Infarct Growth despite Endovascular Thrombectomy Recanalization in Large Vessel Occlusive Stroke

Area of Science:

• Neurology
• Radiology
• Cardiovascular Research

Background:

• Endovascular thrombectomy (EVT) has transformed large vessel occlusion stroke treatment.
• However, not all patients achieve optimal outcomes despite successful reperfusion.

Purpose of the Study:

• To investigate the clinical significance of infarct growth after EVT, even with adequate reperfusion.
• To identify clinical and radiographic factors associated with infarct growth.

Main Methods:

• Retrospective analysis of consecutive EVT patients.
• Adequate reperfusion defined as TICI score 2b-3.
• Infarct volumes measured using diffusion-weighted imaging; infarct growth calculated as post-EVT minus pre-EVT volume.

Main Results:

• Forty-four patients with adequate reperfusion showed infarct growth in all regions (white matter, cortex, basal ganglia).
• Total infarct growth independently reduced the odds of a good outcome (modified Rankin Scale ≤2).
• Female sex, TICI 3 reperfusion, and coronary disease were associated with less infarct growth.

Conclusions:

• Infarct growth occurs post-EVT despite adequate reperfusion, particularly in the cortex, and negatively impacts patient outcomes.
• Infarct growth during hospitalization may be a modifiable therapeutic target.
• Further research is needed to confirm identified determinants of infarct growth in larger cohorts.