Relation between reperfusion and hemorrhagic transformation in acute ischemic stroke

Neuroradiology
A D HorschDUST investigators

Abstract

Intravenous recombinant tissue plasminogen activator (IV-rtPA) is given in acute ischemic stroke patients to achieve reperfusion. Hemorrhagic transformation (HT) is a serious complication of IV-rtPA treatment and related to blood-brain barrier (BBB) injury. It is unclear whether HT occurs secondary to reperfusion in combination with ischemic BBB injury or is caused by the negative effect of IV-rtPA on BBB integrity. The aim of this study was to establish the association between reperfusion and the occurrence of HT. From the DUST study, patients were selected with admission and follow-up non-contrast CT (NCCT) and CT perfusion (CTP) imaging, and a perfusion deficit in the middle cerebral artery territory on admission. Reperfusion was categorized qualitatively as reperfusion or no-reperfusion by visual comparison of admission and follow-up CTP. Occurrence of HT was assessed on follow-up NCCT. The association between reperfusion and occurrence of HT on follow-up was estimated by calculating odds ratios (ORs) and 95 % confidence intervals (CIs) with additional stratification for IV-rtPA treatment. Inclusion criteria were met in 299 patients. There was no significant association between reperfusion and HT (OR 1.2 95%CI 0.5-3.1). In ...Continue Reading

References

Dec 14, 1995·The New England Journal of Medicine·UNKNOWN National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group
Nov 1, 1996·Magnetic Resonance in Medicine : Official Journal of the Society of Magnetic Resonance in Medicine·L OstergaardB R Rosen
Jun 2, 2001·Stroke; a Journal of Cerebral Circulation·C BergerR von Kummer
Mar 16, 2004·Lancet·Werner HackeUNKNOWN NINDS rt-PA Study Group Investigators
Sep 25, 2004·Annals of Neurology·Lawrence L LatourSteven Warach
Dec 13, 2005·Stroke; a Journal of Cerebral Circulation·Jeffrey L Saver
Jan 20, 2007·Stroke; a Journal of Cerebral Circulation·Pooja KhatriJoseph P Broderick
Aug 30, 2008·Neurology·M SaqqurUNKNOWN CLOTBUST Investigators
Apr 15, 2009·Cerebrovascular Diseases·Carlos A Molina, José Alvarez-Sabín
Jun 10, 2011·Physics in Medicine and Biology·Adriënne M MendrikMathias Prokop
Jan 28, 2012·Neurology·J H ParkP B Gorelick

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Citations

Apr 18, 2020·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·Jose Danilo B DiestroAditya Bharatha
Aug 19, 2016·Neurology·Hendrikus J A van OsMarieke J H Wermer

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Clinical Trials Mentioned

NCT00880113

Software Mentioned

CTP
Extended Brilliance workstation

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