Early successful reperfusion after endovascular therapy reduces malignant middle cerebral artery infarction occurrence in young patients with large diffusion‐weighted imaging lesions

Abstract

Background and purpose Malignant middle cerebral artery infarction (MMI) is a severe complication of acute ischaemic stroke (AIS). The aim of our study was to assess whether successful reperfusion after endovascular therapy (EVT) in AIS with clinical and imaging predictors of MMI decreased its occurrence. Methods Data were collected between January 2014 and July 2018 in a monocentric prospective AIS registry of patients treated with EVT. Patients selected were <65 years old with severe anterior circulation AIS with a National Institutes of Health Stroke Scale score >15, baseline Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score ≤ 6 and baseline diffusion‐weighted imaging lesion volume >82 mL within 6 h of symptom onset. Successful reperfusion was defined as a Thrombolysis in Cerebral Ischemia score ≥ 2b. Occurrence of MMI was the primary endpoint. Results A total of 66 EVT‐treated patients were included in our study. MMI occurred in 27 patients (41%). In unadjusted analysis, successful reperfusion was associated with fewer MMIs (31.8% vs. 65.0%; P = 0.015) and with more favorable outcome at 3 months (50% vs. 20%; P = 0.023). In multivariate analysis, successful reperfusion was associated with an adjusted odds ratio (95% confidence intervals) of 0.35 (0.10–1.12) for MMI and 2.77 (0.84–10.43) for 3‐month favorable outcome occurrence. Conclusions Early successful reperfusion performed in patients with AIS with clinical and imaging predictors of MMI was associated with decreased MMI occurrence. Reperfusion status might be considered in evaluating the need for craniectomy in patients with early predictors of MMI.

Abnormal neurological pupil index is associated with malignant cerebral edema after mechanical thrombectomy in large vessel occlusion patients

“…In contrast to our findings, Tracol et al demonstrated that time to MT and infarct volume were independent predictors of MCE, while TICI score was not [33]. In Sabben et al, patients undergoing MT were also analyzed for predictors of MCE, patients with TICI scores ≥ 2B developed significantly less MCE (p < 0.05) [34]. In another retrospective series of 98 patients (35.7% MCE), neither increased clot retrieval attempts nor TICI score predicted MCE [35].…”

No Harmful Effect of Endovascular Treatment before Decompressive Surgery—Implications for Handling Patients with Space-Occupying Brain Infarction

“…Whereas first studies mainly focused on patients with no or only small infarct demarcation, recent randomized controlled trials provided evidence for beneficial effects of EVT also in the situation of an already existing relevant infarct demarcation [7][8][9]. Along with an increasing implementation of EVT in acute stroke management, data on individual courses emerging from the real-world setting indicated a decreased rate of space-occupying brain infarction [10][11][12], in conjunction with a reduced rate of DHC [13][14][15].…”

Tissue perfusion of the kurtosis/diffusion mismatch differs from the central core and peripheral regions in acute cerebral infarction patients

“…Diffusion-weighted imaging (DWI) is highly sensitive to acute ischemia and has been widely adopted in detecting early ischemic damage (1,2). However, the DWI lesion suffers from graded tissue injury (3)(4)(5). Specifically, a portion of the DWI lesion is potentially reversible with early reperfusion, even occasionally in cases with large DWI lesions (6)(7)(8)(9).…”