Hemorrhagic Transformation In Acute Ischemic Stroke Research Articles

Magnetic Resonance Perfusion-Weighted Imaging in Predicting Hemorrhagic Transformation of Acute Ischemic Stroke: A Retrospective Study.

Hemorrhagic transformation (HT) is one of the common complications in patients with acute ischemic stroke (AIS). This study aims to investigate the value of different thresholds of Tmax generated from perfusion-weighted MR imaging (PWI) and the apparent diffusion coefficient (ADC) value in the prediction of HT in AIS. A total of 156 AIS patients were enrolled in this study, with 55 patients in the HT group and 101 patients in non-HT group. The clinical baseline data and multi-parametric MRI findings were compared between HT and non-HT groups to identify indicators related to HT. The optimal parameters for predicting HT and the corresponding cutoff values were obtained using the receiver operating characteristic curve analysis of the volumes of ADC < 620 × 10-6 mm2/s and Tmax > 6 s, 8 s, and 10 s. The results showed that the volumes of ADC < 620 × 10-6 mm2/s and Tmax > 6 s, 8 s, and 10 s in the HT group were all significantly larger than that in the non-HT group and were all independent risk factors for HT. Early measurement of the volume of Tmax > 10 s had the highest value, with a cutoff lesion volume of 10.5 mL.

Low MHR Is Associated with Hemorrhagic Transformation in Acute Large Artery Atherosclerosis Ischemic Stroke Patients with Intravenous Thrombolysis.

Background: Hemorrhagic transformation (HT) is a common complication of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) and may lead to neurological deterioration. This article discusses whether monocyte count to high-density lipoprotein ratio (MHR) level is associated with HT in AIS patients. Materials and methods: The clinical data of AIS patients who underwent rt-PA IVT treatment were continuously collected. According to whether HT occurred, patients were divided into HT group and non-HT group. Potential association between MHR and HT in different subtypes AIS was explored by using logistic regression. Results: A total of 444 AIS patients were retrospective analyzed. The MHR level was lower in HT group compared with the non-HT group in all AIS patients (0.28 vs 0.36, P = .031) and in large-artery atherosclerosis (LAA) type AIS patients (0.31 vs 0.37, P = .032). Low MHR was independently related to HT (OR:0.035, 95%CI:0.003-0.390, P = .006). Among all TOAST subtypes, low MHR was only independently associated with HT in patients of LAA-type AIS after adjusting for confounding factors (OR:0.01, 95%CI:0.00-0.62, P = .031), with an optimal cut-off value of 0.41, sensitivity of 85.7%, and specificity of 43.1%. MHR was not correlated with SVO, VE, and CE subtype AIS. Conclusion: Low MHR may be an independent predictor of HT in patients with AIS and this conclusion only existed in LAA-type AIS.

Elevated ApoB/ApoA-Ι ratio is associated with poor outcome in acute ischemic stroke

BackgroundApolipoproteins are known atherogenic factors that play important roles in many mechanisms related to acute ischemic stroke (AIS). However, it is unclear whether the ApoB/ApoA-Ι ratio is related to the prognosis of patients with AIS. MethodsWe conducted a prospective cohort study in the Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University and investigated the association between ApoB/ApoA-Ι ratio and poor outcomes at 3 months of AIS. Results1,247 patients that met the eligibility criteria were enrolled in our study. We found that ApoA-Ι (Adjusted odds ratios (adjOR) 0.529, 95 %CI 0.327–0.855), ApoB (adjOR 3.015, 95 %CI 1.746–5.207), and ApoB/ApoA-Ι ratio (adjOR 3.986, 95 %CI 2.220–7.155) were independently associated with poor outcomes in acute ischemic stroke. During subgroup analysis, the ApoB/ApoA-Ι ratio was more likely associated with poor AIS outcomes in males and patients younger than 80 with SAO(Small Artery Occlusion) and no history of diabetes or statin use. Restricted cubic spline analyses explored the correlation between poor outcomes and ApoB/ApoA-Ι ratio. ConclusionsHigher ApoB, lower ApoA-Ι, and higher ApoB/ApoA-Ι ratios were independently associated with poor outcomes in AIS. However, ApoB and ApoA-Ι were not related to hemorrhagic transformation in AIS.

Machine Learning-Based Model for Prediction of Hemorrhage Transformation in Acute Ischemic Stroke After Alteplase.

Hemorrhage transformation (HT) is the most dreaded complication of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). The prediction of HT after IVT is important in the treatment decision-making for AIS. We designed and compared different machine learning methods, capable of predicting HT in AIS after IVT. A total of 345 AIS patients who received intravenous alteplase between January 2016 and June 2021 were enrolled in this retrospective study. The demographic characteristics, clinical condition, biochemical data, and neuroimaging variables were included for analysis. HT was confirmed by head computed tomography (CT) or magnetic resonance imaging (MRI) within 48 h after IVT. Based on the neuroimaging results, all of the patients were divided into the non-HT group and the HT group. Then, the variables were applied in logistic regression (LR) and random forest (RF) algorithms to establish HT prediction models. To evaluate the accuracy of the machine learning models, the models were compared to several of the common scales used in clinics, including the multicenter stroke survey (MSS) score, safe implementation of treatments in stroke (SITS) score, and SEDAN score. The performance of these prediction models was evaluated using the receiver operating characteristic (ROC) curve (AUC). Forty-five patients had HT (13.0%) within 48 h after IVT. The ROC curve results showed that the AUCs of HT that were predicted by the RF model, LR model, MSS, SITS, and SEDAN scales after IVT were 0.795 (95% CI, 0.647–0.944), 0.703 (95% CI, 0.515–0.892), 0.657 (95% CI, 0.574–0.741), 0.660 (95% CI, 0.580–0.740) and 0.655 (95% CI, 0.571–0.739), respectively. The RF model performed better than the other models and scales. The top four most influential factors in the RF importance matrix plot were triglyceride, Lpa, the baseline NIHSS, and hemoglobin. The SHapley Additive exPlanation values made the RF prediction model clinically interpretable. In this study, an RF machine learning method was successfully established to predict HT in AIS patients after intravenous alteplase, which the sensitivity was 66.7%, and the specificity was 80.7%.

A clinical study on stroke patients with emphasis on improvement pattern

Introduction: Stroke is a medical emergency and can cause permanent neurological damage, complication, and death if not promptly diagnosed and treated. It is also the third leading cause of death and serious disability, with major societal consequences. Materials and Methods: A prospective observational study on adult patients aged above 18 years diagnosed with acute ischemic stroke to understand the incidence and predictors of hemorrhagic transformation (HT) during hospital stay was conducted over a period of 18 months at a tertiary care hospital in Mangalore, India. The aim of this study was to find out the incidence of HT in acute ischemic stroke during the first week of hospitalization and to find out the predictors associated with the development of HT. Results: The mean age was 61.37 years, 59.28 years, 66.43 years and 48 years in those with mild stroke, moderate stroke, moderate to severe stroke and severe stroke respectively. Overall males had a higher incidence there was a statistically significant difference in the incidence of stroke, 53.33% were males. 16.67% had hemorrhagic transformation in ischemic stroke. Conclusion: Our study found that the risk of hemorrhagic transformation is higher in females than males.

The Stress Hyperglycemia Ratio is Associated with Hemorrhagic Transformation in Patients with Acute Ischemic Stroke.

BackgroundHemorrhagic transformation (HT) is a severe complication occurring in acute ischemic stroke (AIS) patients. Stress hyperglycemia is frequent in patients with acute illness such as stroke. We aimed to explore the association between stress hyperglycemia and HT in AIS patients.MethodsA total of 287 consecutive participants with HT and 285 age- and sex-matched stroke patients without HT were enrolled in this study. Baseline glucose and glycated hemoglobin (HbA1c) levels were collected to measure stress hyperglycemia. The stress hyperglycemia ratio (SHR) was calculated by dividing the fasting plasma glucose at admission with HbA1c. HT was diagnosed by follow-up imaging assessment, and was radiologically classified as hemorrhagic infarction type (HI) 1 or 2 or parenchymal hematoma type (PH) 1 or 2.ResultsUnivariate analysis showed that SHR is significantly higher among patients with HT than those without HT. Compared to the patients in the lower three quartiles of SHR, the incidence of HT was significantly higher among patients with the highest quartile of SHR in total population, diabetic and non-diabetic population. We also observed that patients with the highest SHR quartile were associated with an increased risk of hemorrhagic transformation after adjusted for potential covariates (68.4% versus 39.1%; adjusted odds ratio, 2.320; 95% confidence interval, 1.207–4.459; P=0.012).ConclusionThe stress hyperglycemia ratio, representing the state of stress hyperglycemia, was significantly associated with an increased risk of hemorrhagic transformation in patients with acute ischemic stroke.

SAT-124 LOW GLOMERULAR FILTRATION RATE IS ASSOCIATED WITH HEMORRHAGIC TRANSFORMATION IN ACUTE ISCHEMIC STROKE PATIENTS: A META-ANALYSIS

Acute Ischemic Stroke (AIS) is one of the leading cause of death, premature death, and disability globally. Hemorrhagic transformation (HT) is a common complication of AIS and is related to higher mortality, early neurological deterioration, and worse long‑term functional outcome. Numerous observational studies have been published but the relationship between low eGFR level and HT in AIS patients is still controversial. We sought to do a meta-analysis to determine the association between low eGFR level and HT in AIS.

Abstract TMP10: Is There a Correlation With Number of Passes With a Stentriever and Hemorrhagic Transformation?

Background and Purpose: Intracranial hemorrhage (ICH) presents as a major complication for patients undergoing endovascular treatment (EVT) for acute ischemic stroke (AIS). Our study aims to assess the risk and correlation with the number of passes with a stentriver involved in EVT and hemorrhagic transformation. Methods: We utilized our endovascular database and analyzed all the patients admitted from 2012-2017, who underwent EVT with stentrievers. We collected baseline demographics, clinical characteristics, admission NIHSS, and modified Rankin Scale (mRS) at discharge, as well as groin puncture and recanalization times. The number of stentriver passes during each procedure as well as presence of ICH post procedure were recorded. A logistic regression analysis was done to determine the association between hemorrhagic transformation and number of passes. Results: 277 patients (mean age 71.6 ± 12.6 years; 52% female) with AIS underwent EVT with stentrievers. There was no difference in baseline demographics. (Table 1) Of the 277 patients, 47 (17.0%) were diagnosed with ICH after EVT. Ninety-day mortality was higher in patients with ICH than in patients without ICH (15.7% vs 42.6%; P=.001). On multivariate analysis, the number of passes with a stentriever were not significantly associated with ICH after EVT (OR, 1.3; 95% CI, 0.89-1.9). There was no significant difference in rates of intracranial hemorrhage occurrence with ≥5 passes (OR, 5.0; 95% CI, 0.31-82.4). Conclusions: Our study shows that endovascular treatment with multiple passes of a stentreiver does not increase the incidence of symptomatic hemorrhage in AIS, even up to 5 passes. Large prospective studies are warranted to study the factors that lead to hemorrhagic transformation in AIS.

Prediction of Hemorrhagic Transformation Severity in Acute Stroke From Source Perfusion MRI.

Hemorrhagic transformation (HT) is the most severe complication of reperfusion therapy in acute ischemic stroke (AIS) patients. Management of AIS patients could benefit from accurate prediction of upcoming HT. While prediction of HT occurrence has recently provided encouraging results, the prediction of the severity and territory of the HT could bring valuable insights that are beyond current methods. This study tackles these issues and aims to predict the spatial occurrence of HT in AIS from perfusion-weighted magnetic resonance imaging (PWI) combined with diffusion weighted imaging. In all, 165 patients were included in this study and analyzed retrospectively from a cohort of AIS patients treated with reperfusion therapy in a single stroke center. Machine learning models are compared within our framework; support vector machines, linear regression, decision trees, neural networks, and kernel spectral regression were applied to the dataset. Kernel spectral regression performed best with an accuracy of $\text{83.7} \pm \text{2.6}\%$. The key contribution of our framework formalize HT prediction as a machine learning problem. Specifically, the model learns to extract imaging markers of HT directly from source PWI images rather than from pre-established metrics. Predictions visualized in terms of spatial likelihood of HT in various territories of the brain were evaluated against follow-up gradient recalled echo and provide novel insights for neurointerventionalists prior to endovascular therapy.

Does Prior Antiplatelet Treatment Increase the Risk of Hemorrhagic Transformation and Unfavorable Outcome on Day 90 after Intravenous Thrombolysis in Acute Ischemic Stroke Patients?

The effect of prior antiplatelet (AP) therapy on the risk of hemorrhagic transformation (HT), and on functional outcomes of acute ischemic stroke (AIS) after intravenous thrombolysis (IVT), is not known. We performed a retrospective analysis to determine whether history of AP therapy is associated with post-thrombolysis HT and poor prognosis in AIS patients. Data pertaining to 145 patients with AIS, who underwent IVT between October 2008 and January 2015, were analyzed. The patients were divided into 2 groups based on whether or not they had received prior AP therapy. Neurological outcomes at 24 hours and 3 months after IVT therapy were assessed. Intergroup difference in cost of treatment was also evaluated. A multivariate logistic regression model was used to identify independent predictors of post-thrombolysis HT. Among 145 patients, 23 (15.8%) had received prior AP therapy. On multivariate analyses, older age (odds ratio [OR]: 1.084; confidence interval [CI], 1.028-1.144) and prior AP therapy (OR: 3.318; CI, 1.172-9.398) were found to be independent predictors of HT. In this study, prior AP therapy was independently associated with post-thrombolysis HT in AIS.

Interaction of incidental microbleeds and prior use of antithrombotics with early hemorrhagic transformation: Causative or protective?

Background:Gradient echo (GRE) sequence of magnetic resonance imaging (MRI) is a sensitive tool to detect hemorrhagic transformation (HT) and old cerebral microbleeds (CMBs). Presence of CMBs and prior use of antithrombotics pose a risk of HT in ischemic stroke. We evaluated the association of CMBs and antithrombotic use with resultant HT in acute ischemic stroke (AIS).Methods:This retrospective study included AIS patients admitted to our center between January 2009 and August 2010 who underwent GRE-weighted MRI within 48 h of admission. Demographic and clinical data including diabetes mellitus, hypertension, hyperlipidemia, prior intake of antiplatelets/anticoagulants/statins, and presence of CMBs at admission were collected and compared between patients who developed HT and those who did not. We did a multivariate analysis using logistic regression to assess the effect of CMBs and prior use of antithrombotic agents on the risk of development for early HT in ischemic stroke.Results:Of 529 AIS patients, 81 (15%) were found to have HT during the initial hospital course. CMBs were found in only 9 of 81 patients (11%) with HT and in 40 out of remaining 448 patients (9%) who did not develop HT. The presence of CMBs was not associated with increased risk of HT (P = 0.53). However, prior use of antiplatelets (33% vs. 47% in the patients without HT, P = 0.02) was associated with decreased risk of HT in ischemic stroke.Conclusion:Presence of incidental CMBs was not associated with increased risk for early HT of an ischemic stroke. Interestingly, the prior intake of antiplatelets was found to be protective against HT of ischemic stroke.

Low Glomerular Filtration Rate Increases Hemorrhagic Transformation in Acute Ischemic Stroke

Background: Decreased glomerular filtration rate (GFR) can increase the risk of bleeding tendency and hemorrhagic stroke. However, the relationship between the levels of GFR and hemorrhagic transformation (HT) after acute ischemic stroke is largely unknown. The aim of this study was to assess whether GFR level is associated with HT in acute ischemic stroke. Methods: We reviewed 770 consecutive patients with acute ischemic stroke within 7 days from September 2007 to February 2012 in a prospective stroke registry database. We calculated the patient’s GFR using the Cockcroft-Gault equation, and divided them into 3 groups: ≥60, 30–59 and <30 ml/min/1.73 m². HTs were identified by follow-up computed tomography (CT) or magnetic resonance imaging, and were defined as (1) any degree of high density within the area of low attenuation of vascular territory on noncontrast brain CT, or (2) low-signal intensity area in gradient echo within high-signal intensity meaning acute infarct on diffusion-weighted imaging. Multivariable logistic regression analyses were used to estimate the risk of GFR for HT. Stratification analyses were done according to the presence of HT high risk factors: atrial fibrillation (AF), thrombolysis and large size infarction. Additional logistic regression model for symptomatic HTs was established with the same variables. Results: HTs were noted in 131 patients (17.0%) and symptomatic HTs in 63 patients (8.2%). In univariate analysis, HTs were more frequent in patients with AF (51.9 vs. 16.7%, p < 0.001) and large-size infarction (42.0 vs. 5.3%, p < 0.001). The risk of HT was associated with decreased GFR among 3 subgroups classified according to the value of estimated GFR: 49/394 (12.4%) in the GFR ≥60 group, 66/312 (21.2%) in the 30≤ GFR <59 group and 16/64 (25.0%) in the GFR <30 group (p = 0.002). We found a significant association between the GFR <30 group and HTs in acute ischemic stroke (OR 2.90; 95% CI 1.26–6.68, p = 0.012) after adjusting for other risk factors. Moreover, the incidence of HTs was higher in the subgroups without thrombolysis (OR 3.49; 95% CI 1.44–8.46) and without AF (OR 3.44; 95% CI 1.10–10.76). Decreased GFR also had a tendency of increasing symptomatic HTs (OR 2.39; 95% CI 0.72–7.94, p = 0.154). Conclusions: Low levels of GFR are associated with a high risk of HT after acute ischemic stroke. Further studies are needed to elucidate whether HT in the patients with renal insufficiency are related to a worse outcome after acute ischemic stroke.

Symptomatic Hemorrhagic Transformation and Its Predictors in Acute Ischemic Stroke with Atrial Fibrillation

Background and Purpose: Patients with acute cardioembolic stroke frequently show hemorrhagic transformation (HTr). We attempted to identify predictors of symptomatic HTr in acute ischemic stroke with atrial fibrillation (AF). Methods: Of the consecutive acute ischemic stroke patients with AF at 12 hospitals in Korea, patients with posterior circulation stroke or thrombolytic therapy were excluded. Immediate anticoagulation was recommended to all patients, except those with: (1) large infarcts, 50% or more of the middle cerebral artery territory, (2) significant HTr on initial imaging, or (3) other safety concerns. Symptomatic HTr was defined as cerebral hemorrhage temporally related to neurological deterioration. Results: Of the 389 included patients (mean age 71 years), 260 (67%) were treated with anticoagulation within 1 week from the onset. Symptomatic HTr occurred in 4.6%. Large infarct (OR 6.38, 95% CI 1.16–35.14), previous hemorrhagic stroke (OR 10.67, 1.77–64.25), and low platelet count (OR per 10⁴ increase 0.87, 0.79–0.97) were independent predictors of symptomatic HTr. hsCRP values tended to be higher in patients with symptomatic HTr (p = 0.055). Conclusions: Caution is needed in anticoagulation treatment of acute cardioembolic stroke patients with a large infarct, previous hemorrhagic stroke, low platelet count, or a high hsCRP level.