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PT  - JOURNAL ARTICLE
AU  - You, Jiaxiang
AU  - Li, Xiaoxi
AU  - Xia, Jun
AU  - Li, Haopeng
AU  - Wang, Jun
TI  - Hypoperfusion Intensity Ratio and Hemorrhagic Transformation in Patients with Successful Recanalization after Thrombectomy
AID  - 10.3174/ajnr.A8329
DP  - 2024 Oct 01
TA  - American Journal of Neuroradiology
PG  - 1475--1481
VI  - 45
IP  - 10
4099  - http://www.ajnr.org/content/45/10/1475.short
4100  - http://www.ajnr.org/content/45/10/1475.full
SO  - Am. J. Neuroradiol.2024 Oct 01; 45
AB  - 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) &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.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 &amp;lt; .001) and predict parenchymal hematoma (area under the curve = 0.801; 95% CI, 0.727–0.875; P &amp;lt; .001).CONCLUSIONS: Upon admission, hypoperfusion intensity ratio, an imaging parameter, predicted hemorrhagic transformation after reperfusion therapy in this patient population.AISacute ischemic strokeaORadjusted odds ratioEVTendovascular thrombectomyHIhemorrhagic infarctionHIRhypoperfusion intensity ratioHThemorrhagic transformationLVOlarge vessel occlusionOTPonset-to-puncturePHparenchymal hematomaROCreceiver operating characteristicTmaxtime-to-maximum