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Regional perfusion parameters as potential indicators of parenchymal hematoma risk following reperfusion therapy for
Xinyu Liu1, Lan Hong1, Guangjian Zhao2
1Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Background:
Parenchymal hematoma (PH) is a common complication of acute ischemic stroke, particularly following reperfusion therapy.
Objective:
This study aimed to explore the relationship between regional perfusion parameters and PH outcomes in stroke patients treated beyond the conventional time window.
Design:
This retrospective cohort study included patients from the CHinese Acute tissue-Based imaging selection for Lysis In Stroke-Tenecteplase (CHABLIS-T) trials and the Huashan Hospital stroke registry.
Methods:
Regional perfusion parameters were calculated within Alberta Stroke Program Early CT Score (ASPECTS)-defined regions of interest (ROIs). Mirror indices of cerebral blood flow (CBFmi), cerebral blood volume (CBVmi), and mean transit time were derived as the ratios of median perfusion values within ASPECTS-ROIs in the lesion and its contralateral hemisphere. Absolute time to maximum values for symptomatic ASPECTS-ROIs were also recorded. Logistic regression evaluated associations between perfusion parameters and PH outcomes, with predictive performance assessed using receiver operating characteristic (ROC) curves and area under the curve (AUC). Sensitivity analysis was conducted in patients receiving endovascular treatment (EVT) and in the trial-only population.
Results:
Of 1010 patients screened, 313 met the inclusion criteria, and 54 developed PH. Multivariable stepwise logistic regression identified reduced CBFmi (adjusted odds ratios (aOR) = 0.07, 95% confidence interval (CI), 0.02-0.30, p < 0.001) and CBVmi (aOR = 0.11, 95% CI, 0.03-0.45, p = 0.002) in the lentiform nucleus as significant predictors of PH. ROC analysis showed good discriminative performance (AUC: CBFmi 0.71 (95% CI, 0.62-0.80), CBVmi 0.70 (95% CI, 0.61-0.79)). Sensitivity analysis in patients undergoing EVT and trial-only patients drew similar results.
Conclusion:
Decreased CBFmi and CBVmi in the lentiform nucleus were independently associated with an elevated risk of PH, highlighting their potential utility in predicting hemorrhagic complications.
Trial Registration:
NCT04086147, NCT04516993.
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