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May 8, 2019

ESOC-2019

REPERFUSION IN NON-RECANALIZING STROKE PATIENTS AS A SIGN OF COLLATERAL INVOLVEMENT USING DSC-MRI: A SUBSTUDY OF THE OBSERVATIONAL 1000PLUS STUDY

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collateral flow

outcome

mri

recanalization

reperfusion

clinical outcome

imaging outcome

DSC-MRI

Abstract

Abstract

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Keywords

collateral flow

outcome

mri

recanalization

reperfusion

clinical outcome

imaging outcome

DSC-MRI

Abstract

Introduction Collateral circulation plays an important role in infarct evolution und assessing stroke patients’ eligibility for treatment [1]. Using dynamic susceptibility contrast MRI, we assessed the influence of collateral flow, reperfusion, and recanalization on imaging and clinical outcomes in stroke patients. We hypothesized that reperfusion in patients with persistent vessel occlusion would be associated with good collateral flow. Methods Data from 186 patients from the 1000plus study [2] were analyzed. Inclusion criteria were: Vessel occlusion on MR angiography at baseline (within 24 hours of stroke symptom onset) DSC-MRI at baseline and follow-up (24 hours after baseline) MRI was performed on a 3T Tim Trio using a standard stroke imaging protocol [2] Study variables: Reperfusion: change in Tmax > 6s volume between baseline and follow-up as % of baseline Tmax volume Recanalization [3]: complete (TIMI grade flow = 3), partial (TIMI = 1 and 2) or absent (TIMI = 0) Higashida score: collateral flow scoring system using subtracted dynamic MR perfusion source images consisting of five grades [4]. Dichotomized into good (Higashida score 3, 4) and poor (Higashida score 0-2) Clinical outcome: mRS at day 90 post-stroke Infarct growth: lesion volume difference between baseline DWI and fluid attenuated inversion recovery (FLAIR) lesion on day 5 post-stroke The association between clinical and imaging predictors and reperfusion, clinical outcome, and infarct growth was assessed using robust generalized linear models [5]. Results Sixty-seven patients (36%) had persistent vessel occlusion on follow-up, 64 (34.4%) partial, and 55 (29.6%) complete recanalization Recanalization (partial: b = 27.4, p = 0.006, complete: b = 33.7, p = 0.002) and Higashida score (poor: b = -24.8, p = 0.018) were significant independent predictors of reperfusion No significant interaction between recanalization and Higashida score (poor*partial: b = -12.4, p = 0.388, poor*complete: b = 21.2, p = 0.157) on reperfusion. Discussion Good collateral flow and vessel recanalization were independently associated with more reperfusion, but the association between collateral flow and reperfusion did not depend on recanalization status Recanalization, but neither collateral flow nor reperfusion, was independently associated with clinical outcome Poor collateral flow and higher NIHSS at baseline were independently associated with infarct growth. Reperfusion was associated with less infarct growth in patients with partial recanalization compared to patients with persistent vessel occlusion.

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© Copyright 2019 Morressier GmbH.
All rights reserved.