Skip to main content

ORIGINAL RESEARCH article

Front. Neurol.
Sec. Stroke
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1465481
This article is part of the Research Topic Advances and controversies in ischemic stroke management: from prevention to diagnosis and acute treatment View all 92 articles

A cross-sectional study of Asymmetry of Internal Cerebral Veins Correlation with Hemorrhagic Transformation following Endovascular Thrombectomy

Provisionally accepted
Kunxin Lin Kunxin Lin Wenlong Zhao Wenlong Zhao Quanhong Wu Quanhong Wu *Yiru Zheng Yiru Zheng *Bo Yang Bo Yang *Ying Fu Ying Fu Ning Wang Ning Wang *Ling Fang Ling Fang *
  • First Affiliated Hospital of Fujian Medical University, Fuzhou, China

The final, formatted version of the article will be published soon.

    Introduction: Hemorrhagic transformation (HT) is a severe complication of patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) after endovascular treatment (EVT). We hypothesize that the asymmetry of the internal cerebral veins (ICVs) on baseline CT angiogram (CTA) can be an adjunctive predictor for HT.We studied consecutive AIS-LVO patients from November 2020 and April 2022 with anterior circulation occlusion treated with EVT. Asymmetrical ICVs was assessed using CTA and defined as the presence of hypodensity (less opacification) on the ipsilateral occlusion side as compared with the contralateral side. The primary outcome was HT, which refers to hemorrhage within the ischemic territory. This was evaluated on follow-up imaging (CT scan or magnetic resonance imaging) performed 48 hours after EVT and classified into four subtypes according to the European Cooperative Acute Stroke Study-II.Results: A total of 126 patients were included with an HT rate was 49.2% (62/126). The incidence of ICVs asymmetry was 54.0% (68/126). The ICVs asymmetry group exhibited a significantly higher risk of parenchymatous hematoma type HT (33.8% vs 15.5%, p = 0.019) as well as symptomatic intracerebral hemorrhage (sICH) (23.5% vs 5.2%, p = 0.004). In multivariate logistic regression, ICVs asymmetry (OR 3.809, 95% CI 1.582-9.171), baseline Alberta Stroke Program Early CT Score (OR 0.771, 95% CI 0.608-0.978), intravenous recombinant tissue plasminogen activator (OR 2.847, 95% CI 1.098-2.7.385) and poor collateral circulation (OR 3.998, were independent risk factors of HT.ICVs asymmetry is due to damaged autoregulation or tissue micro-perfusion that hamper cerebral blood flow (CBF) on a tissue level. ICVs asymmetry is a novel radiological sign that can independently predict HT and is associated with a higher risk of sICH in AIS-LVO patients after EVT. Further studies are needed to validate this finding.

    Keywords: Internal cerebral veins, Hemorrhagic transformation, Acute ischemic stroke, Endovascular thrombectomy, Large vessel occlusion

    Received: 16 Jul 2024; Accepted: 12 Dec 2024.

    Copyright: © 2024 Lin, Zhao, Wu, Zheng, Yang, Fu, Wang and Fang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Quanhong Wu, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
    Yiru Zheng, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
    Bo Yang, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
    Ning Wang, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
    Ling Fang, First Affiliated Hospital of Fujian Medical University, Fuzhou, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.