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Abstract Details

Infarct Topography and Reperfusion Injury After Endovascular Thrombectomy for Large Vessel Occlusion Stroke
Cerebrovascular Disease and Interventional Neurology
S20 - Cerebrovascular Disease and Interventional Neurology: Clinical Trials and Outcomes Studies (3:42 PM-3:54 PM)
002
With continued expansion in indications for EVT, understanding the pathophysiology of reperfusion injury and HT becomes increasingly important. Pre-EVT infarct topography may have implications for treatment decisions acutely (e.g. stenting), and with post EVT care (e.g. antithrombotics). 
To quantify region-specific volumes of infarcted tissue on MRI pre-endovascular thrombectomy (EVT), understand their importance for reperfusion injury and hemorrhagic transformation (HT), and identify associations with clinical and imaging characteristics. 
Patients were identified from a prospectively maintained database. Each patient’s diffusion weighted sequence underwent manual infarct delineation and was registered to a standard space for overlay with cortical, subcortical, and white matter atlases. HT was defined as ECASS PH1 or PH2. Variables with p<0.10 in univariate analyses were included in multivariable models. 
165 participants [median age 69 (IQR 56-79), 56% women] were identified. Intravenous alteplase was administered to 52%; 70% achieved TICI 2b-3 reperfusion. HT occurred in 8%. The distribution of pre-EVT infarcts was 48% (38-60%) white matter, 23% (6-47%) cortex, and 15% (4-28%) basal ganglia. Pre-EVT infarct volumes [median (IQR)] were 22 cc (12-43 cc) for total, 11 cc (6-19 cc) for white matter, 5 cc (1-19 cc) for cortex, and 3 cc (1-6 cc) for basal ganglia infarct. Paramagnetic sequences showed 3% had petechial hemorrhage and 40% had susceptibility vessel sign. Basal ganglia infarct volume was independently associated with HT (OR=1.342, 95%CI=1.002,1.797) in a model including white matter infarct volume, cortex infarct volume, smoking, and puncture-to-recanalization time. Basal ganglia infarct volume was linked to susceptibility vessel sign (Beta=0.233, p=0.006) and NIHSS (Beta=0.220, p=0.012), when controlling for total infarct volume. 

Greater basal ganglia infarct volume was associated with a higher risk of HT when accounting for infarct volumes in other regions. Susceptibility vessel sign was associated with basal ganglia infarct volume, which may be related to acute middle cerebral artery perforator occlusion. 

Authors/Disclosures
Robert W. Regenhardt, MD, PhD (Massachusetts General Hospital)
PRESENTER
Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Johnson and Bell Trial Lawyers. The institution of Dr. Regenhardt has received research support from National Institutes of Health. The institution of Dr. Regenhardt has received research support from Society of Vascular and Interventional Neurology. The institution of Dr. Regenhardt has received research support from Heitman Foundation.
Anna Katharina Bonkhoff, MD (Mass General Brigham) Dr. Bonkhoff has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NeuroImage Clinical (Elsevier).
Markus D. Schirmer, PhD (Massachusetts General Hospital) Dr. Schirmer has nothing to disclose.
Alvin Das, MD (Beth Israel Deaconess Medical Center) Dr. Das has nothing to disclose.
Adam A. Dmytriw, MD (Massachusetts General Hospital) Dr. Dmytriw has nothing to disclose.
Justin E. Vranic, MD (Massachusetts General Hospital) Dr. Vranic has nothing to disclose.
Rajiv Gupta, MD,PhD (Massachusetts General Hospital and Harvard Medical School) Dr. Gupta has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for • Idorsia, Inc. Dr. Gupta has received personal compensation in the range of $0-$499 for serving as a Consultant for Mosaic Research Management. Dr. Gupta has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Braintale Inc. Dr. Gupta has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Siemens Medical Solutions, USA. Dr. Gupta has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Mary Hitchcock Memorial Hospital. The institution of Dr. Gupta has received research support from Samsung.
James D. Rabinov James D. Rabinov has stock in Pfizer.
Christopher Stapleton, MD (Massachusetts General Hospital) Dr. Stapleton has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll Circulation.
Thabele M. Leslie-Mazwi, MD Dr. Leslie-Mazwi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for World Care Clinical. Dr. Leslie-Mazwi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Phillips Health Care. Dr. Leslie-Mazwi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for IQVIA. Dr. Leslie-Mazwi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll.
Aman Patel Aman Patel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Penumbra. Aman Patel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Microvention. Aman Patel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. The institution of Aman Patel has received research support from Siemens.
Natalia S. Rost, MD, MPH, FAAN, FAHA (Massachusetts General Hospital) Dr. Rost has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for American Academy of Neurology. Dr. Rost has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care.