Cerebral hyperdensity on CT imaging (CTHD) post-reperfusion treatment in patients with acute cerebral stroke: understanding its clinical meaning.
Anterior circulation stroke
Brain parenchymal hyperdensities
CT imaging
Reperfusion therapy
Journal
La Radiologia medica
ISSN: 1826-6983
Titre abrégé: Radiol Med
Pays: Italy
ID NLM: 0177625
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
received:
14
12
2021
accepted:
30
06
2022
pubmed:
26
7
2022
medline:
28
9
2022
entrez:
25
7
2022
Statut:
ppublish
Résumé
To investigate the clinical meaning of brain parenchymal computed-tomography hyperdensities (CTHD) in patients treated of anterior circulation acute stroke with reperfusion therapy. Patients were retrospectively enrolled from three different hospitals. Brain CT scans were assessed at four time points: We recorded ASPECT scores of pre-treatment CTs, assessed ASPECT scores and the presence of CTHD on post-treatment CTs acquired within 24-30 h and 24-72 h, and examined a one-month CTs follow-up to determine the ischemic evolution of CTHD. We correlated the presence of CTHD with clinical and radiological data to define its predictive and prognostic factors. In total, 165 patients were evaluated. At post-treatment CTs acquired within 24-30 h, 68 (41%) patients showed the presence of CTHD. On post-treatment CTs acquired within 24-72 h, 43 (63%) of the CTHD showed hemorrhagic transformation. Sixty-five (95%) out of the 68 CTHD evolved in a final ischemic brain area. Multivariate statistical analysis identified puncture to recanalization time to be the only independent factors predicting the presence of CTHD (p = 0.045). The presence of CTHD at the first post-treatment CTs was an independent factor for clinical outcome determined with mRS scores at 3-month follow-up (p = 0.05). Outcomes were worse for hemorrhagic transformation at follow-up CTs compared to the ischemic evolution of the CTHD (p = 0.01). The presence of CTHD at CTs imaging acquired within 24-30 h after reperfusion therapy is an independent prognostic factor of a worse clinical outcome, regardless of its ASPECT score at baseline CTs and of its hemorrhagic evolution.
Identifiants
pubmed: 35879628
doi: 10.1007/s11547-022-01525-1
pii: 10.1007/s11547-022-01525-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
973-980Informations de copyright
© 2022. Italian Society of Medical Radiology.
Références
Jickling GC, Liu D, Stamova B (2014) Hemorrhagic transformation after ischemic stroke in animals and humans. J Cereb Blood Flow Metab 34(2):185–199
doi: 10.1038/jcbfm.2013.203
del Zoppo GJ, von Kummer R, Hamann GF (1998) Ischaemic damage of brain microvessels: inherent risks for thrombolytic treatment in stroke. J Neurol Neurosurg Psychiatry 65:1–9
doi: 10.1136/jnnp.65.1.1
Desilles JP, Rouchaud A, Labreuche J et al (2013) Blood-brain barrier disruption is associated with increased mortality after endovascular therapy. Neurology 80:844–851
doi: 10.1212/WNL.0b013e31828406de
Whitney E, Khan YR, Alastra A et al (2020) Contrast extravasation post thrombectomy in patients with acute cerebral stroke: a review and recommendations for future studies. Cureus 12(9):e10616
pubmed: 33123430
pmcid: 7584332
Sun Y, Su Y, Chen Z, He Y, Zhang Y, Chen H (2019) Contrast extravasation after endovascular treatment in posterior circulation stroke. World Neurosurg 130:583–587
doi: 10.1016/j.wneu.2019.06.156
Cabral FB, Castro-Afonso LH, Nakiri GS et al (2017) Hyper-attenuating brain lesions on CT after ischemic stroke and thrombectomy are associated with final brain infarction. Interv Neuroradiol 23:594–600
doi: 10.1177/1591019917729550
An H, Zhao W, Wang J et al (2019) Contrast staining may be associated with intracerebral hemorrhage but not functional outcome in acute ischemic stroke patients treated with endovascular thrombectomy. Aging Dis 10:784–792
doi: 10.14336/AD.2018.0807
Payabvash S, Qureshi MH, Taleb S, Pawar S, Qureshi AI (2015) Middle cerebral artery residual contrast stagnation on noncontrast CT scan following endovascular treatment in acute ischemic stroke patients. J Neuroimaging 25:946–951
doi: 10.1111/jon.12211
Song SY, Ahn SY, Rhee JJ, Lee JW, Hur JW, Lee HK (2015) Extent of contrast enhancement on non-enhanced computed tomography after intra-arterial thrombectomy for acute infarction on anterior circulation: as a predictive value for malignant brain edema. J Korean Neurosurg Soc 58:321–327
doi: 10.3340/jkns.2015.58.4.321
Hassan AE, Kotta H, Shariff U (2019) There is no association between the number of stent retriever passes and the incidence of hemorrhagic transformation for patients undergoing mechanical thrombectomy. Front Neurol 10:818
doi: 10.3389/fneur.2019.00818
Kaesmacher J, Kaesmacher M, Maegerlein C et al (2017) Hemorrhagic transformations after thrombectomy: risk factors and clinical relevance. Cerebrovasc Dis 43:294–304
doi: 10.1159/000460265
Renu A, Laredo C, Tudela R et al (2017) Brain hemorrhage after endovascular reperfusion therapy of ischemic stroke: a threshold-finding whole-brain perfusion CT study. J Cereb Blood Flow Metab 37:153–165
doi: 10.1177/0271678X15621704
Bang OY, Saver JL, Kim SJ et al (2011) Collateral flow averts hemorrhagic transformation after endovascular therapy for acute ischemic stroke. Stroke 42:2235–2239
doi: 10.1161/STROKEAHA.110.604603
Lummel N, Schulte-Altedorneburg G, Bernau C et al (2014) Hyperattenuated intracerebral lesions after mechanical recanalization in acute stroke. AJNR Am J Neuroradiol 35:345–351
doi: 10.3174/ajnr.A3656
Parrilla G, Garcia-Villalba B, Espinosa de Rueda M et al (2012) Hemorrhage/contrast staining areas after mechanical intra-arterial thrombectomy in acute ischemic stroke: imaging findings and clinical significance. AJNR Am J Neuroradiol 33:1791–96
doi: 10.3174/ajnr.A3044
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM et al (2019) Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke 50(12):e344–e418
doi: 10.1161/STR.0000000000000211
Menon BK, O’Brien B, Bivard A, Spratt NJ, Demchuk AM, Miteff F, Lu X, Levi C, Parsons MW (2013) Assessment of leptomeningeal collaterals using dynamic CT angiography in patients with acute ischemic stroke. J Cereb Blood Flow Metab Off J Int Soc Cereb Blood Flow Metab 33(3):365–71
doi: 10.1038/jcbfm.2012.171
Nikoubashman O, Jablawi F, Dekeyzer S et al (2016) MRI appearance of intracerebral iodinated contrast agents. Is it possible to distinguish extravasated contrast agent from hemorrhage? Am J Neuroradiol. https://doi.org/10.3174/ajnr.A4755
doi: 10.3174/ajnr.A4755
pubmed: 27032975
pmcid: 7960282
Nikoubashman O, Reich A, Gindullis M et al (2014) Clinical significance of post-interventional cerebral hyperdensities after endovascular mechanical thrombectomy in acute ischaemic stroke. Neuroradiology 56:41–50
doi: 10.1007/s00234-013-1303-1
Yedavalli V, Sammet S (2017) Contrast extravasation versus hemorrhage after thrombectomy in patients with acute stroke. J Neuroimaging 27:570–576
doi: 10.1111/jon.12446
Morhard D, Ertl L, Gerdsmeier-Petz W et al (2014) Dual-energy CT immediately after endovascular stroke intervention: prognostic implications. Cardiovasc Intervent Radiol 37(5):1171–1178
doi: 10.1007/s00270-013-0804-y
Sven D, Omid N, Bart L (2017) Distinction between contrast staining and hemorrhage after endovascular stroke treatment: one CT is not enough. J Neurointerv Surg 9(4):394–398
doi: 10.1136/neurintsurg-2016-012290
Payabvash S, Qureshi MH, Khan SM et al (2014) Differentiating intraparenchymal hemorrhage from contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients undergoing endovascular treatment. Neuroradiology 56:737–744
doi: 10.1007/s00234-014-1381-8
Kim JT, Heo SH, Cho BH et al (2012) Hyperdensity on non-contrast CT immediately after intra-arterial revascularization. J Neurol 259:936–943
doi: 10.1007/s00415-011-6281-9
Yoon W, Seo JJ, Kim JK, Cho KH, Park JG, Kang HK (2004) Contrast enhancement and contrast extravasation on computed tomography after intra-arterial thrombolysis in patients with acute ischemic stroke. Stroke 35:876–881
doi: 10.1161/01.STR.0000120726.69501.74
Jiang Q, Hou J, Ge J (2021) Clinical significance of hyperdense area after endovascular therapy in patients with acute ischemic stroke: a systematic review and meta-analysis. Cerebrovasc Dis 50(5):500–509
doi: 10.1159/000515410
Chen Z, Zhang Y, Su Y (2020) Contrast extravasation is predictive of poor clinical outcomes in patients undergoing endovascular therapy for acute ischemic stroke in the anterior circulation. J Stroke Cerebrovasc Dis 29(1):104494
doi: 10.1016/j.jstrokecerebrovasdis.2019.104494
Xu C, Zhou Y, Zhang R et al (2019) Metallic hyperdensity sign on noncontrast CT immediately after mechanical thrombectomy predicts parenchymal hemorrhage in patients with acute large-artery occlusion. AJNR Am J Neuroradiol 40:661–667
pubmed: 30846439
pmcid: 7048513
Rouchaud A, Pistocchi S, Blanc R et al (2014) Predictive value of flat-panel CT for hemorrhagic transformations in patients with acute stroke treated with thrombectomy. J Neurointerv Surg 6:139–143
doi: 10.1136/neurintsurg-2012-010644
Lee YB, Yoon W, Lee YY, Kim SK et al (2019) Predictors and impact of hemorrhagic transformations after endovascular thrombectomy in patients with acute large vessel occlusions. J Neurointerv Surg 11(5):469–473
doi: 10.1136/neurintsurg-2018-014080
Nogueira RG, Gupta R, Jovin TG (2015) Predictors and clinical relevance of hemorrhagic transformation after endovascular therapy for anterior circulation large vessel occlusion strokes: a multicenter retrospective analysis of 1122 patients. J Neurointerv Surg. 7(1):16–21
doi: 10.1136/neurintsurg-2013-010743
Neuberger U, Kickingereder P, Schonenberger S et al (2019) Risk factors of intracranial hemorrhage after mechanical thrombectomy of anterior circulation ischemic stroke. Neuroradiology 61:461–469
doi: 10.1007/s00234-019-02180-6
Alawieh A, Pierce AK, Vargas J et al (2018) The golden 35 min of stroke intervention with ADAPT: effect of thrombectomy procedural time in acute ischemic stroke on outcome. J Neurointerv Surg 10(3):213–220
doi: 10.1136/neurintsurg-2017-013040
Shi ZS, Duckwiler GR, Jahan R et al (2018) Early blood-brain barrier disruption after mechanical thrombectomy in acute ischemic stroke. J Neuroimaging 28(3):283–288
doi: 10.1111/jon.12504
Sugiura Y, Yamagami H, Sakai N, Yoshimura S (2017) Predictors of symptomatic intracranial hemorrhage after endovascular therapy in acute ischemic stroke with large vessel occlusion. J Stroke Cerebrovasc Dis 26:766–771
doi: 10.1016/j.jstrokecerebrovasdis.2016.10.015
Zi W, Qiu Z, Li F, Sang H (2021) Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: the DEVT randomized clinical trial. JAMA 325(3):234–243
doi: 10.1001/jama.2020.23523
Suzuki K, Masataka Y, Takeuchi M et al (2021) Effect of mechanical thrombectomy without vs with intravenous thrombolysis on functional outcome among patients with acute ischemic stroke: the SKIP randomized clinical trial. Jama 325(3):244–253
doi: 10.1001/jama.2020.23522