International Review and Advisory Committee

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Interaction of incidental microbleeds and prior use of antithrombotics with early hemorrhagic transformation: Causative or protective?

Background: Gradient echo (GRE) sequence of magnetic resonance imaging (MRI) is a sensitive tool to detect hemorrhagic transformation (HT) and old cerebral microbleeds (CMBs). Presence of CMBs and prior use of antithrombotics pose a risk of HT in ischemic stroke. We evaluated the association of CMBs and antithrombotic use with resultant HT in acute ischemic stroke (AIS). Methods: This retrospective study included AIS patients admitted to our center between January 2009 and August 2010 who underwent GRE-weighted MRI within 48 h of admission. Demographic and clinical data including diabetes mellitus, hypertension, hyperlipidemia, prior intake of antiplatelets/anticoagulants/statins, and presence of CMBs at admission were collected and compared between patients who developed HT and those who did not. We did a multivariate analysis using logistic regression to assess the effect of CMBs and prior use of antithrombotic agents on the risk of development for early HT in ischemic stroke. Results: Of 529 AIS patients, 81 (15%) were found to have HT during the initial hospital course. CMBs were found in only 9 of 81 patients (11%) with HT and in 40 out of remaining 448 patients (9%) who did not develop HT. The presence of CMBs was not associated with increased risk of HT (P = 0.53). However, prior use of antiplatelets (33% vs. 47% in the patients without HT, P = 0.02) was associated with decreased risk of HT in ischemic stroke. Conclusion: Presence of incidental CMBs was not associated with increased risk for early HT of an ischemic stroke. Interestingly, the prior intake of antiplatelets was found to be protective against HT of ischemic stroke

Abstract Number ‐ 155: CT Perfusion May Optimize Selection Of Elderly Patients For Mechanical Stroke Thrombectomy

Introduction Prior studies have demonstrated that CT perfusion (CTP) may be used to select patients for mechanical stroke thrombectomy (MST) with acute ischemic stroke owing to major artery obstruction in the anterior circulation for up to 24 hours. There is limited data on CTP selection of elderly patients aged ≥ 90 years old. We aimed to examine whether selecting nonagenarians with CT perfusion (CTP) imaging would allow for better outcomes. Specifically we aimed to examine hypoperfusion intensity ratio (HIR) and early infarct growth rate (EIGR) to optimize MST selection of nonagenarians. Methods This is a single center retrospective study from a large academic medical center. Patients included were at least 90 years old, presented with an anterior circulation acute ischemic stroke due to large vessel occlusion (LVO) and were treated with mechanical stroke thrombectomy (MST) between January 2018 and April 2022. Patients without CT perfusion (CTP) imaging prior to MST and without complete data were excluded. HIR was defined as time to maximum (Tmax 10 seconds/ Tmax 6 seconds). EIGR was defined as (relative cerebral blood flow 2) at 90 days. HIR was found to be correlated with 90 day mRS (shift to next worse mRS), adjusted odds ratio (aOR) = 14.41 [95%CI 1.16, 179.11] p = 0.04, but not EIGR, aOR = 0.98 [95%CI 0.90, 1.06], p = 0.58. Neither HIR nor EIGR were not associated with excellent reperfusion, p = 0.38 and p = 0.88, respectively. Patients with higher EIGR were more likely to experience proceduralcomplications, aOR = 1.16 [95%CI 1.03, 1.31], p = 0.01, but there was no difference in HIR, p = 0.28. Lastly, there were no differences in HIR or EIGR and sICH, p = 0.07 and p = 0.68, respectively. Conclusions Very elderly patients aged 90 years or older experienced high rates of mortality and low proportions of good outcomes at 90 days. Nonagenarians with better collaterals as measured by HIR may have better outcomes at 90 days. Additionally, nonagenarians with faster growing ischemic cores may be more likely to experience complications during MST