Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec;18(10):1238-1246.
doi: 10.1177/17474930231185690. Epub 2023 Jul 5.

Predictors for hemorrhagic transformation and cerebral edema in stroke patients with first-pass complete recanalization

Manuel Cappellari  1 , Giovanni Pracucci  2 , Valentina Saia  3 , Fabrizio Sallustio  4 , Ilaria Casetta  5 , Enrico Fainardi  6 , Francesco Capasso  6 , Patrizia Nencini  6 , Stefano Vallone  7 , Guido Bigliardi  7 , Andrea Saletti  5 , Alessandro De Vito  5 , Maria Ruggiero  8 , Marco Longoni  8 , Vittorio Semeraro  9 , Giovanni Boero  9 , Umberto Silvagni  10 , Furio Stancati  10 , Elvis Lafe  11 , Federico Mazzacane  12 , Sandra Bracco  13 , Rossana Tassi  13 , Simone Comelli  14 , Maurizio Melis  14 , Daniele Romano  15 , Rosa Napoletano  15 , Roberto Menozzi  16 , Umberto Scoditti  16 , Luigi Chiumarulo  17 , Marco Petruzzellis  17 , Sergio Lucio Vinci  18 , Ludovica Ferraù  18 , Francesco Taglialatela  19 , Andrea Zini  19 , Antioco Sanna  3 , Tiziana Tassinari  3 , Marta Iacobucci  20 , Ettore Nicolini  20 , Mauro Bergui  21 , Paolo Cerrato  21 , Andrea Giorgianni  22 , Lucia Princiotta Cariddi  22 , Pietro Amistà  23 , Monia Russo  23 , Ivan Gallesio  24 , Federica Sepe  24 , Alessio Comai  25 , Enrica Franchini  25 , Pietro Filauri  26 , Berardino Orlandi  26 , Michele Besana  27 , Alessia Giossi  27 , Guido Andrea Lazzarotti  28 , Giovanni Orlandi  28 , Davide Castellano  29 , Andrea Naldi  29 , Mauro Plebani  30 , Cecilia Zivelonghi  30 , Paolo Invernizzi  31 , Salvatore Mangiafico  20   32   33   34 , Danilo Toni  20
Affiliations

Predictors for hemorrhagic transformation and cerebral edema in stroke patients with first-pass complete recanalization

Manuel Cappellari et al. Int J Stroke. 2023 Dec.

Abstract

Background: Predictors of radiological complications attributable to reperfusion injury remain unknown when baseline setting is optimal for endovascular treatment and procedural setting is the best in stroke patients with large vessel occlusion (LVO).

Aims: To identify clinical and radiological/procedural predictors for hemorrhagic transformation (HT) and cerebral edema (CED) at 24 hr in patients obtaining complete recanalization in one pass of thrombectomy for ischemic stroke ⩽ 6 h from symptom onset with intra-cranial anterior circulation LVO and ASPECTS ⩾ 6.

Methods: We conducted a cohort study on prospectively collected data from 1400 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke.

Results: HT was reported in 248 (18%) patients and early CED was reported in 260 (19.2%) patients. In the logistic regression model including predictors from a first model with clinical variables and from a second model with radiological/procedural variables, diabetes mellitus (odds ratio (OR) = 1.832, 95% confidence interval (CI) = 1.201-2.795), higher National Institutes of Health Stroke Scale (NIHSS) (OR = 1.076, 95% CI = 1.044-1.110), lower Alberta Stroke Program Early CT (ASPECTS) (OR = 0.815, 95% CI = 0.694-0.957), and longer onset-to-groin time (OR = 1.005, 95% CI = 1.002-1.007) were predictors of HT, whereas general anesthesia was inversely associated with HT (OR = 0.540, 95% CI = 0.355-0.820). Higher NIHSS (OR = 1.049, 95% CI = 1.021-1.077), lower ASPECTS (OR = 0.700, 95% CI = 0.613-0.801), intravenous thrombolysis (OR = 1.464, 95% CI = 1.061-2.020), longer onset-to-groin time (OR = 1.002, 95% CI = 1.001-1.005), and longer procedure time (OR = 1.009, 95% CI = 1.004-1.015) were predictors of early CED. After repeating a fourth logistic regression model including also good collaterals, the same variables remained predictors for HT and/or early CED, except diabetes mellitus and thrombolysis, while good collaterals were inversely associated with early CED (OR = 0.385, 95% CI = 0.248-0.599).

Conclusions: Higher NIHSS, lower ASPECTS, and longer onset-to-groin time were predictors for both HT and early CED. General anesthesia and good collaterals were inversely associated with HT and early CED, respectively. Longer procedure time was predictor of early CED.

Keywords: Stroke; cerebral edema; first-pass complete reperfusion; hemorrhagic transformation; reperfusion injury; thrombectomy.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Manuel Cappellari received consultancy or advisory board fees or speaker’s honoraria from Boehringer Ingelheim, Pfizer/Bristol Meyer Squibb, and Daiichi Sankyo. Andrea Zini received consulting fees from Boehringer-Ingelheim consulting fees from Boehringer-Ingelheim, Alexion and CLS Behring. All other authors report no conflicts of interest. The other authors report no conflicts.

References

LinkOut - more resources