Clinical and Imaging Markers Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke

Katinka R. van Kranendonk; Kilian M. Treumiet; Anna M. M. Boers; Olvert A. Berkhemer; Lucie A. van den Berg; Vicky Chalos; Hester F. Lingsma; Wim H. van Zwam; Aad van der Lugt; Robert J. van Oostenbrugge; Diederik W. J. Dippel; Yvo B. W. E. M. Roos; Henk A. Marquering; Charles B. L. M. Majoie; Puck S. S. Fransen; Debbie Beumer; Albert J. Yoo; Wouter J. Schonewille; Jan Albert Vos; Paul J. Nederkoorn; Marieke J. H. Wenner; Marianne A. A. van Walderveen; Julie Staals; Jeannette Hofmeijer; Jacques A. van Oostayen; Geert J. Lycklama a Nijeholt; Jells Boiten; Patrick A. Brouwer; Bart J. Emmet; Sebastiaan F. de Bruijn; Lukas C. van Dijk; L. Jaap Kappelle; Rob H. Lo; Ewoud J. van Dijk; Joost de Vries; Paul L. M. de Kort; Willem Jan J. van Rooij; Jan S. P. van den Berg; Boudewijn A. A. M. van Hassell; Leo A. M. Aerden; Rene J. Dallinga; Marieke C. Visser; Joseph C. J. Bot; Patrick C. Vroomen; Omid Eshghi; Tobien H. C. M. L. Schreuder; Roel J. J. Heijboer; Koos Keizer; Alexander Tielbeek; Heleen M. den Hertog; MR CLEAN Investigators

doi:10.1161/STROKEAHA.118.024255

Clinical and Imaging Markers Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke

Katinka R. van Kranendonk^*, Kilian M. Treumiet, Anna M. M. Boers, Olvert A. Berkhemer, Lucie A. van den Berg, Vicky Chalos, Hester F. Lingsma, Wim H. van Zwam, Aad van der Lugt, Robert J. van Oostenbrugge, Diederik W. J. Dippel, Yvo B. W. E. M. Roos, Henk A. Marquering, Charles B. L. M. Majoie, Puck S. S. Fransen, Debbie Beumer, Albert J. Yoo, Wouter J. Schonewille, Jan Albert Vos, Paul J. NederkoornMarieke J. H. Wenner, Marianne A. A. van Walderveen, Julie Staals, Jeannette Hofmeijer, Jacques A. van Oostayen, Geert J. Lycklama a Nijeholt, Jells Boiten, Patrick A. Brouwer, Bart J. Emmet, Sebastiaan F. de Bruijn, Lukas C. van Dijk, L. Jaap Kappelle, Rob H. Lo, Ewoud J. van Dijk, Joost de Vries, Paul L. M. de Kort, Willem Jan J. van Rooij, Jan S. P. van den Berg, Boudewijn A. A. M. van Hassell, Leo A. M. Aerden, Rene J. Dallinga, Marieke C. Visser, Joseph C. J. Bot, Patrick C. Vroomen, Omid Eshghi, Tobien H. C. M. L. Schreuder, Roel J. J. Heijboer, Koos Keizer, Alexander Tielbeek, Heleen M. den Hertog, MR CLEAN Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

18 Citations (Web of Science)

Abstract

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 P

Results- 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.

Original language	English
Pages (from-to)	2037-2043
Number of pages	7
Journal	Stroke
Volume	50
Issue number	8
DOIs	https://doi.org/10.1161/STROKEAHA.118.024255
Publication status	Published - Aug 2019

Keywords

atrial fibrillation
blood pressure
infarction
intracranial hemorrhages
reperfusion
risk factors
stroke
SYMPTOMATIC INTRACRANIAL HEMORRHAGE
TISSUE-PLASMINOGEN ACTIVATOR
HEALTH-CARE PROFESSIONALS
ENDOVASCULAR TREATMENT
INTRAARTERIAL TREATMENT
INTRAVENOUS ALTEPLASE
THROMBOLYTIC THERAPY
BLOOD-PRESSURE
RISK-FACTORS
TRIAL

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10.1161/STROKEAHA.118.024255

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van Kranendonk, K. R., Treumiet, K. M., Boers, A. M. M., Berkhemer, O. A., van den Berg, L. A., Chalos, V., Lingsma, H. F., van Zwam, W. H., van der Lugt, A., van Oostenbrugge, R. J., Dippel, D. W. J., Roos, Y. B. W. E. M., Marquering, H. A., Majoie, C. B. L. M., Fransen, P. S. S., Beumer, D., Yoo, A. J., Schonewille, W. J., Vos, J. A., ... MR CLEAN Investigators (2019). Clinical and Imaging Markers Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke. Stroke, 50(8), 2037-2043. https://doi.org/10.1161/STROKEAHA.118.024255

@article{26e29ae9bbe94754bcdd50cde90ca67b,

title = "Clinical and Imaging Markers Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke",

abstract = "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.",

keywords = "atrial fibrillation, blood pressure, infarction, intracranial hemorrhages, reperfusion, risk factors, stroke, SYMPTOMATIC INTRACRANIAL HEMORRHAGE, TISSUE-PLASMINOGEN ACTIVATOR, HEALTH-CARE PROFESSIONALS, ENDOVASCULAR TREATMENT, INTRAARTERIAL TREATMENT, INTRAVENOUS ALTEPLASE, THROMBOLYTIC THERAPY, BLOOD-PRESSURE, RISK-FACTORS, TRIAL",

author = "{van Kranendonk}, {Katinka R.} and Treumiet, {Kilian M.} and Boers, {Anna M. M.} and Berkhemer, {Olvert A.} and {van den Berg}, {Lucie A.} and Vicky Chalos and Lingsma, {Hester F.} and {van Zwam}, {Wim H.} and {van der Lugt}, Aad and {van Oostenbrugge}, {Robert J.} and Dippel, {Diederik W. J.} and Roos, {Yvo B. W. E. M.} and Marquering, {Henk A.} and Majoie, {Charles B. L. M.} and Fransen, {Puck S. S.} and Debbie Beumer and Yoo, {Albert J.} and Schonewille, {Wouter J.} and Vos, {Jan Albert} and Nederkoorn, {Paul J.} and Wenner, {Marieke J. H.} and {van Walderveen}, {Marianne A. A.} and Julie Staals and Jeannette Hofmeijer and {van Oostayen}, {Jacques A.} and Nijeholt, {Geert J. Lycklama a} and Jells Boiten and Brouwer, {Patrick A.} and Emmet, {Bart J.} and {de Bruijn}, {Sebastiaan F.} and {van Dijk}, {Lukas C.} and Kappelle, {L. Jaap} and Lo, {Rob H.} and {van Dijk}, {Ewoud J.} and {de Vries}, Joost and {de Kort}, {Paul L. M.} and {van Rooij}, {Willem Jan J.} and {van den Berg}, {Jan S. P.} and {van Hassell}, {Boudewijn A. A. M.} and Aerden, {Leo A. M.} and Dallinga, {Rene J.} and Visser, {Marieke C.} and Bot, {Joseph C. J.} and Vroomen, {Patrick C.} and Omid Eshghi and Schreuder, {Tobien H. C. M. L.} and Heijboer, {Roel J. J.} and Koos Keizer and Alexander Tielbeek and {den Hertog}, {Heleen M.} and {MR CLEAN Investigators}",

year = "2019",

month = aug,

doi = "10.1161/STROKEAHA.118.024255",

language = "English",

volume = "50",

pages = "2037--2043",

journal = "Stroke",

issn = "0039-2499",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "8",

}

van Kranendonk, KR, Treumiet, KM, Boers, AMM, Berkhemer, OA, van den Berg, LA, Chalos, V, Lingsma, HF, van Zwam, WH, van der Lugt, A, van Oostenbrugge, RJ, Dippel, DWJ, Roos, YBWEM, Marquering, HA, Majoie, CBLM, Fransen, PSS, Beumer, D, Yoo, AJ, Schonewille, WJ, Vos, JA, Nederkoorn, PJ, Wenner, MJH, van Walderveen, MAA, Staals, J, Hofmeijer, J, van Oostayen, JA, Nijeholt, GJLA, Boiten, J, Brouwer, PA, Emmet, BJ, de Bruijn, SF, van Dijk, LC, Kappelle, LJ, Lo, RH, van Dijk, EJ, de Vries, J, de Kort, PLM, van Rooij, WJJ, van den Berg, JSP, van Hassell, BAAM, Aerden, LAM, Dallinga, RJ, Visser, MC, Bot, JCJ, Vroomen, PC, Eshghi, O, Schreuder, THCML, Heijboer, RJJ, Keizer, K, Tielbeek, A, den Hertog, HM & MR CLEAN Investigators 2019, 'Clinical and Imaging Markers Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke', Stroke, vol. 50, no. 8, pp. 2037-2043. https://doi.org/10.1161/STROKEAHA.118.024255

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 -