Stroke: ADC coefficient gradient, what is the significance after thrombectomy?

Endovascular therapy (EVT) is effective and safe for selected patients with acute ischemic stroke caused by anterior circulation and great vessel occlusion
.

However, since most EVT clinical studies have excluded patients with a large baseline ischemic core, its benefit in this subgroup is uncertain

Vascular stroke However, since most EVT clinical studies have excluded patients with a large baseline ischemic core, its benefit in this subgroup is uncertain

Although patients with large ischemic cores are unlikely to achieve functional independence and are at high risk of hemorrhagic transition8, there is evidence that EVT has a therapeutic effect in this population, and after EVT, 21% to 41% Of the cases documented a good functional outcome
.

Identifying the factors associated with a good outcome is very important to determine which patients may benefit from EVT and which patients can avoid futile recanalization

The volume of ischemic lesions before treatment is related to clinical results, possibly because it contains a large part of irreversibly damaged brain tissue
.

Diffusion weighted imaging (DWI) is considered to be the gold standard for estimating the ischemic core, and the widely used apparent diffusion coefficient (ADC) threshold is ≤620×10-6 mm2/s (ADC620)

However, lesions with high signal intensity on DWI contain tissues with extensive ADC values, which can be partially reversed if rapidly reperfused
.

The higher the ADC value in DWI-positive lesions, the greater the possibility of tissue renormalization

Therefore, the ratio of ADC≤520×10-6 mm2/s (ADC520) or ADC≤540×10-6 mm2/s (ADC540) relative to ADC620 may reflect the ratio of severe ischemic stress areas in diffuse lesions , And is related to the clinical results of patients with large-area ischemic lesions after EVT
.

However, it is unclear whether this is the case
.

In this way, Dong-Seok Gwak and others of Kyungpook National University Hospital explored whether the pre-specified ADC520/ADC620 or ADC540/ADC620 ratio can predict good results for patients with large baseline ischemic lesions and successful recanalization through EVT
.

They retrospectively investigated 82 consecutive patients with anterior circulation large vessel occlusion who were admitted to the hospital ≤24 hours after the onset, and had a baseline diffuse lesion volume (ADC≤620×10-6 mm2/s [ADC620]) ≥50 mL, through endovascular treatment Successfully reconnected
.

Use the automatic Olea software program to measure the lesion volume of 3 ADC thresholds (ADC620, ADC≤520×10-6 mm2/s [ADC520] and ADC≤540×10-6 mm2/s [ADC540])

The median volume of diffuse lesions at baseline was 80.
8 ml (interquartile range, 64.
4-105.
4)
.

Thirty-five patients (42.

The optimal threshold of the predictive function result is determined as ADC540/ADC620 (area under the curve, 0.
833), and the dichotomy is 0.
674
.

After adjusting for age, baseline NIHSS scale score, intravenous tissue-type plasma protein activator, baseline diffuse lesion volume, and time from onset to recovery, low ADC540/ADC620 was independently associated with good functional outcomes (adjusted odds ratio, 10.
72[95% CI, 3.
06-37.
50]; P<0.
001)
.

The important significance of this study lies in the discovery: low ADC540/ADC620 may reflect the lighter ischemic pressure in diffuse lesions, and may help to identify those who have large ischemic cores , but can still gain from endovascular treatment.
Beneficial patients
.

The low ADC540/ADC620 may reflect the lighter ischemic pressure in the diffuse lesions, and may help to identify those with large ischemic cores.

Original source:
Gwak DS, Choi W, Shim DH, et al.

Role of Apparent Diffusion Coefficient Gradient Within Diffusion Lesions in Outcomes of Large Stroke After Thrombectomy.

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