Abstract Details

Title Infarct Topography and Reperfusion Injury After Endovascular Thrombectomy for Large Vessel Occlusion Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S20 - Cerebrovascular Disease and Interventional Neurology: Clinical Trials and Outcomes Studies (3:42 PM-3:54 PM)

Poster/Presentation
Number 002

Background With continued expansion in indications for EVT, understanding the pathophysiology of reperfusion injury and HT becomes increasingly important. Pre-EVT infarct topography may have implications for treatment decisions acutely (e.g. stenting), and with post EVT care (e.g. antithrombotics).

Objective To quantify region-specific volumes of infarcted tissue on MRI pre-endovascular thrombectomy (EVT), understand their importance for reperfusion injury and hemorrhagic transformation (HT), and identify associations with clinical and imaging characteristics.

Design/Methods Patients were identified from a prospectively maintained database. Each patient’s diffusion weighted sequence underwent manual infarct delineation and was registered to a standard space for overlay with cortical, subcortical, and white matter atlases. HT was defined as ECASS PH1 or PH2. Variables with p<0.10 in univariate analyses were included in multivariable models.

Results 165 participants [median age 69 (IQR 56-79), 56% women] were identified. Intravenous alteplase was administered to 52%; 70% achieved TICI 2b-3 reperfusion. HT occurred in 8%. The distribution of pre-EVT infarcts was 48% (38-60%) white matter, 23% (6-47%) cortex, and 15% (4-28%) basal ganglia. Pre-EVT infarct volumes [median (IQR)] were 22 cc (12-43 cc) for total, 11 cc (6-19 cc) for white matter, 5 cc (1-19 cc) for cortex, and 3 cc (1-6 cc) for basal ganglia infarct. Paramagnetic sequences showed 3% had petechial hemorrhage and 40% had susceptibility vessel sign. Basal ganglia infarct volume was independently associated with HT (OR=1.342, 95%CI=1.002,1.797) in a model including white matter infarct volume, cortex infarct volume, smoking, and puncture-to-recanalization time. Basal ganglia infarct volume was linked to susceptibility vessel sign (Beta=0.233, p=0.006) and NIHSS (Beta=0.220, p=0.012), when controlling for total infarct volume.

Conclusions

Greater basal ganglia infarct volume was associated with a higher risk of HT when accounting for infarct volumes in other regions. Susceptibility vessel sign was associated with basal ganglia infarct volume, which may be related to acute middle cerebral artery perforator occlusion.

Authors/Disclosures
Robert W. Regenhardt, MD, PhD (Massachusetts General Hospital) PRESENTER	Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Johnson and Bell Trial Lawyers. The institution of Dr. Regenhardt has received research support from National Institutes of Health. The institution of Dr. Regenhardt has received research support from Society of Vascular and Interventional Neurology. The institution of Dr. Regenhardt has received research support from Heitman Foundation.
Anna K. Bonkhoff, MD (Mass General Brigham)	Dr. Bonkhoff has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NeuroImage Clinical (Elsevier).
Markus D. Schirmer, PhD (Massachusetts General Hospital)	Dr. Schirmer has nothing to disclose.
Alvin Das, MD (Beth Israel Deaconess Medical Center)	Dr. Das has nothing to disclose.
Adam Dmytriw (Massachusetts General Hospital)	No disclosure on file
Justin Vranic (Massachusetts General Hospital)	No disclosure on file
	No disclosure on file
James Rabinov	No disclosure on file
Christopher Stapleton (Massachusetts General Hospital)	No disclosure on file
Thabele M. Leslie-Mazwi, MD	Dr. Leslie-Mazwi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for World Care Clinical. Dr. Leslie-Mazwi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Phillips Health Care. Dr. Leslie-Mazwi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for IQVIA. Dr. Leslie-Mazwi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll.
Aman Patel	No disclosure on file
Natalia S. Rost, MD, MPH, FAHA, FAAN (Massachusetts General Hospital)	Dr. Rost has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for American Academy of Neurology. Dr. Rost has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care.