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Bai X, Yu F, Tian Q, Li W, Sha A, Cao W, Feng Y, Yang B, Chen Y, Gao P, Wang Y, Chen J, Dmytriw AA, Regenhardt RW, Yang R, Fu Z, Ma Q, Lu J, Jiao L. Clinical Significance and Influencing Factors of Microvascular Tissue Reperfusion After Macrovascular Recanalization. Transl Stroke Res 2023; 14:446-454. [PMID: 35759064 DOI: 10.1007/s12975-022-01053-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022]
Abstract
The relevance of impaired microvascular tissue reperfusion despite successful macrovascular angiographic reperfusion (no-reflow) in acute ischemic stroke (AIS) remains controversial. In this study, we aimed to investigate the impact of tissue optimal reperfusion (TOR) and its influencing factors. From December 1, 2020 to December 1, 2021, AIS patients with successful recanalization (modified Thrombolysis in Cerebral Infarction score [mTICI] ≥ 2b) after mechanical thrombectomy (MT) were retrospectively reviewed. Computed tomography perfusion was performed before and after MT. Successful reperfusion was assessed by TOR, defined as > 90% reduction of the Tmax > 6 s lesion volumes between baseline and early follow-up perfusion profiles. The impact of TOR on functional outcomes after successful recanalization and influencing factors for TOR were both investigated. Sixty-three patients were included, including 44 cases in the TOR group and 19 cases in the non-TOR group. The TOR group had a higher rate of favorable outcome (aOR 4.366, 95%CI 1.159-16.445, p = 0.030) and NIHSS improvement (aOR 5.089, 95%CI 1.340-19.322, p = 0.017) than the non-TOR group. Multivariable logistic regression showed baseline glucose (OR 0.648, 95%CI 0.492-0.854, p = 0.002) and mTICI 2c/3 (OR 10.984, 95%CI 2.220-54.343, p = 0.003) predicted TOR in model 1; in model 2, postoperative glucose (OR 0.468, 95%CI 0.278-0.787, p = 0.004) and mTICI 2c/3 (OR 9.436, 95%CI 1.889-47.144, p = 0.006) were predictive. TOR was strongly associated with good functional outcomes after successful recanalization of MT. Higher mTICI grade and lower perioperative glucose level may predict microvascular tissue reperfusion.
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Affiliation(s)
- Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Fan Yu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Qiuyue Tian
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Wei Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Department of Neurosurgery, Liaocheng Brain Hospital, Liaocheng, 252000, Shandong, China
| | - Araman Sha
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Wenbo Cao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Renjie Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Zhaolin Fu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
- China International Neuroscience Institute (China-INI), Beijing, 100053, China.
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Fukutomi H, Yamamoto T, Sibon I, Christensen S, Raposo N, Marnat G, Albucher JF, Olindo S, Calvière L, Sagnier S, Viguier A, Renou P, Guenego A, Poli M, Darcourt J, Debruxelles S, Drif A, Thalamas C, Sommet A, Rousseau V, Mazighi M, Bonneville F, Albers GW, Cognard C, Dousset V, Olivot JM, Tourdias T. Location-weighted versus Volume-weighted Mismatch at MRI for Response to Mechanical Thrombectomy in Acute Stroke. Radiology 2023; 306:e220080. [PMID: 36194114 PMCID: PMC9885343 DOI: 10.1148/radiol.220080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 01/28/2023]
Abstract
Background A target mismatch profile can identify good clinical response to recanalization after acute ischemic stroke, but does not consider region specificities. Purpose To test whether location-weighted infarction core and mismatch, determined from diffusion and perfusion MRI performed in patients with acute stroke, could improve prediction of good clinical response to mechanical thrombectomy compared with a target mismatch profile. Materials and Methods In this secondary analysis, two prospectively collected independent stroke data sets (2012-2015 and 2017-2019) were analyzed. From the brain before stroke (BBS) study data (data set 1), an eloquent map was computed through voxel-wise associations between the infarction core (based on diffusion MRI on days 1-3 following stroke) and National Institutes of Health Stroke Scale (NIHSS) score. The French acute multimodal imaging to select patients for mechanical thrombectomy (FRAME) data (data set 2) consisted of large vessel occlusion-related acute ischemic stroke successfully recanalized. From acute MRI studies (performed on arrival, prior to thrombectomy) in data set 2, target mismatch and eloquent (vs noneloquent) infarction core and mismatch were computed from the intersection of diffusion- and perfusion-detected lesions with the coregistered eloquent map. Associations of these imaging metrics with early neurologic improvement were tested in multivariable regression models, and areas under the receiver operating characteristic curve (AUCs) were compared. Results Data sets 1 and 2 included 321 (median age, 69 years [IQR, 58-80 years]; 207 men) and 173 (median age, 74 years [IQR, 65-82 years]; 90 women) patients, respectively. Eloquent mismatch was positively and independently associated with good clinical response (odds ratio [OR], 1.14; 95% CI: 1.02, 1.27; P = .02) and eloquent infarction core was negatively associated with good response (OR, 0.85; 95% CI: 0.77, 0.95; P = .004), while noneloquent mismatch was not associated with good response (OR, 1.03; 95% CI: 0.98, 1.07; P = .20). Moreover, adding eloquent metrics improved the prediction accuracy (AUC, 0.73; 95% CI: 0.65, 0.81) compared with clinical variables alone (AUC, 0.65; 95% CI: 0.56, 0.73; P = .01) or a target mismatch profile (AUC, 0.67; 95% CI: 0.59, 0.76; P = .03). Conclusion Location-weighted infarction core and mismatch on diffusion and perfusion MRI scans improved the identification of patients with acute stroke who would benefit from mechanical thrombectomy compared with the volume-based target mismatch profile. Clinical trial registration no. NCT03045146 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Nael in this issue.
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Affiliation(s)
- Hikaru Fukutomi
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Takayuki Yamamoto
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Igor Sibon
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Soren Christensen
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Nicolas Raposo
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Gaultier Marnat
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Jean-François Albucher
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Stéphane Olindo
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Lionel Calvière
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Sharmila Sagnier
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Alain Viguier
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Pauline Renou
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Adrien Guenego
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Mathilde Poli
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Jean Darcourt
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Sabrina Debruxelles
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Amel Drif
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Claire Thalamas
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Agnès Sommet
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Vanessa Rousseau
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Mikael Mazighi
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Fabrice Bonneville
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Gregory W. Albers
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Christophe Cognard
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Vincent Dousset
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Jean Marc Olivot
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
| | - Thomas Tourdias
- From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.),
CNRS, UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D.,
T.T.), Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux
Cedex, France; Unité Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.)
and Neuroimagerie Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU
de Bordeaux, Bordeaux, France; Stanford Stroke Center, Stanford University,
Stanford, Calif (S.C., G.W.A.); Unité Neurovasculaire (N.R., J.F.A.,
L.C., A.V., J.M.O.), Service de Neuroradiologie (A.G., J.D., F.B., C.C.), and
Centre d'Investigation Clinique (A.D., C.T., A.S., V.R.), CHU de
Toulouse, Toulouse, France; and Fondation Ophtalmologique Adolphe de Rothschild,
Paris, France (M.M.)
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3
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Sha A, Yu F, Zhang M, Shan Y, Guo D, Shakya MR, Bai X, Ma Q, Jiao L, Lu J. Multimodal CT imaging characteristics may predict post-reperfusion infarct volume in wake-up stroke patients. Quant Imaging Med Surg 2023; 13:878-888. [PMID: 36819283 PMCID: PMC9929407 DOI: 10.21037/qims-22-614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/04/2022] [Indexed: 01/05/2023]
Abstract
Background Accurate prediction of subsequent infarct volume in acute ischemic stroke (AIS) patients helps determine appropriate interventions and prognosis. The objectives are to assess whether early multimodal CT imaging characteristics of wake-up stroke (WUS) patients could predict post-reperfusion infarct volume and evaluate the accuracy of baseline infarct and penumbra volumes for predicting follow-up infarct volume. Methods This retrospective study included WUS patients, last seen well (LSW) >6 h, with multimodal CT imaging at baseline. Baseline non-contrast CT (NCCT) and CT perfusion were analyzed using RAPID software, and CT angiography using maximum intensity projection. Post-reperfusion infarct volume was assessed at 24-h following reperfusion on magnetic resonance diffusion-weighted imaging (DWI). Patients were stratified by treatment module for analyses. Results Of 34 eligible patients, 9 (26.5%) received intravenous recombinant tissue plasminogen activator (r-tPA) alone and 25 (73.5%) received both endovascular thrombectomy (EVT) and r-tPA. All patients had a strong correlation between baseline NCCT alberta stroke program early CT score, clot burden score (CBS), Tan score, infarct volume, penumbra volume with 24-h post-reperfusion infarct volume (respectively, r=0.172, P=0.015; r=0.118, P=0.047; r=0.149, P=0.024; r=0.311, P=0.001 and r=0.120; P=0.045). Among reperfusion therapies, WUS patients who received EVT had a significantly lower 24-h post-reperfusion infarct volume and had a significant difference between baseline infarct volume and 24-h post-reperfusion infarct volume (respectively, 82 vs. 14, P=0.032 and 47 vs. 14, P=0.04). Conclusions Primarily obtained multimodal CT imaging characteristics may predict post-reperfusion infarct volume in WUS patients, and those who underwent EVT had a significantly lower post-reperfusion infarct volume.
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Affiliation(s)
- Arman Sha
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China;,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Fan Yu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China;,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Miao Zhang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China;,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yi Shan
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China;,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Daode Guo
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China;,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Milind Ratna Shakya
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China;,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China;,China International Neuroscience Institute (China-INI), Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China;,China International Neuroscience Institute (China-INI), Beijing, China;,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China;,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
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4
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Laredo C, Rodríguez A, Oleaga L, Hernández‐Pérez M, Renú A, Puig J, Román LS, Planas AM, Urra X, Chamorro Á. Adjunct Thrombolysis Enhances Brain Reperfusion following Successful Thrombectomy. Ann Neurol 2022; 92:860-870. [PMID: 36054449 PMCID: PMC9804472 DOI: 10.1002/ana.26474] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study was undertaken to investigate whether adjunct alteplase improves brain reperfusion following successful thrombectomy. METHODS This single-center, randomized, double-blind, placebo-controlled study included 36 patients (mean [standard deviation] = 70.8 [13.5] years old, 18 [50%] women) with large vessel occlusion undergoing thrombectomy resulting in near-normal (expanded Thrombolysis in Cerebral Infarction [eTICI] b50/67/2c, n = 23, 64%) or normal angiographic reperfusion (eTICI 3, n = 13, 36%). Seventeen patients were randomized to intra-arterial alteplase (0.225mg/kg), and 19 received placebo. At 48 hours, patients had brain perfusion/diffusion-weighted magnetic resonance imaging (MRI) and MRI-spectroscopy. The primary outcome was the difference in the proportion of patients with areas of hypoperfusion on MRI. Secondary outcomes were the infarct expansion ratio (final to initial infarction volume), and the N-acetylaspartate (NAA) peak relative to total creatine as a marker of neuronal integrity. RESULTS The prevalence of hypoperfusion was 24% with intra-arterial alteplase, and 58% with placebo (adjusted odds ratio = 0.20, 95% confidence interval [CI] = 0.04-0.91, p = 0.03). Among 14 patients with final eTICI 3 scores, hypoperfusion was found in 1 of 7 (14%) in the alteplase group and 3 of 7 (43%) in the placebo group. Abnormal brain perfusion was associated with worse functional outcome at day 90. Alteplase significantly reduced the infarct expansion ratio compared with placebo (median [interquartile range (IQR)] = 0.7 [0.5-1.2] vs 3.2 [1.8-5.7], p = 0.01) and resulted in higher NAA peaks (median [IQR] = 1.13 [0.91-1.36] vs 1.00 [0.74-1.22], p < 0.0001). INTERPRETATION There is a high prevalence of areas of hypoperfusion following thrombectomy despite successful reperfusion on angiography. Adjunct alteplase enhances brain reperfusion, which results in reduced expansion of the infarction and improved neuronal integrity. ANN NEUROL 2022;92:860-870.
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Affiliation(s)
- Carlos Laredo
- Area of NeuroscienceAugust Pi i Sunyer Biomedical Research InstituteBarcelonaSpain
| | - Alejandro Rodríguez
- Department of NeuroscienceComprehensive Stroke Center, Hospital Clinic of BarcelonaBarcelonaSpain
| | - Laura Oleaga
- Neuroradiology ServiceHospital Clinic of BarcelonaBarcelonaSpain
| | - María Hernández‐Pérez
- Neuroscience Department, Stroke UnitGermans Trias i Pujol University HospitalBadalonaSpain
| | - Arturo Renú
- Area of NeuroscienceAugust Pi i Sunyer Biomedical Research InstituteBarcelonaSpain,Department of NeuroscienceComprehensive Stroke Center, Hospital Clinic of BarcelonaBarcelonaSpain
| | - Josep Puig
- Department of RadiologyDr Josep Trueta Hospital, Girona Biomedical Research InstituteGironaSpain
| | - Luis San Román
- Neuroradiology ServiceHospital Clinic of BarcelonaBarcelonaSpain
| | - Anna M. Planas
- Area of NeuroscienceAugust Pi i Sunyer Biomedical Research InstituteBarcelonaSpain,Department of Brain Ischemia and NeurodegenerationBarcelona Institute of Biomedical Research–Spanish National Research CouncilBarcelonaSpain
| | - Xabier Urra
- Area of NeuroscienceAugust Pi i Sunyer Biomedical Research InstituteBarcelonaSpain,Department of NeuroscienceComprehensive Stroke Center, Hospital Clinic of BarcelonaBarcelonaSpain,Area of NeuroscienceUniversity of Barcelona, School of MedicineBarcelonaSpain
| | - Ángel Chamorro
- Area of NeuroscienceAugust Pi i Sunyer Biomedical Research InstituteBarcelonaSpain,Department of NeuroscienceComprehensive Stroke Center, Hospital Clinic of BarcelonaBarcelonaSpain,Area of NeuroscienceUniversity of Barcelona, School of MedicineBarcelonaSpain
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Sylaja PN, Sreedharan S, Arun K, Kannath S, Jayadevan ER, Thulaseedharan J. The impact of time to reperfusion on recanalization rates and outcome after mechanical thrombectomy: A single center experience. Ann Indian Acad Neurol 2022; 25:256-260. [PMID: 35693665 PMCID: PMC9175420 DOI: 10.4103/aian.aian_909_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/05/2022] [Accepted: 01/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Timely and effective recanalization to salvage the penumbra is the main determinant of outcome in acute ischemic strokes. Randomized controlled trials on late window mechanical thrombectomy (MT) have proved its safety and efficacy upto 24 h after stroke onset. We looked at the impact of time to reperfusion on vessel recanalization rates and short-term outcome in patients undergoing MT for large vessel occlusion. Methods: The clinical, imaging, and outcome of all patients undergoing MT upto 24 h from last seen normal was extracted from a prospectively maintained ischemic stroke database from January 2012 till September 2019. Results: There were 145 patients with a mean (SD) age of 58.2 (±14) years. Of them, 28 had wake up/unknown time of onset stroke and 9 presented beyond >360 min. There were 23 vertebrobasilar strokes. Median National Institute of Health Stroke scale score (NIHSS) at admission was 16.4 (Inter quartile range (IQR) 12–21). CT-Alberta Stroke program early CT score (CT-ASPECTS) was excellent (8–10) in 39 (31.6%) and fair (5–7) in 77 (63.6%) patients in anterior circulation strokes. About 25% underwent bridging therapy. Recanalization rates did not differ between those presenting early (<6 h) versus wake up strokes and late presenting patients (81.79% vs 71.9%). Symptomatic Intracerebral hemorrhage (ICH) occurred in 5%. At 3 months, excellent outcome (modified rankin scale <2) was observed in 28.9%. While Admission NIHSS remained strong predictor of poor outcome at 3 months, delay in presentation did not impact MT outcome (37.5% vs 45.79% and P = 0.460). Conclusions: The recanalization rates were similar in patients irrespective of the time to reperfusion from stroke onset. The functional outcome was not inferior in late presenters selected by advanced imaging.
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Lansberg MG, Wintermark M, Kidwell CS, Albers GW. Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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7
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Tan Z, Parsons M, Bivard A, Sharma G, Mitchell P, Dowling R, Bush S, Xu A, Yan B. Optimal Tissue Reperfusion Estimation by Computed Tomography Perfusion Post-Thrombectomy in Acute Ischemic Stroke. Stroke 2021; 52:e760-e763. [PMID: 34670411 DOI: 10.1161/strokeaha.121.034581] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Modified Thrombolysis in Cerebral Infarction score (mTICI) ≥2b is defined as successful reperfusion. However, mTICI has rarely been correlated with dynamic perfusion imaging postendovascular therapy for acute stroke. We aimed to study the proportion of tissue optimal reperfusion (TOR) postendovascular therapy across different grades of mTICI. METHODS We conducted a single-center retrospective analysis of patients with acute ischemic strokes who had endovascular therapy between 2018 and 2019. Computer tomography perfusion or magnetic resonance perfusion was performed before and after endovascular therapy. Tmax+6 volume reduction of >90% was defined as TOR. Comparisons of proportions of TOR in different grades of mTICI were performed. In the present study, the requirement for informed consents was waived. RESULTS Eighty-two patients were included. The difference in the proportion of TOR for TICI categories was statistically significant (mTICI score 0, 0%, mTICI score 2A, 0%, mTICI score 2b, 50.0%, mTICI score 2c, 80.0%, mTICI score 3, 81.3%, χ2=14.035, P=0.003). Multivariable logistic regression showed that lower age (odds ratio, 0.932, P=0.017), onset-to-tissue-type plasminogen activator time (odds ratio, 0.980, P=0.005) and TOR (odds ratio, 8.764, P=0.031) were associated with favorable functional outcome. CONCLUSIONS The proportion of TOR achieved by mTICI score of 2b was significantly lower than mTICI score of 2c and mTICI score of 3. TOR was associated with favorable functional outcome, and the degree of reperfusion was more strongly correlated with outcomes than the mTICI scores.
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Affiliation(s)
- Zefeng Tan
- Department of Neurology, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China (Z.T., A.X.).,Department of Neurology, Shun De Hospital of Jinan University, Guangzhou, Guangdong, China (Z.T.).,Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., B.Y.)
| | - Mark Parsons
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., B.Y.)
| | - Andrew Bivard
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., B.Y.)
| | - Gagan Sharma
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., B.Y.)
| | - Peter Mitchell
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Australia (P.M., R.D., S.B., B.Y.)
| | - Richard Dowling
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Australia (P.M., R.D., S.B., B.Y.)
| | - Steven Bush
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Australia (P.M., R.D., S.B., B.Y.)
| | - Anding Xu
- Department of Neurology, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China (Z.T., A.X.)
| | - Bernard Yan
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., B.Y.).,Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Australia (P.M., R.D., S.B., B.Y.)
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8
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Xiao J, Liang H, Wang Y, Wang S, Wang Y, Bi Y. Risk Factors of Hypoperfusion on MRI of Ischemic Stroke Patients Within 7 Days of Onset. Front Neurol 2021; 12:668360. [PMID: 34025571 PMCID: PMC8137898 DOI: 10.3389/fneur.2021.668360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Hypoperfusion is an important factor determining the prognosis of ischemic stroke patients. The present study aimed to investigate possible predictors of hypoperfusion on MRI of ischemic stroke patients within 7 days of stroke onset. Methods: Ischemic stroke patients, admitted to the comprehensive Stroke Center of Shanghai Fourth People's Hospital affiliated to Tongji University within 7 days of onset between January 2016 and June 2017, were recruited to the present study. Magnetic resonance imaging (MRI), including both diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI), was performed within 7 days of the symptom onset. Time to maximum of the residue function (Tmax) maps were automatically evaluated using the RAPID software. The volume of hypoperfusion was measured outside the infarct area based on ADC < 620 × 10−6 mm2/s. The 90 d mRS score was assessed through either clinic visits or telephone calls. Multivariate step-wise analysis was used to assess the correlation between MR findings and clinical variables, including the demographic information, cardio-metabolic characteristics, and functional outcomes. Results: Among 635 patients admitted due to acute ischemic stroke within 7 days of onset, 241 met the inclusion criteria. Hypoperfusion volume of 38 ml was the best cut-off value for predicting poor prognosis of patients with cerebral infarction (90 d-mRS score ≥ 2). The incidences of MR perfusion Tmax > 4–6 s maps with a volume of 0–38 mL or >38 mL were 51.9% (125/241) and 48.1% (116/241), respectively. Prior stroke and vascular stenosis (≥70%) were associated with MR hypoperfusion. Multivariate step-wise analysis showed that prior stroke and vascular stenosis (≥70%) were risk factors of Tmax > 4–6 s maps, and the odds ratios (OR) were 3.418 (adjusted OR 95% CI: 1.537–7.600), and 2.265 (adjusted OR, 95% CI: 1.199–4.278), respectively. Conclusion: Our results suggest that prior stroke and vascular stenosis (≥70%) are strong predictors of hypoperfusion in patients with acute ischemic stroke within 7 days of stroke onset.
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Affiliation(s)
- Jingjing Xiao
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Huazheng Liang
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.,Department of Neurology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Yue Wang
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Shaoshi Wang
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Yi Wang
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.,College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yong Bi
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
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9
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Chen Q, Zhou J, Zhang H, Chen Y, Mao C, Chen X, Ni L, Zhuo Z, Zhang Y, Geng W, Yin X, Lv Y. One-step analysis of brain perfusion and function for acute stroke patients after reperfusion: A resting-state fMRI study. J Magn Reson Imaging 2018; 50:221-229. [PMID: 30569565 DOI: 10.1002/jmri.26571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/23/2018] [Accepted: 10/23/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Resting-state functional magnetic resonance imaging (rs-fMRI) can noninvasively estimate the perfusion and function of the brain. PURPOSE To investigate the perfusion and functional status using rs-fMRI in acute ischemic stroke (AIS) patients after reperfusion therapy. STUDY TYPE Prospective. SUBJECTS Twenty-five AIS patients who underwent dynamic susceptibility contrast (DSC) upon hospital admission and both rs-fMRI and DSC scans at 24 hours after reperfusion therapy. FIELD STRENGTH/SEQUENCE 3T; DSC, rs-fMRI. ASSESSMENT The time delay of the blood oxygenation level-dependent (BOLD) signal was calculated using time-shift-analysis (TSA) and compared with the time to peak (TTP) derived from the DSC. For patients who exhibited partial or complete reperfusion in the supratentorial hemisphere, we quantified the function of different regions (healthy tissue, reperfused tissue, not reperfused tissue) by using three rs-fMRI measurements (functional connectivity, the amplitude of low-frequency fluctuation [ALFF] and regional homogeneity [ReHo]). Correlations between the functional measurements and modified Rankin Scale (mRS) scores were calculated. STATISTICAL TESTS Dice coefficient (DC) analysis, two-sample t-tests, Pearson correlation coefficient. RESULTS Twelve patients who exhibited complete reperfusion on their TTP maps showed no time-delayed areas on the TSA maps. For the remaining 13 patients with partial reperfusion (5/13) or no reperfusion (8/13) on the TTP maps, the TSA detected comparable time-delayed areas. Eleven out of 13 patients showed moderate to good overlap (mean DC, 0.58 ± 0.1) between the TTP and TSA results. Fourteen patients were chosen for functional analyses and most patients (12/14) showed abnormal functional connectivity in the reperfused regions. The reperfused and not reperfused tissues had lower mean ReHo values than those of the healthy tissue (both P < 0.001). The mRS scores showed negative correlation with mean ReHo values of reperfused region (R = -0.523, P = 0.027). DATA CONCLUSION: rs-fMRI might be a useful way to estimate both the perfusion and functional status for AIS patients after reperfusion therapy. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:221-229.
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Affiliation(s)
- Qian Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hong Zhang
- Department of Radiology, Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Yuchen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Cunnan Mao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiangliang Chen
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ling Ni
- Department of Radiology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhizheng Zhuo
- Department of MR Clinical Science, Philips, Beijing, China
| | - Yingdong Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wen Geng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yating Lv
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, Zhejiang, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, China
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10
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Chen Z, Zhang R, Zhou Y, Gong X, Zhang M, Shi F, Yu X, Lou M. Patients With Ischemic Core ≥70 ml Within 6 h of Symptom Onset May Still Benefit From Endovascular Treatment. Front Neurol 2018; 9:933. [PMID: 30455665 PMCID: PMC6230959 DOI: 10.3389/fneur.2018.00933] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/15/2018] [Indexed: 01/01/2023] Open
Abstract
Background: Large core is associated with poor outcome in acute ischemic stroke (AIS) patients. It is unclear whether endovascular treatment (EVT) could bring benefits to patients with core volume ≥70 ml before treatment. We aimed to compare the impact of EVT with intravenous thrombolysis (IVT) on the outcome in patients with core volume ≥70 ml. Methods: We included consecutive anterior circulation AIS patients who underwent MR or CT perfusion within 6 h post stroke onset, which revealed a core ≥70 ml before reperfusion therapy. Good outcome was defined by modified Rankin Scale of 0 to 2 at 90-day. Reperfusion was defined as a reduction in hypoperfusion volume of ≥70% between baseline and 24 h. Results: One hundred four patients were included. Among them, 76 received IVT only, and 28 received EVT. After adjusting for age, NIHSS score, baseline core volume and onset to imaging time, patients in EVT group were more likely to achieve good outcome compared to IVT patients (OR, 3.875; 95% Cl 1.068-14.055, p = 0.039). More patients in EVT group achieved recanalization (84.0 vs. 58.5%, p = 0.027) and reperfusion (66.7 vs. 33.3%, p = 0.010) than in IVT group. Reperfusion also independently predicted good outcome (OR, 7.718; 95% Cl 1.713-34.772, p = 0.008). All patients with good outcome achieved recanalization at 24 h. Conclusions: Our data indicated that patients with core volume ≥70 ml might still benefit from EVT, which was related to its high reperfusion rate.
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Affiliation(s)
- Zhicai Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ruiting Zhang
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiaoxian Gong
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Meixia Zhang
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Feina Shi
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xinfeng Yu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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11
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Chen C, Parsons MW, Clapham M, Oldmeadow C, Levi CR, Lin L, Cheng X, Lou M, Kleinig TJ, Butcher KS, Dong Q, Bivard A. Influence of Penumbral Reperfusion on Clinical Outcome Depends on Baseline Ischemic Core Volume. Stroke 2017; 48:2739-2745. [PMID: 28887396 DOI: 10.1161/strokeaha.117.018587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/30/2017] [Accepted: 08/03/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Chushuang Chen
- From the Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.C., M.P., C.L., L.L., A.B.); Public Health Stream, Hunter Medical Research Institute, Newcastle, Australia (M.C., C.O.); Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (X.C., Q.D.); Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (M.L.); Department of Neurology, Royal Adelaide Hospital, Australia (T.K.); and Division of Neurology,
| | - Mark W. Parsons
- From the Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.C., M.P., C.L., L.L., A.B.); Public Health Stream, Hunter Medical Research Institute, Newcastle, Australia (M.C., C.O.); Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (X.C., Q.D.); Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (M.L.); Department of Neurology, Royal Adelaide Hospital, Australia (T.K.); and Division of Neurology,
| | - Matthew Clapham
- From the Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.C., M.P., C.L., L.L., A.B.); Public Health Stream, Hunter Medical Research Institute, Newcastle, Australia (M.C., C.O.); Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (X.C., Q.D.); Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (M.L.); Department of Neurology, Royal Adelaide Hospital, Australia (T.K.); and Division of Neurology,
| | - Christopher Oldmeadow
- From the Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.C., M.P., C.L., L.L., A.B.); Public Health Stream, Hunter Medical Research Institute, Newcastle, Australia (M.C., C.O.); Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (X.C., Q.D.); Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (M.L.); Department of Neurology, Royal Adelaide Hospital, Australia (T.K.); and Division of Neurology,
| | - Christopher R. Levi
- From the Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.C., M.P., C.L., L.L., A.B.); Public Health Stream, Hunter Medical Research Institute, Newcastle, Australia (M.C., C.O.); Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (X.C., Q.D.); Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (M.L.); Department of Neurology, Royal Adelaide Hospital, Australia (T.K.); and Division of Neurology,
| | - Longting Lin
- From the Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.C., M.P., C.L., L.L., A.B.); Public Health Stream, Hunter Medical Research Institute, Newcastle, Australia (M.C., C.O.); Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (X.C., Q.D.); Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (M.L.); Department of Neurology, Royal Adelaide Hospital, Australia (T.K.); and Division of Neurology,
| | - Xin Cheng
- From the Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.C., M.P., C.L., L.L., A.B.); Public Health Stream, Hunter Medical Research Institute, Newcastle, Australia (M.C., C.O.); Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (X.C., Q.D.); Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (M.L.); Department of Neurology, Royal Adelaide Hospital, Australia (T.K.); and Division of Neurology,
| | - Min Lou
- From the Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.C., M.P., C.L., L.L., A.B.); Public Health Stream, Hunter Medical Research Institute, Newcastle, Australia (M.C., C.O.); Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (X.C., Q.D.); Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (M.L.); Department of Neurology, Royal Adelaide Hospital, Australia (T.K.); and Division of Neurology,
| | - Timothy J. Kleinig
- From the Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.C., M.P., C.L., L.L., A.B.); Public Health Stream, Hunter Medical Research Institute, Newcastle, Australia (M.C., C.O.); Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (X.C., Q.D.); Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (M.L.); Department of Neurology, Royal Adelaide Hospital, Australia (T.K.); and Division of Neurology,
| | - Kenneth S. Butcher
- From the Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.C., M.P., C.L., L.L., A.B.); Public Health Stream, Hunter Medical Research Institute, Newcastle, Australia (M.C., C.O.); Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (X.C., Q.D.); Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (M.L.); Department of Neurology, Royal Adelaide Hospital, Australia (T.K.); and Division of Neurology,
| | - Qiang Dong
- From the Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.C., M.P., C.L., L.L., A.B.); Public Health Stream, Hunter Medical Research Institute, Newcastle, Australia (M.C., C.O.); Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (X.C., Q.D.); Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (M.L.); Department of Neurology, Royal Adelaide Hospital, Australia (T.K.); and Division of Neurology,
| | - Andrew Bivard
- From the Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.C., M.P., C.L., L.L., A.B.); Public Health Stream, Hunter Medical Research Institute, Newcastle, Australia (M.C., C.O.); Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (X.C., Q.D.); Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (M.L.); Department of Neurology, Royal Adelaide Hospital, Australia (T.K.); and Division of Neurology,
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12
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Complete reperfusion is required for maximal benefits of mechanical thrombectomy in stroke patients. Sci Rep 2017; 7:11636. [PMID: 28912596 PMCID: PMC5599658 DOI: 10.1038/s41598-017-11946-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/01/2017] [Indexed: 01/31/2023] Open
Abstract
A mTICI 2b or a mTICI 3 score are currently considered success following mechanical thrombectomy (MT) in acute stroke but is undetermined whether the two scores translate equivalent outcomes. We present a single-center, retrospective cohort of patients with anterior circulation stroke treated with MT and achieving a final mTICI score 2b or 3. A multimodal CT at baseline and a multimodal MRI at 24 hours assessed the growth of the infarct, and the modified Rankin Scale (mRS) assessed functional outcome at 90 days. The primary outcome was the shift analysis of the mRS at day 90 in ordinal regression adjusted for covariates (age, sex, pretreatment NIHSS score, target occlusion, infarct core, pretreatment alteplase), and the collateral score. Infarct growth was explored in a similarly adjusted multiple linear regression model. MT was started within a median of 285 minutes of symptom onset; 51 (41%) patients achieved a mTICI 2b, and 74 (59%), a mTICI 3. mTICI 3 resulted in better mRS score transitions than mTICI 2b (odds ratio 2.018 [95% CI 1.033–3.945], p = 0. 040), and reduced infarct growth (p = 0.002). We conclude that in patients with acute stroke receiving MT, success should be redefined as achieving a mTICI 3 score.
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13
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Lin L, Cheng X, Bivard A, Levi CR, Dong Q, Parsons MW. Quantifying reperfusion of the ischemic region on whole-brain computed tomography perfusion. J Cereb Blood Flow Metab 2017; 37:2125-2136. [PMID: 27461903 PMCID: PMC5464706 DOI: 10.1177/0271678x16661338] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To derive the reperfusion index best predicting clinical outcome of ischemic stroke patients, we retrospectively analysed the acute and 24-h computed tomography perfusion data of 116 patients, collected from two centres equipped with whole-brain computed tomography perfusion. Reperfusion index was defined by the percentage of the ischemic region reperfused from acute to 24-h computed tomography perfusion. Recanalization was graded by arterial occlusive lesion system. Receiver operator characteristic analysis was performed to assess the prognostic value of reperfusion and recanalization in predicting good clinical outcome, defined as modified Rankin Score of 0-2 at 90 days. Among previous reported reperfusion measurements, reperfusion of the Tmax>6 s region resulted in higher prognostic value than recanalization at predicting good clinical outcome (area under the curve = 0.88 and 0.74, respectively, p = 0.002). Successful reperfusion of the Tmax>6 s region (≥60%) had 89% sensitivity and 78% specificity in predicting good clinical outcome. A reperfusion index defined by Tmax>2 s or by mean transit time>145% had much lower area under the curve in comparison to Tmax>6 s measurement (p < 0.001 and p = 0.003, respectively), and had no significant difference to recanalization at predicting clinical outcome (p = 0.58 and 0.63, respectively). In conclusion, reperfusion index calculated by Tmax>6 s is a stronger predictor of clinical outcome than recanalization or other reperfusion measures.
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Affiliation(s)
- Longting Lin
- 1 School of Medicine and Public health, University of Newcastle, Newcastle, Australia
| | - Xin Cheng
- 3 Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Andrew Bivard
- 1 School of Medicine and Public health, University of Newcastle, Newcastle, Australia
| | - Christopher R Levi
- 1 School of Medicine and Public health, University of Newcastle, Newcastle, Australia.,2 Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia
| | - Qiang Dong
- 3 Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mark W Parsons
- 1 School of Medicine and Public health, University of Newcastle, Newcastle, Australia.,2 Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia
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14
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Zhang S, Zhou Y, Zhang R, Zhang M, Campbell B, Lin L, Shi FD, Lou M. Rationale and design of combination of an immune modulator Fingolimod with Alteplase bridging with Mechanical Thrombectomy in Acute Ischemic Stroke (FAMTAIS) trial. Int J Stroke 2017; 12:906-909. [PMID: 28569122 DOI: 10.1177/1747493017710340] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Rationale In acute ischemic stroke patients with large vessel occlusion, although reperfusion within 6 h after stroke onset using combined intravenous alteplase and mechanical thrombectomy (bridging therapy) can improve functional outcome, still approximately 50% patients suffer disability which may result from reperfusion injury. Proof-of-concept clinical trials have indicated that the sphingosine-1-phosphate receptor modulator fingolimod may be efficacious in attenuating brain inflammation and improving clinical outcomes in acute ischemic stroke patients as a single therapy beyond 4.5 h of disease onset, or in combination with alteplase within 4.5 h of disease onset. Aim To assess whether the treatment of fingolimod combined with bridging therapy in large vessel occlusion acute ischemic stroke patients is effective and safe. Design and sample size estimates Fingolimod with Alteplase bridging with Mechanical Thrombectomy in Acute Ischemic Stroke (FAMTAIS) study is a randomized, open-label, multiple central trial. This study includes 98 patients with anterior circulation large vessel occlusion acute ischemic stroke who are eligible for bridging therapy, providing 80% power to reject the null hypothesis that, combined with fingolimod, the bridging therapy has an at least 15% higher penumbra tissue salvage index than receiving bridging therapy alone. Study outcomes The primary outcome is the penumbra tissue salvage index. Key secondary outcomes focus on: infarct growth and extent of clinical improvement from day 1 to day 7, frequency of parenchymal hemorrhage at day 1. Discussion If the hypothesis of FAMTAIS is confirmed, combination of fingolimod with bridging therapy is effective in attenuating reperfusion injury in patients with large vessel occlusion treated with 6 h of stroke onset.
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Affiliation(s)
- Sheng Zhang
- 1 Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ying Zhou
- 1 Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ruiting Zhang
- 1 Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Meixia Zhang
- 1 Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Bruce Campbell
- 2 Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Longting Lin
- 3 The School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Fu-Dong Shi
- 4 Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Min Lou
- 1 Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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15
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Zhou Y, Zhang R, Zhang S, Yan S, Wang Z, Campbell BCV, Liebeskind DS, Lou M. Impact of perfusion lesion in corticospinal tract on response to reperfusion. Eur Radiol 2017; 27:5280-5289. [PMID: 28540481 DOI: 10.1007/s00330-017-4868-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 04/17/2017] [Accepted: 04/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ying Zhou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, 310009, China
| | - Ruiting Zhang
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, 310009, China
| | - Sheng Zhang
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, 310009, China
| | - Shenqiang Yan
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, 310009, China
| | - Ze Wang
- Center for Cognition and Brain Disorders, Institutes of Neurological Science, Hangzhou Normal University, Hangzhou, China
- Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - David S Liebeskind
- Los Angeles Stroke Center, University of California, Los Angeles, CA, USA
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, 310009, China.
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16
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Shiraishi K, Wang Z, Kokuryo D, Aoki I, Yokoyama M. A polymeric micelle magnetic resonance imaging (MRI) contrast agent reveals blood–brain barrier (BBB) permeability for macromolecules in cerebral ischemia-reperfusion injury. J Control Release 2017; 253:165-171. [DOI: 10.1016/j.jconrel.2017.03.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/17/2017] [Accepted: 03/11/2017] [Indexed: 01/10/2023]
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17
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Kasasbeh AS, Christensen S, Straka M, Mishra N, Mlynash M, Bammer R, Albers GW, Lansberg MG. Optimal Computed Tomographic Perfusion Scan Duration for Assessment of Acute Stroke Lesion Volumes. Stroke 2016; 47:2966-2971. [PMID: 27895299 DOI: 10.1161/strokeaha.116.014177] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/18/2016] [Accepted: 09/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The minimal scan duration needed to obtain reliable lesion volumes with computed tomographic perfusion (CTP) has not been well established in the literature. METHODS We retrospectively assessed the impact of gradual truncation of the scan duration on acute ischemic lesion volume measurements. For each scan, we identified its optimal scan time, defined as the shortest scan duration that yields measurements of the ischemic lesion volumes similar to those obtained with longer scanning, and the relative height of the fitted venous output function at its optimal scan time. RESULTS We analyzed 70 computed tomographic perfusion scans of acute stroke patients. An optimal scan time could not be determined in 11 scans (16%). For the other 59 scans, the median optimal scan time was 32.7 seconds (90th percentile 52.6 seconds; 100th percentile 68.9 seconds), and the median relative height of the fitted venous output function at the optimal scan times was 0.39 (90th percentile 0.02; 100th percentile 0.00). On the basis of a linear model, the optimal scan time was T0 plus 1.6 times the width of the venous output function (P<0.001; R2=0.49). CONCLUSIONS This study shows how the optimal duration of a computed tomographic perfusion scan relates to the arrival time and width of the contrast bolus. This knowledge can be used to optimize computed tomographic perfusion scan protocols and to determine whether a scan is of sufficient duration. Provided a baseline (T0) of 10 seconds, a total scan duration of 60 to 70 seconds, which includes the entire downslope of the venous output function in most patients, is recommended.
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Affiliation(s)
- Aimen S Kasasbeh
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Søren Christensen
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Matus Straka
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Nishant Mishra
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Michael Mlynash
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Roland Bammer
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Gregory W Albers
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Maarten G Lansberg
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA.
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18
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Ryu WHA, Avery MB, Dharampal N, Allen IE, Hetts SW. Utility of perfusion imaging in acute stroke treatment: a systematic review and meta-analysis. J Neurointerv Surg 2016; 9:1012-1016. [PMID: 28899932 DOI: 10.1136/neurintsurg-2016-012751] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/20/2016] [Accepted: 10/24/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Variability in imaging protocols and techniques has resulted in a lack of consensus regarding the incorporation of perfusion imaging into stroke triage and treatment. The objective of our study was to evaluate the available scientific evidence regarding the utility of perfusion imaging in determining treatment eligibility in patients with acute stroke and in predicting their clinical outcome. METHODS We performed a systematic review of the literature using PubMed, Web of Science, and Cochrane Library focusing on themes of medical imaging, stroke, treatment, and outcome (CRD42016037817). We included randomized controlled trials, cohort studies, and case-controlled studies published from 2011 to 2016. Two independent reviewers conducted the study appraisal, data abstraction, and quality assessments of the studies. RESULTS Our literature search yielded 13 studies that met our inclusion criteria. In total, 994 patients were treated with the aid of perfusion imaging compared with 1819 patients treated with standard care. In the intervention group 51.1% of patients had a favorable outcome at 3 months compared with 45.6% of patients in the control group (p=0.06). Subgroup analysis of studies that used multimodal therapy (IV tissue plasminogen activator, endovascular thrombectomy) showed a significant benefit of perfusion imaging (OR 1.89, 95% CI 1.43 to 2.51, p<0.01). CONCLUSIONS Perfusion imaging may represent a complementary tool to standard radiographic assessment in enhancing patient selection for reperfusion therapy, with a subset of patients having up to 1.9 times the odds of achieving independent functional status at 3 months. This is particularly important as patients selected based on perfusion status often included individuals who did not meet the current treatment eligibility criteria.
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Affiliation(s)
- Won Hyung A Ryu
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Michael B Avery
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Navjit Dharampal
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Isabel E Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
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19
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Kurz KD, Ringstad G, Odland A, Advani R, Farbu E, Kurz MW. Radiological imaging in acute ischaemic stroke. Eur J Neurol 2016; 23 Suppl 1:8-17. [PMID: 26563093 DOI: 10.1111/ene.12849] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Abstract
Patients who suffer acute ischaemic stroke can be treated with thrombolysis if therapy is initiated early. Radiological evaluation of the intracranial tissue before such therapy can be given is mandatory. In this review current radiological diagnostic strategies are discussed for this patient group. Beyond non-enhanced computed tomography (CT), the standard imaging method for many years, more sophisticated CT stroke protocols including CT angiography and CT perfusion have been developed, and additionally an increasing number of patients are examined with magnetic resonance imaging as the first imaging method used. Advantages and challenges of the different methods are discussed.
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Affiliation(s)
- K D Kurz
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway.,Radiologic Research Group, Stavanger University Hospital, Stavanger, Norway
| | - G Ringstad
- Department of Radiology and Nuclear Imaging, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - A Odland
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway.,Radiologic Research Group, Stavanger University Hospital, Stavanger, Norway
| | - R Advani
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway
| | - E Farbu
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, Haukeland University Hospital, Bergen, Norway
| | - M W Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway
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20
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Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Devlin TG, Lopes DK, Reddy V, du Mesnil de Rochemont R, Jahan R. Solitaire™ with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial: protocol for a randomized, controlled, multicenter study comparing the Solitaire revascularization device with IV tPA with IV tPA alone in acute ischemic stroke. Int J Stroke 2016; 10:439-48. [PMID: 25777831 PMCID: PMC4405096 DOI: 10.1111/ijs.12459] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/06/2015] [Indexed: 01/19/2023]
Abstract
Rationale Early reperfusion in patients experiencing acute ischemic stroke is critical, especially for patients with large vessel occlusion who have poor prognosis without revascularization. Solitaire™ stent retriever devices have been shown to immediately restore vascular perfusion safely, rapidly, and effectively in acute ischemic stroke patients with large vessel occlusions. Aim The aim of the study was to demonstrate that, among patients with large vessel, anterior circulation occlusion who have received intravenous tissue plasminogen activator, treatment with Solitaire revascularization devices reduces degree of disability 3 months post stroke. Design The study is a global multicenter, two-arm, prospective, randomized, open, blinded end-point trial comparing functional outcomes in acute ischemic stroke patients who are treated with either intravenous tissue plasminogen activator alone or intravenous tissue plasminogen activator in combination with the Solitaire device. Up to 833 patients will be enrolled. Procedures Patients who have received intravenous tissue plasminogen activator are randomized to either continue with intravenous tissue plasminogen activator alone or additionally proceed to neurothrombectomy using the Solitaire device within six-hours of symptom onset. Study Outcomes The primary end-point is 90-day global disability, assessed with the modified Rankin Scale (mRS). Secondary outcomes include mortality at 90 days, functional independence (mRS ≤ 2) at 90 days, change in National Institutes of Health Stroke Scale at 27 h, reperfusion at 27 h, and thrombolysis in cerebral infarction 2b/3 flow at the end of the procedure. Analysis Statistical analysis will be conducted using simultaneous success criteria on the overall distribution of modified Rankin Scale (Rankin shift) and proportions of subjects achieving functional independence (mRS 0–2).
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Affiliation(s)
- Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, University of California Los Angeles, Los Angeles, CA, USA
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21
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Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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22
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Albers GW, Goyal M, Jahan R, Bonafe A, Diener HC, Levy EI, Pereira VM, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, de Rochemont RDM, Singer OC, Bammer R, Saver JL. Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME. Ann Neurol 2015; 79:76-89. [PMID: 26476022 DOI: 10.1002/ana.24543] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/01/2015] [Accepted: 10/15/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Within the context of a prospective randomized trial (SWIFT PRIME), we assessed whether early imaging of stroke patients, primarily with computed tomography (CT) perfusion, can estimate the size of the irreversibly injured ischemic core and the volume of critically hypoperfused tissue. We also evaluated the accuracy of ischemic core and hypoperfusion volumes for predicting infarct volume in patients with the target mismatch profile. METHODS Baseline ischemic core and hypoperfusion volumes were assessed prior to randomized treatment with intravenous (IV) tissue plasminogen activator (tPA) alone versus IV tPA + endovascular therapy (Solitaire stent-retriever) using RAPID automated postprocessing software. Reperfusion was assessed with angiographic Thrombolysis in Cerebral Infarction scores at the end of the procedure (endovascular group) and Tmax > 6-second volumes at 27 hours (both groups). Infarct volume was assessed at 27 hours on noncontrast CT or magnetic resonance imaging (MRI). RESULTS A total of 151 patients with baseline imaging with CT perfusion (79%) or multimodal MRI (21%) were included. The median baseline ischemic core volume was 6 ml (interquartile range= 0-16). Ischemic core volumes correlated with 27-hour infarct volumes in patients who achieved reperfusion (r = 0.58, p < 0.0001). In patients who did not reperfuse (<10% reperfusion), baseline Tmax > 6-second lesion volumes correlated with 27-hour infarct volume (r = 0.78, p = 0.005). In target mismatch patients, the union of baseline core and early follow-up Tmax > 6-second volume (ie, predicted infarct volume) correlated with the 27-hour infarct volume (r = 0.73, p < 0.0001); the median absolute difference between the observed and predicted volume was 13 ml. INTERPRETATION Ischemic core and hypoperfusion volumes, obtained primarily from CT perfusion scans, predict 27-hour infarct volume in acute stroke patients who were treated with reperfusion therapies.
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Affiliation(s)
- Gregory W Albers
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA
| | - Mayank Goyal
- Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Reza Jahan
- Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, CA
| | - Alain Bonafe
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier, France
| | | | - Elad I Levy
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY
| | - Vitor M Pereira
- Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - David J Cohen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Werner Hacke
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, Christian Albrechts University of Kiel, Kiel, Germany
| | - Tudor G Jovin
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Raul G Nogueira
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, NY
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL
| | - Blaise W Baxter
- Department of Radiology, Erlanger Hospital at University of Tennessee, Chattanooga, TN
| | - Thomas G Devlin
- Division of Neurology, Erlanger Hospital at University of Tennessee, Chattanooga, TN
| | - Demetrius K Lopes
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Vivek K Reddy
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Oliver C Singer
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
| | - Roland Bammer
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
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23
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Bourcier R, Volpi S, Guyomarch B, Daumas-Duport B, Lintia-Gaultier A, Papagiannaki C, Serfaty JM, Desal H. Susceptibility Vessel Sign on MRI Predicts Favorable Clinical Outcome in Patients with Anterior Circulation Acute Stroke Treated with Mechanical Thrombectomy. AJNR Am J Neuroradiol 2015; 36:2346-53. [PMID: 26316570 DOI: 10.3174/ajnr.a4483] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/18/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The susceptibility vessel sign on MR imaging has been reported to indicate acute occlusion from erythrocyte-rich thrombus. The purpose of this study was to evaluate the influence of the susceptibility vessel sign seen on MR imaging before treatment on the clinical outcome after mechanical thrombectomy for anterior circulation acute stroke. MATERIALS AND METHODS We retrospectively included 73 consecutive patients who were treated for anterior circulation acute stroke by mechanical thrombectomy from December 2009 to September 2013. Each patient underwent MR imaging before mechanical thrombectomy. The presence (susceptibility vessel sign+) or absence of the susceptibility vessel sign (susceptibility vessel sign-) was recorded. Mechanical thrombectomy was performed either alone or in association with IV tPA according to the site and time after occlusion. Good functional outcome was defined by an mRS ≤ 2 at 3 months in susceptibility vessel sign+ and susceptibility vessel sign- groups. Patient clinical characteristics, initial NIHSS score and ASPECTS, site of occlusion, time between onset to groin puncture, TICI after mechanical thrombectomy, NIHSS score at day 1, and spontaneous hyperattenuation on CT at day 1 were also analyzed. RESULTS Fifty-three patients with susceptibility vessel sign+ and 20 with susceptibility vessel sign- were included in our study. mRS ≤ 2 at 3 months occurred in 65% patients in the susceptibility vessel sign+ group and 26% in the susceptibility vessel sign- group (P = .004). On multivariate analysis, the susceptibility vessel sign was the only parameter before treatment that could predict mRS ≤ 2 at 3 months (OR, 8.7; 95% CI, 1.1-69.4; P = .04). CONCLUSIONS Our study strongly suggests that the susceptibility vessel sign on MR imaging before treatment is predictive of favorable clinical outcome for patients presenting with anterior circulation acute stroke and treated with mechanical thrombectomy.
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Affiliation(s)
- R Bourcier
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.)
| | - S Volpi
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.)
| | - B Guyomarch
- Centre d'investigation clinique Thorax (B.G.), l'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France Institut National de la Santé et de la Recherche Médicale, UMR1087 (B.G., J.M.S., H.D.), l'institut du thorax, Nantes, France Centre national de la recherche scientifique (B.G,), UMR 6291, Nantes, France
| | - B Daumas-Duport
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.)
| | - A Lintia-Gaultier
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.)
| | - C Papagiannaki
- Department of Diagnostic and Interventional Neuroradiology (C.P.), Centre Hospitalier Régional Universitaire de Tours, Bretonneau Hospital, Tours, France
| | - J M Serfaty
- Diagnostic Cardiac and Vascular Imaging (J.M.S.), Centre Hospitalier Universitaire Nantes Hôpital G et R Laënnec, Nantes, France Institut National de la Santé et de la Recherche Médicale, UMR1087 (B.G., J.M.S., H.D.), l'institut du thorax, Nantes, France
| | - H Desal
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.) Institut National de la Santé et de la Recherche Médicale, UMR1087 (B.G., J.M.S., H.D.), l'institut du thorax, Nantes, France
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24
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Albers GW, Goyal M, Jahan R, Bonafe A, Diener HC, Levy EI, Pereira VM, Cognard C, Yavagal DR, Saver JL. Relationships Between Imaging Assessments and Outcomes in Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke. Stroke 2015; 46:2786-94. [PMID: 26316344 DOI: 10.1161/strokeaha.115.010710] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Imaging findings can predict outcomes in patients with acute stroke. Relationships between imaging findings and clinical and imaging outcomes in patients randomized to intravenous tissue-type plasminogen activator-alone versus tissue-type plasminogen activator plus endovascular therapy (Solitaire device) in the Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) study were assessed. METHODS We evaluated associations between imaging assessments (baseline mismatch profiles/ischemic core volumes and successful reperfusion) with imaging outcomes (27-hour infarct volume/growth) and clinical outcomes (modified Rankin Scale scores at 90 days). Imaging variables that predict favorable clinical outcomes were assessed in both univariate and multivariate models. RESULTS One hundred and ninety-five patients were included. Successful reperfusion and infarct volume (assessed at 27 hours) were powerful independent predictors of favorable clinical outcomes (modified Rankin Scale score of 0-2 at 90 days). Patients with the target mismatch profile at baseline had a higher rate of reperfusion, lesser infarct growth, smaller infarct volumes, and better clinical outcomes in the Solitaire plus tissue-type plasminogen activator (intervention) group than those in the tissue-type plasminogen activator-alone (control) group. Patients with larger mismatch volumes at baseline had a trend toward better treatment response in the intervention group than patients who had smaller (<50 mL) mismatch volumes. CONCLUSIONS Patients who achieved reperfusion had substantially more favorable clinical and imaging outcomes in both the intervention and the control groups. Infarct volume at 27 hours strongly correlated with clinical outcome at 90 days in both treatment groups. SWIFT PRIME patients with the target mismatch profile had a highly favorable response to endovascular therapy on both clinical and imaging outcomes. Both reperfusion and infarct volumes at 27 hours were powerful and independent predictors of 90-day clinical outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01657461.
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Affiliation(s)
- Gregory W Albers
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.).
| | - Mayank Goyal
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Reza Jahan
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Alain Bonafe
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Hans-Christoph Diener
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Elad I Levy
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Vitor M Pereira
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Christophe Cognard
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Dileep R Yavagal
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Jeffrey L Saver
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
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25
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Ozenne B, Cho TH, Mikkelsen IK, Hermier M, Ribe L, Thomalla G, Pedraza S, Baron JC, Roy P, Berthezène Y, Nighoghossian N, Østergaard L, Maucort-Boulch D. Evaluation of Early Reperfusion Criteria in Acute Ischemic Stroke. J Neuroimaging 2015; 25:952-8. [PMID: 25940773 DOI: 10.1111/jon.12255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Though still debated, early reperfusion is increasingly used as a biomarker for clinical outcome. However, the lack of a standard definition hinders the assessment of reperfusion therapies and study comparisons. The objective was to determine the optimal early reperfusion criteria that predicts clinical outcome in ischemic stroke. METHODS Early reperfusion was assessed voxel-wise in 57 patients within 6 hours of symptom onset. The performance of the time to peak (TTP), the mean transit time (MTT), and the time to maximum of residue function (Tmax ) at various delays thresholds in predicting the neurological response (based on the National Institutes of Health Stroke Scale) and the functional outcome (modified Rankin scale ≤1) at 1 month were compared. A receiver operating characteristics (ROC) analysis determined the optimal extent of reperfusion. A novel unsupervised classification of reperfusion using group-based trajectory modeling (GBTM) was evaluated. RESULTS MTT had a lower performance than TTP and Tmax in predicting the neurological response (P = .008 vs. TTP and P = .006 vs. Tmax ) or the functional outcome (P = .0006 vs. TTP; P = .002 vs. Tmax ). No delay threshold had a significantly higher predictive value than another. The optimal percentage of reperfusion was dependent on the outcome scale (P < .001). The GBTM-based classification of reperfusion was closely associated with the clinical outcome and had a similar accuracy compared to ROC-based classification. CONCLUSIONS TTP and Tmax should be preferred to MTT in defining early reperfusion. GBTM provided a clinically relevant reperfusion classification that does not require prespecified delay thresholds or clinical outcomes.
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Affiliation(s)
- Brice Ozenne
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France, Equipe Biostatistique Santé CNRS UMR 5558, Villeurbanne, France; Université Lyon I, Lyon, France
| | - Tae-Hee Cho
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1; CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Irene Klaerke Mikkelsen
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Hermier
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France, Equipe Biostatistique Santé CNRS UMR 5558, Villeurbanne, France; Université Lyon I, Lyon, France
| | - Lars Ribe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Salvador Pedraza
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Jean-Claude Baron
- INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Pascal Roy
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France, Equipe Biostatistique Santé CNRS UMR 5558, Villeurbanne, France; Université Lyon I, Lyon, France
| | - Yves Berthezène
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1; CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1; CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Leif Østergaard
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Delphine Maucort-Boulch
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France, Equipe Biostatistique Santé CNRS UMR 5558, Villeurbanne, France; Université Lyon I, Lyon, France
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26
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Affiliation(s)
- Jenny P Tsai
- From the Stanford Stroke Center, Department of Neurology, Stanford University Medical Center, Palo Alto, CA.
| | - Gregory W Albers
- From the Stanford Stroke Center, Department of Neurology, Stanford University Medical Center, Palo Alto, CA
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27
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Abstract
PURPOSE OF REVIEW To summarize what is known about the use of MRI in acute stroke treatment (predominantly thrombolysis), to examine the assumptions and theories behind the interpretation of magnetic resonance images of acute ischemic stroke and how they are used to select patients for therapies, and to suggest directions for future research. RECENT FINDINGS Recent studies have been contradictory about the usefulness of MRI in selecting patients for treatment. New MRI models for selecting patients have emerged that focus not only on the ischemic penumbra but also on the infarct core. Fixed time-window selection parameters are being replaced by timing-based individualized MRI stroke features. New ways to interpret traditional MRI stroke sequences are emerging. SUMMARY Although the efficacy of acute stroke treatment is time dependent, the use of fixed time windows cannot account for individual differences in infarct evolution, which could potentially be detected with MRI. Although MRI shows promise for identifying patients who should be treated, as well as excluding patients who should not be treated, definitive evidence is still lacking. Future research should focus on validating the use of MRI to select patients for intravenous therapies in extended time windows.
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28
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Chatterjee NR, Ansari SA, Vakil P, Prabhakaran S, Carroll TJ, Hurley MC. Automated analysis of perfusion weighted MRI using asymmetry in vascular territories. Magn Reson Imaging 2015; 33:618-23. [PMID: 25601529 DOI: 10.1016/j.mri.2015.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/03/2014] [Accepted: 01/10/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE To determine the feasibility of automatic vascular territory region of interest (ROI) construction as a method for standardized quantification of cerebral blood flow (CBF) images. MATERIALS AND METHODS An algorithm for automatic construction of vascular territory ROIs was performed on 10 healthy controls and 25 patients with perfusion abnormalities identified by retrospective chart review. The ROIs were used to quantify perfusion asymmetry for each territory, and perfusion asymmetry was compared in the two cohorts and against blinded neuroradiologist interpretation. The algorithm was additionally applied to a separate cohort of 23 prospectively enrolled patients and perfusion asymmetry was correlated against clinical variables. RESULTS There was significantly greater perfusion asymmetry in territories graded by neuroradiologists as hypoperfused compared to those graded as normally perfused (p<.05) and compared to healthy volunteers (p<.01). An ROC analysis showed that perfusion asymmetry was sensitive and specific for identifying hypoperfusion in vascular territories (84.9% sensitivity and 90.5% specificity for a threshold asymmetry index of .829). In the prospective cohort, perfusion asymmetry was correlated with initial NIH stroke scale (NIHSS) (p<.01) and length of stay (p<.05). CONCLUSIONS Automatic construction of vascular territory ROIs and calculation of perfusion asymmetry is a feasible method for analyzing CBF images. Because the technique is rapid and minimizes bias, it can facilitate analysis of larger scale research studies.
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Affiliation(s)
- Neil R Chatterjee
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737N Michigan Suite 1600, Chicago, IL, USA
| | - Sameer A Ansari
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737N Michigan Suite 1600, Chicago, IL, USA
| | - Parmede Vakil
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737N Michigan Suite 1600, Chicago, IL, USA
| | - Shyam Prabhakaran
- Department of Neurology, Northwestern University Feinberg School of Medicine, Abbott Hall Suite 1123, 710 N Lake Shore Drive, Chicago, IL, USA
| | - Timothy J Carroll
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737N Michigan Suite 1600, Chicago, IL, USA.
| | - Michael C Hurley
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737N Michigan Suite 1600, Chicago, IL, USA
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29
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Spectroscopy of reperfused tissue after stroke reveals heightened metabolism in patients with good clinical outcomes. J Cereb Blood Flow Metab 2014; 34:1944-50. [PMID: 25269516 PMCID: PMC4269749 DOI: 10.1038/jcbfm.2014.166] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 09/08/2014] [Accepted: 09/08/2014] [Indexed: 11/09/2022]
Abstract
The aim of acute stroke treatment is to reperfuse the penumbra. However, not all posttreatment reperfusion is associated with a good outcome. Recent arterial spin labeling (ASL) studies suggest that patients with hyperperfusion after treatment have a better clinical recovery. This study aimed to determine whether there was a distinctive magnetic resonance spectroscopy (MRS) metabolite profile in hyperperfused tissue after stroke reperfusion therapy. We studied 77 ischemic stroke patients 24 hours after treatment using MRS (single voxel spectroscopy, point resolved spectroscopy, echo time 30 ms), ASL, and diffusion-weighted imaging (DWI). Magnetic resonance spectroscopy voxels were placed in cortical tissue that was penumbral on baseline perfusion imaging but had reperfused at 24 hours (and did not progress to infarction). Additionally, 20 healthy age matched controls underwent MRS. In all, 24 patients had hyperperfusion; 36 had reperfused penumbra without hyperperfusion, and 17 were excluded due to no reperfusion. Hyperperfusion was significantly related to better 3-month clinical outcome compared with patients without hyperperfusion (P=0.007). Patients with hyperperfusion showed increased glutamate (P<0.001), increased N-Acetylaspartate (NAA) (P=0.038), and increased lactate (P<0.002) in reperfused tissue compared with contralateral tissue and healthy controls. Hyperperfused tissue has a characteristic metabolite signature, suggesting that it is more metabolically active and perhaps more capable of later neuroplasticity.
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30
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Mattle HP, Brainin M, Chamorro A, Dichgans M, Lees KR, Leys D, Michel P. Second European Stroke Science Workshop. Stroke 2014; 45:e113-22. [DOI: 10.1161/strokeaha.114.005583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Heinrich P. Mattle
- From the Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.); Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria (M.B.); Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich,
| | - Michael Brainin
- From the Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.); Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria (M.B.); Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich,
| | - Angel Chamorro
- From the Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.); Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria (M.B.); Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich,
| | - Martin Dichgans
- From the Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.); Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria (M.B.); Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich,
| | - Kennedy R. Lees
- From the Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.); Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria (M.B.); Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich,
| | - Didier Leys
- From the Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.); Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria (M.B.); Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich,
| | - Patrik Michel
- From the Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.); Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria (M.B.); Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich,
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31
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Albers GW. Endovascular treatment for stroke: when does the window for good outcome close? Lancet Neurol 2014; 13:529-31. [PMID: 24784551 DOI: 10.1016/s1474-4422(14)70086-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Gregory W Albers
- Stanford Stroke Center, School of Medicine, Stanford University, Stanford, CA 94305, USA.
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32
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Affiliation(s)
- Wolf-Dieter Heiss
- From the Max Planck Institute for Neurological Research, Cologne, Germany (W.-D.H.); and Departments of Neurology and Medical Imaging, University of Arizona, Tucson, AZ (C.S.K.)
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33
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Bivard A, Levi C, Krishnamurthy V, Hislop-Jambrich J, Salazar P, Jackson B, Davis S, Parsons M. Defining acute ischemic stroke tissue pathophysiology with whole brain CT perfusion. J Neuroradiol 2014; 41:307-15. [PMID: 24433950 DOI: 10.1016/j.neurad.2013.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/25/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed to identify and validate whole brain perfusion computed tomography (CTP) thresholds for ischemic core and salvageable penumbra in acute stroke patients and develop a probability based model to increase the accuracy of tissue pathophysiology measurements. METHODS One hundred and eighty-three patients underwent multimodal stroke CT using a 320-slice scanner within 6hours of acute stroke onset, followed by 24hour MRI that included diffusion weighted imaging (DWI) and dynamic susceptibility weighted perfusion imaging (PWI). Coregistered acute CTP and 24hour DWI was used to identify the optimum single perfusion parameter thresholds to define penumbra (in patients without reperfusion), and ischemic core (in patients with reperfusion), using a pixel based receiver operator curve analysis. Then, these results were used to develop a sigma curve fitted probability based model incorporating multiple perfusion parameter thresholds. RESULTS For single perfusion thresholds, a time to peak (TTP) of +5seconds best defined the penumbra (area under the curve, AUC 0.79 CI 0.74-0.83) while a cerebral blood flow (CBF) of < 50% best defined the acute ischemic core (AUC 0.73, CI 0.69-0.77). The probability model was more accurate at detecting the ischemic core (AUC 0.80 SD 0.75-0.83) and penumbra (0.85 SD 0.83-0.87) and was significantly closer in volume to the corresponding reference DWI (P=0.031). CONCLUSIONS Whole brain CTP can accurately identify penumbra and ischemic core using similar thresholds to previously validated 16 or 64 slice CTP. Additionally, a novel probability based model was closer to defining the ischemic core and penumbra than single thresholds.
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Affiliation(s)
- A Bivard
- Melbourne Brain Centre, Flory Neuroscience Institute, University of Melbourne, Melbourne, Australia.
| | - C Levi
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia.
| | - V Krishnamurthy
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia.
| | | | - P Salazar
- Vital Images, Minneapolis, United States
| | - B Jackson
- Vital Images, Minneapolis, United States
| | - S Davis
- Melbourne Brain Centre, Flory Neuroscience Institute, University of Melbourne, Melbourne, Australia
| | - M Parsons
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia.
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