RT Journal Article
SR Electronic
T1 Dynamics of cerebral perfusion and oxygenation parameters following endovascular treatment of acute ischemic stroke
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP neurintsurg-2020-017163
DO 10.1136/neurintsurg-2020-017163
A1 Gianluca Brugnara
A1 Christian Herweh
A1 Ulf Neuberger
A1 Mikkel Bo Hansen
A1 Christian Ulfert
A1 Mustafa Ahmed Mahmutoglu
A1 Martha Foltyn
A1 Simon Nagel
A1 Silvia Schönenberger
A1 Sabine Heiland
A1 Peter Arthur Ringleb
A1 Martin Bendszus
A1 Markus Möhlenbruch
A1 Johannes Alex Rolf Pfaff
A1 Philipp Vollmuth
YR 2021
UL http://jnis.bmj.com/content/early/2021/08/23/neurintsurg-2020-017163.abstract
AB Background We studied the effects of endovascular treatment (EVT) and the impact of the extent of recanalization on cerebral perfusion and oxygenation parameters in patients with acute ischemic stroke (AIS) and large vessel occlusion (LVO).Methods Forty-seven patients with anterior LVO underwent computed tomography perfusion (CTP) before and immediately after EVT. The entire ischemic region (Tmax >6 s) was segmented before intervention, and tissue perfusion (time-to-maximum (Tmax), time-to-peak (TTP), mean transit time (MTT), cerebral blood volume (CBV), cerebral blood flow (CBF)) and oxygenation (coefficient of variation (COV), capillary transit time heterogeneity (CTH), metabolic rate of oxygen (CMRO2), oxygen extraction fraction (OEF)) parameters were quantified from the segmented area at baseline and the corresponding area immediately after intervention, as well as within the ischemic core and penumbra. The impact of the extent of recanalization (modified Treatment in Cerebral Infarction (mTICI)) on CTP parameters was assessed with the Wilcoxon test and Pearson’s correlation coefficients.Results The Tmax, MTT, OEF and CTH values immediately after EVT were lower in patients with complete (as compared with incomplete) recanalization, whereas CBF and COV values were higher (P<0.05) and no differences were found in other parameters. The ischemic penumbra immediately after EVT was lower in patients with complete recanalization as compared with those with incomplete recanalization (P=0.002), whereas no difference was found for the ischemic core (P=0.12). Specifically, higher mTICI scores were associated with a greater reduction of ischemic penumbra volumes (R²=−0.48 (95% CI –0.67 to –0.22), P=0.001) but not of ischemic core volumes (P=0.098).Conclusions Our study demonstrates that the ischemic penumbra is the key target of successful EVT in patients with AIS and largely determines its efficacy on a tissue level. Furthermore, we confirm the validity of the mTICI score as a surrogate parameter of interventional success on a tissue perfusion level.Data are available upon reasonable request by contacting the corresponding author.