Role of Brain Imaging in the Prediction of Intracerebral Hemorrhage Following Endovascular Therapy for Acute Stroke

Abstract

Currently most acute ischemic stroke patients presenting with a large vessel occlusion are treated with endovascular therapy (EVT), which results in high rates of successful recanalization. Despite this success, more than half of EVT-treated patients are significantly disabled 3 months later partly due to the occurrence of post-EVT intracerebral hemorrhage. Predicting post-EVT intracerebral hemorrhage is important for individualizing treatment strategies in clinical practice (eg, safe initiation of early antithrombotic therapies), as well as in selecting the optimal candidates for clinical trials that aim to reduce this deleterious outcome. Emerging data suggest that brain and vascular imaging biomarkers may be particularly relevant since they provide insights into the ongoing acute stroke pathophysiology. In this review/perspective, we summarize the accumulating literature on the role of cerebrovascular imaging biomarkers in predicting post-EVT–associated intracerebral hemorrhage. We focus on imaging acquired before EVT, during the EVT procedure, and in the early post-EVT time frames when new therapeutic therapies could be tested. Accounting for the complex pathophysiology of post-EVT–associated intracerebral hemorrhage, this review may provide some guidance for future prospective observational or therapeutic studies.

Blood glucose to predict symptomatic intracranial hemorrhage after endovascular treatment of acute ischemic stroke with large infarct core: a prospective observational study

“…This discrepancy may stem from the inclusion of patients in our study with large infarct cores in the anterior circulation and an ASPECTS score of ≤5, whereas previous EVT studies have largely excluded patients who had large infarct cores already present at the time of preoperative imaging. Several studies have demonstrated an association between larger cores on imaging and an increased risk of sICH after EVT ( 14 , 15 ). In most studies, an ASPECTS score of ≤5 was reported to be associated with an approximately 2-fold risk of ICH ( 16 , 17 ).…”

Asymptomatic parenchymal haemorrhage following endovascular treatment: Impact on functional outcome in patients with acute ischaemic stroke

“…We also raise the possibility that the reason may lie in the definition we use for sICH, as previously mentioned by a recent article [28]. On the one hand, this definition does not consider the causal F I G U R E 3 Shift analysis of the modified Rankin Scale score at 3 months of follow-up according to asymptomatic parenchymal haemorrhage type 1 (aPH1).…”