Introduction:
The overestimation of ischemic core volume by computed tomography perfusion (CTP) is a critical concern in the selection of candidates for reperfusion therapy. This phenomenon is termed as ghost infarct core (GIC). Core growth rate (CGR) has emerged as an indicator of ischemic severity. We aimed to elucidate the association between GIC and CGR.
Methods:
We enrolled consecutive patients with acute ischemic stroke due to large vessel occlusion who received mechanical thrombectomy with successful reperfusion (mTICI grade 2b-3) in our institute from March 2017 to July 2022. The initial ischemic core was measured by pretreatment CTP, while the final infarct volume (FIV) was measured with diffusion-weighted image after 24-72 hours. GIC was defined as initial ischemic core volume minus FIV >10 mL. CGR was calculated by dividing the initial ischemic core volume by time from stroke onset to CTP acquisition. Univariable analysis and a multivariable logistic regression model were performed.
Results:
Eighty patients were included in the study. Of these, 21 patients (26.3%) presented with GIC. GIC was associated with higher CGR (median 14.2 mL/h vs 5.0 mL/h, p=0.03) compared to the non-GIC group. The receiver operating characteristic curve analysis revealed that the optimal cutoff point of CGR to predict GIC was 22 mL/h (sensitivity, 0.48; specificity, 0.75; area under the curve, 0.66). Multivariable logistic regression analysis showed that CGR ≥22 mL/h was an independent predictor of GIC (OR 8.53, 95% CI [2.01-36.10], p<0.01).
Conclusions:
GIC was associated with fast core growth in acute ischemic stroke.