TY - JOUR
T1 - Clinical and Imaging Markers Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke
AU - van Kranendonk, Katinka R.
AU - Treumiet, 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.
AU - Fransen, Puck S. S.
AU - Beumer, Debbie
AU - Yoo, Albert J.
AU - Schonewille, Wouter J.
AU - Vos, Jan Albert
AU - Nederkoorn, Paul J.
AU - Wenner, Marieke J. H.
AU - van Walderveen, Marianne A. A.
AU - Staals, Julie
AU - Hofmeijer, Jeannette
AU - van Oostayen, Jacques A.
AU - Nijeholt, Geert J. Lycklama a
AU - Boiten, Jells
AU - Brouwer, Patrick A.
AU - Emmet, Bart J.
AU - de Bruijn, Sebastiaan F.
AU - van Dijk, Lukas C.
AU - Kappelle, L. Jaap
AU - Lo, Rob H.
AU - van Dijk, Ewoud J.
AU - de Vries, Joost
AU - de Kort, Paul L. M.
AU - van Rooij, Willem Jan J.
AU - van den Berg, Jan S. P.
AU - van Hassell, Boudewijn A. A. M.
AU - Aerden, Leo A. M.
AU - Dallinga, Rene J.
AU - Visser, Marieke C.
AU - Bot, Joseph C. J.
AU - Vroomen, Patrick C.
AU - Eshghi, Omid
AU - Schreuder, Tobien H. C. M. L.
AU - Heijboer, Roel J. J.
AU - Keizer, Koos
AU - Tielbeek, Alexander
AU - den Hertog, Heleen M.
AU - MR CLEAN Investigators
PY - 2019/8
Y1 - 2019/8
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 PResults- 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 mmHg) 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 PResults- 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 mmHg) 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 - SYMPTOMATIC INTRACRANIAL HEMORRHAGE
KW - TISSUE-PLASMINOGEN ACTIVATOR
KW - HEALTH-CARE PROFESSIONALS
KW - ENDOVASCULAR TREATMENT
KW - INTRAARTERIAL TREATMENT
KW - INTRAVENOUS ALTEPLASE
KW - THROMBOLYTIC THERAPY
KW - BLOOD-PRESSURE
KW - RISK-FACTORS
KW - TRIAL
U2 - 10.1161/STROKEAHA.118.024255
DO - 10.1161/STROKEAHA.118.024255
M3 - Article
SN - 0039-2499
VL - 50
SP - 2037
EP - 2043
JO - Stroke
JF - Stroke
IS - 8
ER -