PT  - JOURNAL ARTICLE
AU  - Broocks, Gabriel
AU  - Meyer, Lukas
AU  - Hanning, Uta
AU  - Faizy, Tobias Djamsched
AU  - Bechstein, Matthias
AU  - Kniep, Helge
AU  - Van Horn, Noel
AU  - Schön, Gerhard
AU  - Barow, Ewgenia
AU  - Thomalla, Götz
AU  - Fiehler, Jens
AU  - Kemmling, Andre
TI  - Haemorrhage after thrombectomy with adjuvant thrombolysis in unknown onset stroke depends on high early lesion water uptake
AID  - 10.1136/svn-2022-002264
DP  - 2024 Aug 01
TA  - Stroke and Vascular Neurology
PG  - 390--398
VI  - 9
IP  - 4
4099  - http://svn.bmj.com/content/9/4/390.short
4100  - http://svn.bmj.com/content/9/4/390.full
SO  - Stroke Vasc Neurol2024 Aug 01; 9
AB  - Background and purpose In wake-up stroke, CT-based quantitative net water uptake (NWU) might serve as an alternative tool to MRI to guide intravenous thrombolysis with alteplase (IVT). An important complication after IVT is symptomatic intracerebral haemorrhage (sICH). As NWU directly implies ischaemic lesion progression, reflecting blood-brain barrier injury, we hypothesised that NWU predicts sICH in patients who had a ischaemic stroke undergoing thrombectomy with unknown onset.Methods Consecutive analysis of all patients who had unknown onset anterior circulation ischaemic stroke who underwent CT at baseline and endovascular treatment between December 2016 and October 2020. Quantitative NWU was assessed on baseline CT. The primary endpoint was sICH. The association of NWU and other baseline parameters to sICH was investigated using inverse-probability weighting (IPW) analysis.Results A total of 88 patients were included, of which 46 patients (52.3%) received IVT. The median NWU was 10.7% (IQR: 5.1–17.7). The proportion of patients with any haemorrhage and sICH were 35.2% and 13.6%. NWU at baseline was significantly higher in patients with sICH (19.1% vs 9.6%, p<0.0001) and the median Alberta Stroke Program Early CT Score (ASPECTS) was lower (5 vs 8, p<0.0001). Following IPW, there was no association between IVT and sICH in unadjusted analysis. However, after adjusting for ASPECTS and NWU, there was a significant association between IVT administration and sICH (14.6%, 95% CI: 3.3% to 25.6%, p<0.01).Conclusion In patients with ischaemic stroke with unknown onset, the combination of high NWU with IVT is directly linked to higher rates of sICH. Besides ASPECTS for evaluating the extent of the early infarct lesion, quantitative NWU could be used as an imaging biomarker to assess the degree of blood-brain barrier damage in order to predict the risk of sICH in patients with wake up stroke.Data are available upon reasonable request.