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Severe cerebral hypovolemia on perfusion CT and lower body weight are associated with parenchymal haemorrhage after thrombolysis

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Abstract

Introduction

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).

Conclusion

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.

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Acknowledgements

This study was supported in part by the Swiss Heart Foundation.

Author information

Correspondence to S. Tsetsou.

Ethics declarations

We declare that the analysis of clinical and patient data retrieved from the Acute Stroke Registry Analysis of Lausanne (ASTRAL) has been approved by the Ethics Commission for Research on Humans of the Canton of Vaud (ECCV).

Conflict of interest

PM has received research grants from the Swiss Heart Foundation; speaker fees from Boehringer-Ingelheim, Bayer, Medtronic-Covidien and Stryker; honoraria from scientific advisory boards from Boehringer-Ingelheim, Bayer and Pfizer; consulting fees from Pierre-Fabre, Astra-Zeneca and Amgen; and travel support from Boehringer-Ingelheim and Bayer. All financial support is received by the institution (CHUV) and used for stroke education and research.

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Tsetsou, S., Amiguet, M., Eskandari, A. et al. Severe cerebral hypovolemia on perfusion CT and lower body weight are associated with parenchymal haemorrhage after thrombolysis. Neuroradiology 59, 23–29 (2017). https://doi.org/10.1007/s00234-016-1775-x

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Keywords

  • Parenchymal haemorrhage
  • Stroke
  • Perfusion CT