Abstract
Background Postinterventional cerebral hyperdensity (PCHD) is commonly seen in acute ischemic patients after mechanical thrombectomy. We propose a new classification of PCHD to investigate its correlation with hemorrhagic transformation (HT). The clinical prognosis of PCHD was further studied. Methods Data from 189 acute stroke patients were analyzed retrospectively. According to the European Cooperative Acute Stroke Study criteria (ECASS), HT was classified as hemorrhagic infarction (HI-1 and HI-2) and parenchymal hematoma (pH-1 and pH-2). Referring to the classification of HT, PCHD was classified as PCHD-1, PCHD-2, PCHD-3, and PCHD-4. The prognosis included early neurological deterioration (END) and the modified Rankin Scale (mRS) score at 3 months. Results The incidence of HT was 14.8% (12/81) in the no-PCHD group and 77.8% (84/108) in the PCHD group. PCHD was highly correlated with HT (r = 0.751, p < 0.01). After stepwise regression analysis, PCHD and the National Institutes of Health Stroke Scale (NIHSS) score at admission were found to be independent factors for END (p < 0.001, p = 0.015, respectively). The area of curves (AUC) of PCHD, the NIHSS at admission, and the combined model were 0.810, 0.667, and 0.832, respectively. The optimal diagnostic cutoff of PCHD for END was PCHD > 2. PCHD, the NIHSS score at admission, and good vascular recanalization (VR) were independently associated with 3-month mRS (all p < 0.05). The AUC of PCHD, the NIHSS at admission, good VR, and the combined model were 0.779, 0.733, 0.565, and 0.867, respectively. And the best cutoff of PCHD for the mRS was PCHD > 1. Conclusion The relationship of PCHD and HT suggested PCHD was an early risk indicator for HT. The occurrence of PCHD-3 and PCHD-4 was a strong predictor for END. PCHD-1 is considered to be relatively benign in relation to the 3-month mRS.
Highlights
Postinterventional cerebral hyperdensity (PCHD) is fairly commonly seen in patients with acute ischemic stroke following intra-arterial treatment [1,2,3]
The classification standard of CT values was formulated in clinical trials evaluating arterial thrombolysis [3], and a later study of intra-arterial revascularization suggested that a CT value of >90 poorly predicted hemorrhagic transformation (HT) with low sensitivity (23%) [8]
According to whether a hyperdensity was found on noncontrast CT scans (NCCT) after intravascular intervention, the patients were divided into a no-PCHD group (n = 81) and a PCHD group (n = 108)
Summary
Postinterventional cerebral hyperdensity (PCHD) is fairly commonly seen in patients with acute ischemic stroke following intra-arterial treatment [1,2,3]. Previous small-sample studies revealed that PCHD was a strong predictor for final infarction size [4, 5] but was not a risk factor for symptomatic hemorrhage or poor prognosis [5, 6]. This low predictive efficiency may be due to the analysis of only the occurrence of PCHD, rather than the classification of PCHD. PCHD and the National Institutes of Health Stroke Scale (NIHSS) score at admission were found to be independent factors for END (p < 0:001, p = 0:015, respectively). PCHD-1 is considered to be relatively benign in relation to the 3-month mRS
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