Comparative Studies of Cerebral Reperfusion Injury in the Posterior and Anterior Circulations After Mechanical Thrombectomy

Abstract

Cerebral reperfusion injury is the major complication of mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Contrast extravasation (CE) and intracranial hemorrhage (ICH) are the key radiographical features of cerebral reperfusion injury. The aim of this study was to investigate CE and ICH after MT in the anterior and posterior circulation, and their effect on functional outcome. This is a retrospective study of all consecutive patients who were treated with MT for AIS at University of California Irvine Medical Center between January 1, 2014, and December 31, 2017. Patient characteristics, clinical features, procedural variables, contrast extravasation, ICH, and outcomes after MT were analyzed. A total of 131 patients with anterior circulation (AC) stroke and 25 patients with posterior circulation (PC) stroke underwent MT during the study period. There was no statistically significant difference in admission NIHSS score, blood pressure, rate of receiving intravenous tPA, procedural variables, contrast extravasation, and symptomatic ICH between the 2 groups. Patients with PC stroke had a similar rate of favorable outcome (mRS 0–2) but significantly higher mortality (40.0% vs. 10.7%, p < 0.01) than patients with AC stroke. Multivariate regression analysis identified initial NIHSS score (OR 1.1, CI 1.0–1.2, p = 0.01), number of passes with stent retriever (OR 2.1, CI 1.3–3.6, p < 0.01), and PC stroke (OR 9.3, CI 2.5–35.1, p < 0.01) as independent risk factors for death. There was no significant difference in functional outcomes between patients with and without evidence of cerebral reperfusion injury after MT. We demonstrated that AC and PC stroke had similar rates of cerebral reperfusion injury and favorable outcome after MT. Cerebral reperfusion injury is not a significant independent risk factor for poor functional outcome.

Efficacy and safety of mechanical thrombectomy in the posterior cerebral circulation– a single center study

“…al 8 . Nevertheless, increased mortality was observed in PMT in both: individual studies 5,6,13 and meta-analyzes 7,14 .…”

Penumbra salvage in extensive stroke: exploring limits for reperfusion therapy

“…The existence of an ischemic penumbra (metabolically viable brain tissue that may be salvageable with cerebral blood flow restoration) is the fundamental rationale for reperfusion therapy and hence, measurement of the volume of penumbra salvage may offer a further opportunity to directly compare treatment effects. The effect of EVT on functional outcome is still not entirely understood, also considering factors beyond vessel recanalization such as the degree of tissue injury including the phenomenon of reperfusion injury 20. The most widely used imaging biomarker to describe and compare treatment effects is currently total infarct volume.…”

Immediate CT change after thrombectomy predicting symptomatic hemorrhagic transformation

“…1,2 However, reperfusion injury is the main complication of concern after the procedure, which may cause intracranial hemorrhage (ICH) and is associated with severe neurological deterioration. 3 Either hemorrhagic or transient contrast extravasation is frequently observed on noncontrast brain computer tomography (CT) after intra-arterial intervention. It is critical to distinguish these two imaging phenomenons.…”

“…It is critical to distinguish these two imaging phenomenons. 3 A few studies have indicated that contrast extravasation with a hyperdense lesion with a maximum Hounsfield unit (HU) measurement >90 on the immediate brain CT after an intra-arterial intervention is highly associated with the occurrence of parenchymal hematoma. [4][5][6] Yoon et al 6 assumed that contrast accumulation is associated with disruption of the blood-brain barrier, 5 and the patterns of contrast accumulation may differ between patients with and without further symptomatic ICH.…”

“…It is critical to distinguish these two imaging phenomenons. 3 A few studies have indicated that contrast extravasation with a hyperdense lesion with a maximum Hounsfield unit (HU) measurement >90 on the immediate brain CT after an intra-arterial intervention is highly associated with the occurrence of parenchymal hematoma. 4–6…”