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Abstract
Introduction/Purpose Delayed hemorrhagic transformation (DHT) is a potentially life-threatening complication after thrombectomy for acute ischemic stroke (AIS). While clinical predictors of DHT are well-studied, research on the clinical utility of dual-energy head computed tomography (DEHCT) in post-thrombectomy care remains limited. This study aims to determine the predictive value of contrast density and volume on post-thrombectomy DEHCT for DHT.
Materials and Methods We conducted a retrospective analysis of all patients with large vessel occlusion stroke who prospectively underwent thrombectomy at a comprehensive stroke center from 2018-2021. All patients received DEHCT immediately following thrombectomy and MRI or CT at 24 hours as routine standard of care. The presence of hemorrhage and/or contrast was evaluated using virtual non-contrast images and iodine map of DEHCT (Figure: DEHCT showing contrast on iodine map [A] with no hemorrhage on the virtual non-contrast image [B]). Delayed petechial hemorrhage and parenchymal hematoma were determined by 24-hour imaging. Volume and density of contrast on DEHCT and volume of DHT on 24-hour imaging were calculated using the volumetric measurement tool of SECTRA7. Patients with negative findings or hemorrhage on DEHCT were excluded. Univariate and multivariate analyses were performed to identify risk factors for delayed petechial hemorrhage and parenchymal hematoma. This study was approved by the institutional review board.
Results We identified 97 patients with contrast staining and without hemorrhage on post-thrombectomy DEHCT. Of these, 30 (31%) and 18 (20%) patients developed petechial hemorrhage and parenchymal hematoma, respectively. On univariate analysis, the occurrence of petechial hemorrhage was associated with anticoagulant use (OR,4.30;95%CI,1.54-11.99;p=0.005) and maximum contrast density (OR,1.02; 95%CI,1.01-1.03;p=0.001,per 1HU increase), while the occurrence of parenchymal hematoma was associated with presenting NIHSS (OR,1.08;95%CI,1.00-1.16,p=0.043;per 1score increase), mismatch on CT Perfusion (OR,1.01;95%CI,1.00-1.02;p=0.019;per 1mL increase), and contrast volume (OR,1.02;95%CI:1.01-1.04;p=0.002;per 1mL increase).
On the multivariate logistic regression model, maximum contrast density (OR,1.02;95%CI:1.01-1.03; p=0.004;per 1HU increase) and anticoagulant use (OR,3.53;95%CI:1.19-10.48;p=0.021) predicted the occurrence of petechial hemorrhage. Contrast volume (OR,1.03;95%CI:1.01-1.05;p=0.002;per 1mL increase) and LDL (OR,0.96;95%CI:0.93-0.99;p=0.007;per 1mg/dL increase) independently predicted the occurrence of parenchymal hematoma.
Among these predictors for DHT, the volume of contrast (beta,0.12;SE,0.05;p=0.027) was the only factor that was positively associated with the volume of delayed hemorrhage in the multiple linear regression model.
Conclusion Maximum contrast density predicted the occurrence of delayed petechial hemorrhage, while contrast volume predicted the occurrence and volume of delayed parenchymal hematoma. The volume of contrast on DEHCT can serve as a useful predictor of DHT and may have implications for patient management.
Disclosures S. Ahn: None. S. Roth: None. Y. Ko: None. A. Bhamidipati: None. N. Mummareddy: None. R. Chitale: None. M. Fusco: None. M. Froehler: None.