DOI: 10.1161/str.55.suppl_1.tp137 ISSN: 0039-2499

Abstract TP137: Quantitative Assessment of No-Reflow Zones Predicts Infarct Growth and Functional Outcome

Keon Mahmoudi, Daniel H Kim, Elham Tavakkol, Joe Qiao, Mersedeh Bahr-Hosseini, Banafsheh Salehi, Stephen Cai, Luke Ledbetter, Ceylan Z Cankurtaran, William Speier, Haoyue Zhang, Corey Arnold, Viktor Szeder, Geoffrey P Colby, Reza Jahan, Gary Duckwiler, Jeffrey L Saver, David S Liebeskind, Kambiz Nael
  • Advanced and Specialized Nursing
  • Cardiology and Cardiovascular Medicine
  • Neurology (clinical)

Background: Technically successful but futile angiographic reperfusion (AR) has been reported in 20-50% of acute ischemic stroke patients undergoing endovascular treatment. Persistent occlusions at distal arteries and ischemic capillary bed (i.e. no-reflow phenomenon) have been shown as one of the culprits resulting in infarct growth and poor functional outcome despite thrombectomy. We aimed to quantify the residual no-reflow perfusion in patients who underwent successful AR and assess its effect on infarct growth and functional outcome.

Methods: In this retrospective single institution study, patients with anterior circulation LVO, successful AR (TICI ≥ 2b), and pre and posttreatment MR perfusion (MRP) were included. Hypoperfusion volume along the affected territory was calculated on Tmax maps using thresholds >2, 4, and 6 sec on both pre and posttreatment MRP scans. Infarct growth was calculated by subtracting baseline ischemic core from the final infarct volume. A total of 12 variables including demographic, clinical, and Tmax thresholds were evaluated to predict infarct growth and functional outcome (90day mRS).

Results: A total of 50 patients met inclusion criteria, of whom 19 had infarct growth ≥ 10 mL while 31 had < 10 mL infarct growth. Functional outcome was poor in 27 patients (90day mRS>2). Univariate analysis showed no statistical significance (p>0.05) for either of the baseline Tmax volumes in prediction of infarct growth or functional outcome. Posttreatment hypoperfusion (no-reflow volumes) was significant for prediction of infarct growth at all Tmax volumes (p=0.048, 0.023, 0.021 for Tmax > 2, 4, and 6 sec respectively). Volume of Tmax >6sec was significant (p=0.044) for prediction of poor functional outcome. Multivariate logistic regression analysis revealed Tmax >6 sec residual hypoperfusion volume as an independent variable for prediction of infarct growth ≥ 10 mL (p=0.002) and functional outcome (p=0.007).

Conclusion: In conclusion, no-reflow zones following successful AR were associated with infarct growth at all Tmax thresholds, however volume of residual Tmax > 6 sec was independently associated with infarct growth > 10 ml and poor functional outcome.

More from our Archive