TY - JOUR
T1 - Clinical and Imaging Markers Associated with Hemorrhagic Transformation in Patients with Acute Ischemic Stroke
AU - Van Kranendonk, Katinka R.
AU - Treurniet, Kilian M.
AU - Boers, Anna M.M.
AU - Berkhemer, Olvert A.
AU - Van Den Berg, Lucie A.
AU - Chalos, Vicky
AU - Lingsma, Hester F.
AU - Van Zwam, Wim H.
AU - Van Der Lugt, Aad
AU - Van Oostenbrugge, Robert J.
AU - Dippel, Diederik W.J.
AU - Roos, Yvo B.W.E.M.
AU - Marquering, Henk A.
AU - Majoie, Charles B.L.M.
N1 - Funding Information:
The MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) was partly funded by the Dutch Heart Foundation grant number 2008T30 and by unrestricted grants from AngioCare BV, Medtronic/Covidien/EV3, MEDAC Gmbh/LAMEPRO, Penumbra, Inc, Stryker, and Top Medical/Concentric.
Funding Information:
Academic medical center Amsterdam received funds from Stryker for consultations by Dr Majoie, Roos, and Berkhemer. Dr Majoie received research grants from Cardiovasculair Onderzoek Nederland (CVON)/Dutch Heart Foundation, European Commission, Twin Foundation and Stryker (all paid to institution). Dr Marquering, Dr Boers, Dr Majoie and Dr Roos are shareholders of Nico.lab, a company that focuses on the use of artificial intelligence for medical image analysis. Erasmus University Medical Center received funds from Bracco Imaging for consultations by Dr Dippel. Erasmus University Medical Center received funds from CVON/Dutch Heart Foundation, European Commission, Stryker, Penumbra, and Medtronic for the execution of stroke trials by Drs Dippel and van der Lugt. Maastricht University Medical Center received funds from Stryker and Cerenovus for consultations by Dr Zwam. The other authors report no conflicts.
Publisher Copyright:
© 2019 American Heart Association, Inc.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Background and Purpose-Hemorrhagic transformation (HT) after acute ischemic stroke may cause severe neurological deterioration and affects functional outcome. Identifying patients most likely to suffer from this complication could potentially be used for future treatment selection. Reperfusion after endovascular therapy could be associated with different risk factors for HT than intravenous thrombolytics as these treatments largely differ. In this study, we aimed to identify clinical and imaging markers that are associated with HT subtypes in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) population. Methods-In this post hoc analysis, all patients with follow-up imaging were included. HT was classified according to ECASS II (European Cooperative Acute Stroke Study). Variables with an association of P<0.1 were included in the multivariable logistic regression to identify clinical and radiological variables associated with petechial hemorrhagic infarction, parenchymal hematoma (PH), and symptomatic intracranial hemorrhage. Results-Of the 478 out of 500 included patients in this subanalysis, 46% had HT (n=222). Of these, 66% had hemorrhagic infarction (n=147) and 34% PH (n=75). Symptomatic intracranial hemorrhage was observed in 7.3% (n=35) of all patients. Baseline National Institutes of Health Stroke Scale (odds ratio [OR], 1.05,95% CI, 1.01-1.09 per point) and absent/poor collaterals (OR, 1.90; 95% CI, 1.05-3.42) were significantly associated with hemorrhagic infarction. Increased systolic blood pressure (OR, 1.17; 95% CI, 1.05-1.31 per 10 mm Hg) and atrial fibrillation (OR, 1.94; 95% CI, 1.08-3.48) were associated with PH. Increased systolic blood pressure (OR, 1.28; 95% CI, 1.12-1.48) and antiplatelet use (OR, 2.6; 95% CI, 1.08-6.3) were associated with symptomatic intracranial hemorrhage. Conclusions-Clinical and imaging stroke severity parameters were associated with HT, both in hemorrhagic infarction and PH, whereas baseline patients characteristics like systolic blood pressure, atrial fibrillation, and antiplatelet use were only associated with PH or symptomatic intracranial hemorrhage. Clinical Trial Registration-URL: http://www.controlled-trials.com. Unique identifier: ISRCTN10888758.
AB - Background and Purpose-Hemorrhagic transformation (HT) after acute ischemic stroke may cause severe neurological deterioration and affects functional outcome. Identifying patients most likely to suffer from this complication could potentially be used for future treatment selection. Reperfusion after endovascular therapy could be associated with different risk factors for HT than intravenous thrombolytics as these treatments largely differ. In this study, we aimed to identify clinical and imaging markers that are associated with HT subtypes in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) population. Methods-In this post hoc analysis, all patients with follow-up imaging were included. HT was classified according to ECASS II (European Cooperative Acute Stroke Study). Variables with an association of P<0.1 were included in the multivariable logistic regression to identify clinical and radiological variables associated with petechial hemorrhagic infarction, parenchymal hematoma (PH), and symptomatic intracranial hemorrhage. Results-Of the 478 out of 500 included patients in this subanalysis, 46% had HT (n=222). Of these, 66% had hemorrhagic infarction (n=147) and 34% PH (n=75). Symptomatic intracranial hemorrhage was observed in 7.3% (n=35) of all patients. Baseline National Institutes of Health Stroke Scale (odds ratio [OR], 1.05,95% CI, 1.01-1.09 per point) and absent/poor collaterals (OR, 1.90; 95% CI, 1.05-3.42) were significantly associated with hemorrhagic infarction. Increased systolic blood pressure (OR, 1.17; 95% CI, 1.05-1.31 per 10 mm Hg) and atrial fibrillation (OR, 1.94; 95% CI, 1.08-3.48) were associated with PH. Increased systolic blood pressure (OR, 1.28; 95% CI, 1.12-1.48) and antiplatelet use (OR, 2.6; 95% CI, 1.08-6.3) were associated with symptomatic intracranial hemorrhage. Conclusions-Clinical and imaging stroke severity parameters were associated with HT, both in hemorrhagic infarction and PH, whereas baseline patients characteristics like systolic blood pressure, atrial fibrillation, and antiplatelet use were only associated with PH or symptomatic intracranial hemorrhage. Clinical Trial Registration-URL: http://www.controlled-trials.com. Unique identifier: ISRCTN10888758.
KW - atrial fibrillation
KW - blood pressure
KW - infarction
KW - intracranial hemorrhages
KW - reperfusion
KW - risk factors
KW - stroke
KW - n/a OA procedure
UR - http://www.scopus.com/inward/record.url?scp=85073608511&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.118.024255
DO - 10.1161/STROKEAHA.118.024255
M3 - Article
C2 - 33755497
AN - SCOPUS:85073608511
SN - 0039-2499
VL - 50
SP - 2037
EP - 2043
JO - Stroke
JF - Stroke
IS - 8
ER -
