Parenchymal hematoma and total lesion volume in combined IV/IA revascularization stroke therapy

Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Journal of Neurointerventional Surgery (Impact Factor: 1.38). 08/2011; 4(4):256-60. DOI: 10.1136/neurintsurg-2011-010062
Source: PubMed

ABSTRACT A positive correlation between large parenchymal hematoma (PH) volume and large CT lesion volume in subjects treated with intravenous (IV) recombinant tissue plasminogen activator (rtPA) as well as placebo controls was identified in the European Cooperative Acute Stroke Study II (ECASS II). A study was undertaken to examine the relationship between PH volume and total lesion volume (including both cerebral infarction and hemorrhage) in subjects with symptomatic parenchymal hematoma (sPH) treated with combined IV and intra-arterial (IA) rtPA in the Interventional Management of Stroke (IMS) studies.
Hematoma and lesion volumes were measured planimetrically and by the ABC/2 method in 105 subjects from IMS studies I and II following combined IV and IA rtPA treatment. PH type 1 or 2 was determined by dichotomizing at >30% of lesion volume. Hematoma and lesion volumes for both symptomatic PH1 (sPH1) and PH2 (sPH2) types were compared using both measurement methods. Both sPH types were compared for baseline NIH Stroke Score, baseline Alberta Stroke Program Early CT score and treatment revascularization score based on the planimetric volume method.
The volume of sPH1 and sPH2 did not differ by either method of measurement. Subjects with sPH2 had a lower lesion volume compared with all PH1 (p=0.004) and sPH1 (p=0.02) by both methods. The ABC/2 method overestimated PH volume by 55±33% and lesion volume by 34±22% for sPH compared with the planimetric method.
In IMS I and II, hemorrhages in subjects with sPH2 were similar in volume to those in subjects with sPH1 and were associated with a smaller rather than a larger total lesion volume compared with other PH in the setting of combined IV/IA therapy. The use of PH2 as a sole surrogate for sPH in studies of stroke treatment may underestimate the incidence of clinically significant hemorrhage.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Retrospective data collection from European sites experienced with the use of the Solitaire FR, when used as 1st choice device to treat patients with ischemic stroke and restore blood flow. Six European centers treated 141 patients for acute ischemic stroke using the Solitaire FR, as first intention device, in relation to their own clinical practice which involved the use of mechanical thrombectomy devices and pharmacologic agents from March 2009 to June 2010. The centers involved were Germans Trias Hospital in Barcelona, Geneva University Hospital, Inselspital University Hospital of Bern, Hôpital Gui de Chauliac in Montpellier, Karolinska sjukhuset in Stockholm, AKK Hospital in Essen.Of the 141 patients, 44% were female and 89% of the occlusions were in the anterior anatomy. The median baseline NIHSS score was 18. The revascularization success (TICI≥2b) was 89.4%. The median procedure time from groin puncture to revascularization was 45 min. Good Clinical Outcome (mRS ≤2) at 90 days was 54.6%.
    Journal of Neurointerventional Surgery 07/2011; 3(1). DOI:10.1136/neurintsurg-2011-010097.2 · 1.38 Impact Factor
  • American Journal of Neuroradiology 11/2013; 35(2). DOI:10.3174/ajnr.A3824 · 3.68 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background and Purpose The Tada (ABC/2) formula has been used widely for volume assessment of intracerebral hematoma. However, the formula is crude for irregularly shaped hematoma. We aimed to compare the accuracy of the ABC/2 formula with open source software Slicer. Methods Computed tomographic images of 294 patients with spontaneous intracerebral hematoma were collected. Hematoma volumes were assessed with the ABC/2 formula and calculated with software 3D Slicer. Results of these 2 methods were compared with regard to hematoma size and shape. Results The estimated hematoma volume was 58.4137.83 cm(3) using the ABC/2 formula, compared with 50.38 +/- 31.93 cm(3) with 3D Slicer (mean percentage deviation, 16.38 +/- 9.15%). When allocate patients into groups according to hematoma size, the mean estimation error were 3.24 cm(3) (17.72%), 5.85 cm(3) (13.72%), and 15.14 cm(3) (17.48%) for groups 1, 2, and 3, respectively. When divided by shape, estimation error was 3.33 cm(3) (9.76%), 7.19 cm(3) (18.37%), and 29.39 cm(3) (39.12%) for regular, irregular, and multilobular hematomas. Conclusions There is significant estimation error using the ABC/2 formula to calculate hematoma volume. Compared with hematoma size, estimation error is more significantly associated with hematoma shape.
    Stroke 10/2014; 45(11). DOI:10.1161/STROKEAHA.114.007095 · 6.02 Impact Factor