Post-ischemic hyperemia following endovascular therapy for acute stroke is associated with lesion growth. Issue 6 (June 2023)

• Record Type: Journal Article
• Authors: Luby, Marie; Hsia, Amie W; Lomahan, Carolyn A; Davis, Rachel; Burton, Shannon; Kim, Yongwoo; Craft, Veronica; Uche, Victoria; Cabatbat, Rainier; Adil, Malik M; Thomas, Leila C; De Vis, Jill B; Afzal, Mariam M; McGavern, Dorian; Lynch, John K; Leigh, Richard; Latour, Lawrence L
• Is Part Of: Journal of cerebral blood flow & metabolism. Volume 43:Issue 6(2023)
• Page Start: 856
• Page End: 868
• Publication Date: 2023-06
• Subjects: Hyperemia -- hyperperfusion -- luxury perfusion -- reperfusion injury -- cerebrovascular autoregulation; Cerebral circulation -- Periodicals; Brain -- Metabolism -- Periodicals; Brain -- Blood-vessels -- Periodicals; Cerebrovascular disease -- Periodicals; 612.824
• DOI: 10.1177/0271678X231155222
• Languages: English
• ISSNs: 0271-678X

Abstract

A substantial proportion of acute stroke patients fail to recover following successful endovascular therapy (EVT) and injury to the brain and vasculature secondary to reperfusion may be a contributor. Acute stroke patients were included with: i) large vessel occlusion of the anterior circulation, ii) successful recanalization, and iii) evaluable MRI early after EVT. Presence of hyperemia on MRI perfusion was assessed by consensus using a modified ASPECTS. Three different approaches were used to quantify relative cerebral blood flow (rCBF). Sixty-seven patients with median age of 66 [59–76], 57% female, met inclusion criteria. Hyperemia was present in 35/67 (52%) patients early post-EVT, in 32/65 (49%) patients at 24 hours, and in 19/48 (40%) patients at 5 days. There were no differences in incomplete reperfusion, HT, PH-2, HARM, severe HARM or symptomatic ICH rates between those with and without early post-EVT hyperemia. A strong association (R 2 = 0.81, p < 0.001) was found between early post-EVT hyperemia (p = 0.027) and DWI volume at 24 hours after adjusting for DWI volume at 2 hours (p < 0.001) and incomplete reperfusion at 24 hours (p = 0.001). Early hyperemia is a potential marker for cerebrovascular injury and may help select patients for adjunctive therapy to prevent edema, reperfusion injury, and lesion growth.