Severely Hypoperfused Brain Tissue Correlates with Final Infarct Volume Despite Recanalization in DMVO Stroke

Abstract

Objectives: We sought to assess whether there were any parameter(s) on baseline computed-tomography-perfusion (CTP) strongly correlating with final-infarct-volume, and infarct volume progression after endovascular recanalization of acute ischemic stroke (AIS) with primary distal, medium vessel occlusion (DMVO). Materials and Methods: We performed a retrospective analysis of consecutive AIS patients who were successfully recanalized by thrombectomy for DMVO. By comparing baseline CTP and follow-up MRI, we evaluated the correlation between baseline infarct and hypoperfusion volumes, and final infarct volume and infarct volume progression. We also examined their effect on good clinical outcome at 3 months (defined as an mRS score of 0 to 2). Results: Between January 2018 and January 2021, 38 patients met the inclusion criteria (76% [29/38] female, median age 75 [66–86] years). Median final infarct volume and infarct volume progression were 8.4 mL [IQR: 5.2–44.4] and 7.2 mL [IQR: 4.3–29.1] respectively. TMax>10 sec volume was strongly correlated with both (r=0.831 and r=0.771 respectively, p<0.0001), as well as with good clinical outcome (–0.5, p=0.001). A higher baseline TMax>10 sec volume increased the probability of a higher final-infarct-volume (r2=0.690, coefficient = 0.83 [0.64–1.00], p<0.0001), whereas it decreased the probability of good clinical outcome at 3 months (odds ratio = –0.67 [–1.17 to –0.18], p=0.008). Conclusion: TMax>10 sec volume on baseline CTP correlates strongly with final infarct volume as well as with clinical outcome after mechanical thrombectomy for an AIS with DMVO.