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International Journal of Stroke

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Research article

First published online January 12, 2015

The Growth Rate of Early DWI Lesions is Highly Variable and Associated with Penumbral Salvage and Clinical Outcomes following Endovascular Reperfusion

Hayley M. Wheeler [email protected], Michael Mlynash, Manabu Inoue, Aaryani Tipirnini, John Liggins, Roland Bammer, Maarten G. Lansberg, Stephanie Kemp, Greg Zaharchuk, Matus Straka, and Gregory W. Albers on behalf of the DEFUSE 2 InvestigatorsView all authors and affiliations

Volume 10, Issue 5

https://doi.org/10.1111/ijs.12436

Abstract

Background

The degree of variability in the rate of early diffusion-weighted imaging expansion in acute stroke has not been well characterized.

Aim

We hypothesized that patients with slowly expanding diffusion-weighted imaging lesions would have more penumbral salvage and better clinical outcomes following endovascular reperfusion than patients with rapidly expanding diffusion-weighted imaging lesions.

Methods

In the first part of this substudy of DEFUSE 2, growth curves were constructed for patients with >90% reperfusion and <10% reperfusion. Next, the initial growth rate was determined in all patients with a clearly established time of symptom onset, assuming a lesion volume of 0 ml just prior to symptom onset. Patients who achieved reperfusion (>50% reduction in perfusion-weighted imaging after endovascular therapy) were categorized into tertiles according to their initial diffusion-weighted imaging growth rates. For each tertile, penumbral salvage [comparison of final volume to the volume of perfusion-weighted imaging (Tmax > 6 s)/diffusion-weighted imaging mismatch prior to endovascular therapy], favorable clinical response (National Institutes of Health Stroke Scale improvement of ≥8 points or 0–1 at 30 days), and good functional outcome (90-day modified Rankin score of ≤2) were calculated. A multivariate model assessed whether infarct growth rates were an independent predictor of clinical outcomes.

Results

Sixty-five patients were eligible for this study; the median initial growth rate was 3·1 ml/h (interquartile range 0·7–10·7). Target mismatch patients (n = 42) had initial growth rates that were significantly slower than the growth rates in malignant profile (n = 9 patients, P < 0·001). In patients who achieved reperfusion (n = 38), slower early diffusion-weighted imaging growth rates were associated with better clinical outcomes (P < 0·05) and a trend toward more penumbral salvage (n = 31, P = 0·103). A multivariate model demonstrated that initial diffusion-weighted imaging growth rate was an independent predictor of achieving a 90-day modified Rankin score of ≤2.

Conclusions

The growth rate of early diffusion-weighted imaging lesions in acute stroke patients is highly variable; malignant profile patients have higher growth rates than patients with target mismatch. A slower rate of early diffusion-weighted imaging growth is associated with a greater degree of penumbral salvage and improved clinical outcomes following endovascular reperfusion.

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References

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Published In

International Journal of Stroke

Volume 10, Issue 5

Pages: 723 - 729

Article first published online: January 12, 2015

Issue published: July 2015

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PubMed: 25580662