Core growth rate ⩾ 22 ml/h was an independent predictor of a ghost infarct core in acute ischemic stroke patients undergoing mechanical thrombectomy (OR 6.44; 95% CI 1.59-26.10; p=0.01).
Cohort (n=91)
No
Is the presence of a ghost infarct core associated with fast core growth rate in patients with acute ischemic stroke undergoing mechanical thrombectomy?
In acute ischemic stroke patients undergoing mechanical thrombectomy, a fast core growth rate (≥ 22 ml/h) is strongly associated with the presence of a ghost infarct core, suggesting CT perfusion may overestimate initial core volume in fast progressors.
Effect estimate: OR 6.44 (95% CI 1.59-26.10)
p-value: p=0.01
Abstract Introduction: The overestimation of ischemic core volume by CT perfusion (CTP) is a critical concern in the selection of candidates for reperfusion therapy. This phenomenon is termed a ghost infarct core (GIC). Core growth rate (CGR) is an indicator of ischemic severity. We aimed to elucidate the association between GIC and CGR. Patients and methods: Consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy in our institute from March 2017 to July 2022 were enrolled. The initial ischemic core volume (IICV) was measured by pretreatment CTP, and the final infarct volume (FIV) was measured by diffusion-weighted imaging. A GIC was defined by IICV minus FIV 10 ml. The CGR was calculated by dividing the IICV by the time from onset to CTP. Univariable analysis and a multivariable logistic regression model were used to evaluate the association between GIC-positive and CGR. Results: Of all 91 patients, 21 (23.1%) were GIC-positive. The GIC-positive group had higher CGR (14.2 2.6–46.7 vs 4.8 1.6–17.1 ml/h, p = 0.02) and complete recanalization (n = 15 (71.4%) vs 29 (41.4%), p = 0.02) compared to the GIC-negative group. On receiver-operating characteristic curve analysis, the optimal cutoff point of CGR to predict GIC-positive was 22 ml/h (sensitivity, 0.48; specificity, 0.85; AUC, 0.67). Multivariable logistic regression analysis showed that CGR ⩾ 22 ml/h (OR 6.44, 95% CI 1.59–26.10, p = 0.01) and complete recanalization (OR 3.72, 95% CI 1.14–12.08, p = 0.02) were independent predictors of GIC-positive. Conclusions: A GIC was associated with fast CGR in acute ischemic stroke. Overestimation of the initial ischemic core may be determined by core growth speed.
Saito et al. (Mon,) conducted a cohort in Acute ischemic stroke (n=91). Core growth rate (CGR) ⩾ 22 ml/h vs. CGR < 22 ml/h was evaluated on Ghost infarct core (GIC) positive (OR 6.44, 95% CI 1.59-26.10, p=0.01). Core growth rate ⩾ 22 ml/h was an independent predictor of a ghost infarct core in acute ischemic stroke patients undergoing mechanical thrombectomy (OR 6.44; 95% CI 1.59-26.10; p=0.01).