Correlation between Haemorrhagic Complications and CT Findings before and after Intra-arterial Reperfusion Therapy for Acute Middle Cerebral Artery Occlusion

Abstract

The purpose of this study was to investigate whether haemorrhagic complications can be predicted by evaluating CT findings before and after intra-arterial reperfusion therapy for acute middle cerebral artery (MCA) occlusion. Pretherapeutic early CT signs within three hours after onset and post-therapeutic contrast extravasation were evaluated in 61 patients treated within six hours after onset. Early CT signs were evaluated in the deep (obscuration of the margin of the lentiform nucleus and loss of the insular ribbon) and superficial MCA territories (cortical effacement). Haemorrhagic transformations were seen in 39.3% of patients, 54.2% of them had both pre-therapeutic early CT signs and post-therapeutic contrast extravasation. Obscuration of the entire lentiform nucleus and the presence of contrast extravasation were reliable predictors for haemorrhagic transformations, and cortical effacement had also a tendency to be associated with haemorrhage. Absence of early CT signs did not always result in the absence of haemorrhagic transformations and 37.5% of haemorrhage occurred in the presumed normal area without early CT signs. On the other hand, absence of post-therapeutic contrast extravasation was a reliable negative predictor for intraparenchymal haematoma.