Predicting Hemorrhagic Transformation of Acute Ischemic Stroke

Marsh, Elisabeth B.; Llinás, Rafael H.; Schneider, Andrea L.C.; Hillis, Argye E.; Lawrence, Erin; Dziedzic, Peter; Gottesman, Rebecca F.

doi:10.1097/md.0000000000002430

Cited by 48 publications

(37 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although univariate p -values for leukoaraiosis and international normalized ratio (INR) were above our acceptable threshold, we included them in the multivariate analysis because some authors had proposed them as risk factors [ 18 , 19 ]. As a result of fitting a multivariate BLR model, seven variables were kept in the final equation (Table 5 ).…”

Section: Resultsmentioning

confidence: 99%

The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke

2017

View full text Add to dashboard Cite

BackgroundWe aimed to develop a tool, the hemorrhagic transformation (HT) index (HTI), to predict any HT within 14 days after middle cerebral artery (MCA) stroke onset regardless of the intravenous recombinant tissue plasminogen activator (IV rtPA) use. That is especially important in the light of missing evidence-based data concerning the timing of anticoagulant resumption after stroke in patients with atrial fibrillation (AF).MethodsWe retrospectively analyzed 783 consecutive MCA stroke patients. Clinical and brain imaging data at admission were recorded. A follow-up period was 2 weeks after admission. The patients were divided into derivation (DC) and validation (VC) cohorts by generating Bernoulli variates with probability parameter 0.7. Univariate/multivariate logistic regression, and factor analysis were used to extract independent predictors. Validation was performed with internal consistency reliability and receiver operating characteristic (ROC) analysis. Bootstrapping was used to reduce bias.ResultsThe HTI was composed of 4 items: Alberta Stroke Program Early CT score (ASPECTS), National Institutes of Health Stroke Scale (NIHSS), hyperdense MCA (HMCA) sign, and AF on electrocardiogram (ECG) at admission. According to the predicted probability (PP) range, scores were allocated to ASPECTS as follows: 10–7 = 0; 6–5 = 1; 4–3 = 2; 2–0 = 3; to NIHSS: 0–11 = 0; 12–17 = 1; 18–23 = 2; >23 = 3; to HMCA sign: yes = 1; to AF on ECG: yes = 1. The HTI score varied from 0 to 8. For each score, adjusted PP of any HT with 95% confidence intervals (CI) was as follows: 0 = 0.027 (0.011–0.042); 1 = 0.07 (0.043–0.098); 2 = 0.169 (0.125–0.213); 3 = 0.346 (0.275–0.417); 4 = 0.571 (0.474–0.668); 5 = 0.768 (0.676–0.861); 6 = 0.893 (0.829–0.957); 7 = 0.956 (0.92–0.992); 8 = 0.983 (0.965–1.0). The optimal cutpoint score to differentiate between HT-positive and negative groups was 2 (95% normal-based CI, 1–3) for the DC and VC alike. ROC area/sensitivity/specificity with 95% normal-based CI for the DC and VC were 0.85 (0.82–0.89)/0.82 (0.73–0.9)/0.89 (0.8–0.97) and 0.83 (0.78–0.88)/0.8 (0.66–0.94)/0.87 (0.73–1.0) respectively. McDonald’s categorical omega with 95% bias-corrected and accelerated CI for the DC and VC was 0.81 (0.77–0.84) and 0.82 (0.76–0.86) respectively.ConclusionsThe HTI is a simple yet reliable tool to predict any HT within 2 weeks after MCA stroke onset regardless of the IV rtPA use.

show abstract

Section: Resultsmentioning

confidence: 99%

The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke

2017

View full text Add to dashboard Cite

show abstract

“…There's been several reports on the risk of sICH after MT in LIC, none of which showed an increase in the risk of sICH after MT except in the HERMES collaboration 3 where, for patients with ASPECTS 0-4, sICH was more frequent in the MT group, although not significantly (adjusted cOR, 3.94; 95% CI, 0.94 to 16.49; P interaction=0.025), and not reproduced when restricting the sample to patients with DWI volume ≥70 mL were no significant difference of sICH between EVT (1/23, 4.3%) and best medical treatment (2/37, 5.4%) was found. 3,15 Of critical note, the most important predictor of sICH and parenchymal hemorrhage is core volume, independent of treatment modality, 3,7,19,20,23 likely explaining that successful reperfusion was associated with lower sICH in many "real life" recent studies. 7,19,20 Whether the benefits of not revascularizing a patient to prevent sICH, outweigh those of revascularization to prevent infarction extension is unknown, but very unlikely, especially in patients with important mismatch, at highest risk for infarct progression and progression to malignant infarction.…”

mentioning

confidence: 99%

Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy

et al. 2020

View full text Add to dashboard Cite

Background and Purpose Patients with acute ischemic stroke, proximal vessel occlusion and a large ischemic core at presentation are commonly not considered for mechanical thrombectomy (MT). We tested the hypothesis that in patients with baseline large infarct cores, identification of remaining penumbral tissue using perfusion imaging would translate to better outcomes after MT.<br/>Methods This was a multicenter, retrospective, core lab adjudicated, cohort study of adult patients with proximal vessel occlusion, a large ischemic core volume (diffusion weighted imaging volume ≥70 mL), with pre-treatment magnetic resonance imaging perfusion, treated with MT (2015 to 2018) or medical care alone (controls; before 2015). Primary outcome measure was 3-month favorable outcome (defined as a modified Rankin Scale of 0–3). Core perfusion mismatch ratio (CPMR) was defined as the volume of critically hypo-perfused tissue (Tmax >6 seconds) divided by the core volume. Multivariable logistic regression models were used to determine factors that were independently associated with clinical outcomes. Outputs are displayed as adjusted odds ratio (aOR) and 95% confidence interval (CI).<br/>Results A total of 172 patients were included (MT n=130; Control n=42; mean age 69.0±15.4 years; 36% females). Mean core-volume and CPMR were 102.3±36.7 and 1.8±0.7 mL, respectively. As hypothesized, receiving MT was associated with increased probability of favorable outcome and functional independence, as CPMR increased, a difference becoming statistically significant above a mismatch-ratio of 1.72. Similarly, receiving MT was also associated with favorable outcome in the subgroup of 74 patients with CPMR >1.7 (aOR, 8.12; 95% CI, 1.24 to 53.11; P=0.028). Overall (prior to stratification by CPMR) 73 (42.4%) patients had a favorable outcome at 3 months, with no difference amongst groups.<br/>Conclusions In patients currently deemed ineligible for MT due to large infarct ischemic cores at baseline, CPMR identifies a subgroup strongly benefiting from MT. Prospective studies are warranted.

show abstract

“…[102627] Various predictor scores have been formulated recently to determine HT in AIS patients with an indication for anticoagulation. [11]…”

Section: Discussionmentioning

confidence: 99%

“…[9] Similarly, advanced age, renal impairment, large infarct volume, hyperglycemia, and leukocytosis on admission have been previously shown to be significant predictors of HT. [1011] Further knowledge of risk factors associated with HT in ischemic stroke may improve patient selection and decision-making by physicians during acute settings.…”

Section: Introductionmentioning

confidence: 99%

Interaction of incidental microbleeds and prior use of antithrombotics with early hemorrhagic transformation: Causative or protective?

Malhotra

Khunger

Ouyang

et al. 2016

Ann Indian Acad Neurol

View full text Add to dashboard Cite

Background:Gradient echo (GRE) sequence of magnetic resonance imaging (MRI) is a sensitive tool to detect hemorrhagic transformation (HT) and old cerebral microbleeds (CMBs). Presence of CMBs and prior use of antithrombotics pose a risk of HT in ischemic stroke. We evaluated the association of CMBs and antithrombotic use with resultant HT in acute ischemic stroke (AIS).Methods:This retrospective study included AIS patients admitted to our center between January 2009 and August 2010 who underwent GRE-weighted MRI within 48 h of admission. Demographic and clinical data including diabetes mellitus, hypertension, hyperlipidemia, prior intake of antiplatelets/anticoagulants/statins, and presence of CMBs at admission were collected and compared between patients who developed HT and those who did not. We did a multivariate analysis using logistic regression to assess the effect of CMBs and prior use of antithrombotic agents on the risk of development for early HT in ischemic stroke.Results:Of 529 AIS patients, 81 (15%) were found to have HT during the initial hospital course. CMBs were found in only 9 of 81 patients (11%) with HT and in 40 out of remaining 448 patients (9%) who did not develop HT. The presence of CMBs was not associated with increased risk of HT (P = 0.53). However, prior use of antiplatelets (33% vs. 47% in the patients without HT, P = 0.02) was associated with decreased risk of HT in ischemic stroke.Conclusion:Presence of incidental CMBs was not associated with increased risk for early HT of an ischemic stroke. Interestingly, the prior intake of antiplatelets was found to be protective against HT of ischemic stroke.

show abstract

Predicting Hemorrhagic Transformation of Acute Ischemic Stroke

Cited by 48 publications

References 33 publications

The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke

The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke

Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy

Interaction of incidental microbleeds and prior use of antithrombotics with early hemorrhagic transformation: Causative or protective?

Contact Info

Product

Resources

About