Hyperintense acute reperfusion marker associated with hemorrhagic transformation in the WAKE-UP trial
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Hyperintense acute reperfusion marker associated with hemorrhagic transformation in the WAKE-UP trial. / Wouters, Anke; Scheldeman, Lauranne; Dupont, Patrick; Cheng, Bastian; Ebinger, Martin; Jensen, Märit; Endres, Matthias; Gerloff, Christian; Muir, Keith W.; Nighoghossian, Norbert; Pedraza, Salvador; Simonsen, Claus Z.; Boutitie, Florent; Thijs, Vincent; Thomalla, Götz; Fiebach, Jochen; Lemmens, Robin.
in: EUR STROKE J, Jahrgang 6, Nr. 2, 06.2021, S. 128-133.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Hyperintense acute reperfusion marker associated with hemorrhagic transformation in the WAKE-UP trial
AU - Wouters, Anke
AU - Scheldeman, Lauranne
AU - Dupont, Patrick
AU - Cheng, Bastian
AU - Ebinger, Martin
AU - Jensen, Märit
AU - Endres, Matthias
AU - Gerloff, Christian
AU - Muir, Keith W.
AU - Nighoghossian, Norbert
AU - Pedraza, Salvador
AU - Simonsen, Claus Z.
AU - Boutitie, Florent
AU - Thijs, Vincent
AU - Thomalla, Götz
AU - Fiebach, Jochen
AU - Lemmens, Robin
PY - 2021/6
Y1 - 2021/6
N2 - Introduction: Hyperintense acute reperfusion marker (HARM) is an indicator of early disruption of the blood-brain-barrier. Our aim was to investigate the incidence of HARM in patients with a diffusion weighted imaging (DWI) - fluid attenuated inversion recovery (FLAIR) mismatch and determine the association between this marker and hemorrhagic complications as well as clinical outcome. Patients and Methods: We included patients from the Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke (WAKE-UP) trial who underwent baseline perfusion weighted imaging (PWI). HARM was defined as a hyperintense signal in the cerebrospinal fluid space on FLAIR imaging at 24 h after baseline imaging. We compared baseline characteristics in patients with and without HARM and investigated the association between HARM and any hemorrhagic transformation (HT) and parenchymal hematoma (PH) in a multivariate logistic regression. We also explored HARM as an independent predictor of poor outcome, defined as a modified Rankin Scale of 3–6 at 90 days. Results: HARM was present in 14 of 223 (6%) patients with a DWI-FLAIR mismatch and baseline characteristics were similar in patients with vs without HARM. HARM showed an independent relationship with any HT (OR 6.67; 95%CI 1.72–26.58) and any PH (OR 6.92; 95%CI 1.34–29.49). The rate of HARM was similar in patients with good and poor outcome (5%, p = 0.90). Conclusion: In the WAKE-UP trial, the incidence of HARM was only 6% at 24 h. An association was present between HARM and hemorrhagic complications, but no relationship with functional outcome was observed.
AB - Introduction: Hyperintense acute reperfusion marker (HARM) is an indicator of early disruption of the blood-brain-barrier. Our aim was to investigate the incidence of HARM in patients with a diffusion weighted imaging (DWI) - fluid attenuated inversion recovery (FLAIR) mismatch and determine the association between this marker and hemorrhagic complications as well as clinical outcome. Patients and Methods: We included patients from the Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke (WAKE-UP) trial who underwent baseline perfusion weighted imaging (PWI). HARM was defined as a hyperintense signal in the cerebrospinal fluid space on FLAIR imaging at 24 h after baseline imaging. We compared baseline characteristics in patients with and without HARM and investigated the association between HARM and any hemorrhagic transformation (HT) and parenchymal hematoma (PH) in a multivariate logistic regression. We also explored HARM as an independent predictor of poor outcome, defined as a modified Rankin Scale of 3–6 at 90 days. Results: HARM was present in 14 of 223 (6%) patients with a DWI-FLAIR mismatch and baseline characteristics were similar in patients with vs without HARM. HARM showed an independent relationship with any HT (OR 6.67; 95%CI 1.72–26.58) and any PH (OR 6.92; 95%CI 1.34–29.49). The rate of HARM was similar in patients with good and poor outcome (5%, p = 0.90). Conclusion: In the WAKE-UP trial, the incidence of HARM was only 6% at 24 h. An association was present between HARM and hemorrhagic complications, but no relationship with functional outcome was observed.
KW - DWI-FLAIR mismatch
KW - HARM
KW - hemorrhage
KW - Ischemic stroke
KW - magnetic resonance imaging
U2 - 10.1177/23969873211007686
DO - 10.1177/23969873211007686
M3 - SCORING: Journal article
AN - SCOPUS:85107795690
VL - 6
SP - 128
EP - 133
JO - EUR STROKE J
JF - EUR STROKE J
SN - 2396-9873
IS - 2
ER -
