Abstract
Background: hemorrhagic transformation (HT) is a frequent complication of ischemic stroke, and parenchymal hematoma (PH)-type HT has been shown to correlate with symptomatic deterioration. Because both bone and vascular smooth muscle cells are composed of type 1 collagen, we hypothesized that the integrity of blood vessels around the infarction area might be more damaged in osteoporotic conditions after a cardioembolic stroke. Methods: we measured frontal skull Hounsfield unit (HU) values on brain CT images from cardioembolic stroke patients. We conducted a receiver operating characteristic curve analysis in a large sample registry to identify the optimal HU threshold for predicting osteopenia and osteoporosis. Hazard ratios were estimated using a Cox regression analysis to identify whether osteoporotic conditions were an independent predictor of PH-type HT in patients with cardioembolic stroke. Results: altogether, 600 consecutive patients (>18 years old) with cardioembolic stroke were enrolled over a 12-year period at our hospital. The infarction volume and hypothetical osteoporosis were independent predictive factors for PH-type HT development in patients with cardioembolic stroke. In the male group, hypothetical osteoporosis was an independent predictor for PH-type HT development after cardioembolic stroke (hazard ratio, 4.12; 95% confidence interval, 1.40–12.10; p = 0.010). Conclusions: our study suggests an association between possible osteoporosis and the development of PH-type HT in patients with cardioembolic stroke. Our findings could help to predict PH-type HT by providing a convenient method for measuring the HU value using brain CT images.
Highlights
Hemorrhagic transformation (HT) is a frequent complication of acute ischemic stroke.The incidence of spontaneous HT ranges from 38% to 71% in autopsy studies and from13% to 43% in computed tomography (CT) studies, whereas the incidence of symptomatic HT ranges from 0.6%to 20% [1]
HT is divided into hemorrhagic infarction (HI) and parenchymal hematoma (PH) types [2]
We found no significant association between hypothetical osteoporosis and the development of PH-type HT in the multivariate Cox analysis in the female group
Summary
Hemorrhagic transformation (HT) is a frequent complication of acute ischemic stroke.The incidence of spontaneous HT ranges from 38% to 71% in autopsy studies and from13% to 43% in CT studies, whereas the incidence of symptomatic HT ranges from 0.6%to 20% [1]. The incidence of spontaneous HT ranges from 38% to 71% in autopsy studies and from. 13% to 43% in CT studies, whereas the incidence of symptomatic HT ranges from 0.6%. Patients with HI-type HT have no significantly higher risk of neurological deterioration than patients without HT, but patients with PH-type HT have symptomatic clinical deterioration [1,2,3,4]. According to a previous study, only PH-type HT in ischemic stroke is associated with early or late symptomatic neurological deterioration; we wanted to focus on the risk factors associated with the occurrence of PH-type HT [4]. Cardioembolic stroke is more associated with a high risk of symptomatic HT than other types of ischemic stroke [1,5]. We included only cardioembolic stroke patients in this analysis to reduce the effects of heterogeneity among the subtypes of ischemic stroke on our results
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