Lin Kunxin, Zhao Wenlong, Wu Quanhong, Zheng Yiru, Yang Bo, Fu Ying, Wang Ning, Fang Ling
Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China.
Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Front Neurol. 2025 Jan 7;15:1465481. doi: 10.3389/fneur.2024.1465481. eCollection 2024.
Hemorrhagic transformation (HT) is a severe complication in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) after endovascular treatment (EVT). We hypothesize that asymmetry of the internal cerebral veins (ICVs) on baseline CT angiogram (CTA) may serve as an adjunctive predictor of HT.
We conducted a study on consecutive AIS-LVO patients from November 2020 to April 2022. These patients had anterior circulation occlusions and were treated with EVT. Asymmetrical ICVs were assessed using CTA and defined as hypodensity (reduced opacification) on the ipsilateral side of occlusion compared to the contralateral side. The primary outcome was HT, defined as hemorrhage within the ischemic territory. This was evaluated using follow-up imaging (CT scan or magnetic resonance imaging) performed 48 h post-EVT. HT was classified into four subtypes based on the European Cooperative Acute Stroke Study-II criteria.
A total of 126 patients were included, with an HT rate of 49.2% (62/126). ICV asymmetry was observed in 54.0% (68/126) of patients. The ICV asymmetry group exhibited a significantly higher risk of parenchymatous hematoma-type HT (33.8% vs. 15.5%, = 0.019) and symptomatic intracerebral hemorrhage (sICH) (23.5% vs. 5.2%, = 0.004). In multivariate logistic regression, ICV asymmetry (OR 3.809, 95% CI 1.582-9.171), baseline Alberta Stroke Program Early CT Score (OR 0.771, 95% CI 0.608-0.978), intravenous recombinant tissue plasminogen activator (OR 2.847, 95% CI 1.098-2.7.385), and poor collateral circulation (OR 3.998, 95% CI 1.572-10.169) were identified as independent risk factors of HT.
ICV asymmetry, likely resulting from impaired autoregulation or tissue micro-perfusion hampering cerebral blood flow (CBF), is a novel radiological sign that independently predicts HT. It is associated with a higher risk of sICH in AIS-LVO patients after EVT. Further research is warranted to validate these findings.
出血性转化（HT）是急性缺血性卒中伴大血管闭塞（AIS-LVO）患者血管内治疗（EVT）后的一种严重并发症。我们假设基线CT血管造影（CTA）上大脑内静脉（ICV）的不对称性可能是HT的辅助预测指标。
我们对2020年11月至2022年4月期间连续的AIS-LVO患者进行了一项研究。这些患者有前循环闭塞并接受了EVT治疗。使用CTA评估ICV不对称性，定义为与对侧相比，闭塞同侧的低密度（造影剂充盈减少）。主要结局是HT，定义为缺血区域内的出血。这通过EVT后48小时进行的随访成像（CT扫描或磁共振成像）来评估。根据欧洲急性卒中协作研究-II标准，HT分为四种亚型。
共纳入126例患者，HT发生率为49.2%（62/126）。54.0%（68/126）的患者观察到ICV不对称。ICV不对称组实质性血肿型HT（33.8%对15.5%，P = 0.019）和症状性脑出血（sICH）（23.5%对5.2%，P = 0.004）的风险显著更高。在多因素逻辑回归中，ICV不对称（比值比3.809，95%置信区间1.582 - 9.171）基线阿尔伯塔卒中项目早期CT评分（比值比0.771，95%置信区间0.608 - 0.978）、静脉注射重组组织型纤溶酶原激活剂（比值比2.847，95%置信区间1.098 - 7.385）和侧支循环不良（比值比3.998，95%置信区间1.572 - 10.169）被确定为HT的独立危险因素。
ICV不对称可能是由于自动调节受损或组织微灌注阻碍脑血流（CBF）所致，是一种独立预测HT的新的影像学征象。它与AIS-LVO患者EVT后sICH的较高风险相关。有必要进行进一步研究以验证这些发现。
