Risk factors for infarct growth and haemorrhagic or oedematous complications after endovascular treatment — a literature review

Introduction. Acute ischaemic stroke (AIS) is caused by significant disturbances in the cerebral bloodflow (CBF) that lead to brain ischaemia and eventually result in irreversible brain tissue damage. The main goal of its treatment is to restore bloodflow to the areas at risk of necrosis. Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the mainstay of current therapy, with the latter being widely employed in selected patients with radiologically proven large vessel occlusion (LVO). Despite convincing evidence of its efficacy, up to half of patients undergoing endovascular treatment (EVT) still do not achieve a beneficial functional outcome; this is mainly due to unfavourable brain tissue sequelae. Therefore, factors associated with known adverse brain changes, such as larger infarct size or haemorrhagic and oedematous complications, should be adequately addressed. Objective. To review the available literature describing AIS brain tissue outcome assessed by computed tomography (CT) and/ or magnetic resonance imaging (MRI) in patients undergoing MT treatment. Additionally, to evaluate the association of post-MT tissue changes with short- and long-term prognosis. Material and methods. We searched the PubMed, Scopus, EMBASE, and Google Scholar databases according to established criteria. Results. We found a total of 264 articles addressing the most common types of AIS tissue sequelae after EVT (i.e. MT with or without IVT as bridging therapy) by brain CT and MRI. These were: follow-up infarct volume (FIV), cerebral oedema (COD) and haemorrhagic transformation (HT). As the next step, 37 articles evaluating factors associated with defined outcomes were selected. Several non-modifiable factors such as age, comorbidities, pretreatment neurological deficit, and collateral circulation status were found to affect stroke tissue sequelae, to varying degrees. Additionally, some factors including time to treatment initiation, selection of treatment device, and periprocedural systemic blood pressure, the modification of which can potentially reduce the occurrence of an unfavourable tissue outcome, were identified. Some recently revealed biochemical and serological parameters may play a similar role. Conclusions. The identification of factors that affect post-MT ischaemic area evolution may result in studies assessing the effects of their modification, and potentially improve clinical outcomes. Modifiable parameters, including periprocedural systemic blood pressure and some biochemical factors, may be of particular importance

ETIICA study

Publisher Copyright: © European Stroke Organisation 2025.Introduction: Evidence regarding the benefit of endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (c-ICA-O) is lacking. We assessed the outcomes and safety of EVT in patients with isolated c-ICA-O. Methods: Retrospective multicenter cohort study of patients with an AIS due to isolated c-ICA-O, within 24-h since last-seen-well. Comparisons were made between EVT and best medical therapy (BMT). The primary outcome was 3-months modified Rankin Scale (mRS) ordinal shift. Secondary outcomes included 3-month favorable outcome (mRS 0–2, or return to pre-stroke mRS), symptomatic intracranial hemorrhage (sICH) and any parenchymal hemorrhage. Outcomes were compared combining inverse probability of treatment weighting with regression models and propensity score matching (PSM) as sensitivity analysis. Results: We analyzed 998 patients (66.2% male, mean age 71.1 ± 13.2 years). 487 (48.8%) patients received EVT and 511 (51.2%) received BMT. Patients receiving EVT had a higher admission NIHSS [13 (7–18) vs 5 (2–13)] compared to BMT. There was no difference between EVT and BMT groups in 3-month mRS shift (adjusted common odds ratio [OR], 1.01 [95% CI 0.76–1.34]) and favorable outcome (adjusted OR [aOR] 1.16 [95% CI 0.84–1.60]). No patient (0%) in the BMT group had sICH versus 1.6% in the EVT group. Parenchymal hemorrhage was numerically higher in EVT patients (2.7% vs 0.6%; aOR 3.85 [95% CI 0.98–15.23]). PSM analysis revealed similar results. Discussion and conclusion: In patients with isolated c-ICA-O, EVT was associated with similar odds of disability and intracranial bleeding compared to BMT. Randomized-controlled clinical trials in patients with isolated c-ICA-O are warranted.publishersversioninpres

Blood pressure values and sequelae of acute ischemic stroke on computed tomography imaging in patients treated with mechanical thrombectomy.

Promotor: prof. dr hab. n. med. Halina Bartosik - Psujek - 183 s.Ostry udar niedokrwienny (AIS) jest spowodowany zaburzeniami przepływu krwi w mózgu, które prowadzą do nieodwracalnego uszkodzenia tkanek mózgu. Tromboliza dożylna i trombektomia mechaniczna są podstawą obecnej terapii, przy czym ta ostatnia jest stosowana u wybranych pacjentów z radiologicznie potwierdzoną niedrożnością dużych naczyń. Jednym z istotnych parametrów determinujących wynik leczenia są wartości ciśnienia tętniczego zarówno wyjściowe jak i podczas interwencji terapeutycznej. Optymalne docelowe wartości ciśnienia krwi podczas MT w AIS wciąż jednak pozostają kontrowersyjne. Celem pracy jest ocena zależności pomiędzy parametrami ciśnienia tętniczego w trakcie trombektomii mechanicznej wykonywanej u pacjentów z AIS, a kontrolną objętością zawału, obrzękiem mózgu oraz powikłaniami krwotocznymi obrazowanymi przy pomocy tomografii komputerowej po 24-36 godzinach od zabiegu. Grupę badaną stanowiło 214 chorych, którzy spełnili kryteria kwalifikacji do badania. Należało do nich rozpoznanie udaru niedokrwiennego mózgu spowodowanego niedrożnością ICA lub MCA1 leczone metodą trombektomii mechanicznej w znieczuleniu ogólnym. Na podstawie otrzymanych wyników stwierdzono, że podczas zabiegu mechanicznej trombektomii, u pacjenta z ostrym udarem niedokrwiennym, konieczne jest ograniczanie zarówno zmian ciśnienia tętniczego jak i czasu, w którym utrzymują się nieprawidłowo obniżone lub podwyższone wartości ciśnienia tętniczego krwi.Acute ischemic stroke (AIS) is caused by a disturbance in blood flow in the brain that leads to irreversible damage to the brain's tissues. Therefore, the main goal of treatment is to restore blood flow to areas at risk of necrosis. Intravenous thrombolysis and mechanical thrombectomy are the cornerstones of current therapy, the latter being used in selected patients with radiographically proven large vessel obstruction. One of the important parameters determining the treatment outcome are blood pressure values, both at the baseline and during the therapeutic intervention. Optimal target blood pressure values during EVT in AIS, however, remain controversial. The aim of the study is to assess the relationship between arterial pressure parameters during mechanical thrombectomy performed in patients with AIS and the follow-up infarct volume, cerebral edema and hemorrhagic complications imaged using computed tomography 24 - 36 hours after the procedure. The final study group consisted of 214 patients who met the eligibility criteria for the study. These included the diagnosis of ischemic stroke due to ICA or MCA1 obstruction treated by mechanical thrombectomy under general anesthesia. Based on the results, it was concluded that during mechanical thrombectomy, in a patient with acute ischemic stroke, it is necessary to limit both the changes in blood pressure and the time during which abnormally lowered or elevated blood pressure values persist

Zespół hiperperfuzji mózgowej jako następstwo zabiegów reperfuzyjnych

Zespół hiperperfuzji mózgowej jest rzadkim, ale poważnym powikłaniem, które może wystąpić w następstwie przywrócenia dopływu krwi do mózgu po zabiegach rewaskularyzacyjnych. Dotychczas był on najlepiej poznany u chorych poddawanych zabiegom endarterektomii i stentowania. Po wprowadzeniu do terapii udaru mózgu leczenia swoistego zespół hiperperfuzji zaczęto również obserwować u pacjentów leczonych trombolitycznie lub za pomocą trombektomii mechanicznej. Należy go zawsze rozważyć u pacjentów z pogorszen iem klinicznym po udanej rekanalizacji, gdyż w przypadku niewłaściwego postępowania może prowadzić do poważnych konsekwencji. Dlatego też tak ważne są jego wczesne rozpoznanie i szybkie wdrożenie leczenia. W pracy przedstawiono aktualne doniesienia dotyczące zespołu hiperperfuzji ze szczególnym uwzględnieniem jego występowania po leczeniu udaru niedokrwiennego mózgu

Correction: Wiącek et al. Association between Transient-Continuous Hypotension during Mechanical Thrombectomy for Acute Ischemic Stroke and Final Infarct Volume in Patients with Proximal Anterior Circulation Large Vessel Occlusion. J. Clin. Med. 2024, 13, 3707

In the original publication [...

Association between Transient-Continuous Hypotension during Mechanical Thrombectomy for Acute Ischemic Stroke and Final Infarct Volume in Patients with Proximal Anterior Circulation Large Vessel Occlusion

Background/Objectives: Periprocedural blood pressure changes in stroke patients with a large vessel occlusion are a known modifiable risk factor of unfavorable treatment outcomes. We aimed to evaluate the association between pre-revascularization hypotension and the final infarct volume. Methods: In our retrospective analysis, we included 214 consecutive stroke patients with an anterior circulation large vessel occlusion that underwent mechanical thrombectomy under general anesthesia. Noninvasively obtained blood pressure values prior to symptomatic vessel recanalization were analyzed as a predictor of post-treatment infarct size. Linear logistic regression models adjusted for predefined factors were used to investigate the association between blood pressure parameters and the final infarct volume. Results: In our cohort, higher baseline systolic blood pressure (aβ = 8.32, 95% CI 0.93–15.7, p = 0.027), its maximal absolute drop (aβ = 6.98, 95% CI 0.42–13.55, p = 0.037), and >40% mean arterial pressure decrease (aβ = 41.77, CI 95% 1.93–81.61, p = 0.040) were independently associated with higher infarct volumes. Similarly, continuous hypotension measured as intraprocedural cumulative time spent below either 100 mmHg (aβ = 3.50 per 5 min, 95% CI 1.49–5.50, p = 0.001) or 90 mmHg mean arterial pressure (aβ = 2.91 per 5 min, 95% CI 0.74–5.10, p = 0.010) was independently associated with a larger ischemia size. In the subgroup analysis of 151 patients with an M1 middle cerebral artery occlusion, two additional factors were independently associated with a larger ischemia size: systolic blood pressure maximal relative drop and >40% drop from pretreatment value (aβ = 1.36 per 1% lower than baseline, 95% CI 0.04–2.67, p = 0.043, and aβ = 43.01, 95% CI 2.89–83.1, p = 0.036, respectively). No associations between hemodynamic parameters and post-treatment infarct size were observed in the cohort of intracranial internal carotid artery occlusion. Conclusions: In patients with ischemic stroke due to a proximal middle cerebral artery occlusion, higher pre-thrombectomy treatment systolic blood pressure is associated with a larger final infarct size. In patients treated under general anesthesia, hypotension prior to the M1 portion of middle cerebral artery recanalization is independently correlated with the post-treatment infarct volume. In this group, every 5 min spent below the mean arterial pressure threshold of 100 mmHg is associated with a 4 mL increase in ischemia volume on a post-treatment NCCT. No associations between blood pressure and final infarct volume were present in the subgroup of patients with an intracranial internal carotid artery occlusion