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Perfusion Changes of Unexplained Early Neurological Deterioration After Reperfusion Therapy

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Abstract

Early neurological deterioration (END) after thrombolysis occurs in 10% acute ischemic stroke (AIS) patients, and its mechanism remains unclear in majority of cases, named as unexplained END. We tested the hypothesis that penumbra/infarct growth beyond the initial penumbra might be the cause of unexplained END. We reviewed the database of AIS patients who received reperfusion therapy. Unexplained END was defined as ≥ 2-point increase of NIHSS from baseline to 24 h, without straightforward causes. For each unexplained END patient, we extracted 2 matched controls based on 4 clinical and radiological characteristics which were strongly associated with unexplained END. We defined extra-penumbra and extra-infarct as penumbra and infarct growth at 24 h beyond baseline penumbral tissue and then investigated the relationship between extra-penumbra and extra-infarct and the presence of unexplained END. Finally, 44 unexplained END patients and 88 matched controls were included. The volume of both extra-infarct (OR, 1.032 per 1-mL increase; p = 0.018) and extra-penumbra (OR, 1.070 per 1-mL increase; p < 0.001) were associated with the presence of unexplained END, while the absence of recanalization was associated with the presence of either extra-infarct or extra-penumbra (OR, 3.291; p = 0.001). Moreover, 51.4% cases with extra-penumbra at 24 h finally progressed to infarct at 7 days, and they underwent higher increase of NIHSS from 24 h to 7 days than those that did not progress to infarct at 7 days (4.0 vs 1.0; p = 0.017). Penumbra/infarct growth beyond the initial penumbra is involved in the unexplained END in AIS patients receiving reperfusion therapy.

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Funding

This work was supported by National Natural Science Foundation of China (81622017), National Key Research and Development Program of China (2016YFC1301503), Science Technology Department of Zhejiang Province (2018C04011), Chinese Cardiovascular Association-V.G fund (2017-CCA-VG-004), Natural Science Foundation of Zhejiang Province (LGF19H090021), and Basic Public Interests of Research Plan of Zhejiang Province (GF18H090006).

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Author notes

  1. Jingjing Fu and Ying Zhou contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, 310009, China

    Jingjing Fu, Ying Zhou, Qingqing Li, Ruiting Zhang, Chang Liu & Min Lou

  2. Department of Neurology, the Fourth Affiliated Hospital of Zhejiang University, School of Medicine, Yiwu, China

    Jingjing Fu

  3. Department of Neurology, People’s Hospital of Lishui, the First Affiliated Hospital of Lishui University, College of Medicine and Health, Lishui, China

    Genlong Zhong

  4. Department of Neurology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China

    Sheng Zhang

  5. Department of Radiology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China

    Minming Zhang

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  1. Jingjing Fu
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  2. Ying Zhou
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  3. Qingqing Li
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  4. Genlong Zhong
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  5. Sheng Zhang
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  6. Ruiting Zhang
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  7. Chang Liu
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  8. Minming Zhang
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  9. Min Lou
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Corresponding author

Correspondence to Min Lou.

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All subjects had given written informed consent prior to the study, and the protocols had been approved by the human ethics committee of the second affiliated hospital of Zhejiang University, School of Medicine. Clinical investigation had been conducted according to the principles expressed in the Declaration of Helsinki.

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Fu, J., Zhou, Y., Li, Q. et al. Perfusion Changes of Unexplained Early Neurological Deterioration After Reperfusion Therapy. Transl. Stroke Res. 11, 195–203 (2020). https://doi.org/10.1007/s12975-019-00723-w

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  • DOI: https://doi.org/10.1007/s12975-019-00723-w

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