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Background <p>In patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) and large ischemic cores, there is a&#xa0;need for reliable imaging biomarkers to predict cerebral edema growth. We investigated the association between severely hypoperfused tissue, measured by time-to-maximum greater than 10 s (Tmax &gt; 10 s) volume, and net water uptake (∆NWU) progression.</p> Methods <p>This multicenter retrospective cohort study involved AIS-LVO patients with ASPECTS ≤ 5, undergoing EVT at two comprehensive stroke centers between January 2013 and December 2019. We investigated the relationship between Tmax &gt; 10 s volume derived from perfusion imaging and ∆NWU measured on non-contrast head CT images, hypothesizing that larger Tmax &gt; 10 s volumes are indicative of greater edema growth in large core strokes.</p> Results <p>A&#xa0;total of 95&#xa0;patients (median age, 74&#xa0;years; 55% women) were included. After adjustment for age, sex, glucose, intravenous thrombolysis, admission NIHSS, ASPECTS, Tan collateral score, last known well-to-CT time, and EVT, higher Tmax &gt; 10 s volume (β, −0.34; <i>P</i> = 0.043) and lower ASPECTS (β, −0.30; <i>P</i> = 0.035) were independently associated with greater ∆NWU.</p> Conclusion <p>The study highlights the importance of considering severe pretreatment hypoperfusion, as reflected by larger Tmax &gt; 10 s volumes, in predicting cerebral edema growth in AIS-LVO patients, which could inform clinical strategies, emphasizing the need for larger prospective studies to validate and explore implications.</p>

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Tmax 10 Volume Is Independently Associated with NWU Delta in Large Core Stroke

  • 期刊论文

  • 发表日期：

    2025年9月30日

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  • Vivek Yedavalli,
  • Hamza Adel Salim,
  • Dhairya A. Lakhani,
  • Aneri Balar,
  • Janet Mei,
  • Thanh N. Nguyen,
  • Adrien Guenego,
  • Adam A. Dmytriw,
  • Jens Fiehler,
  • Paul Stracke,
  • Gabriel Broocks,
  • Christian Heitkamp,
  • Max Wintermark,
  • Gregory W. Albers,
  • Jeremy J. Heit,
  • Tobias D. Faizy

摘要

Background

In patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) and large ischemic cores, there is a need for reliable imaging biomarkers to predict cerebral edema growth. We investigated the association between severely hypoperfused tissue, measured by time-to-maximum greater than 10 s (Tmax > 10 s) volume, and net water uptake (∆NWU) progression.

Methods

This multicenter retrospective cohort study involved AIS-LVO patients with ASPECTS ≤ 5, undergoing EVT at two comprehensive stroke centers between January 2013 and December 2019. We investigated the relationship between Tmax > 10 s volume derived from perfusion imaging and ∆NWU measured on non-contrast head CT images, hypothesizing that larger Tmax > 10 s volumes are indicative of greater edema growth in large core strokes.

Results

A total of 95 patients (median age, 74 years; 55% women) were included. After adjustment for age, sex, glucose, intravenous thrombolysis, admission NIHSS, ASPECTS, Tan collateral score, last known well-to-CT time, and EVT, higher Tmax > 10 s volume (β, −0.34; P = 0.043) and lower ASPECTS (β, −0.30; P = 0.035) were independently associated with greater ∆NWU.

Conclusion

The study highlights the importance of considering severe pretreatment hypoperfusion, as reflected by larger Tmax > 10 s volumes, in predicting cerebral edema growth in AIS-LVO patients, which could inform clinical strategies, emphasizing the need for larger prospective studies to validate and explore implications.