The cortical contrast accumulation from brain computed tomography after endovascular treatment predicts symptomatic hemorrhage

Abstract

Our study provides evidence that the cortical involvement of contrast accumulation is associated with symptomatic hemorrhage after endovascular reperfusion treatment.

Evaluation of the CT High-density Area after Endovascular Treatment for Acute Ischemic Stroke

“…23) In addition, HA extending to the cerebral cortex was reported to be more often complicated by PH2 symptomatic hemorrhage and to be related to a poor outcome. 18) Of our patients, two patients (20%) developed hemorrhagic transformation in HA, and it was HI2 and PH1. In one patient (10%), PH2 intracranial hemorrhagic was noted at a site other than HA.…”

“…After excluding one article not providing details of the recanalization procedure, a total of 705 patients consisting of those reported in the remaining 13 articles and our patients were analyzed. [10][11][12][16][17][18][19][20][21][22][23][24][25] Concerning the recanalization procedure, the method for endovascular treatment differed after the report in 2012, and the treatments described in the 13 reports that we reviewed were IAT or clot disruption alone before 2012 and mechanical thrombectomy alone after 2012. IV-tPA was performed concomitantly in both groups.…”

“…11,18,23) Lummel et al 21) classified the disappearance of HA on CT performed 24 hours after the recanalization procedure as contrast extravasation and no disappearance as hemorrhagic transformation and evaluated the relationship of this classification with the outcome. There is a discrepancy among reports concerning the relationship between HA and symptomatic hemorrhage as an adverse prognostic factor ( Table 2).…”

“…However, HA covering 20% or more of the unilateral cerebral hemisphere or extending to the cerebral cortex may lead to brain edema or PH2 symptomatic hemorrhage and requires caution. 18,23) …”

Applications and development of permeability imaging in ischemic stroke (Review)

“…Kim et al (17) performed no-contrast computerized tomography (CT) scans following arterial thrombolysis in patients with acute cerebral infarction and attempted to assess the risk of HT by analyzing the contrast agent retention. This method exhibited good sensitivity but relatively low specificity in predicting the occurrence of HT (18).…”