1
|
Higo N. Motor Cortex Plasticity During Functional Recovery Following Brain Damage. JOURNAL OF ROBOTICS AND MECHATRONICS 2022. [DOI: 10.20965/jrm.2022.p0700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although brain damage causes functional impairment, it is often followed by partial or total recovery of function. Recovery is believed to occur primarily because of brain plasticity. Both human and animal studies have significantly contributed to uncovering the neuronal basis of plasticity. Recent advances in brain imaging technology have enabled the investigation of plastic changes in living human brains. In addition, animal experiments have revealed detailed changes at the neural and genetic levels. In this review, plasticity in motor-related areas of the cerebral cortex, which is one of the most well-studied areas of the neocortex in terms of plasticity, is reviewed. In addition, the potential of technological interventions to enhance plasticity and promote functional recovery following brain damage is discussed. Novel neurorehabilitation technologies are expected to be established based on the emerging research on plasticity from the last several decades.
Collapse
|
2
|
Higo N. Non-human Primate Models to Explore the Adaptive Mechanisms After Stroke. Front Syst Neurosci 2021; 15:760311. [PMID: 34819842 PMCID: PMC8606408 DOI: 10.3389/fnsys.2021.760311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/20/2021] [Indexed: 01/15/2023] Open
Abstract
The brain has the ability to reconstruct neural structures and functions to compensate for the brain lesions caused by stroke, although it is highly limited in primates including humans. Animal studies in which experimental lesions were induced in the brain have contributed to the current understanding of the neural mechanisms underlying functional recovery. Here, I have highlighted recent advances in non-human primate models using primate species such as macaques and marmosets, most of which have been developed to study the mechanisms underlying the recovery of motor functions after stroke. Cortical lesion models have been used to investigate motor recovery after lesions to the cortical areas involved in movements of specific body parts. Models of a focal stroke at the posterior internal capsule have also been developed to bridge the gap between the knowledge obtained by cortical lesion models and the development of intervention strategies because the severity and outcome of motor deficits depend on the degree of lesions to the region. This review will also introduce other stroke models designed to study the plastic changes associated with development and recovery from cognitive and sensory impairments. Although further validation and careful interpretation are required, considering the differences between non-human primate brains and human brains, studies using brain-lesioned non-human primates offer promise for improving translational outcomes.
Collapse
Affiliation(s)
- Noriyuki Higo
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
| |
Collapse
|
3
|
Kaesmacher J, Kaesmacher M, Berndt M, Maegerlein C, Mönch S, Wunderlich S, Meinel TR, Fischer U, Zimmer C, Boeckh-Behrens T, Kleine JF. Early Thrombectomy Protects the Internal Capsule in Patients With Proximal Middle Cerebral Artery Occlusion. Stroke 2021; 52:1570-1579. [PMID: 33827247 PMCID: PMC8078129 DOI: 10.1161/strokeaha.120.031977] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Proximal middle cerebral artery (MCA) occlusions impede blood flow to the noncollateralized lenticulostriate artery territory. Previous work has shown that this almost inevitably leads to infarction of the dependent gray matter territories in the striate even if perfusion is restored by mechanical thrombectomy. Purpose of this analysis was to evaluate potential sparing of neighboring fiber tracts, ie, the internal capsule. METHODS An observational single-center study of patients with proximal MCA occlusions treated with mechanical thrombectomy and receiving postinterventional high-resolution diffusion-weighted imaging was conducted. Patients were classified according to internal capsule ischemia (IC+ versus IC-) at the postero-superior level of the MCA lenticulostriate artery territory (corticospinal tract correlate). Associations of IC+ versus IC- with baseline variables as well as its clinical impact were evaluated using multivariable logistic or linear regression analyses adjusting for potential confounders. RESULTS Of 92 included patients with proximal MCA territory infarctions, 45 (48.9%) had an IC+ pattern. Longer time from symptom-onset to groin-puncture (adjusted odds ratio, 2.12 [95% CI, 1.19-3.76] per hour), female sex and more severe strokes were associated with IC+. Patients with IC+ had lower rates of substantial neurological improvement and functional independence (adjusted odds ratio, 0.26 [95% CI, 0.09-0.81] and adjusted odds ratio, 0.25 [95% CI, 0.07-0.86]) after adjustment for confounders. These associations remained unchanged when confining analyses to patients without ischemia in the corona radiata or the motor cortex and here, IC+ was associated with higher National Institutes of Health Stroke Scale motor item scores (β, +2.8 [95% CI, 1.5 to 4.1]) without a significant increase in nonmotor items (β, +0.8 [95% CI, -0.2 to 1.9). CONCLUSIONS Rapid mechanical thrombectomy with successful reperfusion of the lenticulostriate arteries often protects the internal capsule from subsequent ischemia despite early basal ganglia damage. Salvage of this eloquent white matter tract within the MCA lenticulostriate artery territory seems strongly time-dependent, which has clinical and pathophysiological implications.
Collapse
Affiliation(s)
- Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany (J.K., M.K., M.B., C.M., S.M., C.Z., T.B.-B., J.F.K.).,University Institute of Diagnostic and Interventional Neuroradiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,University Institute of Diagnostic and Interventional and Pediatric Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Mirjam Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany (J.K., M.K., M.B., C.M., S.M., C.Z., T.B.-B., J.F.K.)
| | - Maria Berndt
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany (J.K., M.K., M.B., C.M., S.M., C.Z., T.B.-B., J.F.K.).,Department of Radiology, DONAUISAR Hospital, Deggendorf, Germany (M.B.)
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany (J.K., M.K., M.B., C.M., S.M., C.Z., T.B.-B., J.F.K.)
| | - Sebastian Mönch
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany (J.K., M.K., M.B., C.M., S.M., C.Z., T.B.-B., J.F.K.)
| | - Silke Wunderlich
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany (S.W.)
| | - Thomas R Meinel
- Department of Neurology (T.R.M., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Urs Fischer
- Department of Neurology (T.R.M., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany (J.K., M.K., M.B., C.M., S.M., C.Z., T.B.-B., J.F.K.)
| | - Tobias Boeckh-Behrens
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany (J.K., M.K., M.B., C.M., S.M., C.Z., T.B.-B., J.F.K.)
| | - Justus F Kleine
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany (J.K., M.K., M.B., C.M., S.M., C.Z., T.B.-B., J.F.K.).,Department of Neuroradiology, Charité Universitätsmedizin Berlin, Germany (J.F.K.)
| |
Collapse
|
4
|
Raychev R, Saber H, Saver JL, Hinman JD, Brown S, Vinuela F, Duckwiler G, Jahan R, Tateshima S, Szeder V, Nour M, Colby GP, Restrepo L, Kim D, Bahr-Hosseini M, Ali L, Starkman S, Rao N, Nogueira RG, Liebeskind D. Impact of eloquent motor cortex-tissue reperfusion beyond the traditional thrombolysis in cerebral infarction (TICI) scoring after thrombectomy. J Neurointerv Surg 2021; 13:990-994. [PMID: 33443113 PMCID: PMC8526878 DOI: 10.1136/neurintsurg-2020-016834] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
Background Targeted eloquence-based tissue reperfusion within the primary motor cortex may have a differential effect on disability as compared with traditional volume-based (thrombolysis in cerebral infarction, TICI) reperfusion after endovascular thrombectomy (EVT) in the setting of acute ischemic stroke (AIS). Methods We explored the impact of eloquent reperfusion (ER) within primary motor cortex (PMC) on clinical outcome (modified Rankin Scale, mRS) in AIS patients undergoing EVT. ER-PMC was defined as presence of flow on final digital subtraction angiography (DSA) within four main cortical branches, supplying the PMC (middle cerebral artery (MCA) – precentral, central, postcentral; anterior cerebral artery (ACA) – medial frontal branch arising from callosomarginal or pericallosal arteries) and graded as absent (0), partial (1), and complete (2). Prospectively collected data from two centers were analyzed. Multivariate analysis was conducted to assess the impact of ER-PMC on 90-day disability (mRS) among patients with anterior circulation occlusion who achieved partial reperfusion (TICI 2a and 2b). Results Among the 125 patients who met the study criteria, ER-PMC distribution was: absent (0) in 19/125 (15.2%); partial (1) in 52/125 (41.6%), and complete (2) in 54/125 (43.2%). TICI 2b was achieved in 102/125 (81.6%) and ER-PMC was substantially higher in those patients (P<0.001). In multivariate analysis, in addition to age and symptomatic intracranial hemorrhage, ER-PMC had a profound independent impact on 90-day disability (OR 6.10, P=0.001 for ER-PMC 1 vs 0 and OR 9.87, P<0.001 for ER-PMC 2 vs 0), while the extent of total partial reperfusion (TICI 2b vs 2a) was not related to 90-day mRS. Conclusions Eloquent PMC-tissue reperfusion is a key determinant of functional outcome, with a greater impact than volume-based (TICI) degree of partial reperfusion alone. PMC-targeted revascularization among patients with partial reperfusion may further diminish post-stroke disability after EVT.
Collapse
Affiliation(s)
- Radoslav Raychev
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Hamidreza Saber
- Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Jeffrey L Saver
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Jason D Hinman
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Scott Brown
- BRIGHT Research Partners, Minneapolis, Minnesota, USA
| | - Fernando Vinuela
- Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Gary Duckwiler
- Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Reza Jahan
- Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Satoshi Tateshima
- Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Viktor Szeder
- Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - May Nour
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.,Radiological Scieneces, University of Califronia Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Geoffrey P Colby
- Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Lucas Restrepo
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Doojin Kim
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Mersedeh Bahr-Hosseini
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Latisha Ali
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Sidney Starkman
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Neal Rao
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Raul G Nogueira
- Neurology, Marcus Stroke & Neuroscience Center Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David Liebeskind
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| |
Collapse
|
5
|
Metabolome of Cerebral Thrombi Reveals an Association between High Glycemia at Stroke Onset and Good Clinical Outcome. Metabolites 2020; 10:metabo10120483. [PMID: 33255770 PMCID: PMC7760729 DOI: 10.3390/metabo10120483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 12/01/2022] Open
Abstract
Despite the fact that glucose is the main fuel of the brain, hyperglycemia at hospital admission is generally associated with a poor functional outcome in stroke patients. This paradox may be explained by the lack of information about the blood glucose level at stroke onset. Here, we analyzed the metabolome of blood cells entrapped in cerebral thrombi to gain insight into their metabolism at stroke onset. Fourty-one consecutive stroke patients completely recanalized by mechanical thrombectomy within 6 h were included. The metabolome of retrieved thrombi was analyzed by liquid chromatography tandem with mass spectrometry. Discriminant Analysis (sparse Partial Least Squares Discriminant Analysis (sPLS-DA)) was performed to identify classification models and significant associated features of favorable clinical outcome at 3 months (modified Rankin Scale (mRS) < 2). sPLS-DA of the metabolomes of cerebral thrombi discriminated between stroke patients with a favorable or poor clinical outcome (Area Under the Curve (AUC) = 0.992 (0.931–1)). In addition, our results revealed that high sorbitol and glucose levels in the thrombi positively correlated with favorable clinical outcomes. Sorbitol, a short-term glycemic index reflecting a high blood glucose level at stroke onset, was found to be an independent predictor of good outcome (AUC = 0.908 (0.807–0.995)). This study demonstrates that a high blood glucose level at stroke onset is beneficial to the clinical outcome of the patient.
Collapse
|
6
|
Chen X, Delcourt C, Sun L, Zhou Z, Yoshimura S, You S, Malavera A, Torii-Yoshimura T, Carcel C, Arima H, Hackett ML, Robinson T, Song L, Wang X, Lindley RI, Chalmers J, Anderson CS. Brain Imaging Signs and Health-Related Quality of Life after Acute Ischemic Stroke: Analysis of ENCHANTED Alteplase Dose Arm. Cerebrovasc Dis 2020; 49:427-436. [PMID: 32702699 DOI: 10.1159/000509226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/07/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE The influence of specific brain lesions on health-related quality of life (HRQoL) after acute ischemic stroke (AIS) is uncertain. We aimed to identify imaging predictors of poor HRQoL in alteplase-treated participants of the alteplase dose arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). METHODS ENCHANTED was an international trial of low- versus standard-dose intravenous alteplase in AIS patients, with functional outcome (modified Rankin scale [mRS]) and HRQoL on the 5-dimension European Quality of Life Scale (EQ-5D) assessed at 90 days post-randomization. Brain images were analyzed centrally by trained assessors. Multivariable logistic regression was undertaken in the study population randomly divided (2:1) into training (development) and validation (performance) groups, with age (per 10-year increase), ethnicity, baseline National Institutes of Health Stroke Scale (NIHSS) score, diabetes mellitus, premorbid function (mRS score 0 or 1), and proxy respondent, forced into all models. Data are presented with odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Eight prediction models were developed and validated in 2,526 AIS patients (median age 67.5 years; 38.4% female; 61.7% Asian) with complete brain imaging and 90-day EQ-5D utility score data. The best performance model included acute ischemic changes in the right (OR 1.69, 95% CI: 1.24-2.29) and deep (OR 1.50, 95% CI: 1.03-2.19) middle cerebral artery (MCA) regions. Several background features of brain frailty - atrophy, white matter change, and old infarcts - were significantly associated with adverse physical but not emotional HRQoL domains. CONCLUSIONS In thrombolysed AIS patients, right-sided and deep ischemia within the MCA territory predict poor overall HRQoL, whilst features of old cerebral ischemia are associated with reduced physical HRQoL.
Collapse
Affiliation(s)
- Xiaoying Chen
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Candice Delcourt
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lingli Sun
- The George Institute China at Peking University Health Science Centre, Beijing, China
| | - Zien Zhou
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sohei Yoshimura
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shoujiang You
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Alejandra Malavera
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Takako Torii-Yoshimura
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Division of Neurology, Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Maree L Hackett
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Thompson Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Lili Song
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,The George Institute China at Peking University Health Science Centre, Beijing, China
| | - Xia Wang
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Richard I Lindley
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia, .,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia, .,Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, .,The George Institute China at Peking University Health Science Centre, Beijing, China, .,Heart Health Research Center, Beijing, China,
| | | |
Collapse
|
7
|
Kaesmacher J, Chaloulos-Iakovidis P, Panos L, Mordasini P, Michel P, Hajdu SD, Ribo M, Requena M, Maegerlein C, Friedrich B, Costalat V, Benali A, Pierot L, Gawlitza M, Schaafsma J, Mendes Pereira V, Gralla J, Fischer U. Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0-5. Stroke 2020; 50:880-888. [PMID: 30827193 PMCID: PMC6430594 DOI: 10.1161/strokeaha.118.023465] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— If anterior circulation large vessel occlusion acute ischemic stroke patients presenting with ASPECTS 0–5 (Alberta Stroke Program Early CT Score) should be treated with mechanical thrombectomy remains unclear. Purpose of this study was to report on the outcome of patients with ASPECTS 0–5 treated with mechanical thrombectomy and to provide data regarding the effect of successful reperfusion on clinical outcomes and safety measures in these patients. Methods— Multicenter, pooled analysis of 7 institutional prospective registries: Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy (Clinical Trial Registration—URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064). Primary outcome was defined as modified Rankin Scale 0–3 at day 90 (favorable outcome). Secondary outcomes included rates of day 90 modified Rankin Scale 0–2 (functional independence), day 90 mortality and occurrence of symptomatic intracerebral hemorrhage. Multivariable logistic regression analyses were performed to assess the association of successful reperfusion with clinical outcomes. Outputs are displayed as adjusted Odds Ratios (aOR) and 95% CI. Results— Two hundred thirty-seven of 2046 patients included in this registry presented with anterior circulation large vessel occlusion and ASPECTS 0–5. In this subgroup, the overall rates of favorable outcome and mortality at day 90 were 40.1% and 40.9%. Achieving successful reperfusion was independently associated with favorable outcome (aOR, 5.534; 95% CI, 2.363–12.961), functional independence (aOR, 5.583; 95% CI, 1.964–15.873), reduced mortality (aOR, 0.180; 95% CI, 0.083–0.390), and lower rates of symptomatic intracerebral hemorrhage (aOR, 0.235; 95% CI, 0.062–0.887). The mortality-reducing effect remained in patients with ASPECTS 0–4 (aOR, 0.167; 95% CI, 0.056–0.499). Sensitivity analyses did not change the primary results. Conclusions— In patients presenting with ASPECTS 0–5, who were treated with mechanical thrombectomy, successful reperfusion was beneficial without increasing the risk of symptomatic intracerebral hemorrhage. Although the results do not allow for general treatment recommendations, formal testing of mechanical thrombectomy versus best medical treatment in these patients in a randomized controlled trial is warranted.
Collapse
Affiliation(s)
- Johannes Kaesmacher
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,University Institute of Diagnostic, Interventional and Pediatric Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Panagiotis Chaloulos-Iakovidis
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Leonidas Panos
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Pasquale Mordasini
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Patrik Michel
- Department of Neurology (P. Michel) and Department of Radiology (S.D.H.), CHUV Lausanne, Switzerland
| | - Steven D Hajdu
- Department of Neurology (P. Michel) and Department of Radiology (S.D.H.), CHUV Lausanne, Switzerland
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain (M. Ribo, M. Requena)
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain (M. Ribo, M. Requena)
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M., B.F.)
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M., B.F.)
| | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, France (V.C., A.B.), Toronto Western Hospital, ON
| | - Amel Benali
- Department of Neuroradiology, CHU Montpellier, France (V.C., A.B.), Toronto Western Hospital, ON
| | - Laurent Pierot
- Department of Neuroradiology, CHU Reims, France (L.P., M.G.), Toronto Western Hospital, ON
| | - Matthias Gawlitza
- Department of Neuroradiology, CHU Reims, France (L.P., M.G.), Toronto Western Hospital, ON
| | | | | | - Jan Gralla
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Urs Fischer
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| |
Collapse
|
8
|
Wen TC, Sindhurakar A, Ramirez VC, Park H, Gupta D, Carmel JB. Targeted Infarction of the Internal Capsule in the Rat Using Microstimulation Guidance. Stroke 2019; 50:2531-2538. [PMID: 31390970 DOI: 10.1161/strokeaha.119.025646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Lacunar strokes are subcortical infarcts with small size and high disability rates, largely due to injury of the corticospinal tract in the internal capsule (IC). Current rodent models of lacunar infarcts are created based on stereotactic coordinates. We tested the hypothesis that better understanding of the somatotopy of the IC and guiding the lesion with electrical stimulation would allow a more accurate lesion to the forelimb axons of the IC. Methods- We performed electrophysiological motor mapping and viral tracing to define the somatotopy of the IC of Sprague Dawley rats. For the lesion, we used an optrode, which contains an electrode to localize forelimb responses and an optical fiber to deliver light. The infarct was induced when light activated the photothrombotic agent Rose Bengal, which was administered systemically. Results- We found largely a separate distribution of the forelimb and hindlimb axons in the IC, both by microstimulation mapping and tract tracing. Microstimulation-guided IC lesions ablated the forelimb axons of the IC in rats and caused lasting forelimb impairments while largely preserving the hindlimb axons of the IC and surrounding gray matter. Conclusions- Stimulation guidance enabled selective and reproducible infarcts of the forelimb axons of the IC in rats. Visual Overview- An online visual overview is available for this article.
Collapse
Affiliation(s)
- Tong-Chun Wen
- From the Departments of Neurology and Orthopedics, Movement Recovery Laboratory, Carroll Labs, New York, NY (T.-C.W., A.S., H.P., J.B.C.)
| | - Anil Sindhurakar
- From the Departments of Neurology and Orthopedics, Movement Recovery Laboratory, Carroll Labs, New York, NY (T.-C.W., A.S., H.P., J.B.C.)
| | | | - HongGeun Park
- From the Departments of Neurology and Orthopedics, Movement Recovery Laboratory, Carroll Labs, New York, NY (T.-C.W., A.S., H.P., J.B.C.)
| | - Disha Gupta
- Department of Neurology, New York University School of Medicine (D.G.).,Comprehensive Epilepsy Center, Langone Health, New York University (D.G.)
| | - Jason B Carmel
- From the Departments of Neurology and Orthopedics, Movement Recovery Laboratory, Carroll Labs, New York, NY (T.-C.W., A.S., H.P., J.B.C.)
| |
Collapse
|
9
|
Moulton E, Valabregue R, Lehéricy S, Samson Y, Rosso C. Multivariate prediction of functional outcome using lesion topography characterized by acute diffusion tensor imaging. Neuroimage Clin 2019; 23:101821. [PMID: 30991303 PMCID: PMC6462821 DOI: 10.1016/j.nicl.2019.101821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 11/07/2022]
Abstract
The relationship between stroke topography and functional outcome has largely been studied with binary manual lesion segmentations. However, stroke topography may be better characterized by continuous variables capable of reflecting the severity of ischemia, which may be more pertinent for long-term outcome. Diffusion Tensor Imaging (DTI) constitutes a powerful means of quantifying the degree of acute ischemia and its potential relation to functional outcome. Our aim was to investigate whether using more clinically pertinent imaging parameters with powerful machine learning techniques could improve prediction models and thus provide valuable insight on critical brain areas important for long-term outcome. Eighty-seven thrombolyzed patients underwent a DTI sequence at 24 h post-stroke. Functional outcome was evaluated at 3 months post-stroke with the modified Rankin Score and was dichotomized into good (mRS ≤ 2) and poor (mRS > 2) outcome. We used support vector machines (SVM) to classify patients into good vs. poor outcome and evaluate the accuracy of different models built with fractional anisotropy, mean diffusivity, axial diffusivity, radial diffusivity asymmetry maps, and lesion segmentations in combination with lesion volume, age, recanalization status, and thrombectomy treatment. SVM classifiers built with axial diffusivity maps yielded the best accuracy of all imaging parameters (median [IQR] accuracy = 82.8 [79.3-86.2]%), compared to that of lesion segmentations (76.7 [73.3-82.8]%) when predicting 3-month functional outcome. The analysis revealed a strong contribution of clinical variables, notably - in descending order - lesion volume, thrombectomy treatment, and recanalization status, in addition to the deep white matter at the crossroads of major white matter tracts, represented by brain regions where model weights were highest. Axial diffusivity is a more appropriate imaging marker to characterize stroke topography for predicting long-term outcome than binary lesion segmentations.
Collapse
Affiliation(s)
- Eric Moulton
- Institut du Cerveau et de la Moelle épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013 Paris, France
| | - Romain Valabregue
- Institut du Cerveau et de la Moelle épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013 Paris, France; Centre de Neuro-Imagerie de Recherche, CENIR, ICM, Paris, France
| | - Stéphane Lehéricy
- Institut du Cerveau et de la Moelle épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013 Paris, France; Centre de Neuro-Imagerie de Recherche, CENIR, ICM, Paris, France; ICM Team Movement Investigation and Therapeutics, France; AP-HP, Department of Neuroradiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Yves Samson
- Institut du Cerveau et de la Moelle épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013 Paris, France; AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Charlotte Rosso
- Institut du Cerveau et de la Moelle épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013 Paris, France; ICM Team Movement Investigation and Therapeutics, France; AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France.
| |
Collapse
|
10
|
Benghanem S, Rosso C, Arbizu C, Moulton E, Dormont D, Leger A, Pires C, Samson Y. Aphasia outcome: the interactions between initial severity, lesion size and location. J Neurol 2019; 266:1303-1309. [DOI: 10.1007/s00415-019-09259-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/20/2019] [Accepted: 02/22/2019] [Indexed: 11/25/2022]
|
11
|
Zavanone C, Samson Y, Arbizu C, Dupont S, Dormont D, Rosso C. Critical brain regions related to post-stroke aphasia severity identified by early diffusion imaging are not the same when predicting short- and long-term outcome. BRAIN AND LANGUAGE 2018; 186:1-7. [PMID: 30179751 DOI: 10.1016/j.bandl.2018.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 04/30/2018] [Accepted: 08/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To identify the critical brain regions associated with 7-days, 3 and 6-months aphasia severity using diffusion-weighted imaging (DWI) in acute post-stroke patients. MATERIALS AND METHODS We performed a voxel-based ADC (Apparent Diffusion Coefficient) analysis to identify the critical brain areas correlated with aphasia at the acute (7-days outcome) and chronic stages (3 and 6-months). The location of these areas was compared with the trajectory of the dorsal (the arcuate fasciculus) and the ventral language pathways (the inferior fronto-occipital and the uncinate fasciculi). RESULTS Disconnections of the language fasciculi, which were correlated with aphasia outcome, were not the same for the 7-days outcome (disconnection of the ventral stream) and the chronic outcome (3 and 6 months) (disconnection of the dorsal and ventral streams). CONCLUSION Routine clinical images can be merged with atlases of anatomical connectivity to provide new insights about the relationship between the lesion location and aphasia severity.
Collapse
Affiliation(s)
- Chiara Zavanone
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013 Paris, France; ARAMIS, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, ICM, F-75013 Paris, France; APHP, Neurological Rehabilitation Unit, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
| | - Yves Samson
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013 Paris, France; ARAMIS, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, ICM, F-75013 Paris, France; APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France; UPMC Paris Sorbonne Université, Paris, France.
| | - Céline Arbizu
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France; Centre des Maladies Cognitives et Comportementales, IM2A, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
| | - Sophie Dupont
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013 Paris, France; ARAMIS, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, ICM, F-75013 Paris, France; APHP, Neurological Rehabilitation Unit, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France; UPMC Paris Sorbonne Université, Paris, France.
| | - Didier Dormont
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013 Paris, France; ARAMIS, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, ICM, F-75013 Paris, France; UPMC Paris Sorbonne Université, Paris, France; APHP, Department of Neuroradiology, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
| | - Charlotte Rosso
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013 Paris, France; APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France; UPMC Paris Sorbonne Université, Paris, France; Control of Normal and Abnormal Movement: Physiopathology and Experimental Therapeutics, UPMC Paris 6, Inserm, U1127, CNRS, UMR 7225, Paris, France.
| |
Collapse
|
12
|
Abe H, Jitsuki S, Nakajima W, Murata Y, Jitsuki-Takahashi A, Katsuno Y, Tada H, Sano A, Suyama K, Mochizuki N, Komori T, Masuyama H, Okuda T, Goshima Y, Higo N, Takahashi T. CRMP2-binding compound, edonerpic maleate, accelerates motor function recovery from brain damage. Science 2018; 360:50-57. [DOI: 10.1126/science.aao2300] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 02/01/2018] [Indexed: 12/25/2022]
Abstract
Brain damage such as stroke is a devastating neurological condition that may severely compromise patient quality of life. No effective medication-mediated intervention to accelerate rehabilitation has been established. We found that a small compound, edonerpic maleate, facilitated experience-driven synaptic glutamate AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic-acid) receptor delivery and resulted in the acceleration of motor function recovery after motor cortex cryoinjury in mice in a training-dependent manner through cortical reorganization. Edonerpic bound to collapsin-response-mediator-protein 2 (CRMP2) and failed to augment recovery in CRMP2-deficient mice. Edonerpic maleate enhanced motor function recovery from internal capsule hemorrhage in nonhuman primates. Thus, edonerpic maleate, a neural plasticity enhancer, could be a clinically potent small compound with which to accelerate rehabilitation after brain damage.
Collapse
|
13
|
Kim DH, Lee DS, Nah HW, Cha JK. Clinical and radiological factors associated with unfavorable outcome after intravenous thrombolysis in patients with mild ischemic stroke. BMC Neurol 2018; 18:30. [PMID: 29544461 PMCID: PMC5856376 DOI: 10.1186/s12883-018-1033-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/02/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A significant proportion of patients with mild ischemic stroke become disabled despite receiving intravenous thrombolytic therapy. The purpose of this study was to assess the clinical and radiological factors associated with unfavorable outcomes in patients with minor ischemic stroke that received intravenous recombinant tissue plasminogen activator (rt-PA) therapy. METHODS We identified anterior circulation stroke patients with initial National Institutes of Health Stroke Scale (NIHSS) scores ≤5 who received intravenous thrombolysis within 4.5 h of stroke onset and had pretreatment magnetic resonance (MR)/MR angiography using our prospective stroke database. We analyzed baseline characteristics, infarction patterns on diffusion-weighted imaging (DWI), and steno-occlusive lesions on MR angiography. Unfavorable outcome was defined as a modified Rankin Scale (mRS) score ≥ 2 at 90 days. Logistic regression was used to determine independent predictors of unfavorable outcomes. RESULTS Among 121 patients (85 men; mean age, 63.4 ± 11.3 years) included in this study, 46 (38%) had unfavorable outcomes at 90 days and DWI lesion patterns showing infarction in the deep middle cerebral artery (MCA) territory involving the perforating artery area was observed in 47 (38.8%) patients. On multivariable analysis, unfavorable outcomes at 90 days were associated with diabetes [odds ratio (OR), 3.41; 95% confidence interval (CI), 1.06-10.9; P = 0.039), NIHSS score on admission (OR, 2.11; 95% CI, 1.35-3.30; P = 0.001), and infarction in the deep MCA territory on DWI (OR, 4.19; 95% CI, 1.63-10.8; P = 0.003). Lesions in the deep MCA territory was independently associated with early neurological deterioration (P = 0.032). The patients without deep MCA territory infarction had a higher prevalence of cardiac embolism (P = 0.009). CONCLUSIONS Higher NIHSS scores, diabetes, and deep MCA territory infarction may be useful for predicting unfavorable outcomes in patients with minor stroke treated with intravenous rt-PA therapy.
Collapse
Affiliation(s)
- Dae-Hyun Kim
- Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea. .,Department of Neurology, College of Medicine, Dong-A University, 1, 3-ga Dongdaesin-dong, Seo-gu, Busan, 602-715, Republic of Korea.
| | - Deok-Soo Lee
- Department of Neurology, College of Medicine, Dong-A University, 1, 3-ga Dongdaesin-dong, Seo-gu, Busan, 602-715, Republic of Korea
| | - Hyun-Wook Nah
- Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea.,Department of Neurology, College of Medicine, Dong-A University, 1, 3-ga Dongdaesin-dong, Seo-gu, Busan, 602-715, Republic of Korea
| | - Jae-Kwan Cha
- Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea.,Department of Neurology, College of Medicine, Dong-A University, 1, 3-ga Dongdaesin-dong, Seo-gu, Busan, 602-715, Republic of Korea
| |
Collapse
|
14
|
Song H, Jung W, Lee E, Park JY, Kim MS, Lee MC, Kim HI. Capsular stroke modeling based on somatotopic mapping of motor fibers. J Cereb Blood Flow Metab 2017; 37:2928-2937. [PMID: 27837188 PMCID: PMC5536800 DOI: 10.1177/0271678x16679421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recently, several capsular stroke models have been reported with different targets of destruction. This study was performed to establish an accurate internal capsule (IC) target for capsular stroke modeling in rats. We injected adeno-associated virus serotype 5 (AAV)-CaMKII-EYFP into forelimb motor cortex and AAV-CaMKII-mCherry into hindlimb motor cortex (n = 9) to anterogradely trace the pyramidal fibers and map their somatotopic distribution in the IC. On the basis of the neural tracing results, we created photothrombotic infarct lesions in rat forelimb and hindlimb motor fiber (FMF and HMF) areas of the IC (n = 29) and assessed motor behavior using a forelimb-use asymmetry test, a foot-fault test, and a single-pellet reaching test. We found that the FMFs and HMFs were primarily distributed in the inferior portion of the posterior limb of the IC, with the FMFs located largely ventral to the HMFs but with an area of partial overlap. Photothrombotic lesions in the FMF area resulted in persistent motor deficits. In contrast, lesions in the HMF area did not result in persistent motor deficits. These results indicate that identification of the somatotopic distribution of pyramidal fibers is critical for accurate targeting in animal capsular stroke models: only infarcts in the FMF area resulted in long-lasting motor deficits.
Collapse
Affiliation(s)
- Hanlim Song
- 1 Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Wonbin Jung
- 1 Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Eulgi Lee
- 1 Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Ji-Young Park
- 1 Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Min Sun Kim
- 2 Department of Physiology, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Min-Cheol Lee
- 3 Department of Pathology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyoung-Ihl Kim
- 1 Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea.,4 Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Republic of Korea
| |
Collapse
|
15
|
Payabvash S, Taleb S, Qureshi AI. Cerebral regions preserved by successful endovascular recanalization of acute M1 segment occlusions: a voxel based analysis. Br J Radiol 2017; 90:20160869. [PMID: 28165757 DOI: 10.1259/bjr.20160869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To identify cerebral regions preserved by successful recanalization of the middle cerebral artery M1 segment and their association with early clinical outcome. METHODS 47 patients who underwent endovascular treatment for acute unilateral M1 segment occlusion were included. Successful recanalization was defined by a modified thrombolysis in cerebral infarction score of 2b/3. Final infarct volumes were segmented on follow-up MRI/CT, 2-7 days post-symptom onset. The differences in topography of infarct lesions associated with successful vs unsuccessful recanalization were assessed using voxel-based analysis. Favourable outcome was defined by a modified Rankin Scale score ≤2 at discharge, and disability/death by score >2. RESULTS Successful recanalization of M1 segment occlusion was achieved in 26/47 (55%) patients, which was associated with higher rate of favourable outcome (54% vs 9%, p = 0.002) and smaller final infarct volumes (34.3 ± 43.7 vs 98.1 ± 47.7 ml, p < 0.001). In voxel-based analysis, patients with successful recanalization had a lower rate of infarction in precentral gyrus and posterior insular ribbon compared with those without recanalization. Favourable outcome was achieved in 16 (34%) patients, who were younger (62.2 ± 13.9 vs 70.9 ± 13.9, p = 0.048), had higher rate of successful recanalization (88% vs 39%, p = 0.002) and had smaller infarct volumes (25.2 ± 23.6 vs 82.2 ± 57.1 ml, p < 0.001) compared with those with disability/death. In voxel-based analysis, infarction of the insula, precentral gyrus, middle centrum semiovale and corona radiata were associated with disability/death. CONCLUSION Successful endovascular recanalization of acute M1 segment occlusion tends to preserve posterior insular ribbon and precentral gyrus from infarction; and infarction of these regions was associated with higher rates of disability/death. Advances in knowledge: The knowledge of the topographic location of potentially salvageable cerebral tissue can provide additional information for treatment triage and selection of patients with acute stroke for endovascular treatment based on the "areas at risk" rather than the "volume at risk". Also, such knowledge can help with preferential recanalization, where the neurointerventionalist may choose to preferentially recanalize certain branches supplying salvageable and eloquent cerebral regions in favour of timely reperfusion treatment.
Collapse
Affiliation(s)
- Seyedmehdi Payabvash
- 1 Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA.,2 Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Shayandokht Taleb
- 1 Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA.,3 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | | |
Collapse
|
16
|
Abstract
Rodents have been widely used in the production of cerebral ischemia models. However, successful therapies have been proven on experimental rodent stroke model, and they have often failed to be effective when tested clinically. Therefore, nonhuman primates were recommended as the ideal alternatives, owing to their similarities with the human cerebrovascular system, brain metabolism, grey to white matter ratio and even their rich behavioral repertoire. The present review is a thorough summary of ten methods that establish nonhuman primate models of focal cerebral ischemia; electrocoagulation, endothelin-1-induced occlusion, microvascular clip occlusion, autologous blood clot embolization, balloon inflation, microcatheter embolization, coil embolization, surgical suture embolization, suture, and photochemical induction methods. This review addresses the advantages and disadvantages of each method, as well as precautions for each model, compared nonhuman primates with rodents, different species of nonhuman primates and different modeling methods. Finally it discusses various factors that need to be considered when modelling and the method of evaluation after modelling. These are critical for understanding their respective strengths and weaknesses and underlie the selection of the optimum model.
Collapse
Affiliation(s)
- Jingjing Fan
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Province Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yi Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Province Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xinyu Fu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Province Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Lijuan Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Province Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaoting Hao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Shasha Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Province Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martions Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
17
|
Murata Y, Higo N. Development and Characterization of a Macaque Model of Focal Internal Capsular Infarcts. PLoS One 2016; 11:e0154752. [PMID: 27149111 PMCID: PMC4858287 DOI: 10.1371/journal.pone.0154752] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/19/2016] [Indexed: 12/21/2022] Open
Abstract
Several studies have used macaque monkeys with lesions induced in the primary motor cortex (M1) to investigate the recovery of motor function after brain damage. However, in human stroke patients, the severity and outcome of motor impairments depend on the degree of damage to the white matter, especially that in the posterior internal capsule, which carries corticospinal tracts. To bridge the gap between results obtained in M1-lesioned macaques and the development of clinical intervention strategies, we established a method of inducing focal infarcts at the posterior internal capsule of macaque monkeys by injecting endothelin-1 (ET-1), a vasoconstrictor peptide. The infarcts expanded between 3 days and 1 week after ET-1 injection. The infarct volume in each macaque was negatively correlated with precision grip performance 3 days and 1 week after injection, suggesting that the degree of infarct expansion may have been a cause of the impairment in hand movements during the early stage. Although the infarct volume decreased and gross movement improved, impairment of dexterous hand movements remained until the end of the behavioral and imaging experiments at 3 months after ET-1 injection. A decrease in the abundance of large neurons in M1, from which the descending motor tracts originate, was associated with this later-stage impairment. The present model is useful not only for studying neurological changes underlying deficits and recovery but also for testing therapeutic interventions after white matter infarcts in primates.
Collapse
Affiliation(s)
- Yumi Murata
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Umezono, Tsukuba, Ibaraki, Japan
| | - Noriyuki Higo
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Umezono, Tsukuba, Ibaraki, Japan
- * E-mail:
| |
Collapse
|
18
|
Tateishi Y, Wisco D, Aoki J, George P, Katzan I, Toth G, Hui F, Hussain MS, Uchino K. Large deep white matter lesions may predict futile recanalization in endovascular therapy for acute ischemic stroke. INTERVENTIONAL NEUROLOGY 2015; 3:48-55. [PMID: 25999992 DOI: 10.1159/000369835] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study investigated whether large ischemic lesions in the deep white matter (DWM) on pretreatment diffusion-weighted MRI (DWI) predict futile recanalization. METHODS Consecutive acute stroke patients with anterior circulation ischemia who underwent successful arterial recanalization with thrombolysis in cerebral infarction grade 2b or 3 were enrolled. A large DWI-DWM lesion was defined as a hyperintense lesion in the DWM on initial DWI, located mainly between the anterior and posterior horns of the lateral ventricle. The Alberta Stroke Program Early CT score on CT and DWI and stroke volume on initial DWI were recorded. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score. Futile recanalization was defined as a 30-day modified Rankin scale score of 3-6 despite successful recanalization. Univariate and multivariate regression analyses were performed to identify predictors of futile recanalization. RESULTS In 35 of 46 patients (76%) with successful recanalization, futile recanalization was observed in 20 patients (57%). Patients with futile recanalization were older (median age 74 vs. 58 years; p = 0.053), had higher initial NIHSS scores (median 17 vs. 9; p = 0.042), and a higher prevalence of large DWI-DWM lesions (45 vs. 9%; p = 0.022). Logistic regression analysis showed that a large DWI-DWM lesion was an independent predictor of futile recanalization (OR 13.97; 95% CI 1.32-147.73; p = 0.028). CONCLUSION Patients with large preintervention DWI-DWM lesions may be poor candidates for endovascular therapy.
Collapse
Affiliation(s)
- Yohei Tateishi
- Cerebrovascular Center, Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki City, Tokyo, Japan ; Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dolora Wisco
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Junya Aoki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Pravin George
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Irene Katzan
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gabor Toth
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ferdinand Hui
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Ken Uchino
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
19
|
Rosso C, Pires C, Corvol JC, Baronnet F, Crozier S, Leger A, Deltour S, Valabregue R, Amor-Sahli M, Lehéricy S, Dormont D, Samson Y. Hyperglycaemia, insulin therapy and critical penumbral regions for prognosis in acute stroke: further insights from the INSULINFARCT trial. PLoS One 2015; 10:e0120230. [PMID: 25793765 PMCID: PMC4368038 DOI: 10.1371/journal.pone.0120230] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/03/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Recently, the concept of 'clinically relevant penumbra' was defined as an area saved by arterial recanalization and correlated with stroke outcome. This clinically relevant penumbra was located in the subcortical structures, especially the periventricular white matter. Our aims were to confirm this hypothesis, to investigate the impact of admission hyperglycemia and of insulin treatment on the severity of ischemic damages in this area and to study the respective contributions of infarct volume and ischemic damage severity of the clinically relevant penumbra on 3-month outcome. METHODS We included 99 patients from the INSULINFARCT trial. Voxel-Based Analysis was carried on the Apparent Diffusion Coefficient (ADC) maps obtained at day one to localize the regions, which were more damaged in patients i) with poor clinical outcomes at three months and ii) without arterial recanalization. We determined the intersection of the detected areas, which represents the clinically relevant penumbra and investigated whether hyperglycemic status and insulin regimen affected the severity of ischemic damages in this area. We performed logistic regression to examine the contribution of infarct volume or early ADC decrease in this strategic area on 3-month outcome. FINDINGS Lower ADC values were found in the corona radiata in patients with poor prognosis (p< 0.0001) and in those without arterial recanalization (p< 0.0001). The tracking analysis showed that lesions in this area interrupted many important pathways. ADC values in this area were lower in hyperglycemic than in normoglycemic patients (average decrease of 41.6 ± 20.8 x10(-6) mm2/s) and unaffected by the insulin regimen (p: 0.10). ADC values in the clinically relevant penumbra, but not infarct volumes, were significant predictors of 3-month outcome. CONCLUSION These results confirm that the deep hemispheric white matter is part of the clinically relevant penumbra and show that hyperglycaemia exacerbates the apparition of irreversible ischemic damage within 24 hours in this area. However, early intensive insulin therapy fails to protect this area from infarction. TRIAL REGISTRATION ClinicalTrials.gov NCT00472381.
Collapse
Affiliation(s)
- Charlotte Rosso
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
- UPMC Paris 6, Inserm, U1127; CNRS, UMR 7225, Paris, France
- CONAM, UPMC Paris 6, Inserm, U1127, CNRS, UMR 7225, Paris, France
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
- Institut du Cerveau et de la Moelle épinière, Centre de Neuro-Imagerie de Recherche (CENIR), Paris, France
| | - Christine Pires
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Christophe Corvol
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
- UPMC Paris 6, Inserm, U1127; CNRS, UMR 7225, Paris, France
- INSERM, APHP, Centre d’Investigation Clinique CIC9503, Département des Maladies du Système Nerveux, Hôpital Pitié-Salpêtrière, Paris, France
| | - Flore Baronnet
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sophie Crozier
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Anne Leger
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sandrine Deltour
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Romain Valabregue
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
- UPMC Paris 6, Inserm, U1127; CNRS, UMR 7225, Paris, France
- Institut du Cerveau et de la Moelle épinière, Centre de Neuro-Imagerie de Recherche (CENIR), Paris, France
| | - Mélika Amor-Sahli
- APHP, Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Stéphane Lehéricy
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
- UPMC Paris 6, Inserm, U1127; CNRS, UMR 7225, Paris, France
- CONAM, UPMC Paris 6, Inserm, U1127, CNRS, UMR 7225, Paris, France
- Institut du Cerveau et de la Moelle épinière, Centre de Neuro-Imagerie de Recherche (CENIR), Paris, France
- APHP, Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Didier Dormont
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
- UPMC Paris 6, Inserm, U1127; CNRS, UMR 7225, Paris, France
- APHP, Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, Paris, France
- COGIMAGE, UPMC Paris 6, Inserm, U1127, CNRS, UMR 7225, Paris, France
| | - Yves Samson
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
- UPMC Paris 6, Inserm, U1127; CNRS, UMR 7225, Paris, France
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
- COGIMAGE, UPMC Paris 6, Inserm, U1127, CNRS, UMR 7225, Paris, France
| |
Collapse
|
20
|
Internal capsule stroke in the common marmoset. Neuroscience 2015; 284:400-411. [DOI: 10.1016/j.neuroscience.2014.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/28/2014] [Accepted: 10/01/2014] [Indexed: 12/27/2022]
|
21
|
Presence of anterior temporal artery associates with good outcome in acute atherosclerotic M1-middle cerebral artery occlusion. Neuroradiology 2014; 56:1023-30. [PMID: 25200620 DOI: 10.1007/s00234-014-1422-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION We aim to investigate the correlation between presence of anterior temporal artery (ATA), the first major branch of middle cerebral artery (MCA), on conventional angiography and clinical outcome in patients with acute atherosclerotic M1-MCA occlusion. METHODS Consecutive patients with acute atherosclerotic M1-MCA occlusion from Nanjing Stroke Registry Program (NSRP) between January 2007 and December 2012 were included in this study. All patients underwent MRI followed by conventional angiography. From their data, we analyzed baseline characteristics, infarction patterns, DWI-ASPECTS, and collateral circulation. The correlation of ATA presence and good clinical outcome, modified Rankin Scale (mRS) score ≤ 2, at 3 months was also calculated. RESULTS In 98 patients meeting entry criteria, the presence of ATA was found in 44 patients. Patients with ATA present were found to have less hypertension (p = 0.042), lower baseline National Institutes of Health Stroke Scale (NIHSS) (p = 0.043), more small infarcts in perforating artery territory (p = 0.013), and a higher number of DWI-ASPECTS ≥ 7 (p = 0.034). Binary logistic regression analysis showed an adjusted odds ratio of 4.45 for a good outcome in patients with ATA presence (95% CI 1.52 to 13.03, p = 0.007). CONCLUSION The presence of ATA can be used as a predictor of good outcome in patients with acute atherosclerotic M1-MCA occlusion.
Collapse
|
22
|
The ischemic penumbra: the location rather than the volume of recovery determines outcome. Curr Opin Neurol 2014; 27:35-41. [PMID: 24275722 DOI: 10.1097/wco.0000000000000047] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The clinical efficiency of thrombolysis is explained by the rescue of ischemic penumbra areas resulting from early arterial recanalization. The perfusion-diffusion weighted imaging mismatch is a commonly used MRI surrogate of the ischemic penumbra. However, the randomized trials testing the mismatch hypothesis have been negative. We will review the 'mismatch concept' and the recent studies that aim to localize the clinically eloquent areas of penumbra in middle cerebral artery (MCA) infarcts. RECENT FINDINGS New methods of image analysis have shown that poor outcomes after MCA stroke are related to infarction of an extremely well localized area of the periventricular white matter and adjacent internal capsule, where projections and association tracts are crossing and converging. This area almost colocalizes with the area salvaged by early arterial recanalization and is located extremely close to the initial ischemic core. SUMMARY The location of the area that correlates with disability in MCA stroke patients and that is salvaged by early arterial recanalization is in the same specific region of the deep white matter, close to the initial ischemic core. These findings may have important implications for designing new recanalization trials and support the importance of basic research on white-matter neuroprotection.
Collapse
|
23
|
Tissue at risk in acute stroke patients treated beyond 8 h after symptom onset. Neuroradiology 2013; 55:807-12. [PMID: 23559400 DOI: 10.1007/s00234-013-1164-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 02/27/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The decision on thrombolytics administration is usually based on a generalized, rigid time-based rule rather than an individualized evaluation of the "tissue at risk of infarction" which is the target of the recanalization therapies. The goals of our article are to assess whether there is tissue at risk of infarction in a group of acute stroke patients treated beyond 8 h after symptom onset and to investigate the baseline imaging and clinical features that predict the fate of this tissue at risk. METHODS We retrospectively reviewed a series of patients with acute ischemic stroke treated with endovascular recanalization therapies beyond 8 h after symptom onset. The tissue at risk was calculated as the difference between the infarct volumes on baseline and follow-up imaging (infarct growth). We analyzed the epidemiological distribution of infarct growth, and we performed a multivariate regression analysis to identify the baseline variables that predict infarct growth. RESULTS Our study group included 75 patients (65 ± 13.8 years, baseline National Institutes of Health Stroke Scale 14 ± 4.9, time to treatment 15.2 ± 8.7 h). The mean infarct growth was 78.6 ± 95.0 cc (p < 0.001), and, overall, the infarct growth was greater when the baseline volume of infarct tissue was small (p < 0.001) and in the case of a unsuccessful arterial recanalization (p = 0.001). CONCLUSIONS There is potentially salvageable ischemic tissue at risk in acute stroke patients treated beyond 8 h after symptom onset.
Collapse
|
24
|
Chen JJ, Rosas HD, Salat DH. The relationship between cortical blood flow and sub-cortical white-matter health across the adult age span. PLoS One 2013; 8:e56733. [PMID: 23437228 PMCID: PMC3578934 DOI: 10.1371/journal.pone.0056733] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 01/14/2013] [Indexed: 11/18/2022] Open
Abstract
Degeneration of cerebral white matter is commonly observed in aging, and the associated degradation in neural connectivity contributes to cognitive decline in older adults. Vascular dysfunction has been implicated as a potential mechanism for general age-related neural tissue deterioration; however, no prior study has examined the direct relationship between cortical vascular health and subcortical white-matter integrity. In this work, we aimed to determine whether blood supply to the brain is associated with microstructural integrity of connective tissue, and whether such associations are regionally specific and mainly accounted for by aging. We examined the association between cerebral blood flow (CBF) in the cortical mantle, measured using arterial spin labeling (ASL), and subcortical white-matter integrity, measured using diffusion tensor imaging (DTI), in a group of healthy adults spanning early to late adulthood. We found cortical CBF to be significantly associated with white-matter integrity throughout the brain. In addition, these associations were only partially tied to aging, as they remained even when statistically controlling for age, and when restricting the analyses to a young subset of the sample. Furthermore, vascular risk was not a prominent determinant of these effects. These findings suggest that the overall blood supply to the brain is an important indicator of white-matter health in the normal range of variations amongst adults, and that the decline in CBF with advancing age may potentially exacerbate deterioration of the connective anatomy of the brain.
Collapse
Affiliation(s)
- J Jean Chen
- Rotman Research Institute, Baycrest Centre for Geriatric Care, University of Toronto, Toronto, Canada.
| | | | | |
Collapse
|
25
|
Fiehler J, Söderman M, Turjman F, White PM, Bakke SJ, Mangiafico S, von Kummer R, Muto M, Cognard C, Gralla J. Future trials of endovascular mechanical recanalisation therapy in acute ischemic stroke patients - a position paper endorsed by ESMINT and ESNR : part II: methodology of future trials. Neuroradiology 2012; 54:1303-12. [PMID: 22948788 DOI: 10.1007/s00234-012-1076-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 07/13/2012] [Indexed: 10/27/2022]
Abstract
Based on current data and experience, the joint working group of the European Society of Minimally Invasive Neurological Therapy (ESMINT) and the European Society of Neuroradiology (ESNR) make suggestions on trial design and conduct aimed to investigate therapeutic effects of mechanical thrombectomy (MT). We anticipate that this roadmap will facilitate the setting up and conduct of successful trials in close collaboration with our neighbouring disciplines.
Collapse
Affiliation(s)
- Jens Fiehler
- Department of Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|