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Updated: Oct 27, 2025
Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
Posttreatment Ischemic Lesion Evolution Is Associated With Reduced Favorable Functional Outcome in Patients With
Praneeta Konduri1,2, Henk van Voorst1,2, Amber Bucker1
1Department of Biomedical Engineering and Physics (P.K., H.v.V., A.B., H.M.), Amsterdam UMC, location AMC, the Netherlands.
Background And Purpose:
Ischemic lesion volume can increase even 24 hours after onset of an acute ischemic stroke. In this study, we investigated the association of lesion evolution with functional outcome and the influence of successful recanalization on this association.
Methods:
We included patients from the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) who received good quality noncontrast CT images 24 hours and 1 week after stroke onset. The ischemic lesion delineations included infarct, edema, and hemorrhagic transformation. Lesion evolution was defined as the difference between the volumes measured on the 1-week and 24-hour noncontrast CTs. The association of lesion evolution with functional outcome was evaluated using unadjusted and adjusted logistic regression. Adjustments were made for baseline, clinical, and imaging parameters that were associated P<0.10) in univariate analysis with favorable functional outcome, defined as modified Rankin Scale score of ≤2. Interaction analysis was performed to evaluate the influence of successful recanalization, defined as modified Arterial Occlusion Lesion score of 3 points, on this association.
Results:
Of the 226 patients who were included, 69 (31%) patients achieved the favorable functional outcome. Median lesion evolution was 22 (interquartile range, 10–45) mL. Lesion evolution was significantly inversely correlated with favourable functional outcome: unadjusted odds ratio, 0.76 (95% CI, 0.66–0.86; per 10 mL of lesion evolution; P<0.01) and adjusted odds ratio: 0.85 (95% CI, 0.72–0.97; per 10 mL of lesion evolution; P=0.03). There was no significant interaction of successful recanalization on the association of lesion evolution and favorable functional outcome (odds ratio, 1.01 [95% CI, 0.77–1.36]; P=0.94).
Conclusions:
In our population, subacute ischemic lesion evolution is associated with unfavorable functional outcome. This study suggests that even 24 hours after onset of stroke, deterioration of the brain continues, which has a negative effect on functional outcome. This finding may warrant additional treatment in the subacute phase.
Insights
Subacute ischemic lesion evolution, the increase in brain lesion size after acute ischemic stroke, is linked to worse functional outcomes. Successful recanalization did not alter this association, suggesting potential for new treatments.
Area of Science:
- Neurology
- Stroke Medicine
- Neuroimaging
Background:
- Ischemic lesion volume can expand up to 24 hours post-stroke.
- Understanding lesion evolution is crucial for predicting functional outcomes.
Purpose of the Study:
- To investigate the association between lesion evolution and functional outcome after acute ischemic stroke.
- To determine if successful recanalization influences this association.
Main Methods:
- Analysis of 226 patients from the MR CLEAN trial with CT scans at 24 hours and 1 week.
- Lesion evolution calculated as the volume difference between 1-week and 24-hour scans.
- Logistic regression used to assess the association with functional outcome (modified Rankin Scale ≤2), adjusting for clinical and imaging parameters.
Main Results:
- Median lesion evolution was 22 mL.
- Increased lesion evolution was significantly associated with unfavorable functional outcome (adjusted OR 0.85 per 10 mL; P=0.03).
- Successful recanalization did not significantly modify this association (OR 1.01; P=0.94).
Conclusions:
- Subacute lesion evolution negatively impacts functional outcome in acute ischemic stroke patients.
- Brain deterioration continues in the subacute phase, affecting recovery.
- Findings may support the need for interventions in the subacute stroke period.
