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Angiographic early hyperemia in the middle cerebral artery territory after thrombectomy is associated with favorable clinical outcome in anterior circulation stroke

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Abstract

Objectives

Angiographic cortical early hyperemia (EH) is frequently observed after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke. The aim of the study is to investigate the relationship between EH and clinical outcomes.

Methods

Between January 2015 and September 2018, consecutive patients who underwent EVT for anterior circulation LVO stroke with optimal recanalization (modified thrombolysis in cerebral infarction 2b or 3) were included. Angiographic studies after immediate reperfusion were used for analysis for cortical EH sign. Clinical functional outcomes were evaluated with the modified Rankin Scale (mRS) at 90 days. Safety outcomes, including mortality and intracerebral hemorrhage, were assessed. The association of EH between clinical functional and safety outcomes was analyzed.

Results

A total of 143 patients were analyzed (mean age: 71 years; median National Institutes of Health Stroke Scale score: 18). A positive EH sign was observed in 88 (62%) patients. Good functional outcome at 90 days was significantly different between the EH+ and EH− groups (p = .0157). Intracerebral hemorrhage and mortality did not differ between groups. In multivariate logistic regression analysis, EH was an independent predictor for good clinical outcome (mRS ≤ 2, odds ratio: 3.49, p = .0034) in addition to young age.

Conclusion

Results revealed that the presence of EH is associated with better clinical outcome at 90 days, but not associated with increased hemorrhagic complication. These findings with clinically relevant implications require further validation.

Key Points

• Angiographic cortical hyperemia is a common finding immediately after endovascular thrombectomy.

• Presence of cortical hyperemia is an independent prognostic factor for good clinical outcome.

• Hemorrhagic complication is not associated with cortical hyperemia.

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Abbreviations

ASPECTS:

Alberta Stroke Program Early CT Score

CHM:

Cochran–Mantel–Haenszel

DSA:

Digital subtraction angiography

EH:

Early hyperemia

EVT:

Endovascular thrombectomy

ICA:

Internal carotid artery

IV-tPA:

Intravenous tissue plasminogen activator

LVO:

Large vessel occlusion

MCA:

Middle cerebral artery

mRS:

Modified Rankin Scale

mTICI:

Modified thrombolysis in cerebral infarction

NIHSS:

National Institutes of Health Stroke Scale

PH:

Parenchymal hemorrhage

sICH:

Symptomatic intracerebral hemorrhage

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Acknowledgements

This manuscript was edited by Wallace Academic Editing.

Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

  1. Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10055, Taiwan

    Yen-Heng Lin & Chung-Wei Lee

  2. Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan

    Sung-Chun Tang, Chih-Hao Chen, Li-Kai Tsai & Jiann-Shing Jeng

  3. Department of Medical Imaging, National Taiwan University Hospital Yunlin Branch, Douliu City, Yunlin, Taiwan

    Chi-Ju Lu

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  1. Yen-Heng Lin
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Corresponding author

Correspondence to Chung-Wei Lee.

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Guarantor

The scientific guarantors of this publication are Dr. Chung-Wei Lee and Dr. Sung-Chun Tang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Two of the authors have significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

The study was approved by the research ethics committee of the National Taiwan University Hospital (approval number: RIND9561703046).

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Journal of the Formosan Medical Association (2017) [13].

Methodology

• retrospective

• observational

• performed at one institution

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Lin, YH., Tang, SC., Chen, CH. et al. Angiographic early hyperemia in the middle cerebral artery territory after thrombectomy is associated with favorable clinical outcome in anterior circulation stroke. Eur Radiol 31, 5281–5288 (2021). https://doi.org/10.1007/s00330-020-07578-y

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  • DOI: https://doi.org/10.1007/s00330-020-07578-y

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