Abstract
Background
Recently studies have shown that select acute ischemic stroke (AIS) patients with
large ischemic core could be deemed as reasonable candidates to receive mechanical
thrombectomy (MT) with low risk of developing parenchymal hemorrhage (PH) or symptomatic
intracerebral hemorrhage (sICH); however, the selection criterion remains lacking.
Our study aims to investigate the relationship between a novel imaging biomarker of
largest core mass volume (LCMV) and development of PH in stroke patients with large
ischemic core who have undergone MT.
Methods
A total of 26 AIS patients with large ischemic core (defined as ischemic core volume
≧ 50 ml) were enrolled in the study. Volume of ischemic core and the LCMV measured
with Mistar software were measured in all patients. Fourteen patients with AIS developed
PH while 12 patients showed no signs of PH based on CT imaging obtained between 24 h
and 3 day after MT. We compared the volume of ischemic core and LCMV between two groups.
Results
Volume of ischemic core showed no significant difference between the PH and no PH
group [105.5 (62.4–131.5) vs 75.0 (56.3–102.2), p = 0.105], whereas LCMV was significantly higher in the PH (14.80 ± 5.23) vs. no PH
group (8.40 ± 2.61, p = 0.001). ROC analysis revealed that LCMV was positively correlated with PH (area
under the curve = 0.905). The optimal LCMV associated with PH was ≧ 9.67 ml.
Conclusion
LCMV is an effective and easy-to-use imaging biomarker to predict PH after MT in AIS
patients with large ischemic core.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A randomized trial of intraarterial treatment for acute ischemic stroke.N Engl J Med. 2015; 372: 11-20
- Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke.N Engl J Med. 2015; 372: 2285-2295
- Randomized assessment of rapid endovascular treatment of ischemic stroke.N Engl J Med. 2015; 372: 1019-1030
- Endovascular therapy for ischemic stroke with perfusion-imaging selection.N Engl J Med. 2015; 372: 1009-1018
- Thrombectomy 6 to 24 h after stroke with a mismatch between deficit and infarct.N Engl J Med. 2018; 378: 11-21
- Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials.Lancet. 2016; 387: 1723-1731
- Predictors and impact of hemorrhagic transformations after endovascular thrombectomy in patients with acute large vessel occlusions.J Neurointerv Surg. 2019; 11: 469-473
- Acute stroke with large ischemic core treated by thrombectomy.Stroke. 2019; 50: 1164-1171
- Outcomes of endovascular thrombectomy vs medical management alone in patients with large ischemic cores: a secondary analysis of the optimizing patient’s selection for endovascular treatment in acute ischemic stroke (SELECT) Study.JAMA Neurol. 2019; 76: 1147-1156
- Cerebral blood flow is the optimal CT perfusion parameter for assessing infarct core.Stroke. 2011; 42: 3435-3440
- Prediction of poststroke hemorrhagic transformation using computed tomography perfusion.Stroke. 2013; 44: 3039-3043
- Initial 'TTP map-defect' of computed tomography perfusion as a predictor of hemorrhagic transformation of acute ischemic stroke.Cerebrovasc Dis Extra. 2013; 3: 14-25
- Refining angiographic biomarkers of revascularization: improving outcome prediction after intra-arterial therapy.Stroke. 2013; 44: 2509-2512
- Reliability of the ECASS radiological classification of postthrombolysis brain haemorrhage: a comparison of CT and three MRI sequences.Cerebrovasc Dis. 2010; 29: 597-604
- Patients with ischemic core >/=70 ml within 6 h of symptom onset may still benefit from endovascular treatment.Front Neurol. 2018; 9: 933
- Optimal delay time of CT perfusion for predicting cerebral parenchymal hematoma after intra-arterial tPA treatment.Front Neurol. 2018; 9: 680
- Risk assessment of hemorrhagic transformation of acute middle cerebral artery stroke using multimodal CT.J Neuroimaging. 2012; 22: 160-166
Article info
Publication history
Published online: October 24, 2021
Accepted:
September 14,
2021
Received in revised form:
September 3,
2021
Received:
March 17,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106125
Copyright
© 2021 Elsevier Inc. All rights reserved.
