Year-end Sale % OFF 
Abstract
Background Intracerebral hemorrhage (ICH) is a serious complication of endovascular treatment (EVT) in stroke patients with large vessel occlusion (LVO) and associated with increased morbidity and mortality. Aims Identification of radiological predictors is highly relevant. We investigated the predictive power of computed tomography perfusion (CTP) parameters concerning ICH in patients receiving EVT. Methods 392 patients with anterior circulation LVO with multimodal CT imaging who underwent EVT were analyzed. CTP parameters were visually evaluated for modified ASPECTS regions and compared between patients without ICH, those with hemorrhagic infarction (HI), and those with parenchymal hematoma (PH) according to the ECASS criteria at follow-up imaging and broken down by ASPECTS regions. Results 168 received intravenous thrombolysis (IV-rtPA), and 115 developed subsequent ICH (29.3%), of which 74 were classified as HI and 41 as PH. Patients with HI and PH had lower ASPECTS than patients without ICH and worse functional outcome after 90 days (p < 0.05). In 102 of the 115 patients with ICH, the deep middle cerebral artery (MCA) territory was affected with differences between patients without ICH, those with HI, and those with PH regarding cerebral blood volume (CBV) and blood-brain barrier permeability measured as flow extraction product (FED) relative to the contralateral hemisphere (p < 0.05). Patients with PH showed larger perfusion CT infarct core than patients without ICH (p < 0.01). Conclusion None of the examined CTP parameters was found to be a strong predictor of subsequent ICH. ASPECTS and initial CTP core volume were more reliable and may be useful and even so more practicable to assess the risk of subsequent ICH after EVT.
Highlights
The HERMES [1] individual patient meta-analysis of trials published in 2015 showed clinical benefits for endovascular treatment (EVT) in a multitude of patients, suggesting that benefit from EVT is predictive to a broad range of acute ischemic stroke (AIS) patients with large vessel occlusion (LVO)
Many authors assessed the value of CT perfusion (CTP) regarding the prediction of Intracerebral hemorrhage (ICH) in AIS and tried to determine computed tomography perfusion (CTP) parameters in the prediction of ICH, e.g., cerebral blood flow (CBF), cerebral blood volume (CBV), and blood-brain barrier permeability measured as flow extraction product (FED) [13,14,15,16]
Of the 392 patients, 115 patients (29.3%) had ICH detected in the follow-up imaging: 19 (4.8%) with hemorrhagic infarction (HI) 1, 55 (14%) with HI 2, 18 (4.6%) with parenchymal hematoma (PH) 1, and 23 (5.9%) with PH 2
Summary
The HERMES [1] individual patient meta-analysis of trials published in 2015 showed clinical benefits for endovascular treatment (EVT) in a multitude of patients, suggesting that benefit from EVT is predictive to a broad range of acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). The Alberta Stroke Program Early CT Score (ASPECTS) is considered a Stroke Research and Treatment predictor of functional outcome and ICH [12]. Intracerebral hemorrhage (ICH) is a serious complication of endovascular treatment (EVT) in stroke patients with large vessel occlusion (LVO) and associated with increased morbidity and mortality. We investigated the predictive power of computed tomography perfusion (CTP) parameters concerning ICH in patients receiving EVT. CTP parameters were visually evaluated for modified ASPECTS regions and compared between patients without ICH, those with hemorrhagic infarction (HI), and those with parenchymal hematoma (PH) according to the ECASS criteria at follow-up imaging and broken down by ASPECTS regions.
Sign-in/Register to view highlights & summary 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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
