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Published on: January 23, 2019
Successful reperfusion for better outcomes in medium vessel occlusion: Penumbral salvage versus infarct volume
Guangchen He1,2, Tingyu Yi3, Jiangshan Deng4
1Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
The benefits of endovascular thrombectomy (EVT) over medical treatment for medium vessel occlusion (MeVO) remain uncertain. Understanding how vascular reperfusion leads to favorable outcomes is crucial. This study examines whether penumbra salvage and infarct volume reduction quantify EVT benefits in MeVO patients and assesses their impact on clinical improvement post-reperfusion.
Methods:
We conducted a multicenter, observational study analyzing MeVO patients who underwent thrombectomy and received multimodal CT imaging from January 2020 to June 2024. EVT efficacy was evaluated by measuring follow-up infarct volume (FIV) on CT scans 24-48 h post-procedure and calculating the penumbra salvage index (PSI). PSI is the ratio of salvaged tissue volume (difference between baseline delay time (DT) >3 s volume and FIV) to baseline DT >3 s volume. Mediation analysis assessed PSI and FIV's contributions to successful reperfusion and functional outcomes.
Results:
Of 338 patients, 241 (72%) achieved successful reperfusion. Median FIV was 21 mL (IQR 12-32 mL), and median PSI was 0.68 (IQR 0.50-0.82). Successful reperfusion was linked to a 0.10 increase in PSI (95% CI: 0.05-0.15, p < 0.001) and a 4.36 mL reduction in FIV (95% CI: 1.31-7.20, p = 0.005). Successful reperfusion predicted improved outcomes, with an adjusted odds ratio (aOR) of 1.92 (95% CI: 1.08-3.47, p = 0.020) for excellent outcomes (modified Rankin Scale (mRS) score 0-1) and an aOR of 1.70 (95% CI: 1.01-2.89, p = 0.024) for functional independence (mRS score 0-2). PSI and FIV accounted for 44% and 16%, respectively, of the effect of reperfusion on excellent outcomes.
Conclusions:
In acute MeVO patients, penumbra salvage significantly mediates the beneficial relationship between reperfusion and excellent clinical outcomes, more so than infarct volume reduction.
Insights
Penumbra salvage, not infarct reduction, significantly improves outcomes after endovascular thrombectomy (EVT) for medium vessel occlusion (MeVO). This highlights the importance of preserving brain tissue during reperfusion therapy for better clinical results.
Area of Science:
- Neurology
- Interventional Radiology
- Medical Imaging
Background:
- Endovascular thrombectomy (EVT) benefits for medium vessel occlusion (MeVO) are not fully established.
- Understanding reperfusion's impact on outcomes is critical for MeVO treatment.
- This study investigates tissue salvage and infarct reduction as mediators of EVT efficacy in MeVO.
Purpose of the Study:
- To determine if penumbra salvage and infarct volume reduction quantify EVT benefits in MeVO patients.
- To assess the impact of these factors on clinical improvement after reperfusion.
- To elucidate the mechanisms by which EVT improves outcomes in MeVO.
Main Methods:
- Multicenter observational study of MeVO patients undergoing EVT with multimodal CT imaging (Jan 2020-June 2024).
- Evaluation of EVT efficacy using follow-up infarct volume (FIV) and penumbra salvage index (PSI).
- Mediation analysis to assess PSI and FIV's contribution to reperfusion success and functional outcomes.
Main Results:
- Successful reperfusion achieved in 72% of 338 MeVO patients.
- Successful reperfusion correlated with increased PSI (0.10) and reduced FIV (4.36 mL).
- Reperfusion predicted excellent outcomes (aOR 1.92) and functional independence (aOR 1.70).
- Penumbra salvage accounted for 44% of reperfusion's effect on excellent outcomes, while infarct reduction accounted for 16%.
Conclusions:
- Penumbra salvage significantly mediates the positive relationship between reperfusion and excellent clinical outcomes in acute MeVO.
- Tissue preservation (penumbra salvage) is a more substantial contributor to favorable outcomes than infarct volume reduction post-EVT for MeVO.
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