Contrast enhancement and contrast extravasation on computed tomography after intra-arterial thrombolysis in patients with acute ischemic stroke.
OBJECTIVE
The goal of this study was to determine the CT findings and clinical consequences of contrast enhancement and contrast extravasation on CT scans obtained after intra-arterial thrombolytic therapy for treatment of acute ischemic stroke.


METHODS
Sixty-two patients were treated with intra-arterial thrombolysis. All patients underwent nonenhanced CT scans immediately and 24 hours after thrombolytic therapy. Contrast enhancement was defined as a hyperdense lesion that disappeared on a 24-hour follow-up CT scan. Contrast extravasation was defined as a hyperdense lesion with maximum Hounsfield unit >90 that persisted on a follow-up CT scan. We evaluated the differences in the clinical and radiological data between 3 groups: contrast enhancement, contrast extravasation, and control groups.


RESULTS
Contrast enhancement was found in 14 of 62 patients (22.6%); contrast extravasation was seen in 7 (11.3%). Compared with the control group, the contrast enhancement group had a lower recanalization grade (64.3% versus 34.1%, P=0.048) and a lower incidence of hemorrhagic transformation (14.3% versus 43.9%, P=0.047). The contrast extravasation group had a higher incidence of both hemorrhage (100% versus 43.9%, P=0.006) and symptomatic hemorrhage (100% versus 14.6%, P<0.001) than the control group. Poor outcomes were more frequent in the contrast extravasation group (100% versus 38.9%, P=0.003) than the control group.


CONCLUSIONS
Contrast enhancement on CT scans obtained after intra-arterial thrombolysis is usually not associated with hemorrhagic complications. However, contrast extravasation is highly associated with parenchymatous hematoma and should be considered a negative prognostic sign.
Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, 8 Hak-1-Dong, Dong-gu, Gwangju, 501-757, South Korea. radyoon@cnuh.com
Woong
W
Yoon
Jeong Jin
JJ
Seo
Jae Kyu
JK
Kim
Ki Hyeon
KH
Cho
Jin Gyoon
JG
Park
Heoung Keun
HK
Kang
D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D003287:Contrast Media; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D005343:Fibrinolytic Agents