Relation between reperfusion and hemorrhagic transformation in acute ischemic stroke.
BACKGROUND
Intravenous recombinant tissue plasminogen activator (IV-rtPA) is given in acute ischemic stroke patients to achieve reperfusion. Hemorrhagic transformation (HT) is a serious complication of IV-rtPA treatment and related to blood-brain barrier (BBB) injury. It is unclear whether HT occurs secondary to reperfusion in combination with ischemic BBB injury or is caused by the negative effect of IV-rtPA on BBB integrity. The aim of this study was to establish the association between reperfusion and the occurrence of HT.


METHODS
From the DUST study, patients were selected with admission and follow-up non-contrast CT (NCCT) and CT perfusion (CTP) imaging, and a perfusion deficit in the middle cerebral artery territory on admission. Reperfusion was categorized qualitatively as reperfusion or no-reperfusion by visual comparison of admission and follow-up CTP. Occurrence of HT was assessed on follow-up NCCT. The association between reperfusion and occurrence of HT on follow-up was estimated by calculating odds ratios (ORs) and 95 % confidence intervals (CIs) with additional stratification for IV-rtPA treatment.


RESULTS
Inclusion criteria were met in 299 patients. There was no significant association between reperfusion and HT (OR 1.2 95%CI 0.5-3.1). In patients treated with IV-rtPA (n = 203), the OR was 1.3 (95%CI 0.4-4.0), and in patients not treated with IV-rtPA (n = 96), the OR was 0.8 (95%CI 0.1-4.5). HT occurred in 14 % of the IV-rtPA patients and in 7 % of patients without IV-rtPA (95%CI of difference -1 to 14 %).


CONCLUSIONS
Our results suggest that the increased risk of HT after acute ischemic stroke treatment is not dependent on the reperfusion status.
Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584 CX, Utrecht, The Netherlands. alexanderhorsch@gmail.com.|Department of Radiology, Rijnstate Hospital, Arnhem, The Netherlands. alexanderhorsch@gmail.com.
Alexander D
AD
Horsch
Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584 CX, Utrecht, The Netherlands.
Jan Willem
JW
Dankbaar
Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
Yolanda
Y
van der Graaf
Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584 CX, Utrecht, The Netherlands.
Joris M
JM
Niesten
Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584 CX, Utrecht, The Netherlands.
Tom
T
van Seeters
Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584 CX, Utrecht, The Netherlands.
Irene C
IC
van der Schaaf
Department of Neurology, Utrecht Stroke Center, University Medical Center, Utrecht, The Netherlands.
L Jaap
LJ
Kappelle
Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584 CX, Utrecht, The Netherlands.
Birgitta K
BK
Velthuis
D000368:Aged; D002533:Cerebral Angiography / Q000706:statistics & numerical data; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002548:Cerebral Revascularization / Q000706:statistics & numerical data; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D055420:Perfusion Imaging / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
CT perfusion; Hemorrhagic transformation; Ischemic stroke; Reperfusion; rtPA