Abstract TP59: Clinical Course and Radiological Outcome of Mild Stroke Patients Treated and not Treated with Thrombolysis

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Xabier Urra ◽  
Helena Ariño ◽  
Sergi Amaro ◽  
Víctor Obach ◽  
Alvaro Cervera ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Clinical Course ◽  
Past History ◽  
Infarct Volume ◽  
Clinical Severity ◽  
Lesion Volume ◽  
Radiological Outcome ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Mild Stroke

Background: Around 30% of patients with acute stroke are excluded from thrombolysis because of mild or improving symptoms, but some of these patients don’t achieve a good recovery. We compared the clinical and radiological course in a cohort of 239 patients with mild stroke treated and not treated with thrombolysis in the same institution. Methods: We studied all patients with ischemic stroke admitted within 6 hours of symptom-onset with previous mRS≤1 and mild symptoms (NIHSS≤5) at arrival or during initial evaluation. We compared the baseline characteristics, clinical course (NIHSS), radiological outcome (final DWI lesion volume), incidence of symptomatic intracranial hemorrhage (sICH) and favourable 3-month outcome (mRS≤1) of patients treated with thrombolysis (123 tPA only and 9 endovascular interventions) or not treated (n=107). Results: Treated patients had greater clinical severity at presentation and after imaging and arrived to the hospital faster than not treated patients. In a general linear model of repeated measures, their course was significantly different (p=0.03) and thrombolised patients improved more during hospitalization. Patients with significant neurological improvement (NIHSS score>1) had more severe strokes at presentation but similar outcome, and were more often treated with tPA (p<0.001). Infarct volume was significantly correlated with NIHSS score especially at day 1. Despite the differences in the initial clinical severity, final infarct volume was similar in treated and not treated patients. The rate of sICH was similar in both groups. Outcome at 3-months was associated to past history of stroke, glucose levels and deterioration during hospital stay. On multivariate analysis, thrombolysis remained associated to neurological improvement (OR 4.34;p<0.001) and was non-significantly associated to greater chances of good functional outcome at 3-months (OR 2.38;p=0.099). Conclusions: In patients with mild stroke thrombolysis was safe and was associated to better neurological course. Overall, these results suggest that patients presenting with mild symptoms do benefit from thrombolysis.

Abstract WP106: Redefined Measure of Early Neurological Improvement Shows Treatment Benefit of Intravenous Tissue Plasminogen Activator Treatment in NINDS Rt-PA Acute Stroke Trial at 24 Hours

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shashank Agarwal ◽  
Erica Scher ◽  
Aaron Lord ◽  
Jennifer Frontera ◽  
Koto Ishida ◽  
...  
Keyword(s):  
Roc Curve ◽  
Functional Outcomes ◽  
Infarct Volume ◽  
Surrogate Marker ◽  
Percentage Change ◽  
Treatment Benefit ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Percent Change ◽  
Stroke Study

Background and Purpose: The first of the 2 NINDS Stroke Study trials did not show a significant increase in early neurological improvement (ENI), defined as NIHSS improvement by ≥ 4, with alteplase treatment. We hypothesized that ENI defined as a percentage change in NIHSS (percent change NIHSS) at 24 hours is superior to other definitions in predicting 3-month functional outcomes and using this definition there would be treatment benefit of alteplase over placebo at 24 hours. Methods: We analyzed the NINDS rt-PA Stroke Study (Parts 1 and 2) trial data. Percent change NIHSS was defined as [(admission NIHSS score–24-hour NIHSS score)x100/admission NIHSS score] and delta NIHSS as (admission NIHSS score–24-hour NIHSS score). We compared ENI using these definitions between alteplase vs. placebo patients. We also used receiver operating characteristic (ROC) curve to determine the predictive association of ENI with excellent 3-month functional outcomes [Barthel Index (BI) score 95 – 100 and modified Rankin scale (mRS) 0-1], good 3-month functional outcome (mRS 0-2) and 3-month infarct volume. Results: There was a significantly greater improvement in the 24-hour median percent change NIHSS among patients treated with alteplase compared to the placebo group (28% vs. 15%, p = 0.045) but not median delta NIHSS (3 vs. 2, p = 0.471). ROC curve comparison showed that percent change NIHSS (ROC percent ) was better than delta NIHSS (ROC delta ) and admission NIHSS (ROC admission ) with regards to excellent 3-month BI (ROC percent 0.83, ROC delta 0.76, ROS admission 0.75), excellent 3-month mRS (ROC percent 0.83, ROC delta 0.74, ROS admission 0.78), and good 3-month mRS (ROC percent 0.83, ROC delta 0.76, ROS admission 0.78). Percentage change had a stronger association with 90-day infarct volume than delta NIHSS score and both delta NIHSS and percent change in NIHSS were more pronounced with faster treatment times. Conclusion: In the NINDS rt-PA trial, alteplase was associated with a significant percent change improvement in NIHSS at 24 hours. Percent change in NIHSS may be a better surrogate marker of thrombolytic activity and 3-month outcomes.

Abstract T P107: Change of Day-to-Day BP Variability and Perfusion Status in Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jihoon Kang ◽  
Hee-Joon Bae ◽  
Moon-Ku Han ◽  
Min Uk Jang ◽  
Jeong-Ho Hong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Standard Deviation ◽  
Repeated Measures ◽  
Acute Stage ◽  
Lesion Volume ◽  
Hospital Arrival ◽  
Repeated Measures Anova ◽  
Nihss Score ◽  
Elapsed Time ◽  
Maximum Minimum

Purpose: We investigated how BP is changed over elapsed time according to the perfusion status at acute stage of ischemic stroke. Methods: Patients arrived within 24 hours of symptom onset and have symptomatic occlusion at MCA and ICA were consecutively identified. Among them, we included those were not eligible or failed for recanalization therapy at acute stage. According to the occluded site and perfusion lesion volume, they were dichotomized into upper one-third (large PLV) and others (small-to-medium PLV). For the first consecutive 5 days, daily BP parameters of followings: mean, maximum-minimum and standard deviation (SD) between groups were compared using repeated measures ANOVA. Results: Of enrolled 129 subjects (mean age, 69.3 ± 12.7 years-old and median NIHSS score, 6), cut-offs of large PLV were 143 ml for MCA and 232 ml for ICA. At the day of hospital arrival, mean, maximum-minimum and SD of systolic BP were 136.8, 55.6 and 14.4 mmHg and those at 5th day were 136.2, 32.9 and 11.8 mmHg, respectively. Patients with large PLV were significantly associated with higher maximum-minimum and SD compared to those with small-to-medium PLV (P < 0.001) not averaged value with adjustments for age and baseline NIHSS score (Figure 1). Conclusion: Perfusion status at acute stage of ischemic stroke would be related with day-to-day change of BP variability.

Relationship between elevated plasma trimethylamine N-oxide levels and increased stroke injury

Neurology ◽  
2020 ◽  
Vol 94 (7) ◽  
pp. e667-e677 ◽  
Author(s):  
Chuanjie Wu ◽  
Fang Xue ◽  
Yajun Lian ◽  
Jing Zhang ◽  
Di Wu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Infarct Volume ◽  
Acute Ischemia ◽  
Stroke Severity ◽  
Healthy Controls ◽  
Elevated Plasma ◽  
Operating Characteristics ◽  
Severe Stroke ◽  
Nihss Score ◽  
Mild Stroke

ObjectiveTo investigate whether elevated plasma trimethylamine N-oxide (TMAO) levels are associated with initial stroke severity and infarct volume.MethodsThis cross-sectional study included 377 patients with acute ischemic stroke and 50 healthy controls. Plasma TMAO levels were assessed at admission. Stroke infarct size and clinical stroke severity were measured with diffusion-weighted imaging and the NIH Stroke Scale (NIHSS). Mild stroke was defined as an NIHSS score <6.ResultsPlasma TMAO levels were higher in patients with ischemic stroke than in healthy controls (median 5.1 vs 3.0 μmol/L; p < 0.001). Every 1–µmol/L increase in TMAO was associated with a 1.13-point increase in NIHSS score (95% confidence interval [CI] 1.04–1.29; p < 0.001) and 1.69-mL increase in infarct volume (95% CI 1.41–2.03; p < 0.001) after adjustment for vascular risk factors. At admission, 159 patients (42.2%) had experienced a mild stroke, and their plasma TMAO levels were lower compared to those with moderate to severe stroke (median 3.6 vs 6.5 µmol/L; p < 0.001). The area under the receiver operating characteristics curve of plasma TMAO level in predicting moderate to severe stroke was 0.794 (95% CI 0.748–0.839; p < 0.001), and the optimal cutoff value was 4.95 μmol/L. The sensitivity and specificity of TMAO levels ≥4.95 μmol/L for moderate to severe stroke were 70.2% and 79.9%, respectively.ConclusionsPatients with ischemic stroke had higher plasma TMAO levels compared to healthy controls. Higher plasma TMAO level at admission is an independent predictor of stroke severity and infarct volume in patients with acute ischemia.

scholarly journals Clinical-CT mismatch defined NIHSS ≥ 8 and CT-ASPECTS ≥ 9 as a reliable marker of candidacy for intravenous thrombolytic therapy in acute ischemic stroke

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0251077
Author(s):  
Hung-Ming Wu ◽  
I-Hui Lee ◽  
Chao-Bao Luo ◽  
Chih-Ping Chung ◽  
Yung-Yang Lin
Keyword(s):  
Thrombolytic Therapy ◽  
Intravenous Thrombolysis ◽  
Incidence Rates ◽  
Favorable Outcome ◽  
Stroke Severity ◽  
Lesion Volume ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Early Neurological Deterioration ◽  
Reliable Marker

Background Clinical-diffusion mismatch between stroke severity and diffusion-weighted imaging lesion volume seems to identify stroke patients with penumbra. However, urgent magnetic resonance imaging is sometimes inaccessible or contraindicated. Thus, we hypothesized that using brain computed tomography (CT) to determine a baseline “clinical-CT mismatch” may also predict the responses to thrombolytic therapy. Methods Brain CT lesions were measured using the Alberta Stroke Program Early CT Score (ASPECTS). A total of 104 patients were included: 79 patients with a baseline National Institutes of Health Stroke Scale (NIHSS) score ≥ 8 and a CT-ASPECTS ≥ 9 who were defined as clinical-CT mismatch-positive (P group) and 25 patients with an NIHSS score ≥ 8 and a CT-ASPECTS < 9 who were defined as clinical-CT mismatch-negative (the N group). We compared their clinical outcomes, including early neurological improvement (ENI), early neurological deterioration (END), delta NIHSS score (admission NIHSS—baseline NIHSS score), symptomatic intracranial hemorrhage (sICH), mortality, and favorable outcome at 3 months. Results Patients in the P group had a greater proportion of favorable outcome at 3 months (p = 0.032) and more frequent ENI (p = 0.038) and a greater delta NIHSS score (p = 0.001), as well as a lower proportion of END (p = 0.004) than those in the N group patients. There were no significant differences in the incidence rates of sICH and mortality between the two groups. Conclusions Clinical-CT mismatch may be able to predict which patients would benefit from intravenous thrombolysis.

Abstract WP44: NIHSS Score Components Predict Infarct Volume in Minor Ischemic Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Charlotte Herber ◽  
Amelia K Boehme ◽  
Howard Andrews ◽  
Joshua Z Willey ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Language Disorder ◽  
Infarct Volume ◽  
Final Diagnosis ◽  
Minor Stroke ◽  
Lesion Volume ◽  
Nihss Score ◽  
Therapeutic Implications ◽  
Significant Relationships ◽  
Minor Ischemic Stroke

Background: Prior studies have shown a correlation between the National Institutes of Health Stroke Scale (NIHSS) score and infarct volume on diffusion weighted imaging (DWI); however data are limited in patients with minor stroke whose treatment is controversial. Our aim is to determine the association between DWI lesion(s) volume and the (1) total NIHSS score and (2) NIHSS components in a population of patients with minor ischemic stroke. Methods: We included all patients with minor stroke (NIHSS 0-5) who were enrolled in the prospective Stroke Warning Information and Faster Treatment (SWIFT) study. All patients were admitted to the hospital with a final diagnosis of stroke. We calculated lesion(s) volume (cm 3 ) on DWI sequence using Medical Image Processing, Analysis, and Visualization (MIPAV, NIH, Version 7.1.1). Based on the distribution of lesion volume, we summarized the explanatory value into median cm 3 . We used non-parametric tests to study the association between the primary outcome, DWI lesion(s) volume, and the predictors (NIHSS score and its components). Results: 894 patients had a discharge diagnosis of ischemic stroke; 709 underwent MRI and 510 were DWI positive. There was a weak graded relationship between NIHSS score and median DWI lesion volume in cm 3 : (NIHSS 0: 7.1, NIHSS 1: 8.0, NIHSS 2: 17.1, NIHSS 3: 11.6, NIHSS 4: 19.0, NIHSS 5: 23.6). We also noted highly significant relationships between lesion volume and certain NIHSS components. Compared to patients without the deficit, the median lesion volume was significantly higher in patients with neglect (105.6 vs. 12.5,p=0.025), language disorder (34.6 vs. 11.9,p<0.001), and visual field deficits (185.6 vs. 11.6,p<0.001). Other components of the NIHSS were not associated with lesion volume. Conclusion: In patients with minor stroke, the nature of the neurological deficit improves prediction of infarct volume when added to the total NIHSS score. This may lead to clinical and therapeutic implications.

scholarly journals Delayed functional independence after thrombectomy: temporal characteristics and predictors

2020 ◽  
Vol 12 (9) ◽  
pp. 837-841
Author(s):  
Shashvat M Desai ◽  
Daniel A Tonetti ◽  
Andrew A Morrison ◽  
Bradley J Molyneaux ◽  
Matthew Starr ◽  
...  
Keyword(s):  
Infarct Volume ◽  
Functional Independence ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Early Improvement ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Procedural Information ◽  
Younger Age ◽  
Patients Experience

BackgroundVariability in early neurological improvement after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is well documented. Understanding the temporal progression of functional independence after EVT, especially delayed functional independence in patients who do not experience early improvement, is essential for prognostication and rehabilitation.ObjectiveTo determine the incidence of early and delayed functional independence and identify associated predictors after EVT.MethodsA retrospective analysis of prospectively collected data on patients undergoing EVT in the setting of anterior circulation LVO was performed. Demographic, clinical, radiological, treatment, and procedural information were analyzed. Incidence and predictors of early functional independence (EFI, modified Rankin Scale (mRS) score 0–2 at discharge) and delayed functional independence (DFI, mRS score 0–2 at 90 days in non-EFI patients) were analyzed.ResultsThree hundred and fifty-five patients met the study criteria. 55% were women and mean age was 71±15. Mean National Institutes of Health Stroke Scale (NIHSS) score was 17±6 and median Alberta Stroke Program Early CT Score was 9 (8-10). EFI was observed in 21% (73) of patients. Among non-EFI patients (282), DFI was observed in 30% (85) of patients. Shorter time to treatment (p=0.03), lower 24 hours NIHSS score (p<0.001), and smaller follow-up infarct volume (p=0.003) were independent predictors of EFI. Younger age (p=0.011), lower 24 hours NIHSS score (p=0.001), and absence of parenchymal hemorrhage (PH2; p=0.039) were independent predictors of DFI.ConclusionApproximately one-fifth of patients experience EFI and one-third of non-early improvers experience DFI. Younger age, lower 24 hours NIHSS score, and absence of parenchymal hemorrhage were independent predictors of DFI among non-early improvers. Further studies are required to improve our understanding of DFI.

Abstract W P26: Itemized NIHSS Subsets Predict MRI Positive Strokes In Patients With Mild Deficits

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Charlotte Herber ◽  
Joshua Z Willey ◽  
Howard Andrews ◽  
Randolph S Marshall ◽  
...  
Keyword(s):  
Visual Field ◽  
Infarct Volume ◽  
Final Diagnosis ◽  
Motor Deficits ◽  
Lesion Volume ◽  
Nihss Score ◽  
Visual Deficits ◽  
Multivariable Regression ◽  
The Mean ◽  
Attending Physician

Background: While imaging is useful in confirming the diagnosis of ischemic stroke, negative diffusion weighted imaging (DWI) is reported in up to 10% of patients. We aim to (1) identify predictors of MRI-positive stroke from the itemized NIHSS, and (2) to correlate subsets with infarct volume. Methods: Data were derived from the Stroke Warning Information and Faster Treatment study from 2006 to 2009 among patients with mild deficits (NIHSS 0-5) and attending physician final diagnosis of stroke. Using Medical Image Processing, Analysis, and Visualization (MIPAV, NIH) (Version 7.1.1), we calculated lesion volume (cm3) from DWI sequence. Univariate models studied the association between itemized NIHSS subsets, including cortical deficits (visual field cut, aphasia, or neglect), and presence of DWI hyperintensity and lesion volume. Multivariable regression assessed factors predicting DWI-positive strokes; p<0.05 was considered significant. Results: Of 611 patients with a discharge diagnosis of stroke, 498 underwent MRI and 29.5% were DWI negative. On multivariate analysis, predictors of a positive DWI were NIHSS score of 3-5 (OR= 2.5, 95%CI:1.1-5.5), motor deficits (OR= 1.9, 95%CI:1.1-3.4), and ataxia (OR=3.0, CI:1.5-6.1). All patients with neglect and visual deficits were DWI positive (table). The mean lesion volume in cm3 was larger in patients with NIHSS 3-5 vs. NHSS 0-2 (49.0 vs. 17.3, p=0.002), cortical deficits (112.6 vs. 22.9, p<0.001), neglect (236.6 vs. 29.7, p<0.001), and visual deficits (245.7 vs. 26.4, p<0.001). Other subsets showed no differences. Conclusion: NIHSS score subsets predict DWI positivity and lesion volume in mild strokes. The presence of neglect or visual field deficit on the NIHSS subsets is highly likely to have an MRI correlate even in patients with low NIHSS.

Clinical-Diffusion Mismatch Is Associated with Early Neurological Improvement after Late-Window Endovascular Treatment

2021 ◽  
pp. 1-7
Author(s):  
Bum Joon Kim ◽  
Yoojin Lee ◽  
Boseong Kwon ◽  
Jun Young Chang ◽  
Yun Sun Song ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
National Institutes Of Health ◽  
Lesion Volume ◽  
Diffusion Weighted Image ◽  
Endovascular Thrombectomy ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Window Period ◽  
Score Improvement ◽  
Time Period

<b><i>Background:</i></b> Clinical-diffusion mismatch (CDM) and perfusion-diffusion mismatch (PDM) are used to select patients for endovascular thrombectomy (EVT) in the late-window period. As CDM well reflects true penumbra, we hypothesized that patients with CDM and PDM would respond better to EVT than those with PDM only at the late-window period. <b><i>Methods:</i></b> Acute ischemic stroke patients who received EVT 6–24 h after stroke onset were included. PDM (perfusion-/diffusion-weighted image (DWI) lesion volume &#x3e;1.8) was used to select candidates for EVT in this time-period in our center. CDM was defined according to the DAWN trial criteria. Response to EVT was compared between patients with and without CDM. Early neurological improvement (ENI) was defined as improvement &#x3e;4 points on National Institutes of Health Stroke Scale (NIHSS) score 1 day after EVT. Multivariable analysis was performed to investigate independent factors associated with ENI. The correlation between DWI lesion volume and NIHSS score was investigated in those with and without CDM. <b><i>Results:</i></b> Among 94 patients enrolled, all patients had PDM and 44 (46.3%) had CDM. Forty-eight patients (51.1%) showed ENI. The prevalence of hypertension, initial NIHSS score, improvement in NIHSS score after EVT, and prevalence of ENI were greater in patients with CDM than those without. ENI was independently associated with onset-to-door time (odds ratio [95% confidence interval]: 0.998 [0.997–1.000]; <i>p</i> = 0.042), complete recanalization (23.912 [2.238–255.489]; <i>p</i> = 0.009), initial NIHSS score (1.180 [1.012–1.377]; <i>p</i> = 0.034), and the presence of CDM (5.160 [1.448–18.386]; <i>p</i> = 0.011). The correlation between DWI lesion volume and initial NIHSS score was strong in patients without CDM (<i>r</i> = 0.731) but only moderate in patients with CDM (<i>r</i> = 0.355). <b><i>Conclusion:</i></b> Patients with both CDM and PDM had a better response to late-window EVT than those with PDM only.

scholarly journals Neuroprotective mechanisms of erythropoietin in a rat stroke model

2020 ◽  
Vol 11 (1) ◽  
pp. 48-59
Author(s):  
Martin Juenemann ◽  
Tobias Braun ◽  
Nadine Schleicher ◽  
Mesut Yeniguen ◽  
Patrick Schramm ◽  
...  
Keyword(s):  
Blood Flow ◽  
Infarct Size ◽  
Cerebral Edema ◽  
Infarct Volume ◽  
Artery Occlusion ◽  
Lesion Volume ◽  
Ischemic Lesion ◽  
Human Erythropoietin ◽  
Male Wistar Rats ◽  
Cerebral Artery Occlusion

AbstractObjectiveThis study was designed to investigate the indirect neuroprotective properties of recombinant human erythropoietin (rhEPO) pretreatment in a rat model of transient middle cerebral artery occlusion (MCAO).MethodsOne hundred and ten male Wistar rats were randomly assigned to four groups receiving either 5,000 IU/kg rhEPO intravenously or saline 15 minutes prior to MCAO and bilateral craniectomy or sham craniectomy. Bilateral craniectomy aimed at elimination of the space-consuming effect of postischemic edema. Diagnostic workup included neurological examination, assessment of infarct size and cerebral edema by magnetic resonance imaging, wet–dry technique, and quantification of hemispheric and local cerebral blood flow (CBF) by flat-panel volumetric computed tomography.ResultsIn the absence of craniectomy, EPO pretreatment led to a significant reduction in infarct volume (34.83 ± 9.84% vs. 25.28 ± 7.03%; p = 0.022) and midline shift (0.114 ± 0.023 cm vs. 0.083 ± 0.027 cm; p = 0.013). We observed a significant increase in regional CBF in cortical areas of the ischemic infarct (72.29 ± 24.00% vs. 105.53 ± 33.10%; p = 0.043) but not the whole hemispheres. Infarct size-independent parameters could not demonstrate a statistically significant reduction in cerebral edema with EPO treatment.ConclusionsSingle-dose pretreatment with rhEPO 5,000 IU/kg significantly reduces ischemic lesion volume and increases local CBF in penumbral areas of ischemia 24 h after transient MCAO in rats. Data suggest indirect neuroprotection from edema and the resultant pressure-reducing and blood flow-increasing effects mediated by EPO.

Abstract WP47: Reperfusion Following Ischemic Stroke is Associated with Reduced Brain Edema

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Hannah J Irvine ◽  
Thomas W Battey ◽  
Ann-Christin Ostwaldt ◽  
Bruce C Campbell ◽  
Stephen M Davis ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Brain Edema ◽  
Infarct Volume ◽  
Brain Magnetic Resonance Imaging ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Early Reperfusion ◽  
Echoplanar Imaging ◽  
Swelling Volume

Introduction: Revascularization is a robust therapy for acute ischemic stroke, but animal studies suggest that reperfusion edema may attenuate its beneficial effects. In stroke patients, early reperfusion consistently reduces infarct volume and improves long-term functional outcome, but there is little clinical data available regarding reperfusion edema. We sought to elucidate the relationship between reperfusion and brain edema in a patient cohort of moderate to severe stroke. Methods: Seventy-one patients enrolled in the Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) with serial brain magnetic resonance imaging and perfusion-weighted imaging (PWI) were analyzed. Reperfusion percentage was calculated based on the difference in PWI lesion volume at baseline and follow-up (day 3-5). Midline shift (MLS) was measured on the day 3-5 fluid attenuated inversion recovery (FLAIR) sequence. Swelling volume and infarct growth volume were assessed using region-of-interest analysis on the baseline and follow-up DWI scans based on our prior methods. Results: Greater percentage of reperfusion was associated with less MLS (Spearman ρ = -0.46; P <0.0001) and reduced swelling volume (Spearman ρ = -0.56; P <0.0001). In multivariate analysis, reperfusion was an independent predictor of less MLS ( P <0.006) and decreased swelling volume ( P <0.0054), after adjusting for age, baseline NIHSS, admission blood glucose, baseline DWI volume, and IV tPA treatment. Conclusions: Reperfusion is associated with reduced brain edema as measured by MLS and swelling volume. While our data do not exclude the possibility of reperfusion edema in certain circumstances, in stroke patients, reperfusion following acute stroke is predominantly linked to less brain swelling.

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