CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2021; 5(S 01): S1-S26
DOI: 10.1055/s-0041-1740894
Presentation Abstracts

Effect of Oxygen Extraction (Brush: Sign) on Baseline Core Infarct Depends on Collaterals (HIR)

Adrien Guenego
1   Stanford Medical Center, Stanford, United States
,
Matthew Leipzig
1   Stanford Medical Center, Stanford, United States
,
Robert Fahed
2   Ottawa Hospital, Ottawa, Canada
,
Eric S. Sussman
1   Stanford Medical Center, Stanford, United States
,
Jeremy J. Heit
1   Stanford Medical Center, Stanford, United States
› Author Affiliations
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    Background: Baseline-core-infarct volume is a critical factor in patient selection and outcome in acute ischemic stroke (AIS) before mechanical thrombectomy (MT). We determined whether oxygen extraction efficiency and arterial collaterals, two different physiologic components of the cerebral ischemic cascade, and interacted to modulate baseline-core-infarct volume in patients with AIS-LVO undergoing MT triage.

    Materials and Methods: Between January 2015 and March 2018, consecutive patients with an AIS and M1 occlusion considered for MT with a baseline MRI and perfusion-imaging were included. Variables, such as baseline-core-infarct volume (mL), arterial collaterals (HIR: TMax > 10 s volume/TMax > 6 s), and high oxygen extraction (HOE; presence of the brush-sign on T2*), were assessed. A linear regression was used to test the interaction of HOE and HIR with baseline-core-infarct volume, after including potential confounding variables.

    Results: We included 103 patients. Median age was 70 (58–78) years, and 63% were female. Median baseline-core-infarct volume was 32 mL (IQR: 8–74.5). Seventy-six patients (74%) had HOE. In a multivariate analysis, both favorable HIR collaterals (p = 0.02) and HOE (p = 0.038) were associated with lower baseline-core-infarct volume. However, HOE significantly interacted with HIR (p = 0.01) to predict baseline-core-infarct volume, favorable collaterals (low HIR) with HOE was associated with small baseline-core-infarct, whereas patients with poor collaterals (high HIR) and HOE had large baseline-core-infarct.

    Conclusion: While HOE under effective collateral blood-flow has the lowest baseline-core-infarct volume of all patients, the protective effect of HOE reverses under poor collateral blood flow and may be a maladaptive response to ischemic stroke as measured by core infarctions in AIS-LVO patients undergoing MT triage.


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    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    14 December 2021

    © 2021. The Pan Arab Interventional Radiology Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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