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<meta name="DC.Title" content="Hypoperfusion Intensity Ratio and Hemorrhagic Transformation in Patients with Successful Recanalization after Thrombectomy" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8329" />
<meta name="DC.Date" content="2024-10-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2024 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Hemorrhagic transformation remains a potentially devastating complication of acute ischemic stroke. We aimed to evaluate whether the hypoperfusion intensity ratio, a parameter derived from CT perfusion imaging, is associated with the development of hemorrhagic transformation in patients with anterior large-artery occlusion who had undergone thrombectomy.

MATERIALS AND METHODS: We retrospectively reviewed data from patients with consecutive acute ischemic strokes who had achieved successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) between January 2020 and December 2023. HIR was defined as the ratio of the volume of lesions with a time-to-maximum (Tmax) &gt;6 seconds to those with a Tmax &gt;10 second delay. The primary outcome, based on the European Cooperative Acute Stroke Study, was hemorrhagic transformation, diagnosed by follow-up imaging assessment in 24-hour windows, and radiologically classified as hemorrhagic infarction and parenchymal hematoma. The secondary outcome was a 3-month mRS score of ≥3.

RESULTS: Among 168 patients, 35 of 168 developed hemorrhagic transformation; 14 of 168 developed hemorrhagic infarction, and 21 of 168 developed parenchymal hematoma PH. After adjusting the latent covariates, increased hypoperfusion intensity ratio (per 0.1, adjusted OR [aOR] 1.68, 95% CI 1.26–2.25), ASPECTS (aOR 0.44, 95% CI 0.27–0.72), onset-to-puncture (aOR 1.01, 95% CI 1.00–1.02), and cardioembolism (aOR 5.6, 95% CI 1.59–19.7) were associated with hemorrhagic transformation in multivariable regression. The receiver operating characteristic curve indicated that hypoperfusion intensity ratio can predict hemorrhagic transformation accurately (area under the curve = 0.81; 95% CI, 0.738–0.882; P &lt; .001) and predict parenchymal hematoma (area under the curve = 0.801; 95% CI, 0.727–0.875; P &lt; .001).

CONCLUSIONS: Upon admission, hypoperfusion intensity ratio, an imaging parameter, predicted hemorrhagic transformation after reperfusion therapy in this patient population.

AIS
:   acute ischemic stroke
aOR
:   adjusted odds ratio
EVT
:   endovascular thrombectomy
HI
:   hemorrhagic infarction
HIR
:   hypoperfusion intensity ratio
HT
:   hemorrhagic transformation
LVO
:   large vessel occlusion
OTP
:   onset-to-puncture
PH
:   parenchymal hematoma
ROC
:   receiver operating characteristic
Tmax
:   time-to-maximum" />
<meta name="DC.Contributor" content="Jiaxiang You" />
<meta name="DC.Contributor" content="Xiaoxi Li" />
<meta name="DC.Contributor" content="Jun Xia" />
<meta name="DC.Contributor" content="Haopeng Li" />
<meta name="DC.Contributor" content="Jun Wang" />
<meta name="article:published_time" content="2024-10-01" />
<meta name="article:section" content="Neurovascular/Stroke Imaging" />
<meta name="citation_title" content="Hypoperfusion Intensity Ratio and Hemorrhagic Transformation in Patients with Successful Recanalization after Thrombectomy" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Hemorrhagic transformation remains a potentially devastating complication of acute ischemic stroke. We aimed to evaluate whether the hypoperfusion intensity ratio, a parameter derived from CT perfusion imaging, is associated with the development of hemorrhagic transformation in patients with anterior large-artery occlusion who had undergone thrombectomy.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively reviewed data from patients with consecutive acute ischemic strokes who had achieved successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) between January 2020 and December 2023. HIR was defined as the ratio of the volume of lesions with a time-to-maximum (Tmax) &amp;gt;6 seconds to those with a Tmax &amp;gt;10 second delay. The primary outcome, based on the European Cooperative Acute Stroke Study, was hemorrhagic transformation, diagnosed by follow-up imaging assessment in 24-hour windows, and radiologically classified as hemorrhagic infarction and parenchymal hematoma. The secondary outcome was a 3-month mRS score of ≥3.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Among 168 patients, 35 of 168 developed hemorrhagic transformation; 14 of 168 developed hemorrhagic infarction, and 21 of 168 developed parenchymal hematoma PH. After adjusting the latent covariates, increased hypoperfusion intensity ratio (per 0.1, adjusted OR [aOR] 1.68, 95% CI 1.26–2.25), ASPECTS (aOR 0.44, 95% CI 0.27–0.72), onset-to-puncture (aOR 1.01, 95% CI 1.00–1.02), and cardioembolism (aOR 5.6, 95% CI 1.59–19.7) were associated with hemorrhagic transformation in multivariable regression. The receiver operating characteristic curve indicated that hypoperfusion intensity ratio can predict hemorrhagic transformation accurately (area under the curve = 0.81; 95% CI, 0.738–0.882; &lt;i&gt;P&lt;/i&gt; &amp;lt; .001) and predict parenchymal hematoma (area under the curve = 0.801; 95% CI, 0.727–0.875; &lt;i&gt;P&lt;/i&gt; &amp;lt; .001).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Upon admission, hypoperfusion intensity ratio, an imaging parameter, predicted hemorrhagic transformation after reperfusion therapy in this patient population.&lt;/p&gt;" />
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<meta name="citation_author" content="Jiaxiang You" />
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<meta name="citation_author" content="Xiaoxi Li" />
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<meta name="twitter:title" content="Hypoperfusion Intensity Ratio and Hemorrhagic Transformation in Patients with Successful Recanalization after Thrombectomy" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Hemorrhagic transformation remains a potentially devastating complication of acute ischemic stroke. We aimed to evaluate whether the hypoperfusion intensity ratio, a parameter derived from CT perfusion imaging, is associated with the development of hemorrhagic transformation in patients with anterior large-artery occlusion who had undergone thrombectomy.

MATERIALS AND METHODS: We retrospectively reviewed data from patients with consecutive acute ischemic strokes who had achieved successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) between January 2020 and December 2023. HIR was defined as the ratio of the volume of lesions with a time-to-maximum (Tmax) &gt;6 seconds to those with a Tmax &gt;10 second delay. The primary outcome, based on the European Cooperative Acute Stroke Study, was hemorrhagic transformation, diagnosed by follow-up imaging assessment in 24-hour windows, and radiologically classified as hemorrhagic infarction and parenchymal hematoma. The secondary outcome was a 3-month mRS score of ≥3.

RESULTS: Among 168 patients, 35 of 168 developed hemorrhagic transformation; 14 of 168 developed hemorrhagic infarction, and 21 of 168 developed parenchymal hematoma PH. After adjusting the latent covariates, increased hypoperfusion intensity ratio (per 0.1, adjusted OR [aOR] 1.68, 95% CI 1.26–2.25), ASPECTS (aOR 0.44, 95% CI 0.27–0.72), onset-to-puncture (aOR 1.01, 95% CI 1.00–1.02), and cardioembolism (aOR 5.6, 95% CI 1.59–19.7) were associated with hemorrhagic transformation in multivariable regression. The receiver operating characteristic curve indicated that hypoperfusion intensity ratio can predict hemorrhagic transformation accurately (area under the curve = 0.81; 95% CI, 0.738–0.882; P &lt; .001) and predict parenchymal hematoma (area under the curve = 0.801; 95% CI, 0.727–0.875; P &lt; .001).

CONCLUSIONS: Upon admission, hypoperfusion intensity ratio, an imaging parameter, predicted hemorrhagic transformation after reperfusion therapy in this patient population.

AIS
:   acute ischemic stroke
aOR
:   adjusted odds ratio
EVT
:   endovascular thrombectomy
HI
:   hemorrhagic infarction
HIR
:   hypoperfusion intensity ratio
HT
:   hemorrhagic transformation
LVO
:   large vessel occlusion
OTP
:   onset-to-puncture
PH
:   parenchymal hematoma
ROC
:   receiver operating characteristic
Tmax
:   time-to-maximum" />
<meta name="og-title" property="og:title" content="Hypoperfusion Intensity Ratio and Hemorrhagic Transformation in Patients with Successful Recanalization after Thrombectomy" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/45/10/1475" />
<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: Hemorrhagic transformation remains a potentially devastating complication of acute ischemic stroke. We aimed to evaluate whether the hypoperfusion intensity ratio, a parameter derived from CT perfusion imaging, is associated with the development of hemorrhagic transformation in patients with anterior large-artery occlusion who had undergone thrombectomy.

MATERIALS AND METHODS: We retrospectively reviewed data from patients with consecutive acute ischemic strokes who had achieved successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) between January 2020 and December 2023. HIR was defined as the ratio of the volume of lesions with a time-to-maximum (Tmax) &gt;6 seconds to those with a Tmax &gt;10 second delay. The primary outcome, based on the European Cooperative Acute Stroke Study, was hemorrhagic transformation, diagnosed by follow-up imaging assessment in 24-hour windows, and radiologically classified as hemorrhagic infarction and parenchymal hematoma. The secondary outcome was a 3-month mRS score of ≥3.

RESULTS: Among 168 patients, 35 of 168 developed hemorrhagic transformation; 14 of 168 developed hemorrhagic infarction, and 21 of 168 developed parenchymal hematoma PH. After adjusting the latent covariates, increased hypoperfusion intensity ratio (per 0.1, adjusted OR [aOR] 1.68, 95% CI 1.26–2.25), ASPECTS (aOR 0.44, 95% CI 0.27–0.72), onset-to-puncture (aOR 1.01, 95% CI 1.00–1.02), and cardioembolism (aOR 5.6, 95% CI 1.59–19.7) were associated with hemorrhagic transformation in multivariable regression. The receiver operating characteristic curve indicated that hypoperfusion intensity ratio can predict hemorrhagic transformation accurately (area under the curve = 0.81; 95% CI, 0.738–0.882; P &lt; .001) and predict parenchymal hematoma (area under the curve = 0.801; 95% CI, 0.727–0.875; P &lt; .001).

CONCLUSIONS: Upon admission, hypoperfusion intensity ratio, an imaging parameter, predicted hemorrhagic transformation after reperfusion therapy in this patient population.

AIS
:   acute ischemic stroke
aOR
:   adjusted odds ratio
EVT
:   endovascular thrombectomy
HI
:   hemorrhagic infarction
HIR
:   hypoperfusion intensity ratio
HT
:   hemorrhagic transformation
LVO
:   large vessel occlusion
OTP
:   onset-to-puncture
PH
:   parenchymal hematoma
ROC
:   receiver operating characteristic
Tmax
:   time-to-maximum" />
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      <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">Neurovascular/Stroke Imaging</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Hypoperfusion Intensity Ratio and Hemorrhagic Transformation in Patients with Successful Recanalization after Thrombectomy</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Jiaxiang You</span>, <span class="highwire-citation-author" data-delta="1">Xiaoxi Li</span>, <span class="highwire-citation-author" data-delta="2">Jun Xia</span>, <span class="highwire-citation-author" data-delta="3">Haopeng Li</span> and <span class="highwire-citation-author" data-delta="4">Jun Wang</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 2024,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">45 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1475-1481; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8329 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-110797--6782400523" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Jiaxiang You </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Emergency Medicine (J.Y., J.X., H.L., J.W.), Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, Nanjing, China</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=Jiaxiang%2BYou%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=You%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on 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class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Jun%2BXia%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=Xia%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%3AJun%2BXia%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-3"><div class="author-tooltip-name">Haopeng Li </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Emergency Medicine (J.Y., J.X., H.L., J.W.), Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, Nanjing, China</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=Haopeng%2BLi%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=Li%20H&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%3AHaopeng%2BLi%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">Jun Wang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 45</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 10 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Oct 2024 </div></div>
      
      
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      <div class="highwire-cite-title">Hypoperfusion Intensity Ratio and Hemorrhagic Transformation in Patients with Successful Recanalization after Thrombectomy</div>  
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