A cross-sectional study on the correlation between internal cerebral vein asymmetry and hemorrhagic transformation following endovascular thrombectomy
IntroductionHemorrhagic transformation (HT) is a severe complication in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) after endovascular treatment (EVT). We hypothesize that asymmetry of the internal cerebral veins (ICVs) on baseline CT angiogram (CTA) may serve as an a...
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Frontiers Media S.A.
2025-01-01
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| author | Kunxin Lin Kunxin Lin Wenlong Zhao Wenlong Zhao Quanhong Wu Quanhong Wu Yiru Zheng Yiru Zheng Bo Yang Ying Fu Ying Fu Ning Wang Ning Wang Ling Fang Ling Fang |
| author_facet | Kunxin Lin Kunxin Lin Wenlong Zhao Wenlong Zhao Quanhong Wu Quanhong Wu Yiru Zheng Yiru Zheng Bo Yang Ying Fu Ying Fu Ning Wang Ning Wang Ling Fang Ling Fang |
| author_sort | Kunxin Lin |
| collection | DOAJ |
| description | IntroductionHemorrhagic transformation (HT) is a severe complication in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) after endovascular treatment (EVT). We hypothesize that asymmetry of the internal cerebral veins (ICVs) on baseline CT angiogram (CTA) may serve as an adjunctive predictor of HT.MethodsWe conducted a study on consecutive AIS-LVO patients from November 2020 to April 2022. These patients had anterior circulation occlusions and were treated with EVT. Asymmetrical ICVs were assessed using CTA and defined as hypodensity (reduced opacification) on the ipsilateral side of occlusion compared to the contralateral side. The primary outcome was HT, defined as hemorrhage within the ischemic territory. This was evaluated using follow-up imaging (CT scan or magnetic resonance imaging) performed 48 h post-EVT. HT was classified into four subtypes based on the European Cooperative Acute Stroke Study-II criteria.ResultsA total of 126 patients were included, with an HT rate of 49.2% (62/126). ICV asymmetry was observed in 54.0% (68/126) of patients. The ICV asymmetry group exhibited a significantly higher risk of parenchymatous hematoma-type HT (33.8% vs. 15.5%, p = 0.019) and symptomatic intracerebral hemorrhage (sICH) (23.5% vs. 5.2%, p = 0.004). In multivariate logistic regression, ICV asymmetry (OR 3.809, 95% CI 1.582–9.171), baseline Alberta Stroke Program Early CT Score (OR 0.771, 95% CI 0.608–0.978), intravenous recombinant tissue plasminogen activator (OR 2.847, 95% CI 1.098–2.7.385), and poor collateral circulation (OR 3.998, 95% CI 1.572–10.169) were identified as independent risk factors of HT.ConclusionICV asymmetry, likely resulting from impaired autoregulation or tissue micro-perfusion hampering cerebral blood flow (CBF), is a novel radiological sign that independently predicts HT. It is associated with a higher risk of sICH in AIS-LVO patients after EVT. Further research is warranted to validate these findings. |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-a3009dc0b69e4c51ae6dda854dd94dc82025-01-07T06:51:18ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-01-011510.3389/fneur.2024.14654811465481A cross-sectional study on the correlation between internal cerebral vein asymmetry and hemorrhagic transformation following endovascular thrombectomyKunxin Lin0Kunxin Lin1Wenlong Zhao2Wenlong Zhao3Quanhong Wu4Quanhong Wu5Yiru Zheng6Yiru Zheng7Bo Yang8Ying Fu9Ying Fu10Ning Wang11Ning Wang12Ling Fang13Ling Fang14Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, ChinaDepartment of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, ChinaDepartment of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, ChinaDepartment of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, ChinaDepartment of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, ChinaDepartment of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, ChinaDepartment of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, ChinaDepartment of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, ChinaDepartment of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, ChinaDepartment of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, ChinaDepartment of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, ChinaDepartment of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, ChinaDepartment of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, ChinaDepartment of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, ChinaDepartment of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, ChinaIntroductionHemorrhagic transformation (HT) is a severe complication in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) after endovascular treatment (EVT). We hypothesize that asymmetry of the internal cerebral veins (ICVs) on baseline CT angiogram (CTA) may serve as an adjunctive predictor of HT.MethodsWe conducted a study on consecutive AIS-LVO patients from November 2020 to April 2022. These patients had anterior circulation occlusions and were treated with EVT. Asymmetrical ICVs were assessed using CTA and defined as hypodensity (reduced opacification) on the ipsilateral side of occlusion compared to the contralateral side. The primary outcome was HT, defined as hemorrhage within the ischemic territory. This was evaluated using follow-up imaging (CT scan or magnetic resonance imaging) performed 48 h post-EVT. HT was classified into four subtypes based on the European Cooperative Acute Stroke Study-II criteria.ResultsA total of 126 patients were included, with an HT rate of 49.2% (62/126). ICV asymmetry was observed in 54.0% (68/126) of patients. The ICV asymmetry group exhibited a significantly higher risk of parenchymatous hematoma-type HT (33.8% vs. 15.5%, p = 0.019) and symptomatic intracerebral hemorrhage (sICH) (23.5% vs. 5.2%, p = 0.004). In multivariate logistic regression, ICV asymmetry (OR 3.809, 95% CI 1.582–9.171), baseline Alberta Stroke Program Early CT Score (OR 0.771, 95% CI 0.608–0.978), intravenous recombinant tissue plasminogen activator (OR 2.847, 95% CI 1.098–2.7.385), and poor collateral circulation (OR 3.998, 95% CI 1.572–10.169) were identified as independent risk factors of HT.ConclusionICV asymmetry, likely resulting from impaired autoregulation or tissue micro-perfusion hampering cerebral blood flow (CBF), is a novel radiological sign that independently predicts HT. It is associated with a higher risk of sICH in AIS-LVO patients after EVT. Further research is warranted to validate these findings.https://www.frontiersin.org/articles/10.3389/fneur.2024.1465481/fullinternal cerebral veinshemorrhagic transformationacute ischemic strokeendovascular thrombectomylarge vessel occlusion |
| spellingShingle | Kunxin Lin Kunxin Lin Wenlong Zhao Wenlong Zhao Quanhong Wu Quanhong Wu Yiru Zheng Yiru Zheng Bo Yang Ying Fu Ying Fu Ning Wang Ning Wang Ling Fang Ling Fang A cross-sectional study on the correlation between internal cerebral vein asymmetry and hemorrhagic transformation following endovascular thrombectomy Frontiers in Neurology internal cerebral veins hemorrhagic transformation acute ischemic stroke endovascular thrombectomy large vessel occlusion |
| title | A cross-sectional study on the correlation between internal cerebral vein asymmetry and hemorrhagic transformation following endovascular thrombectomy |
| title_full | A cross-sectional study on the correlation between internal cerebral vein asymmetry and hemorrhagic transformation following endovascular thrombectomy |
| title_fullStr | A cross-sectional study on the correlation between internal cerebral vein asymmetry and hemorrhagic transformation following endovascular thrombectomy |
| title_full_unstemmed | A cross-sectional study on the correlation between internal cerebral vein asymmetry and hemorrhagic transformation following endovascular thrombectomy |
| title_short | A cross-sectional study on the correlation between internal cerebral vein asymmetry and hemorrhagic transformation following endovascular thrombectomy |
| title_sort | cross sectional study on the correlation between internal cerebral vein asymmetry and hemorrhagic transformation following endovascular thrombectomy |
| topic | internal cerebral veins hemorrhagic transformation acute ischemic stroke endovascular thrombectomy large vessel occlusion |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2024.1465481/full |
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