Abstract
Background: In acute ischemic stroke, emergent transportation to comprehensive stroke center (CSC) is crucial for appropriate endovascular therapy (EVT). However, time delay for transfer increase the risk of subsequent intracranial hemorrhage (ICH), Ischemic change in the deep white matter on diffusion-weighted imaging (DWI-W) is one of neuroradiological predictors for subsequent ICH and poor outcome. We hypothesized that pre-transfer DWI-W and DWI-ASPECTS might predict subsequent ICH after EVT. Methods: We retrospectively collected acute stroke patients transferred for EVT to our CSC from October 2013 to July 2017. Patients who underwent MRI before transportation were analyzed. We investigated whether presence of DWI-W was associated with subsequent ICH, and compared the usefulness of ASPECTS+W with traditional scoring system in predicting subsequent ICH after EVT. Results: A total of 99 patients (aged 73.6 ± 11.4 years; initial NIHSS score, median 17 [IQR 10 - 22]; DWI-ASPECTS, 7 [6 - 8]; ASPECTS+W, 8 [6 - 9]) were included. DWI-W was detected in 49 patients (49%), and 35 (35%) developed subsequent ICH. Patients with DWI-W had significantly higher NIHSS score (18 vs. 14, p = 0.038), and developed subsequent ICH after EVT more frequently (46% vs. 24%, p = 0.021) compared to those without. In multivariate analysis, presence of DWI-W (OR 2.86; 95% CI 1.15 - 7.47; p =0.023), presence of dyslipidemia (OR 2.87; 95% CI 1.01 - 8.41; p = 0.046), and administration of IV-tPA (OR 2.74; 95% CI 1.11 - 7.12; p = 0.028) predicted ICH independently. In additional analyses with different models, lower ASPECTS+W (OR 0.79 per point increase; 95% CI 0.64 - 0.98; p = 0.031) predicted ICH better than DWI-ASPECTS (OR 0.80 per point increase; 95% CI 0.63 - 1.01; p = 0.064) did. Conclusions: Presence of DWI-W on MRI before transportation is a useful predictor of subsequent ICH after EVT.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call