title: Infarct growth despite full reperfusion in endovascular therapy for acute ischemic stroke.
abstract: OBJECTIVE
  To explore the predictors of infarct core expansion despite full reperfusion after intra-arterial therapy (IAT).
  
  
  METHODS
  We retrospectively reviewed 604 consecutive patients who underwent IAT for anterior circulation large vessel occlusion acute ischemic stroke in two tertiary centers (2008-2013/2010-2013). Sixty patients selected by MRI or CT perfusion presenting within <24 h of onset with modified Thrombolysis In Cerebral Infarction (mTICI) grade 3 or 2c reperfusion were included. Significant infarct growth (SIG) was defined as infarct expansion >11.6 mL.
  
  
  RESULTS
  Mean age was 67.0±13.7 years, 56% were men. Mean National Institute of Health Stroke Scale (NIHSS) score was 16.2±6.1, time from onset to puncture was 6.8±3.1 h, and procedure length was 1.3±0.6 h. MRI was used for baseline core analysis in 43% of patients. Mean baseline infarct volume was 17.1±19.1 mL, absolute infarct growth was 30.6±74.5 mL, and final infarct volume was 47.7±77.7 mL. Overall, 35% of patients had SIG. Three of 21 patients (14%) treated with stent-retrievers had SIG compared with 14 of 39 (36%) with first-generation devices. Eight of 21 patients (38%) with intravenous tissue plasminogen activator (IV t-PA) had infarct growth compared with 25/39 (64%) without. 23% of patients with SIG had a modified Rankin Scale score ≤2 at 3 months compared with 48% of those without SIG. Multivariate logistic regression indicated that race affected infarct growth. Use of IV t-PA (p=0.03) and stent-retrievers (p=0.03) were independently and inversely correlated with SIG.
  
  
  CONCLUSIONS
  Despite full reperfusion, infarct growth is relatively frequent and may explain poor clinical outcomes in this setting. Ethnicity was found to influence SIG. Use of IV t-PA and stent-retrievers were associated with less infarct core expansion.
authors.affiliation: Emory University School of Medicine/Marcus Stroke & Neuroscience Center-Grady Memorial Hospital, Miami, Florida, USA.
authors.forename: Diogo C
authors.initials: DC
authors.lastname: Haussen
authors.affiliation: Emory University School of Medicine/Marcus Stroke & Neuroscience Center-Grady Memorial Hospital, Miami, Florida, USA.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.affiliation: University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Mohamed Samy
authors.initials: MS
authors.lastname: Elhammady
authors.affiliation: University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Dileep R
authors.initials: DR
authors.lastname: Yavagal
authors.affiliation: Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Aziz-Sultan
authors.affiliation: University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Jeremiah N
authors.initials: JN
authors.lastname: Johnson
authors.affiliation: University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Brandon G
authors.initials: BG
authors.lastname: Gaynor
authors.affiliation: Emory University School of Medicine/Marcus Stroke & Neuroscience Center-Grady Memorial Hospital, Miami, Florida, USA.
authors.forename: Shyian
authors.initials: S
authors.lastname: Jen
authors.affiliation: Emory University School of Medicine/Marcus Stroke & Neuroscience Center-Grady Memorial Hospital, Miami, Florida, USA.
authors.forename: Seena
authors.initials: S
authors.lastname: Dehkharghani
authors.affiliation: University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Peterson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000209:etiology; D057510:Endovascular Procedures / Q000379:methods* / Q000639:trends; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015424:Reperfusion / Q000379:methods* / Q000639:trends; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Angiography; Intervention; Stroke