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Brush sign and collateral supply as potential markers of large infarct growth after successful thrombectomy
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Brush sign and collateral supply as potential markers of large infarct growth after successful thrombectomy
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Journal Article
Brush sign and collateral supply as potential markers of large infarct growth after successful thrombectomy
2023
Overview
Objectives
To investigate the relationships between brush sign and cerebral collateral status on infarct growth after successful thrombectomy.
Methods
HIBISCUS-STROKE cohort includes acute ischemic stroke patients treated with thrombectomy after MRI triage and undergoing a day-6 MRI including FLAIR images to quantify final infarct volume (FIV). Successful reperfusion was defined as a modified thrombolysis in cerebral infarction score ≥ 2B. Infarct growth was calculated by subtracting FIV from baseline ischemic core after co-registration and considered large (LIG) when > 11.6 mL. Brush sign was assessed on T2*-weighted-imaging and collaterals were assessed using the hypoperfusion intensity ratio, which is the volume of Time-To-Tmax (Tmax) ≥ 10 s divided by the volume of Tmax ≥ 6 s. Good collaterals were defined by a hypoperfusion intensity ratio < 0.4.
Results
One hundred and twenty-nine patients were included, of whom 45 (34.9%) had a brush sign and 63 (48.8%) good collaterals. Brush sign was associated with greater infarct growth (
p
= 0.01) and larger FIV (
p
= 0.02). Good collaterals were associated with a smaller baseline ischemic core (
p
< 0.001), larger penumbra (
p
= 0.04), and smaller FIV (
p
< 0.001). Collateral status was not significantly associated with brush sign (
p
= 0.20) or with infarct growth (
p
= 0.67). Twenty-eight (22.5%) patients experienced LIG. Univariate regressions indicated that brush sign (odds ratio (OR) = 4.8; 95% confidence interval (CI): [1.9;13.3];
p
= 0.004) and hemorrhagic transformation (OR = 1.7; 95%CI: [1.2;2.6];
p
= 0.04) were predictive of LIG. In multivariate regression, only the brush sign remained predictive of LIG (OR = 5.2; 95%CI: [1.8–16.6],
p
= 0.006).
Conclusions
Brush sign is a predictor of LIG after successful thrombectomy and cerebral collateral status is not.
Key Points
•
Few predictors of ischemic growth are known in ischemic stroke patients achieving successful mechanical thrombectomy
.
•
Our results suggest that the brush sign—a surrogate marker of severe hypoperfusion—is independently associated with large ischemic growth (> 11.6 mL) after successful thrombectomy whereas cerebral collateral status does not
.
Publisher
Springer Berlin Heidelberg,Springer Nature B.V,Springer Verlag
Subject
