Post-ischemic hyperemia following endovascular therapy for acute stroke is associated with lesion growth.

MedStar author(s):
Citation: Journal of Cerebral Blood Flow & Metabolism. 43(6):856-868, 2023 Jun.PMID: 36748316Institution: MedStar Washington Hospital CenterDepartment: Comprehensive Stroke CenterForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Brain Ischemia | *Endovascular Procedures | *Hyperemia | *Reperfusion Injury | *Stroke | Brain Ischemia/dg [Diagnostic Imaging] | Brain Ischemia/dt [Drug Therapy] | Brain Ischemia/su [Surgery] | Endovascular Procedures/ae [Adverse Effects] | Female | Humans | Male | Stroke/dt [Drug Therapy] | Stroke/su [Surgery] | Thrombectomy | Thrombolytic Therapy | Treatment Outcome | Year: 2023ISSN:
  • 0271-678X
Name of journal: Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and MetabolismAbstract: A substantial proportion of acute stroke patients fail to recover following successful endovascular therapy (EVT) and injury to the brain and vasculature secondary to reperfusion may be a contributor. Acute stroke patients were included with: i) large vessel occlusion of the anterior circulation, ii) successful recanalization, and iii) evaluable MRI early after EVT. Presence of hyperemia on MRI perfusion was assessed by consensus using a modified ASPECTS. Three different approaches were used to quantify relative cerebral blood flow (rCBF). Sixty-seven patients with median age of 66 [59-76], 57% female, met inclusion criteria. Hyperemia was present in 35/67 (52%) patients early post-EVT, in 32/65 (49%) patients at 24 hours, and in 19/48 (40%) patients at 5 days. There were no differences in incomplete reperfusion, HT, PH-2, HARM, severe HARM or symptomatic ICH rates between those with and without early post-EVT hyperemia. A strong association (R2 = 0.81, p < 0.001) was found between early post-EVT hyperemia (p = 0.027) and DWI volume at 24 hours after adjusting for DWI volume at 2 hours (p < 0.001) and incomplete reperfusion at 24 hours (p = 0.001). Early hyperemia is a potential marker for cerebrovascular injury and may help select patients for adjunctive therapy to prevent edema, reperfusion injury, and lesion growth.All authors: Adil MM, Afzal MM, Burton S, Cabatbat R, Craft V, Davis R, De Vis JB, Hsia AW, Kim Y, Latour LL, Leigh R, Lomahan CA, Luby M, Lynch JK, McGavern D, Thomas LC, Uche VFiscal year: FY2023Digital Object Identifier: Date added to catalog: 06/01/2023
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Journal Article MedStar Authors Catalog Article 36748316 Available 36748316

A substantial proportion of acute stroke patients fail to recover following successful endovascular therapy (EVT) and injury to the brain and vasculature secondary to reperfusion may be a contributor. Acute stroke patients were included with: i) large vessel occlusion of the anterior circulation, ii) successful recanalization, and iii) evaluable MRI early after EVT. Presence of hyperemia on MRI perfusion was assessed by consensus using a modified ASPECTS. Three different approaches were used to quantify relative cerebral blood flow (rCBF). Sixty-seven patients with median age of 66 [59-76], 57% female, met inclusion criteria. Hyperemia was present in 35/67 (52%) patients early post-EVT, in 32/65 (49%) patients at 24 hours, and in 19/48 (40%) patients at 5 days. There were no differences in incomplete reperfusion, HT, PH-2, HARM, severe HARM or symptomatic ICH rates between those with and without early post-EVT hyperemia. A strong association (R2 = 0.81, p < 0.001) was found between early post-EVT hyperemia (p = 0.027) and DWI volume at 24 hours after adjusting for DWI volume at 2 hours (p < 0.001) and incomplete reperfusion at 24 hours (p = 0.001). Early hyperemia is a potential marker for cerebrovascular injury and may help select patients for adjunctive therapy to prevent edema, reperfusion injury, and lesion growth.

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