Possibility of predicting hemorrhagic transformation during reperfusion therapy for ischemic stroke in the patient population of the Sverdlovsk Region

Abstract

Hemorrhagic transformation of an infarction focus is the most common and menacing complication of systemic thrombolytic therapy (TLT) for ischemic stroke (IS). Objective: to analyze the rates of hemorrhagic transformation of infarction and to search for the risk factors of hemorrhagic transformation of an ischemic area after systemic TLT. Patients and methods. The data of 469 IS patients who had received systemic thrombolysis at the primary vascular departments of the Sverdlovsk Region in 2009 to 2013 were analyzed. In accordance with the selection criteria, a study group comprised 143 patients from 4 vascular centers of the Sverdlovsk Region, who were analyzed for the incidence of reperfusion hematomas. Neurological deficit was evaluated by the National Institutes of Health Stroke Scale (NIHSS) and self-care abilities were assessed by the modified Rankin scale (mRS). Brain computed tomography was carried out before, on days 1 and 7 after TLT, and when the patient displayed any deterioration in his/her condition. Analysis of TLT complications involved estimation of the rate of hemorrhagic transformation in accordance with the ECASS II criteria. Results and discussion. According to the ECASS II criteria, the clinically obvious bleeding rate was 4.9%. Hemorrhagic transformation was found to affect the time course of changes and degree of neurological deficit regression and self-care ability recovery. Logistic regression analysis has established that disability index on admission and diastolic blood pressure on admission and during TLT are the most important risk factors of reperfusion hematoma.

Keywords

• ischemic stroke
• hemorrhagic transformation
• systemic thrombolytic therapy