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A New Classification System for Postinterventional Cerebral Hyperdensity: The Influence on Hemorrhagic Transformation
Yuan Shao1, Yuyun Xu1, Yumei Li1
1Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
Neural Plasticity
|December 3, 2021
Summary
Postinterventional cerebral hyperdensity (PCHD) is a strong predictor of hemorrhagic transformation (HT) after mechanical thrombectomy. A new PCHD classification system helps identify patients at higher risk for early neurological deterioration and poor outcomes.
Area of Science:
- Neurology
- Radiology
- Interventional Cardiology
Background:
- Postinterventional cerebral hyperdensity (PCHD) is frequently observed in acute ischemic stroke patients undergoing mechanical thrombectomy.
- A novel classification for PCHD is proposed to evaluate its association with hemorrhagic transformation (HT).
- The study also investigates the clinical prognosis related to PCHD.
Purpose of the Study:
- To develop and validate a new classification system for PCHD.
- To assess the correlation between the proposed PCHD classification and HT.
- To analyze the predictive value of PCHD for clinical outcomes, including early neurological deterioration (END) and 3-month functional status (modified Rankin Scale - mRS).
Main Methods:
- Retrospective analysis of data from 189 acute stroke patients.
- Classification of HT based on European Cooperative Acute Stroke Study (ECASS) criteria.
- Development of a 4-tier PCHD classification (PCHD-1 to PCHD-4) based on HT classification.
- Evaluation of prognosis using END and 3-month mRS scores.
Main Results:
- PCHD was significantly correlated with HT (r=0.751, p<0.01), with a higher incidence of HT in the PCHD group (77.8%) compared to the no-PCHD group (14.8%).
- PCHD and NIHSS score at admission were independent predictors of END (p<0.001 and p=0.015, respectively). The optimal cutoff for PCHD predicting END was >2.
- PCHD, NIHSS score, and good vascular recanalization were independently associated with 3-month mRS. The optimal cutoff for PCHD predicting mRS was >1.
Conclusions:
- The proposed PCHD classification serves as an early indicator for HT.
- Higher PCHD grades (PCHD-3 and PCHD-4) are strong predictors of END.
- PCHD-1 is associated with a relatively benign prognosis regarding 3-month functional outcomes.
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