title: Hyperattenuated intracerebral lesions after mechanical recanalization in acute stroke.
abstract: OBJECTIVE
  Following mechanical recanalization of an acute intracranial vessel occlusion, hyperattenuated lesions are frequently found on postinterventional cranial CT. They represent either blood or-more frequently-enhancement of contrast agent. Here, we aimed to evaluate the prognostic value of these hyperattenuated intracerebral lesions.
  
  
  METHODS
  One hundred one consecutive patients with acute stroke in the anterior circulation who underwent mechanical recanalization were included. Risk factors for hyperattenuated intracerebral lesions were assessed, and lesion volume was compared with the volume of final infarction. Clinical outcome and relative risk of secondary hemorrhage were determined in patients with and without any hyperattenuated lesions and compared.
  
  
  RESULTS
  The frequency of hyperattenuated lesions was 84.2%. Risk factors for hyperattenuated lesions were female sex, higher NIHSS score on admission, and higher amount of contrast agent applied. On follow-up, 3 patients showed no infarction; 53 patients, an ischemic infarction; and 45 patients, a hemorrhagic infarction. In all except 1 case, final volume of infarction (median = 92.4 mL) exceeded the volume of hyperattenuated intracerebral lesions (median = 5.6 mL). Patients with hyperattenuated lesions were at a 4 times higher relative risk for hemorrhagic transformation but had no significantly worse clinical outcome.
  
  
  CONCLUSIONS
  Our data show that the extent of postinterventional hyperattenuated intracerebral lesions underestimates the volume of final infarction. Although hyperattenuated lesions indicate a higher risk of secondary hemorrhagic transformation, their presence seems not to be of any prognostic value regarding clinical outcome.
authors.affiliation: From the Departments of Neuroradiology (N.L., M.P., H.J., H.B., J.L.).
authors.forename: N
authors.initials: N
authors.lastname: Lummel
authors.forename: G
authors.initials: G
authors.lastname: Schulte-Altedorneburg
authors.forename: C
authors.initials: C
authors.lastname: Bernau
authors.forename: T
authors.initials: T
authors.lastname: Pfefferkorn
authors.forename: M
authors.initials: M
authors.lastname: Patzig
authors.forename: H
authors.initials: H
authors.lastname: Janssen
authors.forename: C
authors.initials: C
authors.lastname: Opherk
authors.forename: H
authors.initials: H
authors.lastname: Brückmann
authors.forename: J
authors.initials: J
authors.lastname: Linn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology*; D002548:Cerebral Revascularization / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
references.citation: Lancet. 2007 Jan 27;369(9558):275-82
references.pmid: 17258667
references.citation: J Neurointerv Surg. 2010 Jun;2(2):115-9
references.pmid: 21990590
references.citation: AJNR Am J Neuroradiol. 2012 Jun;33(6):1088-94
references.pmid: 22268092
references.citation: Nervenarzt. 1998 Jun;69(6):490-4
references.pmid: 9673972
references.citation: Stroke. 2001 Sep;32(9):2042-8
references.pmid: 11546895
references.citation: AJNR Am J Neuroradiol. 2012 Oct;33(9):1791-6
references.pmid: 22538076
references.citation: AJNR Am J Neuroradiol. 2012 Feb;33(2):336-42
references.pmid: 22095969
references.citation: AJNR Am J Neuroradiol. 1994 Mar;15(3):487-92
references.pmid: 8197945
references.citation: Stroke. 2008 Dec;39(12):3283-7
references.pmid: 18772441
references.citation: Resuscitation. 2011 Aug;82(8):1036-40
references.pmid: 21524837
references.citation: Lancet. 1999 Jun 12;353(9169):2036-7
references.pmid: 10376621
references.citation: Surg Neurol. 1993 Apr;39(4):315-9
references.pmid: 8488452
references.citation: Neurosurgery. 1996 Dec;39(6):1102-7
references.pmid: 8938763
references.citation: Circulation. 1991 Dec;84(6):2568-73
references.pmid: 1835680
references.citation: Eur J Radiol. 2012 Dec;81(12):4075-82
references.pmid: 22940230
references.citation: Stroke. 2004 Apr;35(4):876-81
references.pmid: 14988575
references.citation: Korean J Radiol. 2006 Oct-Dec;7(4):221-8
references.pmid: 17143024
references.citation: Korean J Radiol. 2005 Jan-Mar;6(1):41-3
references.pmid: 15782019
references.citation: N Engl J Med. 1995 Dec 14;333(24):1581-7
references.pmid: 7477192
references.citation: Neurosurgery. 2000 Jun;46(6):1307-14; discussion 1314-5
references.pmid: 10834636
references.citation: Stroke. 2010 May;41(5):1013-7
references.pmid: 20360541
references.citation: Stroke. 2008 Apr;39(4):e71; author reply e72
references.pmid: 18309159
references.citation: Stroke. 2009 Aug;40(8):2743-8
references.pmid: 19498190
references.citation: Stroke. 2001 Jun;32(6):1330-5
references.pmid: 11387495