Highest Lesion Growth Rates in Patients With Hyperacute Stroke

Abstract

Background and Purpose— The early growth of ischemic lesions has been described as being nonlinear, with lesion growth rates at their highest during the earliest period after stroke onset. We hypothesized that the time gap from imaging to revascularization results in higher lesion growth in patients with hyperacute presentation. Methods— Fifty-one patients with ischemic stroke with initial multimodal computed tomography (CT), follow-up CT after 24 hours, and successful endovascular recanalization were included and separated into 2 groups according to their median time from symptom onset to imaging (eg, hyperacute versus acute). The difference in Alberta Stroke Program Early CT Score (ASPECTS) between initial CT and follow-up CT was assessed, as well as volumetric lesion growth from early ischemic core in admission perfusion CT and total lesion volume in follow-up CT. Results— The median time from onset to imaging was 1.85 hours. There was no significant difference in admission ASPECTS (mean, 8.5 versus 8.2) or time from imaging to recanalization in both groups (median, 2.7 versus 2.4 hours; P =0.4). The mean (SD) lesion growth assessed by ASPECTS difference was 2.7 (2.3) in the hyperacute group and 1.6 (1.3) in the acute group ( P =0.03). The mean (SD) volumetric difference in the hyperacute group was 26.6 mL (43.2 mL) and 17.2 mL (26.3 mL; P =0.36) in the acute group, respectively. For every passing hour after onset, ASPECTS lesion growth was reduced by 0.4. Conclusions— Patients in the hyperacute phase showed increased ASPECTS lesion growth from imaging to recanalization suggesting a particular benefit of faster recanalization times in this group of patients with stroke.

Non-contrast head CT alone for thrombectomy in acute ischemic stroke: analysis of the ANGEL-ACT registry

“…In the early presenting patient, the onset-to-reperfusion time is likely to have greater impact with critical implications for clinical outcome. This phenomenon is supported by a prior study21 which showed that there is a higher lesion growth in patients presenting in the hyperacute time window (<1.85 hours of onset to first imaging time) when assessed according to differences in ASPECTS. The accurate time/effect relationship for the direct transfer approach should be further evaluated.…”

Stroke Treatment Delay Limits Outcome After Mechanical Thrombectomy: Stratification by Arrival Time and ASPECTS

“…For instance, patients with high ASPECTS (vs. intermediate or low) have a smaller core 11 and thus are at the highest risk for infarct growth when compared to those with a completed or near completed infarct. Moreover, past studies have shown that the rate of infarct growth is the highest in patients presenting early on from symptoms 12 and slowest in patients presenting in the extended time window 13 …”

Hemodynamics of Leptomeningeal Collaterals after Large Vessel Occlusion and Blood Pressure Management with Endovascular Treatment

“…30 In this sense, early infarct growth will be a function of time from onset, ischemic severity, that is, baseline LMC perfusion, and tissue vulnerability. 31,32 After successful recanalization, the objective of BP management should be to mitigate the risk of hemorrhagic transformation. The prevailing belief is that lowering BP may prevent hemorrhagic transformation after EVT.…”

“…As discussed in the previous section, early infarct growth may be a function of time from onset, ischemic severity (i.e., baseline LMC perfusion), and tissue vulnerability. 31,32 It can be speculated that in patients with poor LMCs after LVO, ischemic injury rapidly develops, and the only effective treatment strategy is to expedite recanalization. In contrast, in the presence of moderate LMCs, tissue viability mainly depends on systemic perfusion, and clinicians should be sensitive to even minute changes in BP.…”