(Stroke. 1999;30:2280-2284.)
© 1999 American Heart Association, Inc.
Original Contributions |
Hemorrhagic Transformation Within 36 Hours of a Cerebral Infarct
Relationships With Early Clinical Deterioration and 3-Month Outcome in the European Cooperative Acute Stroke Study I (ECASS I) Cohort
From the Department of Neurological Science, University La Sapienza, Rome, Italy (M.F., S.B., S.L., L.B.); Department of Neuroradiology, University of Dresden, Dresden, Germany (R. von K.); Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, Calif (G. del Z.); Department of Neurology, University of Toulouse, Toulouse, France (V.L.); Biostatistical Center for Clinical Trials, University of Leuven, Leuven, Belgium (E.L.); Department of Neurology, University of Heidelberg, Heidelberg, Germany (A.P.R.); and the Department of Neuroradiology, University of Toulouse, Toulouse, France (C.M.).
Correspondence to Marco Fiorelli, MD, PhD, Department of Neurological Sciences, University La Sapienza, Viale dell'Università 30, 00185 Rome, Italy. E-mail fiorelli{at}uniroma1.it
Background and Purpose—The clinical correlates of the varying degrees of early hemorrhagic transformation of a cerebral infarct are unclear. We investigated the cohort of a randomized trial of thrombolysis to assess the early and late clinical course associated with different subtypes of hemorrhagic infarction (HI) and parenchymal hematoma (PH) detected within the first 36 hours of an ischemic stroke.
Methods—We exploited the database of the European Cooperative Acute Stroke Study I (ECASS I), a randomized, placebo-controlled, phase III trial of intravenous recombinant tissue plasminogen activator in acute ischemic stroke. Findings on 24- to 36- hour CT were classified into 5 categories: no hemorrhagic transformation, HI types 1 and 2, and PH types 1 and 2. We assessed the risk of concomitant neurological deterioration and of 3-month death and disability associated with subtypes of hemorrhagic transformation, as opposed to no bleeding. Risks were adjusted for age and extent of ischemic damage on baseline CT.
Results—Compared with absence of hemorrhagic transformation, HI1, HI2, and PH1 did not modify the risk of early neurological deterioration, death, and disability, whereas, in both the placebo and the recombinant tissue plasminogen activator groups, PH2 had a devastating impact on early neurological course (odds ratio for deterioration, 32.3; 95% CI, 13.4 to 77.7), and on 3-month death (odds ratio, 18.0; 95% CI, 8.05 to 40.1). Risk of disability was also higher, but not significantly, after PH2.
Conclusions—Risk of early neurological deterioration and of 3-month death was severely increased after PH2, indicating that large hematoma is the only type of hemorrhagic transformation that may alter the clinical course of ischemic stroke.
Key Words: prognosis • stroke, hemorrhagic • tissue plasminogen activator
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