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Yedavalli V, Salim HA, Mei J, Lakhani DA, Balar A, Musmar B, Adeeb N, Hoseinyazdi M, Luna L, Deng F, Hyson NZ, Dmytriw AA, Guenego A, Faizy TD, Heit JJ, Albers GW, Lu H, Urrutia VC, Nael K, Marsh EB, Hillis AE, Llinas R. Decreased Quantitative Cerebral Blood Volume Is Associated With Poor Outcomes in Large Core Patients. Stroke 2024; 55:2409-2419. [PMID: 39185560 DOI: 10.1161/strokeaha.124.047483] [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: 04/12/2024] [Revised: 07/02/2024] [Accepted: 07/23/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Recent large core trials have highlighted the effectiveness of mechanical thrombectomy (MT) in acute ischemic stroke with large vessel occlusion. Variable perfusion-imaging thresholds and poor Alberta Stroke Program Early Computed Tomography Score reliability underline the need for more standardized, quantitative ischemia measures for MT patient selection. We aimed to identify the computed tomography perfusion parameter most strongly associated with poor outcomes in patients with acute ischemic stroke-large vessel occlusion with significant ischemic cores. METHODS In this study from 2 comprehensive stroke centers from 2 comprehensive stroke centers within the Johns Hopkins Medical Enterprise (Johns Hopkins Hospita-East Baltimore and Bayview Medical Campus) from July 29, 2019 to January 29, 2023 in a continuously maintained database, we included patients with acute ischemic stroke-large vessel occlusion with ischemic core volumes defined as relative cerebral blood flow <30% and ≥50 mL on computed tomography perfusion or Alberta Stroke Program Early Computed Tomography Score <6. We used receiver operating characteristics to find the optimal cutoff for parameters like cerebral blood volume (CBV) <34%, 38%, 42%, and relative cerebral blood flow >20%, 30%, 34%, 38%, and time-to-maximum >4, 6, 8, and 10 seconds. The primary outcome was unfavorable outcomes (90-day modified Rankin Scale score 4-6). Multivariable models were adjusted for age, sex, diabetes, baseline National Institutes of Health Stroke Scale, intravenous thrombolysis, and MT. RESULTS We identified 59 patients with large ischemic cores. A receiver operating characteristic curve analysis showed that CBV<42% ≥68 mL is associated with unfavorable outcomes (90-day modified Rankin Scale score 4-6) with an area under the curve of 0.90 (95% CI, 0.82-0.99) in the total and MT-only cohorts. Dichotomizing at this CBV threshold, patients in the ≥68 mL group exhibited significantly higher relative cerebral blood flow, time-to-maximum >8 and 10 seconds volumes, higher CBV volumes, higher HIR, and lower CBV index. The multivariable model incorporating CBV<42% ≥68 mL predicted poor outcomes robustly in both cohorts (area under the curve for MT-only subgroup was 0.87 [95% CI, 0.75-1.00]). CONCLUSIONS CBV<42% ≥68 mL most effectively forecasts poor outcomes in patients with large-core stroke, confirming its value alongside other parameters like time-to-maximum in managing acute ischemic stroke-large vessel occlusion.
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Affiliation(s)
- Vivek Yedavalli
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
| | - Hamza Adel Salim
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
| | - Janet Mei
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
| | - Dhairya A Lakhani
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston (D.A.L., A.A.D.)
| | - Aneri Balar
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
| | - Basel Musmar
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University (B.M., N.A.)
| | - Nimer Adeeb
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University (B.M., N.A.)
| | - Meisam Hoseinyazdi
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
| | - Licia Luna
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
| | - Francis Deng
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
| | - Nathan Z Hyson
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston (D.A.L., A.A.D.)
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.)
| | - Adrien Guenego
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.)
| | - Tobias D Faizy
- Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
| | - Jeremy J Heit
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA (J.J.H., G.W.A.)
| | - Gregory W Albers
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA (J.J.H., G.W.A.)
| | - Hanzhang Lu
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
| | - Victor C Urrutia
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
| | - Kambiz Nael
- David Geffen School of Medicine at UCLA, Los Angeles, CA (K.N.)
| | - Elisabeth B Marsh
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
| | - Argye E Hillis
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
| | - Raf Llinas
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)
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Salim HA, Huang S, Lakhani DA, Mei J, Balar A, Musmar B, Adeeb N, Hoseinyazdi M, Luna L, Deng F, Hyson NZ, Bahouth M, Dmytriw AA, Guenego A, Albers's GW, Lu H, Urrutia VC, Nael K, Marsh EB, Hillis AE, Llinas R, Wintermark M, Heit JJ, Faizy TD, Yedavalli V. Perfusion imaging predicts short-term clinical outcome in isolated posterior cerebral artery occlusion stroke. J Neuroimaging 2024. [PMID: 39223766 DOI: 10.1111/jon.13235] [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: 07/18/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND AND PURPOSE Ischemic strokes due to isolated posterior cerebral artery (PCA) occlusions represent 5% of all strokes but have significant impacts on patients' quality of life, primarily due to visual deficits and thalamic involvement. Current guidelines for acute PCA occlusion management are sparse, and the prognostic value of perfusion imaging parameters remains underexplored. METHODS We conducted a retrospective analysis of 32 patients with isolated PCA occlusions treated at Johns Hopkins Medical Institutions between January 2017 and March 2023. Patients underwent pretreatment perfusion imaging, with perfusion parameters analyzed using RAPID software. The primary outcome was short-term clinical outcome as measured by the National Institutes of Health Stroke Scale (NIHSS) at discharge. RESULTS The median age of the cohort was 70 years, with 34% female and 66% male. Significant correlations were found between NIHSS at discharge and various perfusion parameters, including time-to-maximum (Tmax) >6 seconds (ρ = .55, p = .004), Tmax >8 seconds (ρ = .59, p = .002), Tmax >10 seconds (ρ = .6, p = .001), mismatch volume (ρ = .51, p = .008), and cerebral blood volume (CBV) < 34% (ρ = .59, p = .002). CONCLUSIONS Tmax and CBV volumes significantly correlated with discharge NIHSS with marginal superiority of Tmax >10 seconds and CBV <42% volumes. These findings suggest that CT and MR perfusion imaging can play a crucial role in the acute management of PCA strokes, though larger, standardized studies are needed to validate these results and refine imaging thresholds specific to posterior circulation infarcts.
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Affiliation(s)
- Hamza Adel Salim
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Shenwen Huang
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Dhairya A Lakhani
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Janet Mei
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Aneri Balar
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Basel Musmar
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Nimer Adeeb
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Meisam Hoseinyazdi
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Licia Luna
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Francis Deng
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Nathan Z Hyson
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Mona Bahouth
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Adrien Guenego
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Gregory W Albers's
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA
| | - Hanzhang Lu
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Victor C Urrutia
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Kambiz Nael
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Elisabeth B Marsh
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Argye E Hillis
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Raf Llinas
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Max Wintermark
- Department of Neuroradiology, MD Anderson Medical Center, Houston, Texas, USA
| | - Jeremy J Heit
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA
| | - Tobias D Faizy
- Department of Radiology, Neuroendovascular Program, Münster University Medical Center, Münster, Germany
| | - Vivek Yedavalli
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
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Sojak L, Toebak AM, Gallino C, Von Streng T, Rudin S, Kriemler LF, Zietz A, Wagner B, Gensicke H, Sutter R, Nickel CH, Katan M, Bonati LH, Psychogios M, Dittrich TD, De Marchis GM. Association between ischaemic stroke aetiology and leptomeningeal collateral status: a retrospective cohort study. Swiss Med Wkly 2024; 154:3584. [PMID: 39137358 DOI: 10.57187/s.3584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION There is limited understanding of the pathomechanistic relationship between leptomeningeal collateral formation and ischaemic stroke aetiology. We aimed to assess the association of leptomeningeal collateral status and ischaemic stroke aetiology, using the widely recognised "Trial of Org 10172 in Acute Stroke Treatment" (TOAST) classification categorising strokes into five distinct aetiologies. METHODS Retrospective study of consecutively admitted adult ischaemic stroke patients at a Swiss stroke centre. Leptomeningeal collateral status was assessed on admission with single-phase CT-angiographies using a validated 4-point score. Patients were categorised into large-artery atherosclerosis (LAA), cardioembolic (CE), small-vessel disease (SVD) and cryptogenic (CG) according to the TOAST classification. We performed ordinal and binary (poor [collaterals filling ≤50% of the occluded territory] vs good [collaterals filling >50% of the occluded territory] collateralisation) logistic regression to evaluate the impact of TOAST aetiology on collateral status. RESULTS Among 191 patients, LAA patients had better collateral status compared to non-LAA aetiology (LAA: 2 vs CE: 2 vs SVD: 3 vs CG: 2, pLAA vs non-LAA = 0.04). In weighted multivariate logistic regression, LAA and SVD independently predicted better collateral status (binary models [adjusted odds ratio; aOR]: LAA: 3.72 [1.21-11.44] and SVD: 4.19 [1.21-14.52]; ordinal models [adjusted common odds ratio; acOR]: LAA: 2.26 [95% CI: 1.23-4.15] and SVD: 1.94 [1.03-3.66]), while CE predicted worse collateral status (binary models [aOR]: CE: 0.17 [0.07-0.41]; ordinal models [acOR]: CE: 0.24 [0.11-0.51]). CONCLUSION The aetiology of ischaemic stroke is associated with leptomeningeal collateral status on single-phase CT-angiography, with LAA and SVD predicting better and CE predicting worse collateral status.
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Affiliation(s)
- Lina Sojak
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Anna M Toebak
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology and Stroke Center, Cantonal Hospital St Gallen, St Gallen, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Camilla Gallino
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Tennessee Von Streng
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Salome Rudin
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lilian F Kriemler
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Clinic for Internal Medicine, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland
| | - Annaelle Zietz
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Benjamin Wagner
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
| | - Raoul Sutter
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Intensive Care Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Christian H Nickel
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Emergency Department, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Mira Katan
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Rheinfelden Rehabilitation Clinic, Rheinfelden, Switzerland
| | - Marios Psychogios
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Tolga D Dittrich
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology and Stroke Center, Cantonal Hospital St Gallen, St Gallen, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology and Stroke Center, Cantonal Hospital St Gallen, St Gallen, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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E Y, Jiang H, Yu W, Chen W, He H. Rapid identification and prognosis evaluation by dual-phase computed tomography angiography for stroke patients with a large ischemic region in the anterior circulation treated with endovascular thrombectomy. Front Neurol 2024; 15:1402003. [PMID: 38835999 PMCID: PMC11148382 DOI: 10.3389/fneur.2024.1402003] [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: 03/16/2024] [Accepted: 05/07/2024] [Indexed: 06/06/2024] Open
Abstract
Purpose To investigate the value of dual-phase head-and-neck computed tomography angiography (CTA) in assessing advantages and risks associated with mechanical thrombectomy for stroke with a large ischemic region in the anterior circulation within 6 h of onset. Methods We retrospectively analyzed the data of patients with acute occlusion of the internal carotid artery or middle cerebral artery-M1 segment. Baseline dual-phase CTA was performed for collateral grading using the 4-point visual collateral score (0, 0% filling; 1, >0% and ≤50% filling; 2, >50 and <100% filling; 3, 100% filling). The rates of modified Rankin score (MRS) ≤ 3 at 90 days, any intracranial hemorrhage (ICH) within 48 h, malignant cerebral edema within 24 h, and all-cause 90-day mortality were analyzed. Results Among the 69 study patients, 15, 26, 17, and 11 patients had collateral grades of 0, 1, 2, and 3, respectively. At 90 days, the MRS was ≤3 in 0, 8.33, 29.41, and 36.36% of patients with grades 0, 1, 2, and 3, respectively. ICH incidence was 73.33, 57.69, 29.41, and 18.18% for grades 0, 1, 2, and 3, respectively, while the incidence of malignant brain edema was 100, 76.92, 35.29, and 0%, respectively. All-cause 90-day mortality was 53.33% for grade 0 and 30.77% for grade 1; no deaths occurred at grades 2 and 3. Conclusion Collateral grading based on dual-phase CTA enables simple and rapid preoperative evaluation prior to mechanical thrombectomy for acute anterior-circulation stroke with a large ischemic focus, particularly for patients presenting within the 6-h time window.
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Affiliation(s)
- Yajun E
- Department of Neurology, Yiwu Central Hospital, Yiwu, China
- Wenzhou Medical University, Zhejiang, China
| | - Huigang Jiang
- Department of Neurology, Yiwu Central Hospital, Yiwu, China
- Wenzhou Medical University, Zhejiang, China
| | - Weifei Yu
- Department of Neurology, Yiwu Central Hospital, Yiwu, China
- Wenzhou Medical University, Zhejiang, China
| | - Weiwei Chen
- Department of Neurology, Yiwu Central Hospital, Yiwu, China
- Wenzhou Medical University, Zhejiang, China
| | - Hongfei He
- Department of Neurology, Yiwu Central Hospital, Yiwu, China
- Wenzhou Medical University, Zhejiang, China
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Seymour T, Kobeissi H, Ghozy S, Gupta R, Kadirvel R, Kallmes DF. Under (back) pressure: Better collateral flow may facilitate clot removal in ischemic stroke: A systematic review and meta-analysis. Interv Neuroradiol 2023:15910199231166739. [PMID: 36987690 DOI: 10.1177/15910199231166739] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Collateral status may facilitate clot removal and affect rates of successful reperfusion following endovascular therapy (EVT) for acute ischemic stroke (AIS). METHODS Following the PRISMA guidelines, a systematic literature review of the English language literature was conducted using PubMed, Scopus, Web of Science, and Embase. Papers which focused on collateral status and patients treated with EVT for AIS were included in our analysis. Outcomes of interest included collateral score grading, rates of successful reperfusion defined as thrombolysis in cerebral infarction (TICI) score 2b-3 and onset to revascularization time. We calculated pooled odds ratio (OR) or mean difference (MD) and their corresponding 95% confidence intervals (CI) based on collateral status. RESULTS 16 studies, with 6073 patients, were included in our analysis. Among the included studies, there were six different collateral grading scales, which were dichotomized into "good to moderate" and "poor" collaterals. Odds of successful reperfusion were significantly higher among patients with good to moderate collateral circulation compared to those with poor collaterals (OR = 1.61; 95% CI = 1.24 to 2.09; P-value < 0.001); however, there was heterogeneity among included studies (I2 = 5 4%; P-value = 0.008). Onset to revascularization time was comparable between patients with good to moderate collateral circulation compared to those with poor collaterals (MD = 3.91 min; 95% CI = -8.71 to 16.53; P-value = 0.544); however, there was heterogeneity among included studies (I2= 60%; P-value = 0.014). CONCLUSIONS The presence of good collaterals may increase the odds of achieving successful reperfusion following EVT for AIS. Improved collateral flow was associated with improved angiographic outcomes, although future work is needed to determine if a causal relationship exists.
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Affiliation(s)
- Trey Seymour
- University of Denver College of Natural Science and Mathematics, CO, USA
| | - Hassan Kobeissi
- Central Michigan University of Medicine, Mt. Pleasant, MI, USA
| | - Sherief Ghozy
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Rishabh Gupta
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | | | - David F Kallmes
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
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Mohamed A, Shuaib A, Saqqur M, Fatima N. The impact of leptomeningeal collaterals in acute ischemic stroke: a systematic review and meta-analysis. Neurol Sci 2023; 44:471-489. [PMID: 36195701 DOI: 10.1007/s10072-022-06437-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/24/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Leptomeningeal collaterals provide an alternate pathway to maintain cerebral blood flow in stroke to prevent ischemia, but their role in predicting the outcome is still unclear. So, our study aims at assessing the significance of collateral blood flow (CBF) in acute stroke. METHODS Electronic databases were searched under different MeSH terms from January 2000 to February 2019. Studies were included if there was available data on good and poor CBF in acute ischemic stroke (AIS). The clinical outcomes included were modified Rankin scale (mRS), recanalization, mortality, and symptomatic intracranial hemorrhage (sICH) at 90 days. Data was analyzed using a random-effect model. RESULTS A total of 47 studies with 8194 patients were included. Pooled meta-analysis revealed that there exist twofold higher likelihood of favorable clinical outcome (mRS ≤ 2) at 90 days with good CBF compared with poor CBF (RR: 2.27; 95% CI: 1.94-2.65; p < 0.00001) irrespective of the thrombolytic therapy [RR with IVT: 2.90; 95% CI: 2.14-3.94; p < 0.00001, and RR with IAT/EVT: 1.99; 95% CI: 1.55-2.55; p < 0.00001]. Moreover, there exists onefold higher probability of successful recanalization with good CBF (RR: 1.31; 95% CI: 1.15-1.49; p < 0.00001). However, there was 54% and 64% lower risk of sICH and mortality respectively in patients with good CBF in AIS (p < 0.00001). CONCLUSIONS The relative risk of favorable clinical outcome is more in patients with good pretreatment CBF. This could be explained due to better chances of recanalization combined with a lesser risk of intracerebral hemorrhage with good CBF status.
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Affiliation(s)
- Ahmed Mohamed
- Department of Biology (Physiology), McMaster University, Hamilton, ON, Canada
| | - Ashfaq Shuaib
- Department of Neurology, University of Alberta, Edmonton, AB, Canada
| | - Maher Saqqur
- Department of Neuroscience, Institute for Better Health, MSK Trillium Hospital, University of Toronto at Mississauga, Mississauga, ON, Canada
| | - Nida Fatima
- Division of Neurosurgery, House Institute, Los Angeles, CA, USA.
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Sinha A, Stanwell P, Killingsworth MC, Bhaskar SMM. Prognostic accuracy and impact of cerebral collateral status on clinical and safety outcomes in acute ischemic stroke patients receiving reperfusion therapy: a systematic meta-analysis. Acta Radiol 2023; 64:698-718. [PMID: 35311387 DOI: 10.1177/02841851221080517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cerebral collateral status has a potential role in mediating postreperfusion clinical and safety outcomes in acute ischemic stroke (AIS). PURPOSE To investigate the prognostic accuracy and impact of collateral status on clinical and safety outcomes in patients with AIS receiving reperfusion therapy. MATERIAL AND METHODS Studies with AIS patients treated with reperfusion therapy, collateral status assessed using Tan, ASITN/SIR, or similar collateral grading methods and data stratified according to collateral status were included. Relevant data on clinical outcomes, such as functional outcome at 90 days, mortality at 90 days, angiographic reperfusion, symptomatic intracerebral hemorrhage (sICH) and hemorrhagic transformation (HT), were collated and analyzed. RESULTS A meta-analysis of 18 studies involving 4132 patients with AIS was conducted. Good collateral status was significantly associated with angiographic reperfusion (odds ratio [OR]=1.97, 95% confidence interval [CI]=1.38-2.80; P < 0.0001), sICH (OR=0.67, 95% CI=0.46-0.99; P = 0.042), and 90-day functional outcome (OR=3.05, 95% CI=1.78-5.24; P < 0.0001). However, its association with HT (OR=0.76, 95% CI=0.38-1.51; P = 0.425) and three-month mortality (OR=0.53, 95% CI=0.17-1.69; P = 0.280) did not reach statistical significance. The prognostic accuracy of collaterals for predicting angiographic reperfusion, HT, functional outcome (at 90 days), and mortality (at 90 days) were 63%, 49%, 66%, and 48%, respectively. CONCLUSION Cerebral collaterals are significantly associated with clinical and safety outcomes, albeit with a prognostic accuracy range of 48%-66%; thus, evaluation of their patency is a useful prognostic tool in patients with AIS receiving reperfusion therapy.
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Affiliation(s)
- Akansha Sinha
- Global Health Neurology and Translational Neuroscience Laboratory, 550242Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,7800University of New South Wales (UNSW), 1511South Western Sydney Clinical School, Liverpool, NSW, Australia
| | - Peter Stanwell
- School of Health Sciences, 5982University of Newcastle, Callaghan, Newcastle, NSW, Australia
| | - Murray C Killingsworth
- Global Health Neurology and Translational Neuroscience Laboratory, 550242Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,7800University of New South Wales (UNSW), 1511South Western Sydney Clinical School, Liverpool, NSW, Australia.,NSW Brain Clot Bank, 441551NSW Health Pathology, Sydney, NSW, Australia.,Correlative Microscopy Facility, Department of Anatomical Pathology, 34378NSW Health Pathology, and Liverpool Hospital, Liverpool, NSW, Australia
| | - Sonu M M Bhaskar
- Global Health Neurology and Translational Neuroscience Laboratory, 550242Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,7800University of New South Wales (UNSW), 1511South Western Sydney Clinical School, Liverpool, NSW, Australia.,NSW Brain Clot Bank, 441551NSW Health Pathology, Sydney, NSW, Australia.,Department of Neurology and Neurophysiology, 34378Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia
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Lu WZ, Lin HA, Hou SK, Bai CH, Lin SF. Diagnostic test accuracy of pretreatment collateral score in predicting stroke outcomes after intra-arterial endovascular thrombectomy: a meta-analysis in DSA and CTA. Eur Radiol 2022; 32:6097-6107. [PMID: 35322281 DOI: 10.1007/s00330-022-08706-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study compared the diagnostic accuracy of pretreatment circulation collateral scoring (CS) system using digital subtraction angiography (DSA) and computed tomography angiography (CTA) in predicting favorable functional outcome (FFO) after intra-arterial endovascular thrombectomy (IA-EVT). Subgroup analysis characterizing scoring systems within each category was additionally conducted. MATERIALS AND METHODS We performed a diagnostic meta-analysis to assess the sensitivity and specificity of each CS system by using DSA and CTA, respectively. The hierarchical summary receiver operating characteristic curve (HSROC) models were used to estimate the diagnostic odds ratio (DOR) and area under the curve (AUC). The Bayes theorem was employed to determine posttest probability (PTP). RESULTS In total, 14 and 21 studies were assessed with DSA and CTA, respectively. In DSA, the pooled sensitivity and specificity were 0.72 (95% CI, 0.63-0.79) and 0.61 (0.53-0.68), respectively, and in the HSROC model, the DOR was 3.94 (2.71-5.73), and the AUC was 0.71 (90.67-0.75). CTA revealed a pooled sensitivity and specificity of 0.74 (0.64-0.82) and 0.53 (0.44-0.62), respectively, and in the HSROC model, the DOR was 3.17 (2.34-4.50), and the AUC was 0.67 (0.63-0.71). With a pretest probability of 26.3%, the CS in DSA and CTA exhibited limited increase of PTPs of 39% and 36%, respectively, in detecting the FFO on day 90. CONCLUSION DSA and CTA have comparable accuracy and are limited in predicting the functional outcome. The collateral score systems assessed with DSA and CTA were more suitable for screening than diagnosis for patients before IA-EVT. KEY POINTS • Our study revealed the differences of various scoring systems for assessing collateral status. • DSA and CTA have comparable accuracy, but both imaging modalities played relatively limited roles in predicting functional outcome on day 90. • The collateral score systems assessed with DSA and CTA were more suitable for screening than diagnosis for patients before IA-EVT.
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Affiliation(s)
- Wei-Zhen Lu
- Department of Emergency Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sheng-Feng Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
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Collateral Status and Clinical Outcomes after Mechanical Thrombectomy in Patients with Anterior Circulation Occlusion. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7796700. [PMID: 35126946 PMCID: PMC8808144 DOI: 10.1155/2022/7796700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
Abstract
Background. Successful mechanical thrombectomy (MT) requires reliable, noninvasive selection criteria. We aimed to investigate the association of collateral status and clinical outcomes after MT in patients with ischemic stroke due to anterior circulation occlusion. Methods. 109 patients with poor collaterals and 110 aged, sex-matched patients with good collaterals were enrolled in the study. Collateral circulation was estimated by the CT angiography with a 0–3 scale. The collateral status was categorized as poor collaterals (scores 0–1) and good collaterals (scores 2-3). The reperfusion was assessed by the modified Treatment in Cerebral Infarction scale (mTICI, score 0/1/2a/2b/3). The clinical outcomes included the scores on the modified Rankin scale (mRS, ranging from 0 to 6) and death 90 days after mechanical thrombectomy. Results. Patients with greater scores of collateral status were more likely to achieve successful reperfusion (mTICI 2b/3). Patients with good collaterals were significantly associated with a higher chance of achieving mRS of 0–1 at 90 days (adjusted ORs: 4.55; 95% CI: 3.17–7.24; and
< 0.001) and a lower risk of death at 90 days (adjusted ORs: 0.87; 95% CI: 4.0%–28.0%; and
= 0.012) compared to patients with poor collaterals. In subgroup analyses, patients with statin use seem to benefit more from the effect of collateral status on good mRS (≤2). Conclusion. Among patients with acute ischemic stroke caused by anterior circulation occlusion, better collateral status is associated with higher scores on mRS and lower mortality after mechanical thrombectomy. Statin use might have an interaction with the effect of collateral status.
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10
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Sukovatykh BS, Bolomatov NV, Sidorov DV, Sukovatykh MB. [Acute cerebral circulation impairment associated with percutaneous coronary intervention]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:175-182. [PMID: 35050264 DOI: 10.33529/angio2021420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The article deals with generalized literature data on the current importance of the problem concerning acute cerebral ischemia occurring during percutaneous coronary interventions. Pathophysiological mechanisms of the development of acute cerebral circulation impairment are described, with their classification. Also considered are various risk factors which may cause this formidable complication, followed by describing modern methods of its surgical treatment. It is noted that the main risk factors for neurological complications appearing after revascularization of coronary arteries include age, accompanying diseases (instability of arterial pressure, diabetes mellitus, atrial fibrillation, atherorosclerotic lesions of the aorta and brachiocephalic arteries, previous stroke), as well as systolic dysfunction, leukocytosis, and a low level of cognitive function prior to operation. The development of acute cerebral circulation impairment during and after percutaneous coronary intervention is an indication for using methods of endovascular treatment. It is most appropriate to use a combination of direct percutaneous thrombectomy and a stent retriever. It is underlined in the article that removal of the thrombus form the cerebral artery is not an independent surgical procedure but rather a methodology envisaging an operation to be performed from the simplest technique to the most complicated one. As the first procedure, it is necessary to perform thrombaspiration and then, if ineffective, a second stage consisting in thrombextraction with the help of a stent retriever. Besides, in order to increase efficacy of thrombaspiration there have been worked out several techniques combining the use of direct thrombextraction and a stent retriever. Described in detail are 4 most commonly used techniques.
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Affiliation(s)
- B S Sukovatykh
- Department of General Surgery, Kursk State Medical University of the RF Ministry of Public Health, Kursk, Russia
| | - N V Bolomatov
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Pirogov National Medical and Surgical Centre, Moscow, Russia
| | - D V Sidorov
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Orel Regional Clinical Hospital, Orel, Russia
| | - M B Sukovatykh
- Department of General Surgery, Kursk State Medical University of the RF Ministry of Public Health, Kursk, Russia
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11
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Qian J, Fan L, Zhang W, Wang J, Qiu J, Wang Y. A meta-analysis of collateral status and outcomes of mechanical thrombectomy. Acta Neurol Scand 2020; 142:191-199. [PMID: 32342996 DOI: 10.1111/ane.13255] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To perform a systematic review and meta-analysis to investigate pretreatment collaterals and outcomes of mechanical thrombectomy in patients with acute ischemic stroke of large-vessel occlusion in anterior circulation. METHODS We systematically searched Embase, PubMed, and the Cochrane Library from their dates of inception to March 5, 2020, and also manually searched reference lists of relevant articles. Pooled relative risk with 95% confidence interval on the association between good collaterals and functional independence (in terms of mRS 0-2), symptomatic intracranial hemorrhage, mortality, and successful reperfusion were synthesized using a random-effects model. RESULTS Thirty-four studies enrolling 5768 patients were included in analysis. Good collaterals were significantly associated with functional independence (RR 1.93, 95%CI 1.64-2.27, P < .0001), successful reperfusion (RR 1.23, 95%CI 1.12-1.35, P < .0001), decreased rate of symptomatic intracranial hemorrhage (RR 0.68, 95%CI 0.47-0.97, P = .032), and mortality (RR 0.37, 95%CI 0.27-0.52, P < .0001). The results were consistent in sensitivity analysis. The associations between good collaterals and reperfusion remained stable after adjusting for publication bias. CONCLUSIONS Good pretreatment collaterals were associated with functional independence, successful reperfusion, and decreased rate of sICH and mortality after receiving mechanical thrombectomy in patients with acute ischemic stroke of large-vessel occlusion.
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Affiliation(s)
- Jiacheng Qian
- Department of Neurology Cerebrovascular Disease Center People's HospitalChina Medical University Shenyang China
- China Medical University Shenyang China
| | - Lu Fan
- Department of Neurology Cerebrovascular Disease Center People's HospitalChina Medical University Shenyang China
- Dalian Medical University Dalian China
| | - Weiqing Zhang
- Department of Neurology Cerebrovascular Disease Center People's HospitalChina Medical University Shenyang China
- Dalian Medical University Dalian China
| | - Jian Wang
- Department of Neurology Cerebrovascular Disease Center People's HospitalChina Medical University Shenyang China
| | - Jianting Qiu
- Department of Neurology Cerebrovascular Disease Center People's HospitalChina Medical University Shenyang China
| | - Yujie Wang
- Department of Neurology Cerebrovascular Disease Center People's HospitalChina Medical University Shenyang China
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12
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Yuan Z, Chen N, Zhou M, Guo J, Zhang Y, Li Y, He L. Effects of hypertension in patients receiving mechanical thrombectomy: A meta-analysis. Medicine (Baltimore) 2020; 99:e19803. [PMID: 32311996 PMCID: PMC7440350 DOI: 10.1097/md.0000000000019803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/03/2020] [Accepted: 03/03/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Available evidence shows conflicting results with regard to a potential detrimental effect of hypertension on clinical outcomes in patients who undergo mechanical thrombectomy (MT). We performed a meta-analysis to evaluate the impact of hypertension on the prognosis of patients with acute ischaemic stroke (AIS) treated by MT. METHODS We systematically reviewed previous studies in the PubMed, EMBASE, and Cochrane library databases that reported MT outcomes in AIS patients and their relationships with hypertension or blood pressure. We used a poor outcome (modified Rankin score >2 at 3 months) as the primary end point. Mortality and symptomatic intracranial hemorrhage were the secondary end points. We incorporated a random effect for trials in all models. RESULTS Data from 6650 patients in 31 articles that evaluated the effect of hypertension or blood pressure on outcomes after MT were included. Compared with patients without hypertension, patients with hypertension had significantly higher odds of a poor outcome (odds ratio 0.70; 95% confidence interval 0.57-0.85; I = 43%) and higher mortality (odds ratio 1.70; 95% confidence interval 1.26-2.29; I = 33%). Symptomatic intracranial hemorrhage did not differ by patient hypertension status. CONCLUSIONS The present study confirms that hypertension and high blood pressure are associated with a poor outcome at 3 months after MT in AIS patients. However, the causal relationship between hypertension and a poor outcome remains undetermined, and further investigations are required to ascertain whether AIS patients receiving MT could benefit from intensive blood pressure control.
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Affiliation(s)
- Zhengzhou Yuan
- Department of Neurology, West China Hospital of Sichuan University, ChengDu
- Department of Neurology, Affiliated Hospital of Southwest Medical University, LuZhou, China
| | - Ning Chen
- Department of Neurology, West China Hospital of Sichuan University, ChengDu
| | - Muke Zhou
- Department of Neurology, West China Hospital of Sichuan University, ChengDu
| | - Jian Guo
- Department of Neurology, West China Hospital of Sichuan University, ChengDu
| | - Yanan Zhang
- Department of Neurology, West China Hospital of Sichuan University, ChengDu
| | - Yanbo Li
- Department of Neurology, West China Hospital of Sichuan University, ChengDu
| | - Li He
- Department of Neurology, West China Hospital of Sichuan University, ChengDu
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13
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Huang SJ, Diao SS, Lu Y, Li T, Zhang LL, Ding YP, Fang Q, Cai XY, Xu Z, Kong Y. Value of thrombus imaging in predicting the outcomes of patients with large-vessel occlusive strokes after endovascular therapy. Neurol Sci 2020; 41:1451-1458. [PMID: 32086687 DOI: 10.1007/s10072-020-04296-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute ischemic stroke leads to serious long-term disability and high mortality, especially in patients with large-vessel occlusive strokes. Nowadays, endovascular therapy is considered as an alternative treatment for these patients. Several studies have used thrombus characteristics based on non-contrast computed tomography (NCCT) and computed tomography angiography (CTA) to predict prognosis in ischemic stroke. We conducted a systematic review to identify potential imaging predictive factors for successful recanalization and improved clinical outcome after endovascular therapy in patients with large-vessel occlusion (LVO) in anterior arterial circulation. METHODS The PubMed databases were searched for related studies reported between September 18, 2009, and September 18, 2019. RESULTS We selected 11 studies on revascularization and 12 studies on clinical outcome. Patients with thrombus of higher Hounsfield unit (HU), shorter length, higher clot burden score, and increased thrombus permeability may achieve higher recanalization and improved clinical outcome, but the matter is still under debate. CONCLUSION Imaging of thrombus can be used as an aseessment tool to predict the outcomes and it needs further studies in the future.
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Affiliation(s)
- Shuang-Jiao Huang
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Shan-Shan Diao
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Yue Lu
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Tan Li
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Lu-Lu Zhang
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Yi-Ping Ding
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Qi Fang
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Xiu-Ying Cai
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China.
| | - Zhuan Xu
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China.
| | - Yan Kong
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China.
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Chung GH, Hwang SB, Kwak HS. Use of 3-Dimensional, Black-Blood, Contrast-Enhanced, T1-Weighted Magnetic Resonance Imaging to Identify Vascular Occlusion in the Posterior Circulation After Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2019; 28:104373. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/21/2019] [Accepted: 08/26/2019] [Indexed: 11/30/2022] Open
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15
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Li G, Wu G, Qin Z, Li H, Cheng X, Cai Y. Prognostic Value of Clot Burden Score in Acute Ischemic Stroke after Reperfusion Therapies: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2019; 28:104293. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/12/2019] [Accepted: 07/10/2019] [Indexed: 01/08/2023] Open
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Wu Q, Li T, Zhu D, Lv F, Qin X. Altered expression of long noncoding RNAs in peripheral blood mononuclear cells in patients with impaired leptomeningeal collaterals after acute anterior large vessel occlusions. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:523. [PMID: 31807505 DOI: 10.21037/atm.2019.10.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background In the event of acute ischemic stroke (AIS) due to anterior large vessel occlusion (aLVO), leptomeningeal collaterals (LMCs) status is a key factor to define the severity and functional prognosis of this disease. However, the extent of LMCs exhibits substantial variability among the patients, which is genetic determined. Long non-coding RNAs (lncRNAs) expression profiles in human peripheral blood have been found to be altered after AIS. But whether there are specific lncRNAs correlated with LMC status in aLVO has not yet been investigated. Methods Differential lncRNA expression panels in peripheral blood mononuclear cells (PBMCs) were assessed by microarray analysis and individual quantitative real-time polymerase chain reaction (RT-PCR) in three independent sets consist of 134 patients with aLVO and 73 healthy controls (HCs). LMCs Status in those patients was assessed based on baseline computed tomographic angiography (CTA). Results Microarray analysis showed 23 differentially expressed lncRNAs in patients with poor LMCs status. After independent validations by RT-PCR, lncRNA ENST00000422956 was found to be significantly downregulated in patients with poor LMCs status. Receiver-operating characteristic (ROC) analysis revealed the area under the ROC curve (AUC) for ENST00000422956 to predict poor LMCs status was 0.749. Moreover, ENST00000422956 expression level and baseline National Institutes of Health Stroke Scale (NIHSS) score were identified as independent predictors for impaired LMCs, and a significantly positive correlation was observed between ENST00000422956 expression level and LMCs status. Via cis-regulatory analysis, paired box 8 (Pax8) was identified as the target gene for ENST00000422956. Conclusions The dysregulated lncRNA ENST00000422956 in PBMCs was associated with impairment of LMCs in patients with aLVO, suggesting that measurement of circulatory lncRNAs might be included as possible biomarkers for evaluation of LMCs status in AIS. More importantly, this might be the foundation for understand the potential roles of lncRNAs in LMCs formation after ischemic stroke.
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Affiliation(s)
- Qisi Wu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ting Li
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Department of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Dan Zhu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xinyue Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Ji Z, Fang Q, Yu L. [Collateral circulation and Toll-like receptor 4 levels in patients with acute cerebral infarction after intravenous thrombolysis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:621-626. [PMID: 31140430 DOI: 10.12122/j.issn.1673-4254.2019.05.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the relationship between Toll-like receptor 4 (TLR4) and collateral circulation in patients with acute cerebral infarction (AIS) after thrombolytic therapy. METHODS This retrospective, observational cohort study was conducted among 65 patients with AIS receiving thrombolytic therapy, who were divided according to findings by computed tomographic angiography (CTA) into good collateral circulation (group A, n = 34) and poor collateral circulation (group B, n = 31). Serum samples were collected from all the patients and the levels of TLR4 were measured with ELISA. RESULTS The patients in group A had significantly better outcomes than those in group B. The NIHSS scores at 24 h and 30 days after thrombolytic therapy, mRS scores at 90 days and serum TLR4 levels were significantly lower in group A than in group B (P < 0.05); the percentages of patients with symptomatic intracerebral hemorrhage were comparable between the two groups. The serum levels of TLR4 were negatively correlated with the rMLC score (P < 0.05). Multivariate logistic regression analysis showed that a high level of TLR4 was associated with a poor collateral circulation after thrombolysis. CONCLUSIONS Good collateral circulation can increase the benefit of intravenous thrombolysis in patients with ACI, and the level of TLR4 is a predictive factor for the compensation of collateral circulation following ACI.
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Affiliation(s)
- Zhengxiang Ji
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Qi Fang
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Liqiang Yu
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
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