COMPLEX ANALYSIS OF RISK FACTORS FOR HEMORRHAGIC COMPLICATIONS AFTER REPERFUSION THERAPY IN PATIENTS WITH ISCHEMIC STROKE

 

Hadisova A.G.¹, Zakhmatova T.V.^1,2

 

1  -  I. I. Mechnikov North-West State Medical University.

2 - V.A. Almazov National Medical Research Centre. Saint-Petersburg, Russia.

T

o determine the frequency and risk factors of hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS) after systemic or selective thrombolysis, thromboextraction (TE) and their combined usage.

Materials and methods. Current prospective study included 460 patients with AIS aged from 23 to 97 years who received various types of reperfusion therapy: thrombolytic therapy (TLT) – 263 patients, invasive interventions (thrombextraction (TE), combination TE with TLT and stenting) – 197 patients. Cerebral blood flow was analyzed using ultrasound duplex scanning (USD) of brachiocephalic and intracranial arteries, computed angiography of cerebral vessels and perfusion computed tomography. Patients who received invasive treatment underwent radiopaque cerebral angiography (CAG).

Results. Among the strokes complicated by HT, the cardioembolic subtype plays a leading role which is confirmed by the data of modern studies. Cardiac pathology, especially arrhythmia, is not only the most common potential source of cerebral embolism, but also a predictor of HT. The presence of hypertension, a history of AIS, hemodynamically significant stenosis of the extracranial arteries, and an increase in blood flow velocity in the intracranial arteries can serve as risk factors for the development of hemorrhagic complications in the early period after reperfusion. Ultrasonography of intracranial arteries revealed a significant relationship between blood flow velocity and peripheral resistance indices with the risk of developing HT.

Discussion. Large cerebral infarctions, the cardioembolic subtype of stroke, rhythm disturbances, and arterial hypertension are considered traditional risk factors for HT, which was confirmed by the data of this study. The volume of ischemic focus is a proven predictor of the development of HT, the significance of which was confirmed by the authors at a threshold value of more than 2 cm. The severity of the neurological deficit also correlates with the size of the ischemic focus, which, in turn, according to the data of current study, can be used as a strong predictor of HT. The influence of significant stenosis of extracranial arteries on the risk of HT has been established. The authors confirmed the relationship between an increase in the average blood flow velocity after successful recanalization and the risk of developing hemorrhagic complications, which is consistent with the data of Baracchini C. et al. (2019) and Kneihsl M. et al. (2018). It was noted that hyperperfusion in the early stages after treatment of AIS does not have an independent effect on the risk of developing hemorrhagic complications, but in combination with other factors listed above can serve as a predictor of this complication.

Conclusions. The severity of the neurological deficit, the size of the lesion, the cardioembolic subtype of stroke and cardiac pathology are significant predictors of HT. The role of ultrasonic parameters of intracrianial blood flow as risk factors for the development of hemorrhagic complications in the early period after reperfusion has been confirmed.

 

Keywords: acute ischemic stroke, thrombolytic therapy, thrombextraction, ultrasound duplex scanning, hemorrhagic transformation, ultrasound duplex scanning, time averaged maximum velocity, resistive index, predictors.

 

Corresponding author: Zakhmatova T.V., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript .

 

For citation: Hadisova A.G., Zakhmatova T.V. Complex analysis of risk factors for hemorrhagic complications after reperfusion therapy in patients with ischemic stroke. REJR 2024; 14(3):7-19. DOI: 10.21569/2222-7415-2024-14-3-7-19.

Received: 27.11.23 Accepted: 14.08.24