Relationship between the degree of recanalization and functional outcome in acute ischemic stroke is mediated by penumbra salvage volume
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Relationship between the degree of recanalization and functional outcome in acute ischemic stroke is mediated by penumbra salvage volume. / Broocks, Gabriel; Jafarov, Hashim; McDonough, Rosalie; Austein, Friederike; Meyer, Lukas; Bechstein, Matthias; van Horn, Noel; Nawka, Marie Teresa; Schön, Gerhard; Fiehler, Jens; Kniep, Helge; Hanning, Uta.
in: J NEUROL, Jahrgang 268, Nr. 6, 01.06.2021, S. 2213-2222.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Relationship between the degree of recanalization and functional outcome in acute ischemic stroke is mediated by penumbra salvage volume
AU - Broocks, Gabriel
AU - Jafarov, Hashim
AU - McDonough, Rosalie
AU - Austein, Friederike
AU - Meyer, Lukas
AU - Bechstein, Matthias
AU - van Horn, Noel
AU - Nawka, Marie Teresa
AU - Schön, Gerhard
AU - Fiehler, Jens
AU - Kniep, Helge
AU - Hanning, Uta
PY - 2021/6/1
Y1 - 2021/6/1
N2 - BACKGROUND: The presence of metabolically viable brain tissue that may be salvageable with rapid cerebral blood flow restoration is the fundament rationale for reperfusion therapy in patients with large vessel occlusion stroke. The effect of endovascular treatment (EVT) on functional outcome largely depends on the degree of recanalization. However, the relationship of recanalization degree and penumbra salvage has not yet been investigated. We hypothesized that penumbra salvage volume mediates the effect of thrombectomy on functional outcome.METHODS: 99 acute anterior circulation stroke patients who received multimodal CT and underwent thrombectomy with resulting partial to complete reperfusion (modified thrombolysis in cerebral infarction scale (mTICI) ≥ 2a) were retrospectively analyzed. Penumbra volume was quantified on CT perfusion and penumbra salvage volume (PSV) was calculated as difference of penumbra and net infarct growth from admission to follow-up imaging.RESULTS: In patients with complete reperfusion (mTICI ≥ 2c), the median PSV was significantly higher than the median PSV in patients with partial or incomplete (mTICI 2a-2b) reperfusion (median 224 mL, IQR: 168-303 versus 158 mL, IQR: 129-225; p < 0.01). A higher degree of recanalization was associated with increased PSV (+ 63 mL per grade, 95% CI: 17-110; p < 0.01). Higher PSV was also associated with improved functional outcome (OR/mRS shift: 0.89; 95% CI: 0.85-0.95, p < 0.0001).CONCLUSIONS: PSV may be an important mediator between functional outcome and recanalization degree in EVT patients and could serve as a more accurate instrument to compare treatment effects than infarct volumes.
AB - BACKGROUND: The presence of metabolically viable brain tissue that may be salvageable with rapid cerebral blood flow restoration is the fundament rationale for reperfusion therapy in patients with large vessel occlusion stroke. The effect of endovascular treatment (EVT) on functional outcome largely depends on the degree of recanalization. However, the relationship of recanalization degree and penumbra salvage has not yet been investigated. We hypothesized that penumbra salvage volume mediates the effect of thrombectomy on functional outcome.METHODS: 99 acute anterior circulation stroke patients who received multimodal CT and underwent thrombectomy with resulting partial to complete reperfusion (modified thrombolysis in cerebral infarction scale (mTICI) ≥ 2a) were retrospectively analyzed. Penumbra volume was quantified on CT perfusion and penumbra salvage volume (PSV) was calculated as difference of penumbra and net infarct growth from admission to follow-up imaging.RESULTS: In patients with complete reperfusion (mTICI ≥ 2c), the median PSV was significantly higher than the median PSV in patients with partial or incomplete (mTICI 2a-2b) reperfusion (median 224 mL, IQR: 168-303 versus 158 mL, IQR: 129-225; p < 0.01). A higher degree of recanalization was associated with increased PSV (+ 63 mL per grade, 95% CI: 17-110; p < 0.01). Higher PSV was also associated with improved functional outcome (OR/mRS shift: 0.89; 95% CI: 0.85-0.95, p < 0.0001).CONCLUSIONS: PSV may be an important mediator between functional outcome and recanalization degree in EVT patients and could serve as a more accurate instrument to compare treatment effects than infarct volumes.
KW - Brain Ischemia/complications
KW - Endovascular Procedures
KW - Humans
KW - Ischemic Stroke
KW - Retrospective Studies
KW - Stroke/diagnostic imaging
KW - Thrombectomy
KW - Treatment Outcome
U2 - 10.1007/s00415-021-10410-2
DO - 10.1007/s00415-021-10410-2
M3 - SCORING: Journal article
C2 - 33486602
VL - 268
SP - 2213
EP - 2222
JO - J NEUROL
JF - J NEUROL
SN - 0340-5354
IS - 6
ER -