Comparative Studies of Cerebral Reperfusion Injury in the Posterior and Anterior Circulations After Mechanical Thrombectomy.
Matthew M BowerShuichi SuzukiKiarash GolshaniLi-Mei LinMohammad ShafieHermelinda G AbcedeJay ShahDana StradlingWengui YuPublished in: Translational stroke research (2022)
Cerebral reperfusion injury is the major complication of mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Contrast extravasation (CE) and intracranial hemorrhage (ICH) are the key radiographical features of cerebral reperfusion injury. The aim of this study was to investigate CE and ICH after MT in the anterior and posterior circulation, and their effect on functional outcome. This is a retrospective study of all consecutive patients who were treated with MT for AIS at University of California Irvine Medical Center between January 1, 2014, and December 31, 2017. Patient characteristics, clinical features, procedural variables, contrast extravasation, ICH, and outcomes after MT were analyzed. A total of 131 patients with anterior circulation (AC) stroke and 25 patients with posterior circulation (PC) stroke underwent MT during the study period. There was no statistically significant difference in admission NIHSS score, blood pressure, rate of receiving intravenous tPA, procedural variables, contrast extravasation, and symptomatic ICH between the 2 groups. Patients with PC stroke had a similar rate of favorable outcome (mRS 0-2) but significantly higher mortality (40.0% vs. 10.7%, p < 0.01) than patients with AC stroke. Multivariate regression analysis identified initial NIHSS score (OR 1.1, CI 1.0-1.2, p = 0.01), number of passes with stent retriever (OR 2.1, CI 1.3-3.6, p < 0.01), and PC stroke (OR 9.3, CI 2.5-35.1, p < 0.01) as independent risk factors for death. There was no significant difference in functional outcomes between patients with and without evidence of cerebral reperfusion injury after MT. We demonstrated that AC and PC stroke had similar rates of cerebral reperfusion injury and favorable outcome after MT. Cerebral reperfusion injury is not a significant independent risk factor for poor functional outcome.
Keyphrases
- cerebral ischemia
- subarachnoid hemorrhage
- acute ischemic stroke
- brain injury
- blood brain barrier
- atrial fibrillation
- blood pressure
- magnetic resonance
- emergency department
- high dose
- adipose tissue
- magnetic resonance imaging
- type diabetes
- cardiovascular disease
- case report
- skeletal muscle
- cardiovascular events
- risk factors
- metabolic syndrome
- insulin resistance
- weight loss
- heart rate
- water quality