Clinical Significance of Hyperdense Area after Endovascular Therapy in Patients with Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Cerebrovasc Dis. 2021;50(5):500-509. doi: 10.1159/000515410. Epub 2021 May 27.

Abstract

Objective: We performed a systematic review and meta-analysis to investigate the clinical significance of hyperdense area after thrombectomy in patients with acute ischemic stroke (AIS).

Methods: We searched Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and other Non-Indexed, Cochrane Library Clinical Controlled Trials and Embase from inception to September 2020 and collected the cohort and case-control studies about the clinical significance of hyperdense area on different types of computed tomography (CT) after thrombectomy in patients with AIS. Outcomes were poor functional outcome (modified Rankin Scale [mRS] Score 3-6 at discharge or 90-day), mortality and subtypes of hemorrhage according to the European Cooperative Acute Stroke Study (ECASS).

Results: 1,999 patients from 16 studies were included in this meta-analysis. Pooled results indicated higher risk of symptomatic intracerebral hemorrhage (odds ratio [OR] = 3.02; 95% confidence interval [CI] 1.84-4.95; p < 0.0001, I2 = 0%) in patients with hyperdense area, and the subtype of parenchymal hematoma as well. There was also higher odds of poor functional outcome based on the mRS 3-6 at discharge or 90-day (OR = 1.92; 95% CI 1.35-2.73; p = 0.0003, I2 = 31%) and mortality (OR = 2.06; 95% CI 1.41-3.02; p = 0.0002, I2 = 0%) in patients with hyperdense area after thrombectomy compared with those without hyperdense area.

Conclusions: Our results indicated that the presence of hyperdense area on CT after thrombectomy was associated with high risk of symptomatic intracerebral hemorrhage, poor functional outcome, as well as mortality in patients with AIS. However, further studies were needed to confirm these results. The meta-analysis was conducted in adherence with the PRISMA Statement and was registered at the International Prospective Register of Systematic Reviews (CRD42020164165). To the best of our knowledge, this study is the first meta-analysis investigating the effect of hyperdense area after endovascular therapy in patients with AIS.

Keywords: Acute ischemic stroke; Endovascular therapy; Hyperdense area; Meta-analysis.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cerebral Hemorrhage / diagnostic imaging*
  • Cerebral Hemorrhage / etiology
  • Cerebral Hemorrhage / mortality
  • Cerebral Hemorrhage / physiopathology
  • Cerebrovascular Circulation*
  • Disability Evaluation
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / mortality
  • Female
  • Functional Status
  • Humans
  • Ischemic Stroke / diagnostic imaging
  • Ischemic Stroke / mortality
  • Ischemic Stroke / physiopathology
  • Ischemic Stroke / therapy*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Risk Assessment
  • Risk Factors
  • Thrombectomy* / adverse effects
  • Thrombectomy* / mortality
  • Time Factors
  • Tomography, X-Ray Computed*
  • Treatment Outcome