Collateral status contributes to differences between observed and predicted 24-h infarct volumes in DEFUSE 3

• Published in: Journal of cerebral blood flow and metabolism Vol. 40; no. 10; pp. 1966 - 1974
• Main Authors: Rao, Vaishnavi L, Mlynash, Michael, Christensen, Søren, Yennu, Amarnath, Kemp, Stephanie, Zaharchuk, Greg, Heit, Jeremy J, Marks, Michael P, Lansberg, Maarten G, Albers, Gregory W
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.10.2020
• Subjects: Aged; Aged, 80 and over; Aging; Blood Volume; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - mortality; Cerebral Infarction - physiopathology; Cerebrovascular Circulation; Collateral Circulation; Diffusion Magnetic Resonance Imaging; Endovascular Procedures - methods; Female; Humans; Ischemic Stroke - diagnostic imaging; Ischemic Stroke - mortality; Ischemic Stroke - surgery; Magnetic Resonance Imaging; Male; Middle Aged; Neuroimaging; Original; Predictive Value of Tests; Tomography, X-Ray Computed; Treatment Outcome; brain imaging; Stroke; brain ischemia; perfusion-weighted MRI; collaterals; thrombectomy; reperfusion; diffusion-weighted MRI
• ISSN: 0271-678X; 1559-7016
• DOI: 10.1177/0271678X20918816

We previously demonstrated that in the DEFUSE 3 trial, the union of the baseline core and the 24-h Tmax > 6 s perfusion lesion predicts the infarct volume at 24 h. Presently, we assessed if collateral robustness measured by the hypoperfusion intensity ratio (HIR) and cerebral blood volume (CBV) index accounts for the variance in these predictions. DEFUSE 3 patients underwent MRI/CT perfusion imaging at baseline and 24 h post-randomization. We compared baseline and follow-up HIR and CBV index across subgroups stratified by differences between predicted and observed 24-h infarct volumes. Of 123 eligible patients, 34 with 24-h infarcts larger than predicted had less favorable collaterals at baseline (HIR 0.43 vs. 0.32, p = 0.006; CBV Index 0.78 vs. 0.85, p = 0.001) and 24 h (HIR 0.56 vs. 0.07, p = 0.004; CBV Index 0.47 vs. 0.73, p = 0.006) compared to 71 patients with more accurate infarct volume prediction. Eighteen patients with 24-h infarcts smaller than predicted had similar baseline collateral scores but more favorable 24-h CBV indices (0.81 vs. 0.73, p = 0.040). Overall, patients with 24-h infarcts larger than predicted had evidence of less favorable baseline collaterals that fail within 24 h, while patients with 24-h infarcts smaller than predicted typically had favorable collaterals that persisted for 24 h.