title: Presence of the hyperintense acute reperfusion marker on MRI after mechanical thrombectomy for large vessel occlusion is associated with worse early neurological recovery.
abstract: BACKGROUND
  Mechanical thrombectomy has become the accepted treatment for large vessel occlusion in acute ischemic stroke. Unfortunately, a large cohort of patients do not achieve functional independence with treatment, even though the results are more robust than with medical management. The hyperintense acute reperfusion marker (HARM) on MRI is an indication of the breakdown of the blood-brain barrier and reperfusion injury.
  
  
  OBJECTIVE
  To examine the hypothesis that the presence of HARM on MRI correlates with worse neurological recovery after reperfusion therapy.
  
  
  METHODS
  We retrospectively reviewed 35 consecutive patients who between February 24, 2016 and April 23, 2016 underwent MRI to determine the presence of HARM after thrombectomy for anterior circulation large vessel occlusion. Demographic, radiographic imaging, and outcome data were collected. Univariate and binary logistic regression models were performed to assess predictors for improvement of the National Institutes of Health Stroke Scale (NIHSS) score by ≥8 points at 24 hours.
  
  
  RESULTS
  The 35 patients studied had an average age of 64±14 years of age with a median NIHSS score of 15 (IQR 9-20). Eighteen patients (51%) were found to have a HARM-positive MRI. In univariate analysis, patients with HARM were older, had lower reperfusion rates and more postprocedural hemorrhages. In binary logistic regression modeling, the absence of HARM was independently associated with a ≥8-point NIHSS score improvement at 24 hours (OR=7.14, 95% CI 1.22 to 41.67).
  
  
  CONCLUSIONS
  This preliminary analysis shows that the presence of HARM may be linked to worse neurological recovery 24 hours after thrombectomy. Reperfusion injury may affect the number of patients achieving functional independence after treatment.
authors.affiliation: Wellstar Neurosciences Institute, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Neurological Institute, Columbia Presbyterian Medical Center, New York, New York, USA.
authors.forename: Chung-Huan Johnny
authors.initials: CJ
authors.lastname: Sun
authors.affiliation: Wellstar Neurosciences Institute, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Dustin
authors.initials: D
authors.lastname: Rochestie
authors.affiliation: Wellstar Neurosciences Institute, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Owada
authors.affiliation: Wellstar Neurosciences Institute, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Khaldi
authors.affiliation: Wellstar Neurosciences Institute, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Johnson
authors.affiliation: Wellstar Neurosciences Institute, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Horn
mesh_terms: D000368:Aged; D001812:Blood-Brain Barrier / Q000000981:diagnostic imaging; D002548:Cerebral Revascularization / Q000009:adverse effects* / Q000639:trends; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000639:trends; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology; D015424:Reperfusion / Q000009:adverse effects / Q000639:trends; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects* / Q000639:trends; D016896:Treatment Outcome
keywords: Stroke; Thrombectomy