Contrast Staining on CT after DSA in Ischemic Stroke Patients Progresses to Infarction and Rarely Hemorrhages

Abstract

<jats:p> Contrast staining of brain parenchyma identified on non-contrast CT performed after DSA in patients with acute ischemic stroke (AIS) is an incompletely understood imaging finding. We hypothesize contrast staining to be an indicator of brain injury and suspect the fate of involved parenchyma to be cerebral infarction. </jats:p><jats:p> Seventeen years of AIS data were retrospectively analyzed for contrast staining. Charts were reviewed and outcomes of the stained parenchyma were identified on subsequent CT and MRI. </jats:p><jats:p> Thirty-six of 67 patients meeting inclusion criteria (53.7%) had contrast staining on CT obtained within 72 hours after DSA. Brain parenchyma with contrast staining in patients with AIS most often evolved into cerebral infarction (81%). Hemorrhagic transformation was less likely in cases with staining compared with hemorrhagic transformation in the cohort that did not have contrast staining of the parenchyma on post DSA CT (6% versus 25%, respectively, OR 0.17, 95% CI 0.017–0.98, p = 0.02). </jats:p><jats:p> Brain parenchyma with contrast staining on CT after DSA in AIS patients was likely to infarct and unlikely to hemorrhage. </jats:p>

Evaluation of the CT High-density Area after Endovascular Treatment for Acute Ischemic Stroke

“…Regarding the relationship between the presence or absence of HA and OtoP, HA were reported to have occurred more frequently when the interval between the onset and treatment was short, 13) but no correlation was observed between the presence or absence of HA and OtoP or OtoR in our patients.…”

“…Mechanisms such as disruption of the blood-brain barrier (BBB) caused by reperfusion and influx of a highconcentration contrast medium, and stagnation of the contrast medium due to insufficient recanalization of the capillaries despite recanalization of the major artery ("noreflow phenomenon") have been proposed. 13) Iwata et al 26) reported patients who developed HA after coil embolization for unruptured cerebral aneurysms and speculated that they were caused by disruption of the BBB by the contrast medium.…”

“…13) Hemorrhagic transformation was rated as hemorrhagic infarction (HI) type 1 or 2 and parenchymal hematomas (PH) type 1 or 2 following the classification by Berger et al 15) According to our review, 14 articles published between 1993 and 2015 were found. After excluding one article not providing details of the recanalization procedure, a total of 705 patients consisting of those reported in the remaining 13 articles and our patients were analyzed.…”

“…[5][6][7][8][9] High-density areas occasionally appear on head CT performed early after endovascular treatment for acute ischemic stroke. However, there is no consensus as to the cause of these findings, which have been described as hyperdense areas (HA), 10) hemorrhage/contrast staining areas, 11) contrast enhancement and contrast extravasation, 12) and contrast staining, 13) or their relationship with the clinical outcome.…”

Meta-analysis of diagnostic significance of sixty-four-row multi-section computed tomography angiography and three-dimensional digital subtraction angiography in patients with cerebral artery aneurysm

“…On the other hand, three-dimensional digital subtraction angiography (3D-DSA), used in a bony or dense soft tissue environment, is regarded as a fluoroscopy technique assisted by radiology to obtain vascular images [23]. The operating process is to form a pre-contrast image from radiological equipment; then, images are acquired after injecting contrast medium into the blood vessels and removing distracting structures from the first image [24].…”