Risk factors and functional outcome were associated with hemorrhagic transformation after mechanical thrombectomy for acute large vessel occlusion stroke

Xing, Xiaolian; Wen, Chao; Liu, Hongwei

doi:10.23736/s0390-5616.20.05141-3

Cited by 13 publications

(5 citation statements)

References 35 publications

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“…One study demonstrated that a higher initial NIHSS and larger infarction volume increased the risk of hemorrhagic transformation. 12 However, we found no significant difference between symptomatic and nonsymptomatic hemorrhage groups in the initial NIHSS. As part of a standard protocol in our department, we carry out further comprehensive stroke surveys using MRI when the initial MRI shows a large infarction volume (such as diffusion weighted image [DWI] volume > 100 cc or all cortical involvement).…”

Section: Discussioncontrasting

confidence: 60%

Immediate CT change after thrombectomy predicting symptomatic hemorrhagic transformation

Yang

Huang

et al. 2023

Journal of the Chinese Medical Association

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Background: The prognostic value of contrast accumulation from noncontrast brain computed tomography (CT) conducted immediately after intra mechanical thrombectomy (MT) in patients with acute ischemic stroke to predict symptomatic hemorrhage was studied. Methods: Patients with acute ischemic stroke treated using MT between February 2015 and April 2019 were included. Contrast accumulation was defined as a high attenuation area observed on noncontrast brain CT conducted immediately after thrombectomy treatment, and the patients were categorized into (1) symptomatic hemorrhage, (2) asymptomatic hemorrhage, and (3) no hemorrhage according to the presence of hemorrhagic transformation and their clinical conditions. The pattern and extent of contrast accumulation were compared between patients with and without symptomatic hemorrhage. The maximal Hounsfield unit (HU) of cortical involvement in contrast accumulation was evaluated by calculating the sensitivity, specificity, odds ratio, and area under the receiver operating characteristic (ROC) curve. Results: In total, 101 patients with anterior circulation acute ischemic stroke were treated by endovascular intervention. Nine patients developed symptomatic hemorrhage and 17 developed asymptomatic hemorrhage. Contrast accumulation was associated with all types of hemorrhagic transformation (p < 0.01), and cortical involvement pattern was more frequently associated with symptomatic hemorrhage (p < 0.01). The area under the ROC curve was 0.887. The sensitivity and specificity for HU > 100 in cortical involvement predicting symptomatic hemorrhage after endovascular treatment were 77.8% and 95.7%, respectively, with an odds ratio of 77.0 (95% CI, 11.94-496.50; p < 0.01). Conclusion: Cortical involvement of contrast accumulation with a maximal HU > 100 predicts symptomatic hemorrhage after endovascular reperfusion treatment.

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Section: Discussioncontrasting

confidence: 60%

Immediate CT change after thrombectomy predicting symptomatic hemorrhagic transformation

Yang

Huang

et al. 2023

Journal of the Chinese Medical Association

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“…1 Hemorrhagic transformation (HT) and symptomatic intracerebral hemorrhage (sICH) after thrombectomy may decrease or eliminate the benefits of reperfusion, resulting in poor functional outcomes for patients with acute ischemic stroke. [2][3][4][5] The main mechanism of HT after thrombectomy is thought to be acute reperfusion injuries to the disrupted BBB. 6,7 Data from the Contact Aspiration versus Stent Retriever for Successful Revascularization (ASTER) randomized trial showed that there was no significant lesion growth following successful recanalization with mechanical thrombectomy.…”

Section: Resultsmentioning

confidence: 99%

Association between Infarct Location and Hemorrhagic Transformation of Acute Ischemic Stroke following Successful Recanalization after Mechanical Thrombectomy

Hang

et al. 2022

AJNR Am J Neuroradiol

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“…History of oral antiplatelet and/or anticoagulation drugs seems to increase the risk of HT in patients with acute ischemic stroke undergone to mechanical thrombectomy. In a study of Li et al32 the prior use of oral antithrombotic drugs was associated with ~7-fold risk of parenchimal hematoma after mechanical thrombectomy (OR, 6.694; 95% CI, 1.245-35.977, P =0.027). In the NORDICTUS trial enrolling 1.455 patients with acute ischemic stroke, 19% on oral anticoagulation, vitamin K antagonists but not direct oral anticoagulants were associated with a significant risk of symptomatic HT after mechanical thrombectomy (OR, 1.89 [95% CI, 1.01-3.51) 33…”

Section: Discussionmentioning

confidence: 98%

Predictive Factors for Hemorrhagic Transformation in Acute Ischemic Stroke in the REAL-World Clinical Practice

Grifoni¹,

Bini²,

Signorini³

et al. 2022

The Neurologist

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Background: Few data exists on predictive factors of hemorrhagic transformation (HT) in real-world acute ischemic stroke patients. The aims of this study were: (i) to identify predictive variables of HT (ii) to develop a score for predicting HT. Methods:We retrospectively analyzed the clinical, radiographic, and laboratory data of patients with acute ischemic stroke consecutively admitted to our Stroke Unit along two years. Patients with HT were compared with those without HT. A multivariate logistic regression analysis was performed to identify independent predictors of HT on CT scan at 24 hours to develop a practical score. Results:The study population consisted of 564 patients with mean age 77.5 11.8 years. Fifty-two patients (9.2%) showed HT on brain CT at 24 hours (4.9% symptomatic). NIHSS score ≥ 8 at Stroke Unit admission (3 points), cardioembolic etiology (2 points), acute revascularization by systemic thrombolysis and/or mechanical thrombectomy (1 point), history of previous TIA/stroke (1 point), and major vessel occlusion (1 point) were found independent risk factors of HT and were included in the score (Hemorrhagic Transformation Empoli score (HTE)). The predictive power of HTE score was good with an AUC of 0.785 (95% CI: 0.749-0.818). Compared with 5 HT predictive scores proposed in the literature (THRIVE, SPAN-100, MSS, GRASPS, SITS-SIC), the HTE score significantly better predicted HT.Conclusions: NIHSS score ≥ 8 at Stroke Unit admission, cardioembolism, urgent revascularization, previous TIA/stroke, and major vessel occlusion were independent predictors of HT. The HTE score has a good predictive power for HT. Prospective studies are warranted.

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Risk factors and functional outcome were associated with hemorrhagic transformation after mechanical thrombectomy for acute large vessel occlusion stroke

Cited by 13 publications

References 35 publications

Immediate CT change after thrombectomy predicting symptomatic hemorrhagic transformation

Immediate CT change after thrombectomy predicting symptomatic hemorrhagic transformation

Association between Infarct Location and Hemorrhagic Transformation of Acute Ischemic Stroke following Successful Recanalization after Mechanical Thrombectomy

Predictive Factors for Hemorrhagic Transformation in Acute Ischemic Stroke in the REAL-World Clinical Practice

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