Alejandro Fuerte, MD
Acute ischemic stroke caused because of large-vessel occlusion (LVO) is a neurological emergency characterized by abrupt interruption in blood flow that causes rapid neuronal death. It has been shown that time in this situation is directly proportional to the infarcted brain tissue. In this context, there is an approximate loss of 1.9 million neurons every minute, which means “run!”. However, as we have observed in the DAWN and DEFUSE 3 trials, there is inter-individual variability, and the therapeutic window can be widened in those cases of patients whose ischemic core grows slowly.
The main goal of Desai et al. was to calculate the rate of loss of brain tissue within a cross-section of LVO patients with different infarct growth rate (IGR). For this purpose, they performed a retrospective review of a prospectively acquired database of acute ischemic strokes with occlusion of the internal carotid artery or middle cerebral artery. Ischemic core volume was measured with automated software and time from last known well to imaging was recorded. For the final calculations, they used what is already known about the volume of forebrain (total number of neurons, synapses, and myelinated fiber length) and, with the results, a statistical analysis was performed.