Infarct growth patterns may vary in acute stroke due to large vessel occlusion and recanalization with endovascular therapy

• Published in: European radiology Vol. 30; no. 12; pp. 6432 - 6440
• Main Authors: Gwak, Dong-Seok, Park, Hong-Kyun, Jung, Cheolkyu, Kim, Jae Hyoung, Lee, Juneyoung, Kim, Beom Joon, Han, Moon-Ku, Bae, Hee-Joon
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2020; Springer Nature B.V
• Subjects: Aged; Arterial Occlusive Diseases - complications; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - surgery; Blood vessels; Brain Infarction - etiology; Brain Infarction - surgery; Cardiovascular system; Carotid artery; Carotid Artery, Internal - diagnostic imaging; Carotid Artery, Internal - surgery; Cerebral blood flow; Databases, Factual; Diagnostic Radiology; Diffusion Magnetic Resonance Imaging - methods; Endovascular Procedures - methods; Female; Growth curves; Growth patterns; Humans; Imaging; Internal Medicine; Interventional Radiology; Ischemia; Male; Medicine; Medicine & Public Health; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - surgery; Model testing; Neuro; Neuroradiology; Occlusion; Patients; Prospective Studies; Radiology; Registries; Reperfusion; Republic of Korea; Stroke; Stroke - diagnostic imaging; Stroke - etiology; Stroke - surgery; Treatment Outcome; Ultrasound; Republic of Korea; Cerebral infarction; Thrombectomy; Stroke; Diffusion
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-020-07068-1

Objectives This study aimed to investigate infarct growth patterns in stroke patients with large vessel occlusion (LVO) and successful recanalization by endovascular therapy (EVT). Methods A total of 135 patients with LVO of the internal carotid artery or proximal segment of the middle cerebral artery admitted within 12 h after onset, having baseline National Institute of Health Stroke Scale score ≥ 5 points, and successfully recanalized by EVT were enrolled. Infarct growth pattern models were developed based on infarct volumes on diffusion-weighted imaging before and after reperfusion. Single pattern models of linear, logarithmic, and exponential shapes were initially tested. Their appropriateness was predetermined. If none of these patterns was suitable, the best pattern model, which was the most suitable pattern among the three shapes selected for each individual, was tested. Clinical correlates were explored. Results Each single pattern model was tested for their suitability. However, none of the single pattern models successfully represented infarct growth curves: Of all subjects, only 63.7%, 62.2%, and 54.1% of patients were explained by the logarithmic, linear, and exponential model, respectively. Compared with the single pattern models, the best pattern model explained 80.7% of the subjects. The linear shape fit best in 40 patients, the logarithmic in 51, and the exponential in 44. Those fit best for the logarithmic pattern showed more favorable outcomes at discharge (31.4%) than did the others (linear, 10.0%; exponential, 9.1%; p  = 0.01). Conclusions Infarct growth patterns may vary among individual patients with acute stroke due to LVO and successful treatment with EVT. Key Points • Infarct growth during the acute stage of stroke is highly dynamic and the exact shape remains unknown. • Infarct growth pattern models were developed based on infarct volumes on diffusion-weighted imaging before and after reperfusion. • Infarct growth patterns may not be singular, rather various among individual patients with acute stroke due to LVO and successful treatment with EVT.