scholarly journals Hemorrhagic transformation in ischemic stroke and its treatment during thrombolysis

2011 ◽  
Vol 2 (1S) ◽  
pp. 99-107
Author(s):  
Maurizio Paciaroni ◽  
Luca Masotti ◽  
Valeria Caso
Keyword(s):  
Ischemic Stroke ◽  
Brain Infarction ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Adequate Treatment ◽  
Haemorrhagic Transformation ◽  
Hemorrhagic Infarction ◽  
Brain Infarcts ◽  
Secondary Bleeding ◽  
Key Points

Haemorrhagic transformation (HT) of brain infarction or hemorrhagic infarction is a complication of acute ischemic stroke, especially in cardioembolic stroke, and represents the most feared complication of thrombolysis. HT is a multifocal secondary bleeding into brain infarcts with innumerable foci of capillary and venular extravasation either remaining as discrete petechiae or emerging to form confluent purpura. HT is evidenced as a parenchymal area of increased density within an area of low attenuation in a typical vascular distribution on non-contrasted CT scans and is subdivided into two major categories on the basis of standardised definition: haemorrhagic infarct (HI) and parenchymal haematoma (PH). PH has been associated to poor outcome in ischemic stroke patients. Thus, its prevention, early detection and adequate treatment represent key points in the management of acute stroke.

scholarly journals Hemorrhagic transformation in ischemic stroke and its treatment during thrombolysis

2011 ◽  
Vol 2 (1S) ◽  
pp. 99
Author(s):  
Maurizio Paciaroni ◽  
Luca Masotti ◽  
Valeria Caso
Keyword(s):  
Ischemic Stroke ◽  
Brain Infarction ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Adequate Treatment ◽  
Haemorrhagic Transformation ◽  
Hemorrhagic Infarction ◽  
Brain Infarcts ◽  
Secondary Bleeding ◽  
Key Points

Haemorrhagic transformation (HT) of brain infarction or hemorrhagic infarction is a complication of acute ischemic stroke, especially in cardioembolic stroke, and represents the most feared complication of thrombolysis. HT is a multifocal secondary bleeding into brain infarcts with innumerable foci of capillary and venular extravasation either remaining as discrete petechiae or emerging to form confluent purpura. HT is evidenced as a parenchymal area of increased density within an area of low attenuation in a typical vascular distribution on non-contrasted CT scans and is subdivided into two major categories on the basis of standardised definition: haemorrhagic infarct (HI) and parenchymal haematoma (PH). PH has been associated to poor outcome in ischemic stroke patients. Thus, its prevention, early detection and adequate treatment represent key points in the management of acute stroke.

Abstract W P374: Coated-Platelet Levels Correlate With HAS-BLED Scores in Stroke Patients With Atrial Fibrillation

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Calin Prodan ◽  
Andrea Vincent ◽  
Angelia Kirkpatrick ◽  
George Dale
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Brain Infarction ◽  
Pearson Correlation ◽  
Preventive Treatment ◽  
Bleeding Risk ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Increased Risk

Background: Coated-platelets are a subset of procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin. Coated-platelet levels are increased in non-lacunar ischemic stroke compared to controls; however, patients with early hemorrhagic transformation have lower coated-platelet levels than those without. In contrast to brain infarction, coated-platelet levels are decreased in intracerebral hemorrhage and inversely correlated with the size of the bleed. Because anticoagulation is a key preventive treatment in cardioembolic stroke, we investigated the existence of a relationship between coated-platelets and bleeding risk in stroke patients with atrial fibrillation. Methods: Coated-platelet levels, reported as percent of platelets converted to coated-platelets, were determined in 45 consecutive patients with acute stroke and atrial fibrillation. Exclusion criteria consisted of dementia, stroke due to other causes than atrial fibrillation, > 96 hours between onset of symptoms and coated-platelet assay, current anticoagulation, prior thrombolytics or abnormal PT/PTT/INR. Bleeding risk was determined for each patient using the HAS-BLED score. The correlation between individual coated-platelet levels and HAS-BLED scores was determined using the Pearson correlation coefficient. Results: Coated-platelet levels for the 45 patients were 41.0 ± 13.9% (mean ± SD, range 13.2 to 69.7%), consistent with previous data in patients with non-lacunar ischemic stroke. Mean HAS-BLED score was 3.2 ± 1.6, with a range between 1 and 7. A highly significant inverse linear correlation between coated-platelet levels and HAS-BLED scores was observed (p < 0.001, r = -0.67). Conclusions: Lower coated-platelet levels correlate with higher HAS-BLED scores in patients with stroke due to atrial fibrillation, suggesting that decreased coated-platelet synthesis is present in patients with an increased risk for bleeding. Our results are consistent with previously published research showing lower coated-platelet levels in intracerebral hemorrhage and early hemorrhagic transformation of ischemic stroke, and support a role played by this subset of activated platelets in the balance between thrombosis and hemorrhage.

scholarly journals Stress hyperglycemia as a prognostic factor in acute ischemic stroke patients: a prospective observational cohort study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Hanaa A. El-Gendy ◽  
Mahmoud A. Mohamed ◽  
Amr E. Abd-Elhamid ◽  
Mohammed A. Nosseir
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prognostic Value ◽  
Area Under The Curve ◽  
Hemorrhagic Transformation ◽  
Diabetic Patients ◽  
Stroke Patients ◽  
Stress Hyperglycemia ◽  
Discrimination Power ◽  
Observational Cohort

Abstract Background Hyperglycemia is a risk factor for infarct expansion and poor outcome for both diabetic and non-diabetic patients. We aimed to study the prognostic value of stress hyperglycemia on the outcome of acute ischemic stroke patients as regards National Institutes of Health Stroke Scale (NIHSS) as a primary outcome. Results Patients with high random blood sugar (RBS) on admission showed significantly higher values of both median NIHSS score and median duration of hospital stay. There were significant associations between stress hyperglycemia and the risk of 30-day mortality (p < 0.001), the need for mechanical ventilation (p < 0.001) and vasopressors (p < 0.001), and the occurrence of hemorrhagic transformation (p = 0.001). The 24-h RBS levels at a cut off > 145 mg/dl showed a significantly good discrimination power for 30-day mortality (area under the curve = 0.809). Conclusions Stress hyperglycemia had a prognostic value and was associated with less-favorable outcomes of acute stroke patients. Therefore, early glycemic control is recommended for those patients.

CKD is associated with recurrent ischemia but not with hemorrhagic transformation in acute ischemic stroke patients

Renal Failure ◽  
2013 ◽  
Vol 36 (2) ◽  
pp. 217-221 ◽  
Author(s):  
Hasan Micozkadioglu ◽  
Ruya Ozelsancak ◽  
Semih Giray ◽  
Zulfikar Arlier
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Recurrent Ischemia

scholarly journals Hyper-attenuating brain lesions on CT after ischemic stroke and thrombectomy are associated with final brain infarction

2017 ◽  
Vol 23 (6) ◽  
pp. 594-600 ◽  
Author(s):  
FB Cabral ◽  
LH Castro-Afonso ◽  
GS Nakiri ◽  
LM Monsignore ◽  
SRC Fábio ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Brain Infarction ◽  
Internal Capsule ◽  
Brain Regions ◽  
Hemorrhagic Transformation ◽  
Anterior Circulation ◽  
Caudate Nuclei ◽  
Predictive Values ◽  
Cortical Regions

Purpose Hyper-attenuating lesions, or contrast staining, on a non-contrast brain computed tomography (NCCT) scan have been investigated as a predictor for hemorrhagic transformation after endovascular treatment of acute ischemic stroke (AIS). However, the association of hyper-attenuating lesions and final ischemic areas are poorly investigated in this setting. The aim of the present study was to assess correlations between hyper-attenuating lesions and final brain infarcted areas after thrombectomy for AIS. Methods Data from patients with AIS of the anterior circulation who underwent endovascular treatment were retrospectively assessed. Images of the brain NCCT scans were analyzed in the first hours and late after treatment. The hyper-attenuating areas were compared to the final ischemic areas using the Alberta Stroke Program Early CT Score (ASPECTS). Results Seventy-one of the 123 patients (65.13%) treated were included. The association between the hyper-attenuating region in the post-thrombectomy CT scan and final brain ischemic area were sensitivity (58.3% to 96.9%), specificity (42.9% to 95.6%), positive predictive values (71.4% to 97.7%), negative predictive values (53.8% to 79.5%), and accuracy values (68% to 91%). The highest sensitivity values were found for the lentiform (96.9%) and caudate nuclei (80.4%) and for the internal capsule (87.5%), and the lowest values were found for the M1 (58.3%) and M6 (66.7%) cortices. Conclusions Hyper-attenuating lesions on head NCCT scans performed after endovascular treatment of AIS may predict final brain infarcted areas. The prediction appears to be higher in the deep brain regions compared with the cortical regions.

scholarly journals Suitability of Deep Weakly Supervised Learning to detect Acute Ischemic Stroke and Hemorrhagic Infarction Lesions Using Diffusion-weighted Imaging

2020 ◽  
Author(s):  
Chen Cao ◽  
Zhiyang Liu ◽  
Guohua Liu ◽  
Song Jin ◽  
Shuang Xia
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Supervised Learning ◽  
Superior Performance ◽  
Weakly Supervised Learning ◽  
Hemorrhagic Infarction ◽  
Key Points ◽  
Diagnosis Rate ◽  
Missed Diagnosis ◽  
Weakly Supervised

AbstractObjectivesThe automatic detection of acute ischemic stroke (AIS) and hemorrhagic infarction (HI) based on deep learning could avoid missed diagnosis. The fully supervised learning requires the amount of time and the expertise to manually outline lesions, which limits its applicability. The weakly supervised learning has the potential to reduce the labeling workload. The purpose of this study was to evaluate a weakly supervised method in detection of AIS and HI location using DWI.MethodsWe proposed to adopt weakly supervised learning to spatially-locate AIS lesions by residual neural network (ResNet) and visual geometry group (VGG) network. On an AIS dataset, the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity and precision were calculated. Next, ResNet, which presented superior performance on the AIS dataset, was further applied to an HI dataset.ResultsIn the AIS dataset, the AUCs of ResNet and VGG on identifying image slices with AIS were 0.97 and 0.94, respectively. On spatially-locating the AIS lesions, ResNet provided higher sensitivity and a lower missed diagnosis rate than VGG, especially for pontine AIS lesions. In the HI dataset, the sensitivity of ResNet was 87.73% for AIS detection, and 86.20% for HI detection, respectively.ConclusionsWeakly supervised learning can effectively detect the location of AIS and HI lesions in DWI, which is of paramount importance in avoiding misdiagnosis in clinical scenario.Key pointsThe deep weakly supervised learning can reduce the labeling workload; ResNet can obtain more exact results, especially for pontine AIS lesions; Weakly supervised learning can effectively detect AIS and HI lesions in DWI

Abstract P12: Alteplase Reduces Mortality in Patients With Ischemic Stroke and Atrial Fibrillation: Analysis of the IAC Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Eva Mistry ◽  
Adam H De Havenon ◽  
Christopher Leon Guerrero ◽  
Amre Nouh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Intravenous Thrombolysis ◽  
The United States ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Increased Risk ◽  
Significant Difference

Background and Purpose: Multiple studies have established that intravenous thrombolysis with alteplase improves outcome after acute ischemic stroke. However, assessment of thrombolysis’ efficacy in stroke patients with atrial fibrillation (AF) has yielded mixed results. We sought to determine the association of alteplase with mortality, hemorrhagic transformation (HT), infarct volume, and mortality in patients with AF and acute ischemic stroke. Methods: We retrospectively analyzed consecutive acute ischemic stroke patients with AF included in the Initiation of Anticoagulation after Cardioembolic stroke (IAC) study, which pooled data from 8 comprehensive stroke centers in the United States. 1889 (90.6%) had available 90-day follow up data and were included. For our primary analysis we used a cohort of 1367/1889 (72.4%) patients who did not undergo mechanical thrombectomy (MT). Secondary analyses were repeated in the patients that underwent MT (n=522). Binary logistic regression was used to determine whether alteplase use was independently associated with risk of HT, final infarct volume, and 90-day mortality, respectively, adjusting for potential confounders. Results: In our primary analyses we found that alteplase use was independently associated with an increased risk for HT (adjusted OR 2.14, 95% CI 1.49 - 3.07, p <0.001) but overall reduced risk of 90-day mortality (adjusted OR 0.58, 95% CI 0.39 - 0.87, p = 0.009). Among patients undergoing MT, alteplase use was associated with a trend towards a reduction in 90-day mortality (adjusted OR 0.68 95% CI 0.45 - 1.04, p = 0.077). In the subgroup of patients prescribed DOAC treatment (n = 327; 24 received alteplase), alteplase treatment was associated with a trend towards smaller infarct size (< 10 mL), (adjusted OR 0.40, 95% CI 0.15 - 1.12, p = 0.082) without a significant difference in the odds of 90-day mortality (adjusted OR 0.51, 95% CI 0.12 - 2.13, p = 0.357) or hemorrhagic transformation (adjusted OR 0.27, 95% CI 0.03 - 2.07, p = 0.206). Conclusion: Thrombolysis with intravenous alteplase was associated with reduced 90-day mortality in AF patients with acute ischemic stroke not undergoing MT. Further study is required to assess the safety and efficacy of alteplase in AF patients undergoing MT and those on DOACs.

Abstract TP315: D-dimer is Associated With 30-day Mortality in Acute Ischemic Stroke With Active Cancer

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ki Woong Nam ◽  
Chi Kyung Kim ◽  
Tae Jung Kim ◽  
Sang Joon An ◽  
Kyungmi Oh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Nihss Score ◽  
Patients With Cancer ◽  
Advanced Stages ◽  
D Dimer ◽  
Active Cancer

Background: Stroke in cancer patients is not rare, but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer. In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer. Methods: We included 210 ischemic stroke patients with active cancer. The data of 30-day mortality were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50%) participants to evaluate the effects of treatment response on D-dimer levels. Results: Of the 210 participants, 30-day mortality occurred in 28 (13%) patients. Higher initial NIHSS score, D-dimer levels, CRP levels, frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR) = 2.19; 95% CI, 1.46-3.28, P < 0.001] predicted 30-day mortality after adjusting for confounders. Initial NIHSS score (aOR = 1.07; 95% CI, 1.00-1.14, P = 0.043) and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10-8.29, P = 0.032) were also significant independently from D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease of D-dimer levels, despite treatment, while the survivor group showed opposite responses. Conclusions: D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer.

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