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<meta name="DC.Title" content="Hemorrhage/Contrast Staining Areas after Mechanical Intra-Arterial Thrombectomy in Acute Ischemic Stroke: Imaging Findings and Clinical Significance" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3044" />
<meta name="DC.Date" content="2012-10-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The aim of this study was to report the CT evolution and clinical significance of HCA after intra-arterial mechanical thrombectomy (revascularization by using retrievers and/or other mechanical devices without concomitant delivery of intra-arterial thrombolytics) in our patients. These lesions are common after intra-arterial thrombolysis, being considered a negative prognostic sign. Their significance after pure mechanical thrombectomy remains unknown.

MATERIALS AND METHODS: Forty-eight patients were treated with mechanical thrombectomy by using retrievable stents between April 2010 and February 2011. All patients underwent initial (first 24 hours) and follow-up (48–72 hours) nonenhanced CT. We retrospectively analyzed the clinical and radiologic data of the patients with HCA and compared them with controls.

RESULTS: Fifteen of 48 patients presented with HCA. The site of occlusion was the MCA in 7 patients, both the extra- and intracranial segments of the ICA in 6, and the intracranial ICA in 2. In 7 patients, previous intravenous thrombolysis was administered. Complete recanalization (TICI 3) was achieved in 12 patients, and incomplete recanalization (TICI 2b), in 3. The location of HCA was the subarachnoid space in 6 patients, the brain parenchyma in 4 patients, and both in 5 patients. The HCA were asymptomatic in all patients. There was no statistical difference in final NIHSS score reduction (NIHSS pretreatment–NIHSS at discharge) between patients and controls.

CONCLUSIONS: In our series, HCA are common after mechanical thrombectomy but do not carry an increased risk of symptomatic hemorrhage or negative prognosis. These data might be related to the high rate of recanalization and the absence of intra-arterial thrombolytics.

ASK
:   Australian Streptokinase Trial
HCA
:   hemorrhage/contrast staining areas
Mast-E
:   Multicentre Acute Stroke Trial-Europe
MAST-I
:   Multicentre Acute Stroke Trial-Italy
TICI
:   thrombolysis in cerebral infarction" />
<meta name="DC.Contributor" content="G. Parrilla" />
<meta name="DC.Contributor" content="B. García-Villalba" />
<meta name="DC.Contributor" content="M. Espinosa de Rueda" />
<meta name="DC.Contributor" content="J. Zamarro" />
<meta name="DC.Contributor" content="E. Carrión" />
<meta name="DC.Contributor" content="F. Hernández-Fernández" />
<meta name="DC.Contributor" content="J. Martín" />
<meta name="DC.Contributor" content="R. Hernández-Clares" />
<meta name="DC.Contributor" content="A. Morales" />
<meta name="DC.Contributor" content="A. Moreno" />
<meta name="article:published_time" content="2012-10-01" />
<meta name="article:section" content="Brain" />
<meta name="citation_title" content="Hemorrhage/Contrast Staining Areas after Mechanical Intra-Arterial Thrombectomy in Acute Ischemic Stroke: Imaging Findings and Clinical Significance" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;The aim of this study was to report the CT evolution and clinical significance of HCA after intra-arterial mechanical thrombectomy (revascularization by using retrievers and/or other mechanical devices without concomitant delivery of intra-arterial thrombolytics) in our patients. These lesions are common after intra-arterial thrombolysis, being considered a negative prognostic sign. Their significance after pure mechanical thrombectomy remains unknown.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Forty-eight patients were treated with mechanical thrombectomy by using retrievable stents between April 2010 and February 2011. All patients underwent initial (first 24 hours) and follow-up (48–72 hours) nonenhanced CT. We retrospectively analyzed the clinical and radiologic data of the patients with HCA and compared them with controls.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Fifteen of 48 patients presented with HCA. The site of occlusion was the MCA in 7 patients, both the extra- and intracranial segments of the ICA in 6, and the intracranial ICA in 2. In 7 patients, previous intravenous thrombolysis was administered. Complete recanalization (TICI 3) was achieved in 12 patients, and incomplete recanalization (TICI 2b), in 3. The location of HCA was the subarachnoid space in 6 patients, the brain parenchyma in 4 patients, and both in 5 patients. The HCA were asymptomatic in all patients. There was no statistical difference in final NIHSS score reduction (NIHSS pretreatment–NIHSS at discharge) between patients and controls.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;In our series, HCA are common after mechanical thrombectomy but do not carry an increased risk of symptomatic hemorrhage or negative prognosis. These data might be related to the high rate of recanalization and the absence of intra-arterial thrombolytics.&lt;/p&gt;" />
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<meta name="citation_author" content="B. García-Villalba" />
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<meta name="citation_author" content="M. Espinosa de Rueda" />
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<meta name="twitter:title" content="Hemorrhage/Contrast Staining Areas after Mechanical Intra-Arterial Thrombectomy in Acute Ischemic Stroke: Imaging Findings and Clinical Significance" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The aim of this study was to report the CT evolution and clinical significance of HCA after intra-arterial mechanical thrombectomy (revascularization by using retrievers and/or other mechanical devices without concomitant delivery of intra-arterial thrombolytics) in our patients. These lesions are common after intra-arterial thrombolysis, being considered a negative prognostic sign. Their significance after pure mechanical thrombectomy remains unknown.

MATERIALS AND METHODS: Forty-eight patients were treated with mechanical thrombectomy by using retrievable stents between April 2010 and February 2011. All patients underwent initial (first 24 hours) and follow-up (48–72 hours) nonenhanced CT. We retrospectively analyzed the clinical and radiologic data of the patients with HCA and compared them with controls.

RESULTS: Fifteen of 48 patients presented with HCA. The site of occlusion was the MCA in 7 patients, both the extra- and intracranial segments of the ICA in 6, and the intracranial ICA in 2. In 7 patients, previous intravenous thrombolysis was administered. Complete recanalization (TICI 3) was achieved in 12 patients, and incomplete recanalization (TICI 2b), in 3. The location of HCA was the subarachnoid space in 6 patients, the brain parenchyma in 4 patients, and both in 5 patients. The HCA were asymptomatic in all patients. There was no statistical difference in final NIHSS score reduction (NIHSS pretreatment–NIHSS at discharge) between patients and controls.

CONCLUSIONS: In our series, HCA are common after mechanical thrombectomy but do not carry an increased risk of symptomatic hemorrhage or negative prognosis. These data might be related to the high rate of recanalization and the absence of intra-arterial thrombolytics.

ASK
:   Australian Streptokinase Trial
HCA
:   hemorrhage/contrast staining areas
Mast-E
:   Multicentre Acute Stroke Trial-Europe
MAST-I
:   Multicentre Acute Stroke Trial-Italy
TICI
:   thrombolysis in cerebral infarction" />
<meta name="og-title" property="og:title" content="Hemorrhage/Contrast Staining Areas after Mechanical Intra-Arterial Thrombectomy in Acute Ischemic Stroke: Imaging Findings and Clinical Significance" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/33/9/1791" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: The aim of this study was to report the CT evolution and clinical significance of HCA after intra-arterial mechanical thrombectomy (revascularization by using retrievers and/or other mechanical devices without concomitant delivery of intra-arterial thrombolytics) in our patients. These lesions are common after intra-arterial thrombolysis, being considered a negative prognostic sign. Their significance after pure mechanical thrombectomy remains unknown.

MATERIALS AND METHODS: Forty-eight patients were treated with mechanical thrombectomy by using retrievable stents between April 2010 and February 2011. All patients underwent initial (first 24 hours) and follow-up (48–72 hours) nonenhanced CT. We retrospectively analyzed the clinical and radiologic data of the patients with HCA and compared them with controls.

RESULTS: Fifteen of 48 patients presented with HCA. The site of occlusion was the MCA in 7 patients, both the extra- and intracranial segments of the ICA in 6, and the intracranial ICA in 2. In 7 patients, previous intravenous thrombolysis was administered. Complete recanalization (TICI 3) was achieved in 12 patients, and incomplete recanalization (TICI 2b), in 3. The location of HCA was the subarachnoid space in 6 patients, the brain parenchyma in 4 patients, and both in 5 patients. The HCA were asymptomatic in all patients. There was no statistical difference in final NIHSS score reduction (NIHSS pretreatment–NIHSS at discharge) between patients and controls.

CONCLUSIONS: In our series, HCA are common after mechanical thrombectomy but do not carry an increased risk of symptomatic hemorrhage or negative prognosis. These data might be related to the high rate of recanalization and the absence of intra-arterial thrombolytics.

ASK
:   Australian Streptokinase Trial
HCA
:   hemorrhage/contrast staining areas
Mast-E
:   Multicentre Acute Stroke Trial-Europe
MAST-I
:   Multicentre Acute Stroke Trial-Italy
TICI
:   thrombolysis in cerebral infarction" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node12104--5" data-node-nid="12104" id="top-node-12104--6403297437" data-pisa="ajnr;33/9/1791" data-pisa-master="ajnr;ajnr.A3044" data-apath="/ajnr/33/9/1791.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Brain</span></span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-series highwire-cite-metadata">F</span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Hemorrhage/Contrast Staining Areas after Mechanical Intra-Arterial Thrombectomy in Acute Ischemic Stroke: Imaging Findings and Clinical Significance</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">G. Parrilla</span>, <span class="highwire-citation-author" data-delta="1">B. García-Villalba</span>, <span class="highwire-citation-author" data-delta="2">M. Espinosa de Rueda</span>, <span class="highwire-citation-author" data-delta="3">J. Zamarro</span>, <span class="highwire-citation-author" data-delta="4">E. Carrión</span>, <span class="highwire-citation-author" data-delta="5">F. Hernández-Fernández</span>, <span class="highwire-citation-author" data-delta="6">J. Martín</span>, <span class="highwire-citation-author" data-delta="7">R. Hernández-Clares</span>, <span class="highwire-citation-author" data-delta="8">A. Morales</span> and <span class="highwire-citation-author" data-delta="9">A. Moreno</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">October 2012,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">33 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1791-1796; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3044 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12104--6403297437" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">G. Parrilla </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Departments of Interventional Neuroradiology (G.P., B.G.-V., M.E.d.R., J.Z., F.H.-F., A. Moreno)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology (G.P., E.C., J.M., R.H.-C., A. Morales), Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BParrilla%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Parrilla%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AG.%2BParrilla%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">B. García-Villalba </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Departments of Interventional Neuroradiology (G.P., B.G.-V., M.E.d.R., J.Z., F.H.-F., A. 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Espinosa de Rueda </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Departments of Interventional Neuroradiology (G.P., B.G.-V., M.E.d.R., J.Z., F.H.-F., A. 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Zamarro </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Departments of Interventional Neuroradiology (G.P., B.G.-V., M.E.d.R., J.Z., F.H.-F., A. Moreno)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BZamarro%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zamarro%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.%2BZamarro%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">E. Carrión </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology (G.P., E.C., J.M., R.H.-C., A. Morales), Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.%2BCarri%C3%B3n%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Carri%C3%B3n%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AE.%2BCarri%25C3%25B3n%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">F. Hernández-Fernández </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Departments of Interventional Neuroradiology (G.P., B.G.-V., M.E.d.R., J.Z., F.H.-F., A. Moreno)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.%2BHern%C3%A1ndez-Fern%C3%A1ndez%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hern%C3%A1ndez-Fern%C3%A1ndez%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AF.%2BHern%25C3%25A1ndez-Fern%25C3%25A1ndez%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">J. 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Morales), Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BHern%C3%A1ndez-Clares%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hern%C3%A1ndez-Clares%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AR.%2BHern%25C3%25A1ndez-Clares%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">A. 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<p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> The aim of this study was to report the CT evolution and clinical significance of HCA after intra-arterial mechanical thrombectomy (revascularization by using retrievers and/or other mechanical devices without concomitant delivery of intra-arterial thrombolytics) in our patients. These lesions are common after intra-arterial thrombolysis, being considered a negative prognostic sign. Their significance after pure mechanical thrombectomy remains unknown.</p>
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<p id="p-3"><strong>MATERIALS AND METHODS:</strong> Forty-eight patients were treated with mechanical thrombectomy by using retrievable stents between April 2010 and February 2011. All patients underwent initial (first 24 hours) and follow-up (48–72 hours) nonenhanced CT. We retrospectively analyzed the clinical and radiologic data of the patients with HCA and compared them with controls.</p>
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<p id="p-4"><strong>RESULTS:</strong> Fifteen of 48 patients presented with HCA. The site of occlusion was the MCA in 7 patients, both the extra- and intracranial segments of the ICA in 6, and the intracranial ICA in 2. In 7 patients, previous intravenous thrombolysis was administered. Complete recanalization (TICI 3) was achieved in 12 patients, and incomplete recanalization (TICI 2b), in 3. The location of HCA was the subarachnoid space in 6 patients, the brain parenchyma in 4 patients, and both in 5 patients. The HCA were asymptomatic in all patients. There was no statistical difference in final NIHSS score reduction (NIHSS pretreatment–NIHSS at discharge) between patients and controls.</p>
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<p id="p-5"><strong>CONCLUSIONS:</strong> In our series, HCA are common after mechanical thrombectomy but do not carry an increased risk of symptomatic hemorrhage or negative prognosis. These data might be related to the high rate of recanalization and the absence of intra-arterial thrombolytics.</p>
</div></div><div class="section glossary" id="glossary-1">
<h2>ABBREVIATIONS:</h2>
<dl id="def-list-1"><dt id="def-item-1">ASK<span class="def-item-dt-sep"></span></dt><dd>Australian Streptokinase Trial<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">HCA<span class="def-item-dt-sep"></span></dt><dd>hemorrhage/contrast staining areas<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">Mast-E<span class="def-item-dt-sep"></span></dt><dd>Multicentre Acute Stroke Trial-Europe<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">MAST-I<span class="def-item-dt-sep"></span></dt><dd>Multicentre Acute Stroke Trial-Italy<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">TICI<span class="def-item-dt-sep"></span></dt><dd>thrombolysis in cerebral infarction</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2012 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/33/9/1791.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 33</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 9 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Oct 2012 </div></div>
      
      
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2012, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">33 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1791-1796; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3044 </span></div>
  
  
  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2012, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">33 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1791-1796; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3044 </span></div>
  
  
  
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