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. 2015 Dec;57(12):1219-25.
doi: 10.1007/s00234-015-1577-6. Epub 2015 Sep 4.

Relation between reperfusion and hemorrhagic transformation in acute ischemic stroke

Alexander D Horsch  1   2 , Jan Willem Dankbaar  3 , Yolanda van der Graaf  4 , Joris M Niesten  3 , Tom van Seeters  3 , Irene C van der Schaaf  3 , L Jaap Kappelle  5 , Birgitta K Velthuis  3 ; DUST investigators
Collaborators, Affiliations

Relation between reperfusion and hemorrhagic transformation in acute ischemic stroke

Alexander D Horsch et al. Neuroradiology. 2015 Dec.

Abstract

Introduction: 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.

Methods: 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.

Results: 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 patients treated with IV-rtPA (n = 203), the OR was 1.3 (95%CI 0.4-4.0), and in patients not treated with IV-rtPA (n = 96), the OR was 0.8 (95%CI 0.1-4.5). HT occurred in 14 % of the IV-rtPA patients and in 7 % of patients without IV-rtPA (95%CI of difference -1 to 14 %).

Conclusion: Our results suggest that the increased risk of HT after acute ischemic stroke treatment is not dependent on the reperfusion status.

Keywords: CT perfusion; Hemorrhagic transformation; Ischemic stroke; Reperfusion; rtPA.

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Figures

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Fig. 1
Flow chart patient selection
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