Circadian rhythm of ischaemic core progression in human stroke

• DOI: 10.1136/jnnp-2021-326072
• Publication Date: 2021-05-26T18:58:01Z
• Authors: Paul Reidler; Alex Brehm; Peter B. Sporns; Vanessa Granja Bu...; Lena Stueckelschw...; Gabriel Broocks; Thomas Liebig; Marios-Nikos Psyc...; Jens Ricke; Konstantinos Dimi...; Martin Dichgans; Wolfgang G. Kunz; Steffen Tiedt
• Keywords: Penumbra; Stroke; Ischaemic stroke

Introduction Experimental stroke studies suggest an influence of the time day onset on infarct progression. Whether this holds true after human is unknown, but would have implications for design randomised controlled trials, especially those neuroprotection. Methods We pooled data from 583 patients with anterior large-vessel occlusion three prospectively recruited cohorts. Ischaemic core and penumbra volumes were determined CT perfusion using automated thresholds. Core growth was calculated as ratio volume onset-to-imaging time. To determine circadian rhythmicity, we applied multivariable linear sinusoidal regression analysis adjusting potential baseline confounders. Results Patients symptom at night showed larger ischaemic admission compared during (median, 40.2 mL vs 33.8 mL), also in adjusted analyses (p=0.008). Sinusoidal indicated a peak 11pm. faster (adjusted p=0.01), shorter times. In contrast, did not change across 24-hour cycle. Discussion These results that progression varies cycle interpretation neuroprotection trials.