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

Takei, Jun; Irie, Koreaki; Tanaka, Toshihide; Okuno, Kenji; Hasegawa, Izumu; Shimoyama, Takashi; Yaguchi, Hiroshi; Hatano, Keisuke; Maruyama, Fumiaki; Yamamoto, Yu; Tochigi, Satoru; Hasegawa, Yuzuru; Murayama, Yuichi

doi:10.5797/jnet.oa.2016-0060

Cited by 4 publications

(8 citation statements)

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“…9,12 Clinical outcomes of these hyperdensities on CT have been investigated previously; however, their relationship with hemorrhagic transformation after treatment and their prognosis value are not entirely understood. 8,12,21,22…”

Section: Introductionmentioning

confidence: 99%

“…Diagnostic difficulties occasionally appear with the presence of high-density areas on follow-up computed tomography (CT) performed early after treatment. 8–11 These areas of hyperdensity on post-procedural CT have been described as post-intervention cerebral hyperdensities (PCHDs) and are common occurrences with an incidence of between 31.2 and 60.0%. 12–15 It may be secondary to contrast staining, hemorrhagic transformation or both.…”

Section: Introductionmentioning

confidence: 99%

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Value of high-density sign on CT images after mechanical thrombectomy for large vessel occlusion in predicting hemorrhage and unfavorable outcome

et al. 2020

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Purpose Cerebral hyperdensities can appear on head computed tomography (CT) images performed early after endovascular treatment (EVT) in patients with acute ischemic stroke and may be secondary to contrast staining or hemorrhagic transformation. The aim of this study was to determine how the high-density sign on CT affects mortality and clinical outcome and whether CT parameters predict hemorrhagic conversion or unfavorable outcome. Methods We retrospectively reviewed a database of patients who underwent EVT with mechanical thrombectomy for acute ischemic stroke over 7 years. Included were acute stroke patients with a CT examination within 24 h post-EVT with mechanical thrombectomy, demonstrating areas of hyperdensity. We evaluated morphologic characteristics of these lesions, location, CT Hounsfield units and largest area, as well as patient demographics, EVT methods and patient outcome. Results A total of 29 patients met the strict inclusion criteria. Complete recanalization was achieved in 58.6% (17/29). Seventeen (58.6%) cases of post-intervention cerebral hyperdensities were related to contrast staining and 12 (41.4%) cases to contrast staining and hemorrhage. Patient mortality was significantly higher in the hemorrhagic group (50.0% versus 5.9%, p = 0.003). The increased density on CT was associated with higher hemorrhagic risk (odds ratio 1.05, p = 0.036). Conclusion Patients with the high-density sign on CT images after mechanical thrombectomy for acute ischemic stroke demonstrated increased mortality and worse clinical outcome, primarily when these hyperdensities were related to hemorrhage. CT imaging parameters as higher density areas can help in the differentiation of hemorrhage from contrast staining.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Value of high-density sign on CT images after mechanical thrombectomy for large vessel occlusion in predicting hemorrhage and unfavorable outcome

et al. 2020

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“…Another study has shown a significant difference in symptomatic hemorrhage between the cortical contrast accumulation group and the non-cortical group (39.4% vs. 4.3%, P=0.003), suggesting that widespread contrast accumulation could be related to extensive reperfusion injury (27,28). If covering about 20% or more of the hemisphere, the extent of contrast staining has a predictive value for brain edema or symptomatic hemorrhage in some studies (15,17,23). Variations may exist depending on the modality of endovascular treatment (whether a stent retriever is used or not), recanalization rate, occlusion site, the quality or timing of post-procedural CT scans, amount of contrast agents, and the average time for fluoroscopy, all of which can influence the pattern or the amount of contrast staining.…”

Section: Intraparenchymal Hyperattenuation After Mechanical Thrombectomymentioning

confidence: 98%

“…Takei et al (15) have suggested that those with MT show a higher incidence of hyperdensity lesions due to higher recanalization rates and mechanical injury of intracranial vessels with the stent retriever. Typically, such contrast enhancement will clear within the first 19-24 hours after the procedure without hematoma (4,16).…”

Section: Intraparenchymal Hyperattenuation After Mechanical Thrombectomymentioning

confidence: 99%

“…Dualenergy CT is not yet a standard method. Post-procedural FPCT is a simple, reliable, and rapid tool for prompt followup after MT in the angiography suite without additional patient transport (2,15,31). Rouchaud et al (26,31).and Chen et al (26,31) have reported the performance of FPCT for detecting risk factors for the prediction of hemorrhagic complications with a high positive predictive value (84.2% and 72%, respectively) and a high negative predictive value (92.0% and 98%, respectively).…”

Section: The Role Of Flat-panel Ct After Mechanical Thrombectomymentioning

confidence: 99%

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Hyperattenuations on flat-panel computed tomography after successful recanalization of mechanical thrombectomy for anterior circulation occlusion

Chung¹,

Bae²,

Hong³

et al. 2022

Quant Imaging Med Surg

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Background: To evaluate intraparenchymal hyperattenuation (IPH) on flat-panel computed tomography (FPCT) findings and their clinical usefulness for predicting prognosis after successful mechanical thrombectomy (MT) for acute occlusion of anterior circulation.Methods: A retrospective review was conducted for 158 consecutive patients undergoing mechanical thrombectomy during the last six years. After excluding those with posterior circulation occlusion or incomplete recanalization and those without FPCT, 82 patients were finally included. Immediate postprocedural IPH on FPCT was categorized into four patterns (none, striatal, cortical, or combined pattern).Follow-up magnetic resonance images or CT scans after 48 hours from MT were analyzed according to FPCT findings. The existence of hemorrhagic transformation, intracerebral hemorrhage, and brain swelling was evaluated. Functional clinical outcomes were accessed with post-procedural 3-month modified Rankin scales (mRS). Results: Of 82 patients, 34 patients were found to have IPH (16 with a striatal pattern, 8 with a cortical pattern, and 10 with a combined pattern). Hemorrhagic complication (P<0.001), brain swelling (P<0.001), and poor mRS scores (P=0.042) showed significant differences according to IPH patterns. Multivariate logistic regression analysis revealed that the presence of a striatal pattern (OR: 13.26, P<0.001), cortical pattern (OR: 11.61, P=0.009), and combined pattern (OR: 45.34, P<0.001) independently predicted hemorrhagic complications. The location of the occlusion (OR: 4.13, P=0.034), cortical pattern (OR: 5.94, P=0.039), and combined pattern (OR: 39.85, P=0.001) predicted brain swelling. Age (OR: 1.07, P=0.006) and the presence of a combined pattern (OR: 10.58, P=0.046) predicted poor clinical outcomes.Conclusions: FPCT is a rapid and effective tool for a prompt follow-up just after MT to predict prognosis. Those with striatal patterns showed relatively good clinical outcomes despite significant hemorrhage. Cortical IPH patterns independently predicted a high rate of post-procedural hemorrhage or brain swelling. Combined pattern is a strong predictor for both radiologic and poor clinical outcomes.

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Postthrombectomy Cerebral Hyperdensity: Usefulness as a Predictor of Future Hemorrhage or Infarction

Moussa

Serwi

Tork

2020

The Arab Journal of Interventional Radiology

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Aim: This study aims to examine the association between the presence of postinterventional cerebral hyperdensities (PCHD) and the occurrence of hemorrhagic transformation. Materials and Methods: We retrospectively analyzed the data of 33 patients who underwent successful mechanical thrombectomy for emergent large vessel occlusion of the anterior circulation and received two computed tomography (CT) scans of the brain; the first (CT1) within 4.5 h from the procedure and the second (CT2) within 4 days from the procedure. In patients who showed PCHD on CT1, CT2 was checked to detect hemorrhage or infarction in the location of the noted PCHD. Statistical analysis was done through the Fisher's exact test to detect the association between PCHD and hemorrhagic transformation. Results: 28 of the 33 patients (84.8%) showed PCHD on CT1. 20 of the 28 patients (71.4%) showed infarction on CT2, while 8 patients (28.6%) showed hemorrhage. The 5 patients that did not show PCHD on CT1 all showed infarction on CT2. Analysis of our results revealed that although cases with hemorrhage had more frequent positive contrast compared to infarction, this difference did not reach a statistically significant level (P = 0.302). Conclusion: We concluded that the presence of PCHD may be associated with future risk of hemorrhagic transformation, but this association did not reach statistical significance. Further studies are needed to validate these results, which may affect the use of antiplatelets in the immediate postthrombectomy period in the presence of PCHD.

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

Cited by 4 publications

References 31 publications

Value of high-density sign on CT images after mechanical thrombectomy for large vessel occlusion in predicting hemorrhage and unfavorable outcome

Value of high-density sign on CT images after mechanical thrombectomy for large vessel occlusion in predicting hemorrhage and unfavorable outcome

Hyperattenuations on flat-panel computed tomography after successful recanalization of mechanical thrombectomy for anterior circulation occlusion

Postthrombectomy Cerebral Hyperdensity: Usefulness as a Predictor of Future Hemorrhage or Infarction

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