Abstract 18523: Simultaneous Consideration of Imaging and Blood Markers for Prediction of Hemorrhagic Transformation in Acute Ischemic Stroke

Introduction: Prediction of hemorrhagic transformation (HT) may be helpful for the treatment decision in patients with acute ischemic stroke. Lower scores of Alberta Stroke program early CT score (ASPECTS), or high levels of plasma MMP-9 have been suggested to predict hemorrhage after thrombolytic treatment. Hypothesis: Combined measurements of baseline MMP-9 levels and ASPECTS can be surrogate markers of HT in acute ischemic stroke patients. Methods: Enrolled for this study were patients with acute cerebral infarction in the carotid artery territory who visited within 6 hours after symptom onset. Among them, those whose blood samples could be obtained before the thrombolytic treatment or before administration of any antithrombotic agent, and whose initial non-contrast CT of the brain was available were included. The baseline CT scans were scored by consensus approach of two neurologists. Plasma MMP-9 levels were measured by enzyme-linked immunosorbent assays. Severity of neurologic deficits was assessed based on National Institute of Health Stroke Scale (NIHSS) score at baseline. HT was assessed by CT or MRI. Symptomatic hemorrhage was defined as any increase in the NIHSS score related to the hemorrhage. Results: Total 124 patients were included (67 men, mean age 66 years). Fifty-three patients received the thrombolytic treatment. Median ASPECTS was 9 (range 2-10). Median NIHSS score at baseline was 8 (range 0-25). Median MMP-9 was 22.23 ng/ml (range 0.85-90.02 ng/ml). HT occurred in 40 patients (symptomatic in eight). HT including symptomatic and asymptomatic hemorrhages, was associated with low ASPECTS score, high MMP-9 values, high initial NIHSS score, and thrombolytic treatment in multiple logistic regression analysis. The Receiver operating curve (ROC) analysis was performed to compare predicting power of MMP-9, ASPECTS score, and both of them. The area under the ROC curve performed from the values of both MMP-9 and ASPECTS was greater than those from MMP-9 or ASPECTS alone (0.900 for MMP-9, 0.708 for ASPECTS score, 0.921 for both). Conclusions: Simultaneous assessments and consideration of ASPECTS as an imaging marker and MMP-9 as a blood marker could enhance predictability of hemorrhagic transformation in acute stroke patients.

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