Postthrombectomy Cerebral Hyperdensity: Usefulness as a Predictor of Future Hemorrhage or Infarction

Amgad Moussa; Ahmed El Serwi; Mohamed Tork

doi:10.4103/AJIR.AJIR_8_19

The Arab Journal of Interventional Radiology, Table of Contents

CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2020; 4(01): 11-15
DOI: 10.4103/AJIR.AJIR_8_19

Original Article

Postthrombectomy Cerebral Hyperdensity: Usefulness as a Predictor of Future Hemorrhage or Infarction

Amgad Moussa

Departments of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

,

Ahmed El Serwi

Department of Radiology, Ain Shams University Specialized Hospital, Cairo, Egypt

,

Mohamed Tork

Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

› Author Affiliations

Abstract

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Aim: This study aims to examine the association between the presence of postinterventional cerebral hyperdensities (PCHD) and the occurrence of hemorrhagic transformation. Materials and Methods: We retrospectively analyzed the data of 33 patients who underwent successful mechanical thrombectomy for emergent large vessel occlusion of the anterior circulation and received two computed tomography (CT) scans of the brain; the first (CT1) within 4.5 h from the procedure and the second (CT2) within 4 days from the procedure. In patients who showed PCHD on CT1, CT2 was checked to detect hemorrhage or infarction in the location of the noted PCHD. Statistical analysis was done through the Fisher's exact test to detect the association between PCHD and hemorrhagic transformation. Results: 28 of the 33 patients (84.8%) showed PCHD on CT1. 20 of the 28 patients (71.4%) showed infarction on CT2, while 8 patients (28.6%) showed hemorrhage. The 5 patients that did not show PCHD on CT1 all showed infarction on CT2. Analysis of our results revealed that although cases with hemorrhage had more frequent positive contrast compared to infarction, this difference did not reach a statistically significant level (P = 0.302). Conclusion: We concluded that the presence of PCHD may be associated with future risk of hemorrhagic transformation, but this association did not reach statistical significance. Further studies are needed to validate these results, which may affect the use of antiplatelets in the immediate postthrombectomy period in the presence of PCHD.

Extravasation - hemorrhage - infarction - staining - thrombectomy

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References

References
1 Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018;49:e46-110.
2 Takei J, Irie K, Tanaka T, Okuno K, Hasegawa I, Shimoyama T, et al. Evaluation of the CT high-density area after endovascular treatment for acute ischemic stroke. J Neuroendovasc Ther 2017;11:227-34.
3 Nakano S, Iseda T, Kawano H, Yoneyama T, Ikeda T, Wakisaka S, et al. Parenchymal hyperdensity on computed tomography after intra-arterial reperfusion therapy for acute middle cerebral artery occlusion: Incidence and clinical significance. Stroke 2001;32:2042-8.
4 Amans MR, Cooke DL, Vella M, Dowd CF, Halbach VV, Higashida RT, et al. Contrast staining on CT after DSA in ischemic stroke patients progresses to infarction and rarely hemorrhages. Interv Neuroradiol 2014;20:106-15.
5 Yoon W, Seo JJ, Kim JK, Cho KH, Park JG, Kang HK, et al. Contrast enhancement and contrast extravasation on computed tomography after intra-arterial thrombolysis in patients with acute ischemic stroke. Stroke 2004;35:876-81.
6 Nikoubashman O, Reich A, Gindullis M, Frohnhofen K, Pjontek R, Brockmann MA, et al. Clinical significance of post-interventional cerebral hyperdensities after endovascular mechanical thrombectomy in acute ischaemic stroke. Neuroradiology 2014;56:41-50.
7 Cabral FB, Castro-Afonso LH, Nakiri GS, Monsignore LM, Fábio S, Dos Santos AC, et al. Hyper-attenuating brain lesions on CT after ischemic stroke and thrombectomy are associated with final brain infarction. Interv Neuroradiol 2017;23:594-600.
8 Desilles JP, Rouchaud A, Labreuche J, Meseguer E, Laissy JP, Serfaty JM, et al. Blood-brain barrier disruption is associated with increased mortality after endovascular therapy. Neurology 2013;80:844-51.
9 Khatri R, McKinney AM, Swenson B, Janardhan V. Blood-brain barrier, reperfusion injury, and hemorrhagic transformation in acute ischemic stroke. Neurology 2012;79:S52-7.
10 Lummel N, Schulte-Altedorneburg G, Bernau C, Pfefferkorn T, Patzig M, Janssen H, et al. Hyperattenuated intracerebral lesions after mechanical recanalization in acute stroke. AJNR Am J Neuroradiol 2014;35:345-51.
11 Komiyama M, Nishijima Y, Nishio A, Khosla VK. Extravasation of contrast medium from the lenticulostriate artery following local intracarotid fibrinolysis. Surg Neurol 1993;39:315-9.
12 Parrilla G, García-Villalba B, Espinosa de Rueda M, Zamarro J, Carrión E, Hernández-Fernández F, et al. Hemorrhage/contrast staining areas after mechanical intra-arterial thrombectomy in acute ischemic stroke: Imaging findings and clinical significance. AJNR Am J Neuroradiol 2012;33:1791-6.
13 Schneider T, Mahraun T, Schroeder J, Frölich A, Hoelter P, Wagner M, et al. Intraparenchymal hyperattenuations on flat-panel CT directly after mechanical thrombectomy are restricted to the initial infarct core on diffusion-weighted imaging. Clin Neuroradiol 2018;28:91-7.
14 Tijssen MP, Hofman PA, Stadler AA, van Zwam W, de Graaf R, van Oostenbrugge RJ, et al. The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke. Eur Radiol 2014;24:834-40.
15 Phan CM, Yoo AJ, Hirsch JA, Nogueira RG, Gupta R. Differentiation of hemorrhage from iodinated contrast in different intracranial compartments using dual-energy head CT. AJNR Am J Neuroradiol 2012;33:1088-94.
16 Nikoubashman O, Jablawi F, Dekeyzer S, Oros-Peusquens AM, Abbas Z, Lindemeyer J, et al. MRI appearance of intracerebral iodinated contrast agents: Is it possible to distinguish extravasated contrast agent from hemorrhage? AJNR Am J Neuroradiol 2016;37:1418-21.
17 Hamann GF, Okada Y, del Zoppo GJ. Hemorrhagic transformation and microvascular integrity during focal cerebral ischemia/reperfusion. J Cereb Blood Flow Metab 1996;16:1373-8.
18 del Zoppo GJ, von Kummer R, Hamann GF. Ischaemic damage of brain microvessels: Inherent risks for thrombolytic treatment in stroke. J Neurol Neurosurg Psychiatry 1998;65:1-9.
19 Hamann GF, Okada Y, Fitridge R, del Zoppo GJ. Microvascular basal lamina antigens disappear during cerebral ischemia and reperfusion. Stroke 1995;26:2120-6.
20 Del Maschio A, Zanetti A, Corada M, Rival Y, Ruco L, Lampugnani MG, et al. Polymorphonuclear leukocyte adhesion triggers the disorganization of endothelial cell-to-cell adherens junctions. J Cell Biol 1996;135:497-510.
21 Wilcox J, Wilson AJ, Evill CA, Sage MR. A comparison of blood-brain barrier disruption by intracarotid iohexol and iodixanol in the rabbit. AJNR Am J Neuroradiol 1987;8:769-72.
22 Kurosawa Y, Lu A, Khatri P, Carrozzella JA, Clark JF, Khoury J, et al. Intra-arterial iodinated radiographic contrast material injection administration in a rat middle cerebral artery occlusion and reperfusion model: Possible effects on intracerebral hemorrhage. Stroke 2010;41:1013-7.
23 Sage MR, Wilcox J, Evill CA, Benness GT. Comparison and evaluation of osmotic blood-brain barrier disruption following intracarotid mannitol and methylglucamine iothalamate. Invest Radiol 1982;17:276-81.
24 Molina CA, Montaner J, Abilleira S, Ibarra B, Romero F, Arenillas JF, et al. Timing of spontaneous recanalization and risk of hemorrhagic transformation in acute cardioembolic stroke. Stroke 2001;32:1079-84.
25 Bourcier R, Saleme S, Labreuche J, Mazighi M, Fahed R, Blanc R, et al. More than three passes of stent retriever is an independent predictor of parenchymal hematoma in acute ischemic stroke. J Neurointerv Surg 2019;11:625-9.
26 Soize S, Barbe C, Kadziolka K, Estrade L, Serre I, Pierot L, et al. Predictive factors of outcome and hemorrhage after acute ischemic stroke treated by mechanical thrombectomy with a stent-retriever. Neuroradiology 2013;55:977-87.