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Intracranial Calcification is Predictive for Hemorrhagic Transformation and Prognosis After Intravenous Thrombolysis
Yao Yu1,2,3, Fu-Liang Zhang1,2,3, Yin-Meng Qu1,2,3
1Stroke Center, Department of Neurology, the First Hospital of Jilin University.
Insights
Arterial calcification volume in the brain lesion area is linked to hemorrhagic transformation after thrombolysis for stroke. More calcified vessels increase the risk of a poor prognosis.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Science
Background:
- Hemorrhagic transformation is a major complication of intravenous thrombolysis for ischemic stroke.
- Intracranial calcification is an indicator of atherosclerosis and cerebrovascular function, but its link to hemorrhagic transformation is not fully understood.
Purpose of the Study:
- To quantify calcification in cerebral vessels.
- To investigate the correlation between calcification parameters, hemorrhagic transformation, and prognosis after thrombolysis.
Main Methods:
- Retrospective analysis of 242 acute ischemic stroke patients receiving intravenous thrombolysis.
- CT scans before and 24 hours after thrombolysis were used to measure calcification volume (CT value >130 HU).
- Hemorrhagic transformation was classified using ECASS II criteria.
Main Results:
- Calcification was present in 214 patients.
- A higher calcification volume on the lesion side was associated with hemorrhagic transformation (p=0.004, OR=1.504).
- Patients with poor prognoses had more calcified vessels than those with good prognoses (p=0.014, OR=1.477).
Conclusions:
- Arterial calcification volume on the lesion side is a predictor of hemorrhagic transformation post-thrombolysis.
- Increased calcification correlates with a higher risk of poor prognosis in stroke patients.
Aim:
Hemorrhagic transformation is the major complication of intravenous thrombolysis. Calcification is used widely as an imaging indicator of atherosclerotic burden and cerebrovascular function. The relationship between intracranial calcification and hemorrhagic transformation has not been explored fully. We aimed to identify and quantify calcification in the main cerebral vessels to investigate the correlations between quantitative calcification parameters, hemorrhagic transformation, and prognosis.
Methods:
Acute, non-cardiogenic, ischemic stroke patients with anterior circulation who received intravenous thrombolysis therapy in the First Hospital of Jilin University were retrospectively and consecutively included. All included patients underwent a baseline CT before intravenous thrombolysis and a follow-up CT at 24 hours. A third-party software, ITK-SNAP, was used to segment and measure the calcification volume. A vascular non-bone component with a CT value ＞130 HU was considered calcified. Hemorrhagic transformation was determined based on the ECASS II classification criteria.
Results:
The study included 242 patients, 214 of whom were identified as having calcification. Thirty-one patients developed hemorrhagic transformation. The calcification volume on the lesion side (0.1ml) was associated with hemorrhagic transformation (p=0.004, OR=1.504, 95% CI: 1.140-1.985). Ninety-six patients had poor prognoses. The poor prognosis group had more calcified vessels than the good prognosis group (p=0.014, OR=1.477, 95% CI: 1.083-2.015).
Conclusions:
The arterial calcification volume on the lesion side is associated with hemorrhagic transformation after thrombolysis. The higher the number of calcified vessels, the greater the risk of poor prognosis.
