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Publications

Journal Article Ahead of print

PubMed: 42622228 DOI: 10.1161/JAHA.125.048351

Serial Computed Tomography Perfusion and Diffusion Imaging After Complete Recanalization in Large-Vessel Occlusion.

J Am Heart Assoc

Authors: Nakhoon Kim, Wi-Sun Ryu, Leonard Sunwoo, Younbeom Jeong, Jun Yup Kim, Jihoon Kang, JoonNyung Heo, Sung Hyun Baik, Cheolkyu Jung, Moon-Ku Han, Hee-Joon Bae, Baik Kyun Kim, Johanna Ospel, Longting Lin, Mark Parsons, Beom Joon Kim

Affiliations

  • Department of Neurology Seoul National University Bundang Hospital Seongnam-si Gyeonggi-do Republic of Korea.
  • Artificial Intelligence Research Center JLK Inc. Seoul Republic of Korea.
  • Department of Radiology Seoul National University Bundang Hospital Seongnam-si Gyeonggi-do Republic of Korea.
  • Department of Neurology Yonsei University College of Medicine Seoul Republic of Korea.
  • Department of Neurology Seoul National University Bundang Hospital Seongnam-si Gyeonggi-do Republic of Korea. Department of Neuroscience Seoul National University College of Medicine Seoul Republic of Korea.
  • Department of Neurology Seoul National University Bundang Hospital Seongnam-si Gyeonggi-do Republic of Korea. Department of Neurology Gyeonggi Provincial Medical Center Icheon Hospital Icheon Republic of Korea.
  • Calgary Stroke Program, Department of Clinical Neurosciences and Community Health Sciences, The Hotchkiss Brain Institute and the O'Brien Institute for Public Health University of Calgary Calgary AB Canada.
  • Department of Neurology Liverpool Hospital, University of New South Wales, School of Clinical Medicine, South Western Sydney Clinical Campus Sydney NSW Australia.

Abstract

BACKGROUND

Infarct evolution on diffusion-weighted imaging (DWI) after complete recanalization and its relationships to computed tomography perfusion core and outcome remain uncertain.

METHODS

From a multicenter registry (2014-2024), we identified 189 patients with anterior-circulation large-vessel occlusion, modified Thrombolysis in Cerebral Infarction grade 3 recanalization, prethrombectomy computed tomography perfusion, immediate DWI within 24 hours, and delayed DWI at 24 to 168 hours. Robust linear regression identified predictors of DWI volume change; logistic regression assessed 90-day modified Rankin Scale scores of 0 to 2.

RESULTS

DWI volume increased in 162 of 189 patients (85.7%), from a median of 4.8 mL (interquartile range, 1.1-16.4) immediately after thrombectomy to 11.7 mL (interquartile range, 3.8-40.2) on delayed imaging; the median change was 4.4 mL (interquartile range, 0.7-14.8). Baseline computed tomography perfusion core was method-sensitively associated with greater change in the full model without immediate DWI (β=0.154 [heteroscedasticity-consistent 95% CI, -0.024 to 0.332]; P=0.09; bootstrap 95% CI, 0.018-0.336; P=0.014) and attenuated after immediate DWI adjustment (β=0.100; P=0.22; bootstrap P=0.077). Each decile increase in volume change was associated with lower odds of functional independence (adjusted odds ratio, 0.81 [95% CI, 0.68-0.97]; P=0.021). Delayed DWI showed the best outcome discrimination.

CONCLUSIONS

DWI-defined infarct volume increased after complete recanalization and was associated with functional outcome. The core association was method-sensitive and attenuated after accounting for immediate DWI, supporting a possible mediated rather than independent pathway.

MeSH

Heart Diseases, Ischemic Stroke, Tomography, Thrombectomy