Méot Mathilde, Munsch Fanny, Lapergue Bertrand, Kyheng Maeva, Sibon Igor, Planes David, Micard Emilien, Chen Bailiang, Olivot Jean-Marc, Boulouis Grégoire, Viguier Alain, Tourdias Thomas, Marnat Gaultier
Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
Institut de Bio-Imagerie IBIO, Bordeaux University, Bordeaux, France.
Eur Stroke J. 2025 Jul 15:23969873251357151. doi: 10.1177/23969873251357151.
Hemorrhagic transformation (HT) remains an important issue following ischemic stroke. Efforts have been made to identify predictors of HT, especially imaging features. Among them, the infarct growth rate (IGR) remains underexplored. We investigated the influence of IGR on the risk of subsequent HT in the setting of large vessel occlusion stroke (LVOS) intended for endovascular treatment (EVT) and compared IGR to baseline infarct volume as predictors of HT.
We conducted a secondary analysis of two merged prospectively collected databases (FRAME 2017-2019 and ETIS 2015-2021). Patients presenting with anterior circulation LVOS, a witnessed symptoms onset, baseline MRI within 24 h after symptoms onset and available day 1 imaging (MRI or CT) were included. Posterior circulation LVOS, medium and distal vessel occlusions of the anterior circulation, tandem occlusions and unknown time of stroke onset were excluded. The primary endpoint was the occurrence of any HT detected on day 1 imaging. Secondary endpoint was the occurrence of parenchymal hematoma (defined as PH1 or PH2). Associations between the IGR and the occurrence of any HT and parenchymal hematoma within 24-h after mechanical thrombectomy were assessed using univariable and multivariable logistic regression models.
We included 775 patients (mean age 70.5 years (SD 15.1)). The median of IGR was 8.7 ml per hour (IQR 2.8-24.2). A faster IGR was independently associated with a higher risk of any HT (adjusted OR 1.35; 95% CI 1.16-1.57 per one log unit increase). A faster IGR was also associated with an increased risk of parenchymal hemorrhage in univariate analysis (OR 1.35; 95% CI 1.15-1.58), but the association did not remain significant in multivariable analysis including all the other predictors of parenchymal hemorrhage (adjusted OR 1.16 (95% CI 0.96-1.40) per one log unit increase). ROC analyses revealed that baseline infarct volume significantly better predicted any HT and PH occurrence than the IGR ( = 0.019 and = 0.029 respectively).
In patients presenting with anterior circulation LVOS and treated with EVT, the IGR was significantly associated with an increased risk of HT. However, the baseline infarct volume was a stronger predictor of HT than IGR.
出血性转化（HT）仍是缺血性卒中后的一个重要问题。人们一直在努力寻找HT的预测因素，尤其是影像学特征。其中，梗死灶生长速率（IGR）仍未得到充分研究。我们调查了IGR对拟行血管内治疗（EVT）的大血管闭塞性卒中（LVOS）患者后续发生HT风险的影响，并将IGR与基线梗死灶体积作为HT的预测因素进行比较。
我们对两个前瞻性收集的合并数据库（FRAME 2017 - 2019和ETIS 2015 - 2021）进行了二次分析。纳入出现前循环LVOS、有症状发作见证、症状发作后24小时内进行基线MRI且有第1天影像学检查（MRI或CT）的患者。排除后循环LVOS、前循环中远端血管闭塞、串联闭塞以及卒中发作时间不明的患者。主要终点是第1天影像学检查中检测到的任何HT的发生情况。次要终点是实质血肿的发生情况（定义为PH1或PH2）。使用单变量和多变量逻辑回归模型评估IGR与机械取栓后24小时内任何HT和实质血肿发生之间的关联。
我们纳入了775例患者（平均年龄70.5岁（标准差15.1））。IGR的中位数为每小时8.7毫升（四分位间距2.8 - 24.2）。IGR越快，任何HT的风险独立相关越高（每增加一个对数单位，调整后的比值比为1.35；95%置信区间1.16 - 1.57）。在单变量分析中，IGR越快，实质出血的风险也越高（比值比1.35；95%置信区间1.15 - 1.58），但在包括所有其他实质出血预测因素的多变量分析中，该关联不再显著（每增加一个对数单位，调整后的比值比为1.16（95%置信区间0.96 - 1.40））。ROC分析显示，基线梗死灶体积比IGR能更好地预测任何HT和PH的发生（分别为 = 0.019和 = 0.029）。
在出现前循环LVOS并接受EVT治疗的患者中，IGR与HT风险增加显著相关。然而，基线梗死灶体积比IGR是更强的HT预测因素。
