Predicting hemorrhagic transformation after IV-tPA with CT perfusion

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• CT-perfusion (CTP) is crucial for treatment selection in acute ischemic stroke, primarily studied in endovascular thrombectomy.
• The predictive value of CTP for hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) remains unassessed.

Purpose of the Study:

• To investigate the association between CTP parameters and HT in acute ischemic stroke patients treated solely with IVT.
• To examine the relationship between CTP findings and clinical outcomes in this patient cohort.

Main Methods:

• Retrospective analysis of consecutively enrolled acute stroke patients treated with IVT only.
• CTP was performed on admission, with follow-up non-contrast CT at 24 hours.
• Statistical analysis correlated CTP core and penumbra volumes with HT and clinical outcomes.

Main Results:

• In 427 patients with adequate CTP, core volume was 6.3 ml and penumbra volume was 29.5 ml.
• CTP core and penumbra presence correlated with HT (p < 0.001, p = 0.009).
• Multivariate analysis confirmed CTP core presence associated with HT, worse outcomes, and mortality (p = 0.01, p = 0.025, p = 0.008).

Conclusions:

• CTP core presence, not penumbra, predicts higher rates of HT, poor outcomes, and mortality in acute stroke patients receiving IVT.
• Further research is needed to define CTP's role in optimizing thrombolysis patient selection and prognosis.