Hemorrhagic transformation is associated with poor functional outcome in patients with acute ischemic stroke due to a large vessel occlusion

Abstract

Background and purposeHemorrhagic transformation (HT) is a complication that may cause neurological deterioration in patients with acute ischemic stroke. Various radiological subtypes of HT can be distinguished. Their influence on functional outcome is currently unclear. The purpose of this study was to assess the associations between HT subtypes and functional outcome in acute ischemic stroke patients with proven large vessel occlusion included in the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic stroke in The Netherlands).MethodsAll patients with follow-up imaging were included. HT was classified on follow-up CT scans according to the European Cooperative Acute Stroke Study II classification. Functional outcome was assessed using the modified Rankin Scale (mRS) 90 days after stroke onset. Ordinal logistic regression analysis with adjustment for potential confounders was used to determine the association of HT subtypes with functional outcome.ResultsOf 478 patients, 222 had HT. Of these, 76 (16%) patients were classified as hemorrhagic infarction type 1, 71 (15%) as hemorrhagic infarction type 2, 36 (8%) as parenchymal hematoma type 1, and 39 (8%) as parenchymal hematoma type 2. Hemorrhagic infarction type 2 (adjusted common OR (acOR) 0.54, 95% CI: 0.32 to 0.89) and parenchymal hematoma type 2 (acOR 0.37, 95% CI 0.17 to 0.78) were significantly associated with a worse functional outcome. Hemorrhagic infarction type 1 and parenchymal hematoma type 1 were not significantly associated, although their point estimates pointed in the direction of worse outcome.ConclusionThis study suggests that parenchymal hematoma type 2 is relevant for functional outcome after an acute ischemic stroke, and smaller HTs might also influence long term functional outcome.Trail registration number ISRCTN10888758.

Prognosis and risk factors associated with asymptomatic intracranial hemorrhage after endovascular treatment of large vessel occlusion stroke: a prospective multicenter cohort study

“…In a substudy analysis of the MR CLEAN trial, focusing on ICH after LVO, there was an overall ICH prevalence of 46%, including 189 patients (39%) with asymptomatic ICH (aICH; i.e. an ICH with no more than a 3‐point increase in the National Institutes of Health Stroke Scale [NIHSS] score) and 33 (6.9%) with sICH [3].…”

Association of Blood Pressure at Successful Recanalization and Parenchymal Hemorrhage After Mechanical Thrombectomy With General Anesthesia

“…But more than 50% of patients still have unfavorable outcomes after early successful recanalization (2). The most severe complication is hemorrhagic transformation (HT), especially parenchymal hemorrhage (PH), which could result in early neurological deterioration and long-term outcomes (3). The current guidelines from the American Heart Association/American Stroke Association guidelines arbitrarily recommend blood pressure (BP) control of <180/105 mm Hg during and after MT.…”

Metallic Hyperdensity Sign on Noncontrast CT Immediately after Mechanical Thrombectomy Predicts Parenchymal Hemorrhage in Patients with Acute Large-Artery Occlusion

“…6,7 One of the most common reasons is hemorrhagic transformation (HT), especially parenchymal hemorrhage (PH), which is closely related to deterioration of neurologic symptoms. 8,9 Early prediction of HT, therefore, is important for postinterventional therapy adjustment-that is, whether to start treatment with the glycoprotein IIb/IIIa inhibitor tirofiban to prevent early re-occlusion due to endothelial damage. 10 In some hospitals, immediate postinterventional non-contrastenhanced CT has been introduced to estimate bleeding complications.…”