Hyperintense acute reperfusion marker associated with hemorrhagic transformation in the WAKE-UP trial. (June 2021)

• Record Type: Journal Article
• Authors: Wouters, Anke; Scheldeman, Lauranne; Dupont, Patrick; Cheng, Bastian; Ebinger, Martin; Jensen, Märit; Endres, Matthias; Gerloff, Christian; Muir, Keith W; Nighoghossian, Norbert; Pedraza, Salvador; Simonsen, Claus Z; Boutitie, Florent; Thijs, Vincent; Thomalla, Götz; Fiebach, Jochen; Lemmens, Robin
• Is Part Of: European stroke journal. Volume 6:Number 2(2021)
• Page Start: 128
• Page End: 133
• Publication Date: 2021-06
• Subjects: Ischemic stroke -- DWI-FLAIR mismatch -- HARM -- hemorrhage -- magnetic resonance imaging; Cerebrovascular disease -- Periodicals; 616.8005
• DOI: 10.1177/23969873211007686
• Languages: English
• ISSNs: 2396-9873

Abstract

Introduction: Hyperintense acute reperfusion marker (HARM) is an indicator of early disruption of the blood-brain-barrier. Our aim was to investigate the incidence of HARM in patients with a diffusion weighted imaging (DWI) - fluid attenuated inversion recovery (FLAIR) mismatch and determine the association between this marker and hemorrhagic complications as well as clinical outcome. Patients and Methods: We included patients from the Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke (WAKE-UP) trial who underwent baseline perfusion weighted imaging (PWI). HARM was defined as a hyperintense signal in the cerebrospinal fluid space on FLAIR imaging at 24 h after baseline imaging. We compared baseline characteristics in patients with and without HARM and investigated the association between HARM and any hemorrhagic transformation (HT) and parenchymal hematoma (PH) in a multivariate logistic regression. We also explored HARM as an independent predictor of poor outcome, defined as a modified Rankin Scale of 3–6 at 90 days. Results: HARM was present in 14 of 223 (6%) patients with a DWI-FLAIR mismatch and baseline characteristics were similar in patients with vs without HARM. HARM showed an independent relationship with any HT (OR 6.67; 95%CI 1.72–26.58) and any PH (OR 6.92; 95%CI 1.34–29.49). The rate of HARM was similar in patients with good and poor outcome (5%, p = 0.90). Conclusion: In the WAKE-UP trial, the incidence of HARM was only 6% at 24 h. An association was present between HARM and hemorrhagic complications, but no relationship with functional outcome was observed.