Penumbra salvage in extensive stroke: exploring limits for reperfusion therapy
Gabriel Broocks1, Lukas Meyer2, Matthias Bechstein2
1Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany g.broocks@uke.de.
Journal of Neurointerventional Surgery
|March 6, 2023
Summary
Successful reperfusion after stroke saves brain tissue, but benefits diminish with extensive early damage. Recanalization salvages brain tissue up to specific limits, with uncertain outcomes for very large strokes.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Thrombectomy's efficacy in extensive ischemic stroke is under investigation.
- Penumbra salvage volume (PSV) quantifies rescued brain tissue.
- Uncertainty exists regarding the extent of salvageable tissue in large strokes.
Purpose of the Study:
- To determine if recanalization's effect on PSV varies with early ischemic changes.
- To assess the influence of stroke severity on tissue salvage after thrombectomy.
Main Methods:
- Observational study of anterior circulation ischemic stroke patients undergoing thrombectomy.
- PSV calculated as baseline penumbra minus follow-up infarct volume.
- Multivariable regression analyzed recanalization's effect on PSV based on ASPECTS and core volume.
Main Results:
- Successful recanalization (76% of patients) was linked to 59 mL PSV.
- Penumbra salvage occurred up to ASPECTS of 3 and core volume of 110 mL.
- Recanalization improved functional outcomes (mRS ≤2) for core volumes up to 100 mL.
Conclusions:
- Recanalization significantly salvages penumbra up to ASPECTS 3 and core volume 110 mL.
- Clinical benefit is uncertain for extensive strokes (ASPECTS <3 or core >100 mL).
- Prospective studies are needed to clarify outcomes in severe stroke cases.
