F Bala1,2, J Ospel1,3, B Mulpur4, B J Kim5, J Yoo6, B K Menon1,2,7, M Goyal1, C Federau8, S-I Sohn9, M S Hussain4, M A Almekhlafi10,2,7. 1. From the Calgary Stroke Program (F.B., J.O., B.K.M., M.G., M.A.A.), University of Calgary, Calgary, Alberta, Canada. 2. Department of Clinical Neurosciences (F.B., B.K.M., M.A.A.), University of Calgary, Calgary, Alberta, Canada. 3. Department of Neuroradiology, Clinic of Radiology, and Nuclear Medicine (J.O.), University Hospital Basel, Basel, Switzerland. 4. Cerebrovascular Center and Department of Neurology (B.M., M.S.H.), Neurological Institute, Cleveland Clinic, Ohio. 5. Department of Neurology and Cerebrovascular Center (B.J.K.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. 6. Yonsei University College of Medicine (J.Y.), Yongin Severance Hospital, Yongin, Korea. 7. Department of Radiology (B.K.M., M.A.A.), University of Calgary, Calgary, Alberta, Canada. 8. Institute for Biomedical Engineering (C.F.), Swiss Federal Institute of Technology in Zürich, Zürich, Switzerland. 9. Department of Neurology (S.-I.S.), Keimyung University School of Medicine, Daegu, Korea. 10. From the Calgary Stroke Program (F.B., J.O., B.K.M., M.G., M.A.A.), University of Calgary, Calgary, Alberta, Canada mohammed.almekhlafi1@ucalgary.ca.
Abstract
BACKGROUND: Infarct volume inversely correlates with good recovery in stroke. The magnitude and predictors of infarct growth despite successful reperfusion via endovascular treatment are not known. PURPOSE: We aimed to summarize the extent of infarct growth in patients with acute stroke who achieved successful reperfusion (TICI 2b-3) after endovascular treatment. DATA SOURCES: We performed a systematic review and meta-analysis by searching MEDLINE and Google Scholar for articles published up to October 31, 2020. STUDY SELECTION: Studies of >10 patients reporting baseline and post-endovascular treatment infarct volumes on MR imaging were included. Only patients with TICI 2b-3 were included. We calculated infarct growth at a study level as the difference between baseline and follow-up MR imaging infarct volumes. DATA ANALYSIS: Our search yielded 345 studies, and we included 10 studies reporting on 973 patients having undergone endovascular treatment who achieved successful reperfusion. DATA SYNTHESIS: The mean baseline infarct volume was 19.5 mL, while the mean final infarct volume was 37.5 mL. A TICI 2b reperfusion grade was achieved in 24% of patients, and TICI 2c or 3 in 76%. The pooled mean infarct growth was 14.8 mL (95% CI, 7.9-21.7 mL). Meta-regression showed higher infarct growth in studies that reported higher baseline infarct volumes, higher rates of incomplete reperfusion (modified TICI 2b), and longer onset-to-reperfusion times. LIMITATIONS: Significant heterogeneity among studies was noted and might be driven by the difference in infarct growth between early- and late-treatment studies. CONCLUSIONS: These results suggest considerable infarct growth despite successful endovascular treatment reperfusion and call for a faster workflow and the need for specific therapies to limit infarct growth.
BACKGROUND: Infarct volume inversely correlates with good recovery in stroke. The magnitude and predictors of infarct growth despite successful reperfusion via endovascular treatment are not known. PURPOSE: We aimed to summarize the extent of infarct growth in patients with acute stroke who achieved successful reperfusion (TICI 2b-3) after endovascular treatment. DATA SOURCES: We performed a systematic review and meta-analysis by searching MEDLINE and Google Scholar for articles published up to October 31, 2020. STUDY SELECTION: Studies of >10 patients reporting baseline and post-endovascular treatment infarct volumes on MR imaging were included. Only patients with TICI 2b-3 were included. We calculated infarct growth at a study level as the difference between baseline and follow-up MR imaging infarct volumes. DATA ANALYSIS: Our search yielded 345 studies, and we included 10 studies reporting on 973 patients having undergone endovascular treatment who achieved successful reperfusion. DATA SYNTHESIS: The mean baseline infarct volume was 19.5 mL, while the mean final infarct volume was 37.5 mL. A TICI 2b reperfusion grade was achieved in 24% of patients, and TICI 2c or 3 in 76%. The pooled mean infarct growth was 14.8 mL (95% CI, 7.9-21.7 mL). Meta-regression showed higher infarct growth in studies that reported higher baseline infarct volumes, higher rates of incomplete reperfusion (modified TICI 2b), and longer onset-to-reperfusion times. LIMITATIONS: Significant heterogeneity among studies was noted and might be driven by the difference in infarct growth between early- and late-treatment studies. CONCLUSIONS: These results suggest considerable infarct growth despite successful endovascular treatment reperfusion and call for a faster workflow and the need for specific therapies to limit infarct growth.
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