Frequency and risk factors for spontaneous hemorrhagic transformation of cerebral infarction

Lindley, Richard I.; Wardlaw, Joanna M.; Sandercock, Peter; Rimdusid, Prapan; Lewis, Stephanie; Signorini, D. F.; Ricci, Stefano

doi:10.1016/j.jstrokecerebrovasdis.2004.03.003

Cited by 105 publications

(96 citation statements)

References 38 publications

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“…Consistent with previous findings [17, 26], HMCAS predicts infarct-related haemorrhagic transformation of any type, but the mechanism is unclear as well. This could also reflect the association with severe stroke, as severe stroke is a major predictor of haemorrhagic transformation in patients who do not receive any specific stroke treatment, as well as in those treated with antithrombotic, anticoagulant or thrombolytis drugs [27]. …”

Section: Discussionmentioning

confidence: 99%

Hyperdense Middle Cerebral Artery Sign on Admission CT Scan – Prognostic Significance for Ischaemic Stroke Patients Treated with Intravenous Thrombolysis in the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Register

et al. 2008

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Background: Hyperdense middle cerebral artery sign (HMCAS) on CT scan before stroke thrombolysis is associated with increased risk for haemorrhage and unfavourable outcome in several small studies. Methods: We examined baseline characteristics, intracranial haemorrhage and outcomes of intravenous thrombolysis in patients with and without HMCAS using the internet-based Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register. Symptomatic intracerebral haemorrhage (SICH) was defined as a National Institute of Health Stroke Scale (NIHSS) score decrease of ≥4 points plus type 2 parenchymal haemorrhage on imaging [Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS-MOST) definition], or any haemorrhage on follow-up imaging combined with a decrease of at least 1 point on the NIHSS [randomized controlled trial (RCT) definition]. Three-month outcomes were mortality and independence (modified Rankin scale score = 0–2). Results: 1,905 of 10,023 (19.0%) patients had HMCAS. Patients with HMCAS (vs. no HMCAS) were younger (median age 68 vs. 70 years, p < 0.001), had severer stroke (baseline NIHSS score 17 vs. 11, p < 0.05), higher mortality [23% (95% CI 20.0–25.1) vs. 13% (95% CI 12.1–13.7)] and lower independence [31% (95% CI 28.5–33.0) vs. 56% (95% CI 54.8–57.2)]. SICH rates per the SITS-MOST were 1.3% (95% CI 0.8–1.9) versus 1.8% (95% CI 1.5–2.1) and per the RCT definition 10.3% (95% CI 9.0–11.8) versus 6.8% (95% CI 6.2–7.3). In multivariable analysis, HMCAS was not an independent predictor of SICH but of mortality and independence per the SITS-MOST. Conclusions: HMCAS patients had severer stroke and a worse 3-month outcome. The risk for SICH per the SITS-MOST definition was similar compared to non-HMCAS patients, although increased per the RCT definition. There is not sufficient evidence to exclude these patients from intravenous thrombolysis. Combined treatment approaches might be considered in the perspective of the severe outcome and evaluated in RCTs.

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Section: Discussionmentioning

confidence: 99%

Hyperdense Middle Cerebral Artery Sign on Admission CT Scan – Prognostic Significance for Ischaemic Stroke Patients Treated with Intravenous Thrombolysis in the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Register

et al. 2008

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“…Frequency of HT varies widely [1] , and its risk factors have been generally studied in series of patients receiving thrombolytic therapy. However, these are not representative of all IS patients, as only 2% receive thrombolysis [2] .…”

Section: Frequency and Determinants For Hemorrhagic Transformation Ofmentioning

confidence: 99%

Frequency and Determinants for Hemorrhagic Transformation of Cerebral Infarction

et al. 2009

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Background: Frequency and associated risk factors for hemorrhagic transformation (HT), a worrying complication of ischemic stroke (IS), are not clearly defined. Our aim was to estimate the overall frequency and risk factors for HT in a hospital-based population. Methods: A retrospective review of medical records of patients discharged from our department during the period 2004–2006 with a diagnosis of anterior IS. Demographic, clinical and hematological information was collected. Uni- and multivariate logistic regression analyses were used to estimate risk for spontaneous HT. Results: We included 240 patients (125 males, 52%), mean age at admission was 72.5 years. HT was observed in 29 patients (12%). At univariate analysis, consciousness impairment at admission (OR 5.6, 95% CI 1.3–28.2), the presence of early CT signs (OR 2.4, 95% CI 1.1–5.3), infarcts of medium-large size (OR 11.3, 95% CI 4.1–30.8), cardioembolic stroke (OR 2.3, 95% CI 1.1–5.2) and low total cholesterol levels (OR 3.3, 95% CI 1.3–8.2) were significantly associated with HT. At multivariate analysis, only infarct size (OR 10.2, 95% CI 3.2–32.1) was still significantly associated with HT. Conclusions: Frequency of HT in our study was 12%. Consistently with previous results, HT was associated with the size of ischemic area. As patients included in our study did not receive thrombolytic therapy, our results are applicable to those patients whom clinicians, working in a hospital setting, usually deal with.

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“…However, only few data exist concerning its reliability when transferred to MRI. MRI-based studies reported higher detection rates of HT in acute stroke patients compared to CT, but provided heterogeneous results [10,11]. T 2 *-weighted gradient echo sequences (T 2 *-MRI) or susceptibility-weighted images have been proposed as the most reproducible methods of categorizing HT after tPA treatment [12].…”

Section: Introductionmentioning

confidence: 99%

Predictors and Early Outcome of Hemorrhagic Transformation after Acute Ischemic Stroke

et al. 2011

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Background: Hemorrhagic transformation (HT) after acute ischemic stroke is frequently detected using magnetic resonance imaging (MRI), in particular in patients treated with tissue plasminogen activator (tPA). Knowledge about causes and early clinical consequences of HT mostly arises from computed tomography-based studies. We analyzed potential predictors and early outcome of HT after stroke detected by MRI with T₂*-weighted gradient echo sequences (T₂*-MRI). Methods: 122 consecutive stroke patients (mean age 65.5 years, 41% women) who underwent T₂*-MRI within 6–60 h after stroke onset were included. 25.4% of patients were treated with tPA; the overall detection rate of HT on T₂*-MRI was 20.5%. Potential predictors of HT, such as age, sex, blood pressure, stroke etiology, prior antithrombotic medication, neurological deficit on admission, tPA treatment, and specific MRI findings, were analyzed. In addition, we evaluated the effect of HT on early outcome: a decrease of >4 points on the National Institute of Health Stroke Scale (NIHSS) on day 5 was considered early improvement, and an increase of >4 points was considered early deterioration. Results: The main predictor for occurrence of HT was tPA treatment (48.4 vs. 11.1%; odds ratio 7.50; 95% confidence interval 2.9–19.7; p < 0.001). Furthermore, the development of HT was associated with a severer neurological deficit on admission (mean NIHSS score 9.9 vs. 5.9; p = 0.003), and territorial infarction (88 vs. 58.8%; p = 0.007). 19 patients (15.6%) showed early improvement which was associated with the occurrence of HT (p = 0.011) and tPA treatment (p < 0.001). Conclusions: HT is a frequent finding on T₂*-MRI in patients with acute ischemic stroke associated with tPA treatment, territorial infarction and severer neurological deficits on admission. However, HT does not cause clinical deterioration; it is rather related to a favorable early outcome likely reflecting early recanalization and better reperfusion in these patients.

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Frequency and risk factors for spontaneous hemorrhagic transformation of cerebral infarction

Cited by 105 publications

References 38 publications

Hyperdense Middle Cerebral Artery Sign on Admission CT Scan – Prognostic Significance for Ischaemic Stroke Patients Treated with Intravenous Thrombolysis in the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Register

Hyperdense Middle Cerebral Artery Sign on Admission CT Scan – Prognostic Significance for Ischaemic Stroke Patients Treated with Intravenous Thrombolysis in the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Register

Frequency and Determinants for Hemorrhagic Transformation of Cerebral Infarction

Predictors and Early Outcome of Hemorrhagic Transformation after Acute Ischemic Stroke

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