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Value of angiographic regional circulation signs in predicting hemorrhagic transformation after endovascular thrombectomy - 06/08/22

Doi : 10.1016/j.neurad.2022.07.001 
Shuai Yu 1, Hang Zhang 1, Qian-mei Jiang, Jie Hou, Zhi-liang Guo 2, , Guo-dong Xiao 2,
 Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China 

Corresponding author: Guo-dong Xiao and Zhi-liang Guo, No.1055, Sanxiang Road, Suzhou, Jiangsu Province of China.No.1055, Sanxiang RoadSuzhouJiangsu Province of ChinaChina
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 06 August 2022

Highlights

Patients with postoperative HT or PH were more likely to have regional circulation signs (early venous filling and basal ganglia blush).
Investigate the effect of different stroke severity on the predictive value of regional circulation signs.
Patients with severe stroke accompanied by regional circulation signs have a seemingly higher risk of HT relative to PH.

Le texte complet de cet article est disponible en PDF.

Abstract

Objective

The aim of this study was to evaluate the predictive value of the early venous filling (EVF) sign, the basal ganglia blush (BGB) sign and both the EVF and BGB signs for the hemorrhagic transformation (HT) and parenchymal hematoma (PH) in patients after endovascular thrombectomy.

Methods

This study included patients with anterior circulation large vessel occlusive stroke treated with endovascular thrombectomy from May 2017 to December 2021. The predictive value of regional circulation signs for HT and PH were assessed using logistic regression models adjusted for confounders, and further a multiplicative interaction term was added to investigate the effect of different stroke severity on its predictive value.

Results

Among the 350 patients included and after adjusting for confounders, those with the EVF sign (adjusted OR=3.934, 95% CI:2.326–6.655), the BGB sign (adjusted OR=3.776, 95% CI:2.341–6.089), and both the EVF and BGB signs (adjusted OR=3.250, 95% CI: 1.886–5.600) were more likely to have HT. The EVF sign (adjusted OR=3.545, 95% CI:2.036–6.170), the BGB sign (adjusted OR=3.742, 95% CI:2.110–6.639), and both the EVF and BGB signs (adjusted OR=3.139, 95% CI: 1.776–5.549) were also significantly correlated with PH. When stratified according to stroke severity, we further found there were significant interactions between regional circulation signs and stroke severity on postoperative HT and PH (all P for interaction < 0.001).

Conclusions

Regional circulation signs were independently associated with HT and PH after endovascular thrombectomy and had a higher predictive value in patients with severe stroke compared with mild to moderate stroke.

Le texte complet de cet article est disponible en PDF.

Keywords : Acute ischemic stroke, Endovascular thrombectomy, Angiography, Regional circulation sign, Hemorrhagic transformation

Abbreviations : AIS, ET, HT, PH, EVF, BGB, NIHSS, mTICI, ASITN/SIR, ASPECTS, OPT, SBP, DBP, ICA, MCA, SR, CA, SD, IQR, mRS


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