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Contrast enhancement after mechanical thrombectomy: clinical correlations and impact on outcomes
Farid Khasiyev1, Wilson Rodriguez2, Gunjanpreet Kaur2
1Department of Neurology, SSM Health Saint Louis University Hospital, 1225 S Grand Blvd, St. Louis, MO, 63104, USA. fxasiyev@yahoo.com.
Insights
Contrast enhancement after mechanical thrombectomy is linked to hyperlipidemia, stroke, and early neurological decline. This finding is crucial for optimizing stroke care strategies.
Area of Science:
- Neurology
- Radiology
- Interventional Medicine
Background:
- Contrast enhancement (CE) following mechanical thrombectomy (MT) for stroke has a variable reported prevalence (31–88%).
- Predictors and clinical impact of CE post-MT require further investigation.
Purpose of the Study:
- To identify predictors of contrast enhancement (CE) after mechanical thrombectomy (MT).
- To evaluate the impact of CE on patient outcomes following MT.
Main Methods:
- Retrospective analysis of 106 patients undergoing MT (2018–2022).
- Inclusion criteria: pre- and post-MT head CT scans within 24 hours.
- Comparison of demographic, clinical, laboratory, neuroimaging, and procedural variables using regression analysis.
Main Results:
- CE observed in 32.1% of patients; higher prevalence of hyperlipidemia in the CE group.
- CE correlated with increased NIHSS score (≥4) within 24h, intracerebral hemorrhage (ICH) incidence, and poorer discharge mRS (0-3).
- Adjusted analysis confirmed associations between CE, hyperlipidemia, ICH, early neurological deterioration, and unfavorable discharge outcomes.
Conclusions:
- Contrast enhancement (CE) post-mechanical thrombectomy (MT) is associated with hyperlipidemia, intracerebral hemorrhage (ICH), and early neurological deterioration.
- CE predicts poor functional outcomes at discharge but not long-term outcomes.
- Further research is needed to elucidate CE pathophysiology and optimize stroke care.
Purpose:
Contrast enhancement (CE) after mechanical thrombectomy (MT) remains a subject of investigation, with a reported prevalence ranging from 31 to 88%. We examined our patients to identify predictors of CE and its impact on outcomes, an aspect that remains understudied.
Methods:
We retrospectively analyzed 106 patients who underwent MT at our hospital between 2018 and 2022. The inclusion criteria involved patients who underwent two head CT scans: one immediately after the procedure and a repeat scan within 24 h. This study compared demographic, clinical, laboratory, neuroimaging, and procedure-related variables between patients with CE and those without hyperdensity. Regression analysis was employed to determine the associations between CEs and significant variables.
Results:
Among the analyzed patients, 32.1% had CE. Hyperlipidemia was more prevalent in the CE group. CE correlated with an increase in the National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 within 24 h, intracerebral hemorrhage (ICH) incidence, elevated NIHSS score, and a decreased rate of modified Rankin scale (mRS) 0-3 upon discharge. The adjusted model demonstrated a significant association between CE and the incidence of hyperlipidemia and ICH, with an increase in NIHSS score ≥ 4 within 24 h of ICH and a lower mRS score of 0-3 upon discharge.
Conclusions:
CE is associated with hyperlipidemia, ICH, early neurological deterioration, and poor functional outcomes upon discharge. However, no similar association was shown for long-term outcomes. Further studies are required to clarify the pathophysiology of CE and its implications for optimizing stroke care.
