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.
