Background: and Purpose Infarcts in acute ischemic stroke (AIS) patients may continue to grow even after reperfusion, due to mechanisms such as microvascular obstruction and reperfusion injury. We investigated whether and how much infarcts grow in AIS patients after near-complete (expanded Thrombolysis in Cerebral Infarction [eTICI] 2c/3) reperfusion following endovascular treatment (EVT), and to assess the association of post-reperfusion infarct growth with clinical outcomes. Methods: Data are from a single-center retrospective observational cohort study that included AIS patients undergoing EVT with near-complete reperfusion who received diffusion-weighted magnetic resonance imaging (MRI) within 2 hours post-EVT and 24 hours after EVT. Association of infarct growth between 2 and 24 hours post-EVT and 24-hour National Institutes of Health Stroke Scale (NIHSS) as well as 90-day modified Rankin Scale score was assessed using multivariable logistic regression. Results: Ninety-four of 155 (60.6%) patients achieved eTICI 2c/3 and were included in the analysis. Eighty of these 94 (85.1%) patients showed infarct growth between 2 and 24 hours post-reperfusion. Infarct growth ≥5 mL was seen in 39/94 (41.5%) patients, and infarct growth ≥10 mL was seen in 20/94 (21.3%) patients. Median infarct growth between 2 and 24 hours post-reperfusion was 4.5 mL (interquartile range: 0.4–9.2 mL). Post-reperfusion infarct growth was associated with the 24-hour NIHSS in multivariable analysis (odds ratio: 1.16 [95% confidence interval 1.09–1.24], P<0.01). Conclusion Infarcts continue to grow after EVT, even if near-complete reperfusion is achieved. Investigating the underlying mechanisms may inform future therapeutic approaches for mitigating the process and help improve patient outcome.

BACKGROUND AND PURPOSE: Hemorrhagic transformation (HT) of a large infarct is a relatively common occurrence. However, its prevalence, predictive factors, as well as its clinical significance outside of thrombolysis trials remains obscure, especially in our local setting. Early studies on hemorrhagic transformation occurring in situ were limited by sample size and various methodological flaws. The aim of this study is to determine the risk factors for early (within 3-7 days) hemorrhagic transformation among these subsets of patients.

METHODS: This is a prospective cohort study among adult patients admitted at a tertiary medical center with a diagnosis of medium to large acute ischemic stroke.

RESULTS: Among the 60 patients included in this study (mean age: 57.87 15.86; 53.3% males), 8 (13.3%; mean age: 55.5 +/16.02; 50% males) developed hemorrhagic transformation. All HTs were parenchymal hematomas. Five (62.5%) were PH-1, 3 (37.5%) were PH-2. Inability to speak on presentation (p=0.044), mainstem MCA infarction (p
Human ; Male ; Adult (a Person 19-44 Years Of Age) ; Stroke ; Risk Factors ; Infarction, Middle Cerebral Artery ; Logistic Models ; Prevalence ; Blood Glucose ; Brain Ischemia ; Sample Size ; Prospective Studies ; Hematoma ; Neuroimaging ; Hemorrhage ; Edema