Infarct in new territory after endovascular stroke treatment: A diffusion-weighted imaging study

Data on infarcts in new territory (INT) in patients undergoing endovascular stroke treatment for acute large-vessel occlusions are sparse. Aim of this study was to assess the prevalence, risk factors, and clinical relevance of INT. For this purpose, all patients in a single-center prospective regist...

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Veröffentlicht in:Scientific reports 2020-05, Vol.10 (1), p.8366-8366, Article 8366
Hauptverfasser: Kaesmacher, Johannes, Kurmann, Christoph, Jungi, Noel, Breiding, Philipe, Lang, Matthias F., Meier, Raphael, Dobrocky, Tomas, Piechowiak, Eike, Zibold, Felix, Bellwald, Sebastian, Meinel, Thomas R., Heldner, Mirjam R., Mordasini, Pasquale, Arnold, Marcel, Mosimann, Pascal J., Goyal, Mayank, Gralla, Jan, Fischer, Urs
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container_issue 1
container_start_page 8366
container_title Scientific reports
container_volume 10
creator Kaesmacher, Johannes
Kurmann, Christoph
Jungi, Noel
Breiding, Philipe
Lang, Matthias F.
Meier, Raphael
Dobrocky, Tomas
Piechowiak, Eike
Zibold, Felix
Bellwald, Sebastian
Meinel, Thomas R.
Heldner, Mirjam R.
Mordasini, Pasquale
Arnold, Marcel
Mosimann, Pascal J.
Goyal, Mayank
Gralla, Jan
Fischer, Urs
description Data on infarcts in new territory (INT) in patients undergoing endovascular stroke treatment for acute large-vessel occlusions are sparse. Aim of this study was to assess the prevalence, risk factors, and clinical relevance of INT. For this purpose, all patients in a single-center prospective registry who underwent endovascular stroke treatment and received pre- and post-interventional diffusion-weighted imaging were included (N = 259). Using an established scoring system, INT were classified according to size (I-III, ≤2 mm, >2 mm ≤20 mm, >20 mm) and likelihood of being related to the intervention (A, high likelihood; B, low likelihood). Additionally, a new type of infarct, that occurred in a territory distal to the occlusion, but was initially not hypoperfused, was defined as an infarct in initially not hypoperfused territory (IINHT). A total of 180 INT and 38 IINHT were observed in 32.8% (N = 85/259) of patients. In most patients, INT were angiographically occult (90.2%), and 13 patients had INT/IINHT larger than 2 cm (type III). Absence of protection during stent-retrieval and a cardio-embolic stroke origin were associated with higher incidence of INT/IINHT, whereas pretreatment with IV tPA showed no association, even when different bolus timing was considered. INT/IINHT were associated with lower rates of functional independence with increasing size type after adjusting for confounders ( adjusted Odds Ratio per size group increase 0.63, 95% confidence interval 0.46–0.86). In conclusion, INT and IINHT are not rare, are associated with poor outcome with increasing size, and they may serve as a surrogate endpoint for safety evaluation of new devices and endovascular techniques. Further research on associated factors is warranted.
doi_str_mv 10.1038/s41598-020-64495-2
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Aim of this study was to assess the prevalence, risk factors, and clinical relevance of INT. For this purpose, all patients in a single-center prospective registry who underwent endovascular stroke treatment and received pre- and post-interventional diffusion-weighted imaging were included (N = 259). Using an established scoring system, INT were classified according to size (I-III, ≤2 mm, &gt;2 mm ≤20 mm, &gt;20 mm) and likelihood of being related to the intervention (A, high likelihood; B, low likelihood). Additionally, a new type of infarct, that occurred in a territory distal to the occlusion, but was initially not hypoperfused, was defined as an infarct in initially not hypoperfused territory (IINHT). A total of 180 INT and 38 IINHT were observed in 32.8% (N = 85/259) of patients. In most patients, INT were angiographically occult (90.2%), and 13 patients had INT/IINHT larger than 2 cm (type III). Absence of protection during stent-retrieval and a cardio-embolic stroke origin were associated with higher incidence of INT/IINHT, whereas pretreatment with IV tPA showed no association, even when different bolus timing was considered. INT/IINHT were associated with lower rates of functional independence with increasing size type after adjusting for confounders ( adjusted Odds Ratio per size group increase 0.63, 95% confidence interval 0.46–0.86). In conclusion, INT and IINHT are not rare, are associated with poor outcome with increasing size, and they may serve as a surrogate endpoint for safety evaluation of new devices and endovascular techniques. Further research on associated factors is warranted.</description><identifier>ISSN: 2045-2322</identifier><identifier>EISSN: 2045-2322</identifier><identifier>DOI: 10.1038/s41598-020-64495-2</identifier><identifier>PMID: 32433478</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>59/57 ; 692/308/409 ; 692/499 ; 692/617/375/534 ; 692/700/139/422 ; Aged ; Brain - blood supply ; Brain - diagnostic imaging ; Brain Infarction - diagnosis ; Brain Infarction - epidemiology ; Brain Infarction - etiology ; Cardiovascular system ; Diffusion Magnetic Resonance Imaging ; Endovascular Procedures - adverse effects ; Endovascular Procedures - instrumentation ; Female ; Follow-Up Studies ; Humanities and Social Sciences ; Humans ; Implants ; Male ; Middle Aged ; multidisciplinary ; Occlusion ; Patients ; Postoperative Complications - diagnosis ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Period ; Preoperative Care ; Prospective Studies ; Registries - statistics &amp; numerical data ; Retrospective Studies ; Risk Factors ; Science ; Science (multidisciplinary) ; Severity of Illness Index ; Stents - adverse effects ; Stroke ; Stroke - diagnosis ; Stroke - surgery ; Territory ; Thrombectomy - adverse effects ; Thrombectomy - instrumentation ; Treatment Outcome</subject><ispartof>Scientific reports, 2020-05, Vol.10 (1), p.8366-8366, Article 8366</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020. 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Aim of this study was to assess the prevalence, risk factors, and clinical relevance of INT. For this purpose, all patients in a single-center prospective registry who underwent endovascular stroke treatment and received pre- and post-interventional diffusion-weighted imaging were included (N = 259). Using an established scoring system, INT were classified according to size (I-III, ≤2 mm, &gt;2 mm ≤20 mm, &gt;20 mm) and likelihood of being related to the intervention (A, high likelihood; B, low likelihood). Additionally, a new type of infarct, that occurred in a territory distal to the occlusion, but was initially not hypoperfused, was defined as an infarct in initially not hypoperfused territory (IINHT). A total of 180 INT and 38 IINHT were observed in 32.8% (N = 85/259) of patients. In most patients, INT were angiographically occult (90.2%), and 13 patients had INT/IINHT larger than 2 cm (type III). Absence of protection during stent-retrieval and a cardio-embolic stroke origin were associated with higher incidence of INT/IINHT, whereas pretreatment with IV tPA showed no association, even when different bolus timing was considered. INT/IINHT were associated with lower rates of functional independence with increasing size type after adjusting for confounders ( adjusted Odds Ratio per size group increase 0.63, 95% confidence interval 0.46–0.86). In conclusion, INT and IINHT are not rare, are associated with poor outcome with increasing size, and they may serve as a surrogate endpoint for safety evaluation of new devices and endovascular techniques. 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Aim of this study was to assess the prevalence, risk factors, and clinical relevance of INT. For this purpose, all patients in a single-center prospective registry who underwent endovascular stroke treatment and received pre- and post-interventional diffusion-weighted imaging were included (N = 259). Using an established scoring system, INT were classified according to size (I-III, ≤2 mm, &gt;2 mm ≤20 mm, &gt;20 mm) and likelihood of being related to the intervention (A, high likelihood; B, low likelihood). Additionally, a new type of infarct, that occurred in a territory distal to the occlusion, but was initially not hypoperfused, was defined as an infarct in initially not hypoperfused territory (IINHT). A total of 180 INT and 38 IINHT were observed in 32.8% (N = 85/259) of patients. In most patients, INT were angiographically occult (90.2%), and 13 patients had INT/IINHT larger than 2 cm (type III). Absence of protection during stent-retrieval and a cardio-embolic stroke origin were associated with higher incidence of INT/IINHT, whereas pretreatment with IV tPA showed no association, even when different bolus timing was considered. INT/IINHT were associated with lower rates of functional independence with increasing size type after adjusting for confounders ( adjusted Odds Ratio per size group increase 0.63, 95% confidence interval 0.46–0.86). In conclusion, INT and IINHT are not rare, are associated with poor outcome with increasing size, and they may serve as a surrogate endpoint for safety evaluation of new devices and endovascular techniques. Further research on associated factors is warranted.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>32433478</pmid><doi>10.1038/s41598-020-64495-2</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-0647-9273</orcidid><oa>free_for_read</oa></addata></record>
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subjects 59/57
692/308/409
692/499
692/617/375/534
692/700/139/422
Aged
Brain - blood supply
Brain - diagnostic imaging
Brain Infarction - diagnosis
Brain Infarction - epidemiology
Brain Infarction - etiology
Cardiovascular system
Diffusion Magnetic Resonance Imaging
Endovascular Procedures - adverse effects
Endovascular Procedures - instrumentation
Female
Follow-Up Studies
Humanities and Social Sciences
Humans
Implants
Male
Middle Aged
multidisciplinary
Occlusion
Patients
Postoperative Complications - diagnosis
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Postoperative Period
Preoperative Care
Prospective Studies
Registries - statistics & numerical data
Retrospective Studies
Risk Factors
Science
Science (multidisciplinary)
Severity of Illness Index
Stents - adverse effects
Stroke
Stroke - diagnosis
Stroke - surgery
Territory
Thrombectomy - adverse effects
Thrombectomy - instrumentation
Treatment Outcome
title Infarct in new territory after endovascular stroke treatment: A diffusion-weighted imaging study
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