Related Experiment Video
Updated: Jan 31, 2026
Two-vessel Occlusion Mouse Model of Cerebral Ischemia-reperfusion
Published on: March 1, 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 volume 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 patient recovery.
Area of Science:
- Neurology
- Interventional Radiology
- Medical Imaging
Background:
- The efficacy of endovascular thrombectomy (EVT) compared to medical treatment for medium vessel occlusion (MeVO) is not fully established.
- Understanding the mechanisms by which vascular reperfusion improves outcomes in MeVO patients is critical.
- This study investigates the roles of penumbra salvage and infarct volume reduction in quantifying EVT benefits.
Purpose of the Study:
- To determine if penumbra salvage and infarct volume reduction accurately reflect EVT benefits in MeVO.
- To assess the impact of these factors on clinical improvement following reperfusion.
- To analyze the mediating effects of penumbra salvage and infarct volume reduction on reperfusion success and functional outcomes.
Main Methods:
- A multicenter, observational study included MeVO patients undergoing EVT with multimodal CT imaging.
- Efficacy was assessed by follow-up infarct volume (FIV) and penumbra salvage index (PSI) calculated from CT scans.
- Mediation analysis was used to evaluate the contributions of PSI and FIV to reperfusion and clinical outcomes.
Main Results:
- Successful reperfusion was achieved in 72% of 338 MeVO patients.
- Successful reperfusion correlated with increased PSI (0.10) and reduced FIV (4.36 mL).
- Penumbra salvage (PSI) accounted for 44% of the effect of reperfusion on excellent outcomes, while infarct volume reduction (FIV) accounted for 16%.
Conclusions:
- Penumbra salvage is a significant mediator of the positive relationship between reperfusion and excellent clinical outcomes in acute MeVO.
- Penumbra salvage plays a more substantial role than infarct volume reduction in achieving favorable outcomes post-EVT for MeVO.
- These findings emphasize the importance of maximizing tissue salvage during EVT for MeVO patients.
More Related Videos
14:35Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
06:10A Rat Model of Middle Cerebral Artery Occlusion/Reperfusion Without Damaging the Anatomical Structure of Cerebral Vessels
Published on: May 17, 2024
Related Concept Videos
02:17Ecological Succession
03:11Oxidation-Reduction Reactions
02:24Predicting Reaction Outcomes
01:13Outcomes of Glycolysis
Cellular respiration can occur aerobically (with oxygen) or anaerobically (without oxygen). In the presence of oxygen, cellular respiration starts with glycolysis and continues with pyruvate...
01:11Guidelines for Writing Outcome
Patient outcomes reflect the patient's response to the goal rather than what the nurse aims to achieve. Terminology should be observable and measurable to avoid the reader's interpretation. The desired outcome should be realistic and achievable in the designated care timeframe. Expected outcomes should align with adjunctive therapies. The outcome should enhance care...
02:41Constant Volume Calorimetry