HEMORRHAGIC TRANSFORMATION OF ISCHEMIC STROKE: RISK FACTORS, EARLY OUTCOMES AND REHABILITION OF MOTOR DISORDERS

Objective: Hemorrhagic transformation (HT) after reperfusion therapy for acute ischemic stroke often predicts a poor prognosis. This systematic review and meta-analysis aimed to identify risk factors for HT and how they are modified by hyperacute treatment [intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT)].

Research Methods: PubMed and EMBASE electronic databases were used to search for relevant studies. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated.

Results : A total of 120 studies were included. Atrial fibrillation and NIHSS scores were overall predictors of any intracerebral hemorrhage (ICH) after reperfusion therapy (IVT and EVT), hyperdense artery sign (OR = 2.605, 95% CI 1.212-5.599, I %) and number 2 = 0.000. Thrombectomy (OR = 1.151, 95% CI 1.041-1.272, I 2 = 54.3% were predictors of any ICH after IVT and EVT, respectively. The common predictors for symptomatic ICH (sICH) after reperfusion therapy were age and serum glucose level. Atrial fibrillation (OR = 3.867, 95% CI 1.970-7.591, I 2 = 29.1%), NIHSS score (OR = 1.082, 95% CI 1.060-1.105, I 2 = 54.5%), and time to onset (OR-TO) = 1.003, 95% CI 1.001-1.005, I 2 = 0.0%) were predictors of sICH after IVT. Alberta Stroke Program Early CT Score (ASPECTS) (OR = 0.686, 95% CI 0.565-0.833, I 2 = 77.6%) and number of thrombectomy passes (OR = 1.374, 95% CI 1.012-1.012-1.6 % ) = 1.866, I 2 = 1.866. were predictors of sICH after EVT.

Conclusion : Several predictors of ICH have been identified, which differ depending on the type of treatment. Studies based on larger and multicenter data sets should be prioritized to confirm the results.

Ischemic stroke, which results from a lack of blood supply to the brain, is one of the leading causes of death and disability worldwide. Hemorrhagic transformation (HT), a potentially serious complication of the disease itself or its treatment aimed at restoring optimal blood flow, increases morbidity and mortality. Detailed conclusions can be found in the literature on the pathophysiological background of hemorrhagic transformation, potential clinical risk factors that increase its likelihood, and various biomarkers that are expected to help predict it and contribute to clinical outcome. Clinicopathological studies also contribute to improving our knowledge of hemorrhagic transformation. We summarized the clinical risk factors for hemorrhagic transformation of ischemic stroke in terms of risk reduction and collected the most promising biomarkers in the field. Also, adjuvant treatment options in reperfusion therapy were reviewed and summarized. We emphasized the importance of the optimal timing of revascularization treatment for carefully selected patients and the individual treatment of underlying diseases and comorbidities. Another important conclusion is that more intensive clinical follow-up, including serial cranial CT, may be recommended for selected patients, as clinicopathological examinations indicated that HT was more common than clinically suspected.