Article
Spreading depolarization is associated with infarct growth in patients with malignant hemispheric stroke
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Published: | June 18, 2018 |
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Objective: Lesion progression is one of the most serious in-hospital complications of ischemic stroke. Recently, we demonstrated that a significant proportion of patients with malignant hemispheric stroke (MHS) suffer from delayed infarct progression even after decompressive hemicraniectomy. Among many pathways, spreading depolarization (SD) might be one of the main contributors to this delayed secondary infarct progression. Here we investigated the frequency of SDs in association with infarct progression in patients with MHS.
Methods: Thirty-nine patients with MHS – defined as subtotal or total middle cerebral artery infarction with or without additional infarction of the anterior or posterior cerebral artery – and the clinical indication for decompressive hemicraniectomy were included in the study. SD was measured for 5 to 7 days after decompressive surgery using a subdural 6-contact platinum electrocorticography strip. Infarct progression was volumetrically assessed using serial MRI postoperatively and after the monitoring period, respectively.
Results: During a total monitoring period of 4929.6 hours a total number of 1231 SDs were observed. Delayed infarct progression occurred in 20 out of 39 patients with a mean volume of 53±25 cm³. The total number of SDs per patient correlated significantly with the volume of delayed infarct progression.
Conclusion: Here we provide the first clinical evidence that SDs are associated with delayed infarct progression.