Lower pretreatment cerebral blood volume affects hemorrhagic risks after intra-arterial revascularization in acute stroke.
OBJECTIVE
Intra-arterial therapies are being used more frequently in patients presenting with acute cerebral occlusions, but they have been limited by the potential for hemorrhage. We sought to determine whether pretreatment computed tomography perfusion parameters might help to identify patients at a higher risk of developing intracranial hemorrhage after intra-arterial stroke revascularization treatment.


METHODS
We retrospectively reviewed all patients at the University of Pittsburgh Medical Center and Michigan State University who underwent computed tomography perfusion imaging of the brain before intra-arterial thrombolysis between January 2006 and June 2007. Demographic information, angiographic variables, and types of endovascular interventions were recorded. The mean transit time and cerebral blood volumes were recorded for the ipsilateral and contralateral middle cerebral artery territories. A binary logistic regression model was constructed to determine the independent predictors of developing intracranial hemorrhage.


RESULTS
A total of 57 patients (33 from the University of Pittsburgh and 24 from Michigan State University) with a mean age of 66 +/- 13 years and mean National Institutes of Health Stroke Scale scores of 16 +/- 5 were studied. The overall recanalization (Thrombolysis in Myocardial Infarction Trial scale 2 or 3 flow) was 72% for the cohort, and the overall rate of parenchymal hemorrhage was 5 of 57 (9%) patients. The overall hemorrhage rate was 19 of 57 (33%) patients. The only variable found to be predictive of the development of hemorrhage after intervention was reduced pretreatment cerebral blood volume (odds ratio, 0.49; 95% confidence interval, 0.35-0.91; P < 0.022).


CONCLUSIONS
A reduced pretreatment ipsilateral cerebral blood volume value before endovascular revascularization of an acute middle cerebral artery or internal carotid artery occlusion significantly increases the risk of an intracranial hemorrhage.
Bhatt
Archit
A
Department of Neurology, Division of Cerebrovascular Diseases, Michigan State University, East Lansing, Michigan, USA.
Vora
Nirav A
NA
Thomas
Ajith J
AJ
Majid
Arshad
A
Kassab
Mounzer
M
Hammer
Maxim D
MD
Uchino
Ken
K
Wechsler
Lawrence
L
Jovin
Tudor G
TG
Gupta
Rishi
R
D000208:Acute Disease; D000368:Aged; D001810:Blood Volume; D001921:Brain / Q000098:blood supply / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000209:etiology*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*