Predictors of hemorrhagic transformation occurring spontaneously and on anticoagulants in patients with acute ischemic stroke

Stroke; a Journal of Cerebral Circulation
A V AlexandrovJ W Norris

Abstract

Hemorrhagic transformation (HT) is a common evolution of large-volume ischemic lesions, particularly of cardioembolic origin. We used transcranial Doppler ultrasound (TCD), single-photon emission computed tomography (SPECT) with 99mTc-hexamethylpropyleneamine oxime (HMPAO), and the Toronto Embolic Scale (TES) to decide (1) whether TCD, HMPAO-SPECT, and TES can improve on clinical and CT tests to predict spontaneous HT and (2) whether SPECT can help to predict the outcome of symptomatic HT. Prognostic criteria included Canadian Neurological Scale (CNS) scores < or = 50 on admission, early ischemic changes on CT, M1 middle cerebral artery occlusion on TCD, the focal absence of brain perfusion on SPECT, and a high risk of cardiogenic embolism on TES. In part 1, 85 consecutive patients admitted within the first 6 hours were studied. No patient received thrombolysis. HT was found in 11 patients (13%) at 3 to 5 days. Admission CNS and CT were not predictive of HT: odds ratios (95% confidence intervals) were 0.49 (0.18 to 1.23) (P = .1) and 0.88 (0.23 to 3.45) (P = .8), respectively, TCD, SPECT, and TES were significant predictors of HT (P < .05), as follows: TCD, 8.67 (1.42 to 70.59); SPECT, 17.40 (2.69 to 170.89); and TES, 18.13 (2....Continue Reading

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