Maurizio Acampa1, Silvia Camarri2, Pietro Enea Lazzerini3, Francesca Guideri2, Rossana Tassi2, Raffaella Valenti2, Alessandra Cartocci4, Giuseppe Martini2. 1. Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Siena, Italy. Electronic address: M.Acampa@ao-siena.toscana.it. 2. Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Siena, Italy. 3. Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy. 4. Department of Economics and Statistics, University of Siena, Siena, Italy.
Abstract
BACKGROUND: Hemorrhagic transformation (HT) is a multifactorial phenomenon and represents a possible complication of ischemic stroke, especially after thrombolytic treatment. Increased arterial stiffness has been associated with intracranial hemorrhage, but there is no evidence of association with HT after thrombolytic therapy. The aim of our study is to investigate a possible link between arterial stiffness and HT occurrence after thrombolytic therapy in patients with ischemic stroke. METHODS: We enrolled 258 patients (135 males, 123 females; mean age: 73±12years) with acute ischemic stroke undergoing intravenous thrombolysis or/and mechanical thrombectomy. All stroke patients underwent neuroimaging examination, 24-h heart rate and blood pressure monitoring and brain CT-scan after 24-72h to evaluate HT occurrence. The linear regression slope of diastolic on systolic blood pressure was obtained and assumed as a global measure of arterial compliance, and its complement (1 minus the slope), named arterial stiffness index (ASI), has been taken as a measure of arterial stiffness. RESULTS: Out of 258, HT occurred in 55 patients. ASI was significantly higher in patients with HT than in patients without HT (0.70±0.12 vs 0.62±0.14, p<0.001). Logistic regression model showed ASI as independent predictors of HT (OR: 1.9, 95% CI: 1.09-3.02, for every 0.2 increase of ASI): in particular, OR was 5.2 (CI: 2.22-12.24) when ASI was >0.71, in comparison with ASI lower than 0.57. CONCLUSIONS: Our results point to arterial stiffness as a novel independent risk factor for HT after ischemic stroke treated with thrombolysis, suggesting a particularly high bleeding risk when ASI is >0.71.
BACKGROUND:Hemorrhagic transformation (HT) is a multifactorial phenomenon and represents a possible complication of ischemic stroke, especially after thrombolytic treatment. Increased arterial stiffness has been associated with intracranial hemorrhage, but there is no evidence of association with HT after thrombolytic therapy. The aim of our study is to investigate a possible link between arterial stiffness and HT occurrence after thrombolytic therapy in patients with ischemic stroke. METHODS: We enrolled 258 patients (135 males, 123 females; mean age: 73±12years) with acute ischemic stroke undergoing intravenous thrombolysis or/and mechanical thrombectomy. All strokepatients underwent neuroimaging examination, 24-h heart rate and blood pressure monitoring and brain CT-scan after 24-72h to evaluate HT occurrence. The linear regression slope of diastolic on systolic blood pressure was obtained and assumed as a global measure of arterial compliance, and its complement (1 minus the slope), named arterial stiffness index (ASI), has been taken as a measure of arterial stiffness. RESULTS: Out of 258, HT occurred in 55 patients. ASI was significantly higher in patients with HT than in patients without HT (0.70±0.12 vs 0.62±0.14, p<0.001). Logistic regression model showed ASI as independent predictors of HT (OR: 1.9, 95% CI: 1.09-3.02, for every 0.2 increase of ASI): in particular, OR was 5.2 (CI: 2.22-12.24) when ASI was >0.71, in comparison with ASI lower than 0.57. CONCLUSIONS: Our results point to arterial stiffness as a novel independent risk factor for HT after ischemic stroke treated with thrombolysis, suggesting a particularly high bleeding risk when ASI is >0.71.
Authors: Jason P Appleton; Lisa J Woodhouse; Daniel Bereczki; Eivind Berge; Hanne K Christensen; Rónán Collins; John Gommans; George Ntaios; Serefnur Ozturk; Szabolcs Szatmari; Joanna M Wardlaw; Nikola Sprigg; Peter M Rothwell; Philip M Bath Journal: Stroke Date: 2019-02 Impact factor: 7.914