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. 2023 Aug;54(8):2167-2171.
doi: 10.1161/STROKEAHA.123.043643. Epub 2023 Jun 28.

Infarct Core Growth During Interhospital Transfer For Thrombectomy Is Faster At Night

Pierre Seners  1   2   3   4 , Michael Mlynash  1 , Anirudh Sreekrishnan  1   4 , Adrien Ter Schiphorst  5 , Caroline Arquizan  5 , Vincent Costalat  6 , Hilde Henon  7 , Martin Bretzner  8 , Jeremy J Heit  9 , Jean-Marc Olivot  10 , Maarten G Lansberg  1 , Gregory W Albers  1   4 ; Infarct-Growth collaborators
Collaborators, Affiliations

Infarct Core Growth During Interhospital Transfer For Thrombectomy Is Faster At Night

Pierre Seners et al. Stroke. 2023 Aug.

Abstract

Background: Preclinical stroke models have recently reported faster infarct growth (IG) when ischemia was induced during daytime. Considering the inverse rest-activity cycles of rodents and humans, faster IG during the nighttime has been hypothesized in humans.

Methods: We retrospectively evaluated acute ischemic stroke patients with a large vessel occlusion transferred from a primary to 1 of 3 French comprehensive stroke center, with magnetic resonance imaging obtained at both centers before thrombectomy. Interhospital IG rate was calculated as the difference in infarct volumes on the 2 diffusion-weighted imaging, divided by the time elapsed between the 2 magnetic resonance imaging. IG rate was compared between patients transferred during daytime (7:00-22:59) and nighttime (23:00-06:59) in multivariable analysis adjusting for occlusion site, National Institutes of Health Stroke Scale score, infarct topography, and collateral status.

Results: Out of the 329 patients screened, 225 patients were included. Interhospital transfer occurred during nighttime in 31 (14%) patients and daytime in 194 (86%). Median interhospital IG was faster when occurring at night (4.3 mL/h; interquartile range, 1.2-9.5) as compared to the day (1.4 mL/h; interquartile range, 0.4-3.5; P<0.001). In multivariable analysis, nighttime transfer remained independently associated with IG rate (P<0.05).

Conclusions: Interhospital IG appeared faster in patients transferred at night. This has potential implications for the design of neuroprotection trials and acute stroke workflow.

Keywords: brain; infarct; ischemic stroke; magnetic resonance imaging.

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Conflict of interest statement

Disclosures Dr Henon received speaker fees from Sanofi Aventis. Dr Heit reports consulting fees from Medtronic and MicroVention, and he is a member of the medical and scientific advisory board for iSchemaView. Dr Olivot reports consultant services for Acticor, Abbvie, Boehringer-Ingelheim, Pfizer, Bristol-Myers Squibb, and Medtronic. Dr Albers reports stock holdings in iSchemaView; compensation from Biogen, iSchemaView, and Genentech for consultant services. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.. Flow chart
*for centers 2 and 3, data from patients who did not undergo groin puncture was not available.
Figure 2.
Figure 2.. Relationship between Inter-hospital Infarct Growth Rate and Time of Transfer
The box represents the upper and lower quartiles, the short black line within the box represents the median, the whiskers represent the 5th and 95th percentiles, and the circles extreme values.
See this image and copyright information in PMC

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