Penumbra Consumption Rates Based on Time-to-Maximum Delay and Reperfusion Status: A Post Hoc Analysis of the DEFUSE 3 Trial

 I got nothing out of this.

Pretty much useless since all the other measurements of damages are in understandable figures.

In each  untreated minute,

1.9 million neurons die

14 billion synapses die

12 km (7.5 miles) of myelinated fibers die

brain ages 3.6 years each hour without treatment

Penumbra Consumption Rates Based on Time-to-Maximum Delay and Reperfusion Status: A Post Hoc Analysis of the DEFUSE 3 Trial

Shadi Yaghi

,

Eytan Raz

,

Seena Dehkharghani

,

Howard Riina

,

Ryan McTaggart

,

Mahesh Jayaraman

,

Shyam Prabhakaran

,

David S. Liebeskind

,

Pooja Khatri

,

Brian Mac Grory

, … See all authors

Originally published23 Jun 2021https://doi.org/10.1161/STROKEAHA.120.033806Stroke. ;0:STROKEAHA.120.033806

Abstract

Background and Purpose:

In patients with acute large vessel occlusion, the natural history of penumbral tissue based on perfusion time-to-maximum (T_max) delay is not well established in relation to late-window endovascular thrombectomy. In this study, we sought to evaluate penumbra consumption rates for T_max delays in patients with large vessel occlusion evaluated between 6 and 16 hours from last known normal.

Methods:

This is a post hoc analysis of the DEFUSE 3 trial (The Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke), which included patients with an acute ischemic stroke due to anterior circulation occlusion within 6 to 16 hours of last known normal. The primary outcome is percentage penumbra consumption, defined as (24-hour magnetic resonance imaging infarct volume–baseline core infarct volume)/(T_max 6 or 10 s volume–baseline core volume). We stratified the cohort into 4 categories based on treatment modality and Thrombolysis in Cerebral Infarction (TICI score; untreated, TICI 0-2a, TICI 2b, and TICI3) and calculated penumbral consumption rates in each category.

Results:

We included 141 patients, among whom 68 were untreated. In the untreated versus TICI 3 patients, a median (interquartile range) of 53.7% (21.2%–87.7%) versus 5.3% (1.1%–14.6%) of penumbral tissue was consumed based on T_max >6 s (P<0.001). In the same comparison for T_max>10 s, we saw a difference of 165.4% (interquartile range, 56.1%–479.8%) versus 25.7% (interquartile range, 3.2%–72.1%; P<0.001). Significant differences were not demonstrated between untreated and TICI 0-2a patients for penumbral consumption based on T_max >6 s (P=0.52) or T_max >10 s (P=0.92).

Conclusions:

Among extended window endovascular thrombectomy patients, T_max >10-s mismatch volume may comprise large volumes of salvageable tissue, whereas nearly half the T_max >6-s mismatch volume may remain viable in untreated patients at 24 hours.