Abstract WP78: Intracranial Calcification is Predictive for Hemorrhage Transformation and Prognosis After Intravenous Thrombolysis

Abstract

Introduction: Hemorrhage transformation is the major complication of intravenous thrombolysis, which can deteriorate the prognosis of ischemic stroke patients. Calcification is widely used as an imaging indicator of atherosclerotic burden and cerebrovascular function. The relationship between intracranial calcification and hemorrhage transformation has not been fully explained. Here, we aimed to identify and quantify calcification in the main cerebral vessels to investigate the correlations between quantitative calcification parameters, hemorrhage transformation, and prognosis. Methods: Acute noncardiogenic ischemic stroke patients with anterior circulation who received intravenous thrombolysis therapy in the First Hospital of Jilin University from July 2015 to June 2017 were retrospectively consecutively included. All the patients included underwent a baseline CT before intravenous thrombolysis and a follow-up CT at 24 hours. A third-party software, ITK-SNAP, was used for segmentation and measurement of the calcification volume. A vascular non-bone component with a CT value >130 HU was judged to be calcified. The criterion for poor prognosis was an mRS score > 2 at 3 months. Results: A total of 146 patients were included, among which 128 patients were identified to have calcification. Twenty-one patients developed hemorrhage transformation. The risk of hemorrhage transformation in the extreme group of calcification volume on the lesion side was 10.018 times that of the none to mild groups (OR=10.018, 95% CI: 1.030-97.396). Sixty-one patients had poor prognosis. The risk of poor prognosis increased by 54.7% for each additional calcified vessel (OR=1.547, 95% CI: 1.038-2.305). Conclusions: High calcification volume burden on the lesion side is associated with hemorrhage transformation after intravenous thrombolysis. The higher the number of calcified vessels, the greater is the risk of poor prognosis.