Hyperperfusion Immediately after Reperfusion by Thrombectomy May Predict Hemorrhagic Transformation

JNET Pub Date : 2019-01-01 DOI:10.5797/JNET.OA.2018-0046

T. Yoshihara, R. Kanazawa, H. Ohbuchi, T. Uchida, T. Higashida, Naoyuki Arai, Manabu Osakabe, Yuichi Takahashi

{"title":"Hyperperfusion Immediately after Reperfusion by Thrombectomy May Predict Hemorrhagic Transformation","authors":"T. Yoshihara, R. Kanazawa, H. Ohbuchi, T. Uchida, T. Higashida, Naoyuki Arai, Manabu Osakabe, Yuichi Takahashi","doi":"10.5797/JNET.OA.2018-0046","DOIUrl":null,"url":null,"abstract":"Objective: To evaluate cerebral blood ﬂ ow immediately after reperfusion following thrombectomy for acute large vessel occlusion, and to examine whether cerebral blood ﬂ ow after reperfusion is related to hemorrhagic transformation. Methods: The patients with acute large vessel occlusion in the anterior circulation who obtained reperfusion by thrombectomy were included. Cerebral blood ﬂ ow was evaluated using single photon emission computed tomography (SPECT) within 6 hours after reperfusion. The patients were divided into two groups with or without hemorrhagic transformation, and basic characteristics, the ratio of cerebral blood ﬂ ow (aﬀ ected-side to unaﬀ ected-side ratio) in the perfusion area of the middle cerebral artery (MCA asymmetry index), and functional prognosis were compared among two groups. Results: In all, 23 patients were included; 11 presented hemorrhagic transformation, and 12 did not. The hemorrhagic group exhibited signiﬁ cantly higher MCA asymmetry index than the non-hemorrhagic group (median: 1.54 [1.30–1.83] vs. 1.12 [1.07–1.24], respectively, P = 0.02), and a lower rate tendency of modiﬁ ed Rankin Scale (mRS): 0-2 after 3 months (1 patient [9%] vs. 6 patients [50%], respectively, P = 0.06). Conclusion: In patients with successful reperfusion by thrombectomy, hemorrhagic transformation is predisposed to occur when high MCA asymmetry index is presented. Care should be taken in periprocedural management of blood pressure and sedation for those with high MCA asymmetry index.","PeriodicalId":34768,"journal":{"name":"JNET","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.OA.2018-0046","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JNET","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5797/JNET.OA.2018-0046","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 1

Abstract

Objective: To evaluate cerebral blood ﬂ ow immediately after reperfusion following thrombectomy for acute large vessel occlusion, and to examine whether cerebral blood ﬂ ow after reperfusion is related to hemorrhagic transformation. Methods: The patients with acute large vessel occlusion in the anterior circulation who obtained reperfusion by thrombectomy were included. Cerebral blood ﬂ ow was evaluated using single photon emission computed tomography (SPECT) within 6 hours after reperfusion. The patients were divided into two groups with or without hemorrhagic transformation, and basic characteristics, the ratio of cerebral blood ﬂ ow (aﬀ ected-side to unaﬀ ected-side ratio) in the perfusion area of the middle cerebral artery (MCA asymmetry index), and functional prognosis were compared among two groups. Results: In all, 23 patients were included; 11 presented hemorrhagic transformation, and 12 did not. The hemorrhagic group exhibited signiﬁ cantly higher MCA asymmetry index than the non-hemorrhagic group (median: 1.54 [1.30–1.83] vs. 1.12 [1.07–1.24], respectively, P = 0.02), and a lower rate tendency of modiﬁ ed Rankin Scale (mRS): 0-2 after 3 months (1 patient [9%] vs. 6 patients [50%], respectively, P = 0.06). Conclusion: In patients with successful reperfusion by thrombectomy, hemorrhagic transformation is predisposed to occur when high MCA asymmetry index is presented. Care should be taken in periprocedural management of blood pressure and sedation for those with high MCA asymmetry index.

查看原文本刊更多论文

取栓后再灌注后立即高灌注可预测出血转化

目的:评价急性大血管闭塞取栓术后立即再灌注脑血流量，探讨再灌注后脑血流量是否与出血转化有关。方法:选取经取栓术获得再灌注的急性前循环大血管闭塞患者为研究对象。再灌注后6小时内用单光子发射计算机断层扫描(SPECT)评估脑血流量。将患者分为有无出血转化两组，比较两组患者的基本特征、大脑中动脉灌注区脑血流量(受累侧与未受累侧之比)(MCA不对称指数)及功能预后。结果:共纳入23例患者;11例有出血转化，12例无。出血组MCA不对称指数明显高于非出血组(中位数分别为1.54[1.30-1.83]和1.12 [1.07-1.24]，P = 0.02)， 3个月后修正Rankin量表(mRS)的发生率趋势为0-2(1例[9%]比6例[50%]，P = 0.06)。结论:取栓后再灌注成功的患者，MCA不对称指数高时易发生出血转化。对于MCA不对称指数高的患者，应注意围手术期的血压管理和镇静。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

JNET

自引率

0.00%

发文量

审稿时长

17 weeks

期刊介绍： JNET Journal of Neuroendovascular Therapy is the official journal of the Japanese Society for Neuroendovascular Therapy (JSNET). The JNET publishes peer-reviewed original research related to neuroendovascular therapy, including clinical studies, state-of-the-art technology, education, and basic sciences.