학술논문
Association between CT Perfusion Parameters and Hemorrhagic Transformation after Endovascular Treatment in Acute Ischemic Stroke: Results from the ESCAPE-NA1 Trial.
Document Type
Academic Journal
Author
McDonough RV; From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada rosevmcd@gmail.com.; Rex NB; From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada.; Department of Diagnostic Imaging (N.B.R.), Brown University, Providence, Rhode Island.; Ospel JM; From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada.; Kashani N; Department of Neurosurgery (N.K.), University of Saskatchewan, Saskatchewan, Canada.; Rinkel LA; From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada.; Department of Neurology (L.A.R.), Amsterdam University Medical Centres, Amsterdam, the Netherlands.; Sehgal A; From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada.; Fladt JC; Department of Neurology and Stroke Center (J.C.F.), University Hospital Basel, Basel, Switzerland.; McTaggart RA; Department of Imaging (R.A.M.), Brown University, Providence, Rhode Island.; Nogueira R; Department of Neurology and Neurosurgery (R.N.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.; Menon B; Department of Clinical Neurosciences (B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada.; Demchuk AM; Department of Clinical Neurosciences (B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada.; Poppe A; Department of Neurosciences (A.P.), Centre Hospitalier de L'Université de Montréal, Montreal, Quebec, Canada.; Hill MD; Department of Clinical Neurosciences (B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada.; Goyal M; From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada.; Department of Clinical Neurosciences (B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada.
Source
Publisher: American Society of Neuroradiology Country of Publication: United States NLM ID: 8003708 Publication Model: Electronic Cited Medium: Internet ISSN: 1936-959X (Electronic) Linking ISSN: 01956108 NLM ISO Abbreviation: AJNR Am J Neuroradiol Subsets: MEDLINE
Subject
Language
English
Abstract
Background and Purpose: Hemorrhagic transformation can occur as a complication of endovascular treatment for acute ischemic stroke. This study aimed to determine whether ischemia depth as measured by admission CTP metrics can predict the development of hemorrhagic transformation at 24 hours.
Materials and Methods: Patients with baseline CTP and 24-hour follow-up imaging from the ESCAPE-NA1 trial were included. RAPID software was used to generate CTP volume maps for relative CBF, CBV, and time-to-maximum at different thresholds. Hemorrhage on 24-hour imaging was classified according to the Heidelberg system, and volumes were calculated. Univariable and multivariable regression analyses assessed the association between CTP lesion volumes and hemorrhage/hemorrhage subtypes.
Results: Among 408 patients with baseline CTP, 142 (35%) had hemorrhagic transformation at 24-hour follow-up, with 89 (63%) classified as hemorrhagic infarction (HI1/HI2), and 53 (37%), as parenchymal hematoma (PH1/PH2). Patients with HI or PH had larger volumes of low relative CBF and CBV at each threshold compared with those without hemorrhage. After we adjustied for baseline and treatment variables, only increased relative CBF <30% lesion volume was associated with any hemorrhage (adjusted OR, 1.14; 95% CI, 1.02-1.27 per 10 mL), as well as parenchymal hematoma (adjusted OR, 1.23; 95% CI, 1.06-1.43 per 10 mL). No significant associations were observed for hemorrhagic infarction.
Conclusions: Larger "core" volumes of relative CBF <30% were associated with an increased risk of PH following endovascular treatment. This particular metric, in conjunction with other clinical and imaging variables, may, therefore, help estimate the risk of post-endovascular treatment hemorrhagic complications.
(© 2024 by American Journal of Neuroradiology.)
Materials and Methods: Patients with baseline CTP and 24-hour follow-up imaging from the ESCAPE-NA1 trial were included. RAPID software was used to generate CTP volume maps for relative CBF, CBV, and time-to-maximum at different thresholds. Hemorrhage on 24-hour imaging was classified according to the Heidelberg system, and volumes were calculated. Univariable and multivariable regression analyses assessed the association between CTP lesion volumes and hemorrhage/hemorrhage subtypes.
Results: Among 408 patients with baseline CTP, 142 (35%) had hemorrhagic transformation at 24-hour follow-up, with 89 (63%) classified as hemorrhagic infarction (HI1/HI2), and 53 (37%), as parenchymal hematoma (PH1/PH2). Patients with HI or PH had larger volumes of low relative CBF and CBV at each threshold compared with those without hemorrhage. After we adjustied for baseline and treatment variables, only increased relative CBF <30% lesion volume was associated with any hemorrhage (adjusted OR, 1.14; 95% CI, 1.02-1.27 per 10 mL), as well as parenchymal hematoma (adjusted OR, 1.23; 95% CI, 1.06-1.43 per 10 mL). No significant associations were observed for hemorrhagic infarction.
Conclusions: Larger "core" volumes of relative CBF <30% were associated with an increased risk of PH following endovascular treatment. This particular metric, in conjunction with other clinical and imaging variables, may, therefore, help estimate the risk of post-endovascular treatment hemorrhagic complications.
(© 2024 by American Journal of Neuroradiology.)