Identifying Severe Stroke Patients Likely to Benefit From Thrombectomy Despite Delays of up to a Day
Year: 2019
Type: preprint
Study design: Observational Study
Abstract: Selected patients with large vessel occlusions (LVO) can benefit from thrombectomy up to 24 hours after onset. Identifying patients who might benefit from late intervention after transfer from community hospitals to thrombectomy-capable centers would be valuable. We searched for presentation biomarkers to identify such patients. Frequent MR imaging over 2 days of 38 untreated LVO patients revealed logarithmic growth of the ischemic infarct core. In 24 patients with terminal internal carotid artery or the proximal middle cerebral artery occlusions we found that an infarct core growth rate (IGR) <4.1 ml/hr and initial infarct core volumes (ICV) <19.9 ml had accuracies >89% for identifying patients who would still have a core of <50ml 24 hours after stroke onset, a core size that should predict favorable outcomes with thrombectomy. Published reports indicate that up to half of all LVO stroke patients have an IGR<4.1 ml/hr. Other potentially useful biomarkers include the NIHSS and the perfusion measurements MTT and Tmax. We conclude that many LVO patients have a stroke physiology that is favorable for late intervention, and that there are biomarkers that can accurately identify them at early time points as suitable for transfer for intervention.
DOI: 10.1101/526947
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Development of kurtosis MRI to image acute stroke patients, Normobaric Hyperoxia in Acute Ischemic Stroke, Sharing canonical human stroke data, Indo-US Collaborative Stroke Registry and Infrastructure Development, Specialized Programs of Translational Research in Acute Stroke at the Partners, Quantitative MRI-based metrics for multi-center stroke treatment assessment
OpenAlex ID: W2912134724