Related Experiment Video
Updated: Aug 23, 2025
Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
Early and Delayed Infarct Growth in Patients Undergoing Mechanical Thrombectomy: A Prospective, Serial MRI Study
María Hernández-Pérez1, Mariano Werner1, Sebastián Remollo1
1Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.).
Background:
We studied the evolution over time of diffusion weighted imaging (DWI) lesion volume and the factors involved on early and late infarct growth (EIG and LIG) in stroke patients undergoing endovascular treatment (EVT) according to the final revascularization grade.
Methods:
This is a prospective cohort of patients with anterior large artery occlusion undergoing EVT arriving at 1 comprehensive stroke center. Magnetic resonance imaging was performed on arrival (pre-EVT), <2 hours after EVT (post-EVT), and on day 5. DWI lesions and perfusion maps were evaluated. Arterial revascularization was assessed according to the modified Thrombolysis in Cerebral Infarction (mTICI) grades. We recorded National Institutes of Health Stroke Scale at arrival and at day 7. EIG was defined as (DWI volume post-EVT-DWI volume pre-EVT), and LIG was defined as (DWI volume at 5d-DWI volume post-EVT). Factors involved in EIG and LIG were tested via multivariable lineal models.
Results:
We included 98 patients (mean age 70, median National Institutes of Health Stroke Scale score 17, final mTICI≥2b 86%). Median EIG and LIG were 48 and 63.3 mL in patients with final mTICI<2b, and 3.6 and 3.9 cc in patients with final mTICI≥2b. Both EIG and LIG were associated with higher National Institutes of Health Stroke Scale at day 7 (ρ=0.667; P<0.01 and ρ=0.614; P<0.01, respectively). In patients with final mTICI≥2b, each 10% increase in the volume of DWI pre-EVT and each extra pass leaded to growths of 9% (95% CI, 7%-10%) and 14% (95% CI, 2%-28%) in the DWI volume post-EVT, respectively. Furthermore, each 10% increase in the volume of DWI post-EVT, each extra pass, and each 10 mL increase in TMax6s post-EVT were associated with growths of 8% (95% CI, 6%-9%), 9% (95% CI, 0%-19%), and 12% (95% CI, 5%-20%) in the volume of DWI post-EVT, respectively.
Conclusions:
Infarct grows during and after EVT, especially in nonrecanalizers but also to a lesser extent in recanalizers. In recanalizers, number of passes and DWI volume influence EIG, while number of passes, DWI, and hypoperfused volume after the procedure determine LIG.
Insights
This study examined infarct growth in stroke patients undergoing endovascular treatment (EVT). Infarct volume increased significantly in non-recanalizers, and factors like DWI volume and passes influenced growth in recanalizers.
Area of Science:
- Neurology
- Radiology
- Interventional Cardiology
Background:
- Stroke patients undergoing endovascular treatment (EVT) experience infarct growth.
- Early and late infarct growth (EIG and LIG) are critical metrics in assessing EVT outcomes.
- Understanding factors influencing infarct growth is crucial for improving patient prognosis.
Purpose of the Study:
- To analyze the evolution of diffusion-weighted imaging (DWI) lesion volume over time in stroke patients treated with EVT.
- To identify factors contributing to early and late infarct growth (EIG and LIG) based on final revascularization grade.
Main Methods:
- Prospective cohort study of anterior large artery occlusion patients undergoing EVT.
- Serial magnetic resonance imaging (MRI) including DWI and perfusion maps (pre-EVT, post-EVT, day 5).
- Assessment of revascularization using modified Thrombolysis in Cerebral Infarction (mTICI) grades and multivariable linear models for EIG/LIG factors.
Main Results:
- Significant differences in median EIG and LIG between mTICI < 2b (48 mL, 63.3 mL) and mTICI ≥ 2b (3.6 mL, 3.9 mL) groups.
- Both EIG and LIG correlated with higher National Institutes of Health Stroke Scale scores at day 7.
- In mTICI ≥ 2b patients, pre-EVT DWI volume and extra passes increased post-EVT DWI volume; post-EVT DWI volume, extra passes, and TMax6s increased LIG.
Conclusions:
- Infarct growth occurs during and after EVT, particularly in non-recanalizers.
- In recanalized patients, DWI volume and number of passes impact EIG.
- LIG in recanalized patients is influenced by number of passes, DWI volume, and post-procedure hypoperfused volume.
More Related Videos
09:59A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
13:10Combined Near-infrared Fluorescent Imaging and Micro-computed Tomography for Directly Visualizing Cerebral Thromboemboli
Published on: September 25, 2016