AIM: To explore the predictors of infarct core expansion despite full reperfusion after intra-arterial therapy (IAT). METHODS: We retrospectively reviewed 604 consecutive patients who underwent IAT for anterior circulation large vessel occlusion acute ischemic stroke in two tertiary centers (2008-2013/2010-2013). Sixty patients selected by MRI or CT perfusion presenting within <24 h of onset with modified Thrombolysis In Cerebral Infarction (mTICI) grade 3 or 2c reperfusion were included. Significant infarct growth (SIG) was defined as infarct expansion >11.6 mL. RESULTS: Mean age was 67.0±13.7 years, 56% were men. Mean National Institute of Health Stroke Scale (NIHSS) score was 16.2±6.1, time from onset to puncture was 6.8±3.1 h, and procedure length was 1.3±0.6 h. MRI was used for baseline core analysis in 43% of patients. Mean baseline infarct volume was 17.1±19.1 mL, absolute infarct growth was 30.6±74.5 mL, and final infarct volume was 47.7±77.7 mL. Overall, 35% of patients had SIG. Three of 21 patients (14%) treated with stent-retrievers had SIG compared with 14 of 39 (36%) with first-generation devices. Eight of 21 patients (38%) with intravenous tissue plasminogen activator (IV t-PA) had infarct growth compared with 25/39 (64%) without. 23% of patients with SIG had a modified Rankin Scale score ≤2 at 3 months compared with 48% of those without SIG. Multivariate logistic regression indicated that race affected infarct growth. Use of IV t-PA (p=0.03) and stent-retrievers (p=0.03) were independently and inversely correlated with SIG. CONCLUSIONS: Despite full reperfusion, infarct growth is relatively frequent and may explain poor clinical outcomes in this setting. Ethnicity was found to influence SIG. Use of IV t-PA and stent-retrievers were associated with less infarct core expansion. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
AIM: To explore the predictors of infarct core expansion despite full reperfusion after intra-arterial therapy (IAT). METHODS: We retrospectively reviewed 604 consecutive patients who underwent IAT for anterior circulation large vessel occlusion acute ischemic stroke in two tertiary centers (2008-2013/2010-2013). Sixty patients selected by MRI or CT perfusion presenting within <24 h of onset with modified Thrombolysis In Cerebral Infarction (mTICI) grade 3 or 2c reperfusion were included. Significant infarct growth (SIG) was defined as infarct expansion >11.6 mL. RESULTS: Mean age was 67.0±13.7 years, 56% were men. Mean National Institute of Health Stroke Scale (NIHSS) score was 16.2±6.1, time from onset to puncture was 6.8±3.1 h, and procedure length was 1.3±0.6 h. MRI was used for baseline core analysis in 43% of patients. Mean baseline infarct volume was 17.1±19.1 mL, absolute infarct growth was 30.6±74.5 mL, and final infarct volume was 47.7±77.7 mL. Overall, 35% of patients had SIG. Three of 21 patients (14%) treated with stent-retrievers had SIG compared with 14 of 39 (36%) with first-generation devices. Eight of 21 patients (38%) with intravenous tissue plasminogen activator (IV t-PA) had infarct growth compared with 25/39 (64%) without. 23% of patients with SIG had a modified Rankin Scale score ≤2 at 3 months compared with 48% of those without SIG. Multivariate logistic regression indicated that race affected infarct growth. Use of IV t-PA (p=0.03) and stent-retrievers (p=0.03) were independently and inversely correlated with SIG. CONCLUSIONS: Despite full reperfusion, infarct growth is relatively frequent and may explain poor clinical outcomes in this setting. Ethnicity was found to influence SIG. Use of IV t-PA and stent-retrievers were associated with less infarct core expansion. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Raul G Nogueira; Osama O Zaidat; Alicia C Castonguay; Diogo C Haussen; Coleman O Martin; William E Holloway; Nils Mueller-Kronast; Joey English; Italo Linfante; Guilherme Dabus; Tim W Malisch; Franklin A Marden; Hormozd Bozorgchami; Andrew Xavier; Ansaar T Rai; Michael T Froehler; Aamir Badruddin; Thanh N Nguyen; M Asif Taqi; Michael G Abraham; Vallabh Janardhan; Albert J Yoo; Hashem Shaltoni; Alex Abou-Chebl; Peng R Chen; Gavin W Britz; Roberta Novakovic; Ashish Nanda; Ritesh Kaushal; Mohammad A Issa; Michael R Frankel; Rishi Gupta Journal: Interv Neurol Date: 2016-05-27
Authors: S Dehkharghani; M Bowen; D C Haussen; T Gleason; A Prater; Q Cai; J Kang; R G Nogueira Journal: AJNR Am J Neuroradiol Date: 2016-10-06 Impact factor: 3.825
Authors: Ahmed A Khalil; Kersten Villringer; Vivien Filleböck; Jiun-Yiing Hu; Andrea Rocco; Jochen B Fiebach; Arno Villringer Journal: J Cereb Blood Flow Metab Date: 2018-10-18 Impact factor: 6.200
Authors: Robert W Regenhardt; Mark R Etherton; Alvin S Das; Markus D Schirmer; Joshua A Hirsch; Christopher J Stapleton; Aman B Patel; Thabele M Leslie-Mazwi; Natalia S Rost Journal: J Neuroimaging Date: 2020-10-29 Impact factor: 2.486