Relationship between the degree of recanalization and functional outcome in acute ischemic stroke is mediated by penumbra salvage volume

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 -