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Severely Hypoperfused Brain Tissue Correlates with Final Infarct Volume Despite Recanalization in DMVO Stroke
Maud Wang1,2, Yousra Farouki2, Franny Hulscher2
1Department of Radiology, Leuven University Hospital, Leuven, Belgium.
Insights
Baseline TMax > 10 sec volume on computed-tomography-perfusion scans strongly predicts final infarct size and clinical outcomes in acute ischemic stroke patients undergoing mechanical thrombectomy for distal medium vessel occlusion.
Area of Science:
- Neurology
- Radiology
- Interventional Cardiology
Background:
- Acute ischemic stroke (AIS) due to distal, medium vessel occlusion (DMVO) presents unique challenges for recanalization.
- Predicting final infarct volume and clinical outcomes is crucial for treatment decisions in AIS.
Purpose of the Study:
- To identify baseline computed-tomography-perfusion (CTP) parameters that correlate with final infarct volume and progression in AIS with DMVO.
- To evaluate the impact of these CTP parameters on clinical outcomes after endovascular treatment.
Main Methods:
- Retrospective analysis of 38 AIS patients with successful thrombectomy for DMVO.
- Comparison of baseline CTP and follow-up MRI to assess infarct and hypoperfusion volumes.
- Correlation analysis between baseline CTP parameters, final infarct volume, infarct progression, and 3-month clinical outcomes (mRS 0-2).
Main Results:
- TMax > 10 sec volume on baseline CTP strongly correlated with final infarct volume (r=0.831) and infarct progression (r=0.771).
- Baseline TMax > 10 sec volume was also associated with 3-month clinical outcomes (r=-0.5).
- Higher baseline TMax > 10 sec volume predicted larger final infarcts and poorer clinical outcomes.
Conclusions:
- Baseline TMax > 10 sec volume on CTP is a significant predictor of final infarct volume and clinical outcome in AIS patients with DMVO treated with mechanical thrombectomy.
- This parameter can aid in risk stratification and treatment planning for these patients.
Objectives:
We sought to assess whether there were any parameter(s) on baseline computed-tomography-perfusion (CTP) strongly correlating with final-infarct-volume, and infarct volume progression after endovascular recanalization of acute ischemic stroke (AIS) with primary distal, medium vessel occlusion (DMVO).
Materials And Methods:
We performed a retrospective analysis of consecutive AIS patients who were successfully recanalized by thrombectomy for DMVO. By comparing baseline CTP and follow-up MRI, we evaluated the correlation between baseline infarct and hypoperfusion volumes, and final infarct volume and infarct volume progression. We also examined their effect on good clinical outcome at 3 months (defined as an mRS score of 0 to 2).
Results:
Between January 2018 and January 2021, 38 patients met the inclusion criteria (76% [29/38] female, median age 75 [66-86] years). Median final infarct volume and infarct volume progression were 8.4 mL [IQR: 5.2-44.4] and 7.2 mL [IQR: 4.3-29.1] respectively. TMax > 10 sec volume was strongly correlated with both (r = 0.831 and r = 0.771 respectively, p < 0.0001), as well as with good clinical outcome (-0.5, p = 0.001). A higher baseline TMax > 10 sec volume increased the probability of a higher final-infarct-volume (r2 = 0.690, coefficient = 0.83 [0.64-1.00], p < 0.0001), whereas it decreased the probability of good clinical outcome at 3 months (odds ratio = -0.67 [-1.17 to -0.18], p = 0.008).
Conclusion:
TMax > 10 sec volume on baseline CTP correlates strongly with final infarct volume as well as with clinical outcome after mechanical thrombectomy for an AIS with DMVO.
