Hyper-attenuating brain lesions on CT after ischemic stroke and thrombectomy are associated with final brain infarction

Cabral, FB; Castro-Afonso, LH; Nakiri, GS; Monsignore, LM; Fábio, Src; Santos, AC dos; Pontes-Neto, OM; Abud, DG

doi:10.1177/1591019917729550

Cited by 17 publications

(12 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…27 The most widely accepted hypothesis differentiate the high-density lesions based in the presence of degradation of the basal lamina, which would cause not only leakage of iodine contrast into the extracellular spaces but also some degree of hemorrhage. 28–31 Therefore, the previously used term contrast extravasation better reflects the presence of hemorrhage and impacts in the reported outcomes.…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

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

View full text Add to dashboard Cite

show abstract

“…However, we adjusted for many clinically relevant factors to estimate the effect of ICH on clinical outcomes; thus, the estimates should be robust within the patients who received EVT in daily clinical practice. Second, the incidence of ICH might be overestimated due to the potential extravasated contrast medium used with EVT [30]. However, the assessment of ICH was conducted 24 h after EVT and compared with the images just after EVT.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Prognostic Impact of Intracranial Hemorrhage after Endovascular Treatment for Acute Large Vessel Occlusion

et al. 2020

View full text Add to dashboard Cite

Introduction: Endovascular treatment (EVT) is effective against acute cerebral large vessel occlusion (LVO). However, it has been associated with a high incidence of intracranial hemorrhage (ICH). Because the incidence of ICH and prognostic impact of ICH were not scrutinized in general patients, we investigated the impact of ICH after EVT on functional outcome at 90 days in patients with acute LVO. Methods: RESCUE-Japan Registry 2 was a multicenter registry that enrolled 2,420 consecutive patients with acute LVO within 24 h of onset. We analyzed 1,281 patients who received EVT and compared the functional outcomes between those with and without ICH (ICH and no-ICH groups, respectively) within 24 h after EVT. We explored the factors associated with ICH and prognostic impact of symptomatic ICH (SICH) among patients with ICH. We estimated the adjusted odds ratios (ORs) for good functional outcome as modified Rankin Scale scores 0–2 and mortality. We also explored the prognostic impact of symptomatic ICH (SICH) among patients with ICH. Results: ICH occurred in 333 patients (26.0%). Several factors such as perioperative edaravone, stent retriever, and baseline glucose were associated with development of ICH within 24 h. A good outcome was observed in 80 (24.0%) and 454 (47.9%) patients in the ICH and no-ICH groups, respectively, and the adjusted OR was 0.3 (95% confidence interval [CI] = 0.2–0.5, p < 0.0001). Incidence of mortality within 90 days was not significantly different between the groups (adjusted OR 1.2; 95% CI: 0.7–1.9, p = 0.5). SICH was observed in 36 (10.8%) of 333 patients with ICH, and the good outcomes were 8.3 and 25.9% in patients with SICH and asymptomatic ICH (AICH), respectively (p = 0.02). Mortality at 90 days was 30.6 and 7.1% in patients with SICH and AICH, respectively (p < 0.0001). Conclusions: The functional outcomes at 90 days were significantly worse in patients who developed ICH after receiving EVT for acute LVO, but the mortality was generally similar.

show abstract

“…The presumed mechanism of contrast staining is leakage of the contrast media into the parenchymal extracellular space in areas with ischemiainduced breakdown of the blood-brain barrier (BBB) and basal lamina, BBB disruption due to chemotoxicity or reperfusion injuries following recanalization, or impaired autoregulation/luxury perfusion (7). The significance of IPH after MT is quite variable, ranging from asymptomatic to poor clinical outcome (8)(9)(10). The high density of brain parenchyma in patients with acute ischemic stroke after MT most often evolves into cerebral infarction but rarely into hemorrhages (2).…”

Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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.

show abstract

Hyper-attenuating brain lesions on CT after ischemic stroke and thrombectomy are associated with final brain infarction

Cited by 17 publications

References 29 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

Incidence and Prognostic Impact of Intracranial Hemorrhage after Endovascular Treatment for Acute Large Vessel Occlusion

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

Contact Info

Product

Resources

About