Logo

American Heart Association

  1
  0


Final ID: 30

Association between Time and Severe Hypoperfusion with Risk of Hemorrhagic Transformation in Thrombectomy Stroke Patients

Abstract Body: Background and objective: Perfusion imaging studies consistently show a substantially increased risk of hemorrhagic transformation (HT) in severely hypoperfused tissue. Pathophysiological evidence indicates that ischemic damage is influenced not only by the degree of hypoperfusion but also by the duration of exposure to that hypoperfused state. We aim to investigate the association of time and severe hypoperfusion with parenchymal hematoma (PH) in ischemic stroke and explore whether there is a combined effect of the two variables on PH.
Methods: Data are from the ESCAPE-NA1 trial, which evaluated the effect of nerinetide in large vessel occlusion patients treated with thrombectomy. For this study, we included patients with some degree of recanalization (expanded Thrombolysis in Cerebral Infarct [eTICI] >0) and available baseline CT perfusion. Severe hypoperfusion was defined as at least 1mL volume of relative cerebral blood flow (rCBF)<20%. The primary and secondary outcomes were the presence of PH and of any HT, respectively, assessed on 24-hour imaging, according to Heidelberg criteria. The effect of time and severe hypoperfusion on outcomes was assessed with univariable and multivariable logistic regression analyses, including interaction terms to assess treatment effect modification.
Results: Out of 1105 patients from ESCAPE-NA1, 396 (35.8%) were included. The median age was 70 years (IQR=59.8-79.2), 202 (51%) were females, and 50 (12.6%) experienced PH. Onset-to-imaging time (adjusted OR 1.04 [95%CI=1.01-1.06] per 15-minute increase) and the presence of severe hypoperfusion (adjusted OR 2.63 [95%CI=1.21-5.72]) were the only variables associated with PH in multivariable analysis. No significant interaction effect of time and severe hypoperfusion on PH was found. The presence of severe hypoperfusion has a negative predictive value of 98% and a positive predictive value of 39.4% for predicting PH in patients presenting within three hours and after six hours from symptom onset, respectively.
Conclusion: Both severe hypoperfusion and time affect the risk of hemorrhagic transformation in ischemic cerebral tissue. Analyzing these variables may help identify patients with a leaky, severely compromised blood-brain barrier in the ischemic core—a “leaky core.”
  • Pensato, Umberto  ( Humanitas University , Milan , Italy )
  • Goyal, Mayank  ( university of calgary , Calgary , Alberta , Canada )
  • Demchuk, Andrew  ( University of Calgary , Calgary , Alberta , Canada )
  • Hill, Michael  ( UNIVERSITY CALGARY , Calgary , Alberta , Canada )
  • Ospel, Johanna  ( University of Calgary , Calgary , Alberta , Canada )
  • Author Disclosures:
    Umberto Pensato: DO NOT have relevant financial relationships | Mayank Goyal: DO have relevant financial relationships ; Consultant:Medtronic:Active (exists now) ; Ownership Interest:Circle:Active (exists now) ; Research Funding (PI or named investigator):Cerenovus:Active (exists now) ; Research Funding (PI or named investigator):Medtronic:Active (exists now) ; Advisor:Fluid Biomed:Active (exists now) ; Consultant:Mentice:Active (exists now) ; Consultant:Microvention:Active (exists now) | Andrew Demchuk: DO NOT have relevant financial relationships | Michael Hill: DO have relevant financial relationships ; Consultant:Brainsgate Inc:Past (completed) ; Individual Stocks/Stock Options:Circle Inc:Active (exists now) ; Individual Stocks/Stock Options:Basking Bioscience:Active (exists now) ; Research Funding (PI or named investigator):Boehringer-Ingelheim:Active (exists now) ; Research Funding (PI or named investigator):Medtronic:Active (exists now) ; Consultant:Diamedica Inc:Active (exists now) | Johanna Ospel: DO NOT have relevant financial relationships
Meeting Info:
Session Info:

Imaging Oral Abstracts I

Wednesday, 02/05/2025 , 09:15AM - 10:45AM

Oral Abstract Session

More abstracts on this topic:
A Machine Learning Readmission Risk Prediction Model for Cardiac Disease

Bailey Angela, Wang Wei, Shannon Clarence, Huling Jared, Tignanelli Christopher

Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Insights from the All of Us Research Program

Renedo Daniela, Schwamm Lee, Kamel Hooman, Matouk Charles, Tal Reshef, Sheth Kevin, Falcone Guido, Chaves-rivera Maria Natalia, Rivier Cyprien, Koo Andrew, Clocchiatti-tuozzo Santiago, Huo Shufan, Sujijantarat Nanthiya, Torres Lopez Victor, Hebert Ryan

More abstracts from these authors:
Effect of Hemoglobin and Blood Glucose Levels on CTP Ischemic Core Underestimation: a post-hoc analysis of the ESCAPE-NA1 trial

Pensato Umberto, Demchuk Andrew, Hill Michael, Ospel Johanna, Bosshart Salome, Stebner Alexander, Rohr Axel, Kleinig Timothy, Gupta Rishi, Thomalla Gotz, Heo Ji, Goyal Mayank

Modified Rankin Score at 90 Days vs. NIH Stroke Scale at 24 Hours as Primary Outcome in Acute Stroke Trials

Ospel Johanna, Dippel Diederik, Majoie Charles, Jovin Tudor, Campbell Bruce, Mitchell Peter, Bracard Serge, Guillemin Francis, Hill Michael, Goyal Mayank, Brown Scott, Bosshart Salome, Stebner Alexander, Uchida Kazutaka, Demchuk Andrew, Saver Jeffrey, White Phil, Muir Keith

You have to be authorized to contact abstract author. Please, Login
Not Available

Readers' Comments

We encourage you to enter the discussion by posting your comments and questions below.

Presenters will be notified of your post so that they can respond as appropriate.

This discussion platform is provided to foster engagement, and simulate conversation and knowledge sharing.

 

You have to be authorized to post a comment. Please, Login or Signup.


   Rate this abstract  (Maximum characters: 500)