Infarct Growth despite Successful Endovascular Reperfusion in Acute Ischemic Stroke: A Meta-analysis

Area of Science:

• Neurology
• Interventional Radiology
• Stroke Medicine

Background:

• Infarct volume is a key predictor of stroke recovery.
• The extent and causes of infarct growth after successful endovascular treatment are not well understood.

Purpose of the Study:

• To quantify infarct growth in acute stroke patients who achieved successful reperfusion (TICI 2b-3) with endovascular therapy.
• To identify factors associated with infarct expansion despite successful reperfusion.

Main Methods:

• Systematic review and meta-analysis of studies reporting infarct volumes before and after endovascular treatment.
• Included studies focused on patients with successful reperfusion (TICI 2b-3) and >10 participants.
• Infarct growth was calculated as the difference between baseline and follow-up MR imaging volumes.

Main Results:

• 10 studies including 973 patients were analyzed.
• Mean infarct growth was 14.8 mL (95% CI, 7.9-21.7 mL), with final infarct volumes significantly larger than baseline.
• Higher infarct growth was associated with larger baseline volumes, incomplete reperfusion (TICI 2b), and longer treatment times.

Conclusions:

• Significant infarct growth occurs even after successful endovascular reperfusion in acute stroke.
• These findings highlight the need for optimized treatment workflows and novel therapies to mitigate infarct expansion.
• Further research is needed to address heterogeneity and identify specific treatment strategies.