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- Title
Brush sign and collateral supply as potential markers of large infarct growth after successful thrombectomy.
- Authors
Bani-Sadr, Alexandre; Pavie, Dylan; Mechtouff, Laura; Cappucci, Matteo; Hermier, Marc; Ameli, Roxana; Derex, Laurent; De Bourguignon, Charles; Cho, Tae-Hee; Eker, Omer; Nighoghossian, Norbert; Berthezene, Yves
- Abstract
Objectives: To investigate the relationships between brush sign and cerebral collateral status on infarct growth after successful thrombectomy. Methods: HIBISCUS-STROKE cohort includes acute ischemic stroke patients treated with thrombectomy after MRI triage and undergoing a day-6 MRI including FLAIR images to quantify final infarct volume (FIV). Successful reperfusion was defined as a modified thrombolysis in cerebral infarction score ≥ 2B. Infarct growth was calculated by subtracting FIV from baseline ischemic core after co-registration and considered large (LIG) when > 11.6 mL. Brush sign was assessed on T2*-weighted-imaging and collaterals were assessed using the hypoperfusion intensity ratio, which is the volume of Time-To-Tmax (Tmax) ≥ 10 s divided by the volume of Tmax ≥ 6 s. Good collaterals were defined by a hypoperfusion intensity ratio < 0.4. Results: One hundred and twenty-nine patients were included, of whom 45 (34.9%) had a brush sign and 63 (48.8%) good collaterals. Brush sign was associated with greater infarct growth (p = 0.01) and larger FIV (p = 0.02). Good collaterals were associated with a smaller baseline ischemic core (p < 0.001), larger penumbra (p = 0.04), and smaller FIV (p < 0.001). Collateral status was not significantly associated with brush sign (p = 0.20) or with infarct growth (p = 0.67). Twenty-eight (22.5%) patients experienced LIG. Univariate regressions indicated that brush sign (odds ratio (OR) = 4.8; 95% confidence interval (CI): [1.9;13.3]; p = 0.004) and hemorrhagic transformation (OR = 1.7; 95%CI: [1.2;2.6]; p = 0.04) were predictive of LIG. In multivariate regression, only the brush sign remained predictive of LIG (OR = 5.2; 95%CI: [1.8–16.6], p = 0.006). Conclusions: Brush sign is a predictor of LIG after successful thrombectomy and cerebral collateral status is not. Key Points: • Few predictors of ischemic growth are known in ischemic stroke patients achieving successful mechanical thrombectomy. • Our results suggest that the brush sign—a surrogate marker of severe hypoperfusion—is independently associated with large ischemic growth (> 11.6 mL) after successful thrombectomy whereas cerebral collateral status does not.
- Subjects
THROMBECTOMY; CEREBRAL infarction; STROKE patients
- Publication
European Radiology, 2023, Vol 33, Issue 6, p4502
- ISSN
0938-7994
- Publication type
Article
- DOI
10.1007/s00330-022-09387-x