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Multicenter Study
. 2024 Dec;44(12):1593-1604.
doi: 10.1177/0271678X241242911. Epub 2024 Jul 26.

Exploring ischemic core growth rate and endovascular therapy benefit in large core patients

Longting Lin  1   2 , Yueming Wang  3   4 , Chushuang Chen  2 , Andrew Bivard  5 , Kenneth Butcher  6 , Carlos Garcia-Esperon  2   7   8 , Neil J Spratt  2   7   8 , Christopher R Levi  2   7   8 , Xin Cheng  3 , Qiang Dong  3 , Mark W Parsons  1   2   5   7   8 ; INSPIRE study group
Affiliations
Multicenter Study

Exploring ischemic core growth rate and endovascular therapy benefit in large core patients

Longting Lin et al. J Cereb Blood Flow Metab. 2024 Dec.

Abstract

After stroke onset, ischemic brain tissue will progress to infarction unless blood flow is restored. Core growth rate measures the infarction speed from stroke onset. This multicenter cohort study aimed to explore whether core growth rate influences benefit from the reperfusion treatment of endovascular thrombectomy in large ischemic core stroke patients. It identified 134 patients with large core volume >70 mL assessed on brain perfusion image within 9 hours of stroke onset. Of 134 patients, 71 received endovascular thrombectomy and 63 did not receive the treatment. Overall, poor outcomes were frequent, with 3-month severed disability or death rate at 56% in treatment group and 68% in no treatment group (p = 0.156). Patients were then stratified by core growth rate. For patients with 'ultrafast core growth' of >70 mL/hour, rates of poor outcome were especially high in patients without endovascular thrombectomy (n = 13/14, 93%) and relatively lower in patients received the treatment (n = 12/20, 60%, p = 0.033). In contrast, for patients with core growth rate <70 mL/hour, there was not a large difference in poor outcomes between patients with and without the treatment (55% vs. 61%, p = 0.522). Therefore, patients with 'ultrafast core growth' might stand to benefit the most from endovascular treatment.

Keywords: Stroke; core growth; large core; perfusion imaging; thrombectomy.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Kenneth Butcher reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from BMS/Pfizer, grants and personal fees from Servier, outside the submitted work. Dr. Mark W. Parson reports research partnership with Siemens, Canon, and Apollo Medical Imaging outside the submitted work. All other authors declare that they have no conflict of interest.

Figures

Figure 1.
Figure 1.
Poor clinical outcome distribution across core growth quartiles. (a) 3-month poor clinical outcome measured by modified Rankin score of 5–6; (b) 3-month death. Core growth quartile 1: <30 mL/hour (n = 33), 2: 30–44 mL/hour (n = 34), 3: 44–70 mL/hour (n = 33), 4: >70 mL/hour (n = 34); SE refers to standard error.
Figure 2.
Figure 2.
Clinical outcome comparison between core growth <70 mL/hour and >70 mL/hour. (a) 3-month poor clinical outcome; (b) 3-month death; (c) hemorrhagic transformation (HT) and (d) symptomatic Intracranial hemorrhage (sICH).
Figure 3.
Figure 3.
The distribution of 3-month modified Rankin Score across core growth groups. (a) core growth <70 mL/hour and (b) core growth >70 mL/hour.
See this image and copyright information in PMC

References

    1. Parsons MW. Perfusion CT: is it clinically useful? Int J Stroke 2008; 3: 41–50. - PubMed
    1. Campbell BCV, Majoie C, Albers GW, et al. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurol 2019; 18: 46–55. - PubMed
    1. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49: e46–e110. - PubMed
    1. Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372: 1009–1018. - PubMed
    1. Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372: 2285–2295. 2015/04/18. - PubMed

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