WHAT WILL PREVENT INFARCTION GROWTH? WHOM will do the research to solve that? Nothing will occur, we have NO leadership and NO strategy in stroke, so your children and grandchildren will still be screwed when they have strokes!
LEADERS would look at this and say; 'Let's do the research to solve the problem! You're uselessly predicting a problem; NOT SOLVING IT!
But there are NO FUNCTIONING BRAIN CELLS IN THE STROKE MEDICAL WORLD!
Oxygen Extraction Fraction on Baseline MRI Predicts Infarction Growth in Successfully Reperfused Patients
Asghariahmadabad MD, Ameera MD, Metanat MD, https://orcid.org/0000-0003-2905-4080Tavakkol MD https://orcid.org/0000-0003-2869-8087, Bahr-Hosseini MD https://orcid.org/0000-0003-3049-4542, Viktor Szeder MD, PhD https://orcid.org/0000-0003-0703-8258, Geoffrey P. Colby MD, PhD https://orcid.org/0000-0002-3376-0933, Show All … , and Kambiz Nael, MD https://orcid.org/0000-0002-4194-9488 kambiznael@gmail.com
Author Info & AffiliationsAbstract
In patients with acute ischemic stroke, infarct growth occurs despite successful reperfusion. Oxygen extraction fraction (OEF) has shown promising results in evaluating ischemic tissue viability and can now be quantified from routinely performed dynamic susceptibility contrast perfusion. We aimed to determine the association of OEF alterations within the ischemic tissue on pretreatment magnetic resonance imaging and infarct growth in patients who underwent successful reperfusion.
METHODS:
In this retrospective cohort study from the University of California, Los Angeles, between 2015 and 2020, patients were included if they had anterior circulation large vessel occlusion, achieved successful reperfusion (Thrombolysis in Cerebral Infarction ≥2b), had pretreatment dynamic susceptibility contrast perfusion and posttreatment magnetic resonance imaging within 48 hours from reperfusion. Dynamic susceptibility contrast-derived OEF values were quantified from the segmented ischemic core (apparent diffusion coefficient ≤620×10−6 mm2/s) and penumbra tissue (time-to-maximum [Tmax] >6 s) on pretreatment magnetic resonance imaging and normalized to contralateral hemisphere (relative oxygen extraction fraction [OEFr]). Primary outcome was substantial infarct growth ≥10 mL, and secondary outcomes were continuous measures of infarct growth volume and penumbra-to-infarct conversion ratio. The associations between baseline clinical and imaging variables, including OEFr and outcome measures, were tested by multivariate and regression analysis.
RESULTS:
Among 89 patients who met inclusion criteria, 33 (37%) patients had infarct growth ≥10 mL. Patients with infarct growth had significantly (P<0.0001) lower penumbra-OEFr values compared with those without infarct growth. There was significant association between penumbra OEFr and infarct growth (β=−2.9 [95% CI, −5.0 to −0.8]; P=0.007) and similarly for penumbra-to-infarct conversion ratio (β=−10.4 [95% CI, −19.6 to −1.2]; P=0.028).
CONCLUSIONS:
Our results showed penumbra-OEFr is a promising imaging biomarker for predicting infarct growth in acute ischemic stroke following successful reperfusion. Although elevation of penumbra-OEFr is protective, patients with lower penumbra-OEFr values sustained further ischemic injury and infarct growth.
Graphical Abstract
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