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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

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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, Vol. 16, No. 7, 10.2021, p. 863-872.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Nawabi, J, Flottmann, F, Kemmling, A, Kniep, H, Leischner, H, Sporns, P, Schön, G, Hanning, U, Thomalla, G, Fiehler, J & Broocks, G 2021, 'Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization - When "tissue clock" and "time clock" are desynchronized', INT J STROKE, vol. 16, no. 7, pp. 863-872. https://doi.org/10.1177/1747493019884522

APA

Nawabi, J., Flottmann, F., Kemmling, A., Kniep, H., Leischner, H., Sporns, P., Schön, G., Hanning, U., Thomalla, G., Fiehler, J., & Broocks, G. (2021). Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization - When "tissue clock" and "time clock" are desynchronized. INT J STROKE, 16(7), 863-872. https://doi.org/10.1177/1747493019884522

Vancouver

Nawabi J, Flottmann F, Kemmling A, Kniep H, Leischner H, Sporns P et al. Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization - When "tissue clock" and "time clock" are desynchronized. INT J STROKE. 2021 Oct;16(7):863-872. https://doi.org/10.1177/1747493019884522

Bibtex

@article{5756af4fe30f4049a0a07d8eecc0da57,
title = "Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization - When {"}tissue clock{"} and {"}time clock{"} are desynchronized",
abstract = "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.",
author = "Jawed Nawabi and Fabian Flottmann and Andre Kemmling and Helge Kniep and Hannes Leischner and Peter Sporns and Gerhard Sch{\"o}n and Uta Hanning and G{\"o}tz Thomalla and Jens Fiehler and Gabriel Broocks",
year = "2021",
month = oct,
doi = "10.1177/1747493019884522",
language = "English",
volume = "16",
pages = "863--872",
journal = "INT J STROKE",
issn = "1747-4930",
publisher = "Wiley-Blackwell",
number = "7",

}

RIS

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 -