High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke

Blood-brain barrier (BBB) permeability has been proposed as a predictor of hemorrhagic transformation (HT) after tissue plasminogen activator (tPA) administration; however, the reliability of perfusion computed tomography (PCT) permeability imaging for predicting HT is uncertain. We aimed to determi...

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Autores: Puig Alcántara, Josep, Daunis-i-Estadella, Pepus, Van Eendenburg, Cecile, Carrillo García, María, Aboud, Carlos, Hernández Pérez, María, Serena, Joaquín, Biarnés, Carles, Nael, Kambiz, Liebeskind, David S., Thomalla, Götz, Menon, Bijoy K., Demchuk, Andrew, Wintermark, Max, Pedraza, S., Castellanos Rodrigo, Mar
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2017
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10256/15618
Acceso en línea:http://hdl.handle.net/10256/15618
Access Level:acceso abierto
Palabra clave:Malalties cerebrovasculars
Cerebrovascular disease
Isquèmia cerebral
Cerebral ischemia
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spelling High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in strokePuig Alcántara, JosepDaunis-i-Estadella, PepusVan Eendenburg, CecileCarrillo García, MaríaAboud, CarlosHernández Pérez, MaríaSerena, JoaquínBiarnés, CarlesNael, KambizLiebeskind, David S.Thomalla, GötzMenon, Bijoy K.Demchuk, AndrewWintermark, MaxPedraza, S.Castellanos Rodrigo, MarMalalties cerebrovascularsCerebrovascular diseaseIsquèmia cerebralCerebral ischemiaBlood-brain barrier (BBB) permeability has been proposed as a predictor of hemorrhagic transformation (HT) after tissue plasminogen activator (tPA) administration; however, the reliability of perfusion computed tomography (PCT) permeability imaging for predicting HT is uncertain. We aimed to determine the performance of high-permeability region size on PCT (HPrsPCT) in predicting HT after intravenous tPA administration in patients with acute stroke. Methods We performed a multimodal CT protocol (non-contrast CT, PCT, CT angiography) to prospectively study patients with middle cerebral artery occlusion treated with tPA within 4.5 hours of symptom onset. HT was graded at 24 hours using the European-Australasian Acute Stroke Study II criteria. ROC curves selected optimal volume threshold, and multivariate logistic regression analysis identified predictors of HT. Results The study included 156 patients (50% male, median age 75.5 years). Thirty-seven (23,7%) developed HT [12 (7,7%), parenchymal hematoma type 2 (PH-2)]. At admission, patients with HT had lower platelet values, higher NIHSS scores, increased ischemic lesion volumes, larger HPrs-PCT, and poorer collateral status. The negative predictive value of HPrs-PCT at a threshold of 7mL/100g/min was 0.84 for HT and 0.93 for PH-2. The multiple regression analysis selected HPrs-PCT at 7mL/100g/min combined with platelets and baseline NIHSS score as the best model for predicting HT (AUC 0.77). HPrs-PCT at 7mL/100g/min was the only independent predictor of PH-2 (OR 1, AUC 0.68, p = 0.045). Conclusions HPrs-PCT can help predict HT after tPA, and is particularly useful in identifying patients at low risk of developing HTPublic Library of Science (PLoS)2017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionpeer-reviewedapplication/pdfhttp://hdl.handle.net/10256/15618http://hdl.handle.net/10256/15618PLoS One, 2017, vol. 12, núm. 11, p. e0188238Articles publicats (D-IMA)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)Inglésinfo:eu-repo/semantics/altIdentifier/doi/10.1371/journal.pone.0188238info:eu-repo/semantics/altIdentifier/eissn/1932-6203Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:10256/156182026-05-29T05:05:01Z
dc.title.none.fl_str_mv High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke
title High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke
spellingShingle High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke
Puig Alcántara, Josep
Malalties cerebrovasculars
Cerebrovascular disease
Isquèmia cerebral
Cerebral ischemia
title_short High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke
title_full High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke
title_fullStr High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke
title_full_unstemmed High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke
title_sort High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke
dc.creator.none.fl_str_mv Puig Alcántara, Josep
Daunis-i-Estadella, Pepus
Van Eendenburg, Cecile
Carrillo García, María
Aboud, Carlos
Hernández Pérez, María
Serena, Joaquín
Biarnés, Carles
Nael, Kambiz
Liebeskind, David S.
Thomalla, Götz
Menon, Bijoy K.
Demchuk, Andrew
Wintermark, Max
Pedraza, S.
Castellanos Rodrigo, Mar
author Puig Alcántara, Josep
author_facet Puig Alcántara, Josep
Daunis-i-Estadella, Pepus
Van Eendenburg, Cecile
Carrillo García, María
Aboud, Carlos
Hernández Pérez, María
Serena, Joaquín
Biarnés, Carles
Nael, Kambiz
Liebeskind, David S.
Thomalla, Götz
Menon, Bijoy K.
Demchuk, Andrew
Wintermark, Max
Pedraza, S.
Castellanos Rodrigo, Mar
author_role author
author2 Daunis-i-Estadella, Pepus
Van Eendenburg, Cecile
Carrillo García, María
Aboud, Carlos
Hernández Pérez, María
Serena, Joaquín
Biarnés, Carles
Nael, Kambiz
Liebeskind, David S.
Thomalla, Götz
Menon, Bijoy K.
Demchuk, Andrew
Wintermark, Max
Pedraza, S.
Castellanos Rodrigo, Mar
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Malalties cerebrovasculars
Cerebrovascular disease
Isquèmia cerebral
Cerebral ischemia
topic Malalties cerebrovasculars
Cerebrovascular disease
Isquèmia cerebral
Cerebral ischemia
description Blood-brain barrier (BBB) permeability has been proposed as a predictor of hemorrhagic transformation (HT) after tissue plasminogen activator (tPA) administration; however, the reliability of perfusion computed tomography (PCT) permeability imaging for predicting HT is uncertain. We aimed to determine the performance of high-permeability region size on PCT (HPrsPCT) in predicting HT after intravenous tPA administration in patients with acute stroke. Methods We performed a multimodal CT protocol (non-contrast CT, PCT, CT angiography) to prospectively study patients with middle cerebral artery occlusion treated with tPA within 4.5 hours of symptom onset. HT was graded at 24 hours using the European-Australasian Acute Stroke Study II criteria. ROC curves selected optimal volume threshold, and multivariate logistic regression analysis identified predictors of HT. Results The study included 156 patients (50% male, median age 75.5 years). Thirty-seven (23,7%) developed HT [12 (7,7%), parenchymal hematoma type 2 (PH-2)]. At admission, patients with HT had lower platelet values, higher NIHSS scores, increased ischemic lesion volumes, larger HPrs-PCT, and poorer collateral status. The negative predictive value of HPrs-PCT at a threshold of 7mL/100g/min was 0.84 for HT and 0.93 for PH-2. The multiple regression analysis selected HPrs-PCT at 7mL/100g/min combined with platelets and baseline NIHSS score as the best model for predicting HT (AUC 0.77). HPrs-PCT at 7mL/100g/min was the only independent predictor of PH-2 (OR 1, AUC 0.68, p = 0.045). Conclusions HPrs-PCT can help predict HT after tPA, and is particularly useful in identifying patients at low risk of developing HT
publishDate 2017
dc.date.none.fl_str_mv 2017
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
peer-reviewed
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10256/15618
http://hdl.handle.net/10256/15618
url http://hdl.handle.net/10256/15618
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/doi/10.1371/journal.pone.0188238
info:eu-repo/semantics/altIdentifier/eissn/1932-6203
dc.rights.none.fl_str_mv Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Public Library of Science (PLoS)
publisher.none.fl_str_mv Public Library of Science (PLoS)
dc.source.none.fl_str_mv PLoS One, 2017, vol. 12, núm. 11, p. e0188238
Articles publicats (D-IMA)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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