BACKGROUND AND PURPOSE: Intracerebral hemorrhage poses a severe threat to the outcomes in patients with postthrombectomy acute stroke. We aimed to compare the absolute intracerebral iodine concentration and normalized iodine concentration ratio in predicting intracerebral hemorrhage in patients postthrombectomy. MATERIALS AND METHODS:Patients with acute anterior circulation large-vessel occlusion who underwent mechanical thrombectomy and had successful recanalization were retrospectively included in the study. Dual-energy CT was performed within 1 hour after mechanical thrombectomy. Postprocessing was performed to measure the absolute intracerebral iodine concentration and the normalized iodine concentration ratio. The correlation between the absolute intracerebral iodine concentration and the normalized iodine concentration ratio was analyzed using the Spearman rank correlation coefficient. We compared the area under the receiver operating characteristic curve of the absolute intracerebral iodine concentration and the normalized iodine concentration ratio using the DeLong test. RESULTS:We included 138 patients with successful recanalization. Of 43 patients who did not have parenchymal contrast staining on postthrombectomy dual-energy CT, 5 (11.6%) developed intracerebral hemorrhage. Among patients (95/138, 68.8%) with parenchymal contrast staining, 37 (38.9%, 37/95) developed intracerebral hemorrhage. The absolute intracerebral iodine concentration was significantly correlated with the normalized iodine concentration ratio (r ¼ 0.807; 95% CI, 0.718-0.867; P , .001). The cutoffs of the normalized iodine concentration ratio and absolute intracerebral iodine concentration for identifying patients with intracerebral hemorrhage development were 222.8%, with a sensitivity of 67.6% and specificity of 76.4%, and 2.7 mg I/mL, with a sensitivity of 75.7% and specificity of 65.5%, respectively. No significant difference was found between the areas under the receiver operating characteristic curve for the absolute intracerebral iodine concentration and the normalized iodine concentration ratio (0.753 versus 0.738) (P ¼ .694). CONCLUSIONS:The hemorrhagic transformation predictive power of the normalized iodine concentration ratio is similar to that of the absolute intracerebral iodine concentration in patients with successful recanalization. ABBREVIATIONS: AIIC ¼ absolute intracerebral iodine concentration; AUC ¼ area under the receiver operating characteristic curve; DECT ¼ dual-energy CT; ICH ¼ intracerebral hemorrhage; IQR ¼ interquartile range; MT ¼ mechanical thrombectomy; NICR ¼ normalized iodine concentration ratio; SSS ¼ superior sagittal sinus

Background: The safety and effectiveness of intra-arterial thrombolysis (IAT) in comparison to intravenous thrombolysis (IVT) for the treatment of ischemic stroke is uncertain. Our study aims to assess and compare IAT to IVT for clinically relevant outcomes in patients with occlusion of the anterior cerebral circulation. Methods: Patients with acute ischemic stroke were enrolled for either treatment; those whose symptoms occurred within 4.5 hrs after stroke were treated with IVT, whereas those who presented <4.5 hrs but had contraindications to IVT or presented between 4.5 and 6 hrs were treated with IAT. Evaluated endpoints included: disability at 90 days as measured by the modified Rankin Scale (mRS), incidence of mortality, and incidence of symptomatic intracranial haemorrhage. Results: 78 patients with anterior cerebral circulation occlusion were included in the study (55 in IVT, 23 in IAT). After 90 days, 82.6% patients treated with IAT reached independence in comparison to 56.4% in the IVT group (P=0.028, RR=2.66, 95% CI: 1.10-7.04). The incidence of all intracranial haemorrhages in the IAT and IVT groups respectively were 30.4% and 12.7% (P=0.103, RR=2.391, 95% CI: 0.946-6.047); symptomatic intracranial haemorrhage occurred in 8.7% and 9.1% of patients (P=1.00, RR= 0.957, 95% CI: 0.200-4.579), and mortality in 8.7% and 16.4% (P=0.492, RR=1.882, 95% CI: 0.440-8.045). Conclusion: Results suggest that IAT is more effective than IVT in allowing patients to achieve independence. While inconclusive, the safety of IAT within 6 hrs is comparable to IVT within 4.5 hrs.RÉSUMÉ: Thrombolyse intra-artérielle versus intraveineuse pour traiter l'occlusion de l'artère cérébrale antérieure. Contexte : La sécurité et l'efficacité de la thrombolyse intra-artérielle (TIA) comparée à la thrombolyse intraveineuse (TIV) dans le traitement de l'accident vasculaire cérébral (AVC) sont mal connues. Le but de cette étude était d'évaluer et de comparer la TIA et la TIV quant aux résultats cliniques pertinents chez les patients atteints d'une occlusion de la circulation cérébrale antérieure. Méthodes : Des patients atteints d'un AVC ischémique aigu ont été inclus dans cette étude. Ceux dont les symptômes duraient depuis 4,5 heures ou moins étaient traités par TIV alors que ceux dont les symptômes duraient depuis moins de 4,5 heures mais qui avaient des contre-indications à la TIV ou qui se présentaient entre 4,5 et 6 heures ont reçu une TIA. Les résultats évalués étaient les suivants: l'invalidité après 90 jours selon l'échelle de Rankin modifiée, l'incidence de mortalité et l'incidence d'hémorragie intracrânienne symptomatique. Résultats : Soixante-dix-huit patients atteints d'occlusion de la circulation cérébrale antérieure ont été inclus dans l'étude, soit 55 dans le groupe TIV et 23 dans le groupe TIA. Après 90 jours, 82,6% des patients traités par TIA étaient redevenus indépendants par rapport à 56,4% des patients traités par TIV (p = 0,028; RR = 2,66; IC à 95% de 1,10 à 7,04). L'incidence d'hémorragie intracrânienne d...

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