Hyperperfusion Immediately after Reperfusion by Thrombectomy May Predict Hemorrhagic Transformation

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  • Yoshihara Tomoyuki
    Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Chiba, Japan Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
  • Kanazawa Ryuzaburo
    Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Chiba, Japan
  • Ohbuchi Hidenori
    Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
  • Uchida Takanori
    Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Chiba, Japan
  • Higashida Tetsuhiro
    Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Chiba, Japan
  • Arai Naoyuki
    Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
  • Osakabe Manabu
    Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Chiba, Japan
  • Takahashi Yuichi
    Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Chiba, Japan Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan

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Abstract

<p>Objective: To evaluate cerebral blood flow immediately after reperfusion following thrombectomy for acute large vessel occlusion, and to examine whether cerebral blood flow after reperfusion is related to hemorrhagic transformation.</p><p>Methods: The patients with acute large vessel occlusion in the anterior circulation who obtained reperfusion by thrombectomy were included. Cerebral blood flow was evaluated using single photon emission computed tomography (SPECT) within 6 hours after reperfusion. The patients were divided into two groups with or without hemorrhagic transformation, and basic characteristics, the ratio of cerebral blood flow (affected-side to unaffected-side ratio) in the perfusion area of the middle cerebral artery (MCA asymmetry index), and functional prognosis were compared among two groups.</p><p>Results: In all, 23 patients were included; 11 presented hemorrhagic transformation, and 12 did not. The hemorrhagic group exhibited significantly higher MCA asymmetry index than the non-hemorrhagic group (median: 1.54 [1.30–1.83] vs. 1.12 [1.07–1.24], respectively, P = 0.02), and a lower rate tendency of modified Rankin Scale (mRS): 0-2 after 3 months (1 patient [9%] vs. 6 patients [50%], respectively, P = 0.06).</p><p>Conclusion: In patients with successful reperfusion by thrombectomy, hemorrhagic transformation is predisposed to occur when high MCA asymmetry index is presented. Care should be taken in periprocedural management of blood pressure and sedation for those with high MCA asymmetry index.</p>

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