title: Body Temperature Modulates Infarction Growth following Endovascular Reperfusion.
abstract: The neuronal substrate is highly sensitive to temperature elevation; however, its impact on the fate of the ischemic penumbra has not been established. We analyzed interactions between temperature and penumbral expansion among successfully reperfused patients with acute ischemic stroke, hypothesizing infarction growth and worse outcomes among patients with fever who achieve full reperfusion.
  
  
  
  Data from 129 successfully reperfused (modified TICI 2b/3) patients (mean age, 65 ± 15 years) presenting within 12 hours of onset were examined from a prospectively collected acute ischemic stroke registry. CT perfusion was analyzed to produce infarct core, hypoperfusion, and penumbral mismatch volumes. Final DWI infarction volumes were measured, and relative infarction growth was computed. Systemic temperatures were recorded throughout hospitalization. Correlational and logistic regression analyses assessed the associations between fever (>37.5°C) and both relative infarction growth and favorable clinical outcome (90-day mRS of ≤2), corrected for NIHSS score, reperfusion times, and age. An optimized model for outcome prediction was computed by using the Akaike Information Criterion.
  
  
  
  The median presentation NIHSS score was 18 (interquartile range, 14-22). Median (interquartile range) CTP-derived volumes were: core = 9.6 mL (1.5-25.3 mL); hypoperfusion = 133 mL (84.2-204 mL); and final infarct volume = 9.6 mL (8.3-45.2 mL). Highly significant correlations were observed between temperature of >37.5°C and relative infarction growth (Kendall τ correlation coefficient = 0.24, P = .002). Odds ratios for favorable clinical outcome suggested a trend toward significance for fever in predicting a 90-day mRS of ≤2 (OR = 0.31, P = .05). The optimized predictive model for favorable outcomes included age, NIHSS score, procedure time to reperfusion, and fever. Likelihood ratios confirmed the superiority of fever inclusion (P < .05). Baseline temperature, range, and maximum temperature did not meet statistical significance.
  
  
  
  These findings suggest that imaging and clinical outcomes may be affected by systemic temperature elevations, promoting infarction growth despite reperfusion.
authors.affiliation: From the Department of Radiology and Imaging Sciences (S.D., M.B., T.G., A.P.), Emory University Hospital, Atlanta, Georgia Seena.Dehkharghani@NYUMC.Org.|Department of Neurology (S.D., D.C.H., R.G.N.), Marcus Stroke and Neuroscience Center, Grady Memorial Hospital and Emory University Hospital, Atlanta, Georgia.
authors.forename: S
authors.identifier: 0000-0002-3141-1094
authors.initials: S
authors.lastname: Dehkharghani
authors.affiliation: From the Department of Radiology and Imaging Sciences (S.D., M.B., T.G., A.P.), Emory University Hospital, Atlanta, Georgia.
authors.forename: M
authors.identifier: 0000-0003-2245-7418
authors.initials: M
authors.lastname: Bowen
authors.affiliation: Department of Neurology (S.D., D.C.H., R.G.N.), Marcus Stroke and Neuroscience Center, Grady Memorial Hospital and Emory University Hospital, Atlanta, Georgia.
authors.forename: D C
authors.identifier: 0000-0003-1884-2196
authors.initials: DC
authors.lastname: Haussen
authors.affiliation: From the Department of Radiology and Imaging Sciences (S.D., M.B., T.G., A.P.), Emory University Hospital, Atlanta, Georgia.
authors.forename: T
authors.identifier: 0000-0003-0752-8329
authors.initials: T
authors.lastname: Gleason
authors.affiliation: From the Department of Radiology and Imaging Sciences (S.D., M.B., T.G., A.P.), Emory University Hospital, Atlanta, Georgia.
authors.forename: A
authors.identifier: 0000-0001-9334-1688
authors.initials: A
authors.lastname: Prater
authors.affiliation: Department of Biostatistics (Q.C.), Emory University, Atlanta, Georgia.
authors.forename: Q
authors.identifier: 0000-0001-7603-4096
authors.initials: Q
authors.lastname: Cai
authors.affiliation: Department of Biostatistics (J.K.), University of Michigan, Ann Arbor, Michigan.
authors.forename: J
authors.identifier: 0000-0002-5643-2668
authors.initials: J
authors.lastname: Kang
authors.affiliation: Department of Neurology (S.D., D.C.H., R.G.N.), Marcus Stroke and Neuroscience Center, Grady Memorial Hospital and Emory University Hospital, Atlanta, Georgia.
authors.forename: R G
authors.identifier: 0000-0003-4532-153X
authors.initials: RG
authors.lastname: Nogueira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature; D020520:Brain Infarction / Q000473:pathology* / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015424:Reperfusion / Q000379:methods; D016896:Treatment Outcome