Angiographic Blush after Mechanical Thrombectomy is Associated with Hemorrhagic Transformation of Ischemic Stroke

Autor: Hediyeh Baradaran, Srikanth R. Boddu, Setareh Salehi Omran, Praneil Patel, Ajay Gupta, Iván Díaz, Aaron M. Gusdon, Benjamin R Kummer, Babak B. Navi, Hooman Kamel, Athos Patsalides
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
Adolescent
Computed Tomography Angiography
medicine.medical_treatment
Magnetic resonance angiography
Brain Ischemia
030218 nuclear medicine & medical imaging
Young Adult
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Risk Factors
Occlusion
medicine
Humans
Registries
Aged
Retrospective Studies
Thrombectomy
Neuroradiology
Computed tomography angiography
Aged
80 and over
medicine.diagnostic_test
Cerebral infarction
business.industry
Rehabilitation
Magnetic resonance imaging
Thrombolysis
Middle Aged
medicine.disease
Cerebral Angiography
Stroke
Treatment Outcome
Cerebrovascular Circulation
Angiography
Female
Surgery
Neurology (clinical)
Radiology
Cardiology and Cardiovascular Medicine
business
Intracranial Hemorrhages
Magnetic Resonance Angiography
030217 neurology & neurosurgery
Zdroj: Journal of Stroke and Cerebrovascular Diseases. 27:3124-3130
ISSN: 1052-3057
Popis: Background and Purpose Risk factors for hemorrhagic transformation of ischemic stroke after mechanical thrombectomy (MT) are not well established. We conducted a study to determine if prominent angiographic cerebral vascularity following recanalization with thrombectomy (angiographic blush) is associated with hemorrhagic transformation. Methods Using the Cornell AcutE Stroke Academic Registry, we identified stroke patients who had thrombectomy and achieved recanalization of anterior circulation large-vessel occlusion between 2012 and 2015. The exposure variable was presence of angiographic blush after recanalization, defined as capillary blush with or without early venous drainage. The primary outcome was volume of hemorrhagic transformation on brain imaging after thrombectomy, as determined by semiautomated volumetric analysis on computed tomography or magnetic resonance imaging among those adjudicated to have hemorrhagic conversion by neuroradiology investigators blinded to angiography results. Using a doubly robust estimator with propensity scores and outcome regression adjusting for demographics and known risk factors for hemorrhagic transformation, we evaluated whether angiographic blush after recanalization is associated with an increased volume of hemorrhagic transformation. Results Among 48 eligible patients, 31 (64.6%) had angiographic blush and 26 (54.2%) had radiographic hemorrhagic transformation (mean volume, 7.6 ml). Patients with angiographic blush averaged lower thrombolysis in cerebral infarction scores and more often received intravenous thrombolysis. In adjusted analysis, angiographic blush was associated with an increased volume of hemorrhagic transformation: mean volume, 10.3ml (95% CI, 3.7-16.9 ml) with blush versus 1.8ml (95% Confidence Interval (CII = Confidence Interval), 0.1-3.4 ml) without (P = .01). Conclusions Presence of angiographic blush after MT was independently associated with the volume of hemorrhagic transformation.
Databáze: OpenAIRE
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