Kaesmacher, Johannes; Kurmann, Christoph; Jungi, Noel; Breiding, Philipe; Lang, Matthias F.; Meier, Raphael; Dobrocky, Tomas; Piechowiak, Eike; Zibold, Felix; Bellwald, Sebastian; Meinel, Thomas R.; Heldner, Mirjam R.; Mordasini, Pasquale; Arnold, Marcel; Mosimann, Pascal J.; Goyal, Mayank; Gralla, Jan; Fischer, Urs (2020). Infarct in new territory after endovascular stroke treatment: A diffusion-weighted imaging study. Scientific Reports, 10(1), p. 8366. Nature Publishing Group 10.1038/s41598-020-64495-2
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Infarct_kaesmacher.pdf - Published Version Available under License Creative Commons: Attribution (CC-BY). Download (1MB) | Preview |
Data on infarcts in new territory (INT) in patients undergoing endovascular stroke treatment for acute large-vessel occlusions are sparse. Aim of this study was to assess the prevalence, risk factors, and clinical relevance of INT. For this purpose, all patients in a single-center prospective registry who underwent endovascular stroke treatment and received pre- and post-interventional diffusion-weighted imaging were included (N = 259). Using an established scoring system, INT were classified according to size (I-III, ≤2 mm, >2 mm ≤20 mm, >20 mm) and likelihood of being related to the intervention (A, high likelihood; B, low likelihood). Additionally, a new type of infarct, that occurred in a territory distal to the occlusion, but was initially not hypoperfused, was defined as an infarct in initially not hypoperfused territory (IINHT). A total of 180 INT and 38 IINHT were observed in 32.8% (N = 85/259) of patients. In most patients, INT were angiographically occult (90.2%), and 13 patients had INT/IINHT larger than 2 cm (type III). Absence of protection during stent-retrieval and a cardio-embolic stroke origin were associated with higher incidence of INT/IINHT, whereas pretreatment with IV tPA showed no association, even when different bolus timing was considered. INT/IINHT were associated with lower rates of functional independence with increasing size type after adjusting for confounders (adjusted Odds Ratio per size group increase 0.63, 95% confidence interval 0.46-0.86). In conclusion, INT and IINHT are not rare, are associated with poor outcome with increasing size, and they may serve as a surrogate endpoint for safety evaluation of new devices and endovascular techniques. Further research on associated factors is warranted.
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