Incidence, Risk Factors and Clinical Implications of Subarachnoid Hyperdensities on Flat-Panel Detector Computed Tomography following Mechanical Thrombectomy in Anterior Circulation Acute Ischemic Stroke Patients.

Serrallach, Bettina L; Branca, Mattia; Mujanovic, Adnan; Boronylo, Anna; Hanke, Julie M; Hakim, Arsany; Pilgram-Pastor, Sara; Piechowiak, Eike I; Gralla, Jan; Meinel, Thomas; Kaesmacher, Johannes; Dobrocky, Tomas (2024). Incidence, Risk Factors and Clinical Implications of Subarachnoid Hyperdensities on Flat-Panel Detector Computed Tomography following Mechanical Thrombectomy in Anterior Circulation Acute Ischemic Stroke Patients. AJNR. American journal of neuroradiology, 45(9), pp. 1230-1240. American Society of Neuroradiology 10.3174/ajnr.A8277

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BACKGROUND AND PURPOSE

Flat-panel detector computed tomography (FDCT) immediately after mechanical thrombectomy (MT) can detect complications including early hemorrhagic transformation and subarachnoid hyperdensities (SH). The clinical significance of SH in patients undergoing MT remains unclear.

MATERIALS AND METHODS

We studied 223 patients who underwent MT for anterior circulation stroke, had FDCT performed immediately after the procedure, and had follow-up imaging within 24 hours. SH severity was categorized into 5 grades (SH 0: absent to SH IV: extensive). Baseline and procedural characteristics, as well as outcome measures, were analyzed using group comparisons and multivariable logistic regression analyses.

RESULTS

Overall, 100/223 (45%) of patients showed SH on immediate post-interventional FDCT. The factors associated with an increased SH risk were: medium vessel occlusion or distal vessel occlusion as compared to a large vessel occlusion, a more distal device position, a higher number of device passes, a larger volume of contrast applied, and worse final reperfusion eTICI. Occurrence of SH grade II-IV was independently associated with worse functional outcomes (aOR for mRS 3-6: 2.2, 95% CI 1.1-4.3), whereas patients with SH grade I had similar outcomes to patients without SH.

CONCLUSIONS

Our study identified risk factors for SH, most of which reflect increasingly challenging procedures or more peripheral recanalization attempts. The presence of SH grades II-IV was associated with poorer outcomes, suggesting the need for personalized strategies to reduce its incidence and severity or potentially improve recovery after SH.

ABBREVIATIONS

DVO = distal vessel occlusion; FDCT = flat-panel detector computed tomography; LVO = large vessel occlusion; MVO = medium vessel occlusion; MT = mechanical thrombectomy; SH = subarachnoid hyperdensities.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

Serrallach, Bettina Lara, Branca, Mattia, Mujanović, Adnan, Boronylo, Anna, Hanke, Julie Marie, Hakim, Arsany, Pilgram-Pastor, Sara Magdalena, Piechowiak, Eike Immo, Gralla, Jan, Meinel, Thomas Raphael, Kaesmacher, Johannes, Dobrocky, Tomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1936-959X

Publisher:

American Society of Neuroradiology

Language:

English

Submitter:

Pubmed Import

Date Deposited:

09 Apr 2024 12:30

Last Modified:

11 Sep 2024 00:12

Publisher DOI:

10.3174/ajnr.A8277

PubMed ID:

38589058

BORIS DOI:

10.48350/195797

URI:

https://boris.unibe.ch/id/eprint/195797

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