A cross-sectional study on the correlation between internal cerebral vein asymmetry and hemorrhagic transformation following endovascular thrombectomy

Kunxin Lin; Wenlong Zhao; Quanhong Wu; Yiru Zheng; Bo Yang; Ying Fu; Ning Wang; Ling Fang

doi:10.3389/fneur.2024.1465481

A cross-sectional study on the correlation between internal cerebral vein asymmetry and hemorrhagic transformation following endovascular thrombectomy

Front Neurol. 2025 Jan 7:15:1465481. doi: 10.3389/fneur.2024.1465481. eCollection 2024.

Authors

Kunxin Lin^{1

2}, Wenlong Zhao^{1

2}, Quanhong Wu^{1

2}, Yiru Zheng^{1

2}, Bo Yang³, Ying Fu^{1

2}, Ning Wang^{1

2}, Ling Fang^{1

2}

Affiliations

¹ Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China.
² Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
³ Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.

Abstract

Introduction: Hemorrhagic transformation (HT) is a severe complication in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) after endovascular treatment (EVT). We hypothesize that asymmetry of the internal cerebral veins (ICVs) on baseline CT angiogram (CTA) may serve as an adjunctive predictor of HT.

Methods: We conducted a study on consecutive AIS-LVO patients from November 2020 to April 2022. These patients had anterior circulation occlusions and were treated with EVT. Asymmetrical ICVs were assessed using CTA and defined as hypodensity (reduced opacification) on the ipsilateral side of occlusion compared to the contralateral side. The primary outcome was HT, defined as hemorrhage within the ischemic territory. This was evaluated using follow-up imaging (CT scan or magnetic resonance imaging) performed 48 h post-EVT. HT was classified into four subtypes based on the European Cooperative Acute Stroke Study-II criteria.

Results: A total of 126 patients were included, with an HT rate of 49.2% (62/126). ICV asymmetry was observed in 54.0% (68/126) of patients. The ICV asymmetry group exhibited a significantly higher risk of parenchymatous hematoma-type HT (33.8% vs. 15.5%, p = 0.019) and symptomatic intracerebral hemorrhage (sICH) (23.5% vs. 5.2%, p = 0.004). In multivariate logistic regression, ICV 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, 95% CI 1.572-10.169) were identified as independent risk factors of HT.

Conclusion: ICV asymmetry, likely resulting from impaired autoregulation or tissue micro-perfusion hampering cerebral blood flow (CBF), is a novel radiological sign that independently predicts HT. It is associated with a higher risk of sICH in AIS-LVO patients after EVT. Further research is warranted to validate these findings.

Keywords: acute ischemic stroke; endovascular thrombectomy; hemorrhagic transformation; internal cerebral veins; large vessel occlusion.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Young and Middle-aged Talent Training Project in Health System of Fujian Province, grant number 2015-ZQN-JC-21; the Major Scientific Research Program for Young and Middle-aged Health Professionals of Fujian Province, grant number 2022ZQNZD005; the Provincial Health and Youth Research Project, grant number 2020QNB027; the Joint Funds for the Innovation of Science and Technology of Fujian Province, grant number 2023Y9029.