Skip to main content

Advertisement

SpringerLink
Log in

Pre-treatment risk markers for hemorrhagic transformation in posterior circulation acute ischemic stroke treated with reperfusion therapy

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Background

Hemorrhagic transformation (HT) is an uncommon complication of posterior circulation acute ischemic stroke (PCS) compared to anterior circulation stroke. Nevertheless, it remains a major concern especially following reperfusion therapy. This study aimed at identifying potential predictive factors associated with HT in PCS.

Methods

Consecutive patients, from a multicenter cohort, with PCS treated by IVT or EVT or the combination of both, were included from December 2015 to May 2019. The European Cooperative Acute Stroke Study criteria was used to identify HT. Potential risk factors were analyzed using univariate and multivariable testing models.

Results

A total of 96 patients were included in our study. Median age was 66 (57–83) years, 54 patients (56%) were male and median baseline NIHSS was 8 (4–14). 77 patients (80%) received IVT and 54 patients (56%) benefited from EVT. HT occurred in 19 patients (20%), while sHT occurred in 3 patients (3%). HT was found to be associated with poor functional status at 3 months in univariate analysis (p = 0.0084). Multivariable analysis confirmed that higher baseline NIHSS (OR 1.1008; 95% CI [1.0216–1.1862]; p = 0.0117) and lobar topography of ischemia (OR 4.4275; 95% CI [1.3732–14.2753]; p = 0.0127) were independent predictors of the occurrence of HT.

Discussion

HT is associated with increased morbidity in patients with PCS; higher NIHSS and lobar ischemia were independent predictors of HT in our population. Easy-to-use predictive markers may help to tailor therapeutic management of patients with PCS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Study data are available from the corresponding author upon reasonable request.

References

  1. Tao WD, Liu M, Fisher M, Wang DR, Li J, Furie KL et al (2012) Posterior versus anterior circulation infarction: how different are the neurological deficits? Stroke 43(8):2060–2065

    Article  PubMed  Google Scholar 

  2. Dorňák T, Král M, Sedláčková Z, Šaňák D, Čecháková E, Divišová P et al (2018) Predictors for intracranial hemorrhage following intravenous thrombolysis in posterior circulation stroke. Transl Stroke Res 9(6):582–588

    Article  PubMed  Google Scholar 

  3. Merwick Á, Werring D (2014) Posterior circulation ischaemic stroke. BMJ 19(348):g3175

    Article  Google Scholar 

  4. Pirson FAV, Boodt N, Brouwer J, Bruggeman AAE, den Hartog SJ, Goldhoorn RJB et al (2022) Endovascular treatment for posterior circulation stroke in routine clinical practice: results of the multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands registry. Stroke 53(3):758–768

    Article  PubMed  Google Scholar 

  5. Mokin M, Ansari SA, McTaggart RA, Bulsara KR, Goyal M, Chen M et al (2019) Indications for thrombectomy in acute ischemic stroke from emergent large vessel occlusion (ELVO): report of the SNIS Standards and Guidelines Committee. J NeuroIntervent Surg 11(3):215–220

    Article  Google Scholar 

  6. Berge E, Whiteley W, Audebert H, De Marchis GM, Fonseca AC, Padiglioni C, et al (2021) European stroke organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J 6(1):I–LXII

  7. Dorňák T, Král M, Hazlinger M, Herzig R, Veverka T, Buřval S et al (2015) Posterior vs. anterior circulation infarction: demography, outcomes, and frequency of hemorrhage after thrombolysis. Int J Stroke Off J Int Stroke Soc 10(8):1224–8

    Article  Google Scholar 

  8. Sung SF, Chen CH, Chen YW, Tseng MC, Shen HC, Lin HJ (2013) Predicting symptomatic intracerebral hemorrhage after intravenous thrombolysis: stroke territory as a potential pitfall. J Neurol Sci 335(1–2):96–100

    Article  PubMed  Google Scholar 

  9. Sarikaya H, Arnold M, Engelter ST, Lyrer PA, Mattle HP, Georgiadis D et al (2011) Outcomes of intravenous thrombolysis in posterior versus anterior circulation stroke. Stroke 42(9):2498–2502

    Article  PubMed  Google Scholar 

  10. Weber R, Minnerup J, Nordmeyer H, Eyding J, Krogias C, Hadisurya J et al (2019) Thrombectomy in posterior circulation stroke: differences in procedures and outcome compared to anterior circulation stroke in the prospective multicentre REVASK registry. Eur J Neurol 26(2):299–305

    Article  CAS  PubMed  Google Scholar 

  11. Brouwer J, Ergezen S, Mulder MJHL, Nijeholt GJL a, Es ACGM van, Lugt A van der, et al (2022) Endovascular treatment for isolated posterior cerebral artery occlusion stroke in the MR CLEAN registry. J NeuroIntervent Surg [Internet]. [cited 2022 Apr 13]; Available from: https://jnis.bmj.com/content/early/2022/03/14/neurintsurg-2021-018505

  12. Meyer L, Stracke P, Wallocha M, Broocks G, Sporns P, Piechowiak EI, et al (2022) Aspiration versus stent retriever thrombectomy for distal, medium vessel occlusion stroke in the posterior circulation: a subanalysis of the TOPMOST study. Stroke. https://doi.org/10.1161/STROKEAHA.121.037792.

  13. Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM et al (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet Lond Engl 387(10029):1723–1731

    Article  Google Scholar 

  14. Wahlgren N, Ahmed N, Dávalos A, Ford GA, Grond M, Hacke W et al (2007) Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet Lond Engl 369(9558):275–282

    Article  CAS  Google Scholar 

  15. European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis Basel Switz 25(5):457–507

  16. Turc G, Tsivgoulis G, Audebert HJ, Boogaarts H, Bhogal P, Marchis GMD et al (2022) European Stroke Organisation (ESO)–European Society for Minimally Invasive Neurological Therapy (ESMINT) expedited recommendation on indication for intravenous thrombolysis before mechanical thrombectomy in patients with acute ischemic stroke and anterior circulation large vessel occlusion. J NeuroIntervent Surg 14(3):209–227

    Article  Google Scholar 

  17. MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset | NEJM [Internet]. [cited 2022 Apr 13]. Available from: https://www.nejm.org/doi/full/10.1056/nejmoa1804355

  18. Ford G, Freemantle N (1999) ECASS-II: intravenous alteplase in acute ischaemic stroke. European co-operative acute stroke study-II. Lancet Lond Engl 353(9146):65 (author reply 67–68)

  19. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D et al (2008) Thrombolysis with alteplase 3–4.5 h after acute ischemic stroke. N Engl J Med 359(13):1317–29

    Article  CAS  PubMed  Google Scholar 

  20. Venditti L, Chassin O, Ancelet C, Legris N, Sarov M, Lapergue B et al (2021) Pre-procedural predictive factors of symptomatic intracranial hemorrhage after thrombectomy in stroke. J Neurol 268(5):1867–1875

    Article  PubMed  Google Scholar 

  21. McCarron MO, Nicoll JAR (2004) Cerebral amyloid angiopathy and thrombolysis-related intracerebral haemorrhage. Lancet Neurol 3(8):484–492

    Article  PubMed  Google Scholar 

  22. Álvarez-Sabín J, Maisterra O, Santamarina E, Kase CS (2013) Factors influencing haemorrhagic transformation in ischaemic stroke. Lancet Neurol 12(7):689–705

    Article  PubMed  Google Scholar 

  23. Kim JS, Yang WI, Shim CY, Ha JW, Chung N, Chang HJ (2011) Hemorrhagic transformation of ischemic stroke: severe complications of prosthetic valve endocarditis. Korean Circ J 41(8):490–493

    Article  PubMed  PubMed Central  Google Scholar 

  24. Tao C, Nogueira RG, Zhu Y, Sun J, Han H, Yuan G et al (2022) Trial of endovascular treatment of acute basilar-artery occlusion. N Engl J Med 387(15):1361–1372

    Article  PubMed  Google Scholar 

  25. Jovin TG, Li C, Wu L, Wu C, Chen J, Jiang C et al (2022) Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion. N Engl J Med 387(15):1373–1384

    Article  PubMed  Google Scholar 

  26. Arba F, Rinaldi C, Caimano D, Vit F, Busto G, Fainardi E (2021) Blood–brain barrier disruption and hemorrhagic transformation in acute ischemic stroke: systematic review and meta-analysis. Front Neurol 21(11):594613

    Article  Google Scholar 

  27. Charbonnier G, Bonnet L, Biondi A, Moulin T. Intracranial bleeding after reperfusion therapy in acute ischemic stroke. Front Neurol [Internet]. 2021 [cited 2022 Apr 13];11. Available at: https://www.frontiersin.org/article/10.3389/fneur.2020.629920

  28. Lekic T, Krafft PR, Coats JS, Obenaus A, Tang J, Zhang JH (2011) Infratentorial strokes for posterior circulation folks: clinical correlations for current translational therapeutics. Transl Stroke Res 2(2):144–151

    Article  PubMed  PubMed Central  Google Scholar 

  29. Demirtas BS, Ocek L, Zorlu Y, Oztekin O (2019) Factors associated with hemorrhagic transformation in infarctions involving the posterior circulation system. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc 28(8):2193–2200

    Article  Google Scholar 

  30. Cano LM, Cardona P, Quesada H, Mora P, Rubio F (2012) Cerebellar infarction: prognosis and complications of vascular territories. Neurol Engl Ed 27(6):330–335

    CAS  Google Scholar 

  31. Sakamoto Y, Kimura K, Iguchi Y, Shibazaki K, Aoki J (2011) Hemorrhagic transformation in acute cerebellar infarction. Cerebrovasc Dis 32(4):327–333

    Article  PubMed  Google Scholar 

  32. Alemseged F, Rocco A, Arba F, Schwabova JP, Wu T, Cavicchia L et al (2022) Posterior national institutes of health stroke scale improves prognostic accuracy in posterior circulation stroke. Stroke 53(4):1247–1255

    Article  CAS  PubMed  Google Scholar 

  33. Sato S, Toyoda K, Uehara T, Toratani N, Yokota C, Moriwaki H et al (2008) Baseline NIH Stroke Scale Score predicting outcome in anterior and posterior circulation strokes. Neurology 70(24 Part 2):2371–7

    Article  CAS  PubMed  Google Scholar 

  34. Constant Dit Beaufils P, Preterre C, De Gaalon S, Labreuche J, Mazighi M, Di Maria F et al (2021) Prognosis and risk factors associated with asymptomatic intracranial hemorrhage after endovascular treatment of large vessel occlusion stroke: a prospective multicenter cohort study. Eur J Neurol 28(1):229–37

    Article  CAS  PubMed  Google Scholar 

  35. Neuberger U, Seker F, Schönenberger S, Nagel S, Ringleb PA, Bendszus M et al (2019) Prediction of intracranial hemorrhages after mechanical thrombectomy of basilar artery occlusion. J NeuroIntervent Surg 11(12):1181–1186

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Diagnostic and Interventional Neuroradiology Department, NEURI Brain Vascular Center, Bicêtre University-Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France

    Claire Ancelet, Sophie Neveü, Jonathan Cortese, Coralie Pelissou, Elsa Talab Berthou, Matthias Babin, Ghaidaa Nasser, Farida Benoudiba & Laurent Spelle

  2. Department of Neurology, Hôpital Bicêtre, Stroke Center, 78 Rue du General Leclerc, 94270, Le Kremlin Bicêtre, France

    Laura Venditti, Oliver Chassin, Nicolas Legris, Mariana Sarov Rivière & Christian Denier

  3. Paris-Saclay University Faculty of Medicine, INSERM U1195, Le Kremlin-Bicêtre, France

    Jonathan Cortese, Nicolas Chausson, Laurent Spelle & Christian Denier

  4. Department of Neurology, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91100, Corbeil-Essonnes, France

    Nicolas Chausson

Authors
  1. Claire Ancelet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sophie Neveü
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Venditti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jonathan Cortese
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Oliver Chassin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Coralie Pelissou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elsa Talab Berthou
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Matthias Babin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ghaidaa Nasser
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Farida Benoudiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Nicolas Legris
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Mariana Sarov Rivière
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Nicolas Chausson
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Laurent Spelle
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Christian Denier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claire Ancelet.

Ethics declarations

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical statement

According to French legislation, as a non-interventional retrospective study of routinely acquired data, the need for written informed consent for this study was waived. Patients were informed they could oppose the use of their health-related data for research purposes.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ancelet, C., Neveü, S., Venditti, L. et al. Pre-treatment risk markers for hemorrhagic transformation in posterior circulation acute ischemic stroke treated with reperfusion therapy. J Neurol 270, 5493–5501 (2023). https://doi.org/10.1007/s00415-023-11886-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-023-11886-w

Keywords

Search

Navigation