1
|
Kaloss AM, Theus MH. Leptomeningeal anastomoses: Mechanisms of pial collateral remodeling in ischemic stroke. WIREs Mech Dis 2022; 14:e1553. [PMID: 35118835 PMCID: PMC9283306 DOI: 10.1002/wsbm.1553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 12/13/2022]
Abstract
Arterial collateralization, as determined by leptomeningeal anastomoses or pial collateral vessels, is a well‐established vital player in cerebral blood flow restoration and neurological recovery from ischemic stroke. A secondary network of cerebral collateral circulation apart from the Circle of Willis, exist as remnants of arteriole development that connect the distal arteries in the pia mater. Recent interest lies in understanding the cellular and molecular adaptations that control the growth and remodeling, or arteriogenesis, of these pre‐existing collateral vessels. New findings from both animal models and human studies of ischemic stroke suggest a multi‐factorial and complex, temporospatial interplay of endothelium, immune and vessel‐associated cell interactions may work in concert to facilitate or thwart arteriogenesis. These valuable reports may provide critical insight into potential predictors of the pial collateral response in patients with large vessel occlusion and may aid in therapeutics to enhance collateral function and improve recovery from stroke. This article is categorized under:Neurological Diseases > Molecular and Cellular Physiology
Collapse
Affiliation(s)
- Alexandra M Kaloss
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| | - Michelle H Theus
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.,School of Neuroscience, Virginia Tech, Blacksburg, Virginia, USA.,Center for Regenerative Medicine, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| |
Collapse
|
2
|
Guenego A, Leipzig M, Fahed R, Sussman ES, Faizy TD, Martin BW, Marcellus DG, Wintermark M, Olivot JM, Albers GW, Lansberg MG, Heit JJ. Effect of Oxygen Extraction (Brush-Sign) on Baseline Core Infarct Depends on Collaterals (HIR). Front Neurol 2021; 11:618765. [PMID: 33488506 PMCID: PMC7815586 DOI: 10.3389/fneur.2020.618765] [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: 10/18/2020] [Accepted: 12/07/2020] [Indexed: 12/23/2022] Open
Abstract
Objectives: Baseline-core-infarct volume is a critical factor in patient selection and outcome in acute ischemic stroke (AIS) before mechanical thrombectomy (MT). We determined whether oxygen extraction efficiency and arterial collaterals, two different physiologic components of the cerebral ischemic cascade, interacted to modulate baseline-core-infarct volume in patients with AIS-LVO undergoing MT triage. Methods: Between January 2015 and March 2018, consecutive patients with an AIS and M1 occlusion considered for MT with a baseline MRI and perfusion-imaging were included. Variables such as baseline-core-infarct volume [mL], arterial collaterals (HIR: TMax > 10 s volume/TMax > 6 s), high oxygen extraction (HOE, presence of the brush-sign on T2*) were assessed. A linear-regression was used to test the interaction of HOE and HIR with baseline-core-infarct volume, after including potential confounding variables. Results: We included 103 patients. Median age was 70 (58–78), and 63% were female. Median baseline-core-infarct volume was 32 ml (IQR 8–74.5). Seventy six patients (74%) had HOE. In a multivariate analysis both favorable HIR collaterals (p = 0.02) and HOE (p = 0.038) were associated with lower baseline-core-infarct volume. However, HOE significantly interacted with HIR (p = 0.01) to predict baseline-core-infarct volume, favorable collaterals (low HIR) with HOE was associated with small baseline-core-infarct whereas patients with poor collaterals (high HIR) and HOE had large baseline-core-infarct. Conclusion: While HOE under effective collateral blood-flow has the lowest baseline-core-infarct volume of all patients, the protective effect of HOE reverses under poor collateral blood-flow and may be a maladaptive response to ischemic stroke as measured by core infarctions in AIS-LVO patients undergoing MT triage.
Collapse
Affiliation(s)
- Adrien Guenego
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | - Matthew Leipzig
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | - Robert Fahed
- Division of Neurology, Department of Medicine, Ottawa Hospital, Ottawa, ON, Canada
| | - Eric S Sussman
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | - Tobias D Faizy
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | - Blake W Martin
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | - David G Marcellus
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | - Max Wintermark
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| | | | - Gregory W Albers
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Maarten G Lansberg
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Jeremy J Heit
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United States
| |
Collapse
|
3
|
Chang YM, Tenenbaum M, Xiong Y, Selim M, Bhadelia R, Hacein-Bey L, Ivanovic V. Brain Computed Tomography Angiography Maximum Intensity Projection Images for ASPECTS Derivation and Detection of Large Infarct Volumes: Preliminary Study. J Stroke Cerebrovasc Dis 2020; 30:105548. [PMID: 33360519 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105548] [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: 11/05/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Non-contrast CT ASPECTS (NCCTasp) has an established role in determining eligibility for mechanical thrombectomy in centers without ready access to perfusion or DWI. Moreover, it has been suggested that CTA source ASPECTS (CTAasp) may be superior to NCCTasp in predicting final infarct volume (FIV). In this study, we hypothesized that CTA maximum intensity projection ASPECTS (MIPSasp) would be superior compared to both NCCTasp and CTAasp in predicting FIV as measured by DWI. MATERIALS AND METHODS In 41 consecutive patients with MCA territory infarcts, NCCTasp, CTAasp and MIPSasp were visually assessed by 2 neuroradiologists. Disagreements were adjudicated by a third neuroradiologist, and the reconciled data used for all further analysis. MR-DWI was used as the standard for FIV determination. Receiver operating characteristic curve analysis was used to compare the area under the curve for all three CT-based methods in predicting FIV ≥70 ml. RESULTS MIPSasp (AUC: 0.98, CI: 0.88-1.00) were statistically better than NCCTasp (AUC: 0.87, 95% CI: 0.72-0.95; p=0.01) in predicting FIV ≥70 ml. MIPSasp were also superior to CTAasp (AUC: 0.9, CI: 0.79-.98; p˂0.05). Optimal test performance for predicting FIV ≥70 ml for MIPSasp was ≤6 (sensitivity=100%, specificity=91.4%; Youden's J=0.98). CONCLUSION Our preliminary study suggests that a novel CTA-MIPS derived ASPECTS better predicts large MCA territory infarcts compared to CTA source and non-contrast ASPECTS. Thus, MIPSasp may be a promising technique for future studies aimed at improving ischemic stroke treatment in centers using ASPECTS for stroke management.
Collapse
Affiliation(s)
- Yu-Ming Chang
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States.
| | | | - Yunyun Xiong
- Beijing Tiantan Hospital, China; Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Magdy Selim
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Rafeeque Bhadelia
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Lotfi Hacein-Bey
- Davis School of Medicine, University of California, United States
| | | |
Collapse
|
4
|
Mulder IA, Holswilder G, van Walderveen MAA, van der Schaaf IC, Bennink E, Horsch AD, Kappelle LJ, Velthuis BK, Dankbaar JW, Terwindt GM, Schonewille WJ, Visser MC, Ferrari MD, Algra A, Wermer MJH. Stroke progression and clinical outcome in ischemic stroke patients with a history of migraine. Int J Stroke 2019; 14:946-955. [DOI: 10.1177/1747493019851288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Patients with migraine might be more susceptible of spreading depolarizations, which are known to affect vascular and neuronal function and penumbra recovery after stroke. We investigated whether these patients have more severe stroke progression and less favorable outcomes after recanalization therapy. Methods We included patients from a prospective multicenter ischemic stroke cohort. Lifetime migraine history was based on the International Classification of Headache Disorders II criteria. Patients without confirmed migraine diagnosis were excluded. Patients underwent CT angiography and CT perfusion <9 h of onset and follow-up CT after three days. On admission, presence of a perfusion deficit, infarct core and penumbra volume, and blood brain barrier permeability (BBBP) were assessed. At follow-up we assessed malignant edema, hemorrhagic transformation, and final infarct volume. Outcome at three months was evaluated with the modified Rankin Scale (mRS). We calculated adjusted relative risks (aRR) or difference of means (aB) with regression analyses. Results We included 600 patients of whom 43 had migraine. There were no differences between patients with or without migraine in presence of a perfusion deficit on admission (aRR: 0.98, 95%CI: 0.77–1.25), infarct core volume (aB: -10.8, 95%CI: -27.04–5.51), penumbra volume (aB: -11.6, 95%CI: -26.52–3.38), mean blood brain barrier permeability (aB: 0.08, 95%CI: -3.11–2.96), malignant edema (0% vs. 5%), hemorrhagic transformation (aRR: 0.26, 95%CI: 0.04–1.73), final infarct volume (aB: -14.8, 95%CI: 29.9–0.2) or outcome after recanalization therapy (mRS > 2, aRR: 0.50, 95%CI: 0.21–1.22). Conclusion Elderly patients with a history of migraine do not seem to have more severe stroke progression and have similar treatment outcomes compared with patients without migraine.
Collapse
Affiliation(s)
- Inge A Mulder
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ghislaine Holswilder
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexander D Horsch
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Marieke C Visser
- Department of Neurology, VU Medical Center, Amsterdam, the Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ale Algra
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marieke JH Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | |
Collapse
|
5
|
Saito M, Ishizuka K, Hoshino T, Toi S, Kitagawa K. Leptomeningeal anastomosis and early ischemic lesions on diffusion-weighted imaging in male murine focal cerebral ischemia. J Neurosci Res 2019; 97:752-759. [PMID: 31006898 DOI: 10.1002/jnr.24403] [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: 12/07/2018] [Revised: 01/25/2019] [Accepted: 02/05/2019] [Indexed: 11/12/2022]
Abstract
Leptomeningeal anastomosis is a key factor for determining early ischemic lesions on diffusion-weighted imaging (DWI) in human stroke. However, few studies have validated this relationship in an experimental model. This study sought to clarify the involvement of leptomeningeal anastomosis in early ischemic lesions using a murine model. Adult male C57BL/6 mice were subjected to unilateral common carotid artery (CCA) occlusion or sham surgery. Seven or 14 days later, the middle cerebral artery (MCA) was occluded for 45 min. In the first experiment, the leptomeningeal collaterals were visualized using magnetic resonance imaging (MRI) DWI. In the second experiment, DWI was performed immediately after MCA occlusion, and the infarct sizes were determined 24 hr after recirculation. Unilateral CCA occlusion reduced the size of early ischemic lesions, enlarged the pial vessel diameter, and mitigated infarct size. The relationship between the DWI lesion size and pial vessel diameter was significant (r = 0.84, p < 0.01). The association between infarct size and DWI lesion size was also significant (r = 0.96, p < 0.01). In conclusion, involvement of the collateral circulation in early ischemic lesions was evident in the murine model. Both MRI and evaluation of leptomeningeal anastomosis could be used to develop a novel strategy targeting enhancement of the collateral circulation.
Collapse
Affiliation(s)
- Moeko Saito
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kentaro Ishizuka
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Takao Hoshino
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Sono Toi
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| |
Collapse
|
6
|
Mehrkhani F, Berkhemer OA, Majoie CBLM, Mansouri M, Karimi Z, Lev MH, Yoo AJ. Combined Evaluation of Noncontrast CT ASPECTS and CT Angiography Collaterals Improves Detection of Large Infarcts in Proximal Artery Occlusive Stroke. J Neuroimaging 2018; 28:524-529. [PMID: 29749671 DOI: 10.1111/jon.12522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Imaging may identify patients with very large infarcts who are unlikely to benefit from intra-arterial therapy. Although computed tomography (CT) is widely used, it suffers from poor sensitivity. We sought to evaluate whether combined evaluation of noncontrast CT (NCCT) and CT angiography (CTA) collaterals would improve the detection of large infarcts. METHODS All patients with anterior circulation proximal artery occlusion and baseline CT, CTA, and magnetic resonance imaging (MRI) performed were identified. NCCT ASPECTS, CTA collateral score (CS), and diffusion-weighted imaging (DWI) lesion volume were determined. Receiver-operating characteristic analyses were performed to test the discrimination of NCCT ASPECTS 0-4, CTA malignant collaterals (CS = 0: absent collaterals in >50% of M2 territory), and the combination for DWI volume > 100 mL. RESULTS Among 54 patients, mean age was 67 years; median NIHSS was 14. Occlusion locations were ICA terminus (18 [33%]), MCA M1 (20 [37%]), and M2 (16 [30%]). Median NCCT ASPECTS was 8; 8 (15%) had ASPECTS 0-4. Median CTA CS was 2; 9 (17%) were categorized as malignant. Median DWI lesion volume was 25 mL; 12 (22%) had lesions >100 mL. Individually, the CTA malignant collateral profile (98%) and NCCT ASPECTS 0-4 (100%) demonstrated high specificity for DWI lesion volume >100 mL, but had suboptimal sensitivity (both 67%). In the combined approach (CTA CS = 0 and/or NCCT ASPECTS ≤4), the sensitivity improved significantly to 92%, while maintaining high specificity (98%). CONCLUSIONS Combined evaluation of NCCT ASPECTS and CTA collaterals identifies patients with infarcts >100 mL with high accuracy, and can improve patient selection using current CT techniques.
Collapse
Affiliation(s)
- Farhad Mehrkhani
- Department of Radiology, Case Western Reserve University, Cleveland
| | - Olvert A Berkhemer
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | - Zahra Karimi
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston
| | - Michael H Lev
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Albert J Yoo
- Division of Neurointervention, Texas Stroke Institute, Dallas, TX
| |
Collapse
|
7
|
Luo C, Liang F, Ren H, Yao X, Liu Q, Li M, Qin D, Yuan TF, Pei Z, Su H. Collateral blood flow in different cerebrovascular hierarchy provides endogenous protection in cerebral ischemia. Brain Pathol 2017; 27:809-821. [PMID: 27859886 DOI: 10.1111/bpa.12458] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/11/2016] [Indexed: 01/01/2023] Open
Abstract
Collateral blood flow as vascular adaptions to focal cerebral ischemia is well recognized. However, few studies directly investigate the dynamics of collateral vessel recruitment in vivo and little is known about the effect of collateral blood flow in different cerebrovascular hierarchy on the neuropathology after focal ischemic stroke. Here, we report that collateral blood flow is critically involved in blood vessel compensations following regional ischemia. We occluded a pial arteriole using femtosecond laser ablating under the intact thinned skull and documented the changes of collateral flow around the surface communication network and between the surface communication network and subsurface microcirculation network using in vivo two photon microscopy imaging. Occlusion of the pial arteriole apparently increased the diameter and collateral blood flow of its leptomeningeal anastomoses, which significantly reduced the cortical infarction size. This result suggests that the collateral flow via surface communicating network connected with leptomeningeal anastomoses could greatly impact on the extent of infarction. We then further occluded the target pial arteriole and all of its leptomeningeal anastomoses. Notably, this type of occlusion led to reversals of blood flow in the penetrating arterioles mainly proximal to the occluded pial arteriole in a direction from the subsurface microcirculation network to surface arterioles. Interesting, the cell death in the area of ischemic penumbra was accelerated when we performed occlusion to cease the reversed blood flow in those penetrating arterioles, suggesting that the collateral blood flow from subsurface microcirculation network exerts protective roles in delaying cell death in the ischemic penumbra. In conclusion, we provide the first experimental evidence that collateral blood vessels at different cerebrovascular hierarchy are endogenously compensatory mechanisms in brain ischemia.
Collapse
Affiliation(s)
- Chuanming Luo
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Fengyin Liang
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, First Affiliated Hospital Sun Yat-Sen University, Guangzhou, 510080, China
| | - Huixia Ren
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Xiaoli Yao
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, First Affiliated Hospital Sun Yat-Sen University, Guangzhou, 510080, China
| | - Qiang Liu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Mingyue Li
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, First Affiliated Hospital Sun Yat-Sen University, Guangzhou, 510080, China
| | - Dajiang Qin
- South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Ti-Fei Yuan
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Zhong Pei
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, First Affiliated Hospital Sun Yat-Sen University, Guangzhou, 510080, China
| | - Huanxing Su
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| |
Collapse
|
8
|
van Seeters T, Biessels GJ, Kappelle LJ, van der Graaf Y, Velthuis BK. Determinants of leptomeningeal collateral flow in stroke patients with a middle cerebral artery occlusion. Neuroradiology 2016; 58:969-977. [PMID: 27438804 PMCID: PMC5069303 DOI: 10.1007/s00234-016-1727-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/07/2016] [Indexed: 11/26/2022]
Abstract
Introduction Poor leptomeningeal collateral flow is related to worse clinical outcome in acute ischemic stroke, but the factors that determine leptomeningeal collateral patency are largely unknown. We explored the determinants of leptomeningeal collateral flow and assessed their effect on the relation between leptomeningeal collateral flow and clinical outcome. Methods We included 484 patients from the Dutch acute stroke study (DUST) with a middle cerebral artery (MCA) occlusion. The determinants of poor leptomeningeal collateral flow (≤50 % collateral filling) were identified with logistic regression. We calculated the relative risk (RR) of poor leptomeningeal collateral flow in relation to poor clinical outcome (90-day modified Rankin Scale 3–6) using Poisson regression and assessed whether the determinants of leptomeningeal collateral flow affected this relation. Results Leptomeningeal collateral flow was poor in 142 patients (29 %). In multivariable analyses, higher admission glucose level (odds ratio (OR) 1.1 per mmol/L increase (95 % CI 1.0–1.2)), a proximal MCA occlusion (OR 1.9 (95 % CI 1.3–3.0)), and an incomplete posterior circle of Willis (OR 1.7 (95 % CI 1.1–2.6)) were independently related to poor leptomeningeal collateral flow. Poor leptomeningeal collateral flow was related to poor clinical outcome (unadjusted RR 1.7 (95 % CI 1.4–2.0)), and this relation was not affected by the determinants of leptomeningeal collateral flow. Conclusion Our study shows that admission glucose level, a proximal MCA occlusion, and an incomplete ipsilateral posterior circle of Willis are determinants of leptomeningeal collateral flow that represent a combination of congenital, acquired, and acute factors. After adjustment for these determinants, leptomeningeal collateral flow remains related to clinical outcome.
Collapse
Affiliation(s)
- Tom van Seeters
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01 132, 3584 CX, Utrecht, The Netherlands.
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01 132, 3584 CX, Utrecht, The Netherlands
| |
Collapse
|
9
|
van Seeters T, Biessels GJ, Kappelle LJ, van der Schaaf IC, Dankbaar JW, Horsch AD, Niesten JM, Luitse MJA, Majoie CBLM, Vos JA, Schonewille WJ, van Walderveen MAA, Wermer MJH, Duijm LEM, Keizer K, Bot JCJ, Visser MC, van der Lugt A, Dippel DWJ, Kesselring FOHW, Hofmeijer J, Lycklama À Nijeholt GJ, Boiten J, van Rooij WJ, de Kort PLM, Roos YBWEM, Meijer FJA, Pleiter CC, Mali WPTM, van der Graaf Y, Velthuis BK. CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke. Neuroradiology 2016; 58:327-37. [PMID: 26767380 PMCID: PMC4819789 DOI: 10.1007/s00234-015-1636-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/17/2015] [Indexed: 01/26/2023]
Abstract
Introduction We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. Methods We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R2 was assessed to determine the additional value of CTA and CTP. Results At follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8–69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79–0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82–0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95 % CI 0.87–0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95 % CI 0.87–0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R2 = 0.58) was superior to patient characteristics and non-contrast CT alone (R2 = 0.44) and to addition of CTA alone (R2 = 0.55) or CTP alone (R2 = 0.54; all p < 0.001). Conclusion In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment. Electronic supplementary material The online version of this article (doi:10.1007/s00234-015-1636-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tom van Seeters
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands.
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene C van der Schaaf
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
| | - Alexander D Horsch
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
| | - Joris M Niesten
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
| | - Merel J A Luitse
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
| | | | - Jan Albert Vos
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Koos Keizer
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Joseph C J Bot
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Marieke C Visser
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Jelis Boiten
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands
| | | | - Paul L M de Kort
- Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Frederick J A Meijer
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Willem P T M Mali
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
| | | |
Collapse
|