Post-ischemic hyperemia following endovascular therapy for acute stroke is associated with lesion growth

Marie Luby, Amie W. Hsia, Carolyn A. Lomahan, Rachel Davis, Shannon Burton, Yongwoo Kim, Veronica Craft, Victoria Uche, Rainier Cabatbat, Malik Adil, Leila C. Thomas, Jill De Vis, Mariam M. Afzal, Dorian McGavern, John K. Lynch, Richard Leigh, Lawrence L. Latour

Research output: Contribution to journalArticlepeer-review

Abstract

A substantial proportion of acute stroke patients fail to recover following successful endovascular therapy (EVT) and injury to the brain and vasculature secondary to reperfusion may be a contributor. Acute stroke patients were included with: i) large vessel occlusion of the anterior circulation, ii) successful recanalization, and iii) evaluable MRI early after EVT. Presence of hyperemia on MRI perfusion was assessed by consensus using a modified ASPECTS. Three different approaches were used to quantify relative cerebral blood flow (rCBF). Sixty-seven patients with median age of 66 [59–76], 57% female, met inclusion criteria. Hyperemia was present in 35/67 (52%) patients early post-EVT, in 32/65 (49%) patients at 24 hours, and in 19/48 (40%) patients at 5 days. There were no differences in incomplete reperfusion, HT, PH-2, HARM, severe HARM or symptomatic ICH rates between those with and without early post-EVT hyperemia. A strong association (R2 = 0.81, p < 0.001) was found between early post-EVT hyperemia (p = 0.027) and DWI volume at 24 hours after adjusting for DWI volume at 2 hours (p < 0.001) and incomplete reperfusion at 24 hours (p = 0.001). Early hyperemia is a potential marker for cerebrovascular injury and may help select patients for adjunctive therapy to prevent edema, reperfusion injury, and lesion growth.

Original languageEnglish (US)
Pages (from-to)856-868
Number of pages13
JournalJournal of Cerebral Blood Flow and Metabolism
Volume43
Issue number6
DOIs
StatePublished - Jun 2023

Keywords

  • Hyperemia
  • cerebrovascular autoregulation
  • hyperperfusion
  • luxury perfusion
  • reperfusion injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Cardiology and Cardiovascular Medicine

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