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Modeling diffusion-weighted imaging lesion expansion between 2 and 24 h after endovascular thrombectomy in acute ischemic stroke

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

Diffusion-weighted imaging (DWI) lesion expansion after endovascular thrombectomy (EVT) is not well characterized. We used serial diffusion-weighted magnetic resonance imaging (MRI) to measure lesion expansion between 2 and 24 h after EVT.

Methods

In this single-center observational analysis of patients with acute ischemic stroke due to large vessel occlusion, DWI was performed post-EVT (< 2 h after closure) and 24-h later. DWI lesion expansion was evaluated using multivariate generalized linear mixed modeling with various clinical moderators.

Results

We included 151 patients, of which 133 (88%) had DWI lesion expansion, defined as a positive change in lesion volume between 2 and 24 h. In an unadjusted analysis, median baseline DWI lesion volume immediately post-EVT was 15.0 mL (IQR: 6.6–36.8) and median DWI lesion volume 24 h post-EVT was 20.8 mL (IQR: 9.4–66.6), representing a median change of 6.1 mL (IQR: 1.5–17.7), or a 39% increase. There were no significant associations among univariable models of lesion expansion. Adjusted models of DWI lesion expansion demonstrated that relative lesion expansion (defined as final/initial DWI lesion volume) was consistent across eTICI scores (0–2a, 0.52%; 2b, 0.49%; 2c–3, 0.42%, p = 0.69). For every 1 mL increase in lesion volume, there was 2% odds of an increase in 90-day mRS (OR: 1.021, 95%CI [1.009, 1.034], p < 0.001).

Conclusion

We observed substantial lesion expansion post-EVT whereby relative lesion expansion was consistent across eTICI categories, and greater absolute lesion expansion was associated with worse clinical outcome. Our findings suggest that alternate endpoints for cerebroprotectant trials may be feasible.

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Data Availability

The data used to support the findings of this study are available from the corresponding author upon request.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Brown University, 593 Eddy Street Providence, Providence, RI, 02903, USA

    Nathaniel Rex, Karim Oueidat, Grayson L. Baird, Scott Collins, Gaurav Jindal, Matthew D. Alvin, Jerrold Boxerman, Mahesh Jayaraman, Wendy Smith, Amanda Amirault-Capuano & Ryan McTaggart

  2. Department of Radiology, University of Calgary, Calgary, Canada

    Nathaniel Rex, Johanna Ospel, Rosalie McDonough, Leon Rinkel, Phil Barber & Mayank Goyal

  3. Department of Clinical Neuroscience, University of Calgary, Calgary, Canada

    Michael Hill

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  1. Nathaniel Rex
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Corresponding author

Correspondence to Ryan McTaggart.

Ethics declarations

Ethics approval

This study was approved by the Rhode Island Hospital Institutional Review Board. This study was performed in line with the principles of the Declaration of Helsinki.

Informed consent

After review by the IRB, the need for informed consent was waived due to the retrospective nature of this study.

Conflict of interest

Nathaniel Rex does not report any conflicts of interest.

Karim Oueidat does not report any conflicts of interest.

Johanna Ospel does not report any conflicts of interest.

Rosalie McDonough does not report any conflicts of interest.

Leon Rinkel does not report any conflicts of interest.

Grayson Baird does not report any conflicts of interest.

Scott Collins does not report any conflicts of interest.

Gaurav Jindal does not report any conflicts of interest.

Matthew Alvin does not report any conflicts of interest.

Jerrold Boxerman does not report any conflicts of interest.

Phil Barber does not report any conflicts of interest.

Mahesh Jayaraman does not report any conflicts of interest.

Wendy Smith does not report any conflicts of interest.

Amanda Amirault-Capuano does not report any conflicts of interest.

Michael Hill reports grants from Canadian Institutes for Health Research, Alberta Innovates, and NoNO, for the conduct of the study; reports personal fees from Merck; reports non-financial support from Hoffmann-La Roche Canada; reports grants from Covidien (Medtronic), Boehringer-Ingleheim, Stryker, and Medtronic, outside the submitted work; reports a patent for systems and methods for assisting in decision-making and triaging for acute stroke patients, issued to US Patent office Number 62/086,077; owns stock in Calgary Scientific; is a director of the Canadian Federation of Neurological Sciences and Circle NeuroVascular; and has received grant support from Alberta Innovates Health Solutions, CIHR, Heart & Stroke Foundation of Canada, and the National Institutes of Neurological Disorders and Stroke. CGM holds stock from NoNO.

Mayank Goyal reports personal fees from Medtronic, Stryker, Microvention, and Mentice, during the conduct of the study; unrestricted research grants to University of Calgary from NoNO, Stryker, and Medtronic; patents for a system of acute stroke diagnosis, with royalties paid to GE Healthcare, and a system of simulation for acute neurointervention, with royalties paid to Mentice; and ownership interest in Circle Neurovascular.

Ryan McTaggart does not report any conflicts of interest.

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Nathaniel Rex and Karim Oueidat are co-first authors.

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Rex, N., Oueidat, K., Ospel, J. et al. Modeling diffusion-weighted imaging lesion expansion between 2 and 24 h after endovascular thrombectomy in acute ischemic stroke. Neuroradiology 66, 621–629 (2024). https://doi.org/10.1007/s00234-024-03294-2

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