Ultrasound identification of patients at increased risk of intracranial hemorrhage after successful endovascular recanalization for acute ischemic stroke.

Ultrasound identification of patients at increased risk of intracranial hemorrhage after successful endovascular recanalization for acute ischemic stroke.

World Neurosurg. 2019 Feb 08;:

Authors: Baracchini C, Farina F, Pieroni A, Palmieri A, Kulyk C, Viaro F, Gabrieli JD, Cester G, Causin F, Manara R

Abstract
BACKGROUND: Intracranial hemorrhage (ICH) is the most feared complication of endovascular treatment (EVT) for acute ischemic stroke due to anterior circulation large vessel occlusion (LVO). The purpose of this study was to identify cerebral hemodynamic predictors of ICH and poor outcome in patients with successful recanalization.
MATERIALS AND METHODS: Serial transcranial color-coded sonography (TCCS) examinations assessed vessel status and cerebral hemodynamics of 226 [mean-age 69.8±12.5 years, 130 (57.5%) men] consecutive patients with acute anterior circulation LVO soon after, at 48 hours and one week after EVT. Middle cerebral artery peak systolic velocity (PSVMCA) and PSVMCA Ratio (recanalized PSVMCA/contralateral PSVMCA) were recorded.
RESULTS: Out of 180 (79.6%) successfully recanalized patients, 28/180 (15.5%) had ICH. They had more often arterial hypertension [(25/28) 89.3% vs (106/152) 69.7%, P=0.04], a more severe stroke syndrome [18 (10-23) vs 16 (5-26), P=0.01], a worse clinical outcome [90-day mRS 3-5: (16/28) 57.1% vs (42/152) 27.6%, P=0.004] and soon after EVT showed a significantly higher mean PSVMCA Ratio (3.4±0.1 vs 2.4±0.1, P<0.0001) compared to non-ICH patients. In multivariate analysis, early PSVMCA Ratio was independently associated with post-interventional ICH [OR 13.379 (95% CI 2.466-50.372), P<0.01]. Those ICH patients [19/28 (67.9%)] who resumed normal PSVMCA values at one week from EVT had a better outcome [90-day mRS 0-2: 8/19 (42.1%) vs 0/9 (0%)].
CONCLUSIONS: Early TCCS detection of high PSVMCA Ratio in successfully recanalized stroke patients indicates an increased risk of ICH, while cerebral hemodynamics normalization at one week in patients with post-interventional ICH predicts a relatively better 3-month outcome.

PMID: 30743030 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2N0gGFH