The presence of HARM on post-contrast FLAIR imaging was independently associated with early neurologic deterioration after mechanical thrombectomy (aOR 3.45; 95% CI 1.33-8.95).
Cohort (n=229)
Yes
Are HARM and GLOS on post-contrast FLAIR imaging associated with poor clinical outcomes after mechanical thrombectomy in patients with acute ischemic stroke?
HARM on post-contrast FLAIR imaging is an independent predictor of early neurologic deterioration and infarct progression after mechanical thrombectomy for acute ischemic stroke.
Odds Ratio: 3.45 (95% CI 1.33–8.95)
BACKGROUND AND OBJECTIVES: Despite successful recanalization after mechanical thrombectomy for acute ischemic stroke, a substantial proportion of patients experience early neurologic deterioration or infarct progression. Early blood-brain barrier disruption, visualized on post-contrast fluid-attenuated inversion recovery (pcFLAIR) imaging as hyperintense acute reperfusion marker (HARM) or gadolinium leakage in ocular structures (GLOS), has been proposed as a marker of reperfusion injury, but its determinants and prognostic significance in thrombectomy cohorts remain uncertain. We aimed to evaluate whether HARM and GLOS are associated with poor clinical outcomes after mechanical thrombectomy. Secondary objectives included their association with poor radiologic outcomes and the identification of baseline and procedural predictors. METHODS: We retrospectively analyzed data from the French Endovascular Treatment in Ischemic Stroke (ETIS) registry (2010-2021), including consecutive patients admitted to Versailles and Foch Hospital. All patients underwent mechanical thrombectomy at Foch Hospital and pcFLAIR imaging within 4-48 hours postgadolinium administration. Independent predictors of HARM and GLOS were identified through multivariable logistic regression, and their associations with early neurologic deterioration, poor 3-month functional outcome, infarct growth, and hemorrhagic transformation (HT) outcomes were evaluated. RESULTS: Among 229 patients (mean age 69.7 ± 14.9 years, 52.0% female), HARM was observed in 48.9% and GLOS in 41.9%. Overall, 60.3% of patients had either HARM or GLOS, including 29.3% with both markers, 19.7% with isolated HARM, and 11.4% with isolated GLOS. HARM was independently associated with early neurologic deterioration (adjusted odds ratio aOR 3.45; 95% CI 1.33-8.95) and infarct growth (aOR 2.46; 95% CI 1.22-4.95), but not with HT or 3-month functional outcome. GLOS was not independently associated with clinical or radiologic outcomes. Older age, higher creatinine, and a shorter interval between the first and second FLAIR were common predictors of both HARM and GLOS, whereas single-pass recanalization was an independent predictor of HARM only. DISCUSSION: In this large thrombectomy cohort, HARM was independently associated with early neurologic deterioration and infarct progression after thrombectomy, supporting its role as an imaging marker of early blood-brain barrier disruption. GLOS, although frequent, was not independently associated with clinical or radiologic outcomes. Prospective studies with early and serial imaging are required to clarify the prognostic relevance of HARM. TRIAL REGISTRATION INFORMATION: NCT03776877 (ETIS registry).
“In this issue of Neurology, Bousfiha et al. report the clinical significance of HARM and gadolinium leakage in ocular structures (GLOS) in a large retrospective cohort of patients who underwent mechanical thrombectomy for acute ischemic stroke. The authors are to be commended for their comprehensive analysis of these imaging markers of blood-brain and blood-ocular barrier disruption. Their findings contribute to our understanding of the pathophysiology of reperfusion injury and have potential implications for patient management and future research.”
Bousfiha et al. (Tue,) conducted a cohort in Acute ischemic stroke (n=229). Hyperintense acute reperfusion marker (HARM) and ocular gadolinium leakage (GLOS) vs. Absence of HARM or GLOS was evaluated on Early neurologic deterioration (aOR 3.45, 95% CI 1.33-8.95). The presence of HARM on post-contrast FLAIR imaging was independently associated with early neurologic deterioration after mechanical thrombectomy (aOR 3.45; 95% CI 1.33-8.95).