Reperfusion after ischemic stroke is associated with reduced brain edema.

J Cereb Blood Flow Metab 2018 10 21;38(10):1807-1817. Epub 2017 Jul 21.

1 Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.

Rapid revascularization is highly effective for acute stroke, but animal studies suggest that reperfusion edema may attenuate its beneficial effects. We investigated the relationship between reperfusion and edema in patients from the Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) and Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) cohorts. Reperfusion percentage was measured as the difference in perfusion-weighted imaging lesion volume between baseline and follow-up (day 3-5 for EPITHET; day 6-8 for MR RESCUE). Midline shift (MLS) and swelling volume were quantified on follow-up MRI. We found that reperfusion was associated with less MLS (EPITHET: Spearman ρ = -0.46; P < 0.001, and MR RESCUE: Spearman ρ = -0.49; P < 0.001) and lower swelling volume (EPITHET: Spearman ρ = -0.56; P < 0.001, and MR RESCUE: Spearman ρ = -0.27; P = 0.026). Multivariable analyses performed in EPITHET and MR RESCUE demonstrated that reperfusion independently predicted both less MLS (ß coefficient = -0.056; P = 0.025, and ß coefficient = -0.38; P = 0.028, respectively) and lower swelling volumes (ß coefficient = -4.7; P = 0.007, and ß coefficient = -10.7; P = 0.009, respectively), after adjusting for age, sex, NIHSS, admission glucose and follow-up lesion size. Taken together, our data suggest that even modest improvement in perfusion is associated with less brain edema in EPITHET and MR RESCUE.

Download full-text PDF

Source
http://dx.doi.org/10.1177/0271678X17720559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168909PMC
October 2018
101 Reads

Publication Analysis

Top Keywords

reperfusion edema
8
reperfusion
5
percentage measured
4
reperfusion percentage
4
cohorts reperfusion
4
measured difference
4
rescue cohorts
4
imaging lesion
4
perfusion-weighted imaging
4
difference perfusion-weighted
4
lesion volume
4
clots embolectomy
4
trial epithet
4
evaluation trial
4
thrombolysis evaluation
4
imaging thrombolysis
4
epithet mechanical
4
mechanical retrieval
4
volume baseline
4
stroke clots
4

References

(Supplied by CrossRef)

Goyal M et al.
Lancet 2016

Zaidat OO et al.
Am J Neuroradiol 2005

Similar Publications