Hypoperfusion Intensity Ratio Is Correlated With the Risk of Parenchymal Hematoma After Endovascular Stroke Treatment
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Hypoperfusion Intensity Ratio Is Correlated With the Risk of Parenchymal Hematoma After Endovascular Stroke Treatment. / Winkelmeier, Laurens; Heit, Jeremy J.; Adusumilli, Gautam; Geest, Vincent; Christensen, Soren; Kniep, Helge; Horn, Noel van; Steffen, Paul; Bechstein, Matthias; Sporns, Peter; Lansberg, Maarten G.; Albers, Gregory W.; Wintermark, Max; Fiehler, Jens; Faizy, Tobias D.
in: STROKE, Jahrgang 54, Nr. 1, 01.01.2023, S. 135-143.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Hypoperfusion Intensity Ratio Is Correlated With the Risk of Parenchymal Hematoma After Endovascular Stroke Treatment
AU - Winkelmeier, Laurens
AU - Heit, Jeremy J.
AU - Adusumilli, Gautam
AU - Geest, Vincent
AU - Christensen, Soren
AU - Kniep, Helge
AU - Horn, Noel van
AU - Steffen, Paul
AU - Bechstein, Matthias
AU - Sporns, Peter
AU - Lansberg, Maarten G.
AU - Albers, Gregory W.
AU - Wintermark, Max
AU - Fiehler, Jens
AU - Faizy, Tobias D.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Background:Parenchymal hematoma (PH) is a major complication after endovascular treatment (EVT) for ischemic stroke. The hypoperfusion intensity ratio (HIR) represents a perfusion parameter reflecting arterial collateralization and cerebral microperfusion in ischemic brain tissue. We hypothesized that HIR correlates with the risk of PH after EVT.Methods:Retrospective multicenter cohort study of patients with large vessel occlusion who underwent EVT between 2013 and 2021 at one of the 2 comprehensive stroke centers (University Medical Center Hamburg-Eppendorf, Germany and Stanford University School of Medicine, CA). HIR was automatically calculated on computed tomography perfusion studies as the ratio of brain volume with time-to-max (Tmax) delay >10 s over volume with Tmax >6 s. Reperfusion hemorrhages were assessed according to the Heidelberg Bleeding Classification. Primary outcome was PH occurrence (PH+) or absence (PH−) on follow-up imaging. Secondary outcome was good clinical outcome defined as a 90-day modified Rankin Scale score of 0 to 2.Results:A total of 624 patients met the inclusion criteria. We observed PH in 91 (14.6%) patients after EVT. PH+ patients had higher HIR on admission compared with PH− patients (median, 0.6 versus 0.4; P<0.001). In multivariable regression, higher admission blood glucose (adjusted odds ratio [aOR], 1.08 [95% CI, 1.04–1.13]; P<0.001), extensive baseline infarct defined as Alberta Stroke Program Early CT Score ≤5 (aOR, 2.48 [1.37–4.42]; P=0.002), and higher HIR (aOR, 1.22 [1.09–1.38]; P<0.001) were independent determinants of PH after EVT. Both higher HIR (aOR, 0.83 [0.75–0.92]; P<0.001) and PH on follow-up imaging (aOR, 0.39 [0.18–0.80]; P=0.013) were independently associated with lower odds of achieving good clinical outcome.Conclusions:Poorer (higher) HIR on admission perfusion imaging was strongly associated with PH occurrence after EVT. HIR as a surrogate for cerebral microperfusion might reflect tissue vulnerability for reperfusion hemorrhages. This automated and quickly available perfusion parameter might help to assess the need for intensive medical care after EVT.
AB - Background:Parenchymal hematoma (PH) is a major complication after endovascular treatment (EVT) for ischemic stroke. The hypoperfusion intensity ratio (HIR) represents a perfusion parameter reflecting arterial collateralization and cerebral microperfusion in ischemic brain tissue. We hypothesized that HIR correlates with the risk of PH after EVT.Methods:Retrospective multicenter cohort study of patients with large vessel occlusion who underwent EVT between 2013 and 2021 at one of the 2 comprehensive stroke centers (University Medical Center Hamburg-Eppendorf, Germany and Stanford University School of Medicine, CA). HIR was automatically calculated on computed tomography perfusion studies as the ratio of brain volume with time-to-max (Tmax) delay >10 s over volume with Tmax >6 s. Reperfusion hemorrhages were assessed according to the Heidelberg Bleeding Classification. Primary outcome was PH occurrence (PH+) or absence (PH−) on follow-up imaging. Secondary outcome was good clinical outcome defined as a 90-day modified Rankin Scale score of 0 to 2.Results:A total of 624 patients met the inclusion criteria. We observed PH in 91 (14.6%) patients after EVT. PH+ patients had higher HIR on admission compared with PH− patients (median, 0.6 versus 0.4; P<0.001). In multivariable regression, higher admission blood glucose (adjusted odds ratio [aOR], 1.08 [95% CI, 1.04–1.13]; P<0.001), extensive baseline infarct defined as Alberta Stroke Program Early CT Score ≤5 (aOR, 2.48 [1.37–4.42]; P=0.002), and higher HIR (aOR, 1.22 [1.09–1.38]; P<0.001) were independent determinants of PH after EVT. Both higher HIR (aOR, 0.83 [0.75–0.92]; P<0.001) and PH on follow-up imaging (aOR, 0.39 [0.18–0.80]; P=0.013) were independently associated with lower odds of achieving good clinical outcome.Conclusions:Poorer (higher) HIR on admission perfusion imaging was strongly associated with PH occurrence after EVT. HIR as a surrogate for cerebral microperfusion might reflect tissue vulnerability for reperfusion hemorrhages. This automated and quickly available perfusion parameter might help to assess the need for intensive medical care after EVT.
U2 - 10.1161/STROKEAHA.122.040540
DO - 10.1161/STROKEAHA.122.040540
M3 - SCORING: Journal article
VL - 54
SP - 135
EP - 143
JO - STROKE
JF - STROKE
SN - 0039-2499
IS - 1
ER -