Computed Tomography Perfusion Alberta Stroke Program Early Computed Tomography Score Is Associated with Hemorrhagic Transformation after Acute Cardioembolic Stroke.

Lan Liu,Yanyan Cao,Louis R Caplan,Jinglong Zhao,Bo Wu,Nikita Dedhia,Qiaoshu Wang

doi:10.3389/fneur.2017.00591

Abstract

Alberta Stroke Program Early Computed Tomography (CT) score (ASPECTS) has been applied to CT perfusion (CTP) with good interrater agreement to predict early ischemic stroke, and it can be useful in decision making in acute ischemic stroke. The aim of the present study was to assess the predictive value of CTP ASPECTS of hemorrhagic transformation (HT) in acute cardioembolic stroke. This is a single-enter, retrospective study. All patients hospitalized with acute cardioembolic stroke from January 2008 to September 2013 were included. ASPECTS of baseline non-contrast CT, CTP maps of cerebral blood volume (CBV), cerebral blood flow, and mean transit time were collected from 52 consecutive patients with less than 12-h anterior circulation ischemic stroke. MRI scan was performed within 72 h of symptom onset after index stroke including T2*-weighted gradient echo to identify HT. For bleeding risk assessment, CTP and diffusion-weighted imaging ASPECTS were categorized into 0–7 or 8–10. Baseline characteristics, ASPCETS scores and HT were compared. Eighteen (34.6%) patients had HT and four (7.7%) developed symptomatic HT. On univariate analysis, the proportion of patients with CBV-ASPECTS 0–7 was significantly higher in HT patients as compared to patients without HT (44 versus 9%, P = 0.005). CBV ASPECTS 0–7 remained independent prognostic factors for HT after adjustment for clinical baseline variables. CBV ASPECTS could be of value to predict HT risk after acute cardioembolic stroke and may be a quick risk assessment approach before reperfusion therapy.

Highlights

Hemorrhagic transformation (HT) can cause devastating consequence of ischemic stroke, especially for cardioembolic stroke, occurring in up to 90% of patients within the first week after symptom onset [1,2,3,4]
Patients were included in the present analysis if [1] they had acute cardioembolic stroke in the anterior circulation and undergone non-contrast CT (NCCT) and CT perfusion (CTP) within 12 h of symptom onset and [2] an MRI scan was performed within 72 h of symptom onset after index CTP including Diffusion-weighted imaging (DWI), T2*-weighted gradient echo (GRE), and MR angiography (MRA)
Of 61 patients suspected of having an acute cardioembolic stroke in the anterior circulation territory, 9 patients were excluded due to no GRE imaging (1 patient), poor imaging of CTP (3 patients), posterior circulation or anterior cerebral artery infarction (5 patients)

Summary

Introduction

Hemorrhagic transformation (HT) can cause devastating consequence of ischemic stroke, especially for cardioembolic stroke, occurring in up to 90% of patients within the first week after symptom onset [1,2,3,4]. In recent endovascular therapy for ischemic stroke, computed tomography (CT) perfusion (CTP) was used to identify the ischemic penumbra in the EXTEND-IA trial, and in the MR CLEAN trial, perfusion imaging was not used as an inclusion/exclusion criteria, CTP was done in about 65% of patients [5, 6]. The purpose of using CTP in these studies was to exclude patients with large ischemic stroke and without salvageable ischemic tissue, and such patients have higher odds of hemorrhage or malignant edema caused by reperfusion [7, 8]. The present study aims to assess the value of CTP ASPECTS as a method of predicting the HT after acute cardioembolic stroke

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