Reperfusion Injury Is Associated With Poor Outcome in Patients With Recanalization After Thrombectomy

Ying Zhou; Yaode He; Shenqiang Yan; Lin Chen; Ruoxia Zhang; Jinjin Xu; Haitao Hu; David S Liebeskind; Min Lou

doi:10.1161/STROKEAHA.122.039337

Reperfusion Injury Is Associated With Poor Outcome in Patients With Recanalization After Thrombectomy

Stroke. 2023 Jan;54(1):96-104. doi: 10.1161/STROKEAHA.122.039337. Epub 2022 Nov 11.

Authors

Ying Zhou^#¹, Yaode He^#¹, Shenqiang Yan^#¹, Lin Chen¹, Ruoxia Zhang¹, Jinjin Xu¹, Haitao Hu¹, David S Liebeskind², Min Lou¹

Affiliations

¹ Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (Y.Z., Y.H., S.Y., L.C., R.Z., J.X., H.H., M.L.).
² University of California-Los Angeles Stroke Center (D.S.L.).

^# Contributed equally.

PMID: 36367100
DOI: 10.1161/STROKEAHA.122.039337

Abstract

Background: The existence of cerebral reperfusion injury in human beings remains controversial. Thus, we aimed to explore the presence of reperfusion injury in acute ischemic stroke patients with recanalization after mechanical thrombectomy and analyzed its impact on neurological outcome.

Methods: We reviewed our prospectively collected database CIPPIS (Comparison Influence to Prognosis of CTP and MRP in AIS Patients, NCT03367286), and enrolled anterior circulation large artery occlusion patients with recanalization after mechanical thrombectomy who underwent (1) computed tomography (CT) perfusion on admission and immediately after recanalization to determine reperfusion region, and (2) CT and/or magnetic resonance imaging (MRI) immediately and 24 hours after recanalization to determine lesion areas. The expansion of lesion between recanalization and 24 hours within reperfusion region was potentially caused by reperfusion, thus termed as radiological observed reperfusion injury (RORI). Based on the imaging modality immediately after recanalization, RORI was further divided into RORI_CT and RORI_MRI. We first included a small cohort who had performed both CT and MRI immediately after recanalization to validate the consistency between RORI_CT and RORI_MRI (Study 1). Then the association with RORI_CT and poor outcome, defined as 3-month modified Rankin Scale score of 3 to 6, was explored in a larger cohort (Study 2).

Results: Study 1 included 23 patients and good consistency was found between RORI_CT and RORI_MRI (intraclass correlation=0.97, P<0.001). Among 226 patients included in Study 2, a total of 106 (46.9%) were identified with RORI. The ratio of RORI to reperfusion region was 30.1 (16.2, 51.0)% and was independently associated with poor outcome (odds ratio=1.55 per 10% [95% CI' 1.30-1.84]; P<0.001).

Conclusions: Our findings suggested that RORI was relatively frequent in stroke patients with recanalization after mechanical thrombectomy and associated with poor outcome despite successful recanalization.

Registration: URL: https://www.

Clinicaltrials: gov; Unique identifier: NCT03367286.

Keywords: acute ischemic stroke; hemorrhage; mechanical thrombectomy; recanalization; reperfusion injury.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Brain Ischemia* / diagnostic imaging
Brain Ischemia* / surgery
Humans
Ischemic Stroke*
Reperfusion
Reperfusion Injury*
Retrospective Studies
Stroke* / diagnostic imaging
Stroke* / surgery
Thrombectomy / methods
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT03367286