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Infarct Growth despite Endovascular Thrombectomy Recanalization in Large Vessel Occlusive Stroke
Author(s) -
Regenhardt Robert W.,
Etherton Mark R.,
Das Alvin S.,
Schirmer Markus D.,
Hirsch Joshua A.,
Stapleton Christopher J.,
Patel Aman B.,
LeslieMazwi Thabele M.,
Rost Natalia S.
Publication year - 2020
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon.12796
Subject(s) - medicine , modified rankin scale , thrombolysis , odds ratio , stroke (engine) , infarction , cardiology , white matter , magnetic resonance imaging , radiology , myocardial infarction , ischemia , ischemic stroke , mechanical engineering , engineering
BACKGROUND AND PURPOSE Endovascular thrombectomy (EVT) has revolutionized large vessel occlusion stroke care. However, not all patients with good endovascular results achieve good outcomes. We sought to understand the clinical significance of magnetic resonance imaging defined infarct growth despite adequate reperfusion and identify associated clinical and radiographic variables. METHODS History, presentation, treatments, and outcomes for consecutive EVT patients at a referral center were collected. Adequate reperfusion was defined as thrombolysis in cerebral infarction (TICI) score 2b‐3. Region‐specific infarct volumes in white matter, cortex, and basal ganglia were determined on diffusion‐weighted imaging. Infarct growth was defined as post‐EVT minus pre‐EVT volume. Good outcome was defined as 90‐day modified Rankin Scale ≤2. RESULTS Forty‐four patients with adequate reperfusion were identified with median age 72 years; 64% were women. Each region showed infarct growth: white matter (median pre‐EVT 7 cubic centimeters [cc], post‐EVT 16 cc), cortex (4 cc, 15 cc), basal ganglia (2 cc, 4 cc), total (20 cc, 39 cc). In multivariable regression, total infarct growth independently decreased the odds of good outcome (odds ratio = .946, 95% CI = .897, .998). Further multivariable analyses for determinants of infarct growth identified female sex was associated with less total growth (β = −.294, P = .042), TICI 3 was associated with less white matter growth (β = −.277, P = .048) and cortical growth (β = −.335, P = .017), and both female sex (β = −.332, P = .015) and coronary disease (β = −.337, P = .015) were associated with less cortical growth. CONCLUSIONS Infarct growth occurred despite adequate reperfusion, disproportionately in the cortex, and independently decreased the odds of good outcome. Infarct growth occurred while patients were hospitalized and may represent a therapeutic target. Potential determinants of region‐specific infarct growth were identified that require confirmation in larger studies.