) (6), two studies were of a prospective design (7,9), and five were retrospective (5,8,11–13). Hemorrhagic transformation categorized as hemorrhagic infarction and parenchymal hematoma was evaluated according to the European Cooperative Acute Stroke Study (4).…”

Section: Resultsmentioning

confidence: 99%

MRI for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis

et al. 2019

View full text Add to dashboard Cite

Background Hemorrhagic transformation increases mortality and morbidity in patients with acute ischemic stroke. Purpose The purpose of this study is to evaluate the diagnostic performance of magnetic resonance imaging (MRI) for prediction of hemorrhagic transformation in acute ischemic stroke. Material and Methods A systematic literature search of MEDLINE and EMBASE was performed up to 27 July 2018, including the search terms “acute ischemic stroke,” “hemorrhagic transformation,” and “MRI.” Studies evaluating the diagnostic performance of MRI for prediction of hemorrhagic transformation in acute ischemic stroke were included. Diagnostic meta-analysis was conducted with a bivariate random-effects model to calculate the pooled sensitivity and specificity. Subgroup analysis was performed including studies using advanced MRI techniques including perfusion-weighted imaging, diffusion-weighted imaging, and susceptibility-weighted imaging. Results Nine original articles with 665 patients were included. Hemorrhagic transformation is associated with high permeability, hypoperfusion, low apparent diffusion coefficient (ADC), and FLAIR hyperintensity. The pooled sensitivity was 82% (95% confidence interval [CI] 61–93) and the pooled specificity was 79% (95% CI 71–85). The area under the hierarchical summary receiver operating characteristic curve was 0.85 (95% CI 0.82–0.88). Although study heterogeneity was present in both sensitivity (I2=67.96%) and specificity (I2=78.93%), a threshold effect was confirmed. Studies using advanced MRI showed sensitivity of 92% (95% CI 70–98) and specificity of 78% (95% CI 65–87) to conventional MRI. Conclusion MRI may show moderate diagnostic performance for predicting hemorrhage in acute ischemic stroke although the clinical significance of this hemorrhage is somewhat uncertain.

show abstract

“…Some MRI-based technique such as diffusion (apparent diffusion coefficient [ADC]),[41] and spin-label MRI after reperfusion (arterial spin labelling [ASL]),[42] may offer some aid in the prediction of SICH postthrombolysis. An ADC ratio (ADC in the affected area/ADC in the normal contralateral area) <0.65 was an independent predictor of hemorrhagic transformation, so was FLAIR hyperintensity.…”

Section: Introductionmentioning

confidence: 99%

“…An ADC ratio (ADC in the affected area/ADC in the normal contralateral area) <0.65 was an independent predictor of hemorrhagic transformation, so was FLAIR hyperintensity. [41] Focal hyperperfusion in the damaged area after reperfusion on ASL in a ratio higher than 1.5 (ipsilateral/contralateral) was also a reliable predictor of hemorrhagic transformation. [42]…”

Section: Introductionmentioning

confidence: 99%

The risk of symptomatic intracranial hemorrhage after thrombolysis for acute stroke: Current concepts and perspectives

Modrego¹

2019

Ann Indian Acad Neurol

View full text Add to dashboard Cite

Background: Thrombolysis is the standard of treatment for acute ischemic stroke, with a time window of up to 4½ h from stroke onset. Despite the long experience with the use of recombinant tissue plasminogen activator and the adherence to protocols symptomatic intracranial hemorrhage (SICH) may occur in around 6% of cases, with high-mortality rate and poor-functional outcomes. Many patients are excluded from thrombolysis on the basis of an evaluation of known risk factors, but there are other less known factors involved. Objective: The purpose of this work is to analyze the less known risk factors for SICH after thrombolysis. A search of articles related with this field has been undertaken in PubMed with the keywords (brain hemorrhage, thrombolysis, and acute ischemic stroke). Some risk factors for SICH have emerged such as previous microbleeds on brain magnetic resonance imaging, leukoaraiosis, and previous antiplatelet drug use or statin use. Serum matrix metalloproteinases have emerged as a promising biomarker for better selection of patients, but further research is needed. Conclusions: In addition to the already known risk factors considered in the standard protocols, an individualized evaluation of risks is needed to minimize the risk of brain hemorrhage after thrombolysis for ischemic stroke.

show abstract

Prediction of hemorrhagic transformation after acute thrombolysis following major artery occlusion using relative ADC ratio: A retrospective study

Cited by 15 publications

References 24 publications

Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator

Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator

MRI for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis

The risk of symptomatic intracranial hemorrhage after thrombolysis for acute stroke: Current concepts and perspectives

Contact Info

Product

Resources

About