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Time-dependent infarct volume affects the benefit of recanalization.

ABSTRACT: OBJECTIVES:The benefit threshold of infarct volume from recanalization remains unclear. We assumed that the threshold decreased over time, and then investigated the benefit curve of infarct volume during different time periods. METHODS:We reviewed prospectively collected clinical and imaging data from acute ischemic stroke patients with internal carotid artery and M1 occlusion who underwent angiography before and 24?h after reperfusion therapy. Ordinal analyses of modified Rankin Scale scores were performed and curves were fitted. RESULTS:Of the included 445 patients, the median age was 71?years and 157 (35.3%) were women. The mean time from onset to treatment (OTT) was 248?±?142?min. The median baseline infarct core volume was 49 (IQR 22-85) ml. Follow-up angiography revealed recanalization in 265 (59.6%) patients. The fitting curves showed that patients with an OTT ?3?h would benefit from recanalization no matter how large the infarct volume was, whereas patients with an OTT between 3 and 4.5?h and with an infarct volume???125?ml, and those with an OTT???4.5?h and with an infarct volume???80?ml did not benefit from recanalization. CONCLUSIONS:We established a time-dependent benefit threshold of infarct volume from recanalization, and thus suggested to estimate infarct core volume to select patients for reperfusion therapy in those with an OTT beyond 3?h.

SUBMITTER: Hu H

PROVIDER: S-EPMC6734046 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Time-dependent infarct volume affects the benefit of recanalization.

Hu Haitao H Yan Shenqiang S Zhou Ying Y Lou Min M

NeuroImage. Clinical 20190901

<h4>Objectives</h4>The benefit threshold of infarct volume from recanalization remains unclear. We assumed that the threshold decreased over time, and then investigated the benefit curve of infarct volume during different time periods.<h4>Methods</h4>We reviewed prospectively collected clinical and imaging data from acute ischemic stroke patients with internal carotid artery and M1 occlusion who underwent angiography before and 24 h after reperfusion therapy. Ordinal analyses of modified Rankin ...[more]

PMID: 31494401

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Project description:Background and purposeIn acute middle cerebral artery (MCA) stroke, CT angiographic (CTA) source images (CTA-SI) identify tissue likely to infarct despite early recanalization. This pilot study evaluated the impact of recanalization status on clinical and radiologic predictors of patient outcomes.Materials and methodsOf 44 patients undergoing CT/CTA within 6 hours of developing symptoms of proximal MCA ischemia, 19 patients achieved complete proximal MCA (MCA M1) recanalization. Admission National Institutes of Health Stroke Scale (NIHSS) score, onset-to-imaging time, CTA-SI Alberta Stroke Program Early CT Score, MCA M1 occlusion, cerebrovascular collaterals score, and CTA-SI lesion volume were correlated with 3- to 6-month follow-up modified Rankin Scale (mRS). We developed 2 stepwise regression models: one for patients with complete MCA M1 recanalization and one for patients without complete recanalization.ResultsComplete and incomplete recanalization groups had similar median admission NIHSS scores (19 versus 19) and mean onset-to-imaging times (2.3 versus 1.9 hours) but different proportions of patients achieving mRS scores 0-2 (74% versus 40%; P = .04). The only independent predictors of clinical outcome in patients with complete recanalization were onset-to-imaging time and admission CTA-SI lesion volume (total model R(2) = 0.75; P = .01). The only independent predictors of outcome in patients with incomplete recanalization were admission CTA-SI lesion volume and NIHSS score (total model R(2) = 0.66; P = .007).ConclusionRegardless of recanalization status, admission CTA-SI lesion volume was associated with clinical outcome. Recanalization status did, however, affect which variables in addition to CTA-SI volume significantly impacted clinical outcome: time with complete recanalization and NIHSS with incomplete recanalization. This finding may support the development of a model predicting the potential clinical benefit expected with early successful recanalization.

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Time-dependent infarct volume affects the benefit of recanalization.

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Time-dependent infarct volume affects the benefit of recanalization.

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