Cargando…

Initial ‘TTP Map-Defect’ of Computed Tomography Perfusion as a Predictor of Hemorrhagic Transformation of Acute Ischemic Stroke

BACKGROUND: Hemorrhagic transformation (HT) following acute ischemic stroke is a major problem, especially for the indication of reperfusion therapy including intravenous administration of recombinant tissue plasminogen activator (IV rt-PA). The specific predictive factors of HT have not yet been es...

Descripción completa

Detalles Bibliográficos
Autores principales: Shinoyama, Mizuya, Nakagawara, Jyoji, Yoneda, Hiroshi, Suzuki, Michiyasu, Ono, Hidetoshi, Kunitsugu, Ichiro, Kamiyama, Kenji, Osato, Toshiaki, Nakamura, Hirohiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: S. Karger AG 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3617882/
https://www.ncbi.nlm.nih.gov/pubmed/23637697
http://dx.doi.org/10.1159/000346113
_version_ 1782265321817636864
author Shinoyama, Mizuya
Nakagawara, Jyoji
Yoneda, Hiroshi
Suzuki, Michiyasu
Ono, Hidetoshi
Kunitsugu, Ichiro
Kamiyama, Kenji
Osato, Toshiaki
Nakamura, Hirohiko
author_facet Shinoyama, Mizuya
Nakagawara, Jyoji
Yoneda, Hiroshi
Suzuki, Michiyasu
Ono, Hidetoshi
Kunitsugu, Ichiro
Kamiyama, Kenji
Osato, Toshiaki
Nakamura, Hirohiko
author_sort Shinoyama, Mizuya
collection PubMed
description BACKGROUND: Hemorrhagic transformation (HT) following acute ischemic stroke is a major problem, especially for the indication of reperfusion therapy including intravenous administration of recombinant tissue plasminogen activator (IV rt-PA). The specific predictive factors of HT have not yet been established. The present study evaluated the findings of computed tomography perfusion (CTP) images as predictors of subsequent HT to identify patients with low HT risk for reperfusion therapy such as IV rt-PA. METHODS: We retrospectively reviewed 68 consecutive stroke patients (41 males; mean age 72.9 years) with steno-occlusive lesions in the major trunk, including 10 patients who underwent IV rt-PA. Each HT was detected on a follow-up T2*-weighted magnetic resonance image until 2 weeks after stroke onset and categorized into four groups [hemorrhagic infarction (HI) type 1 and 2, and parenchymal hematoma (PH) type 1 and 2] according to the European Cooperative Acute Stroke Study (ECASS) classification. We assessed clinical features and radiological findings between the HT and non-HT groups or the PH2 and non-PH2 groups. The efficacy of initial time to peak (TTP) mapping of CTP for predicting HT or PH2 was evaluated. RESULTS: Thirty-four patients (50%) developed subsequent HT: 18 (52.9%) had HI and 16 (47.1%) had PH, including 9 PH2 patients (13.2%). IV rt-PA was not significantly associated with HT or PH2 occurrence. Forty of the 68 patients (59%) revealed defect areas on the initial TTP mapping (TTP map-defect), and 34 of these 40 patients (85%) developed secondary HT and 9 patients (22.5%) developed PH2. Initial ‘TTP map-defect’ was significantly associated with the occurrence of HT (p < 0.0001) and PH2 (p = 0.0070). Thirty of the 34 patients (88.2%) in the HT group experienced delayed recanalization of the occluded vessels, in contrast to only 8 of the 34 patients (23.6%) in the non-HT group. All patients of the PH2 group showed recanalization (p = 0.0042). In 40 ‘TTP map-defect’-positive patients, delayed recanalization was associated with the occurrence of HT (p < 0.0001) and PH2 (p = 0.0491). All 28 patients without ‘TTP map-defect’ did not develop HT, including 8 patients (28.6%) with delayed recanalization. CONCLUSIONS: Initial ‘TTP map-defect’ of CTP could accurately predict HT risk including PH2 risk and identify low-risk patients even in the delayed period.
format Online
Article
Text
id pubmed-3617882
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher S. Karger AG
record_format MEDLINE/PubMed
spelling pubmed-36178822013-05-01 Initial ‘TTP Map-Defect’ of Computed Tomography Perfusion as a Predictor of Hemorrhagic Transformation of Acute Ischemic Stroke Shinoyama, Mizuya Nakagawara, Jyoji Yoneda, Hiroshi Suzuki, Michiyasu Ono, Hidetoshi Kunitsugu, Ichiro Kamiyama, Kenji Osato, Toshiaki Nakamura, Hirohiko Cerebrovasc Dis Extra Original Paper BACKGROUND: Hemorrhagic transformation (HT) following acute ischemic stroke is a major problem, especially for the indication of reperfusion therapy including intravenous administration of recombinant tissue plasminogen activator (IV rt-PA). The specific predictive factors of HT have not yet been established. The present study evaluated the findings of computed tomography perfusion (CTP) images as predictors of subsequent HT to identify patients with low HT risk for reperfusion therapy such as IV rt-PA. METHODS: We retrospectively reviewed 68 consecutive stroke patients (41 males; mean age 72.9 years) with steno-occlusive lesions in the major trunk, including 10 patients who underwent IV rt-PA. Each HT was detected on a follow-up T2*-weighted magnetic resonance image until 2 weeks after stroke onset and categorized into four groups [hemorrhagic infarction (HI) type 1 and 2, and parenchymal hematoma (PH) type 1 and 2] according to the European Cooperative Acute Stroke Study (ECASS) classification. We assessed clinical features and radiological findings between the HT and non-HT groups or the PH2 and non-PH2 groups. The efficacy of initial time to peak (TTP) mapping of CTP for predicting HT or PH2 was evaluated. RESULTS: Thirty-four patients (50%) developed subsequent HT: 18 (52.9%) had HI and 16 (47.1%) had PH, including 9 PH2 patients (13.2%). IV rt-PA was not significantly associated with HT or PH2 occurrence. Forty of the 68 patients (59%) revealed defect areas on the initial TTP mapping (TTP map-defect), and 34 of these 40 patients (85%) developed secondary HT and 9 patients (22.5%) developed PH2. Initial ‘TTP map-defect’ was significantly associated with the occurrence of HT (p < 0.0001) and PH2 (p = 0.0070). Thirty of the 34 patients (88.2%) in the HT group experienced delayed recanalization of the occluded vessels, in contrast to only 8 of the 34 patients (23.6%) in the non-HT group. All patients of the PH2 group showed recanalization (p = 0.0042). In 40 ‘TTP map-defect’-positive patients, delayed recanalization was associated with the occurrence of HT (p < 0.0001) and PH2 (p = 0.0491). All 28 patients without ‘TTP map-defect’ did not develop HT, including 8 patients (28.6%) with delayed recanalization. CONCLUSIONS: Initial ‘TTP map-defect’ of CTP could accurately predict HT risk including PH2 risk and identify low-risk patients even in the delayed period. S. Karger AG 2013-02-13 /pmc/articles/PMC3617882/ /pubmed/23637697 http://dx.doi.org/10.1159/000346113 Text en Copyright © 2013 by S. Karger AG, Basel http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No-Derivative-Works License (http://creativecommons.org/licenses/by-nc-nd/3.0/). Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.
spellingShingle Original Paper
Shinoyama, Mizuya
Nakagawara, Jyoji
Yoneda, Hiroshi
Suzuki, Michiyasu
Ono, Hidetoshi
Kunitsugu, Ichiro
Kamiyama, Kenji
Osato, Toshiaki
Nakamura, Hirohiko
Initial ‘TTP Map-Defect’ of Computed Tomography Perfusion as a Predictor of Hemorrhagic Transformation of Acute Ischemic Stroke
title Initial ‘TTP Map-Defect’ of Computed Tomography Perfusion as a Predictor of Hemorrhagic Transformation of Acute Ischemic Stroke
title_full Initial ‘TTP Map-Defect’ of Computed Tomography Perfusion as a Predictor of Hemorrhagic Transformation of Acute Ischemic Stroke
title_fullStr Initial ‘TTP Map-Defect’ of Computed Tomography Perfusion as a Predictor of Hemorrhagic Transformation of Acute Ischemic Stroke
title_full_unstemmed Initial ‘TTP Map-Defect’ of Computed Tomography Perfusion as a Predictor of Hemorrhagic Transformation of Acute Ischemic Stroke
title_short Initial ‘TTP Map-Defect’ of Computed Tomography Perfusion as a Predictor of Hemorrhagic Transformation of Acute Ischemic Stroke
title_sort initial ‘ttp map-defect’ of computed tomography perfusion as a predictor of hemorrhagic transformation of acute ischemic stroke
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3617882/
https://www.ncbi.nlm.nih.gov/pubmed/23637697
http://dx.doi.org/10.1159/000346113
work_keys_str_mv AT shinoyamamizuya initialttpmapdefectofcomputedtomographyperfusionasapredictorofhemorrhagictransformationofacuteischemicstroke
AT nakagawarajyoji initialttpmapdefectofcomputedtomographyperfusionasapredictorofhemorrhagictransformationofacuteischemicstroke
AT yonedahiroshi initialttpmapdefectofcomputedtomographyperfusionasapredictorofhemorrhagictransformationofacuteischemicstroke
AT suzukimichiyasu initialttpmapdefectofcomputedtomographyperfusionasapredictorofhemorrhagictransformationofacuteischemicstroke
AT onohidetoshi initialttpmapdefectofcomputedtomographyperfusionasapredictorofhemorrhagictransformationofacuteischemicstroke
AT kunitsuguichiro initialttpmapdefectofcomputedtomographyperfusionasapredictorofhemorrhagictransformationofacuteischemicstroke
AT kamiyamakenji initialttpmapdefectofcomputedtomographyperfusionasapredictorofhemorrhagictransformationofacuteischemicstroke
AT osatotoshiaki initialttpmapdefectofcomputedtomographyperfusionasapredictorofhemorrhagictransformationofacuteischemicstroke
AT nakamurahirohiko initialttpmapdefectofcomputedtomographyperfusionasapredictorofhemorrhagictransformationofacuteischemicstroke