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Original research
Persistent perfusion abnormalities at day 1 correspond to different clinical trajectories after stroke
  1. Charlotte Rosso1,2,3,
  2. Samia Belkacem4,
  3. Mélika Amor-Sahli4,
  4. Frédéric Clarençon2,5,
  5. Anne Leger1,2,
  6. Flore Baronnet1,2,
  7. Didier Dormont3,4,
  8. Sonia Alamowitch1,2,
  9. Stéphane Lehericy3,4,
  10. Yves Samson1
  1. 1APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
  2. 2STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
  3. 3Inserm U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
  4. 4APHP-Neuroradiology Department, Hôpital Pitié-Salpêtrière, Paris, France
  5. 5APHP-Interventional Neuroradiology Department, Hôpital Pitié-Salpêtrière, Paris, France
  1. Correspondence to Dr Charlotte Rosso, APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France; charlotte.rosso{at}gmail.com

Abstract

Background Perfusion abnormalities after thrombolysis are frequent within and surrounding ischemic lesions, but their relative frequency is not well known.

Objective To describe the different patterns of perfusion abnormalities observed at 24 hours and compare the characteristics of the patients according to their perfusion pattern.

Methods From our thrombolysis registry, we included 226 consecutive patients with an available arterial spin labeling (ASL) perfusion sequence at day 1. We performed a blinded assessment of the perfusion status (hypoperfusion-h, hyperperfusion-H, or normal-N) in the ischemic lesion and in the surrounding tissue. We compared the time course of clinical recovery, the rate of arterial recanalization, and hemorrhagic transformations in the different perfusion profiles.

Results We identified seven different perfusion profiles at day 1. Four of these (h/h, h/H, H/H, and H/N) represented the majority of the population (84.1%). The H/H profile was the most frequent (34.5%) and associated with 3-month good outcome (modified Rankin Scale (mRS): 63.5%). Patients with persistent hypoperfusion within and outside the lesion (h/h, 12.4%) exhibited worse outcomes after treatment (mRS score 0–2: 23.8%) than other patients, were less frequently recanalized (40.7%), and had more parenchymal hematoma (17.8%). The h/H profile had an intermediate clinical trajectory between the h/h profile and the hyperperfused profiles.

Conclusion ASL hypoperfusion within the infarct and the surrounding tissue was associated with poor outcome. A more comprehensive view of the mechanisms in the hypoperfused surrounding tissue could help to design new therapeutic approaches during and after reperfusion therapies.

  • Thrombolysis
  • MR perfusion
  • Stroke

Data availability statement

No data are available. The data are not publicly available due to ethical restrictions.

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Data availability statement

No data are available. The data are not publicly available due to ethical restrictions.

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Footnotes

  • Contributors Substantial contributions to the conception or design of the work: CR, SB, YS, SL, or the acquisition, analysis: MA-S, AL, FB, FC, CR, SB or interpretation of data for the work: CR, SA, YS, SL, DD and drafting the work or revising it critically for important intellectual content: all; and final approval of the version to be published: all; and agreement to be accountable for all aspects of the work in fensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all. CR acts as guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The research leading to these results has received funding from “Investissements d’avenir” ANR-10-IAIHU-06.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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