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Published on: May 9, 2013
Effect of early and delayed recanalization on infarct pattern in proximal middle cerebral artery occlusion
Marek Humpich1, Oliver C Singer, Richard du Mesnil de Rochemont
1Department of Neurology, J.W. Goethe University, Frankfurt am Main, Germany.
Background:
To investigate the effect of early (<6 h) versus delayed (>6 h) recanalization on infarct pattern in acute middle cerebral artery (MCA) occlusion.
Methods:
35 patients with acute MCA occlusion (M1 segment; symptom onset <6 h) were analyzed. Stroke MRI was performed immediately after admission (day 0), and on days 1 and 7. In addition, vessel status was assessed within 6 h, at 24 h and on day 7. Patients were grouped according to early (
Results:
Lesion growth was significantly larger in the group without recanalization (125 +/- 100 cm(3); mean +/- SD) compared to patients with early (41 +/- 42 cm(3); p = 0.02) or delayed (47 +/- 45 cm(3); p < 0.05) recanalization. The analysis of infarct patterns revealed extensive sparing of peripheral cortical regions in both the early and delayed recanalization groups compared to the persistent occlusion group. In the early/delayed recanalization groups, cortical involvement was often limited to the central MCA territory (i.e. insular region and adjacent cortex, in addition to the basal ganglia). The final infarct volume was 80 +/- 71 cm(3) in patients with early, 93 +/- 62 cm(3) in those with delayed, and 194 +/- 156 cm(3) in those without recanalization.
Conclusions:
Delayed recanalization significantly limits DWI lesion expansion in patients with proximal MCA occlusion and selectively saves peripheral cortical regions. Collateral supply to the peripheral MCA territory may be sufficient for an extended period of time.
