title: Severe cerebral hypovolemia on perfusion CT and lower body weight are associated with parenchymal haemorrhage after thrombolysis.
abstract: BACKGROUND
  Haemorrhagic transformation of acute ischemic stroke (AIS) and particularly parenchymal haemorrhage (PH) remains a feared complication of intravenous thrombolysis (IVT). We aimed to identify clinical and perfusion CT (PCT) variables which are independently associated with PHs.
  
  
  METHODS
  In this observational cohort study, based on the Acute Stroke Registry Analysis of Lausanne (ASTRAL) from 2003 to December 2013, we selected patients with AIS involving the middle cerebral artery (MCA) territory who were thrombolysed within 4.5 h of symptoms' onset and who had a good quality baseline PCT at the beginning of IVT. In addition to demographic, clinical, laboratory and non-contrast CT data, volumes of salvageable tissue and ischemic core on PCT, as well as absolute CBF and CBV values within the ischemic regions were compared in patients with and without PH in multivariate analysis.
  
  
  RESULTS
  Of the 190 included patients, 24 (12.6%) presented a PH (11 had PH1 and 13 had PH2). In multivariate analysis of the clinical and radiological variables, the lowest CBV in the core and lower body weight was both significantly associated with PH (p = 0.009 and p = 0.024, respectively).
  
  
  CONCLUSIONS
  In thrombolysed MCA strokes, maximal hypoperfusion severity depicted by lowest CBV values in the core region and lower body weight are independently correlated with PH. This information, if confirmed in other case series, may add to the stratification of revascularisation decisions in patients with a perceived high PH risk.
authors.affiliation: Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland. stsetsou@hotmail.com.
authors.forename: S
authors.identifier: http://orcid.org/0000-0003-4521-5745
authors.initials: S
authors.lastname: Tsetsou
authors.affiliation: Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Amiguet
authors.affiliation: Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Eskandari
authors.affiliation: Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Meuli
authors.affiliation: Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Maeder
authors.affiliation: Department of Radiology, Neuroradiology Division, Stanford University and Medical Center, Stanford, CA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Department of Radiology, Neuroradiology Division, Stanford University and Medical Center, Stanford, CA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Wintermark
authors.affiliation: Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Michel
mesh_terms: D000368:Aged; D001835:Body Weight; D002533:Cerebral Angiography / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D003287:Contrast Media; D005260:Female; D006801:Humans; D020896:Hypovolemia / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D007472:Iohexol; D018810:Magnetic Resonance Angiography; D008297:Male; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D003287:Contrast Media; D007472:Iohexol
keywords: Parenchymal haemorrhage; Perfusion CT; Stroke