Abstract Details

Title Prediction of Infarct Volume at the 24 Hours after Late Window Presentation with Perfusion Imaging in Patients with Anterior Circulation Large Vessel Occlusion

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S6 - Cerebrovascular Disease and Interventional Neurology: Acute Stroke Treatment (4:00 PM-4:08 PM)

Poster/Presentation
Number 001

Background NA

Objective

We sought to evaluate the accuracy of perfusion weighted imaging (PWI) in late presenting patients for estimating the infarct volume at 24 hours after presentation.

Design/Methods This is a secondary analysis of DEFUSE 3, which included stroke patients with anterior circulation occlusion within 6-16 hours of last known normal. The primary outcome is final infarct volume on a 24-hour MRI scan (volume of DWI positive tissue), adjusted for the baseline infarct volume. We censored 3 patients with 24-hour follow-up MRI infarct volumes >300 mL, which we considered non-physiologic for a hemispheric stroke. The primary predictors are the baseline volume of Tmax >6s, Tmax >10s, and hypoperfusion intensity ratio (HIR: Tmax10/Tmax6) on CT/MR perfusion at hospital admission. We stratified the cohort into 4 categories (untreated, TICI 0-2a, TICI 2b, and TICI3) and fit linear regression models to each of our predictors.

Results

We included 147 patients, of which 69 were untreated, 17 had TICI 0-2a, 46 had TICI 2b, and 15 had TICI 3. In untreated patients both HIR (β-weight=0.30; p=0.006) and Tmax10 (β-weight=0.31; p=0.004) volume were predictive of adjusted 24-hour follow-up infarct volume. In treated patients, there were no consistent relationships between the perfusion imaging variables and adjusted final infarct volume.

Conclusions For patients with late window anterior circulation large vessel occlusion stroke, HIR and Tmax10 volume appear to be reliable predictors of subsequent infarct volume in untreated patients. For patients treated with thrombectomy, further research is warranted to better understand the more complex relationship between baseline perfusion imaging and the 24 hour, and beyond, infarct volume.

Authors/Disclosures
Shashank Agarwal, MD, MBBS (RWJBH Cooperman Barnabas Medical Center) PRESENTER	Dr. Agarwal has nothing to disclose.
Eytan Raz	No disclosure on file
	No disclosure on file
	No disclosure on file
Maarten G. Lansberg, MD (Stanford Stroke Center)	Dr. Lansberg has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Lansberg has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Lansberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novo Nordisk. Dr. Lansberg has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Richard & Connor. Dr. Lansberg has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Fraser Watson Croutch. Dr. Lansberg has received publishing royalties from a publication relating to health care.
Shadi Yaghi, MD	Dr. Yaghi has nothing to disclose.
Adam De Havenon, MD, FAAN (Yale University)	Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has stock in Certus. Dr. De Havenon has stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.