Abstract Details

Title Post-thrombectomy Hemorrhagic Transformation in Large Vessel Strokes Involving the Basal Ganglia and Insular Ribbon

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 038

Objective The objective of the study was to determine if involvement of basal ganglia (BG) or insular ribbon (IR) on CT perfusion (CTP) core or CT Alberta Stroke Program Early CT Score (CT-ASPECTS) was associated with higher incidence of post-thrombectomy intracranial hemorrhage (ICH) in patients with large vessel occlusion stroke (LVOs) who had favorable CT perfusion scan (CTP) at presentation.

Background The distinct anatomy of basal ganglia (BG) and insular ribbon (IR) renders them vulnerable to hemorrhagic transformation following successful recanalization.

Design/Methods We performed a retrospective chart review of 263 patients who underwent mechanical thrombectomy for LVOs during January 2018 – July 2020. Patients were excluded if they did not have CTP, post-recanalization scan, failed recanalization (TICI 0 or 1), or had posterior circulation stroke. CT and CTP were reviewed for the involvement of BG and IR. European Cooperative Acute Stroke Study (ECASS II) criteria were used to grade hemorrhagic transformation (HT) in post-recanalization CT or MRI. ICH with an increase in National Institutes of Health Stroke Scale (NIHSS) >3 points were considered symptomatic. Chi-square test was used to compare the groups with HT and without HT.

Results

120 patients met inclusion criteria. Median NIHSS at presentation was 14 and 36% received tPA. 40 patients (33%) had HT. 9 of these (22.5%) were major bleeds (PH2), 3 (7.5%) symptomatic. Median NIHSS, tPA administration rates, and time to recanalization were similar between the two groups. Involvement of IR on CT-ASPECTS (65%) was significantly higher among patients with HT when compared to those without HT (40%). (p= 0.009) However, 90% of HT was asymptomatic. Although the involvement of lentiform nucleus and internal capsule was higher in HT group, this was not statistically significant.

Conclusions Involvement of IR in CT-ASPECTS at presentation confers higher risk of post-thrombectomy HT in LVOs. However, majority of this HT is asymptomatic.

Authors/Disclosures
Saurav Das, MD, FAAN (Washington University in St. Louis) PRESENTER	Dr. Das has nothing to disclose.
	No disclosure on file
Arjun Padalia, MD	Dr. Padalia has nothing to disclose.
Michael R. Butler II, MD (BJC Medical Group-Neurology Associates at Missouri Baptist Medical Center)	Dr. Butler has nothing to disclose.
	No disclosure on file

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