Abstract
Background: Ischemic lesions commonly continue to progress even days after treatment, and this lesion growth is associated with unfavorable functional outcome in acute ischemic stroke patients. The aim of this study is to elucidate the role of edema in subacute lesion progression and its influence on unfavorable functional outcome by quantifying net water uptake. Methods: We included all 187 patients from the MR CLEAN trial who had high quality follow-up non-contrast CT at 24 h and 1 week. Using a CT densitometry-based method to calculate the net water uptake, we differentiated total ischemic lesion volume (TILV) into edema volume (EV) and edema-corrected infarct volume (ecIV). We calculated these volumes at 24 h and 1 week after stroke and determined their progression in the subacute period. We assessed the effect of 24-h lesion characteristics on EV and ecIV progression. We evaluated the influence of edema and edema-corrected infarct progression on favorable functional outcome after 90 days (modified Rankin Scale: 0–2) after correcting for potential confounders. Lastly, we compared these volumes between subgroups of patients with and without successful recanalization using the Mann–Whitney U-test. Results: Median TILV increased from 37 (IQR: 18–81) ml to 68 (IQR: 30–130) ml between 24 h and 1 week after stroke, while the net water uptake increased from 22 (IQR: 16–26)% to 27 (IQR: 22–32)%. The TILV progression of 20 (8.8–40) ml was mostly caused by ecIV with a median increase of 12 (2.4–21) ml vs. 6.5 (2.7–15) ml of EV progression. Larger TILV, EV, and ecIV volumes at 24 h were all associated with more edema and lesion progression. Edema progression was associated with unfavorable functional outcome [aOR: 0.53 (0.28–0.94) per 10 ml; p-value: 0.05], while edema-corrected infarct progression showed a similar, non-significant association [aOR: 0.80 (0.62–0.99); p-value: 0.06]. Lastly, edema progression was larger in patients without successful recanalization, whereas ecIV progression was comparable between the subgroups. Conclusion: EV increases in evolving ischemic lesions in the period between 1 day and 1 week after acute ischemic stroke. This progression is larger in patients without successful recanalization and is associated with unfavorable functional outcome. However, the extent of edema cannot explain the total expansion of ischemic lesions since edema-corrected infarct progression is larger than the edema progression.
| Original language | English |
|---|---|
| Article number | 705221 |
| Journal | Frontiers in Neurology |
| Volume | 12 |
| DOIs | |
| Publication status | Published - 20 Jul 2021 |
Bibliographical note
Funding Information:We would like to thank Amber Bucker (Department of Radiology, University Medical Center Groningen, Groningen, Netherlands) for her contribution in patient selection and delineation of the 24-h ischemic lesion volumes. Funding. MR CLEAN was partly funded by the Dutch Heart Foundation (2008 T030). MR CLEAN was also funded by unrestricted grants from: AngioCare BV, Covidien/EV3?, MEDAC Gmbh/LAMEPRO, Penumbra Inc., and Concentric Medical/TOP Medical BV. This study was designed, conducted, analyzed, and interpreted by the investigators independently of all. This sub-study was also funded by INSIST (www.insist-h2020.eu): a European Union's Horizon 2020 research and innovation program (Grant Agreement Number: 777072).
Publisher Copyright:
© Copyright © 2021 Konduri, van Kranendonk, Boers, Treurniet, Berkhemer, Yoo, van Zwam, Oostenbrugge, van der Lugt, Dippel, Roos, Bot, Majoie, Marquering and the MR CLEAN Trial Investigators (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands).