1
|
Bouchez L, Altrichter S, Pellaton A, Ouared R, Kulcsar Z, Sztajzel R, Platon A, Machi P, Poletti PA, Lövblad KO. Can clot density predict recanalization in acute ischemic stroke treated with intravenous tPA? CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2017. [DOI: 10.1177/2514183x17718310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stroke has become an absolute emergency that is treated by additional endovascular means or by replacing pharmacological options. Modern neuroradiological techniques such as computed tomography (CT) allow us to examine multiple parameters of the diseased brain. These focused on the parenchyma and hemodynamics for pretherapeutic decisions. However, it has become evident that the clot is the current target for interventional measures. Clot length is established as a marker for recanalization. The dense artery sign is known as an acute CT sign of stroke that is readily visible on acute nonenhanced CT. The rationale behind our study was to study if clot density might represent clot vulnerability or resistance to treatment. We conducted a prospective study of all consecutive stroke patients admitted to our hospital over 1 year, who presented with signs of acute middle cerebral artery stroke within the therapeutic window, and who underwent either intravenous or combined intravenous and intra-arterial thrombolysis. All patients were evaluated with a complete stroke CT protocol, transcranial color-coded duplex sonography monitoring, and clinical evaluation with the National Institutes of Health Stroke Scale (NIHSS) score. We measured clot length using planimetry on unenhanced CT and measured Hounsfield units in the clots on the same images. A total of 31 patients were included in the study (19 men, 12 women, aged 35–90 years). We found that patients with a longer clot on the unenhanced CT had a higher NIHSS score, confirming previous literature. However, we found that patients with a lower clot density recanalized to a more marked degree and had a better clinical outcome. Patients who did not recanalize had a higher clot density (49 Hounsfield units) than those who did recanalize (23 Hounsfield units). Overall, measuring the clot seems to be an important additional parameter to be taken into account. In our study, CT clot density seems to correlate with clinical outcome and recanalization. The higher density seems to represent a higher red blood cell content. This is evidence that clot composition could play a much more important role in acute stroke than thought until now and characterizing it with imaging may help in choosing the adequate treatment modality. Higher density seems to reflect erythrocyte content. Therefore, patients with a longer and denser clot may necessitate direct thrombectomy.
Collapse
Affiliation(s)
- Laurie Bouchez
- Radiology Division, Geneva University Hospital, Geneva, Switzerland
- Neuroradiology Division, Geneva University Hospital, Geneva, Switzerland
| | - Stephen Altrichter
- Neuroradiology Division, Geneva University Hospital, Geneva, Switzerland
| | - Alain Pellaton
- Neuroradiology Division, Geneva University Hospital, Geneva, Switzerland
| | - Rafik Ouared
- Neuroradiology Division, Geneva University Hospital, Geneva, Switzerland
| | - Zsolt Kulcsar
- Neuroradiology Division, Geneva University Hospital, Geneva, Switzerland
| | - Roman Sztajzel
- Neurology Department, Geneva University Hospital, Geneva, Switzerland
| | - Alexandra Platon
- Radiology Division, Geneva University Hospital, Geneva, Switzerland
| | - Paolo Machi
- Radiology Division, Geneva University Hospital, Geneva, Switzerland
| | | | - Karl-Olof Lövblad
- Neuroradiology Division, Geneva University Hospital, Geneva, Switzerland
| |
Collapse
|
2
|
Lövblad KO. Neuroradiology provides personalized medicine today! CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2017. [DOI: 10.1177/2514183x17714115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This paper discusses the implications of the use of neuroradiological tools for a personalized management of patients.
Collapse
|
3
|
Abdelgawad EA, Higazi MM, Abdelbaky AO, Abdelghany HS. Diagnostic performance of CT cerebral blood volume colour maps for evaluation of acute infarcts; comparison with diffusion-weighted MRI within 12hours of major stroke onset. J Neuroradiol 2017; 44:10-16. [DOI: 10.1016/j.neurad.2016.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 08/10/2016] [Accepted: 10/17/2016] [Indexed: 01/19/2023]
|
4
|
Bouchez L, Sztajzel R, Vargas MI, Machi P, Kulcsar Z, Poletti PA, Pereira VM, Lövblad KO. CT imaging selection in acute stroke. Eur J Radiol 2016; 96:153-161. [PMID: 28277288 DOI: 10.1016/j.ejrad.2016.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/21/2016] [Accepted: 10/23/2016] [Indexed: 11/27/2022]
Abstract
Acute stroke has become an increasingly treatable cause of acute neurological deficits. Indeed, over the last two decades, the introduction of first thrombolysis, and now thrombectomy has improved patient outcomes and extended the therapeutic window. Computed tomography has been established as the most simple and readily available technique for the diagnosis and management of patients with acute stroke. Indeed, CT allows easy confirmation or exclusion of acute hemorrhage on the one hand, and on the other hand the early signs are quite reliable in the detection of ischemia. In the early phase the clot can be seen as well as exchanges related to early changes in water concentration in ischemia and the surrounding penumbra. Additional techniques such as angio-CT show the location of the clot and perfusion techniques reveal local hemodynamics as well as potential tissue viability. Newer techniques such as double energy CT and late phase CT should provide information on collateral flow as well as on the presence of early hemorrhagic transformation. All these techniques should thus make available new information on tissue viability,that is indispensable in the choice of revascularization technique. Thus CT techniques allow a quick and reliable triage as well as a finer characterization of the ischemic process. The use of all these CT techniques in an optimal way should help improve patient triage and selection of the most adequate treatment with further improvements in clinical outcomes as a result.
Collapse
Affiliation(s)
- Laurie Bouchez
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Roman Sztajzel
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Maria Isabel Vargas
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Paolo Machi
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Zsolt Kulcsar
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Pierre-Alexandre Poletti
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Vitor Mendes Pereira
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Karl-Olof Lövblad
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland.
| |
Collapse
|
5
|
Radiation dose reduction in perfusion CT imaging of the brain: A review of the literature. J Neuroradiol 2016; 43:1-5. [DOI: 10.1016/j.neurad.2015.06.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/04/2015] [Accepted: 06/10/2015] [Indexed: 11/30/2022]
|
6
|
Emeriau S, Soize S, Riffaud L, Toubas O, Pombourcq F, Pierot L. Parenchymal FLAIR hyperintensity before thrombolysis is a prognostic factor of ischemic stroke outcome at 3 Tesla. J Neuroradiol 2015; 42:269-77. [DOI: 10.1016/j.neurad.2015.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 11/26/2022]
|