Incidence, prognosis, and prediction of haemorrhagic transformation after revascularisation for stroke
Introduction: Haemorrhagic transformation is a major complication of acute ischaemic stroke (AIS). We sought to determine the predictors and clinical impact of intracranial haemorrhage (ICH) after revascularisation therapy. Methods: We conducted a retrospective, single-centre study including 235 pat...
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| Format: | Article |
| Language: | English |
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Elsevier España
2021-10-01
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| Series: | Neurología (English Edition) |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2173580820300699 |
| _version_ | 1819156322000568320 |
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| author | P.B. García Jurado E. Roldán Romero M.E. Pérez Montilla R. Valverde Moyano I.M. Bravo Rey F. Delgado Acosta F.A. Bravo-Rodríguez |
| author_facet | P.B. García Jurado E. Roldán Romero M.E. Pérez Montilla R. Valverde Moyano I.M. Bravo Rey F. Delgado Acosta F.A. Bravo-Rodríguez |
| author_sort | P.B. García Jurado |
| collection | DOAJ |
| description | Introduction: Haemorrhagic transformation is a major complication of acute ischaemic stroke (AIS). We sought to determine the predictors and clinical impact of intracranial haemorrhage (ICH) after revascularisation therapy. Methods: We conducted a retrospective, single-centre study including 235 patients with AIS who underwent intravenous recombinant tissue plasminogen activator (IV-rtPA) therapy and/or endovascular treatment. A binary logistic regression model was used to determine the variables associated with ICH, parenchymal haematomas (PH), modified Rankin Scale (mRS) scores, and mortality. Results: ICH was detected in 57 (30 with PH) of 183 patients included. Mechanical thrombectomy, either alone (OR 3.3 [1.42-7.63], P = .005) or in combination with IV-rtPA (OR 3.39 [1.52-7.56], P = .003), was associated with higher risk of ICH, while higher Alberta Stroke Program Early CT scores (OR 0.71 [0.55-0.91], P = .007) were associated with lower risk. Patients with older age (OR 1.07 [1.02-1.13], P = .006) and occlusion of the terminal branch of the internal carotid artery (OR 4.03 [1.35-11.99], P = .012) had a higher risk of PH, while the use of IV-rtPA alone (OR 0.24 [0.08-0.68], P = .008) was associated with lower risk of PH. Only PH was associated with disability as measured by the mRS (OR 3.2 [1.17-8.76], P = .02) and higher mortality (OR 5.06 [1.65-15.5], P = .005). Conclusions: Greater understanding about the predictors of ICH, mRS scores, and mortality could enable better selection of patients and treatments. Resumen: Introducción: La transformación hemorrágica es una complicación importante del ictus isquémico agudo (IIA). El propósito del trabajo es analizar el impacto clínico y los factores predictores de las hemorragias intracraneales (HIC) tras terapia revascularizadora. Métodos: Análisis retrospectivo monocéntrico de 235 pacientes con IIA tratados mediante trombólisis intravenosa (TIV) o tratamiento endovascular (TE). Se ha realizado un modelo de regresión logística binaria para determinar los factores asociados con las HIC, las hemorragias parenquimatosas (HP), la escala mRS y la mortalidad. Resultados: De los 183 pacientes incluidos, 57 tuvieron HIC (30 HP). El TE mecánico (OR 3,3 [1,42-7,63], p = 0,005) y la TIV junto con TE mecánico (OR 3,39 [1,52-7,56], p = 0,003) se han asociado a mayor riesgo de HIC, mientras que valores altos de ASPECTS (OR 0,71 [0,55-0,91], p = 0,007) se han asociado a menor riesgo. Mayor edad (OR 1,07 [1,02-1,13], p = 0,006) y la oclusión de la carótida interna terminal (OR 4,03 [1,35-11,99], p = 0,012) han sido factores predictores de HP, mientras que haber recibido TIV exclusivamente (OR 0,24 [0,08-0,68], p = 0,008) se ha asociado con menor riesgo. Solo las HP se han asociado a valores invalidantes de mRS (OR = 3,2 [1,17-8,76], p = 0,02) y mayor mortalidad (OR 5,06 [1,65-15,5], p = 0,005). Conclusiones: Una mejor comprensión de los factores predictores de HIC, mRS y mortalidad puede permitir una mejor selección de pacientes y tratamientos. |
| first_indexed | 2024-12-22T15:51:01Z |
| format | Article |
| id | doaj.art-57e34c59de8d4af8b53dd7cce7dd5d4b |
| institution | Directory Open Access Journal |
| issn | 2173-5808 |
| language | English |
| last_indexed | 2024-12-22T15:51:01Z |
| publishDate | 2021-10-01 |
| publisher | Elsevier España |
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| series | Neurología (English Edition) |
| spelling | doaj.art-57e34c59de8d4af8b53dd7cce7dd5d4b2022-12-21T18:20:54ZengElsevier EspañaNeurología (English Edition)2173-58082021-10-01368589596Incidence, prognosis, and prediction of haemorrhagic transformation after revascularisation for strokeP.B. García Jurado0E. Roldán Romero1M.E. Pérez Montilla2R. Valverde Moyano3I.M. Bravo Rey4F. Delgado Acosta5F.A. Bravo-Rodríguez6Corresponding author.; Sección de Neurorradiología Diagnóstica y Terapéutica, UGC Radiodiagnóstico, Servicio de Neurología, Hospital Universitario Reina Sofía, Córdoba, SpainSección de Neurorradiología Diagnóstica y Terapéutica, UGC Radiodiagnóstico, Servicio de Neurología, Hospital Universitario Reina Sofía, Córdoba, SpainSección de Neurorradiología Diagnóstica y Terapéutica, UGC Radiodiagnóstico, Servicio de Neurología, Hospital Universitario Reina Sofía, Córdoba, SpainSección de Neurorradiología Diagnóstica y Terapéutica, UGC Radiodiagnóstico, Servicio de Neurología, Hospital Universitario Reina Sofía, Córdoba, SpainSección de Neurorradiología Diagnóstica y Terapéutica, UGC Radiodiagnóstico, Servicio de Neurología, Hospital Universitario Reina Sofía, Córdoba, SpainSección de Neurorradiología Diagnóstica y Terapéutica, UGC Radiodiagnóstico, Servicio de Neurología, Hospital Universitario Reina Sofía, Córdoba, SpainSección de Neurorradiología Diagnóstica y Terapéutica, UGC Radiodiagnóstico, Servicio de Neurología, Hospital Universitario Reina Sofía, Córdoba, SpainIntroduction: Haemorrhagic transformation is a major complication of acute ischaemic stroke (AIS). We sought to determine the predictors and clinical impact of intracranial haemorrhage (ICH) after revascularisation therapy. Methods: We conducted a retrospective, single-centre study including 235 patients with AIS who underwent intravenous recombinant tissue plasminogen activator (IV-rtPA) therapy and/or endovascular treatment. A binary logistic regression model was used to determine the variables associated with ICH, parenchymal haematomas (PH), modified Rankin Scale (mRS) scores, and mortality. Results: ICH was detected in 57 (30 with PH) of 183 patients included. Mechanical thrombectomy, either alone (OR 3.3 [1.42-7.63], P = .005) or in combination with IV-rtPA (OR 3.39 [1.52-7.56], P = .003), was associated with higher risk of ICH, while higher Alberta Stroke Program Early CT scores (OR 0.71 [0.55-0.91], P = .007) were associated with lower risk. Patients with older age (OR 1.07 [1.02-1.13], P = .006) and occlusion of the terminal branch of the internal carotid artery (OR 4.03 [1.35-11.99], P = .012) had a higher risk of PH, while the use of IV-rtPA alone (OR 0.24 [0.08-0.68], P = .008) was associated with lower risk of PH. Only PH was associated with disability as measured by the mRS (OR 3.2 [1.17-8.76], P = .02) and higher mortality (OR 5.06 [1.65-15.5], P = .005). Conclusions: Greater understanding about the predictors of ICH, mRS scores, and mortality could enable better selection of patients and treatments. Resumen: Introducción: La transformación hemorrágica es una complicación importante del ictus isquémico agudo (IIA). El propósito del trabajo es analizar el impacto clínico y los factores predictores de las hemorragias intracraneales (HIC) tras terapia revascularizadora. Métodos: Análisis retrospectivo monocéntrico de 235 pacientes con IIA tratados mediante trombólisis intravenosa (TIV) o tratamiento endovascular (TE). Se ha realizado un modelo de regresión logística binaria para determinar los factores asociados con las HIC, las hemorragias parenquimatosas (HP), la escala mRS y la mortalidad. Resultados: De los 183 pacientes incluidos, 57 tuvieron HIC (30 HP). El TE mecánico (OR 3,3 [1,42-7,63], p = 0,005) y la TIV junto con TE mecánico (OR 3,39 [1,52-7,56], p = 0,003) se han asociado a mayor riesgo de HIC, mientras que valores altos de ASPECTS (OR 0,71 [0,55-0,91], p = 0,007) se han asociado a menor riesgo. Mayor edad (OR 1,07 [1,02-1,13], p = 0,006) y la oclusión de la carótida interna terminal (OR 4,03 [1,35-11,99], p = 0,012) han sido factores predictores de HP, mientras que haber recibido TIV exclusivamente (OR 0,24 [0,08-0,68], p = 0,008) se ha asociado con menor riesgo. Solo las HP se han asociado a valores invalidantes de mRS (OR = 3,2 [1,17-8,76], p = 0,02) y mayor mortalidad (OR 5,06 [1,65-15,5], p = 0,005). Conclusiones: Una mejor comprensión de los factores predictores de HIC, mRS y mortalidad puede permitir una mejor selección de pacientes y tratamientos.http://www.sciencedirect.com/science/article/pii/S2173580820300699Hemorragia intracranealIctus isquémico agudoPronósticoTransformación hemorrágicaTratamiento endovascularTrombólisis intravenosa |
| spellingShingle | P.B. García Jurado E. Roldán Romero M.E. Pérez Montilla R. Valverde Moyano I.M. Bravo Rey F. Delgado Acosta F.A. Bravo-Rodríguez Incidence, prognosis, and prediction of haemorrhagic transformation after revascularisation for stroke Neurología (English Edition) Hemorragia intracraneal Ictus isquémico agudo Pronóstico Transformación hemorrágica Tratamiento endovascular Trombólisis intravenosa |
| title | Incidence, prognosis, and prediction of haemorrhagic transformation after revascularisation for stroke |
| title_full | Incidence, prognosis, and prediction of haemorrhagic transformation after revascularisation for stroke |
| title_fullStr | Incidence, prognosis, and prediction of haemorrhagic transformation after revascularisation for stroke |
| title_full_unstemmed | Incidence, prognosis, and prediction of haemorrhagic transformation after revascularisation for stroke |
| title_short | Incidence, prognosis, and prediction of haemorrhagic transformation after revascularisation for stroke |
| title_sort | incidence prognosis and prediction of haemorrhagic transformation after revascularisation for stroke |
| topic | Hemorragia intracraneal Ictus isquémico agudo Pronóstico Transformación hemorrágica Tratamiento endovascular Trombólisis intravenosa |
| url | http://www.sciencedirect.com/science/article/pii/S2173580820300699 |
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