Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2023

Open Access 01-12-2023 | Stroke | Research

Early antithrombotic therapy in patients with postinterventional cerebral hyperdensity reduces early neurological deterioration after mechanical thrombectomy

Authors: Yunhe Luo, Min Chu, Daosheng Wang, Xin Gu, Delong Wang, Jin Zheng, Jing Zhao

Published in: BMC Neurology | Issue 1/2023

Login to get access

Abstract

Background

Initiation of early antithrombotic therapy after acute ischemic stroke (AIS) is crucial. We aimed to investigate whether early antithrombotic therapy influences early neurological deterioration (END) in AIS patients with postinterventional cerebral hyperdensity (PCHD) immediately after mechanical thrombectomy (MT).

Methods

We retrospectively analyzed 108 consecutive anterior circulation AIS patients with PCHD immediately after MT. All patients were divided into END group and non-END group and END was defined as an increase of four points or more on the postinterventional National Institutes of Health Stroke Scale (NIHSS) score within the first 72 h after MT. Early antithrombotic therapy was defined as patients with PCHD who received antithrombotic therapy within 24 h after MT. Statistical analyses were performed to evaluate the association between early antithrombotic therapy and the risk of END.

Results

Among 108 patients, 27 (25%) patients developed END. Multivariate regression analysis revealed that early use of antithrombotic therapy (OR = 0.229, 95%CI = 0.083–0.626, P = 0.004) was an independent protector of END and postinterventional low density shadow exceeding 1/3 of the vascular territory (OR = 4.000, 95%CI = 1.157–13.834, P = 0.029) was an independent risk factor for END.

Conclusion

Antithrombotic therapy within 24 h after MT maybe associated with the reduced risk of END in anterior circulation AIS patients with PCHD.
Literature
1.
Collaborators GN. Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the global burden of Disease Study 2016. Lancet Neurol. 2019;18(5):459–80.CrossRef
2.
Chen NH, Zhang YM, Jiang FP, Liu S, Zhao HD, Hou JK, et al. FLAIR vascular hyperintensity predicts early neurological deterioration in patients with acute ischemic Stroke receiving endovascular thrombectomy. Neurol Sci. 2022;43(6):3747–57.CrossRefPubMed
3.
Li X, Gu F, Ding J, Bian J, Wang N, Shu R, et al. The predictors and prognosis for unexpected reocclusion after mechanical thrombectomy: a meta-analysis. Ann Transl Med. 2020;8(23):1566.CrossRefPubMedPubMedCentral
4.
Saqqur M, Molina CA, Salam A, Siddiqui M, Ribo M, Uchino K, et al. Clinical deterioration after intravenous recombinant tissue plasminogen activator treatment: a multicenter transcranial Doppler study. Stroke. 2007;38(1):69–74.CrossRefPubMed
5.
Tijssen M, Hofman P, Stadler A, van Zwam W, de Graaf R, van Oostenbrugge R, et al. The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic Stroke. Eur Radiol. 2014;24(4):834–40.CrossRefPubMed
6.
You SH, Kim B, Kim BK, Suh SI. MR Imaging for differentiating contrast staining from Hemorrhagic Transformation after Endovascular Thrombectomy in Acute ischemic Stroke: Phantom and Patient Study. AJNR Am J Neuroradiol. 2018;39(12):2313–9.CrossRefPubMedPubMedCentral
7.
Choi Y, Shin NY, Jang J, Ahn KJ, Kim BS. Dual-energy CT for differentiating acute intracranial Hemorrhage from contrast staining or calcification: a meta-analysis. Neuroradiology. 2020;62(12):1617–26.CrossRefPubMed
8.
Almqvist H, Holmin S, Mazya MV. Dual energy CT after Stroke thrombectomy alters assessment of hemorrhagic Complications. Neurology. 2019;93(11):e1068–e75.CrossRefPubMed
9.
Cho KH, You SH, Cho BH, Yu S, Park HK, Cho AH. Differentiation of hemorrhagic infarction from primary intracerebral Hemorrhage in the chronic period. J Clin Neurosci. 2020;79:118–22.CrossRefPubMed
10.
Niesen WD, Schläger A, Reinhard M, Fuhrer H. Transcranial sonography to Differentiate Primary Intracerebral Hemorrhage from Cerebral Infarction with Hemorrhagic Transformation. J Neuroimaging. 2018;28(4):370–3.CrossRefPubMed
11.
England TJ, Bath PM, Sare GM, Geeganage C, Moulin T, O’Neill D, et al. Asymptomatic hemorrhagic transformation of infarction and its relationship with functional outcome and Stroke subtype: assessment from the Tinzaparin in Acute Ischaemic Stroke Trial. Stroke. 2010;41(12):2834–9.CrossRefPubMed
12.
Zhong W, Yan S, Chen Z, Luo Z, Chen Y, Zhang X et al. Stroke outcome of early antiplatelet in post-thrombolysis haemorrhagic infarction. J Neurol Neurosurg Psychiatry. 2022.
13.
Neuberger U, Kickingereder P, Schönenberger S, Schieber S, Ringleb PA, Bendszus M, et al. Risk factors of intracranial Hemorrhage after mechanical thrombectomy of anterior circulation ischemic Stroke. Neuroradiology. 2019;61(4):461–9.CrossRefPubMed
14.
Tijssen MP, Hofman PA, Stadler AA, van Zwam W, de Graaf R, van Oostenbrugge RJ, et al. The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic Stroke. Eur Radiol. 2014;24(4):834–40.CrossRefPubMed
15.
Rudd MA, Johnstone MT, Rabbani LE, George D, Ware JA, Loscalzo J. Thrombolytic therapy causes an increase in vascular permeability that is reversed by 1-deamino-8-D-vasopressin. Circulation. 1991;84(6):2568–73.CrossRefPubMed
16.
Dekeyzer S, Nikoubashman O, Lutin B, De Groote J, Vancaester E, De Blauwe S, et al. Distinction between contrast staining and Hemorrhage after endovascular Stroke treatment: one CT is not enough. J Neurointerv Surg. 2017;9(4):394–8.CrossRefPubMed
17.
Yoon W, Seo JJ, Kim JK, Cho KH, Park JG, Kang HK. Contrast enhancement and contrast extravasation on computed tomography after intra-arterial thrombolysis in patients with acute ischemic Stroke. Stroke. 2004;35(4):876–81.CrossRefPubMed
18.
Payabvash S, Qureshi MH, Khan SM, Khan M, Majidi S, Pawar S, et al. Differentiating intraparenchymal Hemorrhage from contrast extravasation on post-procedural noncontrast CT scan in acute ischemic Stroke patients undergoing endovascular treatment. Neuroradiology. 2014;56(9):737–44.CrossRefPubMed
19.
Lummel N, Schulte-Altedorneburg G, Bernau C, Pfefferkorn T, Patzig M, Janssen H, et al. Hyperattenuated intracerebral lesions after mechanical recanalization in acute Stroke. AJNR Am J Neuroradiol. 2014;35(2):345–51.CrossRefPubMedPubMedCentral
20.
Shao Y, Xu Y, Li Y, Wen X, He X. A new classification system for Postinterventional Cerebral Hyperdensity: the influence on Hemorrhagic Transformation and Clinical Prognosis in Acute Stroke. Neural Plast. 2021;2021:6144304.CrossRefPubMedPubMedCentral
21.
Parrilla G, García-Villalba B, Espinosa de Rueda M, Zamarro J, Carrión E, Hernández-Fernández F, et al. Hemorrhage/contrast staining areas after mechanical intra-arterial thrombectomy in acute ischemic Stroke: imaging findings and clinical significance. AJNR Am J Neuroradiol. 2012;33(9):1791–6.CrossRefPubMedPubMedCentral
22.
Saver JL, Altman H. Relationship between neurologic deficit severity and final functional outcome shifts and strengthens during first hours after onset. Stroke. 2012;43(6):1537–41.CrossRefPubMedPubMedCentral
23.
Vynckier J, Maamari B, Grunder L, Goeldlin MB, Meinel TR, Kaesmacher J et al. Early neurologic deterioration in Lacunar Stroke: Clinical and Imaging predictors and Association with Long-Term Outcome. Neurology. 2021.
24.
Kobeissi H, Ghozy S, Seymour T, Bilgin C, Kadirvel R, Kallmes DF. Early neurological deterioration as a predictor of outcomes after endovascular thrombectomy for Stroke: a systematic review and meta-analysis. Interv Neuroradiol. 2022:15910199221135289.
25.
Li W, Yuan S, Sui X, Bian H, Wei M, Chen Z, et al. Higher serum occludin after successful reperfusion is associated with early neurological deterioration. CNS Neurosci Ther. 2022;28(7):999–1007.CrossRefPubMedPubMedCentral
26.
Sun D, Tong X, Huo X, Jia B, Raynald, Wang A, et al. Unexplained early neurological deterioration after endovascular treatment for acute large vessel occlusion: incidence, predictors, and clinical impact: data from ANGEL-ACT registry. J Neurointerv Surg. 2022;14(9):875–80.CrossRefPubMed
27.
Castillo J, Leira R, Moro MA, Lizasoain I, Serena J, Dávalos A. Neuroprotective effects of aspirin in patients with acute cerebral infarction. Neurosci Lett. 2003;339(3):248–50.CrossRefPubMed
28.
Lin J, Han Z, Yi X, Luo H, Zhou Q, Zhou J. Prestroke Aspirin Use is Associated with Clinical outcomes in ischemic Stroke patients with atherothrombosis, small artery Disease, and Cardioembolic Stroke. J Atheroscler Thromb. 2019;26(6):528–37.CrossRefPubMedPubMedCentral
29.
He F, Xia C, Zhang JH, Li XQ, Zhou ZH, Li FP, et al. Clopidogrel plus aspirin versus aspirin alone for preventing early neurological deterioration in patients with acute ischemic Stroke. J Clin Neurosci. 2015;22(1):83–6.CrossRefPubMed
30.
Xia H, Wang Z, Tian M, Liu Z, Zhou Z. Low-molecular-weight heparin Versus Aspirin in Early Management of Acute ischemic Stroke: a systematic review and Meta-analysis. Front Immunol. 2022;13:823391.CrossRefPubMedPubMedCentral
31.
Wang Q, Chen C, Chen XY, Han JH, Soo Y, Leung TW, et al. Low-molecular-weight heparin and early neurologic deterioration in acute Stroke caused by large artery occlusive Disease. Arch Neurol. 2012;69(11):1454–60.CrossRefPubMed
32.
Amans MR, Cooke DL, Vella M, Dowd CF, Halbach VV, Higashida RT, et al. Contrast staining on CT after DSA in ischemic Stroke patients progresses to infarction and rarely hemorrhages. Interv Neuroradiol. 2014;20(1):106–15.CrossRefPubMedPubMedCentral
33.
Renú A, Amaro S, Laredo C, Román LS, Llull L, Lopez A, et al. Relevance of blood-brain barrier disruption after endovascular treatment of ischemic Stroke: dual-energy computed tomographic study. Stroke. 2015;46(3):673–9.CrossRefPubMed
34.
Molina CA, Selim MH. The dilemma of resuming anticoagulation after intracranial Hemorrhage: little evidence facing big fears. Stroke. 2011;42(12):3665–6.CrossRefPubMed
35.
Taussky P, Tawk RG, Daugherty WP, Hanel RA. Medical therapy for ischemic Stroke: review of intravenous and intra-arterial treatment options. World Neurosurg. 2011;76(6 Suppl):9–15.CrossRef
36.
Arba F, Piccardi B, Palumbo V, Biagini S, Galmozzi F, Iovene V, et al. Blood-brain barrier leakage and hemorrhagic transformation: the Reperfusion Injury in ischemic StroKe (RISK) study. Eur J Neurol. 2021;28(9):3147–54.CrossRefPubMed
37.
Bernardo-Castro S, Sousa JA, Brás A, Cecília C, Rodrigues B, Almendra L, et al. Pathophysiology of blood-brain barrier permeability throughout the different stages of ischemic Stroke and its implication on Hemorrhagic Transformation and Recovery. Front Neurol. 2020;11:594672.CrossRefPubMedPubMedCentral
38.
Wakai S, Nagai M. Histological verification of microaneurysms as a cause of Cerebral Haemorrhage in surgical specimens. J Neurol Neurosurg Psychiatry. 1989;52(5):595–9.CrossRefPubMedPubMedCentral
39.
Furie KL, Jayaraman MV. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke. 2018;49(3):509 – 10.
40.
Collaboration R. Effects of antiplatelet therapy after Stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial. Lancet. 2019;393(10191):2613–23.CrossRef
Metadata
Title
Early antithrombotic therapy in patients with postinterventional cerebral hyperdensity reduces early neurological deterioration after mechanical thrombectomy
Authors
Yunhe Luo
Min Chu
Daosheng Wang
Xin Gu
Delong Wang
Jin Zheng
Jing Zhao
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2023
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-023-03497-9

Other articles of this Issue 1/2023

BMC Neurology 1/2023 Go to the issue

Case Report

Novel heterozygous VPS13A pathogenic variants in chorea-neuroacanthocytosis: a case report

Correction

Correction: Cognitive performance of adult patients with SMA before and after treatment initiation with nusinersen

Study Protocol

Core protocol development for phase 2/3 clinical trials in the leukodystrophy vanishing white matter: a consensus statement by the VWM consortium and patient advocates

Case report

Ischemic optic neuropathy as first presentation in patient with m.3243 A > G MELAS classic mutation

Research

Factors influencing procalcitonin in the cerebrospinal fluid of patients after neurosurgery and its diagnostic value for intracranial infection

Research

Elevated SIRT2 of serum exosomes is positively correlated with diagnosis of acute ischemic stroke patients