Tmax 10 Volume Is Independently Associated with NWU Delta in Large Core Stroke

Background: In patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) and large ischemic cores, there is a need for reliable imaging biomarkers to predict cerebral edema growth. We investigated the association between severely hypoperfused tissue, measured by time-to-maximum greater than 10 s (Tmax > 10 s) volume, and net water uptake (∆NWU) progression. Methods: This multicenter retrospective cohort study involved AIS-LVO patients with ASPECTS ≤ 5, undergoing EVT at two comprehensive stroke centers between January 2013 and December 2019. We investigated the relationship between Tmax > 10 s volume derived from perfusion imaging and ∆NWU measured on non-contrast head CT images, hypothesizing that larger Tmax > 10 s volumes are indicative of greater edema growth in large core strokes. Results: A total of 95 patients (median age, 74 years; 55% women) were included. After adjustment for age, sex, glucose, intravenous thrombolysis, admission NIHSS, ASPECTS, Tan collateral score, last known well-to-CT time, and EVT, higher Tmax > 10 s volume (β, −0.34; P = 0.043) and lower ASPECTS (β, −0.30; P = 0.035) were independently associated with greater ∆NWU. Conclusion: The study highlights the importance of considering severe pretreatment hypoperfusion, as reflected by larger Tmax > 10 s volumes, in predicting cerebral edema growth in AIS-LVO patients, which could inform clinical strategies, emphasizing the need for larger prospective studies to validate and explore implications.