Prognostic Value of a New Integrated Parameter-Both Collateral Circulation and Permeability Surface-in Hemorrhagic Transformation of Middle Cerebral Artery Occlusion Acute Ischemic Stroke: Retrospective Cohort Study.

Chanchan Li,Xiaozhu Hao,Yanmei Yang,Chengfeng Sun,Luyi Lin,Hai Yu,Zhenwei Yao,Xiaoyuan Feng

doi:10.3389/fnagi.2021.703734

Chanchan Li, Xiaozhu Hao + Show 6 more

Open Access

https://doi.org/10.3389/fnagi.2021.703734

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Abstract

BackgroundMultimodal CT, including CT angiography (CTA) and CT perfusion (CTP), was increasingly used in stroke triage. This study was to determine the relationship between a new integrated parameter—both collateral circulation and relative permeability surface (PS)—and the hemorrhagic transformation (HT) in acute ischemic stroke (AIS) with middle cerebral artery occlusion (MCAO).MethodsWe retrospectively reviewed consecutive AIS patients with MCAO who underwent baseline CTA/CTP within 4 h of symptom onset and follow-up susceptibility-weighted imaging (SWI) within 3 weeks. Collateral circulation was assessed on the baseline CTA. Baseline CTP data were postprocessed to generate PS parameter. The patients with poor collateral circulation and at the same time with high relative PS were classified as the group of both poor collateral circulation and high relative PS. HT was defined according to European Cooperative Acute Stroke Study II criteria on follow-up SWI imaging. Multivariate logistic regression analysis was performed using HT as an outcome variable.ResultsThe group of patients with both poor collateral circulation and high relative PS was thirteen and thirty-three (52%) developed HT of the final cohort sixty-three AIS patients with MCAO. Multivariate logistic analysis revealed the new integrated parameter—both collateral circulation and relative PS (odds ratio, 16.59; 95% confidence interval, 13.09–19.10; P < 0.001) was independent predictor of HT. The area under the curve was 0.85 (95% confidence interval, 0.81–0.89). The sensitivity was 57%, specificity 97% and positive predictive value 92%, negative predictive value 58%.ConclusionsFor AIS patients with MCAO, these with poor collateral circulation on CTA and at the same time with high relative PS on CTP were at high risk for HT.

Highlights

Hemorrhagic transformation (HT) is an unwanted complication of acute ischemic stroke (AIS) that may severely worsen the prognosis (Knight et al, 2019)
Patients were included if the following inclusion criteria were met: (1) age > 18 years and < 85 years; (2) National Institutes of Health Stroke Scale (NIHSS) was 4 to 22 at admission; (3) time from symptom onset to no-contrast CT (NCCT)/CT perfusion (CTP)/CT angiography (CTA) was within 4 h and before recanalization treatment; (4) AIS with middle cerebral artery (MCA)-M1 occlusion documented on CTA; (5) the admission NCCT showed no evidence of intracerebral hemorrhage; (6) time from symptom onset to follow-up susceptibility-weighted imaging (SWI) was within 3 weeks
The baseline characteristics had no significant difference between the patients involved and not involved in this study (Supplementary Table I)

Summary

Introduction

Hemorrhagic transformation (HT) is an unwanted complication of acute ischemic stroke (AIS) that may severely worsen the prognosis (Knight et al, 2019). Risks factors for HT have been investigated and included higher age, higher stroke severity, large vessel occlusion and collateral score on CTA and permeability surface (PS) on CTP et al (Hom et al, 2011; Bivard et al, 2016; Marsh et al, 2016; Wang et al, 2016; Kalinin et al, 2017; Li Q. et al, 2017; Li Y. et al, 2017; Liu et al, 2017; Puig et al, 2017). This study was to determine the relationship between a new integrated parameter—both collateral circulation and relative permeability surface (PS)—and the hemorrhagic transformation (HT) in acute ischemic stroke (AIS) with middle cerebral artery occlusion (MCAO)

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