Abstract W MP21: Contrast Staining on Ct After Endovascular Treatment for Acute Ischemic Stroke: Association With Worse Outcomes
Introduction: Parenchymal contrast staining may appear on computerized tomography after intra-arterial therapy for acute ischemic stroke. This finding may not be associated with hemorrhagic transformation and has been reported to be transient. However, the incidence, associations and clinical consequences have not been well described.
Methods: We reviewed a prospectively collected database of acute ischemic stroke patients admitted between January of 2012 and April of 2013. We included patients with acute ischemic stroke and large vessel occlusion who underwent endovascular therapy. Demographic, clinical and imaging characteristics were assessed. Post-procedure brain CTs were reviewed for contrast staining and ASPECTS score. Discharge and 30-day follow up data were compared using Wilcoxon two-sample tests and chi square tests.
Results: 59 patients (34 (57.6%) female, mean age: 66.7 years;) were included in the analysis. Twenty two patients (37.3%) had contrast staining on post-procedure brain CT scan. Of this group, the initial median NIHSS was 16.5 and initial median ASPECTS score was 7 (compared to initial median NIHSS of 15 and median ASPECTS of 9 in those without contrast staining) (p=0.297 and 0.166, respectively). Recanalization rates were similar for both groups (82% vs. 83%, p=0.882). Upon discharge, the group of patients with post-procedure CT with contrast staining had significantly higher NIHSS (median of 15) and lower CT ASPECTS score (median of 6), (compared to NIHSS of 7 and CT ASPECTS of 8 in those without contrast staining) (p=0.025 and 0.017). Patients who had contrast staining tended to be more likely to have a hemorrhagic transformation of the ischemic infarct area (59.1% versus 36.1%, p=0.088) with rates of PH1 being 18.2% (versus 8.1%, p=0.407) and PH2 being 22.7% (versus 5.4%, p=0.090). The data also suggest a difference in the 30-day NIHSS (10 in the contrast staining group versus 4, p=0.092) and 30-day MRS (4 in the contrast staining group versus 3, p=0.107).
Conclusion: The presence of contrast staining on CT obtained after intra-arterial therapy for acute ischemic stroke may be associated with worse imaging and clinical outcomes, including hemorrhagic transformation and worse neurologic deficits upon discharge and at 30 days.
Author Disclosures: E. Cheng-Ching: None. M.S. Hussain: None. G. Toth: None. N. Obuchowski: None. S. Man: None. D. Wisco: None. K. Uchino: None. F. Hui: None.
- © 2014 by American Heart Association, Inc.