Hemorrhagic transformation in cardioembolic cerebral infarction.

Hornig, C. R.; Bauer, Timm; Simon, Christopher; Trittmacher, Susan; Dorndorf, W.

doi:10.1161/01.str.24.3.465

Cited by 95 publications

(57 citation statements)

References 13 publications

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“…In our series, the incidence of hemorrhage was 29%, including five patients (10%) with parenchymal hematoma; this was similar to the rate seen in other series in which thrombolytic therapy was employed (5,12), and in series involving spontaneous hemorrhagic transformation of the infarction (16,17). The frequency of hemorrhage was unrelated to the presence or absence of recanalization.…”

Section: Esupporting

confidence: 87%

Outcome Evaluation of Intra-arterial Infusion of Urokinase for Acute Ischemic Stroke

Shi

Suh

Lim

et al. 2000

J Korean Radiol Soc

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Acute occlusion of the intracranial artery probably causes sudden severe neurological ischemic change, and the prognosis is poor (1, 2). In patients with acute ischemic stroke, intra-arterial infusion of urokinase has To evaluate the results of intra-arterial urokinase thrombolysis in cases of acute ischemic stroke and to define the factors affecting prognosis.Forty-eight patients with angiographically proven occlusion of the intracranial arteries were treated with local intra-arterial infusion of urokinase within six hours of the onset of symptoms. Neurologic status was evaluated on admission and on discharge using the NIH(National Institute of Health) stroke scale score (SSS). When the SSS decreased by at least four points, this was considered indicative of an improved clinical outcome.Complete recanalization was achieved in 17/48 patients (35%), including 8 of 13 (62%) with occlusion of the vertebrobasilar artery (VBA), 9 of 20 (45%) with occlusion of the middle cerebral artery (MCA), and none of 15 with occlusion of the internal carotid artery (ICA). Neurologic status improved in 12 (60%) of patients with MCA occlusion, in five (38%) of those with VBA occlusion and in three (20%) of those with ICA occlusion (P<0.05). Patients in whom occluded MCA was completely recanalized showed greater clinical improvement than those with partial or no recanalization (P<0.05). The overall mortality rate was 21%, 43% (9/21) in patients in whom CT revealed signs of early infarct, but only 4% (1/27) in those without this sign (P<0.05). The mortality rate of patients with parenchymal hematoma (4/5) was higher than that of those with hemorrhagic infarct (3/9) or without hemorrhage (3/34) (P<0.05).In patients in whom occluded MCA was completely recanalized, the clinical outcome was better, while patients with VBA occlusion did not benefit from recanalization. The presence on CT scans of signs of early infarct and of parenchymal hematoma after thrombolysis correlated with a high mortality rate.Brain, blood flow Brain, ischemia Thrombolysis Urokinase

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Section: Esupporting

confidence: 87%

Outcome Evaluation of Intra-arterial Infusion of Urokinase for Acute Ischemic Stroke

Shi

Suh

Lim

et al. 2000

J Korean Radiol Soc

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“…Color-coded permeability maps show clearly the regions of high (arrow) and low permeability in treated and control rats. 60% of patients after an embolic stroke (Hornig et al, 1993). The use of rtPA carries the risk of increasing the incidence of symptomatic hemorrhage 10 times.…”

Section: Bb1101mentioning

confidence: 99%

Early Beneficial Effect of Matrix Metalloproteinase Inhibition on Blood—Brain Barrier Permeability as Measured by Magnetic Resonance Imaging Countered by Impaired Long-Term Recovery after Stroke in Rat Brain

Sood

Taheri

Candelario‐Jalil

et al. 2007

J Cereb Blood Flow Metab

102

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Proteolytic disruption of the extracellular matrix with opening of the blood-brain barrier (BBB) because of matrix metalloproteinases (MMPs) occurs in reperfusion injury after stroke. Matrix metalloproteinase inhibition blocks the early disruption of the BBB, but the long-term consequences of short-term MMP inhibition are not known. Recently, a method to quantify BBB permeability by graphical methods was described, which provides a way to study both early disruption of the BBB and long-term effects on recovery in the same animal. We used a broad-spectrum MMP inhibitor, BB1101, to determine both the usefulness of the Magnetic resonance imaging (MRI) method for treatment studies and the long-term effects on recovery. Magnetic resonance imaging studies were performed in control (N = 6) and drug-treated (N = 8) groups on a dedicated 4.7-T MRI scanner. Adult Wistar-Kyoto underwent a 2-h middle cerebral artery occlusion followed by an MRI study after 3 h of reperfusion, which consisted of T2-and diffusion-weighted techniques. Additionally, a rapid T1 mapping protocol was also implemented to acquire one pre-gadolinium-diethylenetriaminepentaacetic acid baseline data set followed by postinjection data sets at 3-min intervals for 45 mins. The same animal was imaged again at 48 h for lesion size estimation. Data was postprocessed pixel-wise to generate apparent diffusion coefficient and permeability coefficient maps. Treatment with BB-1101 significantly reduced BBB permeability at 3 h, but failed to reduce lesion size at 48 h. Behavioral studies showed impairment in recovery in treated rats. Magnetic resonance imaging allowed for the monitoring of multiple parameters in the same animal. Our studies showed that BB-1101 was an excellent inhibitor of the BBB damage. However, results show that BB-1101 may be responsible for significant deterioration in neurologic status of treated animals. Although these preliminary results suggest that BB-1101 is useful in reducing early BBB leakage owing to reperfusion injury in stroke, further studies will be needed to determine whether the later detrimental effects can be eliminated by shorter time course of drug delivery.

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“…[2][3][4][5][6][7][8][9][10][11] Furthermore, most of the information on the effect of early HT on clinical outcomes derives from studies on thrombolysis for ischemic stroke, [12][13][14][15][16] and data on early HT in patients not receiving thrombolysis mainly derives from patients randomized to placebo in the thrombolysis trials. 17,18 The aims of this prospective study in consecutive patients were therefore to assess: (1) the rate of early HT in patients admitted for ischemic stroke, (2) the correlation between early HT and functional outcome at 3 months, and (3) the risk factors for early HT.…”

mentioning

confidence: 99%

Early Hemorrhagic Transformation of Brain Infarction: Rate, Predictive Factors, and Influence on Clinical Outcome

Paciaroni

Agnelli

Corea

et al. 2008

Stroke

428

352

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Background and Purpose-Early hemorrhagic transformation (HT) is a complication of ischemic stroke but its effect on patient outcome is unclear. The aims of this study were to assess: (1) the rate of early HT in patients admitted for ischemic stroke, (2) the correlation between early HT and functional outcome at 3 months, and (3) the risk factors for early HT. Methods-Consecutive patients with ischemic stroke were included in this prospective study in 4 study centers. Early HT was assessed by CT examination performed at day 5Ϯ2 after stroke onset. Study outcomes were 3-month mortality or disability. Disability was assessed using a modified Rankin score (Ն3 indicating disabling stroke) by neurologists unaware of the occurrence of HT in the individual cases.

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Hemorrhagic transformation in cardioembolic cerebral infarction.

Cited by 95 publications

References 13 publications

Outcome Evaluation of Intra-arterial Infusion of Urokinase for Acute Ischemic Stroke

Outcome Evaluation of Intra-arterial Infusion of Urokinase for Acute Ischemic Stroke

Early Beneficial Effect of Matrix Metalloproteinase Inhibition on Blood—Brain Barrier Permeability as Measured by Magnetic Resonance Imaging Countered by Impaired Long-Term Recovery after Stroke in Rat Brain

Early Hemorrhagic Transformation of Brain Infarction: Rate, Predictive Factors, and Influence on Clinical Outcome

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