Abstract TP49: Association Between Low CBV and ICH in Acute Stroke Patients Undergoing Intra-Arterial Therapy

Abstract

Background: Acute stroke patients with middle cerebral artery (MCA) or intracranial internal carotid artery (ICA) occlusion who have decreased cerebral blood volume (CBV) in the basal ganglia (BG) on CT perfusion (CTP) imaging are thought to be at high risk of intracerebral hemorrhage (ICH) following recanalization with intra-arterial therapy (IAT). We sought to determine if low BG CBV in patients with MCA or ICA occlusion is associated with post-IAT ICH. Methods: This is a single-center retrospective chart review of consecutive stroke patients seen in the emergency room from 6/07 - 12/10. All acute stroke patients with an MCA (M1) or intracranial ICA occlusion on CT angiogram, who underwent CTP imaging and were treated with IAT (IA tpa and/or thrombectomy) were included. The primary outcome was the presence of ICH on CT 24 hours post-IAT. Good clinical outcome was defined as a modified Rankin score ≤ 3 at discharge. Clinical variables, CBV, and ICH were each assessed by investigators who were blinded to the other abstracted data. CBV and ICH were agreed upon by at least 2 readers. Univariate analyses were performed using chi-square tests. Multivariate analyses of other potential predictors of ICH were done using logistic regression. Results: Sixty-two patients were included in these analyses. The mean age was 65.8 years, 44% were male, and 34% were non-white. The mean time to artery recanalization was 717 minutes. In univariate analysis, there was a trend toward higher rates of post-IAT ICH in patients with low BG CBV compared to those with preserved CBV (64.3% vs. 47.1%, p=0.175). Patients with post-IAT ICH had higher rates of a poor outcome than those without ICH (94.1% vs 64.3%, p=0.0031). Multivariate analyses did not demonstrate any independent predictors of ICH. Conclusion: Acute stroke patients with proximal MCA or ICA occlusion and low BG CBV on CTP imaging had a trend toward a higher risk of post-IAT ICH, but this association was not statistically significant, possibly due to the small sample size. Given that ICH is associated with poor outcome, future studies are needed to determine if patients with low BG CBV should be excluded from IAT due to increased risk of ICH. .