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Neurological Functional Independence After Endovascular Thrombectomy and Different Imaging Modalities for Large Infarct Core Assessment : A Systematic Review and Meta-analysis. Clin Neuroradiol 2023; 33:21-29. [PMID: 35920865 DOI: 10.1007/s00062-022-01202-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the rate of neurological functional independence (NFI) at 90 days in patients with large infarct core (LIC), which was evaluated by different imaging modalities before endovascular thrombectomy (EVT). METHODS PubMed and EMBASE were searched for original studies on clinical functional outcomes at 90 days in LIC patients who received EVT treatment from inception to 28 September 2021. The pooled NFI rates were calculated using random effects model according to different imaging modalities and criteria. RESULTS We included 34 studies enrolling 2997 LIC patients. The NFI rates were 23% (95% confidence interval, CI 15-32%) and 24% (95% CI 10-38%) when LIC was defined as core volume ≥50 ml and ≥ 70 ml separately on computed tomography perfusion, 36% (95% CI 23-48%) and 21% (95% CI 17-25%) when LIC was defined as core volume ≥ 50 ml and ≥ 70 ml separately on magnetic resonance diffusion-weighted imaging (DWI), 28% (95% CI 24-32%) and 37% (95% CI 21-53%) when LIC was defined as DWI-ASPECTS ≤ 5 and ≤ 6 separately, 23% (95% CI 19-27%) and 32% (95% CI 18-46%) when LIC was defined as NCCT-ASPECTS ≤ 5 and ≤ 6 separately. CONCLUSION Similar NFI rates could be obtained after EVT in LIC patients if proper LIC criteria were select according to the imaging modality.
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Benzakoun J, Charron S, Turc G, Hassen WB, Legrand L, Boulouis G, Naggara O, Baron JC, Thirion B, Oppenheim C. Tissue outcome prediction in hyperacute ischemic stroke: Comparison of machine learning models. J Cereb Blood Flow Metab 2021; 41:3085-3096. [PMID: 34159824 PMCID: PMC8756479 DOI: 10.1177/0271678x211024371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Machine Learning (ML) has been proposed for tissue fate prediction after acute ischemic stroke (AIS), with the aim to help treatment decision and patient management. We compared three different ML models to the clinical method based on diffusion-perfusion thresholding for the voxel-based prediction of final infarct, using a large MRI dataset obtained in a cohort of AIS patients prior to recanalization treatment. Baseline MRI (MRI0), including diffusion-weighted sequence (DWI) and Tmax maps from perfusion-weighted sequence, and 24-hr follow-up MRI (MRI24h) were retrospectively collected in consecutive 394 patients AIS patients (median age = 70 years; final infarct volume = 28mL). Manually segmented DWI24h lesion was considered the final infarct. Gradient Boosting, Random Forests and U-Net were trained using DWI, apparent diffusion coefficient (ADC) and Tmax maps on MRI0 as inputs to predict final infarct. Tissue outcome predictions were compared to final infarct using Dice score. Gradient Boosting had significantly better predictive performance (median [IQR] Dice Score as for median age, maybe you can replace the comma with an equal sign for consistency 0.53 [0.29-0.68]) than U-Net (0.48 [0.18-0.68]), Random Forests (0.51 [0.27-0.66]), and clinical thresholding method (0.45 [0.25-0.62]) (P < 0.001). In this benchmark of ML models for tissue outcome prediction in AIS, Gradient Boosting outperformed other ML models and clinical thresholding method and is thus promising for future decision-making.
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Affiliation(s)
- Joseph Benzakoun
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France.,Faculté de médecine, Université de Paris, Paris, France
| | - Sylvain Charron
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Faculté de médecine, Université de Paris, Paris, France
| | - Guillaume Turc
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Faculté de médecine, Université de Paris, Paris, France.,Department of Neurology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France
| | - Wagih Ben Hassen
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France
| | - Laurence Legrand
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France
| | - Grégoire Boulouis
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France.,Faculté de médecine, Université de Paris, Paris, France
| | - Olivier Naggara
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France.,Faculté de médecine, Université de Paris, Paris, France
| | - Jean-Claude Baron
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Faculté de médecine, Université de Paris, Paris, France.,Department of Neurology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France
| | | | - Catherine Oppenheim
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France.,Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, FHU Neurovasc, Paris, France.,Faculté de médecine, Université de Paris, Paris, France
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3
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Baron JC. The core/penumbra model: implications for acute stroke treatment and patient selection in 2021. Eur J Neurol 2021; 28:2794-2803. [PMID: 33991152 DOI: 10.1111/ene.14916] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 12/30/2022]
Abstract
Despite major advances in prevention, ischaemic stroke remains one of the leading causes of death and disability worldwide. After centuries of nihilism and decades of failed neuroprotection trials, the discovery, initially in non-human primates and subsequently in man, that ischaemic brain tissue termed the ischaemic penumbra can be salvaged from infarction up to and perhaps beyond 24 h after stroke onset has underpinned the development of highly efficient reperfusion therapies, namely intravenous thrombolysis and endovascular thrombectomy, which have revolutionized the management of the acute stroke patient. Animal experiments have documented that how long the penumbra can survive depends not only on time elapsed since arterial occlusion ('time is brain'), but also on how severely perfusion is reduced. Novel imaging techniques allowing the penumbra and the already irreversibly damaged core in the individual subject to be mapped have documented that the time course of core growth at the expense of the penumbra widely differs from patient to patient, and hence that individual physiology should be considered in addition to time since stroke onset for decision-making. This concept has been implemented to optimize patient selection in pivotal trials of reperfusion therapies beyond 3 h after stroke onset and is now routinely applied in clinical practice, using computed tomography or magnetic resonance imaging. The notion that, in order to be both efficient and harmless, treatment should be tailored to each patient's physiological characteristics represents a radical move towards precision medicine.
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Affiliation(s)
- Jean-Claude Baron
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM U1266, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
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4
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Lakomkin N, Pan J, Stein L, Malkani B, Dhamoon M, Mocco J. Diffusion MRI Reversibility in Ischemic Stroke Following Thrombolysis: A Meta-Analysis. J Neuroimaging 2020; 30:471-476. [PMID: 32436311 DOI: 10.1111/jon.12703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted magnetic resonance imaging (DWI) detects early infarction in acute stroke. With the substantial progress in stroke therapies, the frequency of posttreatment DWI reversibility in modern stroke cohorts is currently unknown. The purpose of this study was to perform a systematic literature review examining the relationship between characteristics of patients with ischemic stroke and DWI reversibility following treatment with lytic therapy. METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, yielding a total of 422 unique articles. Studies that were nonclinical or did not report data pertaining to DWI reversibility in the context of an acute stroke series were excluded. Characteristics regarding presentation, diagnosis, intervention, and the timing of DWI reversibility were collected for each study. RESULTS After full-text review, 10 studies were identified as meeting inclusion criteria. The number of patients with DWI reversal ranged from .9% to 50%, whereas the extent of reversal ranged from 1.8% to 72.7%. Studies reporting on younger patients describe greater rates of reversibility following stroke treatment. CONCLUSIONS These data suggest that early DWI signal may not represent the definitive DWI burden in recanalized populations. However, substantial heterogeneity exists regarding the rate of DWI reversal following recanalization. Additional studies are needed to elucidate the relationship among time to treatment, early reversal rates, and clinical outcomes. Physicians should use caution when basing clinical decisions on DWI lesion volumes, as these likely change to some degree with recanalization.
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Affiliation(s)
- Nikita Lakomkin
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jonathan Pan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Laura Stein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brijesh Malkani
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mandip Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
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5
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Nagaraja N, Forder JR, Warach S, Merino JG. Reversible diffusion-weighted imaging lesions in acute ischemic stroke: A systematic review. Neurology 2020; 94:571-587. [PMID: 32132175 DOI: 10.1212/wnl.0000000000009173] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/27/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To systematically review the literature for reversible diffusion-weighted imaging (DWIR) lesions and to describe its prevalence, predictors, and clinical significance. METHODS Studies were included if the first DWI MRI was performed within 24 hours of stroke onset and follow-up DWI or fluid-attenuated inversion recovery (FLAIR)/T2 was performed within 7 or 90 days, respectively, to measure DWIR. We abstracted clinical, imaging, and outcomes data. RESULTS Twenty-three studies met the study criteria. The prevalence of DWIR was 26.5% in DWI-based studies and 6% in FLAIR/T2-based studies. DWIR was associated with recanalization or reperfusion of the ischemic tissue with or without the use of tissue plasminogen activator (t-PA) or endovascular therapy, earlier treatment with t-PA, shorter time to endovascular therapy after MRI, and absent or less severe perfusion deficit within the DWI lesion. DWIR was associated with early neurologic improvement in 5 of 6 studies (defined as improvement in the NIH Stroke Scale (NIHSS) score by 4 or 8 points from baseline or NIHSS score 0 to 2 at 24 hours after treatment or at discharge or median NIHSS score at 7 days) and long-term outcome in 6 of 7 studies (defined as NIHSS score ≤1, improvement in the NIHSS score ≥8 points, or modified Rankin Scale score up to ≤2 at 30 or 90 days) likely due to reperfusion. CONCLUSIONS DWIR is seen in up to a quarter of patients with acute ischemic stroke, and it is associated with good clinical outcome following reperfusion. Our findings highlight the pitfalls of DWI to define ischemic core in the early hours of stroke.
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Affiliation(s)
- Nandakumar Nagaraja
- From the Department of Neurology (N.N.), University of Florida College of Medicine, Gainesville; Department of Radiology and Biomedical Engineering (J.R.F.), University of Florida, Gainesville; Dell Medical School (S.W.), University of Texas at Austin; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, Washington, DC.
| | - John R Forder
- From the Department of Neurology (N.N.), University of Florida College of Medicine, Gainesville; Department of Radiology and Biomedical Engineering (J.R.F.), University of Florida, Gainesville; Dell Medical School (S.W.), University of Texas at Austin; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, Washington, DC
| | - Steven Warach
- From the Department of Neurology (N.N.), University of Florida College of Medicine, Gainesville; Department of Radiology and Biomedical Engineering (J.R.F.), University of Florida, Gainesville; Dell Medical School (S.W.), University of Texas at Austin; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, Washington, DC
| | - Jośe G Merino
- From the Department of Neurology (N.N.), University of Florida College of Medicine, Gainesville; Department of Radiology and Biomedical Engineering (J.R.F.), University of Florida, Gainesville; Dell Medical School (S.W.), University of Texas at Austin; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, Washington, DC
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Kaesmacher J, Chaloulos-Iakovidis P, Panos L, Mordasini P, Michel P, Hajdu SD, Ribo M, Requena M, Maegerlein C, Friedrich B, Costalat V, Benali A, Pierot L, Gawlitza M, Schaafsma J, Mendes Pereira V, Gralla J, Fischer U. Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0-5. Stroke 2020; 50:880-888. [PMID: 30827193 PMCID: PMC6430594 DOI: 10.1161/strokeaha.118.023465] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— If anterior circulation large vessel occlusion acute ischemic stroke patients presenting with ASPECTS 0–5 (Alberta Stroke Program Early CT Score) should be treated with mechanical thrombectomy remains unclear. Purpose of this study was to report on the outcome of patients with ASPECTS 0–5 treated with mechanical thrombectomy and to provide data regarding the effect of successful reperfusion on clinical outcomes and safety measures in these patients. Methods— Multicenter, pooled analysis of 7 institutional prospective registries: Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy (Clinical Trial Registration—URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064). Primary outcome was defined as modified Rankin Scale 0–3 at day 90 (favorable outcome). Secondary outcomes included rates of day 90 modified Rankin Scale 0–2 (functional independence), day 90 mortality and occurrence of symptomatic intracerebral hemorrhage. Multivariable logistic regression analyses were performed to assess the association of successful reperfusion with clinical outcomes. Outputs are displayed as adjusted Odds Ratios (aOR) and 95% CI. Results— Two hundred thirty-seven of 2046 patients included in this registry presented with anterior circulation large vessel occlusion and ASPECTS 0–5. In this subgroup, the overall rates of favorable outcome and mortality at day 90 were 40.1% and 40.9%. Achieving successful reperfusion was independently associated with favorable outcome (aOR, 5.534; 95% CI, 2.363–12.961), functional independence (aOR, 5.583; 95% CI, 1.964–15.873), reduced mortality (aOR, 0.180; 95% CI, 0.083–0.390), and lower rates of symptomatic intracerebral hemorrhage (aOR, 0.235; 95% CI, 0.062–0.887). The mortality-reducing effect remained in patients with ASPECTS 0–4 (aOR, 0.167; 95% CI, 0.056–0.499). Sensitivity analyses did not change the primary results. Conclusions— In patients presenting with ASPECTS 0–5, who were treated with mechanical thrombectomy, successful reperfusion was beneficial without increasing the risk of symptomatic intracerebral hemorrhage. Although the results do not allow for general treatment recommendations, formal testing of mechanical thrombectomy versus best medical treatment in these patients in a randomized controlled trial is warranted.
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Affiliation(s)
- Johannes Kaesmacher
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,University Institute of Diagnostic, Interventional and Pediatric Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Panagiotis Chaloulos-Iakovidis
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Leonidas Panos
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Pasquale Mordasini
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Patrik Michel
- Department of Neurology (P. Michel) and Department of Radiology (S.D.H.), CHUV Lausanne, Switzerland
| | - Steven D Hajdu
- Department of Neurology (P. Michel) and Department of Radiology (S.D.H.), CHUV Lausanne, Switzerland
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain (M. Ribo, M. Requena)
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain (M. Ribo, M. Requena)
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M., B.F.)
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M., B.F.)
| | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, France (V.C., A.B.), Toronto Western Hospital, ON
| | - Amel Benali
- Department of Neuroradiology, CHU Montpellier, France (V.C., A.B.), Toronto Western Hospital, ON
| | - Laurent Pierot
- Department of Neuroradiology, CHU Reims, France (L.P., M.G.), Toronto Western Hospital, ON
| | - Matthias Gawlitza
- Department of Neuroradiology, CHU Reims, France (L.P., M.G.), Toronto Western Hospital, ON
| | | | | | - Jan Gralla
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Urs Fischer
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
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7
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Nagel S, Joly O, Pfaff J, Papanagiotou P, Fassbender K, Reith W, Möhlenbruch MA, Herweh C, Grunwald IQ. e-ASPECTS derived acute ischemic volumes on non-contrast-enhanced computed tomography images. Int J Stroke 2019; 15:995-1001. [PMID: 31570065 PMCID: PMC7739116 DOI: 10.1177/1747493019879661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and purpose Validation of automatically derived acute ischemic volumes (AAIV) from e-ASPECTS on non-contrast computed tomography (NCCT). Materials and methods Data from three studies were reanalyzed with e-ASPECTS Version 7. AAIV was calculated in milliliters (ml) in all scored ASPECTS regions of the hemisphere detected by e-ASPECTS. The National Institute of Health Stroke Scale (NIHSS) determined stroke severity at baseline and clinical outcome was measured with the modified Rankin Scale (mRS) between 45 and 120 days. Spearman ranked correlation coefficients (R) of AAIV and e-ASPECTS scores with NIHSS and mRS as well as Pearson correlation of AAIV with diffusion-weighted imaging and CT perfusion-estimated ischemic “core” volumes were calculated. Multivariate regression analysis (odds ratio, OR with 95% confidence intervals, CI) and Bland–Altman plots were performed. Results We included 388 patients. Mean AAIV was 11.6 ± 18.9 ml and e-ASPECTS was 9 (8–10: median and interquartile range). AAIV, respectively e-ASPECTS correlated with NIHSS at baseline (R = 0.35, p < 0.001; R = −0.36, p < 0.001) and follow-up mRS (R = 0.29, p < 0.001; R = −0.3, p < 0.001). In subsets of patients, AAIV correlated strongly with diffusion-weighted imaging (n = 37, R = 0.68, p < 0.001) and computed tomography perfusion-derived ischemic “core” (n = 41, R = 0.76, p < 0.001) lesion volume and Bland–Altman plots showed a bias close to zero (−2.65 ml for diffusion-weighted imaging and 0.45 ml forcomputed tomography perfusion “core”). Within the whole cohort, the AAIV (OR 0.98 per ml, 95% CI 0.96–0.99) and e-ASPECTS scores (OR 1.3, 95%CI 1.07–1.57) were independent predictors of good outcome Conclusion AAIV on NCCT correlated moderately with clinical severity but strongly with diffusion-weighted imaging lesion and computed tomography perfusion ischemic “core” volumes and predicted clinical outcome.
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Affiliation(s)
- Simon Nagel
- Department of Neurology, University Hospital Heidelberg, Germany
| | | | - Johannes Pfaff
- Department of Neuroradiology, University Hospital Heidelberg, Germany
| | | | - Klaus Fassbender
- Department of Neurology, University of the Saarland, Homburg, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, University of the Saarland, Homburg, Germany
| | | | - Christian Herweh
- Department of Neuroradiology, University Hospital Heidelberg, Germany
| | - Iris Q Grunwald
- Brainomix Ltd, Oxford, UK.,Neuroscience Department, Anglia Ruskin University, Essex, UK
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8
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Fukuda M, Ando N, Sugasawa Y, Inoue R, Nakauchi S, Miura M, Nishimura K. Volatile anesthetic sevoflurane pretreatment alleviates hypoxia‐induced potentiation of excitatory inputs to striatal medium spiny neurons of mice. Eur J Neurosci 2019; 50:3520-3530. [DOI: 10.1111/ejn.14524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/15/2019] [Accepted: 07/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Masataka Fukuda
- Department of Anesthesiology and Pain Medicine Faculty of Medicine and Graduate School of Medicine Juntendo University Tokyo Japan
- Neurophysiology Research Group Tokyo Metropolitan Institute of Gerontology Tokyo Japan
| | - Nozomi Ando
- Department of Anesthesiology and Pain Medicine Faculty of Medicine and Graduate School of Medicine Juntendo University Tokyo Japan
- Neurophysiology Research Group Tokyo Metropolitan Institute of Gerontology Tokyo Japan
| | - Yusuke Sugasawa
- Department of Anesthesiology and Pain Medicine Faculty of Medicine and Graduate School of Medicine Juntendo University Tokyo Japan
- Neurophysiology Research Group Tokyo Metropolitan Institute of Gerontology Tokyo Japan
| | - Ritsuko Inoue
- Neurophysiology Research Group Tokyo Metropolitan Institute of Gerontology Tokyo Japan
| | - Sakura Nakauchi
- Neurophysiology Research Group Tokyo Metropolitan Institute of Gerontology Tokyo Japan
| | - Masami Miura
- Neurophysiology Research Group Tokyo Metropolitan Institute of Gerontology Tokyo Japan
| | - Kinya Nishimura
- Department of Anesthesiology and Pain Medicine Faculty of Medicine and Graduate School of Medicine Juntendo University Tokyo Japan
- Neurophysiology Research Group Tokyo Metropolitan Institute of Gerontology Tokyo Japan
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9
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Alegiani AC, MacLean S, Braass H, Gellißen S, Cho TH, Derex L, Hermier M, Berthezene Y, Nighoghossian N, Gerloff C, Fiehler J, Thomalla G. Dynamics of Water Diffusion Changes in Different Tissue Compartments From Acute to Chronic Stroke-A Serial Diffusion Tensor Imaging Study. Front Neurol 2019; 10:158. [PMID: 30863361 PMCID: PMC6399390 DOI: 10.3389/fneur.2019.00158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/07/2019] [Indexed: 01/09/2023] Open
Abstract
Background and Purpose: The immediate decrease of the apparent diffusion coefficient (ADC) is the main characteristic change of water diffusion in acute ischemic stroke. There is only limited information on the time course of diffusion parameters in different tissue compartments of cerebral ischemia. Materials and Methods: In a longitudinal study, we examined 21 patients with acute ischemic stroke by diffusion tensor imaging within 5 h after symptom onset, 3 h later, 2 days, and 1 month after symptom onset. Acute diffusion lesion and the fluid-attenuated inversion recovery (FLAIR) after 2 days were used as volumes of interest to define persistent core, lesion growth, and reversible acute diffusion lesion. For all diffusion parameters ratios between the stroke lesion VOIs and the mirror VOIs were calculated for each time point. ADC ratio, fractional anisotropy ratios, and eigenvalues ratios were measured in these volumes of interest and in contralateral mirror regions at each time points. Results: In the persistent core, ADC ratio (0.772) and all eigenvalues ratios were reduced on admission up to 1 day after stroke and increased after 1 month (ADC ratio 1.067). Within the region of infarct growth time course of diffusion parameter changes was similar, but delayed. In the brain area with reversible diffusion lesion, a partial normalization of diffusion parameters over the time was observed, while after 1 month diffusion parameters did not show the signature of healthy brain tissue. There were significantly different trends for all parameters over time between the three tissue compartments. Conclusion: Diffusion tensor imaging displays characteristic changes of water diffusion in different tissue compartments over time in acute ischemic stroke. Even regions with reversible diffusion lesion show diffusion signatures of persisting tissue alterations.
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Affiliation(s)
| | - Simon MacLean
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Braass
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellißen
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Lyon, Lyon, France
| | - Laurent Derex
- Department of Stroke Medicine, Université Lyon, Lyon, France
| | - Marc Hermier
- Department of Neuroradiology, Université Lyon, Lyon, France
| | | | | | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Pruvost-Robieux E, Calvet D, Ben Hassen W, Turc G, Marchi A, Mélé N, Seners P, Oppenheim C, Baron JC, Mas JL, Gavaret M. Design and Methodology of a Pilot Randomized Controlled Trial of Transcranial Direct Current Stimulation in Acute Middle Cerebral Artery Stroke (STICA). Front Neurol 2018; 9:816. [PMID: 30356889 PMCID: PMC6190876 DOI: 10.3389/fneur.2018.00816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/10/2018] [Indexed: 01/01/2023] Open
Abstract
Background: Stroke is a major cause of death and disability worldwide. The related burden is expected to further increase due to aging populations, calling for more efficient treatment. Ischemic stroke results from a focal reduction in cerebral blood flow due to the sudden occlusion of a brain artery. Ischemic brain injury results from a sequence of pathophysiological events that evolve over time and space. This cascade includes excitotoxicity and peri-infarct depolarizations (PIDs). Focal impairment of cerebral blood flow restricts the delivery of energetics substrates and impairs ionic gradients. Membrane potential is eventually lost, and neurons depolarize. Although recanalization therapies target the ischemic penumbra, they can only rescue the penumbra still present at the time of reperfusion. A promising novel approach is to "freeze" the penumbra until reperfusion occurs. Transcranial direct current stimulation (tDCS) is a non-invasive method of neuromodulation. Based on preclinical evidence, we propose to test the penumbra freezing concept in a clinical phase IIa trial assessing whether cathodal tDCS-shown in rodents to reduce infarction volume-prevents early infarct growth in human acute Middle Cerebral Artery (MCA) stroke, in adjunction to conventional revascularization methods. Methods: This is a monocentric randomized, double-blind, and placebo-controlled trial performed in patients with acute MCA stroke eligible to revascularization procedures. Primary outcome is infarct volume growth on diffusion weighted imaging (DWI) at day 1 relative to baseline. Secondary outcomes include safety and clinical efficacy. Significance: Results from this clinical trial are expected to provide rationale for a phase III study. Clinical trial registration-EUDRACT: 2016-A00160-51.
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Affiliation(s)
- Estelle Pruvost-Robieux
- Department of Neurophysiology, Sainte-Anne Hospital, Paris, France.,Faculty of Medicine, Paris Descartes University, Paris, France
| | - David Calvet
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neurology, Sainte-Anne Hospital, Paris, France
| | - Wagih Ben Hassen
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neuroradiology, Sainte-Anne Hospital, Paris, France
| | - Guillaume Turc
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neurology, Sainte-Anne Hospital, Paris, France
| | - Angela Marchi
- Department of Neurophysiology, Sainte-Anne Hospital, Paris, France
| | - Nicolas Mélé
- Department of Neurology, Sainte-Anne Hospital, Paris, France
| | - Pierre Seners
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neurology, Sainte-Anne Hospital, Paris, France
| | - Catherine Oppenheim
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neuroradiology, Sainte-Anne Hospital, Paris, France
| | - Jean-Claude Baron
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neurology, Sainte-Anne Hospital, Paris, France
| | - Jean-Louis Mas
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neurology, Sainte-Anne Hospital, Paris, France
| | - Martine Gavaret
- Department of Neurophysiology, Sainte-Anne Hospital, Paris, France.,Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France
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11
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Lekoubou A, Awoumou JJ, Kengne AP. Incidence of seizure in stroke patients treated with recombinant tissue plasminogen activator: A systematic review and meta-analysis. Int J Stroke 2017; 12:923-931. [DOI: 10.1177/1747493017729239] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Recombinant tissue plasminogen activator is the only FDA-approved thrombolytic agent for acute stroke treatment. However, there are concerns that recombinant tissue plasminogen activator may increase the risk of seizures (including early and late seizures). Aims We performed a systematic review to assess the incidence of seizures and the association of recombinant tissue plasminogen activator with seizure occurrence. Summary of review We searched major databases for articles published between 1995 and February 2016. The pooled incidence of post-stroke seizure, early seizure, late seizure, and seizures sub-types was estimated overall and by status for recombinant tissue plasminogen activator treatment, and unadjusted odds ratio used to quantify the effects of recombinant tissue plasminogen activator on post-stroke seizure occurrence. In all, 4362 stroke participants were included with 49–63% being male and median age ranging from 68 to 71 years. A total of 792 received recombinant tissue plasminogen activator. The incidence of post-stroke seizure per 1000 participants (95% CI) was 95 (31–196) overall, 113 (49–202) in recombinant tissue plasminogen activator and 169 (6–326) in non-recombinant tissue plasminogen activator-treated (all heterogeneity- p<0.0001). Incidence of early seizure per 1000 (95% CI) was 35 (27–45) overall; 34 (22–50) among recombinant tissue plasminogen activator-treated patients, and 36 (25–48) among recombinant tissue plasminogen activator naïve participants (all heterogeneity- p > 0.826). The pool incidence rate per 1000 (95% CI) of late seizure was 84 (4–263), 46 (2–145), and 212 (184–241), respectively, in the overall, the recombinant tissue plasminogen activator-treated group and non-recombinant tissue plasminogen activator-treated group (heterogeneity for overall and recombinant tissue plasminogen activator-treated group < 0.0001, non-recombinant tissue plasminogen activator naïve = 0.999). The pooled odds ratio for post-stroke seizure (recombinant tissue plasminogen activator vs. no recombinant tissue plasminogen activator) was 0.94 (95% CI: 0. 17–5.26, heterogeneity- p < 0.0001). The pooled incidence per 1000 participants (95% CI) was 30 (0–144), 17 (2–49), 16 (2–44), and 9 (0–50), respectively, for focal seizure without impairment of consciousness, focal seizure with impairment of consciousness, generalized convulsive seizure, and status epilepticus; all heterogeneity- p < 0.0003. Accompanying pooled odds ratio (recombinant tissue plasminogen activator vs. no recombinant tissue plasminogen activator) based on one study was always in favor of non-significantly lower risk in recombinant tissue plasminogen activator-treated patients (all heterogeneity- p = 1). There were insufficient data to compute pooled odds ratio for early and late seizure. Conclusions Seizures affect nearly 1 out of every 10 stroke patients with inconclusive suggestion that rates are similar in recombinant tissue plasminogen activator-treated and recombinant tissue plasminogen activator naïve patients. Large prospective studies are needed to better understand the relationship between recombinant tissue plasminogen activator and post-stroke seizure occurrence.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | | | - André Pascal Kengne
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council of South Africa, Cape Town, South Africa
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12
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Can the benefits of rtPA treatment for stroke be improved? Rev Neurol (Paris) 2017; 173:566-571. [PMID: 28797689 DOI: 10.1016/j.neurol.2017.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/02/2017] [Accepted: 07/07/2017] [Indexed: 12/14/2022]
Abstract
Tissue-type plasminogen activator (tPA) is a serine protease well known to promote fibrinolysis. This is why: its recombinant form (rtPA) can be used, either alone or combined with thrombectomy, to promote recanalization/reperfusion following ischemic stroke. However, its overall benefits are counteracted by some of its side-effects, including incomplete lysis of clots, an increased risk of hemorrhagic transformation and the possibility of neurotoxicity. Nevertheless, better understanding of the mechanisms by which tPA influences brain function and promotes its alteration may help in the design of new strategies to improve stroke therapy.
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13
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Yi KS, Choi CH, Lee SR, Lee HJ, Lee Y, Jeong KJ, Hwang J, Chang KT, Cha SH. Sustained diffusion reversal with in-bore reperfusion in monkey stroke models: Confirmed by prospective magnetic resonance imaging. J Cereb Blood Flow Metab 2017; 37:2002-2012. [PMID: 27401804 PMCID: PMC5464696 DOI: 10.1177/0271678x16659302] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although early diffusion lesion reversal after recanalization treatment of acute ischaemic stroke has been observed in clinical settings, the reversibility of lesions observed by diffusion-weighted imaging remains controversial. Here, we present consistent observations of sustained diffusion lesion reversal after transient middle cerebral artery occlusion in a monkey stroke model. Seven rhesus macaques were subjected to endovascular transient middle cerebral artery occlusion with in-bore reperfusion confirmed by repeated prospective diffusion-weighted imaging. Early diffusion lesion reversal was defined as lesion reversal at 3 h after reperfusion. Sustained diffusion lesion reversal was defined as the difference between the ADC-derived pre-reperfusion maximal ischemic lesion volume (ADCD-P Match) and the lesion on 4-week follow-up FLAIR magnetic resonance imaging. Diffusion lesions were spatiotemporally assessed using a 3-D voxel-based quantitative technique. The ADCD-P Match was 9.7 ± 6.0% (mean ± SD) and the final infarct was 1.2-6.0% of the volume of the ipsilateral hemisphere. Early diffusion lesion reversal and sustained diffusion lesion reversal were observed in all seven animals, and the calculated percentages compared with their ADCD-P Match ranged from 8.3 to 51.9% (mean ± SD, 26.9 ± 15.3%) and 41.7-77.8% (mean ± SD, 65.4 ± 12.2%), respectively. Substantial sustained diffusion lesion reversal and early reversal were observed in all animals in this monkey model of transient focal cerebral ischaemia.
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Affiliation(s)
- Kyung Sik Yi
- 1 Department of Radiology, Chungbuk National University Hospital, Chungbuk, Republic of Korea
| | - Chi-Hoon Choi
- 1 Department of Radiology, Chungbuk National University Hospital, Chungbuk, Republic of Korea
| | - Sang-Rae Lee
- 2 National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Chungbuk, Republic of Korea
| | - Hong Jun Lee
- 3 Medical Research Institute, Chung-Ang University, Seoul, Korea
| | - Youngjeon Lee
- 2 National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Chungbuk, Republic of Korea
| | - Kang-Jin Jeong
- 2 National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Chungbuk, Republic of Korea
| | - Jinwoo Hwang
- 4 Clinical Science, Philips Healthcare, Seoul, Republic of Korea
| | - Kyu-Tae Chang
- 2 National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Chungbuk, Republic of Korea
| | - Sang-Hoon Cha
- 1 Department of Radiology, Chungbuk National University Hospital, Chungbuk, Republic of Korea.,5 College of Medicine, Chungbuk National University, Chungbuk, Republic of Korea
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14
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Sato A, Shimizu Y, Koyama J, Hongo K. A new threshold of apparent diffusion coefficient values in white matter after successful tissue plasminogen activator treatment for acute brain ischemia. J Neuroradiol 2017; 44:223-226. [DOI: 10.1016/j.neurad.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/02/2015] [Accepted: 12/21/2016] [Indexed: 11/16/2022]
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15
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Ong E, Mewton N, Bouvier J, Chauveau F, Ritzenthaler T, Mechtouff L, Derex L, Buisson M, Berthezène Y, Ovize M, Nighoghossian N, Cho TH. Effect of Cyclosporine on Lesion Growth and Infarct Size within the White and Gray Matter. Front Neurol 2017; 8:151. [PMID: 28496428 PMCID: PMC5406390 DOI: 10.3389/fneur.2017.00151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 04/03/2017] [Indexed: 12/21/2022] Open
Abstract
Background In a recent trial, cyclosporine A (CsA) failed to reduce infarct size in acute stroke patients treated with intravenous thrombolysis. White matter (WM) and gray matter (GM) may have distinct vulnerability to ischemia and response to therapy. Using final infarct size and lesion growth as endpoints, our objectives were to (1) investigate any tissue-specific effect of CsA and (2) compare WM and GM response to thrombolysis. Materials and methods We analyzed 84 patients from the randomized and placebo-controlled CsA-Stroke trial, who underwent MRI both on admission and at 1 month. Lesion growth was defined voxel-wise as infarcted tissue at 1 month with no visible lesion on baseline diffusion-weighted imaging. After automatic segmentation of GM/WM, final infarct size and lesion growth were compared within the GM and WM. Results Occlusion level was distal (>M1) in 51% of cases. No significant difference in GM/WM proportions was observed within final infarcts between treatment groups (P = 0.21). Infarct size within the GM or WM was similar between the CsA and control groups [GM: 9.2 (2.4; 22.8) with CsA vs 8.9 (3.7; 28.4) mL with placebo, P = 0.74; WM: 9.9 (4.7; 25.4) with CsA vs 14.1 (5.6; 34.1) mL with placebo, P = 0.26]. There was no significant effect of CsA on lesion growth in either the GM or WM. Pooling all patients, a trend for increased relative lesion growth in WM compared to GM was observed [49.0% (14.7; 185.7) vs 43.1% (15.4; 117.1), respectively; P = 0.12]. Conclusion No differential effect of CsA was observed between WM and GM. Pooling all patients, a trend toward greater lesion growth in WM was observed.
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Affiliation(s)
- Elodie Ong
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Nathan Mewton
- Department of Cardiology, Clinical Investigation Center, Université Lyon 1, Lyon, France.,CarMeN, CNRS-UMR1060, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Julien Bouvier
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Fabien Chauveau
- Lyon Neuroscience Research Center, Université Lyon 1, Lyon, France.,CNRS-UMR5292, Lyon, France.,INSERM-U1028, Lyon, France
| | - Thomas Ritzenthaler
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Laura Mechtouff
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Marielle Buisson
- Department of Cardiology, Clinical Investigation Center, Université Lyon 1, Lyon, France.,CarMeN, CNRS-UMR1060, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Michel Ovize
- Department of Cardiology, Clinical Investigation Center, Université Lyon 1, Lyon, France.,CarMeN, CNRS-UMR1060, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
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16
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Tisserand M, Turc G, Charron S, Legrand L, Edjlali M, Seners P, Roca P, Lion S, Naggara O, Mas JL, Méder JF, Baron JC, Oppenheim C. Does Diffusion Lesion Volume Above 70 mL Preclude Favorable Outcome Despite Post-Thrombolysis Recanalization? Stroke 2016; 47:1005-11. [DOI: 10.1161/strokeaha.115.012518] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/12/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Marie Tisserand
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Guillaume Turc
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Sylvain Charron
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Laurence Legrand
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Myriam Edjlali
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Pierre Seners
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Pauline Roca
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Stéphanie Lion
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Olivier Naggara
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-Louis Mas
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-François Méder
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-Claude Baron
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Catherine Oppenheim
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
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17
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Hassen WB, Tisserand M, Turc G, Charron S, Seners P, Edjlali M, Legrand L, Lion S, Calvet D, Naggara O, Mas JL, Meder JF, Baron JC, Oppenheim C. Comparison between voxel-based and subtraction methods for measuring diffusion-weighted imaging lesion growth after thrombolysis. Int J Stroke 2016; 11:221-8. [DOI: 10.1177/1747493015616636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Infarct growth (IG) is used as surrogate end-point in therapeutic trials. For practical reasons, infarct growth is commonly assessed using simple subtraction of acute from follow-up diffusion-weighted imaging (DWI) lesion volumes. However, the volume subtraction method will underestimate true infarct growth in case of diffusion-weighted imaging lesion reversal. Aim To measure the size of the difference between true infarct growth on voxel-based coregistration and infarct growth approximated with simple volume subtraction. Methods We retrospectively analyzed 322 consecutive stroke patients (median (IQR) age: 70 years (57–80), National Institute of Health Stroke Score at admission 14 (8–19)), who underwent a magnetic resonance imaging before (DWI1) and ≈24 h (DWI2) after IV-thrombolysis. IGvoxel-based was defined as the volume of signal changes on DWI2 that did not overlap with that on coregistered DWI1. This was compared with simply subtracting DWI1 from DWI2 lesion volume (IGsubtracted). We also compared these two metrics for the prediction of three-month unfavorable outcome (mRS ≥ 2) using c-statistics of multivariable models, adjusted for age, and National Institute of Health Stroke Score. Results Infarct growth volume metrics were strongly correlated (ρ = 0.94), but IGsubtracted substantially underestimated IGvoxel-based (median (IQR): 9.52 (0.23–38.9) vs. 16.98 (4.4–45.4) mL). Of the 75 patients with shrinking or stable diffusion-weighted imaging lesion using volume subtraction, IGvoxel-based was ≥5 mL in 20 (27% of the subset, 6.2% of the whole population). Moreover, IGvoxel-based better predicted unfavorable outcome than IGsubtracted (c-statistics = 0.86 (95% CI, 0.82–0.90) vs. 0.82 (0.78–0.87), P = 0.003). Conclusion At early post-thrombolysis time points, the simple subtraction of lesion volumes masked substantial diffusion-weighted imaging lesion growth in 6.2% of patients. Although more time-consuming, the voxel-based method may impact results of trials that use infarct growth attenuation as an end-point.
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Affiliation(s)
- Wajih Ben Hassen
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Marie Tisserand
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Guillaume Turc
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
- Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
| | - Sylvain Charron
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Pierre Seners
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
- Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
| | - Myriam Edjlali
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Laurence Legrand
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Stéphanie Lion
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
| | - David Calvet
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
- Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
| | - Olivier Naggara
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Jean-Louis Mas
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
- Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
| | - Jean-François Meder
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Jean-Claude Baron
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
- Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
| | - Catherine Oppenheim
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
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18
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Hébert M, Lesept F, Vivien D, Macrez R. The story of an exceptional serine protease, tissue-type plasminogen activator (tPA). Rev Neurol (Paris) 2015; 172:186-97. [PMID: 26626577 DOI: 10.1016/j.neurol.2015.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/08/2015] [Accepted: 10/04/2015] [Indexed: 12/17/2022]
Abstract
The only acute treatment of ischemic stroke approved by the health authorities is tissue recombinant plasminogen activator (tPA)-induced thrombolysis. Under physiological conditions, tPA, belonging to the serine protease family, is secreted by endothelial and brain cells (neurons, astrocytes, microglia, oligodendrocytes). Although revascularisation induced by tPA is beneficial during a stroke, research over the past 20 years shows that tPA can also be deleterious for the brain parenchyma. Thus, in this review of the literature, after a brief history on the discovery of tPA, we reviewed current knowledge of mechanisms by which tPA can influence brain function in physiological and pathological conditions.
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Affiliation(s)
- M Hébert
- Inserm, UMR-S U919 serine proteases and pathophysiology of the neurovascular unit, 14000 Caen, France
| | - F Lesept
- Inserm, UMR-S U919 serine proteases and pathophysiology of the neurovascular unit, 14000 Caen, France
| | - D Vivien
- Inserm, UMR-S U919 serine proteases and pathophysiology of the neurovascular unit, 14000 Caen, France
| | - R Macrez
- Inserm, UMR-S U919 serine proteases and pathophysiology of the neurovascular unit, 14000 Caen, France.
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19
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Moulton E, Amor-Sahli M, Perlbarg V, Pires C, Crozier S, Galanaud D, Valabregue R, Yger M, Baronnet-Chauvet F, Samson Y, Dormont D, Rosso C. Axial Diffusivity of the Corona Radiata at 24 Hours Post-Stroke: A New Biomarker for Motor and Global Outcome. PLoS One 2015; 10:e0142910. [PMID: 26562509 PMCID: PMC4642950 DOI: 10.1371/journal.pone.0142910] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 10/27/2015] [Indexed: 12/05/2022] Open
Abstract
Fractional anisotropy (FA) is an effective marker of motor outcome at the chronic stage of stroke yet proves to be less efficient at early time points. This study aims to determine which diffusion metric in which location is the best marker of long-term stroke outcome after thrombolysis with diffusion tensor imaging (DTI) at 24 hours post-stroke. Twenty-eight thrombolyzed patients underwent DTI at 24 hours post-stroke onset. Ipsilesional and contralesional FA, mean (MD), axial (AD), and radial (RD) diffusivities values were calculated in different Regions-of-Interest (ROIs): (1) the white matter underlying the precentral gyrus (M1), (2) the corona radiata (CoRad), (3) the posterior limb of the internal capsule (PLIC) and (4) the cerebral peduncles (CP). NIHSS scores were acquired at admission, day 1, and day 7; modified Rankin Scores (mRS) at 3 months. Significant decreases were found in FA, MD, and AD of the ipsilesional CoRad and M1. MD and AD were also significantly lower in the PLIC. The ratio of ipsi and contralesional AD of the CoRad (CoRad-rAD) was the strongest diffusion parameter correlated with motor NIHSS scores on day 7 and with the mRS at 3 months. A Receiver-Operator Curve analysis yielded a model for the CoRad-rAD to predict good outcome based on upper limb NIHSS motor scores and mRS with high specificity and sensitivity. FA values were not correlated with clinical outcome. In conclusion, axial diffusivity of the CoRad from clinical DTI at 24 hours post-stroke is the most appropriate diffusion metric for quantifying stroke damage to predict outcome, suggesting the importance of early axonal damage.
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Affiliation(s)
- Eric Moulton
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
- UPMC Paris 6, Inserm, U1127, CNRS, UMR 7225, Paris, France
- CONAM, UPMC Paris 6, Inserm, U1127, CNRS, UMR 7225, Paris, France
| | - Mélika Amor-Sahli
- AP-HP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Vincent Perlbarg
- INSERM U1146, CNRS UMR7371, laboratoire d’imagerie biomédicale, Sorbonne université, UPMC université, Paris 60 UMCR2, Hôpital de la Pitié-Salpêtrière, Paris, France
- IHU-A-ICM, Bioinformatics/Biostatistics Plateform, Paris, France
| | - Christine Pires
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sophie Crozier
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Damien Galanaud
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
- UPMC Paris 6, Inserm, U1127, CNRS, UMR 7225, Paris, France
- AP-HP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- COGIMAGE, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Romain Valabregue
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
- UPMC Paris 6, Inserm, U1127, CNRS, UMR 7225, Paris, France
- COGIMAGE, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
- Centre de Neuro-Imagerie de Recherche, http://cenir.org, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marion Yger
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Yves Samson
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
- UPMC Paris 6, Inserm, U1127, CNRS, UMR 7225, Paris, France
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
- COGIMAGE, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Didier Dormont
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
- UPMC Paris 6, Inserm, U1127, CNRS, UMR 7225, Paris, France
- AP-HP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- COGIMAGE, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Charlotte Rosso
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
- UPMC Paris 6, Inserm, U1127, CNRS, UMR 7225, Paris, France
- CONAM, UPMC Paris 6, Inserm, U1127, CNRS, UMR 7225, Paris, France
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
- * E-mail:
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20
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Mundiyanapurath S, Möhlenbruch M, Ringleb PA, Bösel J, Wick W, Bendszus M, Radbruch A. Posterior Circulation Acute Stroke Prognosis Early Computed Tomography Score Using Hypointense Vessels on Susceptibility Weighted Imaging Independently Predicts Outcome in Patients with Basilar Artery Occlusion. PLoS One 2015; 10:e0132587. [PMID: 26176682 PMCID: PMC4503629 DOI: 10.1371/journal.pone.0132587] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/16/2015] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Appearance of hypointense vessels on susceptibility weighted imaging (SWI) has been reported to correlate with outcome in patients with ischemia of the anterior circulation. This study investigates the correlation between the appearance of hypointense vessels on SWI after recanalization therapy and outcome in patients with basilar artery occlusion. METHODS Patients with basilar artery occlusion who were treated with endovascular recanalization or intravenous alteplase and received an MRI including SWI after therapy were retrieved from the hospital database for retrospective analysis. Posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pcASPECTS) was calculated based on regions displaying hypointense vessels on SWI and compared to lesions on diffusion weighted imaging (DWI). Subsequently, SWI based pcASPECTS was correlated with outcome determined with modified Rankin Scale (mRS), categorized as favorable outcome (mRS 0-2) or unfavorable outcome (3-6). RESULTS Twenty-two MRI of patients with basilar artery occlusion were analyzed. In seven out of eight areas of the pcASPECTS hypointense vessels on SWI were significantly correlated to areas of restricted diffusion on DWI. In univariate analysis median pcASPECTS on SWI was significantly higher in patients with favorable outcome (7.5 vs. 5, p=0.02). In a multivariate analysis pcASPECTS on SWI was an independent predictor of favorable outcome (OR 2.02; CI [1.02;3,99]; p=0.04). CONCLUSION pcASPECTS based on hypointense vessels on SWI after therapy predicts outcome in patients with basilar artery occlusion and might potentially be used as an additional imaging biomarker in the management of patients with stroke in the posterior circulation. This needs to be confirmed in larger prospective clinical trials.
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Affiliation(s)
- S. Mundiyanapurath
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - M. Möhlenbruch
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - P. A. Ringleb
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - J. Bösel
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - W. Wick
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - M. Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - A. Radbruch
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
- German Cancer Research Center, Department of Radiology, Heidelberg, Germany
- * E-mail:
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21
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Abstract
PURPOSE OF REVIEW The axon plays a central role in both the injury and repair phases after stroke. This review highlights emerging principles in the study of axonal injury in stroke and the role of the axon in neural repair after stroke. RECENT FINDINGS Ischemic stroke produces a rapid and significant loss of axons in the acute phase. This early loss of axons results from a primary ischemic injury that triggers a wave of calcium signaling, activating proteolytic mechanisms and downstream signaling cascades. A second progressive phase of axonal injury occurs during the subacute period and damages axons that survive the initial ischemic insult but go on to experience a delayed axonal degeneration driven in part by changes in axoglial contact and axonal energy metabolism. Recovery from stroke is dependent on axonal sprouting and reconnection that occurs during a third degenerative/regenerative phase. Despite this central role played by the axon, comparatively little is understood about the molecular pathways that contribute to early and subacute axonal degeneration after stroke. Recent advances in axonal neurobiology and signaling suggest new targets that hold promise as potential molecular therapeutics including axonal calcium signaling, axoglial energy metabolism and cell adhesion as well as retrograde axonal mitogen-activated protein kinase pathways. These novel pathways must be modeled appropriately as the type and severity of axonal injury vary by stroke subtype. SUMMARY Stroke-induced injury to axons occurs in three distinct phases each with a unique molecular underpinning. A wealth of new data about the molecular organization and molecular signaling within axons is available but not yet robustly applied to the study of axonal injury after stroke. Identifying the spatiotemporal patterning of molecular pathways within the axon that contribute to injury and repair may offer new therapeutic strategies for the treatment of stroke.
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22
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Abstract
Background and Purpose—
Here, we assessed how sustained is reversal of the acute diffusion lesion (RAD) observed 24 hours after intravenous thrombolysis, and the relationships between RAD fate and early neurological improvement.
Methods—
We analyzed 155 consecutive patients thrombolyzed intravenously 152 minutes (median) after stroke onset and who underwent 3 MR sessions: 1 before and 2 after treatment (median times from onset, 25.6 and 54.3 hours, respectively). Using voxel-based analysis of diffusion-weighted imaging (DWI)
1
, DWI
2
, and DWI
3
lesions on coregistered image data sets, we assessed the outcome of RAD voxels (hyperintense on DWI
1
but not on DWI
2
) as transient or sustained on DWI
3
, and their relationships with early neurological improvement, defined as ΔNational Institutes of Health Stroke Scale ≥8 or National Institutes of Health Stroke Scale ≤1 at 24 hours.
T
max
and apparent diffusion coefficient values were compared between sustained and transient RAD voxels.
Results—
The median (interquartile range) baseline National Institutes of Health Stroke Scale and DWI
1
lesion volume were 11 (7–18) mL and 15.6 (6.0–50.9) mL, respectively. The median (interquartile range) RAD volume on DWI
2
was 2.8 (1.1–6.6) mL, of which 70% was sustained on DWI
3
. Sixteen (10.3%) patients had sustained RAD ≥10 mL. As compared with transient RAD voxels, sustained RAD voxels had nonsignificantly higher baseline apparent diffusion coefficient values (median [interquartile range], 793 [717–887] versus 777 [705–869]×10
−6
mm
2
·s
−1
, respectively;
P
=0.08) and significantly better perfusion (
T
max
, mean±SD, 6.3±3.2 versus 7.8±4.0 s;
P
<0.001). At variance with transient RAD, the volume of sustained RAD was associated with early neurological improvement in multivariate analysis (odds ratio, 1.08; 95% confidence interval, [1.01–1.17], per 1-mL increase;
P
=0.03).
Conclusions—
After thrombolysis, over two-thirds of the DWI lesion reversal captured on 24-hour follow-up MR is sustained. Sustained DWI lesion reversal volume is a strong imaging correlate of early neurological improvement.
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