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What is effective in malignant middle cerebral artery infarction: reperfusion, craniectomy, or both? An experimental
T Engelhorn1, R von Kummer, W Reith
1Department of Neuroradiology, University of Essen, Germany. tobias.engelhorn@uni-essen.de
Background And Purpose:
We sought to evaluate the effects of reperfusion and craniectomy treatment at different time points after middle cerebral artery (MCA) occlusion on infarct volume and neurological outcome in MCA infarction in rats.
Methods:
We used an endovascular technique to obtain MCA occlusion in 182 rats. Thirteen groups with 14 animals each were investigated: control group 1 with no treatment; groups 2 to 7 with only reperfusion or craniectomy at 1, 4, or 12 hours, respectively; and groups 8 to 13 with reperfusion at 1 or 4 hours combined with craniectomy at 1, 4, or 12 hours, respectively. We used infarct volume and neurological performance as study end points in all animals at day 7.
Results:
Neurological score and infarct volume in animals undergoing early reperfusion at 1 hour were significantly smaller (1.8/79+/-59 mm3) than those in control animals (3.8/225+/-26 mm3) (P<0.01). Reperfusion at 4 hours (2.8/182+/-62 mm3) and 12 hours (3.7/231+/-69 mm3) did not result in significant improvement. Animals undergoing craniectomy at 1, 4, and 12 hours demonstrated significantly better outcome and significantly reduced infarct volume (1.6/96+/-30 mm3, 1.9/109+/-39 mm3, and 2.6/150+/-34 mm3, respectively) (P<0.05). Compared with 1 treatment at a time, combined reperfusion and craniectomy did not result in a significant additional benefit.
Conclusions:
Early reperfusion and craniectomy at 1 hour are both effective in large MCA infarction. While reperfusion later than 1 hour was not beneficial, late craniectomy at 4 and 12 hours still resulted in significant improvement of neurological score and reduction of infarction size. Combined treatment at different time points yields no significant additional benefit compared with 1 treatment at a time.
Insights
Early reperfusion and craniectomy effectively treat middle cerebral artery (MCA) infarction in rats. While reperfusion after 1 hour showed no benefit, craniectomy up to 12 hours improved outcomes, with no added advantage from combined treatments.
Area of Science:
- Neuroscience
- Cerebrovascular Research
- Experimental Neurology
Background:
- Middle cerebral artery (MCA) infarction is a leading cause of stroke.
- Understanding optimal treatment timing for reperfusion and craniectomy is crucial.
Purpose of the Study:
- To evaluate the efficacy of reperfusion and craniectomy at various time points post-MCA occlusion in a rat model.
- To determine the impact on infarct volume and neurological deficits.
Main Methods:
- An endovascular technique was used to induce MCA occlusion in 182 rats.
- Animals were assigned to 13 groups, receiving reperfusion, craniectomy, or combined treatments at 1, 4, or 12 hours.
- Infarct volume and neurological performance were assessed at day 7.
Main Results:
- Early reperfusion (1 hour) significantly reduced infarct volume and improved neurological scores.
- Craniectomy at 1, 4, and 12 hours demonstrated significant benefits in outcome and infarct size reduction.
- Reperfusion beyond 1 hour showed no significant improvement; combined treatments offered no additional benefit over single interventions.
Conclusions:
- Both early reperfusion and craniectomy are effective interventions for MCA infarction.
- Craniectomy remains beneficial even when performed later (4 and 12 hours).
- Combined reperfusion and craniectomy do not provide superior outcomes compared to individual treatments.