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Aging and disease    2019, Vol. 10 Issue (4) : 784-792     DOI: 10.14336/AD.2018.0807
Orginal Article |
Contrast Staining may be Associated with Intracerebral Hemorrhage but Not Functional Outcome in Acute Ischemic Stroke Patients Treated with Endovascular Thrombectomy
Hong An1,2, Wenbo Zhao1, Jianguo Wang3, Joshua C Wright4, Omar Elmadhoun5,6, Di Wu2, Shuyi Shang1, Chuanjie Wu1, Chuanhui Li7, Longfei Wu1,2, Jian Chen8, Jiangang Duan7, Hongqi Zhang8, Haiqing Song1, Yuchuan Ding2,5, Xunming Ji2,8,*
1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
2China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.
3Department of Rehabilitation, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
4Wayne State University School of Medicine, Detroit, MI, USA.
5Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA.
6Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Massachusetts, USA.
7Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China.
8Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Abstract  

To evaluate the incidence of post-interventional contrast staining (PICS) in acute ischemic stroke (AIS) Chinese patients who were treated with endovascular thrombectomy (ET) and investigate potential association of PICS with functional outcome and intracerebral hemorrhage (ICH). This observational study was based on a single-center prospective registry study. AIS patients who underwent ET from January 2013 to February 2017 were recruited into this study. All patients had dual-energy CT (DECT) scan of the head at 12 to 24 hours post-ET. The primary outcome was the incidence of PICS. Secondary outcomes were total ICH, symptomatic ICH (sICH), 3-month functional outcome, and long-term functional outcome. One hundred and eighty patients were enrolled in this study. PICS was detected in 50 patients (28%) based on the post-interventional CT scan. We first used basic statistical analyses, showing that the incidence of both total ICH (60% vs. 25%, p<0.001) and sICH (18% vs. 8%, p=0.044) were higher in patients with PICS than those without, and fewer patients achieved no disability (mRS≤1) in the PICS group compared to the control group at both 3-month and long-term follow-up (p<0.01 each). However, multivariate regression analysis further revealed that PICS only increased total (adjusted odds ratio, 7.38; 95% confidence interval 1.66 to 32.9; p=0.009) but not sICH risk. Furthermore, the logistic regression analyses did not show statistical difference in good clinical outcomes or mortality between the two groups. PICS is a common phenomenon in Chinese AIS patients. It is associated with total ICH after ET, but it seems to have no effect on functional outcome and sICH. Further large-scale studies are warranted to validate these results.

Keywords post-interventional contrast staining      endovascular thrombectomy      outcome      intracerebral hemorrhage     
Corresponding Authors: Ji Xunming   
About author:

These authors contributed equally to this work.

Just Accepted Date: 21 August 2018   Issue Date: 01 August 2019
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Hong An
Wenbo Zhao
Jianguo Wang
Joshua C Wright
Omar Elmadhoun
Di Wu
Shuyi Shang
Chuanjie Wu
Chuanhui Li
Longfei Wu
Jian Chen
Jiangang Duan
Hongqi Zhang
Haiqing Song
Yuchuan Ding
Xunming Ji
Cite this article:   
Hong An,Wenbo Zhao,Jianguo Wang, et al. Contrast Staining may be Associated with Intracerebral Hemorrhage but Not Functional Outcome in Acute Ischemic Stroke Patients Treated with Endovascular Thrombectomy[J]. Aging and disease, 2019, 10(4): 784-792.
URL:  
http://www.aginganddisease.org/EN/10.14336/AD.2018.0807     OR     http://www.aginganddisease.org/EN/Y2019/V10/I4/784
All patients
N=180
PICS
N=50
Control
N=130
p values
Age at onset, mean±SD, y61.3±12.861.8±13.160.8±12.40.581
Male, n (%)129 (72)30 (60)99 (76)0.031*
NIHSS, median (IQR)20 (14-30)20 (15-33)21 (14-29)0.615
ASPECTS/pc-ASPECTS, median (IQR)9 (8-10)9 (8-10)9 (8-10)0.198
Treatment with IV alteplase, n (%)42 (23)10 (20)32 (25)0.512
OTP time, median (IQR), min312 (236-378)297 (238-372)315 (232-379)0.909
OTR time, median (IQR), min379 (312-434)403 (331-447)372 (284-421)0.058
Vascular risk factors, n (%)
Hypertension121 (67)29 (58)92 (71)0.102
DM48 (26)12 (24)36 (28)0.616
AF49 (27)22 (45)27 (21)0.001*
Smoking80 (44)19 (40)61 (48)0.317
Etiology of stroke, n (%)
LAA121 (67)29 (58)92 (71)0.676
Cardioembolism43 (24)16 (32)27 (21)0.037*
Other16 (9)5 (10)11 (9)0.547
Operational details, n (%)
General anesthesia120 (67)34 (68)86 (68)0.971
Additional intra-arterial thrombolysis24 (13)6 (12)18 (14)0.744
Stenting53 (29)26 (32)37 (29)0.641
Balloon10 (6)2 (4)8 (6)0.840
Tirofiban90 (50)22 (44)68 (52)0.318
TICI=016 (9)5 (10)11 (9)0.547
TICI=2b/3149 (83)41 (82)108 (72)0.160
Table 1  Demographic and clinical characteristics of all patients.
All patients
N=118
PICS
N=42
Control
N=76
p-values
Age at onset, mean±SD62.2 ± 12.866.52 ± 11.3959.83 ± 13.050.006*
Male, n (%)77 (65)26 (62)51 (67)0.570
NIHSS, median (IQR)17 (13-21)18.5 (14-27)16 (13-20)0.363
ASPECT, median (IQR)9 (8-10)9 (8-10)9 (8-10)0.037*
Treatment with IV alteplase, n (%)37 (31%)10 (24)27 (36)0.189
OTP time, median (IQR)286 (223-346)295 (238-372)275.5 (197-332)0.044*
Vascular risk factors, n (%)
Hypertension68 (58)22 (52)46 (61)0.391
DM26 (22)9 (21)17 (22)0.906
AF41 (35)19 (46)22 (29)0.075
Smoking47 (40)15 (38)32 (44)0.513
Stroke etiology, n (%)
LAA68 (58)23 (55)45 (59)0.640
Cardioembolism38 (32)14 (33)24 (32)0.845
Other12 (10)5 (12)7 (9)0.643
Operation, n (%)
General anesthesia68 (58)27 (64)41 (56)0.394
Additional intra-arterial thrombolysis11 (9)3 (7)8 (11)0.545
Stenting35 (30)13 (31)22 (29)0.819
Balloon6 (5)2 (5)4 (5)0.906
Tirofiban56 (48)20 (48)36 (47)0.979
TICI=012 (10)5 (12)7 (9)0.643
TICI=2b/397 (82)34 (79)63 (83)0.606
Table 2  Demographic and clinical characteristics of anterior circulation stroke.
All patients
N=62
PICS
N=8
Control
N=54
P-values
Age at onset, mean±SD59.7±12.666.38±9.2158.72±12.790.109
Male, n(%)52 (84)4 (50)48 (89)0.023*
NIHSS, median (IQR)28 (18-32)33 (15.5-35.75)26 (18-30)0.212
ASPECT, median (IQR)9 (8-10)7.5 (7-8)9 (8-10)0.004*
Treatment with IV alteplase, n (%)5 (8)05 (9)0.369
OTP time, median (IQR)385 (306-445)317 (220-373)397 (314-460)0.079
Vascular risk factors, n (%)
Hypertension53 (86)7 (88)46 (85)0.862
DM22 (36)3 (38)19 (35)0.898
AF8 (13)3 (38)5 (9)0.026*
Smoking33 (53)4 (50)29 (54)0.845
Stroke etiology, n (%)
LAA53 (86)6 (75)47 (87)0.367
Cardioembolism5 (8)2 (25)3 (6)0.059
Other4 (6)04 (7)0.426
Operation, n (%)
General anesthesia52 (84)7 (88)45 (83)0.765
Additional intra-arterial thrombolysis13 (21)3 (38)10 (19)0.218
Stenting18 (29)3 (38)15 (28)0.572
Balloon4 (7)04 (7.4)0.426
Tirofiban34(55)2 (25)32 (59)0.069
TICI=04 (7)04 (7)0.427
TICI=2b/352 (84)7 (88)45 (83)0.765
Table 3  Demographic and clinical characteristics of posterior circulation stroke.
All patients,
N=180
Anterior circulation
stroke, N=118
Posterior circulation
stroke, N=62
AllPICS
N=50
Control
N=130
p-valuesPICS
N=42
Control
N=76
p-valuesPICS
N=8
Control
N=54
p-values
Total ICH, n (%)63 (35)30 (60)33 (25)<0.001*25 (60)29 (38)0.026*5 (63)4 (7)<0.001*
sICH, n (%)19 (11)9 (18)10 (8)0.044*6 (14)9 (12)0.7033 (38)1 (2)<0.001*
3-month mRS, n (%)
mRS, 0-143 (24)5 (10)38 (29)0.007*5 (12)29 (38)0.003*09 (17)0.212
mRS, 0-274 (41)16 (32)58 (45)0.12315 (36)43 (56)0.0301 (13)15 (28)0.357
mRS, 649 (27)17 (34)32 (25)0.20511 (26)16 (21)0.5256 (75)16 (30)0.012*
Table 4  Intracerebral hemorrhage and 3-month follow up.
All patient,
N=161
Anterior circulation stroke, N=107Posterior circulation stroke, N=54
AllPICS
N=45
Control
N=116
P
values
PICS
N=37
Control
N=70
P
values
PICS
N=8
Control
N=46
P
values
Length of follow up, month12 (3-26.5)3 (3-24)15 (3-27)0.36512 (3-27)16 (3-27)0.6561 (1-3)10 (1-24)0.074
mRS, 0-1, n (%)52 (32)7 (16)44 (38)0.006*7 (19)33 (47)0.004*011 (24)0.121
mRS, 0-2, n (%)74 (46)16 (36)58 (50)0.09914 (38)42 (60)0.029*2 (25)16 (34.8)0.588
mRS, 6, n (%)53 (33)18(40)35 (30)0.23412 (32)17 (24)0.3676 (75)18 (39)0.060
Table 5  Long-term outcome.
OutcomeAdjusted P valueOR95% CIs
Lower limitUpper limit
Total ICH#0.018*7.381.6632.90
sICH#0.994------
3-months mRS, 0-10.5220.500.064.182
3-months mRS, 0-20.4512.030.3212.77
3-months mortality0.9371.070.186.46
PCS mortality§0.1479.480.45198.30
Long-term mRS, 0-10.1410.220.031.65
Long-term mRS, 0-20.1813.300.5817.65
Long-term mortality0.1220.720.114.61
Table 6  Multivariate regression analysis of the effects of PICS on ICH and functional outcome.
VariatesOR95% CIP-value
Age0.9690.91-1.030.296
Hypertension3.1650.49-20.440.226
DM0.3290.05-2.090.238
AF4.9350.62-39.180.131
NIHSS0.9990.92-1.090.984
Pre-Antiplatelet/ Anticoagulation0.3420.06-1.880.218
Etiology of stroke1.7360.87-3.480.120
ASPECT/pc-ASPECTS0.5900.36-0.970.036
OTP time0.9970.99-1.000.401
Additional intra-arterial thrombolysis7.5811.16-49.740.035*
Treatment with IV alteplase2.6250.51-13.550.249
PICS6.3701.37-29.700.018*
Table 7  Multivariate analysis of ICH.
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