Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization - When "tissue clock" and "time clock" are desynchronized
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Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization - When "tissue clock" and "time clock" are desynchronized. / Nawabi, Jawed; Flottmann, Fabian; Kemmling, Andre; Kniep, Helge; Leischner, Hannes; Sporns, Peter; Schön, Gerhard; Hanning, Uta; Thomalla, Götz; Fiehler, Jens; Broocks, Gabriel.
in: INT J STROKE, Jahrgang 16, Nr. 7, 10.2021, S. 863-872.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization - When "tissue clock" and "time clock" are desynchronized
AU - Nawabi, Jawed
AU - Flottmann, Fabian
AU - Kemmling, Andre
AU - Kniep, Helge
AU - Leischner, Hannes
AU - Sporns, Peter
AU - Schön, Gerhard
AU - Hanning, Uta
AU - Thomalla, Götz
AU - Fiehler, Jens
AU - Broocks, Gabriel
PY - 2021/10
Y1 - 2021/10
N2 - BACKGROUND: Ischemic water uptake in acute stroke is a reliable indicator of lesion age. Nevertheless, inter-individually varying edema progression has been observed and elevated water uptake has recently been described as predictor of malignant infarction.AIMS: We hypothesized that early-elevated lesion water uptake indicates accelerated "tissue clock" desynchronized with "time clock" and therefore predicts poor clinical outcome despite successful recanalization.METHODS: Acute middle cerebral artery stroke patients with multimodal admission-CT who received successful thrombectomy (TICI 2b/3) were analyzed. Net water uptake (NWU), a quantitative imaging biomarker of ischemic edema, was determined in admission-CT and tested as predictor of clinical outcome using modified Rankin Scale (mRS) after 90 days. A binary outcome was defined for mRS 0-4 and mRS 5-6.RESULTS: Seventy-two patients were included. The mean NWU (SD) in patients with mRS 0-4 was lower compared to patients with mRS 5-6 (5.0% vs. 12.1%; p < 0.001) with similar time from symptom onset to imaging (2.6 h vs. 2.4 h; p = 0.7). Based on receiver operating curve analysis, NWU above 10% identified patients with very poor outcome with high discriminative power (AUC 0.85), followed by Alberta Stroke Program Early CT Score (ASPECTS) (AUC: 0.72) and National Institutes of Health Stroke Scale (NIHSS) (AUC: 0.72).CONCLUSIONS: Quantitative NWU may serve as an indicator of "tissue clock" and pronounced early brain edema with elevated NWU might suggest a desynchronized "tissue clock" with real "time clock" and therefore predict futile recanalization with poor clinical outcome.
AB - BACKGROUND: Ischemic water uptake in acute stroke is a reliable indicator of lesion age. Nevertheless, inter-individually varying edema progression has been observed and elevated water uptake has recently been described as predictor of malignant infarction.AIMS: We hypothesized that early-elevated lesion water uptake indicates accelerated "tissue clock" desynchronized with "time clock" and therefore predicts poor clinical outcome despite successful recanalization.METHODS: Acute middle cerebral artery stroke patients with multimodal admission-CT who received successful thrombectomy (TICI 2b/3) were analyzed. Net water uptake (NWU), a quantitative imaging biomarker of ischemic edema, was determined in admission-CT and tested as predictor of clinical outcome using modified Rankin Scale (mRS) after 90 days. A binary outcome was defined for mRS 0-4 and mRS 5-6.RESULTS: Seventy-two patients were included. The mean NWU (SD) in patients with mRS 0-4 was lower compared to patients with mRS 5-6 (5.0% vs. 12.1%; p < 0.001) with similar time from symptom onset to imaging (2.6 h vs. 2.4 h; p = 0.7). Based on receiver operating curve analysis, NWU above 10% identified patients with very poor outcome with high discriminative power (AUC 0.85), followed by Alberta Stroke Program Early CT Score (ASPECTS) (AUC: 0.72) and National Institutes of Health Stroke Scale (NIHSS) (AUC: 0.72).CONCLUSIONS: Quantitative NWU may serve as an indicator of "tissue clock" and pronounced early brain edema with elevated NWU might suggest a desynchronized "tissue clock" with real "time clock" and therefore predict futile recanalization with poor clinical outcome.
U2 - 10.1177/1747493019884522
DO - 10.1177/1747493019884522
M3 - SCORING: Journal article
C2 - 31657283
VL - 16
SP - 863
EP - 872
JO - INT J STROKE
JF - INT J STROKE
SN - 1747-4930
IS - 7
ER -