Abstract WMP81: Low Dose tPA Worsens The Short Term Outcomes After Thromboembolic Stroke In Both Male And Female Diabetic Animals

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Weiguo Li ◽  
John Paul Valenzuela ◽  
Guangkuo Dong ◽  
Rebecca Ward ◽  
Susan C Fagan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Infarct Size ◽  
Functional Outcome ◽  
Low Dose ◽  
Hemorrhagic Transformation ◽  
Artery Occlusion ◽  
Diabetic Rats ◽  
Embolic Stroke ◽  
Neurological Deficits ◽  
Male And Female

Diabetes worsens stroke outcome and increases the risk of hemorrhagic transformation (HT) after ischemic stroke, especially with tPA treatment. We previously showed that low dose tPA decreased infarct size and improved functional outcome in both male and female control rats with embolic stroke. In the current study, we hypothesized that low dose tPA will also improve the functional recovery after the embolic stroke in both male and female animals with diabetes. Diabetes was induced in age matched male and female Wistar rats with high fat diet and low dose streptozotocin (30 mg/kg, i.p.). Embolic stroke was induced with middle cerebral artery occlusion. The animals were treated with or without tPA (1 mg/kg, i.v.) at 90 min after surgery. Neurological deficits (composite score and adhesive removal test-ART), infarct size, edema ratio, and HT index were assessed 3 days after surgery. The blood flow has increased in the tPA treated animals in the first 1 to 1.5 hr after treatment. The infarct size and edema was not significantly different in untreated animals, but HT was greater in female diabetic rats. The tPA treatment worsened HT in both genders with no change in infarct size. Decline in ART was worsened with tPA treatment in both sexes. Our data suggest that the low dose tPA after ischemic stroke has detrimental effects on the cerebrovascular recovery and functional outcome in both male and female animals with diabetes.

Abstract WP291: Diabetes Impairs Long-term Functional Recovery in an Embolic Stroke Model in Sex Independent Manner

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Weiguo Li ◽  
Sherif Hafez ◽  
John Paul Valenzuela ◽  
Rebecca Ward ◽  
Guangkuo Dong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Recovery ◽  
Hemorrhagic Transformation ◽  
Cognitive Outcome ◽  
Embolic Stroke ◽  
Neurological Deficits ◽  
Independent Manner ◽  
Male And Female ◽  
The Impact

Ischemic stroke is a leading cause of death and disability. Diabetes not only increases the risk of stroke, it also worsens the outcomes, increases the risk of hemorrhagic transformation (HT) and impairs recovery after stroke. It is well established that young females are more protected and show better outcomes than males after stroke. However, the impact of diabetes on long term recovery after stroke in both sexes was not clear. Accordingly, this study tested the hypothesis that diabetes impairs long term functional recovery after ischemic stroke in a sex independent manner. Methods: Diabetes was induced in male and female Wistar rats using high fat diet and low dose streptozotocin (30 mg/Kg). After 8 weeks of diabetes, animals were subjected to embolic stroke. Male and female Wistar normoglycemic age matched rats were used as controls. Motor (composite score: 14 best outcome and adhesive removal-ART) and cognitive (novel object recognition, NOR) deficits were assessed at day1, 3, 7 and 14. Results: Female control animals had better outcomes compared to the males. Mortality was higher in diabetic animals, especially in males. The neurological deficits were greater in diabetic animals with no difference between males and females. Conclusion: Diabetes impaired functional and cognitive outcome and recovery after ischemic stroke in a sex independent manner.

Abstract TP33: Ischemic Stroke Outcomes in Medical vs Endovascular Treatment of Proximal Carotid Artery Occlusion

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Yamin Shwe ◽  
Chunyan Cai ◽  
Anjail Z Sharrief ◽  
Amrou Sarrraj
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Endovascular Treatment ◽  
Small Sample Size ◽  
Retrospective Chart Review ◽  
Hemorrhagic Transformation ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Small Sample ◽  
Neurological Deficits

Background: Acute ischemic stroke (AIS) due to proximal carotid artery occlusion (pCAO) can be associated with significant neurological deficits and poor outcome without timely intervention and successful reperfusion. Intravenous thrombolytics (IT) have low recanalization rates in pCAO and these patients were excluded from recent randomized controlled trials which showed superiority of endovascular therapy (EVT) over IT. Purpose: The purpose of this study is to investigate clinical outcomes in AIS due to pCAO treated with medical vs. endovascular treatment. Methods: We conducted a retrospective chart review of patients who underwent IT or EVT±IT for all types of pCAO from January 2008 to June 2015. Our primary outcome was the functional outcome at discharge measured by modified Rankin score (mRS) 0-3. The secondary outcomes were hemorrhagic transformation (HT), neurological worsening (NW), symptomatic hemorrhage (sICH) and death. Logistic regression analysis was used to compare outcomes between the two groups. Results: A total of 133 patients were included in the study. Baseline characteristics are depicted in table 1. There were no significant differences between the two groups. IV tPA was given in 56% IT vs. 72% EVT (p=0.14). While there was a shift towards better outcomes in the mRS distribution in EVT group (22% vs. 16%) as shown in Figure 1, the treatment effect did not reach significance (OR 1.71, 95% CI (0.55, 5.34), p=0.35). There was also no difference in HT (26% vs. 14%, p=0.14), or NW (26% vs. 21%, p=0.6). However, sICH was higher in EVT (3.7% vs. 0%, p=0.2). Conclusion: Our study did not show difference in discharge functional outcomes between EVT and IT in AIS with pCAO. Our results are limited by small sample size and retrospective nature. Future prospective studies randomizing patients to medical vs. endovascular treatments are warranted to guide management.

Abstract T P212: The Impact of the Method of Ischemia/reperfusion Injury on Stroke Outcomes in Type 2 Diabetes

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Weiguo Li ◽  
Zhi Qu ◽  
Handong Ma ◽  
Roshini Prakash ◽  
Md Nasrul Hoda ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Infarct Size ◽  
Functional Outcome ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Artery Occlusion ◽  
Motor Deficit ◽  
Vascular Protection ◽  
Gk Rats ◽  
The Impact

Diabetes worsens functional outcome after ischemic stroke and is associated with greater hemorrhagic transformation (HT) occurrence. We have shown that male diabetic Goto-Kakizaki (GK) rats develop greater HT and neurological deficit despite smaller infarcts after temporary (3/21 hr) middle cerebral artery occlusion (MCAO) induced by the suture model. The impact of the duration of ischemia/reperfusion (I/R) and the method of ischemia on neurovascular injury and functional outcome in diabetic stroke remain unknown. To address this gap, control Wistar and diabetic GK rats were subjected to 90 min/23 hr, 3 hr/21 hr, or 3 hr/7 day MCAO by suture occlusion or embolus placement. In all groups, infarct size, edema, HT occurrence and severity (hemoglobin level), and functional outcome (grip strength and composite deficit score) were measured (Table). Infarct size was smaller in GK rats with suture or embolic MCAO, but expanded with longer reperfusion period. Edema, HT occurrence and severity were all increased in GK rats after 90 min and 3 hr occlusion with the suture model, but not in the embolic MCAO. Motor deficit was greater in diabetic rats. These findings suggest that diabetes accelerates the development of HT and amplifies vascular damage especially in the suture model where blood flow is rapidly reestablished. These results highlight the importance of earlier vascular protection to improve neurological outcome of acute ischemic stroke in diabetes.

Abstract P781: Ischemic Postconditioning Protects Against Hemorrhagic Transformation Induced by Hyperglycemia in Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Hansen Chen ◽  
Michelle Y Cheng ◽  
Tonya Bliss ◽  
Heng Zhao ◽  
Gary Steinberg
Keyword(s):  
Ischemic Stroke ◽  
Mortality Rate ◽  
Infarct Size ◽  
Brain Edema ◽  
Neurological Deficit ◽  
Hemorrhagic Transformation ◽  
Artery Occlusion ◽  
Ischemic Postconditioning ◽  
Brain Infarct ◽  
Acute Hyperglycemia

Background: Hyperglycemia occurs in over 40% of ischemic stroke patients, which induces hemorrhagic transformation (HT) and worsens stroke outcomes. The management of hyperglycemia with insulin did not show favorable outcomes. Thus, strategies for managing hyperglycemia-exacerbated stroke injury are urgently needed. We previously demonstrated that ischemic postconditioning (IPostC) (repeated transient interruption of cerebral blood flow during reperfusion) can reduce brain infarct size and improve neurological outcomes. In this study, we hypothesized that IPostC can reduce HT in ischemic stroke with acute hyperglycemia. Method: Male mice were subjected to middle cerebral artery occlusion (MCAO) for 1 hour, followed by reperfusion to mimic ischemic stroke. Glucose was injected before MCAO to induce hyperglycemia. IPostC was initiated upon reperfusion with 3 cycles of 30-second reperfusion followed by 10 seconds of MCA occlusion. Brain infarct was visualized by TTC staining and quantitated using Image J. Hemorrhagic transformation was evaluated by hemorrhagic scores. Result: Acute hyperglycemia significantly increased the brain infarct size (by 25%, p<0.01), brain edema (p<0.001) and hemorrhagic transformation (HT) (average HT scores: 0.75 in MCAO group vs 15.6 in MCAO plus hyperglycemia group, p<0.001), Mice with hyperglycemia also exhibited more severe neurological deficit and higher mortality rate at 24 hours after MCAO. 2) IPostC treatment significantly reduced brain infarct size (p<0.01), brain edema (p<0.05) and attenuated HT (p<0.001). Neurological deficit and mortality rate was reduced with IPostC treatment. Conclusion: Our findings suggest that IPostC can counteract the effects of acute hyperglycemia and reduce brain injury, edema and HT after stroke. Grant/Other Support: NIH Grant R01NS064136C

scholarly journals Targets of vascular protection in acute ischemic stroke differ in type 2 diabetes

2013 ◽  
Vol 304 (6) ◽  
pp. H806-H815 ◽  
Author(s):  
Aisha I. Kelly-Cobbs ◽  
Roshini Prakash ◽  
Weiguo Li ◽  
Bindu Pillai ◽  
Sherif Hafez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Hemorrhagic Transformation ◽  
Artery Occlusion ◽  
Neurological Deficits ◽  
Diabetic Patients ◽  
Vascular Protection ◽  
Acute Therapy

Hemorrhagic transformation is an important complication of acute ischemic stroke, particularly in diabetic patients receiving thrombolytic treatment with tissue plasminogen activator, the only approved drug for the treatment of acute ischemic stroke. The objective of the present study was to determine the effects of acute manipulation of potential targets for vascular protection [i.e., NF-κB, peroxynitrite, and matrix metalloproteinases (MMPs)] on vascular injury and functional outcome in a diabetic model of cerebral ischemia. Ischemia was induced by middle cerebral artery occlusion in control and type 2 diabetic Goto-Kakizaki rats. Treatment groups received a single dose of the peroxynitrite decomposition catalyst 5,10,15,20-tetrakis(4-sulfonatophenyl)prophyrinato iron (III), the nonspecific NF-κB inhibitor curcumin, or the broad-spectrum MMP inhibitor minocycline at reperfusion. Poststroke infarct volume, edema, hemorrhage, neurological deficits, and MMP-9 activity were evaluated. All acute treatments reduced MMP-9 and hemorrhagic transformation in diabetic groups. In addition, acute curcumin and minocycline therapy reduced edema in these animals. Improved neurological function was observed in varying degrees with treatment, as indicated by beam-walk performance, modified Bederson scores, and grip strength; however, infarct size was similar to untreated diabetic animals. In control animals, all treatments reduced MMP-9 activity, yet bleeding was not improved. Neuroprotection was only conferred by curcumin and minocycline. Uncovering the underlying mechanisms contributing to the success of acute therapy in diabetes will advance tailored stroke therapies.

scholarly journals Low-Dose Activated Protein C Suppresses the Development of Cerebral Infarction and Neurological Deficits in Mice

2020 ◽  
Vol 1 (4) ◽  
Author(s):  
Keiko Yamato ◽  
Yukako Nakajo ◽  
Hitomi Yamamoto-Imoto ◽  
Koichi Kokame ◽  
Toshiyuki Miyata ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Protein C ◽  
Low Dose ◽  
Activated Protein C ◽  
Chronic Phase ◽  
Hemorrhagic Transformation ◽  
Neurological Deficits ◽  
High Dose ◽  
Vessel Occlusion ◽  
Significant Attenuation

Abstract BACKGROUND A large prospective study previously reported that a higher plasma level of protein C (PC) was associated with a lower incidence of ischemic stroke. OBJECTIVE To investigate the neuroprotective properties of activated PC (APC) against acute ischemic stroke using the 3-vessel occlusion model. METHODS Male C57BL/6J mice received APC (human APC) at 0.25, 0.5, or 1.0 (low dose) or 2.0, 4.0, or 8.0 mg/kg (high dose). Edaravone (Eda) (1.0, 3.0, or 10 mg/kg, a neuroprotectant approved for use in Japan), albumin (2.0 mg/kg), heparin (100 or 600 U/kg), or saline was used as the control. The drug or control was administered intravenously twice in the initial 24 h or 5 times in 3 d, starting 5 min after the induction of ischemia. RESULTS Low-dose APC significantly reduced lesion volumes, not affecting the depth of ischemia. High-dose APC did not significantly reduce lesion volumes, causing hemorrhagic transformation in some cases. In the chronic phase, lesion volumes were significantly suppressed in the APC or Eda group, and only the APC group showed a significant attenuation of neurological deficits. The protease-activated receptor (PAR)-1 antagonist SCH79797, administered during preischemia, completely abolished APC-induced neuroprotection. The overshoot-like abrupt recovery in regional cerebral blood flow observed in the control in the initial reperfusion phase was significantly suppressed by the APC treatment, indicating that the cerebral autoregulation system, consisting of endothelial cells and blood-brain barrier functions, was preserved. CONCLUSION Low-dose APC, potentially via the PAR-1-dependent anti-inflammatory cascade, protects the brain against ischemic stroke without increasing the risk of hemorrhagic transformation or death.

Abstract WP294: Deferoxamine Treatment Improves Outcomes After Embolic Stroke in Diabetic Rats

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Weiguo Li ◽  
John Paul Valenzuela ◽  
Guangkuo Dong ◽  
Yasir Abdul ◽  
Rebecca Ward ◽  
...  
Keyword(s):  
Iron Chelation ◽  
Hemorrhagic Transformation ◽  
Artery Occlusion ◽  
Diabetic Rats ◽  
Embolic Stroke ◽  
High Risk Population ◽  
Excess Iron ◽  
Male Wistar Rats ◽  
Poor Outcomes ◽  
Cerebral Ischemic

Diabetes increases the risk of hemorrhagic transformation (HT) after a cerebral ischemic event, a major factor limiting the use of tissue plasminogen activator (tPA) for stroke patients. We previously showed that increased HT is associated with poorer recovery in diabetes. In the current study, we hypothesized that excess iron contributes to poor recovery and that iron chelation with deferoxamine (DFX) will improve the neurological recovery after embolic stroke in diabetes. Diabetes was induced with high fat diet and low dose streptozotocin injection (30 mg/kg) in male Wistar rats. Both control and diabetes animals were subjected to embolic stroke with middle cerebral artery occlusion and sacrificed 2 weeks after the surgery. DFX (100 mg/kg) or vehicle was given every 12 h for 7 days after stroke. The composite score (Bederson’s score and beam walk), adhesive removal (ART) and novel object recognition (NOR) were assessed at day 1, 3, 7 and 14 after the surgery. DFX reduced mortality in diabetes. Diabetic animals displayed poor outcomes. By Day 14, DFX reduced motor and cognitive deficits in diabetes but not in controls. These results suggest that iron chelation therapy may improve outcomes after ischemic stroke in this high risk population.

Abstract WP7: Leukoaraiosis And Outcomes After Intra-arterial Therapy In Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Dan-Victor V Giurgiutiu ◽  
Albert J Yoo ◽  
Kaitlin Fitzpatrick ◽  
Zeshan Chaudhry ◽  
Lee H Schwamm ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Artery Occlusion ◽  
Post Stroke ◽  
Good Functional Outcome ◽  
Grade 3 ◽  
Risk Of Hemorrhage

Background: Selecting patients most likely to benefit (MLTB) from intra-arterial therapy (IAT) is essential to assure favorable outcomes after intervention for acute ischemic stroke (AIS). Leukoaraiosis (LA) has been linked to infarct growth, risk of hemorrhage after IV rt-PA, and poor post-stroke outcomes. We investigated whether LA severity is associated with AIS outcomes after IAT. Methods: We analyzed consecutive AIS subjects from our institutional GWTG-Stroke database enrolled between 01/01/2007-06/30/2009, who met our pre-specified criteria for MLTB: CTA and MRI within 6 hours from last known well, NIHSS score ≥8, baseline DWI volume (DWIv) ≤ 100 cc, and proximal artery occlusion and were treated with IAT. LA volume (LAv) was assessed on FLAIR using validated, semi-automated protocols. We analyzed CTA to assess collateral grade; post-IAT angiogram for recanalization status (TICI score ≥2B); and the 24-hour CT for symptomatic ICH (sICH). Logistic regression was used to determine independent predictors of good functional outcome (mRS≤ 2) and mortality at 90 days post-stroke. Results: There were 48 AIS subjects in this analysis (mean age 69.2, SD±13.8; 55% male; median LAv 4cc, IQR 2.2-8.8cc; median NIHSS 15, IQR 13-19; median DWIv 15.4cc, IQR 9.2-20.3cc). Of these, 34 (72%) received IV rt-PA; 3 (6%) had sICH; 21 (44.7%) recanalized; and 23 (50%) had collateral grade ≥3. At 90 days, 15/48 (36.6%) were deceased and 15/48 had mRS≤ 2. In univariate analysis, recanalization (OR 6.2, 95%CI 1.5-25.5), NIHSS (OR 0.8 per point, 95%CI 0.64-0.95), age (OR 0.95 per yr, 95%CI 0.89-0.99) were associated with good outcome, whereas age (OR 1.1, 95%CI 1.01-1.14) and HTN (OR 5.6, 95%CI 1.04-29.8) were associated with mortality. In multivariable analysis including age, NIHSS, recanalization, collateral grade, and LAv, only recanalization independently predicted good functional outcome (OR 21.3, 95%CI 2.3-199.9) and reduced mortality (OR 0.15, 95%CI 0.02-1.12) after IAT. Conclusions: LA severity is not associated with poor outcome in patients selected MLTB for IAT. Among AIS patients considered likely to benefit from IAT, only recanalization independently predicted good functional outcome and decreased mortality.

Abstract W MP96: Low Dose Tissue Plasminogen Activator Amplifies Vascular Injury and Worsens Functional Outcomes in Acute Hyperglycemic Stroke Independent of the Model of Reperfusion

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Sherif Hafez ◽  
Md Nasrul Hoda ◽  
Xinyue Guo ◽  
Susan Fagan ◽  
Adviye Ergul
Keyword(s):  
Infarct Size ◽  
Vascular Injury ◽  
Functional Outcomes ◽  
Low Dose ◽  
Hemorrhagic Transformation ◽  
Occurrence Rate ◽  
Translational Study ◽  
Flow Monitoring ◽  
Tissue Plasminogen ◽  
Tissue Hemoglobin

Clinically, hyperglycemia (HG) exacerbates reperfusion injury and aggravates tPA-induced hemorrhagic transformation (HT). Yet, most of the experimental hyperglycemic stroke studies exclusively employed suture occlusion model. Only few studies involved tPA in hyperglycemic setting and employed a 10-fold higher dose of tPA than that is used in patients. Thus, in this translational study using suture and thromboembolic occlusion of middle cerebral artery (MCA), with and without human tPA dose, we tested the hypothesis that even acute mild HG worsens the neurovascular injury and functional outcomes irrespective of the method of reperfusion, and that the use of low dose tPA amplifies this injury. Methods: Control and mildly HG rats (140-200 mg/dl, achieved by 30% glucose ip injection 15 min prior to surgery, n=7-9/group) were subjected to MCA occlusion by either suture (90 min) or humanized clot and 24 h reperfusion. tPA (1mg/kg) was injected IV 2 h after induction of ischemia. At 24 h, neurological deficit, infarct size, edema, HT occurrence rate (HT index) and tissue hemoglobin (Hb) were measured. Results: Cerebral blood flow monitoring indicated that % drop at occlusion were similar across the groups and that low dose tPA effectively resolved the clot in the embolic model. tPA did not increase the infarct size in either control or hyperglycemic animals when compared to no tPA groups (Table). HG increased vascular injury (HT index and Hb content) in both suture and embolic occlusion models. The combination of HG and tPA exacerbated the vascular injury and worsened functional outcomes more than each alone. Conclusion: The interaction between HG and even low dose tPA has a significant deleterious effect on cerebrovasculature and functional outcomes independent of the method of reperfusion.

Abstract WMP17: Computerized Tomography Perfusion to Characterize Lack of Clinical Improvement After Recanalization in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alvaro Garcia-Tornel ◽  
Marta Olive-Gadea ◽  
Marc Ribo ◽  
David Rodriguez-Luna ◽  
Jorge Pagola ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Infarct Volume ◽  
Significant Proportion ◽  
Hemorrhagic Transformation ◽  
Vessel Occlusion ◽  
Clinical Recovery ◽  
Good Functional Outcome ◽  
Significant Difference

A significant proportion of patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) present poor functional outcome despite recanalization. We aim to investigate computed tomography perfusion (CTP) patterns after EVT and their association with outcome Methods: Prospective study of anterior large vessel occlusion AIS patients who achieved complete recanalization (defined as modified Thrombolysis in Cerebral Ischemia (TICI) 2b - 3) after EVT. CTP was performed within 30 minutes post-EVT recanalization (POST-CTP): hypoperfusion was defined as volume of time to maximal arrival of contrast (Tmax) delay ≥6 seconds in the affected territory. Hyperperfusion was defined as visual increase in cerebral blood flow (CBF) and volume (CBV) with advanced Tmax compared with the unaffected hemisphere. Dramatic clinical recovery (DCR) was defined as a decrease of ≥8 points in NIHSS score at 24h or NIHSS≤2 and good functional outcome by mRS ≤2 at 3 months. Results: One-hundred and forty-one patients were included. 49 (34.7%) patients did not have any perfusion abnormality on POST-CTP, 60 (42.5%) showed hypoperfusion (median volume Tmax≥6s 17.5cc, IQR 6-45cc) and 32 (22.8%) hyperperfusion. DCR appeared in 56% of patients and good functional outcome in 55.3%. Post-EVT hypoperfusion was related with worse final TICI, and associated worse early clinical evolution, larger final infarct volume (p<0.01 for all) and was an independent predictor of functional outcome (OR 0.98, CI 0.97-0.99, p=0.01). Furthermore, POST-CTP identified patients with delayed improvement: in patients without DCR (n=62, 44%), there was a significant difference in post-EVT hypoperfusion volume according to functional outcome (hypoperfusion volume of 2cc in good outcome vs 11cc in poor outcome, OR 0.97 CI 0.93-0.99, p=0.04), adjusted by confounding factors. Hyperperfusion was not associated with worse outcome (p=0.45) nor symptomatic hemorrhagic transformation (p=0.55). Conclusion: Hypoperfusion volume after EVT is an accurate predictor of functional outcome. In patients without dramatic clinical recovery, hypoperfusion predicts good functional outcome and defines a “stunned-brain” pattern. POST-CTP may help to select EVT patients for additional therapies.

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