Dynamics of cerebral perfusion and oxygenation parameters following endovascular treatment of acute ischemic stroke

All you are measuring is intermediate steps, survivors don't give a damn about those, they want to know how you are getting them 100% recovered.

Dynamics of cerebral perfusion and oxygenation parameters following endovascular treatment of acute ischemic stroke

1. http://orcid.org/0000-0003-2461-1407Gianluca Brugnara1,
2. Christian Herweh1,
3. http://orcid.org/0000-0002-3085-3886Ulf Neuberger1,
4. Mikkel Bo Hansen2,
5. Christian Ulfert1,
6. Mustafa Ahmed Mahmutoglu1,
7. Martha Foltyn1,
8. Simon Nagel3,
9. Silvia Schönenberger3,
10. Sabine Heiland1,
11. Peter Arthur Ringleb3,
12. Martin Bendszus1,
13. Markus Möhlenbruch1,
14. http://orcid.org/0000-0003-0672-5718Johannes Alex Rolf Pfaff1,
15. http://orcid.org/0000-0002-6224-0064Philipp Vollmuth1

1. Correspondence to Dr Philipp Vollmuth, Department of Neuroradiology, University Hospital Heidelberg, Heidelberg 69120, Baden-Württemberg, Germany; philipp.vollmuth@med.uni-heidelberg.de

Abstract

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 (T_max >6 s) was segmented before intervention, and tissue perfusion (time-to-maximum (T_max), time-to-peak (TTP), mean transit time (MTT), cerebral blood volume (CBV), cerebral blood flow (CBF)) and oxygenation (coefficientof 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 T_max, 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 (There is no success if not 100% recovered! You are assuming your intermediate step of recanalization can be called success. NO IT CAN'T) on a tissue perfusion level.

http://dx.doi.org/10.1136/neurintsurg-2020-017163

• Request Permissions

View Full Text

Footnotes

• Twitter @GianBrugna, @vollmuthp

• Contributors Research concept and design: PV, GB, MB. Data acquisition: all authors. Imaging data post-processing: GB, MAM, MF, UN. Data analysis and interpretation: GB, PV. Statistical analysis: GB, PV. Drafting the manuscript: PV, GB. Critical revision of the manuscript for important intellectual content: all authors. Responsibility for funding and supervision: PV.

• Funding PV was supported by the Else Kroner-Fresenius Foundation (Else-Kroner Memorial Scholarship).