PT  - JOURNAL ARTICLE
AU  - McDonough, Rosalie V.
AU  - Rex, Nathaniel B.
AU  - Ospel, Johanna M.
AU  - Kashani, Nima
AU  - Rinkel, Leon A.
AU  - Sehgal, Arshia
AU  - Fladt, Joachim C.
AU  - McTaggart, Ryan A.
AU  - Nogueira, Raul
AU  - Menon, Bijoy
AU  - Demchuk, Andrew M.
AU  - Poppe, Alexandre
AU  - Hill, Michael D.
AU  - Goyal, Mayank
AU - on behalf of the ESCAPE-NA1 Investigators
TI  - Association between CT Perfusion Parameters and Hemorrhagic Transformation after Endovascular Treatment in Acute Ischemic Stroke: Results from the ESCAPE-NA1 Trial
AID  - 10.3174/ajnr.A8227
DP  - 2024 Jul 01
TA  - American Journal of Neuroradiology
PG  - 887--892
VI  - 45
IP  - 7
4099  - http://www.ajnr.org/content/45/7/887.short
4100  - http://www.ajnr.org/content/45/7/887.full
SO  - Am. J. Neuroradiol.2024 Jul 01; 45
AB  - BACKGROUND AND PURPOSE: Hemorrhagic transformation can occur as a complication of endovascular treatment for acute ischemic stroke. This study aimed to determine whether ischemia depth as measured by admission CTP metrics can predict the development of hemorrhagic transformation at 24 hours.MATERIALS AND METHODS: Patients with baseline CTP and 24-hour follow-up imaging from the ESCAPE-NA1 trial were included. RAPID software was used to generate CTP volume maps for relative CBF, CBV, and time-to-maximum at different thresholds. Hemorrhage on 24-hour imaging was classified according to the Heidelberg system, and volumes were calculated. Univariable and multivariable regression analyses assessed the association between CTP lesion volumes and hemorrhage/hemorrhage subtypes.RESULTS: Among 408 patients with baseline CTP, 142 (35%) had hemorrhagic transformation at 24-hour follow-up, with 89 (63%) classified as hemorrhagic infarction (HI1/HI2), and 53 (37%), as parenchymal hematoma (PH1/PH2). Patients with HI or PH had larger volumes of low relative CBF and CBV at each threshold compared with those without hemorrhage. After we adjustied for baseline and treatment variables, only increased relative CBF <30% lesion volume was associated with any hemorrhage (adjusted OR, 1.14; 95% CI, 1.02–1.27 per 10 mL), as well as parenchymal hematoma (adjusted OR, 1.23; 95% CI, 1.06–1.43 per 10 mL). No significant associations were observed for hemorrhagic infarction.CONCLUSIONS: Larger “core” volumes of relative CBF <30% were associated with an increased risk of PH following endovascular treatment. This particular metric, in conjunction with other clinical and imaging variables, may, therefore, help estimate the risk of post-endovascular treatment hemorrhagic complications.AUCarea under the curveeTICIexpanded TICIEVTendovascular treatmentHIhemorrhagic infarctionIQRinterquartile rangePHparenchymal hematomarCBFrelative CBFsICHsymptomatic intracerebral hemorrhageTmaxtime-to-maximum