Early infarct growth predicts long-term clinical outcome after thrombolysis

Cho, Kyung Hee; Kwon, Sun U.; Lee, Deok Hee; Shim, Woo-Hyun; Choi, Choong-Gon; Kim, Sang Joon; Suh, Dae Chul; Kim, Jong Seung; Kang, Dong Wha

doi:10.1016/j.jns.2012.01.015

Cited by 23 publications

(18 citation statements)

References 25 publications

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“…18–20 We confirmed that ΔDWI represents a composite measure that encompasses both infarct growth into new anatomic territory and space-occupying brain edema by testing the association of the binary variables for swelling and infarct growth with ΔDWI. Both were independently associated with ΔDWI, confirming that each contributed to lesion expansion (both p < 0.0001).…”

Section: Resultsmentioning

confidence: 52%

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Brain Edema Predicts Outcome After Nonlacunar Ischemic Stroke

Battey

Karki

Singhal

et al. 2014

Stroke

150

144

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Background and Purpose In malignant infarction, brain edema leads to secondary neurological deterioration and poor outcome. We sought to determine whether swelling is associated with outcome in smaller volume strokes. Methods Two research cohorts of acute stroke subjects with serial brain magnetic resonance imaging (MRI) were analyzed. The categorical presence of swelling and/or infarct growth was assessed on diffusion weighted imaging (DWI) by comparing baseline and follow-up scans. The increase in stroke volume (ΔDWI) was then subdivided into swelling and infarct growth volumes using region-of-interest analysis. The relationship of these imaging markers with outcome was evaluated in univariable and multivariable regression. Results The presence of swelling independently predicted worse outcome after adjustment for age, NIH stroke scale, admission glucose, and baseline DWI volume(OR4.55, 95%CI1.21-18.9, p < 0.02). Volumetric analysis confirmed ΔDWI was associated with outcome (OR4.29, 95%CI 2.00-11.5, p < 0.001). After partitioning ΔDWI into swelling and infarct growth volumetrically, swelling remained an independent predictor of poor outcome (OR1.09, 95%CI 1.03-1.17, p < 0.005). Larger infarct growth was also associated with poor outcome (OR7.05, 95%CI 1.04-143, p < 0.045), although small infarct growth was not. The severity of cytotoxic injury measured on apparent diffusion coefficient maps was associated with swelling, whereas the perfusion deficit volume was associated with infarct growth. Conclusions Swelling and infarct growth each contribute to total stroke lesion growth in the days following stroke. Swelling is an independent predictor of poor outcome, with abrain swelling volume of ≥11mL identified as the threshold with greatest sensitivity and specificity for predicting poor outcome.

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Section: Resultsmentioning

confidence: 52%

“…17–20 The presence or absence of swelling and infarct growth was assessed by two readers (T.W.K.B., W.T.K.) blinded to clinical and outcome data.…”

Section: Methodsmentioning

confidence: 99%

Brain Edema Predicts Outcome After Nonlacunar Ischemic Stroke

Battey

Karki

Singhal

et al. 2014

Stroke

150

144

View full text Add to dashboard Cite

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“…Infarct volume growth was defined as the difference between volumes from initial and follow-up (24 and 72 h) DWI [17] . Previous report showed that change of DWI infarct volume ≥ 30% within 5 days stroke onset was associated with poor clinical outcome [18] . We also examined the association between persistent HG and the change of DWI infarct volume ≥ 30% at 24 and 72 h.…”

Section: Neuroimagingmentioning

confidence: 98%

Post Stroke Dysglycemia and Acute Infarct Volume Growth: A Study Using Continuous Glucose Monitoring

Shimoyama

Kimura²,

Uemura³

et al. 2016

Eur Neurol

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Background: The aim of the present study was to clarify the effect of glucose profiles after stroke, which was assessed by a continuous glucose monitoring (CGM) device. Methods: Acute ischemic stroke patients within 24 h of onset were prospectively studied. CGM was performed for 72 h after admission. CGM parameters were evaluated as follows: (1) mean glucose level, (2) area under the curve (AUC) for glucose level >140 mg/dl and (3) SD of the glucose level. Infarct volume was measured at admission and 24 and 72 h after admission using diffusion-weighted imaging. CGM data and infarct volume growth were compared at 24 and 72 h. Results: Seventy-eight patients were enrolled in the present study. Spearman's rank correlation coefficients showed that both the mean glucose level (r = 0.433, p < 0.001 for 24 h; r = 0.308, p = 0.006 for 72 h) and AUC >140 mg/dl (r = 0.417, p < 0.001 for 24 h; r = 0.277, p = 0.014 for 72 h) were significantly correlated with acute infarct volume growth. The SD of the glucose level was associated with infarct volume growth at 24 h (r = 0.303, p = 0.007), but not 72 h (r = 0.195, p = 0.088). Conclusion: Post-stroke hyperglycemia was associated with infarct volume growth during the acute phase of ischemic stroke.

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“…Early infarction enlargement is an independent predictor of adverse outcomes . Currently, diffusion‐weighted imaging (DWI) and perfusion‐weighted imaging (PWI) mismatch has been proposed to predict the evolution of cerebral infarction . However, there is controversy about the prediction value of PWI‐DWI mismatch on clinical outcome, because of the PWI/DWI mismatch providing only an approximation of the ischemic penumbra .…”

mentioning

confidence: 99%

“…[3][4][5] Currently, diffusionweighted imaging (DWI) and perfusion-weighted imaging (PWI) mismatch has been proposed to predict the evolution of cerebral infarction. 6,7 However, there is controversy about the prediction value of PWI-DWI mismatch on clinical outcome, because of the PWI/DWI mismatch providing only an approximation of the ischemic penumbra. 6,[8][9][10] In addition, contrast agents cannot be used in patients with renal failure.…”

mentioning

confidence: 99%