Fast Versus Slow Progressors of Infarct Growth in Large Vessel Occlusion Stroke

Rocha, Marcelo; Jovin, Tudor G

doi:10.1161/strokeaha.117.017673

Cited by 246 publications

(197 citation statements)

References 82 publications

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“…For patients with LPS, poor collateralization—a marker of fast infarct growth30—is indicative of a high likelihood that the ischemic lesion is already completely established, and it has been clearly associated with poor outcomes even with successful recanalization 31. In our study, the proportion of patients with favorable collateral status in the group treated within 6 hours was similar to the WUS/LPS group.…”

Section: Discussionsupporting

confidence: 58%

NCCT and CTA-based imaging protocol for endovascular treatment selection in late presenting or wake-up strokes

Santos

Carvalho

Cunha

et al. 2018

J NeuroIntervent Surg

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Section: Discussionsupporting

confidence: 58%

NCCT and CTA-based imaging protocol for endovascular treatment selection in late presenting or wake-up strokes

Santos

Carvalho

Cunha

et al. 2018

J NeuroIntervent Surg

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“…Significant modifications by time on the effect of EVT was demonstrated in Figure 2b, which also corroborated the concept of the late window paradox and slow progressor of infarction [4, 20]. In our center, evaluation and management of acute cerebral LVO patients were done without expensive perfusion quantification tools.…”

Section: Discussionsupporting

confidence: 78%

Tenacity of Collateral Perfusion in Proximal Cerebral Arterial Occlusions 6–12 h after Onset

Kim

Jeong

et al. 2018

Cerebrovasc Dis

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Background: Clinical trials have shown that benefits of endovascular recanalization (EVT) for acute ischemic stroke patients with sizable penumbral tissues seems plausible even beyond 6 h after their last seen normal (LSN). Persistency of ischemic penumbra remains unclear in delayed periods. Methods: From a prospective stroke registry database, we identified 111 acute ischemic stroke patients who had internal carotid artery or middle cerebral artery occlusion with baseline National Institutes of Health Stroke Scale scores ≥6 points and arrived 6–12 h after LSN. Baseline information and functional outcomes were prospectively collected as a clinical registry. Attending physicians made treatment decisions for EVT based on the current guidelines and institutional protocols. MR image parameters, including the volume of diffusion-restricted lesions and mapping of the hypoperfused area, were quantified using automated commercial software. Binary logistic regression analysis models, with modified Rankin Scale (mRS) scores of 0–1 at 3 months after stroke included as a dependent variable, were constructed. Results: Between 6 and 12 h after onset, 58% had a mismatch ratio of ≥1.8 at baseline and 42% had favorable imaging profiles as determined by DEFUSE 2 study. After 9 h, there was a mismatch ratio of ≥1.8 in 47 and 38% favorable profiles. EVT was performed in 54% of cases. A 3-month mRS score of 0–1 was found in 19% (25% in EVT and 12% in medical treatment groups) of cases. EVT was associated with an increased OR of having a mRS score of 0–1 at 3 months after stroke (adjusted OR 7.59 [95% CI 1.28–61.60]). Conclusions: Penumbral tissues were persistent in a substantial proportion of anterior circulation occlusion cases 6–12 h after LSN. EVT at 6–12 h in a predominantly Asian cohort resulted in better outcomes.

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“…The results of the DAWN trial have shown that there exists a proportion of patients with LVO strokes who have enough collateral support to sustain a penumbra and harbor small ischemic cores (‘slow progressors') 9. The median change in ischemic core volume at 24 hours in the DAWN control arm was 13 mL (median infarct growth rate of 0.5 mL/hour) 6.…”

Section: Discussionmentioning

confidence: 99%