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Radiologic Cerebral Reperfusion at 24 h Predicts Good Clinical Outcome

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Abstract

Cerebral reperfusion and arterial recanalization are radiological features of the effectiveness of thrombolysis in acute ischemic stroke (AIS) patients. Here, an investigation of the prognostic role of early recanalization/reperfusion on clinical outcome was performed. In AIS patients (n = 55), baseline computerized tomography (CT) was performed ≤ 8 h from symptom onset, whereas CT determination of reperfusion/recanalization was assessed at 24 h. Multiple linear and logistic regression models were used to correlate reperfusion/recanalization with radiological (i.e., hemorrhagic transformation, ischemic core, and penumbra volumes) and clinical outcomes (assessed as National Institutes of Health Stroke Scale [NIHSS] reduction ≥ 8 points or a NIHSS ≤ 1 at 24 h and as modified Rankin Scale [mRS] < 2 at 90 days). At 24 h, patients achieving radiological reperfusion were n = 24, while the non-reperfused were n = 31. Among non-reperfused, n = 15 patients were recanalized. Radiological reperfusion vs. recanalization was also confirmed by early increased levels of circulating inflammatory biomarkers (i.e., serum osteopontin). In multivariate analysis, ischemic lesion volume reduction was associated with both recanalization (β = 0.265; p = 0.014) and reperfusion (β = 0.461; p < 0.001), but only reperfusion was independently associated with final infarct volume (β = − 0.333; p = 0.007). Only radiological reperfusion at 24 h predicted good clinical response at day 1 (adjusted OR 16.054 [1.423–181.158]; p = 0.025) and 90-day good functional outcome (adjusted OR 25.801 [1.483–448.840]; p = 0.026). At ROC curve analysis the AUC of reperfusion was 0.777 (p < 0.001) for the good clinical response at 24 h and 0.792 (p < 0.001) for 90-day clinical outcome. Twenty-four-hour radiological reperfusion assessed by CT is associated with good clinical response on day 1 and good functional outcome on day 90 in patients with ischemic stroke.

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Funding

Analysis and interpretation of data were supported by a grant from the European Commission to Prof F. Mach (FP7-INNOVATION I HEALTH-F2-2013-602114.

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Authors and Affiliations

  1. First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine, 6 viale Benedetto XV, 13132, Genoa, Italy

    Federico Carbone, Franco Dallegri & Fabrizio Montecucco

  2. Struttura Organizzativa Dipartimentale di Radiodiagnostica 2, Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, 3 Largo Brambilla, 50134, Florence, Italy

    Giorgio Busto & Stefano Colagrande

  3. Unità Operativa di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Arcispedale S. Anna, Ferrara, Italy

    Marina Padroni

  4. Unità Operativa di Neuroradiologia, Dipartimento di Neuroscienze, Azienda Ospedaliero-Universitaria di Ferrara, Arcispedale S. Anna, 203 Corso della Giovecca, 44121, Ferrara, Italy

    Andrea Bernardoni

  5. Ospedale Policlinico San Martino, 10 Largo Benzi, 16132, Genoa, Italy

    Franco Dallegri & Fabrizio Montecucco

  6. Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, 16132, Genoa, Italy

    Fabrizio Montecucco

  7. Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, 3 Largo Brambilla, 50134, Florence, Italy

    Enrico Fainardi

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  1. Federico Carbone
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Correspondence to Federico Carbone.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Carbone, F., Busto, G., Padroni, M. et al. Radiologic Cerebral Reperfusion at 24 h Predicts Good Clinical Outcome. Transl. Stroke Res. 10, 178–188 (2019). https://doi.org/10.1007/s12975-018-0637-8

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