TY - JOUR
T1 - Added Prognostic Value of Hemorrhagic Transformation Quantification 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 - Coutinho, Jonathan M.
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.
AU - MR CLEAN Investigators
N1 - Funding Information:
Funding. 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.
Publisher Copyright:
© Copyright © 2020 van Kranendonk, Treurniet, Boers, Berkhemer, Coutinho, Lingsma, van Zwam, van der Lugt, van Oostenbrugge, Dippel, Roos, Marquering, Majoie and the MR CLEAN investigators.
PY - 2020/11/10
Y1 - 2020/11/10
N2 - Introduction and Aim: Hemorrhagic transformation (HT) frequently occurs after acute ischemic stroke and negatively influences the functional outcome. Usually, HT is classified by its radiological appearance. Discriminating between the subtypes can be complicated, and interobserver variation is considerable. Therefore, we aim to quantify rather than classify hemorrhage volumes and determine the association of hemorrhage volume with functional outcome in comparison with the European Cooperative Acute Stroke Study II classification.Patients and Methods: We included patients from the MR CLEAN trial with follow-up imaging. Hemorrhage volume was estimated by manual delineation of the lesion, and HT was classified according to the European Cooperative Acute Stroke Study II classification [petechial hemorrhagic infarction types 1 (HI1) and 2 (HI2) and parenchymal hematoma types 1 (PH1) and 2 (PH2)] on follow-up CT 24 h to 2 weeks after treatment. We assessed functional outcome using the modified Rankin Scale 90 days after stroke onset. Ordinal logistic regression with and without adjustment for potential confounders was used to describe the association of hemorrhage volume with functional outcome. We created regression models including and excluding total lesion volume as a confounder.Results: We included 478 patients. Of these patients, 222 had HT. Median hemorrhage volume was 3.37 ml (0.80-12.6) and per HT subgroup; HI1: 0.2 (0.0-1.7), HI2: 3.2 (1.7-6.1), PH1: 6.3 (4.2-13), and PH2: 47 (19-101). Hemorrhage volume was associated with functional outcome [adjusted common odds ratio (acOR): 0.83, 95% CI: 0.73-0.95] but not anymore after adjustment for total lesion volume (acOR: 0.99, 95% CI: 0.86-1.15, per 10 ml). Hemorrhage volume in patients with PH2 was significantly associated with functional outcome after adjusting total lesion volume (acOR: 0.70, 95% CI: 0.50-0.98).Conclusion: HT volume is associated with functional outcomes in patients with acute ischemic stroke but not independent of total lesion volume. The extent of a PH2 was associated with outcome, suggesting that measuring hemorrhage volume only provides an additional benefit in the prediction of the outcome when a PH2 is present.
AB - Introduction and Aim: Hemorrhagic transformation (HT) frequently occurs after acute ischemic stroke and negatively influences the functional outcome. Usually, HT is classified by its radiological appearance. Discriminating between the subtypes can be complicated, and interobserver variation is considerable. Therefore, we aim to quantify rather than classify hemorrhage volumes and determine the association of hemorrhage volume with functional outcome in comparison with the European Cooperative Acute Stroke Study II classification.Patients and Methods: We included patients from the MR CLEAN trial with follow-up imaging. Hemorrhage volume was estimated by manual delineation of the lesion, and HT was classified according to the European Cooperative Acute Stroke Study II classification [petechial hemorrhagic infarction types 1 (HI1) and 2 (HI2) and parenchymal hematoma types 1 (PH1) and 2 (PH2)] on follow-up CT 24 h to 2 weeks after treatment. We assessed functional outcome using the modified Rankin Scale 90 days after stroke onset. Ordinal logistic regression with and without adjustment for potential confounders was used to describe the association of hemorrhage volume with functional outcome. We created regression models including and excluding total lesion volume as a confounder.Results: We included 478 patients. Of these patients, 222 had HT. Median hemorrhage volume was 3.37 ml (0.80-12.6) and per HT subgroup; HI1: 0.2 (0.0-1.7), HI2: 3.2 (1.7-6.1), PH1: 6.3 (4.2-13), and PH2: 47 (19-101). Hemorrhage volume was associated with functional outcome [adjusted common odds ratio (acOR): 0.83, 95% CI: 0.73-0.95] but not anymore after adjustment for total lesion volume (acOR: 0.99, 95% CI: 0.86-1.15, per 10 ml). Hemorrhage volume in patients with PH2 was significantly associated with functional outcome after adjusting total lesion volume (acOR: 0.70, 95% CI: 0.50-0.98).Conclusion: HT volume is associated with functional outcomes in patients with acute ischemic stroke but not independent of total lesion volume. The extent of a PH2 was associated with outcome, suggesting that measuring hemorrhage volume only provides an additional benefit in the prediction of the outcome when a PH2 is present.
KW - ischemic stroke (IS)
KW - hemorrhagic transformation (HT)
KW - intracranial hemorrhage (ICH)
KW - endovascular therapy (EVT)
KW - hemorrhage volume
KW - thrombolysis
KW - THROMBOLYTIC THERAPY
KW - VOLUME
KW - TRIAL
U2 - 10.3389/fneur.2020.582767
DO - 10.3389/fneur.2020.582767
M3 - Article
C2 - 33240206
SN - 1664-2295
VL - 11
JO - Frontiers in Neurology
JF - Frontiers in Neurology
M1 - 582767
ER -