Subarachnoid Contrast Accumulation and Alberta Stroke Program Early Computed Tomography Score Applied to Contrast Accumulation After Thrombectomy as Predictors of Symptomatic Hemorrhage

Kim, Hyeongseok; Lee, Seung-Jae; Lee, Tae-Kyeong; Jung, Kyu-On

doi:10.1016/j.wneu.2020.03.102

Cited by 11 publications

(5 citation statements)

References 29 publications

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“…This study has identified two key clinical factors, namely, ASPECT score and ORT, as independent predictors for hemorrhage in patients with PTIH. Previous studies have shown that the ASPECT score has a predictive value for hemorrhage in patients with AIS following EVT or thrombolysis, with a lower ASPECT score indicating a higher risk of hemorrhage, which is consistent with our findings [17][18][19]. In addition, a collaborative pooled analysis has demonstrated that prolonged ORT is associated with a higher incidence of intracerebral hemorrhage following successful endovas-cular treatment [20].…”

Section: Discussionsupporting

confidence: 91%

CT Texture-Based Nomogram in Ischemic Stroke to Differentiate Intracerebral Hemorrhage from Contrast Extravasation after Thrombectomy

An,

Chen,

Dong

et al. 2024

Cerebrovasc Dis

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Introduction: Post-thrombectomy intraparenchymal hyperdense (PTIH) in patients with acute ischaemic stroke (AIS) is a common CT sign, making it difficult for physicians to distinguish intracerebral hemorrhage in the early post-thrombectomy period. The aim of this study is to develop an effective model to differentiate intracerebral hemorrhage from contrast extravasation in patients with PTIH. Methods: We retrospectively collected information on patients who underwent endovascular thrombectomy (EVT) at two stroke centers between August 2017 and January 2023. A total of 222 patients were included in the study, including 118 patients in the development cohort, 52 patients in the internal validation cohort and 52 patients in the external validation cohort. The nomogram was constructed using R software based on independent predictors derived from the multivariate logistic regression analysis, including clinical factors and CT texture features extracted from hyperdense areas on CT images. The performance and accuracy of the derived nomogram was assessed by the area under the receiver operating characteristic curve (AUC-ROC) and calibration curves. Additionally, decision curve analysis was conducted to appraise the clinical utility of the nomogram. Results: Our nomogram was derived from two clinical factors (ASPECT score and onset to reperfusion time) and two CT texture features ( variance and uniformity), with AUC-ROC of 0.943, 0.930 and 0.937 in the development, internal validation and external validation cohorts, respectively. Furthermore, the calibration plot exhibited a strong agreement between the predicted outcome and the actual outcome. In addition, the decision curve analysis revealed the clinical utility of the nomogram in accurately predicting hemorrhage in patients with PTIH. Conclusion: The developed nomogram, based on clinical factors and CT texture features, proves to be effective in distinguishing intracerebral hemorrhage from contrast extravasation in patients with PTIH.

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Section: Discussionsupporting

confidence: 91%

CT Texture-Based Nomogram in Ischemic Stroke to Differentiate Intracerebral Hemorrhage from Contrast Extravasation after Thrombectomy

An,

Chen,

Dong

et al. 2024

Cerebrovasc Dis

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“…In contrast, the prevalence of collateral artery formation and recruitment was decrease in those patients, CES now not being related to continual cerebral underperfusion [10]. There has been a connection between large infarct length and poor collateral circulation, according to previous studies, perhaps because the presence of a larger penumbra is associated with excellent movement within the collateral pathway, and the time window for possible reperfusion can be extended by prolonging the survival time of the penumbra [25]. According to a study published in 2021, ischemic stroke victims who present within 24 hours of onset have extremely high chances of surviving; the penumbra device permits for secure and effective revascularisation; in other phrases, properly collateral stream limits the enlargement of the infarct core and determines the final infarct volume [16].…”

Section: Discussionmentioning

confidence: 97%

NT-proBNP Levels and Collateral Circulation Status in Patients with Acute Ischemic Stroke

et al. 2023

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Background and Objectives. Strokes resulting from atrial fibrillation (AF) increase with age. The relationship between N-terminal- (NT-) prohormone brain natriuretic peptide (NT-proBNP) level and National Institutes of Health Stroke Scale (NIHSS) score is not well established. Also, the collateral circulation plays an important role in NHISS scores. In this study, the effects of NT-proBNP on collateralization were assessed in patients with and without AF. Methods. In this study, 326 hospitalized patients with acute anterior circulation ischemic stroke (AACIS) were included. A comparison of the clinical characteristics of those with and without AF was conducted. The Spearman rank correlation was used for the correlation analysis of plasma NT-proBNP level, regional leptomeningeal collateral (rLMC) score, and computed tomography perfusion (CTP) status in the AF and non-AF groups. An analysis of multivariate linear regression was used to determine how plasma NT-proBNP level, rLMC score, and CTP status influenced the score on the NIHSS. Results. There was a greater plasma NT-proBNP level in the AF group compared with the non-AF group, an increased CTP volume (including CTP ischemic volume, CTP infarct core volume, and CTP ischemic penumbra volume ( P = 0.002 )), higher NIHSS score on admission, and lower rLMC score ( P < 0.001 for the remaining parameters). A negative correlation exists between plasma NT-proBNP level and rLMC score ( r = − 0.156 , P = 0.022 ), but a positive correlation exists between plasma NT-proBNP level and both CTP ischemic volume and CTP infarct core volume ( r = 0.148 , P = 0.003 ) in the AF group, but not in the non-AF group. Multivariate linear regression analysis demonstrated that NT-proBNP, CTP ischemic penumbra volume, and rLMC score were associated with NIHSS score, and NT-proBNP was positively associated with NIHSS scores (95% confidence interval (CI), 0.000-0.002; P = 0.004 ) in the AF group, whatever in the unadjusted model or adjusted models, but not in the nonlarge artery atherosclerosis (LAA) group. Conclusion. In AACIS patients with AF, NT-proBNP level negatively correlated with collateral status, positively with CTP ischemic volume, and positively with NIHSS score.

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“…Two independent investigators, blinded to clinical and imaging outcomes, assessed for the presence or absence of CE lesions and graded CE lesions according to the ASPECT-CE score, which ranges from 0 (CE involving the whole middle cerebral artery territory) to 10 (no CE). 23 An ASPECT-CE score of 6 was chosen as a cutoff to discriminate extensive vs nonextensive CE lesions, as previously published. 23 We did not compare the prognostic significance of CE (presence or absence) vs the CE-ASPECT on the flat panel, as we decided to simultaneously assess these 2 parameters in the analysis to test whether not only the presence of CE was associated with worse outcomes but also its severity (CE-ASPECTS <6).…”

Section: Methodsmentioning

confidence: 99%

“…23 An ASPECT-CE score of 6 was chosen as a cutoff to discriminate extensive vs nonextensive CE lesions, as previously published. 23 We did not compare the prognostic significance of CE (presence or absence) vs the CE-ASPECT on the flat panel, as we decided to simultaneously assess these 2 parameters in the analysis to test whether not only the presence of CE was associated with worse outcomes but also its severity (CE-ASPECTS <6). The presence or absence of CE and the ASPECT-CE were finally compared with ICH occurrence assessed on brain CT within 24-36 h (see below).…”

Section: Flat-panel Ct Analysismentioning

confidence: 99%

Association of Contrast Enhancement After Reperfusion With Outcomes According to Blood Pressure Lowering in Patients With Acute Ischemic Stroke

Maïer

Brauner²,

Escalard³

et al. 2022

Neurology

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Background and Objectives:Observational studies described associations between higher systolic blood pressure (SBP) values and intracranial hemorrhages (ICH) and worse outcomes after successful reperfusion by endovascular therapy (EVT). However, the BP-TARGET trial [BP-Target in Acute Ischemic Stroke to Reduce Hemorrhage after EVT] found that an intensive SBP target did not reduce ICH rates after successful EVT. The presence of contrast enhancement (CE) immediately after reperfusion is also associated with higher odds of ICH and worse outcomes. Our research question was to investigate the effect of two SBP strategies after reperfusion on ICH rates and functional outcomes according to the presence of CE in the BP-TARGET trial. We hypothesized that patients with CE could benefit from an intensive SBP control.Methods:We included BP-TARGET patients in whom a brain flat-panel was performed immediately after reperfusion. We described CE as present or absent, ICH consisted of any radiographic ICH 24 hours after EVT, unfavorable outcome consisted of a modified Rankin scale between 3-6 at 3 months.Results:Among the 324 patients randomized in BP-TARGET, 164 were included in this analysis, of whom 113 (68.9%) presented CE after reperfusion. The 24-hour mean SBP was significantly lower in the intensive SBP group compared with the standard group (129.7 versus 138.3 mmHg, p<0.001). Patients with CE and randomized in the intensive and standard SBP group had increased ICH rates: aOR=11.26, 95%CI 4.59-27.63 and aOR=4.08, 95%CI 1.75-9.50, respectively. However, the test of heterogeneity did not reach the significant level (aOR=2.76, 95%CI 0.80 to 9.48, p=0.11). Patients with CE and randomized in the intensive SBP group had also higher odds of unfavorable outcomes (aOR=2.91, 95%CI 1.24-6.82) but this association was not significant in the standard SBP group (aOR=1.89, 95%CI 0.85-4.23). No significant of heterogeneity was found between the two groups (aOR, 1.54, 95%CI 0.48 to 4.97, p=0.47).Discussion:Altogether, patients with CE and randomized in the intensive SBP group did not have lower rates of ICH or improved outcomes compared to the standard SBP group, as CE was associated with higher odds of ICH in both groups, without significant heterogeneity.Trial Registration Information:NCT03160677.Classification of Evidence:This study provides class IV evidence that for adults with contrast-enhancing lesions after successful EVT of an AIS, intensive blood pressure management did not significantly increase the risk of ICH.

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Subarachnoid Contrast Accumulation and Alberta Stroke Program Early Computed Tomography Score Applied to Contrast Accumulation After Thrombectomy as Predictors of Symptomatic Hemorrhage

Cited by 11 publications

References 29 publications

CT Texture-Based Nomogram in Ischemic Stroke to Differentiate Intracerebral Hemorrhage from Contrast Extravasation after Thrombectomy

CT Texture-Based Nomogram in Ischemic Stroke to Differentiate Intracerebral Hemorrhage from Contrast Extravasation after Thrombectomy

NT-proBNP Levels and Collateral Circulation Status in Patients with Acute Ischemic Stroke

Association of Contrast Enhancement After Reperfusion With Outcomes According to Blood Pressure Lowering in Patients With Acute Ischemic Stroke

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