From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada
From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada.
AJNR Am J Neuroradiol. 2024 Jul 8;45(7):887-892. doi: 10.3174/ajnr.A8227.
Hemorrhagic transformation can occur as a complication of endovascular treatment for acute ischemic stroke. This study aimed to determine whether ischemia depth as measured by admission CTP metrics can predict the development of hemorrhagic transformation at 24 hours.
Patients with baseline CTP and 24-hour follow-up imaging from the ESCAPE-NA1 trial were included. RAPID software was used to generate CTP volume maps for relative CBF, CBV, and time-to-maximum at different thresholds. Hemorrhage on 24-hour imaging was classified according to the Heidelberg system, and volumes were calculated. Univariable and multivariable regression analyses assessed the association between CTP lesion volumes and hemorrhage/hemorrhage subtypes.
Among 408 patients with baseline CTP, 142 (35%) had hemorrhagic transformation at 24-hour follow-up, with 89 (63%) classified as hemorrhagic infarction (HI1/HI2), and 53 (37%), as parenchymal hematoma (PH1/PH2). Patients with HI or PH had larger volumes of low relative CBF and CBV at each threshold compared with those without hemorrhage. After we adjustied for baseline and treatment variables, only increased relative CBF <30% lesion volume was associated with any hemorrhage (adjusted OR, 1.14; 95% CI, 1.02-1.27 per 10 mL), as well as parenchymal hematoma (adjusted OR, 1.23; 95% CI, 1.06-1.43 per 10 mL). No significant associations were observed for hemorrhagic infarction.
Larger "core" volumes of relative CBF <30% were associated with an increased risk of PH following endovascular treatment. This particular metric, in conjunction with other clinical and imaging variables, may, therefore, help estimate the risk of post-endovascular treatment hemorrhagic complications.
血管内治疗急性缺血性卒中后可发生出血性转化。本研究旨在确定入院 CTP 指标测量的缺血深度是否可以预测 24 小时内出血性转化的发生。
纳入 ESCAPE-NA1 试验的基线 CTP 和 24 小时随访成像患者。使用 RAPID 软件为不同阈值的相对 CBF、CBV 和达到最大值时间生成 CTP 容积图。根据海德堡系统对 24 小时成像上的出血进行分类，并计算容积。单变量和多变量回归分析评估 CTP 病变容积与出血/出血亚型之间的关系。
在 408 例基线 CTP 患者中，142 例（35%）在 24 小时随访时发生出血性转化，其中 89 例（63%）为出血性梗死（HI1/HI2），53 例（37%）为脑实质血肿（PH1/PH2）。与无出血患者相比，HI 或 PH 患者各阈值的低相对 CBF 和 CBV 容积更大。在调整基线和治疗变量后，仅相对 CBF<30%的病变体积增加与任何出血（调整后的比值比，1.14；95%置信区间，每 10 mL 增加 1.02-1.27）以及脑实质血肿（调整后的比值比，1.23；95%置信区间，每 10 mL 增加 1.06-1.43）相关。未观察到出血性梗死的显著相关性。
相对 CBF<30%的较大“核心”容积与血管内治疗后 PH 的风险增加相关。因此，这种特定的指标，结合其他临床和影像学变量，可能有助于估计血管内治疗后出血性并发症的风险。
