The early hemorrhagic transformation after reperfusion therapy of acute ischemic stroke

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Abstract

Introduction. Intravenous thrombolytic therapy (IVT) and endovascular thrombectomy (EVT) are effective in the treatment of patients with ischemic stroke (IS). A frequent complication is hemorrhagic transformation (HT) of cerebral infarction. The relationship between HT and functional outcomes in IS remains controversial.

The aim of the study is to analyze the frequency of early HT following reperfusion therapies and assess its prognostic value in patients with IS in the carotid territory.

Materials and methods. The retrospective study included 191 patients (median age 70 [64.5; 77.0] years; 49.8% male) who underwent IVT within 4.5 hours of symptom onset, and 251 patients (median age 66 [58; 73] years; 62.3% male) with IS who underwent EVT within 6 hours. HT was assessed using ECASS II classification on neuroimaging at 48 hours post-stroke; functional outcomes at discharge and at Day 90 were evaluated using the modified Rankin Scale.

Results. Early HT was observed in 34 (17.8%) IVT patients and 79 (31.5%) EVT patients (p = 0.001). Early HT after both IVT and EVT increased the likelihood of unfavorable outcomes (OR = 3.32 [95% CI 1.44–7.66], p = 0.005 and OR = 2.27 [95% CI 1.31–3.92], p = 0.003, respectively) and mortality (OR = 4.5 [95% CI 1.84–10.99], p < 0.001 and OR = 2.21 [95% CI 1.26–3.86], p = 0.005, respectively) at Day 90 post-stroke. Similar associations were found only for parenchymal hematomas within HT subtypes. For IVT, these trends persisted regardless of thrombolytic agent used; for EVT, only in patients achieving mTICI 2b-3 reperfusion.

Conclusion. Early HT, particularly parenchymal hematomas, predicts unfavorable outcomes in IS patients undergoing reperfusion treatment. HT in patients achieving optimal recanalization after ET may reflect reperfusion injury.

About the authors

Maksim A. Domashenko

M.V. Lomonosov Moscow State University

Author for correspondence.
Email: mdomashenko@gmail.com
ORCID iD: 0009-0000-3630-6130

Cand. Sci. (Med.), Head, Department of neurology and neurosurgery, Faculty of Medicine

Russian Federation, Moscow

Mark A. Loskutnikov

M.V. Lomonosov Moscow State University

Email: losmark@mail.ru
ORCID iD: 0000-0003-0179-2735

Cand. Sci (Med.), Head, Department of neurology for acute stroke patients, Central Clinical Hospital, chief stroke neurologist

Russian Federation, Moscow

Viktor I. Konstantinov

Central Clinical Medical Sanitary Hospital

Email: bluesbart@mail.ru
ORCID iD: 0000-0003-1681-4773

Head, Department of endovascular diagnostics and treatment methods

Russian Federation, Magnitogorsk

Renata Iu. Zaliautdinova

Central Clinical Medical Sanitary Hospital

Email: renatika94@gmail.com
ORCID iD: 0000-0002-7009-735X

neurologist, 2nd Neurology department

Russian Federation, Magnitogorsk

Yan V. Vishnevskii

Central Clinical Medical Sanitary Hospital

Email: Yanv95@mail.ru
ORCID iD: 0009-0008-9086-7842

neurologist, 1st Neurology department

Russian Federation, Magnitogorsk

Marina Yu. Maximova

Russian Center of Neurology and Neurosciences

Email: ncnmaximova@mail.ru
ORCID iD: 0000-0002-7682-6672

D. Sci (Med.), Prof., Head, 2nd Neurology department

Russian Federation, Moscow

Мarine M. Tanashyan

Russian Center of Neurology and Neurosciences

Email: mtanashyan@neurology.ru
ORCID iD: 0000-0002-5883-8119

D. Sci. (Med.), Prof., Full Member of RAS, Deputy director for scientific research work, Head, 1st Neurology department, Institute of Clinical and Preventive Neurology

Russian Federation, Moscow

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