RT Journal Article
SR Electronic
T1 Hypoperfusion Intensity Ratio and Hemorrhagic Transformation in Patients with Successful Recanalization after Thrombectomy
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1475
OP 1481
DO 10.3174/ajnr.A8329
VO 45
IS 10
A1 You, Jiaxiang
A1 Li, Xiaoxi
A1 Xia, Jun
A1 Li, Haopeng
A1 Wang, Jun
YR 2024
UL http://www.ajnr.org/content/45/10/1475.abstract
AB BACKGROUND AND PURPOSE: Hemorrhagic transformation remains a potentially devastating complication of acute ischemic stroke. We aimed to evaluate whether the hypoperfusion intensity ratio, a parameter derived from CT perfusion imaging, is associated with the development of hemorrhagic transformation in patients with anterior large-artery occlusion who had undergone thrombectomy.MATERIALS AND METHODS: We retrospectively reviewed data from patients with consecutive acute ischemic strokes who had achieved successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) between January 2020 and December 2023. HIR was defined as the ratio of the volume of lesions with a time-to-maximum (Tmax) >6 seconds to those with a Tmax >10 second delay. The primary outcome, based on the European Cooperative Acute Stroke Study, was hemorrhagic transformation, diagnosed by follow-up imaging assessment in 24-hour windows, and radiologically classified as hemorrhagic infarction and parenchymal hematoma. The secondary outcome was a 3-month mRS score of ≥3.RESULTS: Among 168 patients, 35 of 168 developed hemorrhagic transformation; 14 of 168 developed hemorrhagic infarction, and 21 of 168 developed parenchymal hematoma PH. After adjusting the latent covariates, increased hypoperfusion intensity ratio (per 0.1, adjusted OR [aOR] 1.68, 95% CI 1.26–2.25), ASPECTS (aOR 0.44, 95% CI 0.27–0.72), onset-to-puncture (aOR 1.01, 95% CI 1.00–1.02), and cardioembolism (aOR 5.6, 95% CI 1.59–19.7) were associated with hemorrhagic transformation in multivariable regression. The receiver operating characteristic curve indicated that hypoperfusion intensity ratio can predict hemorrhagic transformation accurately (area under the curve = 0.81; 95% CI, 0.738–0.882; P < .001) and predict parenchymal hematoma (area under the curve = 0.801; 95% CI, 0.727–0.875; P < .001).CONCLUSIONS: Upon admission, hypoperfusion intensity ratio, an imaging parameter, predicted hemorrhagic transformation after reperfusion therapy in this patient population.AISacute ischemic strokeaORadjusted odds ratioEVTendovascular thrombectomyHIhemorrhagic infarctionHIRhypoperfusion intensity ratioHThemorrhagic transformationLVOlarge vessel occlusionOTPonset-to-puncturePHparenchymal hematomaROCreceiver operating characteristicTmaxtime-to-maximum