Early Cerebrovascular Ultrasonography as a Predictor of Hemorrhagic Transformation After Thrombectomy |
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| Authors: | L Cruz A Silva J Lopes D Damas J Lourenço A Costa F Silva J Sousa O Galego C Nunes R Veiga C Machado B Rodrigues C Cecilia L Almendra A Bras G Santo E Machado J Sargento-Freitas |
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| Institution: | 1. Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal;2. Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal;2. Departments of Cardiothoracic Surgery, University of Michigan, Ann Arbor, Michigan;3. Departments of Radiology, University of Michigan, Ann Arbor, Michigan;4. Departments of Neurology, University of Michigan, Ann Arbor, Michigan;1. Department of Neurology, University of Pretoria, South Africa,;2. Department of Internal Medicine, University of Pretoria, South Africa;2. Université Paris-Saclay, APHP, Service de Neurologie, CHU Bicêtre, Le Kremlin Bicêtre, France;3. Faculté de Médecine Paris Saclay, Le Kremlin Bicêtre, France;4. Université Paris-Saclay, APHP, Service d''Immunologie Biologique, CHU Bicêtre, Le Kremlin Bicêtre, France;5. APHP, Service de Rhumatologie, CHU Bicêtre, Le Kremlin Bicêtre, France;2. Unit of Public Health and Preventive Medicine, Yokohama City University School of Medicine, Kanagawa, Japan;3. Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan;4. Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan;1. Department of Hypertension and Nephrology (retired), Mayo Clinic, Jacksonville, FL, United States;2. Department of Interventional Cardiology, White Oak Medical Center, Silver Springs, MD, United States;3. Department of Vascular Surgery, Ochsner Health System, New Orleans, LA, United States;4. Department of Neurology, Medical University of South Carolina, Charleston, SC, United States;5. Department of Neurology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, United States |
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| Abstract: | ObjectivesTo determine the predictive value of early transcranial color-coded sonography (TCCS) for intracranial hemorrhage (ICH) in patients with large artery occlusion (LAO) stroke of carotid circulation, who were submitted to endovascular therapy (EVT) with successful reperfusion.Materials and MethodsRetrospective study evaluating a cohort of consecutive stroke patients with LAO of the carotid circulation that were recanalyzed with EVT. We measured angle-corrected peak systolic velocities, end-diastolic velocities and mean flow velocities (PSV, EDV and MFV) of the symptomatic and asymptomatic middle cerebral artery (MCA). The ratio between MFV of the symptomatic MCA and MFV of the asymptomatic MCA (MCA-Ra) was calculated. Parenchymal hematoma in the 24 hours control CT was considered as ICH. Univariate associations and multivariate analyses were used to identify early independent predictors for ICH among TCCS findings.ResultsWe included 234 patients, mean age 72.5 (SD 12.6) years, 52.1% male. The mean time between recanalization and TCCS was 12.3 hours (range 3-22). Patients who developed postinterventional ICH showed a higher MCA-Ra (1.02 ± 0.26 vs 1.16 ± 0,21, p = 0.036). In multivariate analysis, only higher MCA-Ra remained independently associated with postinterventional ICH (OR: 6.778, 95%CI: 1.152–39.892, p = 0.034). A value of MCA-Ra ≥ 1,05 was associated with ICH, showing a sensitivity of 81.3% and a specificity of 65.9%; the AUC based of the ROC analysis was 0.688 (95% CI 0.570-0.806).ConclusionTCCS performed within the first 24 hours after stroke onset can help to predict hemorrhagic transformation in patients with LAO. |
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