Predictors of Hemorrhagic Transformation in Patients Receiving Intra-Arterial Thrombolysis

Abstract

Background and Purpose-Hemorrhagic transformation (HT) is a major complication of intra-arterial (IA) thrombolytic therapy. Identifying significant predictors of hemorrhage after thrombolysis would be useful in guiding patient selection for IA treatment. Methods-Data were collected retrospectively on consecutive patients with acute focal cerebral ischemia within the anterior or posterior circulation who were treated with combined intravenous (IV)-IA or pure IA thrombolysis over an 8-year period at the UCLA Medical Center. Results-Eighty-nine patients were treated. Median baseline National Institutes of Health Stroke Scale (NIHSS) score was 16, and mean age was 69 years. Twenty-six patients received IA tissue plasminogen activator (tPA) only, 22 received IV-IA tPA, and 41 received IA urokinase only. Asymptomatic HT occurred in 29 patients (33%), minor symptomatic HT (1-to 3-point worsening in NIHSS score) occurred in 10 patients (11%), and major symptomatic HT (Ն4-point worsening in NIHSS score) occurred in 6 patients (7%). The rate of any HT was similar in patients treated with pure IA thrombolysis (39%) versus combined IV-IA thrombolysis (41%). In pure IA cases, the rate of any HT was 50% with tPA versus 32% with urokinase (Pϭ0.2). Eighty-six percent of the patients with HT versus 39% of the patients without HT were dead or disabled (modified Rankin score Ͼ2) at day 7 (PϽ0.0001). On multivariate analysis, independent predictors of any HT were higher NIHSS score, longer time to recanalization, lower platelet count, and higher glucose level. A model using these variables correctly predicted HT with positive predictive value 70% and overall accuracy 78%. Conclusions-In

Measuring Elevated Microvascular Permeability and Predicting Hemorrhagic Transformation in Acute Ischemic Stroke Using First-Pass Dynamic Perfusion CT Imaging

“…Although there are many studies that report various clinical and molecular variables predictive of HT, 30,31 imaging BBB permeability is an intuitive and conceptually attractive method to assess for HT risks. Abnormal BBB permeability can be seen qualitatively as parenchymal enhancement in conventional delayed postgadolinium enhanced MR imaging, with enhancement in the early period of AIS being predictive of HT.…”

Increased globulin and its association with hemorrhagic transformation in patients receiving intra-arterial thrombolysis therapy

“…Hemorrhagic transformation (HT) is a common complication of intra-arterial thrombolysis for the treatment of acute ischemic stroke, with an estimated incidence rate of 18-71% [1,2] , depending on factors such as the thrombolytic agent used and the route of administration [1,3,4] . Recent studies showed that different s ubtypes of HT may have a different prognosis, some having a higher recanalization rate and better outcome [5] ,while some are associated with very poor clinical outcomes [6] .…”

Contrast Enhancement and Contrast Extravasation on Computed Tomography After Intra-Arterial Thrombolysis in Patients With Acute Ischemic Stroke

“…Intra-arterial thrombolytic therapy is increasingly used at many large institutions for treatment of acute ischemic stroke. [2][3][4][5] Recently, on the basis of results of the Prolyse in Acute Cerebral Thromboembolism (PROACT) II investigation, 5 the American Society of Interventional and Therapeutic Neuroradiology stated that intra-arterial thrombolytic therapy could be considered acceptable and appropriate for acute stroke in selected patients. 6 Hemorrhagic transformation with deterioration of neurological symptoms is the major complication of intra-arterial thrombolytic therapy; a frequency between 10% and 15.4% has been observed.…”