Jn Goldstein1, Hb Brouwers, Jm Romero, K McNamara, K Schwab, Sm Greenberg, J Rosand. 1. Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA ; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA ; Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA 02114, USA.
Abstract
INTRODUCTION: The ATACH-II trial is designed to evaluate whether intensive blood pressure reduction can reduce hematoma growth and improve outcome. However, it is difficult to determine, at presentation, which patients are at highest risk of ongoing bleeding, and will receive the most clinical benefit from blood pressure therapy. It may be that improved predictive markers will lead to efficient, personalized selection of optimal therapy. We hypothesize that specific imaging findings on CT angiography (CTA) and MRI will mark those patients who receive the most benefit from intensive blood pressure reduction. METHODS: Many patients enrolled in ATACH-II will undergo CTA and/or MRI as part of routine clinical care. We will perform a blinded analysis of these images. For CTA, we will determine the presence of contrast pooling (also termed contrast extravasation or the "Spot Sign"). In addition, we will calculate a Spot Sign Score, a score that includes number of Spot Signs, diameter, and contrast density. For MRI, we will focus on the presence, number, and location of cerebral microbleeds (CMBs) on sensitive T2*-weighted MRI sequences. RESULTS: We will test the hypothesis that patients with a Spot Sign will receive clinical benefit from intensive blood pressure reduction. In addition, we will determine whether patients with the highest Spot Sign Scores receive the most benefit from intensive blood pressure reduction. Finally, we will determine whether the absence of CMBs marks those at higher risk for hematoma expansion, and therefore more likely to benefit from treatment. CONCLUSION: This ancillary study offers the tremendous opportunity to determine whether imaging findings can risk stratify ICH patients for acute therapies aimed at limiting hematoma growth.
INTRODUCTION: The ATACH-II trial is designed to evaluate whether intensive blood pressure reduction can reduce hematoma growth and improve outcome. However, it is difficult to determine, at presentation, which patients are at highest risk of ongoing bleeding, and will receive the most clinical benefit from blood pressure therapy. It may be that improved predictive markers will lead to efficient, personalized selection of optimal therapy. We hypothesize that specific imaging findings on CT angiography (CTA) and MRI will mark those patients who receive the most benefit from intensive blood pressure reduction. METHODS: Many patients enrolled in ATACH-II will undergo CTA and/or MRI as part of routine clinical care. We will perform a blinded analysis of these images. For CTA, we will determine the presence of contrast pooling (also termed contrast extravasation or the "Spot Sign"). In addition, we will calculate a Spot Sign Score, a score that includes number of Spot Signs, diameter, and contrast density. For MRI, we will focus on the presence, number, and location of cerebral microbleeds (CMBs) on sensitive T2*-weighted MRI sequences. RESULTS: We will test the hypothesis that patients with a Spot Sign will receive clinical benefit from intensive blood pressure reduction. In addition, we will determine whether patients with the highest Spot Sign Scores receive the most benefit from intensive blood pressure reduction. Finally, we will determine whether the absence of CMBs marks those at higher risk for hematoma expansion, and therefore more likely to benefit from treatment. CONCLUSION: This ancillary study offers the tremendous opportunity to determine whether imaging findings can risk stratify ICHpatients for acute therapies aimed at limiting hematoma growth.
Authors: Andrea Morotti; Javier M Romero; Michael J Jessel; Andrew M Hernandez; Anastasia Vashkevich; Kristin Schwab; Joseph D Burns; Qaisar A Shah; Thomas A Bergman; M Fareed K Suri; Mustapha Ezzeddine; Jawad F Kirmani; Sachin Agarwal; Angela Hays Shapshak; Steven R Messe; Chitra Venkatasubramanian; Katherine Palmieri; Christopher Lewandowski; Tiffany R Chang; Ira Chang; David Z Rose; Wade Smith; Chung Y Hsu; Chun-Lin Liu; Li-Ming Lien; Chen-Yu Hsiao; Toru Iwama; Mohammad Rauf Afzal; Christy Cassarly; Steven M Greenberg; Renee' Hebert Martin; Adnan I Qureshi; Jonathan Rosand; John M Boone; Joshua N Goldstein Journal: Neuroradiology Date: 2017-07-20 Impact factor: 2.804
Authors: Andrea Morotti; H Bart Brouwers; Javier M Romero; Michael J Jessel; Anastasia Vashkevich; Kristin Schwab; Mohammad Rauf Afzal; Christy Cassarly; Steven M Greenberg; Renee Hebert Martin; Adnan I Qureshi; Jonathan Rosand; Joshua N Goldstein Journal: JAMA Neurol Date: 2017-08-01 Impact factor: 18.302
Authors: Gregoire Boulouis; Andrea Morotti; H Bart Brouwers; Andreas Charidimou; Michael J Jessel; Eitan Auriel; Octávio Pontes-Neto; Alison Ayres; Anastasia Vashkevich; Kristin M Schwab; Jonathan Rosand; Anand Viswanathan; Mahmut E Gurol; Steven M Greenberg; Joshua N Goldstein Journal: JAMA Neurol Date: 2016-08-01 Impact factor: 18.302
Authors: A Morotti; J M Romero; M J Jessel; H B Brouwers; R Gupta; K Schwab; A Vashkevich; A Ayres; C D Anderson; M E Gurol; A Viswanathan; S M Greenberg; J Rosand; J N Goldstein Journal: AJNR Am J Neuroradiol Date: 2016-05-19 Impact factor: 3.825
Authors: H Bart Brouwers; Miriam R Raffeld; Koen M van Nieuwenhuizen; Guido J Falcone; Alison M Ayres; Kristen A McNamara; Kristin Schwab; Javier M Romero; Birgitta K Velthuis; Anand Viswanathan; Steven M Greenberg; Christopher S Ogilvy; Albert van der Zwan; Gabriel J E Rinkel; Joshua N Goldstein; Catharina J M Klijn; Jonathan Rosand Journal: Neurology Date: 2014-08-06 Impact factor: 9.910