Immediate CT change after thrombectomy predicting symptomatic hemorrhagic transformation

Area of Science:

• Neuroradiology
• Stroke Imaging
• Interventional Neurology

Background:

• Assessing the risk of symptomatic hemorrhage after mechanical thrombectomy (MT) is crucial for acute ischemic stroke management.
• Noncontrast computed tomography (CT) performed immediately post-MT can reveal contrast accumulation, a potential imaging biomarker.

Purpose of the Study:

• To evaluate the prognostic value of contrast accumulation on immediate post-MT noncontrast CT for predicting symptomatic hemorrhage.
• To determine if the pattern and extent of contrast accumulation correlate with symptomatic hemorrhage risk.

Main Methods:

• Retrospective analysis of 101 acute ischemic stroke patients undergoing MT.
• Categorization of patients based on symptomatic hemorrhage, asymptomatic hemorrhage, or no hemorrhage.
• Analysis of contrast accumulation patterns and maximal Hounsfield units (HU) in cortical areas using ROC curves, sensitivity, specificity, and odds ratios.

Main Results:

• Contrast accumulation was significantly associated with all types of hemorrhagic transformation (p < 0.01).
• Cortical involvement of contrast accumulation was more frequent in patients with symptomatic hemorrhage (p < 0.01).
• Maximal HU > 100 in cortical areas demonstrated high predictive value (AUC=0.887, sensitivity=77.8%, specificity=95.7%, OR=77.0) for symptomatic hemorrhage.

Conclusions:

• Cortical involvement of contrast accumulation with a maximal HU > 100 is a strong predictor of symptomatic hemorrhage post-endovascular reperfusion treatment.
• This imaging finding can aid in risk stratification and clinical decision-making for stroke patients undergoing MT.