Perfusion Changes of Unexplained Early Neurological Deterioration After Reperfusion Therapy

• Published in: Translational stroke research 2020-04, Vol.11 (2), p.195-203
• Main Authors: Fu, Jingjing, Zhou, Ying, Li, Qingqing, Zhong, Genlong, Zhang, Sheng, Zhang, Ruiting, Liu, Chang, Zhang, Minming, Lou, Min
• Format: Article
• Language: English
• Subjects: Biomedical and Life Sciences; Biomedicine; Cardiology; Edema; Hypotheses; Ischemia; Neurology; Neurosciences; Neurosurgery; Normal distribution; Original Article; Patients; Regression analysis; Statistical analysis; Stroke; Vascular Surgery; Veins & arteries
• ISSN: 1868-4483; 1868-601X
• DOI: 10.1007/s12975-019-00723-w

Early neurological deterioration (END) after thrombolysis occurs in 10% acute ischemic stroke (AIS) patients, and its mechanism remains unclear in majority of cases, named as unexplained END. We tested the hypothesis that penumbra/infarct growth beyond the initial penumbra might be the cause of unexplained END. We reviewed the database of AIS patients who received reperfusion therapy. Unexplained END was defined as ≥ 2-point increase of NIHSS from baseline to 24 h, without straightforward causes. For each unexplained END patient, we extracted 2 matched controls based on 4 clinical and radiological characteristics which were strongly associated with unexplained END. We defined extra-penumbra and extra-infarct as penumbra and infarct growth at 24 h beyond baseline penumbral tissue and then investigated the relationship between extra-penumbra and extra-infarct and the presence of unexplained END. Finally, 44 unexplained END patients and 88 matched controls were included. The volume of both extra-infarct (OR, 1.032 per 1-mL increase; p  = 0.018) and extra-penumbra (OR, 1.070 per 1-mL increase; p