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Aim of this study was to assess the prevalence, risk factors, and clinical relevance of INT. For this purpose, all patients in a single-center prospective registry who underwent endovascular stroke treatment and received pre- and post-interventional diffusion-weighted imaging were included (N\u2009=\u2009259). Using an established scoring system, INT were classified according to size (I-III, \u22642\u2009mm, &gt;2\u2009mm \u226420\u2009mm, &gt;20\u2009mm) and likelihood of being related to the intervention (A, high likelihood; B, low likelihood). Additionally, a new type of infarct, that occurred in a territory distal to the occlusion, but was initially not hypoperfused, was defined as an infarct in initially not hypoperfused territory (IINHT). A total of 180 INT and 38 IINHT were observed in 32.8% (N\u2009=\u200985\/259) of patients. In most patients, INT were angiographically occult (90.2%), and 13 patients had INT\/IINHT larger than 2\u2009cm (type III). Absence of protection during stent-retrieval and a cardio-embolic stroke origin were associated with higher incidence of INT\/IINHT, whereas pretreatment with IV tPA showed no association, even when different bolus timing was considered. INT\/IINHT were associated with lower rates of functional independence with increasing size type after adjusting for confounders <jats:bold>(<\/jats:bold>adjusted Odds Ratio per size group increase 0.63, 95% confidence interval 0.46\u20130.86). In conclusion, INT and IINHT are not rare, are associated with poor outcome with increasing size, and they may serve as a surrogate endpoint for safety evaluation of new devices and endovascular techniques. Further research on associated factors is warranted.<\/jats:p>","DOI":"10.1038\/s41598-020-64495-2","type":"journal-article","created":{"date-parts":[[2020,5,20]],"date-time":"2020-05-20T10:02:32Z","timestamp":1589968952000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Infarct in new territory after endovascular stroke treatment: A diffusion-weighted imaging study"],"prefix":"10.1038","volume":"10","author":[{"given":"Johannes","family":"Kaesmacher","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Kurmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noel","family":"Jungi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipe","family":"Breiding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias F.","family":"Lang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raphael","family":"Meier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomas","family":"Dobrocky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eike","family":"Piechowiak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Zibold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Bellwald","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0647-9273","authenticated-orcid":false,"given":"Thomas R.","family":"Meinel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirjam R.","family":"Heldner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pasquale","family":"Mordasini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcel","family":"Arnold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascal J.","family":"Mosimann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mayank","family":"Goyal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Gralla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Urs","family":"Fischer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,5,20]]},"reference":[{"key":"64495_CR1","unstructured":"Balami, J. 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Dr Fischer is a global principal investigator for the SWIFT DIRECT study (Medtronic) and receives research grants from the SNSF. Dr Mosimann receives research grants from the SNSF to study new therapeutic options for cerebral aneurysms. The other authors report no conflicts.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"8366"}}