Journal
INTERNATIONAL JOURNAL OF STROKE
Volume 10, Issue 5, Pages 723-729Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1111/ijs.12436
Keywords
ischemic stroke; lesions; MRI; radiology; reperfusion; stroke
Categories
Funding
- National Institute for Neurological Disorders and Stroke (NINDS) [R01 NS03932505, K23 NS051372]
- Stanford Medical Scholars Fellowship Program
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BackgroundThe degree of variability in the rate of early diffusion-weighted imaging expansion in acute stroke has not been well characterized. AimWe hypothesized that patients with slowly expanding diffusion-weighted imaging lesions would have more penumbral salvage and better clinical outcomes following endovascular reperfusion than patients with rapidly expanding diffusion-weighted imaging lesions. MethodsIn the first part of this substudy of DEFUSE 2, growth curves were constructed for patients with >90% reperfusion and <10% reperfusion. Next, the initial growth rate was determined in all patients with a clearly established time of symptom onset, assuming a lesion volume of 0ml just prior to symptom onset. Patients who achieved reperfusion (>50% reduction in perfusion-weighted imaging after endovascular therapy) were categorized into tertiles according to their initial diffusion-weighted imaging growth rates. For each tertile, penumbral salvage [comparison of final volume to the volume of perfusion-weighted imaging (Tmax>6s)/diffusion-weighted imaging mismatch prior to endovascular therapy], favorable clinical response (National Institutes of Health Stroke Scale improvement of 8 points or 0-1 at 30 days), and good functional outcome (90-day modified Rankin score of 2) were calculated. A multivariate model assessed whether infarct growth rates were an independent predictor of clinical outcomes. ResultsSixty-five patients were eligible for this study; the median initial growth rate was 31ml/h (interquartile range 07-107). Target mismatch patients (n=42) had initial growth rates that were significantly slower than the growth rates in malignant profile (n=9 patients, P<0001). In patients who achieved reperfusion (n=38), slower early diffusion-weighted imaging growth rates were associated with better clinical outcomes (P<005) and a trend toward more penumbral salvage (n=31, P=0103). A multivariate model demonstrated that initial diffusion-weighted imaging growth rate was an independent predictor of achieving a 90-day modified Rankin score of 2. ConclusionsThe growth rate of early diffusion-weighted imaging lesions in acute stroke patients is highly variable; malignant profile patients have higher growth rates than patients with target mismatch. A slower rate of early diffusion-weighted imaging growth is associated with a greater degree of penumbral salvage and improved clinical outcomes following endovascular reperfusion.
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