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Journal Title: Association between pre-treatment perfusion profile and cerebral edema after reperfusion therapies in ischemic stroke
Authors: Ng, Felix C
Churilov, Leonid
Yassi, Nawaf
Kleinig, Timothy J
Thijs, Vincent
Wu, Teddy Y
Shah, Darshan
Dewey, Helen M
Sharma, Gagan
Desmond, Patricia M
Yan, Bernard
Parsons, Mark W
Donnan, Geoffrey A
Davis, Stephen M
Mitchell, Peter J
Campbell, Bruce C. V.
Keywords: Intravenous
Brain Edema
Endovascular Procedures
Fibrinolytic Agents
Follow-Up Studies
Ischemic Stroke
Middle Aged
Perfusion Imaging
Prospective Studies
Tissue Plasminogen Activator
Treatment Outcome
Acute Stroke
Brain Edema
Brain Imaging
Brain Ischemia
Issue Date: 2021
Date Accessioned: 2023-04-24T02:44:20Z
Date Available: 2023-04-24T02:44:20Z
Accession Number: 33993795
Description Affiliation: Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
Department of Neurology, Austin Hospital, Austin Health, Heidelberg, Australia.
The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.
Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia.
Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia.
Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.
Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Eastern Health and Eastern Health Clinical School, Department of Neurosciences, Monash University, Clayton, Australia.
Department of Radiology, the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
Format Startpage: 2887-2896
Source Volume: 41
Issue Number: 11
Notes: eng
Clinical Trial, Phase I
Clinical Trial, Phase II
Comparative Study
Multicenter Study
Randomized Controlled Trial
DOI: 10.1177/0271678X211017696
Date: 2021
Abstract: The relationship between reperfusion and edema is unclear, with experimental and clinical data yielding conflicting results. We investigated whether the extent of salvageable and irreversibly-injured tissue at baseline influenced the effect of therapeutic reperfusion on cerebral edema. In a pooled analysis of 415 patients with anterior circulation large vessel occlusion from the Tenecteplase-versus-Alteplase-before-Endovascular-Therapy-for-Ischemic-Stroke (EXTEND-IA TNK) part 1 and 2 trials, associations between core and mismatch volume on pre-treatment CT-Perfusion with cerebral edema at 24-hours, and their interactions with reperfusion were tested. Core volume was associated with increased edema (p < 0.001) with no significant interaction with reperfusion (p = 0.82). In comparison, a significant interaction between reperfusion and mismatch volume (p = 0.03) was observed: Mismatch volume was associated with increased edema in the absence of reperfusion (p = 0.009) but not with reperfusion (p = 0.27). When mismatch volume was dichotomized at the median (102 ml), reperfusion was associated with reduced edema in patients with large mismatch volume (p < 0.001) but not with smaller mismatch volume (p = 0.35). The effect of reperfusion on edema may be variable and dependent on the physiological state of the cerebral tissue. In patients with small to moderate ischemic core volume, the benefit of reperfusion in reducing edema is related to penumbral salvage.
Journal Title: Journal of Cerebral Blood Flow and Metabolism
Type: Journal Article
Appears in Collections:SWH Data Contributions

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