Advertisement

Novel Imaging Biomarker Prediction of Parenchymal Hemorrhage after Mechanical Thrombectomy in Patients with Large Ischemic Core

  • Author Footnotes
    1 These authors contributed equally to the work.
    Yiqi Wang
    Footnotes
    1 These authors contributed equally to the work.
    Affiliations
    Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to the work.
    Peng Wang
    Footnotes
    1 These authors contributed equally to the work.
    Affiliations
    Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
    Search for articles by this author
  • Sheng Zhang
    Affiliations
    Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
    Search for articles by this author
  • Zongjie Shi
    Affiliations
    Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
    Search for articles by this author
  • Jiangyong Min
    Correspondence
    Corresponding authors.
    Affiliations
    Conprehensive Stroke Center, Department of Neurosciences, Spectrum Health Neurosciences, Michigan State University, Grand Rapids, MI 49503, USA
    Search for articles by this author
  • Yu Geng
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to the work.

      Abstract

      Background

      Recently studies have shown that select acute ischemic stroke (AIS) patients with large ischemic core could be deemed as reasonable candidates to receive mechanical thrombectomy (MT) with low risk of developing parenchymal hemorrhage (PH) or symptomatic intracerebral hemorrhage (sICH); however, the selection criterion remains lacking. Our study aims to investigate the relationship between a novel imaging biomarker of largest core mass volume (LCMV) and development of PH in stroke patients with large ischemic core who have undergone MT.

      Methods

      A total of 26 AIS patients with large ischemic core (defined as ischemic core volume ≧ 50 ml) were enrolled in the study. Volume of ischemic core and the LCMV measured with Mistar software were measured in all patients. Fourteen patients with AIS developed PH while 12 patients showed no signs of PH based on CT imaging obtained between 24 h and 3 day after MT. We compared the volume of ischemic core and LCMV between two groups.

      Results

      Volume of ischemic core showed no significant difference between the PH and no PH group [105.5 (62.4–131.5) vs 75.0 (56.3–102.2), p = 0.105], whereas LCMV was significantly higher in the PH (14.80 ± 5.23) vs. no PH group (8.40 ± 2.61, p = 0.001). ROC analysis revealed that LCMV was positively correlated with PH (area under the curve = 0.905). The optimal LCMV associated with PH was ≧ 9.67 ml.

      Conclusion

      LCMV is an effective and easy-to-use imaging biomarker to predict PH after MT in AIS patients with large ischemic core.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Berkhemer OA
        • Fransen PS
        • Beumer D
        • van den Berg LA
        • Lingsma HF
        • Yoo AJ
        • et al.
        A randomized trial of intraarterial treatment for acute ischemic stroke.
        N Engl J Med. 2015; 372: 11-20
        • Saver JL
        • Goyal M
        • Bonafe A
        • Diener HC
        • Levy EI
        • Pereira VM
        • et al.
        Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke.
        N Engl J Med. 2015; 372: 2285-2295
        • Goyal M
        • Demchuk AM
        • Menon BK
        • Eesa M
        • Rempel JL
        • Thornton J
        • et al.
        Randomized assessment of rapid endovascular treatment of ischemic stroke.
        N Engl J Med. 2015; 372: 1019-1030
        • Campbell BC
        • Mitchell PJ
        • Kleinig TJ
        • Dewey HM
        • Churilov L
        • Yassi N
        • et al.
        Endovascular therapy for ischemic stroke with perfusion-imaging selection.
        N Engl J Med. 2015; 372: 1009-1018
        • Nogueira RG
        • Jadhav AP
        • Haussen DC
        • Bonafe A
        • Budzik RF
        • Bhuva P
        • et al.
        Thrombectomy 6 to 24 h after stroke with a mismatch between deficit and infarct.
        N Engl J Med. 2018; 378: 11-21
        • Goyal M
        • Menon BK
        • van Zwam WH
        • Dippel DW
        • Mitchell PJ
        • Demchuk AM
        • et al.
        Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials.
        Lancet. 2016; 387: 1723-1731
        • Lee YB
        • Yoon W
        • Lee YY
        • Kim SK
        • Baek BH
        • Kim JT
        • et al.
        Predictors and impact of hemorrhagic transformations after endovascular thrombectomy in patients with acute large vessel occlusions.
        J Neurointerv Surg. 2019; 11: 469-473
        • Panni P
        • Gory B
        • Xie Y
        • Consoli A
        • Desilles JP
        • Mazighi M
        • et al.
        Acute stroke with large ischemic core treated by thrombectomy.
        Stroke. 2019; 50: 1164-1171
        • Sarraj A
        • Hassan AE
        • Savitz S
        • Sitton C
        • Grotta J
        • Chen P
        • et al.
        Outcomes of endovascular thrombectomy vs medical management alone in patients with large ischemic cores: a secondary analysis of the optimizing patient’s selection for endovascular treatment in acute ischemic stroke (SELECT) Study.
        JAMA Neurol. 2019; 76: 1147-1156
        • Campbell BC
        • Christensen S
        • Levi CR
        • Desmond PM
        • Donnan GA
        • Davis SM
        • et al.
        Cerebral blood flow is the optimal CT perfusion parameter for assessing infarct core.
        Stroke. 2011; 42: 3435-3440
        • Yassi N
        • Parsons MW
        • Christensen S
        • Sharma G
        • Bivard A
        • Donnan GA
        • et al.
        Prediction of poststroke hemorrhagic transformation using computed tomography perfusion.
        Stroke. 2013; 44: 3039-3043
        • Shinoyama M
        • Nakagawara J
        • Yoneda H
        • Suzuki M
        • Ono H
        • Kunitsugu I
        • et al.
        Initial 'TTP map-defect' of computed tomography perfusion as a predictor of hemorrhagic transformation of acute ischemic stroke.
        Cerebrovasc Dis Extra. 2013; 3: 14-25
        • Yoo AJ
        • Simonsen CZ
        • Prabhakaran S
        • Chaudhry ZA
        • Issa MA
        • Fugate JE
        • et al.
        Refining angiographic biomarkers of revascularization: improving outcome prediction after intra-arterial therapy.
        Stroke. 2013; 44: 2509-2512
        • Renou P
        • Sibon I
        • Tourdias T
        • Rouanet F
        • Rosso C
        • Galanaud D
        • et al.
        Reliability of the ECASS radiological classification of postthrombolysis brain haemorrhage: a comparison of CT and three MRI sequences.
        Cerebrovasc Dis. 2010; 29: 597-604
        • Chen Z
        • Zhang R
        • Zhou Y
        • Gong X
        • Zhang M
        • Shi F
        • et al.
        Patients with ischemic core >/=70 ml within 6 h of symptom onset may still benefit from endovascular treatment.
        Front Neurol. 2018; 9: 933
        • Wu B
        • Liu N
        • Wintermark M
        • Parsons MW
        • Chen H
        • Lin L
        • et al.
        Optimal delay time of CT perfusion for predicting cerebral parenchymal hematoma after intra-arterial tPA treatment.
        Front Neurol. 2018; 9: 680
        • Lin K
        • Zink WE
        • Tsiouris AJ
        • John M
        • Tekchandani L
        • Sanelli PC
        Risk assessment of hemorrhagic transformation of acute middle cerebral artery stroke using multimodal CT.
        J Neuroimaging. 2012; 22: 160-166