Predicting hemorrhagic transformation after IV-tPA with CT perfusion

CT-perfusion (CTP) is widely used for treatment selection in acute ischemic stroke. Most studies have discussed CTP's role in the setting of endovascular thrombectomy. However, CTP's ability to predict hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) has not been assessed to date. Therefore, we aimed to examine the interrelation between CTP parameters, HT and clinical outcomes among patients treated with thrombolysis solely.

This study included consecutively enrolled acute stroke patients treated with thrombolysis only, from two comprehensive stroke centers. All patients underwent CTP on admission and follow-up non-contrast CT 24 h post-thrombolysis. CTP parameters including core and penumbra volumes were analyzed. Statistical analysis was performed to examine CTP parameters' association with HT and outcomes.

482 patients were included, of whom 427 (88.6 %) had adequate CTP acquisition (core volume 6.3 ± 15.1 ml, penumbra volume 29.5 ± 41.0 ml). Poor CTP acquisition was associated with worse baseline mRS, atrial fibrillation, lower rates of favorable outcome and higher rates of mortality. CTP core and penumbra presence were associated with the HT (p < 0.001, p = 0.009). After multivariate analysis, CTP core presence remained associated with HT, worse outcome, and mortality (p = 0.01, p = 0.025, p = 0.008, respectively).

CTP core presence, but not penumbra, is associated with higher rates of HT, poor outcome and mortality among acute stroke patients treated with IV-thrombolysis solely. Further studies are needed to clarify CTP's role in patient selection and prognosis for thrombolysis.