DOES EARLY REPERFUSION OF A CEREBRAL INFARCT INFLUENCE CEREBRAL INFARCT SWELLING IN THE ACUTE STAGE OR THE FINAL CLINICAL OUTCOME

Forty-seven patients presenting with symptoms of large middle cerebral artery territory infarcts were studied prospectively using serial CT brain scanning to assess infarct extent and swelling, and transcranial Doppler ultrasound to assess middle cerebral artery patency. The sing le most important determinant of cerebral infarct swelling was the ext ent of the infarct: the larger the infarct, the greater the amount of swelling (Spearman Rank correlation coefficient 0.74, p<0.0001). In ad dition, if the blood velocity in the symptomatic middle cerebral arter y did not increase in the first 5 days after symptom onset (implying n o early reperfusion) the odds of severe infarct swelling were increase d 7.6-fold (95% confidence interval 1.2- to 46.4-fold, 2p = 0.03), and the odds of a poor clinical outcome (dead or dependent in activities of daily living at 3 months) were increased 10-fold (95% confidence in terval 2.7- to 41.6-fold, 2p = 0.0007). The only patients who recovere d sufficiently to be able to return home by 3 months after stroke were amongst those whose symptomatic middle cerebral artery blood velocity increased (either spontaneously or associated with fibrinolytic or an tithrombotic therapy) in the first 5 days after stroke. We conclude th at early reperfusion is not associated with a worsening of acute cereb ral infarct swelling, and may lead to a better clinical outcome.