title: Predictors of infarct growth after endovascular therapy for acute ischemic stroke.
abstract: BACKGROUND
  Intra-arterial (IA) thrombectomy for acute ischemic stroke has an excellent recanalization rate but variable outcomes. The core infarct also grows at a variable rate despite recanalization. We aim to study the factors that are associated with infarct growth after IA therapy.
  
  
  METHODS
  We reviewed the hyperacute ischemic stroke imaging database at Cleveland Clinic for those undergoing endovascular thrombectomy of anterior circulation from 2009 to 2012. Patients with both pretreatment and follow-up magnetic resonance imaging were included. Seventy-six patients were stratified into quartiles by infarct volume growth from initial to follow-up diffusion-weighted imaging (DWI) measure by a region of interest demarcation.
  
  
  RESULTS
  The median infarct growth of each quartile was .6 cm(3) (no-growth group), 13.8, 37, and 160.2 cm(3) (large-growth group). Pretreatment stroke severity was comparable among groups. Compared with the no-growth group, the large-growth group had larger initial infarct defined by computed tomography (CT) Alberta Stroke Program Early CT score (median 10 versus 8, P = .032) and DWI volume (mean 13.8 versus 29.2 cm(3), P = .034), lack of full collateral vessels on CT angiography (36.8% versus 0%, P = .003), and a lower recanalization rate (thrombolysis in cerebral infarction ≥2b, P = .044). The increase in infarct growth is associated with decrease in favorable outcomes defined by a modified Rankin Scale score of 0-2 at 30 days: 57.9%, 42.1%, 21.1%, and 5.3%, respectively (P < .001). DWI reversal was observed in 11 of 76 patients, translating to 82% favorable outcome.
  
  
  CONCLUSIONS
  Infarct evolution after endovascular thrombectomy is associated with an outcome. DWI reversal or no growth translated to a favorable outcome. Small initial ischemic core, good collateral support, and better recanalization grades predict the smaller infarct growth and favorable outcome after endovascular thrombectomy.
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Shumei
authors.initials: S
authors.lastname: Man
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Hussain
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Dolora
authors.initials: D
authors.lastname: Wisco
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tateishi
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Gabor
authors.initials: G
authors.lastname: Toth
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ferdinand K
authors.initials: FK
authors.lastname: Hui
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: uchino_garcia@yahoo.com.
authors.forename: Ken
authors.initials: K
authors.lastname: Uchino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D061185:Mechanical Thrombolysis; D008875:Middle Aged; D011379:Prognosis; D020521:Stroke / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: MRI; ischemic stroke; mechanical thrombectomy; outcome