The clinical utility of dual-energy CT in post-thrombectomy care: Part 2, the predictive value of contrast density and volume for delayed hemorrhagic transformation

Ahn, Seoiyoung; Roth, Steven G.; Mummareddy, Nishit; Ko, Young Hyeh; Bhamidipati, Akshay; Jo, Jacob; DiNitto, Julie; Fusco, Matthew R.; Chitale, Rohan; Froehler, Michael T.

doi:10.1016/j.jstrokecerebrovasdis.2023.107216

Cited by 6 publications

(3 citation statements)

References 16 publications

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“…Nonetheless, our analysis identified a trend toward an increased risk of delayed PH in patients with higher presenting NIHSS, lower NCCT-based ASPECTS, and larger CTP-derived infarct core volumes, although statistical significance was not attained within our cohort. Moreover, our finding of insignificant association among thrombolytic administration, time to recanalization, and successful recanalization with delayed PH are in line with existing literature [ 28 ]. Nevertheless, it is important to note that the lack of significant associations in our study might be due to the limited sample size inherent in our single-center retrospective design.…”

Section: Discussionsupporting

confidence: 91%

Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma

Ahn¹,

Roth²,

Jo³

et al. 2023

Neurointervention

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Purpose: Low levels of low-density lipoprotein cholesterol (LDL-C) have been suggested to increase the risk of hemorrhagic transformation (HT) following acute ischemic stroke. However, the literature on the relationship between LDL-C levels and post-thrombectomy HT is sparse. The aim of our study is to investigate the association between LDL-C and delayed parenchymal hematoma (PH) that was not seen on immediate post-thrombectomy dual-energy computed tomography (DECT).Materials and Methods: A retrospective analysis was conducted on all patients with anterior circulation large vessel occlusion who underwent thrombectomy at a comprehensive stroke center from 2018–2021. Per institutional protocol, all patients received DECT immediately post-thrombectomy and magnetic resonance imaging or CT at 24 hours. The presence of immediate hemorrhage was assessed by DECT, while delayed PH was assessed by 24-hour imaging. Multivariable analysis was performed to identify predictors of delayed PH. Patients with hemorrhage on immediate post-thrombectomy DECT were excluded to select only those with delayed PH.Results: Of 159 patients without hemorrhage on immediate post-thrombectomy DECT, 18 (11%) developed delayed PH on 24-hour imaging. In multivariable analysis, LDL-C (odds ratio [OR], 0.76; P=0.038; 95% confidence interval [CI], 0.59–0.99; per 10 mg/dL increase) independently predicted delayed PH. High-density lipoprotein cholesterol, triglyceride, and statin use were not associated. After adjusting for potential confounders, LDL-C ≤50 mg/dL was associated with an increased risk of delayed PH (OR, 5.38; P=0.004; 95% CI, 1.70–17.04), while LDL-C >100 mg/dL was protective (OR, 0.26; P=0.041; 95% CI, 0.07–0.96).Conclusion: LDL-C ≤50 mg/dL independently predicted delayed PH following thrombectomy and LDL-C >100 mg/dL was protective, irrespective of statin. Thus, patients with low LDL-C levels may warrant vigilant monitoring and necessary interventions, such as blood pressure control or anticoagulation management, following thrombectomy even in the absence of hemorrhage on immediate post-thrombectomy DECT.

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Section: Discussionsupporting

confidence: 91%

Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma

Ahn¹,

Roth²,

Jo³

et al. 2023

Neurointervention

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“…Our study revealed that the presence of CS on DECT post-thrombectomy is probably associated with the development of HT, which supports the concept that both CS and HT are successive stages of BBB disruption [ 24 ]. Ahn et al [ 25 ] showed that delayed petechial hemorrhage was predicted by anticoagulant use and maximum contrast density. It is recommended that the patients with evident CS following thrombectomy warrant close monitoring and necessary interventions such as avoiding or reversing anticoagulation [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ahn et al [ 25 ] showed that delayed petechial hemorrhage was predicted by anticoagulant use and maximum contrast density. It is recommended that the patients with evident CS following thrombectomy warrant close monitoring and necessary interventions such as avoiding or reversing anticoagulation [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of contrast staining on dual-energy CT after endovascular therapy in acute ischemic stroke: a meta-analysis

Yang,

Zeng,

Zhu

et al. 2023

BMC Neurol

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Background Contrast staining (CS) on dual-energy CT (DECT) is common after endovascular therapy (EVT) in acute ischemic stroke (AIS). We performed a meta-analysis to investigate the prognostic significance of CS detected by DECT after EVT in AIS. Method MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and Scopus databases were searched from inception to July 2023 for publications on the prognostic significance of CS on DECT after EVT in patients with AIS. Prognostic outcomes were hemorrhage transformation (HT) and poor functional outcome (modified Rankin Scale [mRS] Score of 3–6 at the 90-day follow-up). Data are presented as odds ratios (OR) and 95% confidence intervals (CI). Results Eleven studies including 1123 cases of AIS were included. Pooled results indicated a higher risk of HT in patients with CS than in those without CS (OR = 2.22; 95% CI 1.41–3.51, P = 0.001; I2 = 45.4%). No association between CS and symptomatic HT was observed (OR = 2.10; 95% CI 0.64–6.95, P = 0.223; I2 = 67.3%). Moreover, there was also higher odds of poor functional outcome in patients with CS than in those without CS (OR = 2.76; 95% CI 1.53–4.97, P = 0.001; I2 = 44.9%). Conclusions The presence of contrast staining on DECT after EVT is associated with a higher risk of hemorrhage transformation and poor functional outcome. However, further high-quality studies with standardized processes are required to confirm these results.

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Clinical Applications of Dual‐Energy Computed Tomography for Acute Ischemic Stroke

Chen,

Bodanapally,

Colasurdo

et al. 2024

SVIN

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Acute ischemic stroke is a leading cause for neurological disability worldwide, and treatment strategies are rapidly evolving. Patient selection for recanalization therapy and postintervention management relies heavily on diagnostic imaging. In this narrative review, we searched the existing literature for clinical applications of dual‐energy computed tomography for acute ischemic stroke. We summarized the current clinical evidence on the use of dual‐energy computed tomography for identifying early cerebral ischemia, detecting and predicting hemorrhagic transformations, and characterizing clots and stenotic plaques. We also highlight future opportunities for dual‐energy computed tomography to be used to address important diagnostic challenges during acute stroke triage and postintervention management. Dual‐energy computed tomography is a powerful tool that can be used to improve the diagnostic accuracy of ischemia, hemorrhage, and vascular lesions in the context of acute ischemic stroke.

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The clinical utility of dual-energy CT in post-thrombectomy care: Part 2, the predictive value of contrast density and volume for delayed hemorrhagic transformation

Cited by 6 publications

References 16 publications

Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma

Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma

Prognostic value of contrast staining on dual-energy CT after endovascular therapy in acute ischemic stroke: a meta-analysis

Clinical Applications of Dual‐Energy Computed Tomography for Acute Ischemic Stroke

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