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Pretreatment parameters associated with hemorrhagic transformation among successfully recanalized medium vessel occlusions

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Abstract

Although pretreatment radiographic biomarkers are well established for hemorrhagic transformation (HT) following successful mechanical thrombectomy (MT) in large vessel occlusion (LVO) strokes, they are yet to be explored for medium vessel occlusion (MeVO) acute ischemic strokes. We aim to investigate pretreatment imaging biomarkers representative of collateral status, namely the hypoperfusion intensity ratio (HIR) and cerebral blood volume (CBV) index, and their association with HT in successfully recanalized MeVOs. A prospectively collected registry of acute ischemic stroke patients with MeVOs successfully recanalized with MT between 2019 and 2023 was retrospectively reviewed. A multivariate logistic regression for HT of any subtype was derived by combining significant univariate predictors into a forward stepwise regression with minimization of Akaike information criterion. Of 60 MeVO patients successfully recanalized with MT, HT occurred in 28.3% of patients. Independent factors for HT included: diabetes mellitus history (p = 0.0005), CBV index (p = 0.0071), and proximal versus distal occlusion location (p = 0.0062). A multivariate model with these factors had strong diagnostic performance for predicting HT (area under curve [AUC] 0.93, p < 0.001). Lower CBV indexes, distal occlusion location, and diabetes history are significantly associated with HT in MeVOs successfully recanalized with MT. Of note, HIR was not found to be significantly associated with HT.

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De-identified data will be made available upon reasonable request to the corresponding author.

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Funding

This study is supported by the Johns Hopkins University School of Medicine Department of Radiology Physician Scientist Incubator Program (RAD-PSI) in addition to the following grants: R01 N106711 and P41 EB031771.

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Authors and Affiliations

  1. Cooper Medical School of Rowan University, Camden, NJ, USA

    Manisha Koneru

  2. Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA

    Meisam Hoseinyazdi, Richard Wang, Nathan Z. Hyson, Elisabeth Breese Marsh, Rafael H. Llinas, Victor C. Urrutia, Richard Leigh, Luis Fernando Gonzalez, Risheng Xu, Justin M. Caplan, Judy Huang, Hanzhang Lu, Licia Luna, Argye E. Hillis & Vivek S. Yedavalli

  3. MD Anderson Cancer Center, Houston, TX, USA

    Burak Berksu Ozkara & Max Wintermark

  4. Massachusetts General Hospital, Boston, MA, USA

    Adam A. Dmytriw

  5. Universite Libre De Bruxelles Hospital Erasme, Anderlecht, Belgium

    Adrien Guenego

  6. Stanford University School of Medicine, Stanford, CA, USA

    Gregory W. Albers & Jeremy J. Heit

  7. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Kambiz Nael

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  1. Manisha Koneru
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by VY. The analysis was performed by MK. The first draft of the manuscript was written by MK and VY, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Vivek S. Yedavalli.

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Conflicts of interest

Drs. Vivek Yedavalli, Jeremy Heit, and Gregory Albers are consultants for iSchemaView (Menlo Park, CA, USA), not related to submitted work.

Ethical approval

This study was approved by the institutional review board of the Johns Hopkins School of Medicine.

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This retrospective study was approved by the IRB with waiver of informed consent.

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Koneru, M., Hoseinyazdi, M., Wang, R. et al. Pretreatment parameters associated with hemorrhagic transformation among successfully recanalized medium vessel occlusions. J Neurol 271, 1901–1909 (2024). https://doi.org/10.1007/s00415-023-12149-4

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