RT Journal Article
SR Electronic
T1 Association between CT Perfusion Parameters and Hemorrhagic Transformation after Endovascular Treatment in Acute Ischemic Stroke: Results from the ESCAPE-NA1 Trial
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 887
OP 892
DO 10.3174/ajnr.A8227
VO 45
IS 7
A1 McDonough, Rosalie V.
A1 Rex, Nathaniel B.
A1 Ospel, Johanna M.
A1 Kashani, Nima
A1 Rinkel, Leon A.
A1 Sehgal, Arshia
A1 Fladt, Joachim C.
A1 McTaggart, Ryan A.
A1 Nogueira, Raul
A1 Menon, Bijoy
A1 Demchuk, Andrew M.
A1 Poppe, Alexandre
A1 Hill, Michael D.
A1 Goyal, Mayank
A1 on behalf of the ESCAPE-NA1 Investigators
YR 2024
UL http://www.ajnr.org/content/45/7/887.abstract
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