Frontiers in Neurology (Feb 2023)

Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis

  • Jiacheng Sun,
  • Jiacheng Sun,
  • Christina Lam,
  • Christina Lam,
  • Lauren Christie,
  • Lauren Christie,
  • Lauren Christie,
  • Christopher Blair,
  • Christopher Blair,
  • Christopher Blair,
  • Xingjuan Li,
  • Freda Werdiger,
  • Freda Werdiger,
  • Qing Yang,
  • Andrew Bivard,
  • Andrew Bivard,
  • Longting Lin,
  • Longting Lin,
  • Mark Parsons,
  • Mark Parsons,
  • Mark Parsons

DOI
https://doi.org/10.3389/fneur.2023.1079205
Journal volume & issue
Vol. 14

Abstract

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BackgroundHemorrhagic transformation (HT) following reperfusion therapies for acute ischaemic stroke often predicts a poor prognosis. This systematic review and meta-analysis aims to identify risk factors for HT, and how these vary with hyperacute treatment [intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT)].MethodsElectronic databases PubMed and EMBASE were used to search relevant studies. Pooled odds ratio (OR) with 95% confidence interval (CI) were estimated.ResultsA total of 120 studies were included. Atrial fibrillation and NIHSS score were common predictors for any intracerebral hemorrhage (ICH) after reperfusion therapies (both IVT and EVT), while a hyperdense artery sign (OR = 2.605, 95% CI 1.212–5.599, I2 = 0.0%) and number of thrombectomy passes (OR = 1.151, 95% CI 1.041–1.272, I2 = 54.3%) were predictors of any ICH after IVT and EVT, respectively. Common predictors for symptomatic ICH (sICH) after reperfusion therapies were age and serum glucose level. Atrial fibrillation (OR = 3.867, 95% CI 1.970–7.591, I2 = 29.1%), NIHSS score (OR = 1.082, 95% CI 1.060–1.105, I2 = 54.5%) and onset-to-treatment time (OR = 1.003, 95% CI 1.001–1.005, I2 = 0.0%) were predictors of sICH after IVT. Alberta Stroke Program Early CT score (ASPECTS) (OR = 0.686, 95% CI 0.565–0.833, I2 =77.6%) and number of thrombectomy passes (OR = 1.374, 95% CI 1.012–1.866, I2 = 86.4%) were predictors of sICH after EVT.ConclusionSeveral predictors of ICH were identified, which varied by treatment type. Studies based on larger and multi-center data sets should be prioritized to confirm the results.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=268927, identifier: CRD42021268927.

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