Neuroimaging features of hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke / 国际脑血管病杂志

ABSTRACT

Objective:To investigate the neuroimaging features of hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke received intravenous thrombolysis with a standard dose of alteplase in the Department of Neurology, Ninghe District Hospital from April 2018 to May 2022 and had HT within 24 h after treatment were retrospectively included. Demography, clinical data and neuroimaging findings of HT were recorded. The clinical data of symptomatic intracerebral hemorrhage (sICH) group and asymptomatic intracerebral hemorrhage (asICH) group, as well as HT in the infarct group and HT outside the infarct group were compared. Multivariate logistic regression analysis was used to determine independent risk factors for HT types. Results:A total of 63 patients with HT were enrolled (40 males and 23 females, aged 73.5±8.95 years). There were 42 patients with sICH (66.7%), 21 (33.3%) with asICH, 37 (58.7%) with HT in the infarct (ECASS classification hemorrhagic infarction [HI]-1, 5 cases [7.9%]; HI-2, 6 cases [9.5%]; parenchymal hematoma [PH]-1, 11 cases [17.5%]; PH-2, 15 cases [23.8%]), 17 (27.0%) with HT outside the infarct, and 9 cases (14.3%) with HT both inside and outside the infarct. Heidelberg classification 1a HI-1, 5 cases (7.9%); 1b HI-2, 6 cases (9.5%); 1c PH-1, 11 cases (17.5%); 2, 15 cases (23.8%); 3a, 14 cases (22.2%); 3b, 6 cases (9.5%); 3c, 4 cases (6.3%); and 3d, 2 cases (3.2%). Multivariate logistic regression analysis showed that lower baseline National Institutes of Health Stroke Scale (NIHSS) score (odds ratio [ OR] 1.413, 95% confidence interval [ CI] 1.216-1.447; P=0.001), small vessel occlusion ( OR 1.378, 95% CI 1.134-1.429; P=0.002), minor stroke ( OR 1.447, 95% CI 1.120-1.467; P<0.001), and HT outside the infarct ( OR 1.335, 95% CI 1.131-1.363; P=0.007) were independently associated with sICH. Higher baseline NIHSS scores ( OR 1.737, 95% CI1.102-1.801; P<0.001), cardiogenic embolism ( OR 1.789, 95% CI 1.095-1.881; P<0.001), and severe stroke ( OR 1.648, 95% CI 1.110-1.672; P<0.001) were independently associated with HT in the infarct. Conclusions:The most common neuroimaging feature of HT after intravenous thrombolysis in patients with acute ischemic stroke is PH in the infarct, while HT outside the infarct and HT both inside and outside the infarct are rare. For patients with cardiogenic embolism with higher baseline NIHSS score, the HT after thrombolysis was mostly asICH, and its imaging features were mostly multiple punctuate hemorrhage in the infarct. In patients with small vessel occlusion with lower baseline NIHSS score, most of the HT after thrombolytic therapy is sICH, and their imaging features are mostly PH outside the infarct.