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Radiologic Cerebral Reperfusion at 24 h Predicts Good Clinical Outcome

  • Federico Carbone
  • Giorgio Busto
  • Marina Padroni
  • Andrea Bernardoni
  • Stefano Colagrande
  • Franco Dallegri
  • Fabrizio Montecucco
  • Enrico Fainardi
Original Article
  • 39 Downloads

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.

Keywords

Ischemic stroke Reperfusion Recanalization Ischemic core Penumbra Inflammation 

Notes

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.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Research Involving Human Participants and/or Animals

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.

Informed consent was obtained from all individual participants included in the study.

This article does not contain any studies with animals performed by any of the authors.

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.First Clinic of Internal Medicine, Department of Internal MedicineUniversity of Genoa School of MedicineGenoaItaly
  2. 2.Struttura Organizzativa Dipartimentale di Radiodiagnostica 2, Dipartimento di Scienze Biomediche, Sperimentali e ClinicheUniversità degli Studi di Firenze, Azienda Ospedaliero-Universitaria CareggiFlorenceItaly
  3. 3.Unità Operativa di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e PsicologicheUniversità di FerraraFerraraItaly
  4. 4.Unità Operativa di Neuroradiologia, Dipartimento di NeuroscienzeAzienda Ospedaliero-Universitaria di FerraraFerraraItaly
  5. 5.Ospedale Policlinico San MartinoGenoaItaly
  6. 6.Centre of Excellence for Biomedical Research (CEBR)University of GenoaGenoaItaly
  7. 7.Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Scienze Biomediche, Sperimentali e ClinicheUniversità degli Studi di Firenze, Azienda Ospedaliero-Universitaria CareggiFlorenceItaly

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