Luby Marie, Hsia Amie W, Lomahan Carolyn A, Uche Victoria, Davis Rachel, Kim Yongwoo, Somani Sana, Burton Shannon, Cabatbat Rainier, Craft Veronica, De Vis Jill B, Adil Malik M, Afzal Mariam M, Thomas Leila C, Gandler William, McCreedy Evan S, Lynch John K, Latour Lawrence L
NIH/NINDS, Stroke Branch, Bethesda, Maryland, USA.
MedStar Washington Hospital Center Comprehensive Stroke Center, Washington, District of Columbia, USA.
Cerebrovasc Dis. 2025;54(1):129-137. doi: 10.1159/000536470. Epub 2024 Feb 27.
Stroke lesion volume on MRI or CT provides objective evidence of tissue injury as a consequence of ischemic stroke. Measurement of "final" lesion volume at 24-h following endovascular therapy (post-EVT) has been used in multiple studies as a surrogate for clinical outcome. However, despite successful recanalization, a significant proportion of patients do not experience favorable clinical outcome. The goals of this study were to quantify lesion growth during the first week after treatment, identify early predictors, and explore the association with clinical outcome.
This is a prospective study of stroke patients at two centers who met the following criteria: (i) anterior large vessel occlusion acute ischemic stroke, (ii) attempted EVT, and (iii) had 3T MRI post-EVT at 24-h and 5-day. We defined "early" and "late" lesion growth as ≥10 mL lesion growth between baseline and 24-h diffusion-weighted imaging (DWI) and between 24-h DWI and 5-day fluid attenuated inversion recovery imaging, respectively. Complete reperfusion was defined as >90% reduction of the volume of tissue with perfusion delay (Tmax>6 s) between pre-EVT and 24-h post-EVT. Favorable clinical outcome was defined as modified Rankin scale (mRS) of 0-2 at 30 or 90 days.
One hundred twelve patients met study criteria with median age 67 years, 56% female, median admit NIHSS 19, 54% received IV or IA thrombolysis, 66% with M1 occlusion, and median baseline DWI volume 21.2 mL. Successful recanalization was achieved in 87%, and 68% had complete reperfusion, with an overall favorable clinical outcome rate of 53%. Nearly two-thirds (65%) of the patients did not have late lesion growth with a median volume change of -0.3 mL between 24-h and 5-day and an associated high rate of favorable clinical outcome (64%). However, ∼1/3 of patients (35%) did have significant late lesion growth despite successful recanalization (87%: 46% mTICI 2b/41% mTICI 3). Late lesion growth patients had a 27.4 mL change in late lesion volume and 30.1 mL change in early lesion volume. These patients had an increased hemorrhagic transformation (HT) rate of 68% with only 1 in 3 patients having favorable clinical outcome. Late lesion growth was independently associated with incomplete reperfusion, HT, and unfavorable outcome.
Approximately 1 out of 3 patients had late lesion growth following EVT, with a favorable clinical outcome occurring in only 1 out of 3 of these patients. Most patients with no early lesion growth had no late lesion growth. Identification of patients with late lesion growth could be critical to guide clinical management and inform prognosis post-EVT. Additionally, it can serve as an imaging biomarker for the development of adjunctive therapies to mitigate reperfusion injury.
Stroke lesion volume on MRI or CT provides objective evidence of tissue injury as a consequence of ischemic stroke. Measurement of "final" lesion volume at 24-h following endovascular therapy (post-EVT) has been used in multiple studies as a surrogate for clinical outcome. However, despite successful recanalization, a significant proportion of patients do not experience favorable clinical outcome. The goals of this study were to quantify lesion growth during the first week after treatment, identify early predictors, and explore the association with clinical outcome.
This is a prospective study of stroke patients at two centers who met the following criteria: (i) anterior large vessel occlusion acute ischemic stroke, (ii) attempted EVT, and (iii) had 3T MRI post-EVT at 24-h and 5-day. We defined "early" and "late" lesion growth as ≥10 mL lesion growth between baseline and 24-h diffusion-weighted imaging (DWI) and between 24-h DWI and 5-day fluid attenuated inversion recovery imaging, respectively. Complete reperfusion was defined as >90% reduction of the volume of tissue with perfusion delay (Tmax>6 s) between pre-EVT and 24-h post-EVT. Favorable clinical outcome was defined as modified Rankin scale (mRS) of 0-2 at 30 or 90 days.
One hundred twelve patients met study criteria with median age 67 years, 56% female, median admit NIHSS 19, 54% received IV or IA thrombolysis, 66% with M1 occlusion, and median baseline DWI volume 21.2 mL. Successful recanalization was achieved in 87%, and 68% had complete reperfusion, with an overall favorable clinical outcome rate of 53%. Nearly two-thirds (65%) of the patients did not have late lesion growth with a median volume change of -0.3 mL between 24-h and 5-day and an associated high rate of favorable clinical outcome (64%). However, ∼1/3 of patients (35%) did have significant late lesion growth despite successful recanalization (87%: 46% mTICI 2b/41% mTICI 3). Late lesion growth patients had a 27.4 mL change in late lesion volume and 30.1 mL change in early lesion volume. These patients had an increased hemorrhagic transformation (HT) rate of 68% with only 1 in 3 patients having favorable clinical outcome. Late lesion growth was independently associated with incomplete reperfusion, HT, and unfavorable outcome.
Approximately 1 out of 3 patients had late lesion growth following EVT, with a favorable clinical outcome occurring in only 1 out of 3 of these patients. Most patients with no early lesion growth had no late lesion growth. Identification of patients with late lesion growth could be critical to guide clinical management and inform prognosis post-EVT. Additionally, it can serve as an imaging biomarker for the development of adjunctive therapies to mitigate reperfusion injury.
MRI或CT上的卒中病灶体积为缺血性卒中所致组织损伤提供了客观证据。血管内治疗（EVT）后24小时的“最终”病灶体积测量已在多项研究中用作临床结局的替代指标。然而，尽管再通成功，但仍有相当一部分患者未获得良好的临床结局。本研究的目的是量化治疗后第一周内的病灶生长情况，识别早期预测因素，并探讨其与临床结局的关联。
这是一项对两个中心符合以下标准的卒中患者进行的前瞻性研究：（i）前循环大血管闭塞急性缺血性卒中，（ii）尝试进行EVT，（iii）在EVT后24小时和5天进行3T MRI检查。我们将“早期”和“晚期”病灶生长分别定义为基线与24小时扩散加权成像（DWI）之间以及24小时DWI与5天液体衰减反转恢复成像之间病灶生长≥10 mL。完全再灌注定义为EVT前与EVT后24小时之间灌注延迟（Tmax>6秒）的组织体积减少>90%。良好的临床结局定义为30或90天时改良Rankin量表（mRS）评分为0-2。
112例患者符合研究标准，中位年龄67岁，56%为女性，入院时NIHSS中位数为19，54%接受静脉或动脉内溶栓治疗，66%为M1段闭塞，基线DWI体积中位数为21.2 mL。87%实现了成功再通，68%实现了完全再灌注，总体良好临床结局率为53%。近三分之二（65%）的患者没有晚期病灶生长，24小时至5天之间的体积变化中位数为-0.3 mL，且良好临床结局率较高（64%）。然而，约三分之一（35%）的患者尽管再通成功（87%：46% mTICI 2b/41% mTICI 3），但仍有显著的晚期病灶生长。晚期病灶生长患者的晚期病灶体积变化为27.4 mL，早期病灶体积变化为30.1 mL。这些患者的出血转化（HT）率增加至68%，只有三分之一的患者获得良好临床结局。晚期病灶生长与不完全再灌注、HT和不良结局独立相关。
约三分之一的患者在EVT后有晚期病灶生长，其中只有三分之一的患者获得良好临床结局。大多数无早期病灶生长的患者也无晚期病灶生长。识别有晚期病灶生长的患者对于指导临床管理和告知EVT后的预后可能至关重要。此外，它可作为开发减轻再灌注损伤辅助治疗的影像学生物标志物。
MRI或CT上的卒中病灶体积为缺血性卒中所致组织损伤提供了客观证据。血管内治疗（EVT）后24小时的“最终”病灶体积测量已在多项研究中用作临床结局的替代指标。然而，尽管再通成功，但仍有相当一部分患者未获得良好的临床结局。本研究的目的是量化治疗后第一周内的病灶生长情况，识别早期预测因素，并探讨其与临床结局的关联。
这是一项对两个中心符合以下标准的卒中患者进行的前瞻性研究：（i）前循环大血管闭塞急性缺血性卒中，（ii）尝试进行EVT，（iii）在EVT后24小时和5天进行3T MRI检查。我们将“早期”和“晚期”病灶生长分别定义为基线与24小时扩散加权成像（DWI）之间以及24小时DWI与5天液体衰减反转恢复成像之间病灶生长≥10 mL。完全再灌注定义为EVT前与EVT后24小时之间灌注延迟（Tmax>6秒）的组织体积减少>90%。良好的临床结局定义为30或90天时改良Rankin量表（mRS）评分为0-2。
112例患者符合研究标准，中位年龄67岁，56%为女性，入院时NIHSS中位数为
