Volumetric Infarct Size Predicts Secondary Haemorrhagic Transformation of Ischaemic Stroke

Area of Science:

• Neurology
• Radiology
• Internal Medicine

Background:

• Identifying predictors of secondary hemorrhagic transformation is crucial for acute ischemic stroke management.
• Secondary hemorrhagic transformation (HI and PH) is a significant complication after stroke, especially with thrombolytic therapy.

Purpose of the Study:

• To determine clinical, laboratory, and radiological predictors of spontaneous secondary hemorrhagic transformation.
• To investigate these predictors in both rt-PA treated and non-treated acute ischemic stroke patients.

Main Methods:

• Retrospective analysis of 909 acute ischemic stroke patients (161 rt-PA treated, 748 non-treated) with MRI.
• Clinical, laboratory, and radiological data were analyzed using ANOVA and regression analyses.
• Occurrence of hemorrhagic infarction (HI) and parenchymal hemorrhage (PH) within 5 days post-stroke was assessed.

Main Results:

• Patients treated with rt-PA had more severe clinical conditions and larger infarct volumes, with higher rates of HI and PH.
• In non-treated patients, clinical status did not differ between those with and without HI/PH.
• Atrial fibrillation, diabetes mellitus, and infarct volume were identified as significant predictors of HI and PH.

Conclusions:

• Greater infarct size is associated with increased risk of secondary hemorrhagic transformation in acute ischemic stroke, with or without rt-PA.
• Risk factor reduction may prevent both ischemic stroke and its secondary hemorrhagic transformation.
• Radiological assessment of infarct volume is a relevant prognostic factor for hemorrhagic transformation.