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Li Y, Cao W, Xu X, Li T, Chen Y, Wang Y, Chen J, Gao P, Yang B, Dmytriw AA, Regenhardt RW, Chen F, Ma Q, Lu J, Liu Y, Wang C, Bai X, Jiao L. Early venous filling after mechanical thrombectomy in acute ischemic stroke due to large vessel occlusion in anterior circulation. J Neurointerv Surg 2024; 16:248-252. [PMID: 37197935 DOI: 10.1136/jnis-2023-020336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND The significance of early venous filling (EVF) after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) is not fully understood. In this study, we aimed to investigate the impact of EVF after MT. METHODS From January 2019 to May 2022, AIS patients with successful recanalization (modified Thrombolysis in Cerebral Infarction score (mTICI) ≥2b) after MT were retrospectively reviewed. EVF was evaluated on final digital subtraction angiography runs after successful recanalization and was categorized into phase subgroups (arterial phase and capillary phase) and pathway subgroups (cortical veins subgroup and thalamostriate veins subgroup), respectively. The impact of EVF subgroups on functional outcomes after successful recanalization were both investigated. RESULTS A total of 349 patients achieving successful recanalization after MT were included, including 45 patients in the EVF group and 304 patients in the non-EVF group. Multivariable logistic regression analysis showed the EVF group had a higher rate of intracranial hemorrhage (ICH; 66.7% vs 22%, adjusted odds ratio (aOR) 6.805, 95% CI 3.389 to 13.662, P<0.001), symptomatic ICH (sICH; 28.9% vs 4.9%, aOR 6.011, 95% CI 2.493 to 14.494, P<0.001) and malignant cerebral edema (MCE; 20% vs 6.9%, aOR 2.682, 95% CI 1.086 to 6.624, P=0.032) than the non-EVF group. Furthermore, the cortical veins subgroup of EVF had a higher rate of mortality than the thalamostriate veins subgroup (37.5% vs 10.3%, P=0.029). CONCLUSIONS EVF is independently associated with ICH, sICH and MCE after successful recanalization of MT, but not with favorable outcome and mortality.
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Affiliation(s)
- Yi Li
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Neurology, Guangzhou Red Cross Hospital, Guangzhou, China
| | - Wenbo Cao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Neurosurgery, China International Neuroscience Institute, Beijing, China
| | - Xin Xu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Neurosurgery, China International Neuroscience Institute, Beijing, China
| | - Tianhua Li
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Neurosurgery, China International Neuroscience Institute, Beijing, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Neurosurgery, China International Neuroscience Institute, Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Neurosurgery, China International Neuroscience Institute, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Neurosurgery, China International Neuroscience Institute, Beijing, China
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Neurosurgery, China International Neuroscience Institute, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Neurosurgery, China International Neuroscience Institute, Beijing, China
| | - Adam A Dmytriw
- Neurointerventional Program, Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
- Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fei Chen
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Radiology and Nuclear Medicine, Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yuqi Liu
- Department of Neurological Sciences, Escope Innovation Academy, Beijing, China
| | - Chunliang Wang
- Department of Neurological Sciences, Escope Innovation Academy, Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Neurosurgery, China International Neuroscience Institute, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Neurosurgery, China International Neuroscience Institute, Beijing, China
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Value of Angiographic Regional Circulation Signs in Predicting Hemorrhagic Transformation after Endovascular Thrombectomy. J Neuroradiol 2022; 50:327-332. [PMID: 35926715 DOI: 10.1016/j.neurad.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the predictive value of the early venous filling (EVF) sign, the basal ganglia blush (BGB) sign and both the EVF and BGB signs for the hemorrhagic transformation (HT) and parenchymal hematoma (PH) in patients after endovascular thrombectomy. METHODS This study included patients with anterior circulation large vessel occlusive stroke treated with endovascular thrombectomy from May 2017 to December 2021. The predictive value of regional circulation signs for HT and PH were assessed using logistic regression models adjusted for confounders, and further a multiplicative interaction term was added to investigate the effect of different stroke severity on its predictive value. RESULTS Among the 350 patients included and after adjusting for confounders, those with the EVF sign (adjusted OR=3.934, 95% CI:2.326-6.655), the BGB sign (adjusted OR=3.776, 95% CI:2.341-6.089), and both the EVF and BGB signs (adjusted OR=3.250, 95% CI: 1.886-5.600) were more likely to have HT. The EVF sign (adjusted OR=3.545, 95% CI:2.036-6.170), the BGB sign (adjusted OR=3.742, 95% CI:2.110-6.639), and both the EVF and BGB signs (adjusted OR=3.139, 95% CI: 1.776-5.549) were also significantly correlated with PH. When stratified according to stroke severity, we further found there were significant interactions between regional circulation signs and stroke severity on postoperative HT and PH (all P for interaction < 0.001). CONCLUSIONS Regional circulation signs were independently associated with HT and PH after endovascular thrombectomy and had a higher predictive value in patients with severe stroke compared with mild to moderate stroke.
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Janvier P, Kerleroux B, Turc G, Pasi M, Farhat W, Bricout N, Benzakoun J, Legrand L, Clarençon F, Bracard S, Oppenheim C, Boulouis G, Henon H, Naggara O, Ben Hassen W. TAGE Score for Symptomatic Intracranial Hemorrhage Prediction After Successful Endovascular Treatment in Acute Ischemic Stroke. Stroke 2022; 53:2809-2817. [PMID: 35698971 DOI: 10.1161/strokeaha.121.038088] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Determine if early venous filling (EVF) after complete successful recanalization with mechanical thrombectomy in acute ischemic stroke is an independent predictor of symptomatic intracranial hemorrhage (sICH) and integrate EVF into a risk score for sICH prediction. METHODS Consecutive patients with anterior acute ischemic stroke treated by mechanical thrombectomy issued from patients enrolled in the THRACE trial (Thrombectomie des Artères Cérébrales) and from 2 prospective registries were included and divided into a derivation (Center I; n=402) and validation cohorts (THRACE and center 2; n=507). EVF was evaluated by 2 blinded readers. sICH was defined according to the modified European cooperative acute stroke study II. Clinical and radiological data were analyzed in the derivation cohort (C1) to identify independent predictors of sICH and construct a predictive score test on the validation cohort (THRACE + C2). RESULTS Symptomatic ICH rate was similar between the two cohorts (9.9% and 8.9% respectively, P=0.9). Time from onset-to-successful recanalization >270 minutes (odds ratio [OR], 7.8 [95% CI, 2.5-24]), Alberta Stroke Program Early CT Score (≤5 [OR, 2.49 (95% CI, 1.8-8.1) or 6-7 [OR, 1.15 (95% CI, 1.03-4.46)]), glucose blood level >7 mmol/L (OR, 2.92 [95% CI, 1.26-6.7]), and EVF presence (OR, 11.9 [95% CI, 3.8-37.5]) were independent predictors of sICH and constituted the Time-Alberta Stroke Program Early CT-Glycemia-EVF score. Time-Alberta Stroke Program Early CT-Glycemia-EVF score was associated with an increased risk of sICH in the derivation cohort (OR increase per unit, 1.99 [95% CI, 1.53-2.59]; P<0.001) with area under the curve, 0.832 [95% CI, 0.767-0.898]. The score had good performance in the validation cohort (area under the curve, 0.801 [95% CI, 0.69-0.91]). CONCLUSIONS Time-Alberta Stroke Program Early CT-Glycemia-EVF score is a simple tool with readily available clinical variables with good performances for sICH prediction after mechanical thrombectomy. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01062698.
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Affiliation(s)
- Paul Janvier
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Basile Kerleroux
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Guillaume Turc
- Neurolog, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France.y (G.T.)
| | - Marco Pasi
- Department of Neurology, Lille University, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France. (M.P., H.H.)
| | - Wassim Farhat
- Department of Neurology, Saint-Joseph Hospital, Paris, France (W.F.)
| | - Nicolas Bricout
- Department of Interventional Neuroradiology, Lille University, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France. (N.B.)
| | - Joseph Benzakoun
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Laurence Legrand
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Frédéric Clarençon
- Department of Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France (F.C.)
| | - Serge Bracard
- Department of Neuroradiology, Nancy University (S.B.)
| | - Catherine Oppenheim
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, INSERM U1253 iBrain, University Hospital of Tours, Centre Val de Loire Region, France (G.B.)
| | - Hilde Henon
- Department of Neurology, Lille University, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France. (M.P., H.H.)
| | - Olivier Naggara
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Wagih Ben Hassen
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
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Liang W, Wang Y, Du Z, Mang J, Wang J. Intraprocedural Angiographic Signs Observed During Endovascular Thrombectomy in Patients With Acute Ischemic Stroke: A Systematic Review. Neurology 2021; 96:1080-1090. [PMID: 33893205 DOI: 10.1212/wnl.0000000000012069] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the real-world practice of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), the analysis of intraprocedural angiographic signs (IPASs) still challenges neurointerventionists. This review provides insights into the significance of these subtle changes for predicting underlying etiology, technical feasibility, and patient prognosis, thus promoting the potential real-time application of these signs. METHODS A systematic literature search was conducted using PubMed, Ovid Medline/Embase, and Cochrane. The search focused on studies published between January 1995 and August 2020 that reported findings related to intraprocedural angiographic manifestations in endovascular recanalization therapy for AIS. RESULTS We identified 12 IPASs in 22 studies involving 1,683 patients. The IPASs were assigned into 3 subsets according to their clinical meanings. CONCLUSION The systematic analysis of IPAS in clinical trials and practice will lead to a better understanding of treatment effects, responses, and mechanisms during EVT. Studies of larger cohorts using more robust statistical methods are needed.
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Affiliation(s)
- Wenzhao Liang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Yimeng Wang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Zhihua Du
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Jing Mang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China.
| | - Jun Wang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
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Elands S, Casimir P, Bonnet T, Mine B, Lubicz B, Sjøgård M, Ligot N, Naeije G. Early Venous Filling Following Thrombectomy: Association With Hemorrhagic Transformation and Functional Outcome. Front Neurol 2021; 12:649079. [PMID: 33776899 PMCID: PMC7987949 DOI: 10.3389/fneur.2021.649079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Previous studies have noted the angiographic appearance of early venous filling (EVF) following recanalisation in acute ischemic stroke. However, the prognostic implications of EVF as a novel imaging biomarker remain unclear. We aimed to evaluate the correlation between EVF with (i) the risk of subsequent reperfusion hemorrhage (RPH) and (ii) the association of EVF on both the NIHSS score at 24 h and functional outcome as assessed with the Modified Rankin Scale (mRS) score at 90 days. Methods: We conducted a retrospective cohort study of patients presenting with an acute ischemic stroke due to a proximal large-vessel occlusion of the anterior circulation treated by thrombectomy. Post-reperfusion digital subtraction angiography was reviewed to look for EVF as evidenced by the contrast opacification of any cerebral vein before the late arterial phase. Results: EVF occurred in 22.4% of the 147 cases included. The presence of EVF significantly increased the risk of RPH (p = 0.0048), including the risk of symptomatic hemorrhage (p = 0.0052). The presence of EVF (p = 0.0016) and the absence of RPH (p = 0.0021) were independently associated with a better outcome as defined by the NIHSS difference at 24 h, most significantly in the EVF+RPH- group. No significant relationship was however found between either EVF or RPH and a mRS score ≤ 2 at 90 days. Conclusion: Early venous filling on angiographic imaging is a potential predictor of reperfusion hemorrhage. The absence of subsequent RPH in this sub-group is associated with better outcomes at 24 h post-thrombectomy than in those with RPH.
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Affiliation(s)
- Sophie Elands
- Department of Neurology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Casimir
- Department of Neurology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Bonnet
- Department of Interventional Neuroradiology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Benjamin Mine
- Department of Interventional Neuroradiology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Boris Lubicz
- Department of Interventional Neuroradiology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Martin Sjøgård
- Laboratoire de Cartographie Fonctionnelle du Cerveau, Neuroscience Institute (ULB-Neuroscience Institute), Université Libre de Bruxelles, Brussels, Belgium
| | - Noémie Ligot
- Department of Neurology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Gilles Naeije
- Department of Neurology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Very Late Leptomeningeal Collaterals—Potential New Way to Subdivide Modified Thrombolysis in Cerebral Ischemia (mTICI) 2B. Clin Neuroradiol 2018; 30:77-83. [DOI: 10.1007/s00062-018-0747-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
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7
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Salehi Omran S, Boddu SR, Gusdon AM, Kummer B, Baradaran H, Patel P, Díaz I, Navi BB, Gupta A, Kamel H, Patsalides A. Angiographic Blush after Mechanical Thrombectomy is Associated with Hemorrhagic Transformation of Ischemic Stroke. J Stroke Cerebrovasc Dis 2018; 27:3124-3130. [PMID: 30087078 DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/25/2018] [Accepted: 07/01/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND PURPOSE Risk factors for hemorrhagic transformation of ischemic stroke after mechanical thrombectomy (MT) are not well established. We conducted a study to determine if prominent angiographic cerebral vascularity following recanalization with thrombectomy (angiographic blush) is associated with hemorrhagic transformation. METHODS Using the Cornell AcutE Stroke Academic Registry, we identified stroke patients who had thrombectomy and achieved recanalization of anterior circulation large-vessel occlusion between 2012 and 2015. The exposure variable was presence of angiographic blush after recanalization, defined as capillary blush with or without early venous drainage. The primary outcome was volume of hemorrhagic transformation on brain imaging after thrombectomy, as determined by semiautomated volumetric analysis on computed tomography or magnetic resonance imaging among those adjudicated to have hemorrhagic conversion by neuroradiology investigators blinded to angiography results. Using a doubly robust estimator with propensity scores and outcome regression adjusting for demographics and known risk factors for hemorrhagic transformation, we evaluated whether angiographic blush after recanalization is associated with an increased volume of hemorrhagic transformation. RESULTS Among 48 eligible patients, 31 (64.6%) had angiographic blush and 26 (54.2%) had radiographic hemorrhagic transformation (mean volume, 7.6 ml). Patients with angiographic blush averaged lower thrombolysis in cerebral infarction scores and more often received intravenous thrombolysis. In adjusted analysis, angiographic blush was associated with an increased volume of hemorrhagic transformation: mean volume, 10.3ml (95% CI, 3.7-16.9 ml) with blush versus 1.8ml (95% Confidence Interval (CII = Confidence Interval), 0.1-3.4 ml) without (P = .01). CONCLUSIONS Presence of angiographic blush after MT was independently associated with the volume of hemorrhagic transformation.
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Affiliation(s)
| | | | - Aaron M Gusdon
- Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Benjamin Kummer
- Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Hediyeh Baradaran
- Department of Radiology, Division of Neuroradiology, Weill Cornell Medicine, New York, NY
| | - Praneil Patel
- Department of Radiology, Division of Neuroradiology, Weill Cornell Medicine, New York, NY
| | - Iván Díaz
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY; and
| | - Babak B Navi
- Department of Neurology, Weill Cornell Medicine, New York, NY; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
| | - Ajay Gupta
- Department of Radiology, Division of Neuroradiology, Weill Cornell Medicine, New York, NY
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medicine, New York, NY; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
| | - Athos Patsalides
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY
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Cartmell SC, Ball RL, Kaimal R, Telischak NA, Marks MP, Do HM, Dodd RL, Albers GW, Lansberg MG, Heit JJ. Early Cerebral Vein After Endovascular Ischemic Stroke Treatment Predicts Symptomatic Reperfusion Hemorrhage. Stroke 2018; 49:1741-1746. [DOI: 10.1161/strokeaha.118.021402] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/14/2018] [Accepted: 03/28/2018] [Indexed: 11/16/2022]
Affiliation(s)
| | - Robyn L. Ball
- Department of Medicine, Quantitative Sciences Unit (R.L.B., R.K.)
| | - Rajani Kaimal
- Department of Medicine, Quantitative Sciences Unit (R.L.B., R.K.)
| | - Nicholas A. Telischak
- Stanford University School of Medicine, CA; Neurointerventional Surgery, California Pacific Medical Center, San Francisco (N.A.T.)
| | - Michael P. Marks
- Neuroimaging and Neurointervention Division, Department of Radiology (M.P.M., H.M.D., R.L.D., J.J.H.)
| | - Huy M. Do
- Neuroimaging and Neurointervention Division, Department of Radiology (M.P.M., H.M.D., R.L.D., J.J.H.)
- Department of Neurosurgery (H.M.D., R.L.D.)
| | - Robert L. Dodd
- Neuroimaging and Neurointervention Division, Department of Radiology (M.P.M., H.M.D., R.L.D., J.J.H.)
- Department of Neurosurgery (H.M.D., R.L.D.)
| | - Gregory W. Albers
- Department of Neurology (G.W.A., M.G.L.), Stanford School of Medicine, CA
| | | | - Jeremy J. Heit
- Neuroimaging and Neurointervention Division, Department of Radiology (M.P.M., H.M.D., R.L.D., J.J.H.)
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Tong LS, Guo ZN, Ou YB, Yu YN, Zhang XC, Tang J, Zhang JH, Lou M. Cerebral venous collaterals: A new fort for fighting ischemic stroke? Prog Neurobiol 2017; 163-164:172-193. [PMID: 29199136 DOI: 10.1016/j.pneurobio.2017.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/03/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022]
Abstract
Stroke therapy has entered a new era highlighted by the use of endovascular therapy in addition to intravenous thrombolysis. However, the efficacy of current therapeutic regimens might be reduced by their associated adverse events. For example, over-reperfusion and futile recanalization may lead to large infarct, brain swelling, hemorrhagic complication and neurological deterioration. The traditional pathophysiological understanding on ischemic stroke can hardly address these occurrences. Accumulating evidence suggests that a functional cerebral venous drainage, the major blood reservoir and drainage system in brain, may be as critical as arterial infusion for stroke evolution and clinical sequelae. Further exploration of the multi-faceted function of cerebral venous system may add new implications for stroke outcome prediction and future therapeutic decision-making. In this review, we emphasize the anatomical and functional characteristics of the cerebral venous system and illustrate its necessity in facilitating the arterial infusion and maintaining the cerebral perfusion in the pathological stroke content. We then summarize the recent critical clinical studies that underscore the associations between cerebral venous collateral and outcome of ischemic stroke with advanced imaging techniques. A novel three-level venous system classification is proposed to demonstrate the distinct characteristics of venous collaterals in the setting of ischemic stroke. Finally, we discuss the current directions for assessment of cerebral venous collaterals and provide future challenges and opportunities for therapeutic strategies in the light of these new concepts.
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Affiliation(s)
- Lu-Sha Tong
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Departments of Physiology, Loma Linda University, School of Medicine, CA, USA
| | - Zhen-Ni Guo
- Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China; Departments of Physiology, Loma Linda University, School of Medicine, CA, USA
| | - Yi-Bo Ou
- Department of Neurosurgery, Tong-ji Hospital, Wuhan, China; Departments of Physiology, Loma Linda University, School of Medicine, CA, USA
| | - Yan-Nan Yu
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiao-Cheng Zhang
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jiping Tang
- Department of Anesthesiology, Loma Linda University, School of Medicine, CA, USA
| | - John H Zhang
- Departments of Physiology, Loma Linda University, School of Medicine, CA, USA.
| | - Min Lou
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
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Kaesmacher J, Maegerlein C, Kaesmacher M, Zimmer C, Poppert H, Friedrich B, Boeckh-Behrens T, Kleine JF. Thrombus Migration in the Middle Cerebral Artery: Incidence, Imaging Signs, and Impact on Success of Endovascular Thrombectomy. J Am Heart Assoc 2017; 6:e005149. [PMID: 28202431 PMCID: PMC5523786 DOI: 10.1161/jaha.116.005149] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/20/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Thrombus migration (TM) in intracranial vessels during ischemic stroke has been reported in the form of case reports, but its incidence, impact on the technical success of subsequent endovascular thrombectomy and patients' outcome have never been studied systematically. METHODS AND RESULTS Retrospective analysis was done of 409 patients with isolated middle cerebral artery occlusions treated with endovascular thrombectomy. TM was observed (1) by analyzing discrepancies between computed tomographic angiography and digital subtraction angiography and (2) by comparing infarct pattern in the striatocapsular region with exact, angiographically assessed thrombus location within the M1-segment and the involvement of the middle cerebral artery perforators. Preinterventional infarction of discrepant regions (infarction in regions supplied by more proximal vessels than those occluded by the clot) was ensured by carefully reviewing available preinterventional multimodal imaging. Adequate imaging inclusion criteria were met by 325 patients. Ninety-seven patients showed signs of TM (26 with direct evidence, 71 with indirect evidence). There was no difference in the frequency of preinterventional intravenous recombinant tissue plasminogen activator administration between patients with TM and those without (63.9% vs 64.9%, P=0.899). TM was associated with lower rates of complete reperfusion (Thrombolysis in Cerebral Infarction score 3) (adjusted odds ratio 0.400, 95% CI 0.226-0.707). Subsequently, preinterventional TM was associated with lower rates of substantial neurologic improvement (adjusted odds ratio 0.541, 95% CI 0.309-0.946). CONCLUSIONS Preinterventional TM does not seem to be facilitated by intravenous recombinant tissue plasminogen activator and often occurs spontaneously. However, TM is associated with the risk of incomplete reperfusion in subsequent thrombectomy, suggesting increased clot fragility. Occurrence of TM may thereby have a substantial impact on the outcome of endovascularly treated stroke patients.
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Affiliation(s)
- Johannes Kaesmacher
- Department of Neuroradiology, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Christian Maegerlein
- Department of Neuroradiology, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Mirjam Kaesmacher
- Department of Neuroradiology, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Holger Poppert
- Department of Neurology, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Benjamin Friedrich
- Department of Neuroradiology, Klinikum rechts der Isar, TU München, Munich, Germany
| | | | - Justus F Kleine
- Department of Neuroradiology, Klinikum rechts der Isar, TU München, Munich, Germany
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11
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Munuera J, Blasco G, Hernández-Pérez M, Daunis-I-Estadella P, Dávalos A, Liebeskind DS, Wintermark M, Demchuk A, Menon BK, Thomalla G, Nael K, Pedraza S, Puig J. Venous imaging-based biomarkers in acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2017; 88:62-69. [PMID: 27807197 DOI: 10.1136/jnnp-2016-314814] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/06/2016] [Accepted: 10/10/2016] [Indexed: 11/04/2022]
Abstract
Vascular neuroimaging plays a decisive role in selecting the best therapy in patients with acute ischaemic stroke. However, compared with the arterial system, the role of veins has not been thoroughly studied. In this review, we present the major venous imaging-based biomarkers in ischaemic stroke. First, the presence of hypodense veins in the monophasic CT angiography ipsilateral to the arterial occlusion. Second, the asymmetry of venous drainage in the pathological cerebral hemisphere on CT and MRI dynamic angiography. Finally, the presence of hypodense veins on T2* -based MRI. From the physiological point of view, the venous imaging-based biomarkers would detect the alteration of brain perfusion (flow), as well as the optimisation of extraction oxygen mechanisms (misery perfusion). Several studies have correlated the venous imaging-based biomarkers with grade of collateral circulation, the ischaemic penumbra and clinical functional outcome. Although venous imaging-based biomarkers still have to be validated, growing evidence highlights a potential complementary role in the acute stroke clinical decision-making process.
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Affiliation(s)
- Josep Munuera
- Diagnostic Imaging Institute (IDI), Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Gerard Blasco
- Institute of Diagnostic Imaging (IDI)-Research Unit (IDIR), Girona, Spain.,Girona Biomedical Research Institute (IDIBGI)-Medical Imaging, Girona, Spain
| | | | - Pepus Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - Antoni Dávalos
- Stroke Unit, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Los Angeles, California, USA
| | - Max Wintermark
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California, USA
| | - Andrew Demchuk
- Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bijoy K Menon
- Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Götz Thomalla
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kambiz Nael
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Salvador Pedraza
- Girona Biomedical Research Institute (IDIBGI)-Medical Imaging, Girona, Spain.,Institute of Diagnostic Imaging (IDI)-Dr. Josep Trueta University Hospital, Girona, Spain
| | - Josep Puig
- Institute of Diagnostic Imaging (IDI)-Research Unit (IDIR), Girona, Spain.,Girona Biomedical Research Institute (IDIBGI)-Medical Imaging, Girona, Spain
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12
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Association of Cortical Vein Filling with Clot Location and Clinical Outcomes in Acute Ischaemic Stroke Patients. Sci Rep 2016; 6:38525. [PMID: 27917948 PMCID: PMC5137111 DOI: 10.1038/srep38525] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 11/11/2016] [Indexed: 01/19/2023] Open
Abstract
Delay in cortical vein filling during the late-venous phase (delayed-LCVF) is characterized by opacification of cerebral veins despite contrast clearance from contralateral veins on dynamic computed tomography angiography (dCTA) in acute ischemic stroke (AIS) patients. The aim of the study was to investigate the associations of delayed-LCVF with clot location, reperfusion status at 24 hours, and 90-days functional outcome in AIS patients who received reperfusion therapy. A prospective cohort of AIS patients treated with intravenous thrombolysis was studied. Groupwise comparison, univariate, and multivariate regression analyses were used to study the association of delayed-LCVF with clot location and clinical outcomes. Of 93 patients (mean age = 72 ± 12 years) with hemispheric AIS included in the study, 46 (49%) demonstrated delayed-LCVF. Patients with delayed-LCVF demonstrated a significantly higher proportion of proximal occlusion (72% vs 13%, P =< 0.0001), and poor reperfusion at 24 hours (41% vs 11%, P = 0.001). The proportion of poor functional outcome at 90 days was not significantly different (22/56 (48%) vs 17/61 (36%), P = 0.297). The appearance of delayed-LCVF on baseline dCTA may be a surrogate for large vessel occlusion, and an early marker for poor 24-hour angiographic reperfusion.
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13
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Arteriovenous shunts and capillary blush as an early sign of basal ganglia infarction after successful mechanical intra-arterial thrombectomy in ischaemic stroke. Eur Radiol 2015; 25:3060-5. [DOI: 10.1007/s00330-015-3704-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/03/2015] [Accepted: 03/04/2015] [Indexed: 11/26/2022]
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14
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Gerber JC, Miaux YJ, von Kummer R. Scoring flow restoration in cerebral angiograms after endovascular revascularization in acute ischemic stroke patients. Neuroradiology 2014; 57:227-40. [PMID: 25407716 DOI: 10.1007/s00234-014-1460-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 10/30/2014] [Indexed: 12/18/2022]
Abstract
Endovascular revascularization techniques are increasingly used to treat arterial occlusions in patients with acute ischemic stroke. To monitor and communicate treatment results, a valid, reproducible, and clinically relevant, yet easy to use grading scheme of arterial recanalization and tissue reperfusion for digital subtraction angiography is needed. An ideal scoring system would consider the target arterial lesion, the perfusion deficit, and the collateral status before treatment and measure recanalization, reperfusion, early venous shunting, vasospasm, as well as distal embolization after flow restoration. Currently, a variety of different flow restoration scales are in use, including the Thrombolysis in Myocardial Infarction scoring system, the Thrombolysis in Cerebral Infarction score, and the Arterial Occlusive Lesion score, which describe the local recanalization result. These scores are not used homogeneously throughout the literature, are often modified and not fully documented, which make them inept to compare treatment effects across studies. In addition, none of these scores cover all of the above-mentioned aspects, nor are they able to describe satisfactorily all relevant angiographic findings, and data on their reliability and predictive power regarding clinical outcome are sparse. We aimed to review and illustrate the different revascularization scales, discuss their advantages and limitations as well as the available data regarding standardization, reliability testing, and outcome prediction. In addition, we give examples for the use of the scales and show potential pitfalls.
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Affiliation(s)
- Johannes C Gerber
- Neuroradiology, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany,
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15
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Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL, Marks MP, Prabhakaran S, Kallmes DF, Fitzsimmons BFM, Mocco J, Wardlaw JM, Barnwell SL, Jovin TG, Linfante I, Siddiqui AH, Alexander MJ, Hirsch JA, Wintermark M, Albers G, Woo HH, Heck DV, Lev M, Aviv R, Hacke W, Warach S, Broderick J, Derdeyn CP, Furlan A, Nogueira RG, Yavagal DR, Goyal M, Demchuk AM, Bendszus M, Liebeskind DS. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke 2013; 44:2650-63. [PMID: 23920012 PMCID: PMC4160883 DOI: 10.1161/strokeaha.113.001972] [Citation(s) in RCA: 1146] [Impact Index Per Article: 104.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Osama O Zaidat
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
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