RT Journal Article
SR Electronic
T1 Identifying Severe Stroke Patients Likely to Benefit From Thrombectomy Despite Delays of up to a Day
JF bioRxiv
FD Cold Spring Harbor Laboratory
SP 526947
DO 10.1101/526947
A1 R. Gilberto González
A1 Gisele Sampaio Silva
A1 Julian He
A1 Saloomeh Sadaghiani
A1 Ona Wu
A1 Aneesh B. Singhal
YR 2020
UL http://biorxiv.org/content/early/2020/02/21/526947.abstract
AB 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.