Angiographic Blush after Mechanical Thrombectomy is Associated with Hemorrhagic Transformation of Ischemic Stroke.

TitleAngiographic Blush after Mechanical Thrombectomy is Associated with Hemorrhagic Transformation of Ischemic Stroke.
Publication TypeJournal Article
Year of Publication2018
AuthorsOmran SSalehi, Boddu SReddy, Gusdon AM, Kummer B, Baradaran H, Patel P, Díaz I, Navi BB, Gupta A, Kamel H, Patsalides A
JournalJ Stroke Cerebrovasc Dis
Date Published2018 Nov
KeywordsAdolescent, Adult, Aged, Aged, 80 and over, Brain Ischemia, Cerebral Angiography, Cerebrovascular Circulation, Computed Tomography Angiography, Female, Humans, Intracranial Hemorrhages, Magnetic Resonance Angiography, Male, Middle Aged, Predictive Value of Tests, Registries, Retrospective Studies, Risk Factors, Stroke, Thrombectomy, Treatment Outcome, Young Adult

BACKGROUND AND PURPOSE: Risk factors for hemorrhagic transformation of ischemic stroke after mechanical thrombectomy (MT) are not well established. We conducted a study to determine if prominent angiographic cerebral vascularity following recanalization with thrombectomy (angiographic blush) is associated with hemorrhagic transformation.

METHODS: Using the Cornell AcutE Stroke Academic Registry, we identified stroke patients who had thrombectomy and achieved recanalization of anterior circulation large-vessel occlusion between 2012 and 2015. The exposure variable was presence of angiographic blush after recanalization, defined as capillary blush with or without early venous drainage. The primary outcome was volume of hemorrhagic transformation on brain imaging after thrombectomy, as determined by semiautomated volumetric analysis on computed tomography or magnetic resonance imaging among those adjudicated to have hemorrhagic conversion by neuroradiology investigators blinded to angiography results. Using a doubly robust estimator with propensity scores and outcome regression adjusting for demographics and known risk factors for hemorrhagic transformation, we evaluated whether angiographic blush after recanalization is associated with an increased volume of hemorrhagic transformation.

RESULTS: Among 48 eligible patients, 31 (64.6%) had angiographic blush and 26 (54.2%) had radiographic hemorrhagic transformation (mean volume, 7.6 ml). Patients with angiographic blush averaged lower thrombolysis in cerebral infarction scores and more often received intravenous thrombolysis. In adjusted analysis, angiographic blush was associated with an increased volume of hemorrhagic transformation: mean volume, 10.3ml (95% CI, 3.7-16.9 ml) with blush versus 1.8ml (95% Confidence Interval (CII = Confidence Interval), 0.1-3.4 ml) without (P = .01).

CONCLUSIONS: Presence of angiographic blush after MT was independently associated with the volume of hemorrhagic transformation.

Alternate JournalJ Stroke Cerebrovasc Dis
PubMed ID30087078
Grant ListK23 NS082367 / NS / NINDS NIH HHS / United States
K23 NS091395 / NS / NINDS NIH HHS / United States