Abstract T P25: Angiographic Predictors Of Hemorrhagic Transformation In Acute Endovascular Treatment Of Ischemic Stroke: A Retrospective Review

Abstract

Background: Hemorrhagic transformation can follow endovascular recanalization in the setting of acute ischemic stroke (AIS). There are several case series and reports that have looked at CT based predictors of hemorrhage, none exist for conventional angiography. Herein, we present preliminary data on conventional digital subtraction angiography (DSA) predictors of hemorrhagic transformation. Objectives: To identify DSA predictors of hemorrhagic transformation in AIS patients undergoing endovascular treatment. Methods: We retrospectively identified 27 consecutive AIS patients who underwent endovascular treatment at two large tertiary urban hospitals. DSA images from endovascular intervention and post-procedure CTs were reviewed in these patients. DSA images were screened for time to recanalization, as well as presence of early venous shunting (VS) and early and persistent parenchymal contrast staining (CS). Results: There were 14 males and 13 females with a mean age of 59.5 ± 17.1 years and an average NIH stroke scale of 16 ± 6.1. Fourteen patients also received IV tPA prior to DSA. Average time from symptom onset to recanalization was 346 ± 250 minutes, 6/27 patients did not have known time of onset. New hemorrhage on post-procedure CT was seen in 13/27 (48%) patients. In these 13 patients DSA showed early VS in 11 (84%) and CS in 9 (69%) , both VS and CS were present in 8 (61.5%). Neither VS nor CS was noted in the 14 patients who did not have hemorrhagic transformation following endovascular intervention. Conclusion: Our findings suggest that the presence of early VS and/or CS in DSA images of AIS patients may predict subsequent hemorrhagic transformation. The presence of such findings should alert the interventionalist to cease further attempts at endovascular revascularization.