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Tokunaga K, Tokunaga S, Hara K, Yasaka M, Okada Y, Kitazono T, Tsumoto T. Fluid-attenuated inversion recovery vascular hyperintensity-diffusion-weighted imaging mismatch and functional outcome after endovascular reperfusion therapy for acute ischemic stroke. Interv Neuroradiol 2024; 30:189-194. [PMID: 35903941 PMCID: PMC11095359 DOI: 10.1177/15910199221113900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Fluid-attenuated inversion recovery vascular hyperintensity (FVH) outside of the diffusion-weighted imaging (DWI) lesion, termed FVH-DWI mismatch, may represent penumbral tissue with good collateral status. METHODS Consecutive patients who underwent endovascular reperfusion therapy (EVT) for acute internal carotid artery (ICA) or middle cerebral artery (MCA)-M1 occlusion were enrolled. FVH-DWI mismatch score was defined as the number of cortical Alberta Stroke Program Early CT Score areas (I and M1 to M6) that involved FVH but no DWI lesion (0 to 7 points). The outcome measure was set as good functional outcome, defined as a modified Rankin Scale score of 0 to 2, at 90 days after onset. RESULTS Of 196 consecutive patients who underwent EVT for acute ICA or MCA-M1 occlusion, 32 without brain MRI before EVT were excluded, and the remaining 164 were analyzed. The median FVH-DWI mismatch score was 2 (interquartile range, 0 to 4). At 90 days after EVT, 2 patients were lost-to follow-up, and 73 had good functional outcome. The frequency of good functional outcome at 90 days after EVT increased significantly with increasing FVH-DWI mismatch score (P for trend <0.001). FVH-DWI mismatch score was independently associated with good functional outcome at 90 days after onset (adjusted odds ratio per 1 point,1.46; 95% confidence interval, 1.15-1.89). CONCLUSIONS Patients with large FVH-DWI mismatch had good functional outcome after EVT for acute ICA or MCA-M1 occlusion.
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Affiliation(s)
- Keisuke Tokunaga
- Department of Neuroendovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - So Tokunaga
- Department of Neuroendovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kenta Hara
- Department of Neuroendovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyuki Tsumoto
- Department of Neuroendovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Lv B, Ran Y, Lv J, Lou X, Tian C. Individualized interpretation for the clinical significance of fluid-attenuated inversion recovery vessel hyperintensity in ischemic stroke and transient ischemic attack: A systematic narrative review. Eur J Radiol 2023; 166:111010. [PMID: 37523872 DOI: 10.1016/j.ejrad.2023.111010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/09/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023]
Abstract
Fluid-attenuated inversion recovery (FLAIR) vessel hyperintensity(FVH)refers to the hyperintensity corresponding to the arteries in the subarachnoid space. It is caused by critically slowed blood flow and is commonly encountered in patients with large artery steno-occlusions. Quite a few studies have focused on the clinical significance of FLAIR vessel hyperintensity in terms of its relationship to the prognosis of transient ischemic attack (TIA), baseline severity or infarction volume, early neurological deterioration or infarction growth, and functional outcomes in acute ischemic stroke (AIS). However, inconsistent or conflicting findings were common in these studies and caused confusion in the clinical decision-making process guided by this imaging marker. Through reviewing the available studies on the etiologic mechanism of FVH and investigating findings on its clinical significance in AIS and TIA, this review aims to elucidate the key factors for interpreting the clinical significance of FVH individually.
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Affiliation(s)
- Bin Lv
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing 100853, China
| | - Ye Ran
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing 100853, China
| | - Jinhao Lv
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing 100853, China
| | - Xin Lou
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing 100853, China.
| | - Chenglin Tian
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing 100853, China.
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Bani-Sadr A, Escande R, Mechtouff L, Pavie D, Hermier M, Derex L, Choc TH, Eker OF, Nighoghossian N, Berthezène Y. Vascular hyperintensities on baseline FLAIR images are associated with functional outcome in stroke patients with successful recanalization after mechanical thrombectomy. Diagn Interv Imaging 2023; 104:337-342. [PMID: 37355301 DOI: 10.1016/j.diii.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The purpose of this study was to assess the prognostic value of vascular hyperintensities on FLAIR images (VHF) at admission MRI in patients with acute ischemic stroke (AIS) achieving successful recanalization after mechanical thrombectomy. MATERIALS AND METHODS Patients with AIS treated by mechanical thrombectomy following admission MRI from the single-center HIBISCUS-STROKE cohort were assessed for eligibility. VHF were categorized using a four-scale classification and were considered poor when grade < 3 (i.e., absence of distal VHF). Recanalization was considered successful when modified thrombolysis in cerebral infarction score was ≥ 2B Functional outcome was considered poor if modified Rankin scale (mRS) at three months was > 2. Univariable and multiple variable logistic regressions were performed to identify factors associated with poor functional outcome despite successful recanalization. RESULTS A total of 108 patients were included. There were 65 men and 43 women with a median age of 70.5 years (interquartile range: 55.0, 81.0; age range: 22.0-93.0 years). Among them, 39 subjects (36.1%) had poor functional outcome at three months. Univariable logistic regressions indicated that poorly extended VHF (VHF grade < 3) were associated with a poor functional outcome (P = 0.008) as well as age, hypertension and diabetes, baseline National Institute of Health Stroke Scale (NIHSS) score, pre-stroke mRS, lack of intravenous thrombolysis, cerebral microangiopathy and the presence of microbleeds. Multivariable analysis confirmed that poor VHF status was independently associated with a poor functional outcome (odds ratio [OR], 4.26; 95% confidence interval [CI]: 1.55-12.99; P = 0.007) in combination with hypertension (OR, 1.25; 95% CI: 0.87-1.85; P = 0.02), baseline NIHSS score (OR, 1.09; 95% CI: 1.04-1.20; P = 0.03), pre-stroke mRS (OR, 2.05; 95% CI: 1.07-4.61; P = 0.05) and lack of intravenous thrombolysis (OR, 0.23; 95% CI: 0.08-0.61; P = 0.004). CONCLUSION Poorly extended VHF (grade <3) at admission MRI are associated with a poor functional outcome at three months despite successful recanalization by mechanical thrombectomy.
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Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France.
| | - Raphaël Escande
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Laura Mechtouff
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Dylan Pavie
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Laurent Derex
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; Research on Healthcare Performance (RESHAPE), INSERM U 1290, Claude Bernard Lyon I University, 69373, Lyon Cedex 08, France
| | - Tae-Hee Choc
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Omer F Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France
| | - Norbert Nighoghossian
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Yves Berthezène
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France
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Abousrafa SE, Mair G. MRI for collateral assessment pre-thrombectomy and association with outcome: a systematic review and meta-analysis. Neuroradiology 2023; 65:1001-1014. [PMID: 36847834 PMCID: PMC10169893 DOI: 10.1007/s00234-023-03127-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Various neuroimaging methods exist to assess the collateral circulation in stroke patients but much of the evidence is based on computed tomography. Our aim was to review the evidence for using magnetic resonance imaging for collateral status evaluation pre-thrombectomy and assess the impact of these methods on functional independence. METHODS We systematically reviewed EMBASE and MEDLINE for studies that evaluated baseline collaterals using MRI pre-thrombectomy and conducted a meta-analysis to express the relationship between good collaterals (defined variably as the presence [good] vs absence [poor] or quality [ordinal scores binarized as good-moderate vs poor] of collaterals) and functional independence (modified Rankin score mRS≤2) at 90 days. Outcome data were presented as relative risk (RR, 95% confidence interval, 95%CI). We assessed for study heterogeneity, publication bias, and conducted subgroup analyses of different MRI methods and affected arterial territories. RESULTS From 497 studies identified, we included 24 (1957 patients) for the qualitative synthesis, and 6 (479 patients) for the metanalysis. Good pre-thrombectomy collaterals were significantly associated with favorable outcome at 90 days (RR=1.91, 95%CI=1.36-2.68], p= 0.0002) with no difference between MRI methods and affected arterial territory subgroups. There was no evidence of statistical heterogeneity (I2=25%) among studies but there was evidence of publication bias. CONCLUSION In stroke patients treated with thrombectomy, good pre-treatment collaterals assessed using MRI are associated with double the rate of functional independence. However, we found evidence that relevant MR methods are heterogenous and under-reported. Greater standardization and clinical validation of MRI for collateral evaluation pre-thrombectomy are required.
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Affiliation(s)
| | - Grant Mair
- Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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Lyu J, Hu J, Wang X, Bian X, Wei M, Wang L, Duan Q, Lan Y, Zhang D, Wang X, Zhang T, Tian C, Lou X. Association of fluid-attenuated inversion recovery vascular hyperintensity with ischaemic events in internal carotid artery or middle cerebral artery occlusion. Stroke Vasc Neurol 2023; 8:69-76. [PMID: 36219570 PMCID: PMC9985801 DOI: 10.1136/svn-2022-001589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/18/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE Individuals with intracranial artery occlusion have high rates of ischaemic events and recurrence. It has been challenging to identify patients who had high-risk stroke using a simple, valid and non-invasive screening approach. This study aimed to investigate whether fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH), a specific imaging sign on the FLAIR sequence, could be a predictor of ischaemic events in a population with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion. METHODS We retrospectively analysed 147 patients (mean 60.43±12.83 years) with 149 lesions, including 37 asymptomatic and 112 symptomatic cases of ICA or MCA occlusion. Symptomatic occlusion was considered if ischaemic events were present in the relevant territory within 90 days. FVH Alberta Stroke Program Early Computed Tomography Score (FVH-ASPECTS: 0-7, with 0 indicating absence of FVH and 7 suggesting prominent FVH) and collateral circulation grade were assessed for each participant. Multivariable logistic regression analysis was performed to detect independent markers associated with symptomatic status. RESULTS A lower FVH-ASPECTS was associated with a more favourable collateral circulation grade (rho=-0.464, p<0.0001). The FVH-ASPECTS was significantly lower in the asymptomatic occlusion group than in the symptomatic occlusion group (p<0.0001). FVH-ASPECTS (Odd ratio, 2.973; 95% confidence interval, 1.849 to 4.781; p<0.0001) was independently associated with symptomatic status after adjustment for age, sex, lesion location and collateral circulation grade in the multivariate logistic regression. The area under the curve was 0.861 for the use of FVH-ASPECTS to identify symptomatic occlusion. CONCLUSIONS The ability to discriminate symptomatic from asymptomatic occlusion suggests that FVH may be a predictor of stroke. As a simple imaging sign, FVH may serve as a surrogate for haemodynamic impairments and can be used to identify high-risk stroke cases early in ICA or MCA occlusion.
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Affiliation(s)
- Jinhao Lyu
- Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Jianxing Hu
- Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xinrui Wang
- Radiology, Chinese PLA General Hospital, Beijing, China
| | | | - Mengting Wei
- Radiology, Chinese PLA General Hospital, Beijing, China
| | - Liuxian Wang
- Radiology, Chinese PLA General Hospital, Beijing, China
| | - Qi Duan
- Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Yina Lan
- Radiology, Chinese PLA General Hospital, Beijing, China
| | - Dekang Zhang
- Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xueyang Wang
- Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Tingyang Zhang
- Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Chenglin Tian
- Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xin Lou
- Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
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Legrand L, Le Berre A, Seners P, Benzakoun J, Ben Hassen W, Lion S, Boulouis G, Cottier JP, Costalat V, Bracard S, Berthezene Y, Ozsancak C, Provost C, Naggara O, Baron JC, Turc G, Oppenheim C. FLAIR Vascular Hyperintensities as a Surrogate of Collaterals in Acute Stroke: DWI Matters. AJNR Am J Neuroradiol 2023; 44:26-32. [PMID: 36521962 PMCID: PMC9835925 DOI: 10.3174/ajnr.a7733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE FLAIR vascular hyperintensities are thought to represent leptomeningeal collaterals in acute ischemic stroke. However, whether all-FLAIR vascular hyperintensities or FLAIR vascular hyperintensities-DWI mismatch, ie, FLAIR vascular hyperintensities beyond the DWI lesion, best reflects collaterals remains debated. We aimed to compare the value of FLAIR vascular hyperintensities-DWI mismatch versus all-FLAIR vascular hyperintensities for collateral assessment using PWI-derived collateral flow maps as a reference. MATERIALS AND METHODS We retrospectively reviewed the registries of 6 large stroke centers and included all patients with acute stroke with anterior circulation large-vessel occlusion who underwent MR imaging with PWI before thrombectomy. Collateral status was graded from 1 to 4 on PWI-derived collateral flow maps and dichotomized into good (grades 3-4) and poor (grades 1-2). The extent of all-FLAIR vascular hyperintensities and FLAIR vascular hyperintensities-DWI mismatch was assessed on the 7 cortical ASPECTS regions, ranging from 0 (absence) to 7 (extensive), and associations with good collaterals were compared using receiver operating characteristic curves. RESULTS Of the 209 included patients, 133 (64%) and 76 (36%) had good and poor collaterals, respectively. All-FLAIR vascular hyperintensity extent was similar between collateral groups (P = .76). Conversely, FLAIR vascular hyperintensities-DWI mismatch extent was significantly higher in patients with good compared with poor collaterals (P < .001). The area under the curve was 0.80 (95% CI, 0.74-0.87) for FLAIR vascular hyperintensities-DWI mismatch and 0.52 (95% CI, 0.44-0.60) for all-FLAIR vascular hyperintensities (P < .001 for the comparison), to predict good collaterals. Variables independently associated with good collaterals were smaller DWI lesion volume (P < .001) and larger FLAIR vascular hyperintensities-DWI mismatch (P = .02). CONCLUSIONS In acute ischemic stroke with large-vessel occlusion, the extent of FLAIR vascular hyperintensities does not reliably reflect collateral status unless one accounts for DWI.
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Affiliation(s)
- L Legrand
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - A Le Berre
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - P Seners
- Department of Neurology (P.S.), Hôpital Fondation Rothschild, Paris, France
| | - J Benzakoun
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - W Ben Hassen
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - S Lion
- Edmus Services (S.L.), Fondation Edmus, Lyon, France
| | - G Boulouis
- Department of Diagnostic and Interventional Neuroradiology (G.B., J-.P.C.), Bretonneau Hospital, University of Tours, Institut National de la Santé et de la Recherche Médicale 1253 iBrain, Tours, France
| | - J-P Cottier
- Department of Diagnostic and Interventional Neuroradiology (G.B., J-.P.C.), Bretonneau Hospital, University of Tours, Institut National de la Santé et de la Recherche Médicale 1253 iBrain, Tours, France
| | - V Costalat
- Department of Interventional Neuroradiology (V.C.), Centre Hospitalier Regional Universitaire Gui de Chauliac, Montpellier, France
| | - S Bracard
- Department of Diagnostic and Interventional Neuroradiology (S.B.), University Hospital of Nancy, Institut National de la Santé et de la Recherche Médicale U947, Nancy, France
| | - Y Berthezene
- Department of Neuroradiology (Y.B.), Hospices Civils de Lyon, Lyon, France
| | - C Ozsancak
- Department of Neurology (C. Ozsancak), Orleans Hospital, Orleans, France
| | - C Provost
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - O Naggara
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - J-C Baron
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Neurology (J.-C.B., G.T.), Groupe Hospitalier Universitaire-Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - G Turc
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Neurology (J.-C.B., G.T.), Groupe Hospitalier Universitaire-Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - C Oppenheim
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
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Derraz I, Ahmed R, Mourand I, Dargazanli C, Cagnazzo F, Gaillard N, Gascou G, Riquelme C, Lefevre PH, Bonafe A, Arquizan C, Costalat V. FLAIR vascular hyperintensities predict functional outcome after endovascular thrombectomy in patients with large ischemic cores. Eur Radiol 2022; 32:6136-6144. [PMID: 35394187 DOI: 10.1007/s00330-022-08683-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/03/2022] [Accepted: 02/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To establish whether collateral circulation was associated with functional outcome in stroke patients with large infarct size (Alberta Stroke Program Early CT Score [ASPECTS] ≤ 5) undergoing endovascular thrombectomy (EVT) METHODS: Consecutive patients with acute ischemic stroke due to large-vessel occlusion in the anterior circulation and an ASPECTS of ≤ 5 were analyzed. Quantification of collateral circulation was performed using a fluid-attenuated inversion recovery vascular hyperintensity (FVH)-ASPECTS rating system (score ranging from 0 [no FVH] to 7 [FVHs abutting all ASPECTS cortical areas]) by two independent neuroradiologists. Good functional outcome was defined by modified Rankin Scale (mRS) score of 0 to 3 at 3 months. We determined the association between FVH score and clinical outcome using multivariable regression analyses. RESULTS A total of 139 patients (age, 63.1 ± 20.8 years; men, 51.8%) admitted between March 2012 and December 2017 were included. Good functional outcome (mRS 0-3) was observed in 65 (46.8%) patients, functional independence (mRS 0-2) was achieved in 43 (30.9%) patients, and 33 (23.7%) patients died at 90 days. The median FVH score was 4 (IQR, 3-5). FVH score was independently correlated with good outcome (adjusted OR = 1.41 [95% CI, 1.03-1.92]; p = 0.03 per 1-point increase). CONCLUSIONS In stroke patients with large-volume infarcts, good collaterals as measured by the FVH-ASPECTS rating system are associated with improved outcomes and may help select patients for reperfusion therapy. KEY POINTS • Endovascular thrombectomy can allow almost 1 in 2 patients with large infarct cores to achieve good functional outcome (modified Rankin Scale [mRS] of 0-3) and 1 in 3 patients to regain functional independence (mRS 0-2) at 3 months. • The extent of FVH score (as reflected by FLAIR vascular hyperintensity [FVH]-Alberta Stroke Program Early CT Score [ASPECTS] values) is associated with functional outcome at 3 months in this patient group.
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Affiliation(s)
- Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France.
| | - Raed Ahmed
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Isabelle Mourand
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Nicolas Gaillard
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Alain Bonafe
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
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8
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Lyu JH, Zhang SH, Wang XY, Meng ZH, Wu XY, Chen W, Wang GH, Niu QL, Li X, Bian YT, Han D, Guo WT, Yang S, Wei MT, Zhang TY, Duan Q, Duan CH, Bian XB, Tian CL, Lou X. FLAIR vessel hyperintensities predict functional outcomes in patients with acute ischemic stroke treated with medical therapy. Eur Radiol 2022; 32:5436-5445. [DOI: 10.1007/s00330-022-08661-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 12/13/2022]
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9
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Zhu L, Jiang F, Wang M, Zhai Q, Zhang Q, Wang F, Mao X, Chen N, Zhou J, Xi G, Shi Y. Fluid-Attenuated Inversion Recovery Vascular Hyperintensity as a Potential Predictor for the Prognosis of Acute Stroke Patients After Intravenous Thrombolysis. Front Neurosci 2022; 15:808436. [PMID: 35145376 PMCID: PMC8823327 DOI: 10.3389/fnins.2021.808436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/08/2021] [Indexed: 12/15/2022] Open
Abstract
BackgroundFluid-attenuated inversion recovery vascular hyperintensity (FVH) can reflect the collateral status, which may be a valuable indicator to predict the functional outcome of acute stroke (AS) patients.MethodsA total of 190 AS patients with large vessel occlusion (LVO) were retrospectively investigated. All patients completed a 6-month follow-up and their modified Rankin Scale (mRS) scores were recorded at 1, 3, and 6 months after intravenous thrombolysis (IVT). Based on their mRS at 3 months, patients were divided into two groups: poor prognosis (131 patients; 68.9% of all subjects) and favorable prognosis (59 patients; 31.1% of all subjects). The death records of 28 patients were also analyzed in the poor prognosis group.Results(1) Univariate and multivariate analyses showed that the higher National Institutes of Health Stroke Scale (NIHSS) score at admission, higher fasting blood glucose, and lower FVH score were independent risk factors to predict the poor prognosis of IVT. (2) Survival analysis indicated that FVH score was the only baseline factor to predict the 6-month survival after IVT. (3) Baseline FVH score had great prediction performance for the prognosis of IVT (area under the curve = 0.853). (4) Baseline FVH score were negatively correlated with the NIHSS score at discharge and mRS score at 1, 3, and 6 months.ConclusionAmong various baseline clinical factors, only the FVH score might have implications for 3-month outcome and 6-month survival of AS patients after IVT. Baseline FVH score showed great potential to predict the prognosis of the AS patients.
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Affiliation(s)
- Lin Zhu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fuping Jiang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Meng Wang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qian Zhai
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qing Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Wang
- Department of Neurology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
| | - Xuqiang Mao
- Department of Neurology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
| | - Nihong Chen
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Guangjun Xi
- Department of Neurology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
- *Correspondence: Guangjun Xi,
| | - Yachen Shi
- Department of Neurology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
- Yachen Shi,
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10
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Chen NH, Zhang YM, Jiang FP, Liu S, Zhao HD, Hou JK, Jiang T, Shi JQ, Zhou JS, Zhang YD. FLAIR vascular hyperintensity predicts early neurological deterioration in patients with acute ischemic stroke receiving endovascular thrombectomy. Neurol Sci 2022; 43:3747-3757. [PMID: 35064345 DOI: 10.1007/s10072-021-05853-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/26/2021] [Indexed: 02/06/2023]
Abstract
Fluid-attenuated inversion recovery vascular hyperintensity (FVH) is frequently observed in patients with acute ischemic stroke (AIS). FVH is associated with functional outcome at 3 months in AIS patients receiving endovascular thrombectomy. In the present study, we assessed whether FVH predicted early neurological deterioration (END) and hemorrhagic transformation (HT) within 72 h in AIS patients receiving endovascular thrombectomy. We retrospectively analyzed 104 patients with acute internal-carotid-artery or proximal middle-cerebral-artery occlusion within 16 h after symptom onset. Before thrombectomy, all patients underwent brain magnetic resonance imaging. END was defined as an increase of 4 points or more from baseline National Institutes of Health Stroke Scale (NIHSS) during 72 h following onset. HT was assessed by brain computed tomography. Statistical analyses were performed to predict END and HT. The proportion of high FVH score, high American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grade in non-END group was higher than that in END group (p < 0.001, p < 0.001, respectively). FVH score was positively correlated with ASITN/SIR grade (r = 0.461, p < 0.001). FVH score was a predictor factor for END (adjusted OR, 13.552; 95% CI, 2.408-76.260; p = 0.003), while FVH score was not a predictor factor for HT. Furthermore, NIHSS at admission (adjusted OR, 1.112; 95% CI, 1.006-1.228; p = 0.038) and high-density lipoprotein cholesterol (adjusted OR, 18.865; 95% CI, 2.998-118.683; p = 0.002) were predictor factors for HT. To assess FVH score before thrombectomy might be useful for predicting END in AIS patients receiving endovascular thrombectomy.
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Affiliation(s)
- Ni-Hong Chen
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China
| | - Yi-Ming Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China
| | - Fu-Ping Jiang
- Department of Geriatrics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, 210006, People's Republic of China
| | - Shen Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China
| | - Hong-Dong Zhao
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China
| | - Jian-Kang Hou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China
| | - Teng Jiang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China
| | - Jian-Quan Shi
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China.
| | - Jun-Shan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China.
| | - Ying-Dong Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China.
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11
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Tian DS, Qin C, Zhou LQ, Yang S, Chen M, Xiao J, Shang K, Bosco DB, Wu LJ, Wang W. FSAP aggravated endothelial dysfunction and neurological deficits in acute ischemic stroke due to large vessel occlusion. Signal Transduct Target Ther 2022; 7:6. [PMID: 34992208 PMCID: PMC8738761 DOI: 10.1038/s41392-021-00802-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/09/2021] [Accepted: 10/19/2021] [Indexed: 11/09/2022] Open
Abstract
Revascularization and angiogenesis, as substrates of sustained collateral circulation, play a crucial role in determining the severity and clinical outcome of acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Developing an adjunct biomarker to help identify and monitor collateral status would aid stroke diagnosis and prognosis. To screen the potential biomarkers, proteomic analysis was performed in this study to identify those distinct plasma protein profiles in AIS due to LVO with different collateral status. Interestingly, we found that levels of Plasma Factor VII Activating Protease (FSAP) significantly increased in those AIS patients with poor collaterals, and were correlated with worse neurological outcome. Furtherly, both in vitro and in vivo models of ischemic stroke were used to explore pathological mechanisms of FSAP in endothelial dysfunction. We demonstrated that the FSAP inhibitor, high-molecular-weight hyaluronan (HMW-HA), enhanced the pro-angiogenic vascular factors, improved the integrity of brain blood barrier, and promoted newly formed cerebral microvessels in the ischemic penumbra, consequently improving neurological function. To elucidate the pathways that might contribute to revascularization during LVO, we applied transcriptomic analysis via unbiased RNA sequencing and showed that Wnt signaling was highly involved in FSAP mediated endothelial dysfunction. Notably, inhibition of Wnt5a largely reversed the protective effects from HMW-HA treatment, implying that FSAP might aggravate endothelial dysfunction and neurological deficits by regulating Wnt5a signaling. Therefore, FSAP may represent a potential biomarker for collateral status after LVO and a promising therapeutic target to be explored in the treatment of stroke.
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Affiliation(s)
- Dai-Shi Tian
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Chuan Qin
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Luo-Qi Zhou
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Sheng Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Man Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Jun Xiao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Ke Shang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Dale B Bosco
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Long-Jun Wu
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China.
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12
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Ryu WS, Yoon HS, Jeong SW, Kim DE. Hyperintense Vessel Sign in Large-Vessel Occlusion Stroke of Mild-to-Moderate Severity Ineligible for Recanalization. J Clin Neurol 2021; 17:516-523. [PMID: 34595859 PMCID: PMC8490907 DOI: 10.3988/jcn.2021.17.4.516] [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: 04/14/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose The impact of fluid-attenuated inversion recovery hyperintense vessels (FHVs) on outcomes in patients ineligible for recanalization therapy with large-vessel occlusion (LVO) is unclear. We investigated the impact of FHVs determined using the FHV–Alberta Stroke Program Early CT Score (ASPECTS) on clinical outcomes in patients with LVO stroke of mild-to-moderate severity ineligible for recanalization therapy. Methods Sixty-eight consecutive patients with M1-middle cerebral artery occlusion who underwent magnetic resonance imaging within 24 hours of symptom onset and were ineligible for recanalization were included. Patients were dichotomized into a severe-FHV group (FHV-ASPECTS ≤4; n=33) and a mild-FHV group (FHV-ASPECTS >4; n=35), and multiple logistic regression analysis was used to examine the relationships of FHV scores with early neurological deterioration (END) and an unfavorable 3-month outcome (modified Rankin Scale score ≥3). Results Mean age was 66.2±13.5 years (mean±SD), and 30 (44%) were female. The severe-FHV group had a larger infarct volume (median, 5.5 mL vs. 3 mL) and more frequently exhibited the susceptibility vessel sign (30% vs. 3%) than the mild-FHV group. Ipsilateral old nonlacunar infarct was more frequent in the mild-FHV group than in the severe-FHV group (37% vs. 15%). The severe-FHV group had a fivefold higher risk of END (odds ratio [OR] 5.02, 95% confidence interval [CI] 1.36–18.45) and unfavorable outcome (OR 5.97, 95% CI 1.18–33.31, p=0.03) compared with the mild-FHV group. Conclusions Greater FHV extent was associated with higher risk of END and unfavorable outcome in patients with LVO stroke of mild-to-moderate severity.
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Affiliation(s)
- Wi Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.
| | - Ho Sang Yoon
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sang Wuk Jeong
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Dong Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
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13
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Riou-Comte N, Gory B, Soudant M, Zhu F, Xie Y, Humbertjean L, Mione G, Oppenheim C, Guillemin F, Bracard S, Richard S. Clinical imaging factors of excellent outcome after thrombolysis in large-vessel stroke: a THRACE subgroup analysis. Stroke Vasc Neurol 2021; 6:631-639. [PMID: 34103393 PMCID: PMC8717776 DOI: 10.1136/svn-2020-000852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background For patients with stroke with large-vessel occlusion (LVO), study of factors predicting response to intravenous thrombolysis (IVT) would allow identifying subgroups with high expected gain, and those for whom it could be considered as futile, and even detrimental. From patients included in the Mechanical Thrombectomy After Intravenous Alteplase vs Alteplase Alone After Stroke trial, we investigated clinical-imaging factors associated with optimal response to IVT. Methods We included patients receiving IVT alone. Excellent outcome was defined by a 3-month modified Rankin Scale (mRS) score ≤1. Clinical-imaging predictors were assessed on multivariate analysis after multiple imputations. The predictive performance of the model was assessed with the C-statistic. Results Among 247 patients with LVO treated with IVT alone, 77 (31%) showed 3-month mRS ≤1. Predictors of 3-month mRS ≤1 were no medical history of hypertension (OR 2.43; 95% CI 1.74 to 3.38; p=0.007); no current smoking (OR 2.76; 95% CI 1.79 to 4.26; p=0.02); onset-to-IVT time (OR 0.47 per hour increase; 95% CI 0.23 to 0.78; p=0.003); diffusion-weighted imaging (DWI) volume (OR 0.78 per 10 mL increase; 95% CI 0.68 to 0.89; p=0.0004); presence of susceptibility vessel sign (SVS) (OR 7.89; 95% CI 1.65 to 37.78; p=0.01) and SVS length (OR 0.87 per mm increase; 95% CI 0.80 to 0.94; p=0.001). The prediction models showed a C-statistic=0.79 (95% CI 0.79 to 0.80). Conclusions In patients with stroke with anterior-circulation LVO treated with IVT alone, predictors of excellent outcome at 3 months were no medical history of hypertension or current smoking, reduced onset-to-IVT time, small DWI volume, presence of SVS and short SVS length. These predictive factors could help practitioners in decision-making for IVT implementation in reperfusion strategies, all the more for the drip and ship paradigm. Trial registration number NCT01062698.
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Affiliation(s)
- Nolwenn Riou-Comte
- Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Marc Soudant
- Clinical Investigation Centre-Clinical Epidemiology 1433, INSERM, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - François Zhu
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Yu Xie
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Lisa Humbertjean
- Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Gioia Mione
- Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Catherine Oppenheim
- Department of Neuroradiology, INSERM U894, Université Paris-Descartes, Sainte-Anne Hospital, Paris, France
| | - Francis Guillemin
- Clinical Investigation Centre-Clinical Epidemiology 1433, INSERM, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Serge Bracard
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Sébastien Richard
- Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
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14
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Jing L, Sui B, Shen M, Qin H, Ke D, Gao P. Comparison of three FLAIR vascular hyperintensities methodologies in patients with acute ischemic stroke. Acta Radiol 2021; 62:766-775. [PMID: 32660319 DOI: 10.1177/0284185120939271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple methods have been used to analyze fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs) which may represent collaterals in patients with acute ischemic stroke (AIS); however, there is no consensus between methods. PURPOSE To compare three frequently used FVH methods for predicting early infarct volume and clinical outcome in patients with AIS. MATERIAL AND METHODS Patients with AIS in middle cerebral artery territory were recruited. FVHs were evaluated using extensive FVHs, FVH-diffusion-weighted imaging (DWI) mismatch, and FVH-in/out-DWI. Infarct volume at baseline and day 7 were measured. Early neurological improvement (ENI) was assessed. Good outcomes were defined by modified Rankin Scale scores of 0-2 at 90 days. RESULTS Fifty-one patients were included. ENI was 55.6% in patients with extensive FVHs and 23.3% in those without (P = 0.024). Patients with extensive FVHs had smaller infarct volume growth at seven days than those without (P = 0.041). ENI was 48.3% in patients with FVH-DWI mismatch and 15.8% in those without (P = 0.021). Patients with FVH-DWI mismatch had smaller infarct volumes at seven days than those without (P = 0.038). Patients with FVH-out-DWI had smaller baseline infarct volumes, smaller seven-day volumes, and smaller infarct growth than those with FVH-in-DWI (P<0.001, P<0.001, and P = 0.031, respectively). In multivariate logistic regression analysis, the infarct growth at seven days negatively independently predicted ENI (OR = 0.737, 95% CI 0.593-0.915, P = 0.006). However, none of the FVH classifications could predict a good 90-day outcome. CONCLUSION Patients with extensive FVHs or FVH-DWI mismatch tend to have early favorable clinical outcome. FVH-out-DWI being associated with smaller infarct growth may also indicate early favorable clinical outcome.
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Affiliation(s)
- Lina Jing
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Binbin Sui
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Mi Shen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Haiqiang Qin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Dena Ke
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Peiyi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
- Beijing Neurosurgical Institute, Beijing, PR China
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15
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Derraz I, Ahmed R, Benali A, Corti L, Cagnazzo F, Dargazanli C, Gascou G, Riquelme C, Lefevre PH, Bonafe A, Arquizan C, Costalat V. FLAIR vascular hyperintensities and functional outcome in nonagenarians with anterior circulation large-vessel ischemic stroke treated with endovascular thrombectomy. Eur Radiol 2021; 31:7406-7416. [PMID: 33851277 DOI: 10.1007/s00330-021-07866-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To establish whether imaging assessments of irreversibly injured ischemic core and potentially salvageable penumbral volumes and collateral circulation were associated with functional outcome in nonagenarians (90 years or older) undergoing endovascular thrombectomy (EVT). METHODS Data from a prospectively maintained institutional registry of consecutive stroke patients treated with EVT from January 2012 to December 2018 were retrospectively analyzed. Functional outcome was evaluated with the modified Rankin scale (mRS) at 3 months. mRS score of 0-3 was defined as a good clinical outcome. Ischemic core and penumbral volumes were calculated using the RAPID software. Quantification of collateral circulation was performed using a fluid-attenuated inversion recovery vascular hyperintensity (FVH)-Alberta Stroke Program Early CT Score (ASPECTS) rating system. RESULTS Among 85 patients (age, 92.4 ± 2.6 years; men, 30.6%) treated with EVT, good outcome (mRS 0-3) was achieved in 29 (34.1%) patients and 31 (36.5%) patients died at 90 days. The median estimated ischemic core volume was 15 mL (IQR, 7-27 mL). The median mismatch volume was 83 mL (IQR, 43-120 mL). The median FVH score was 4 (IQR, 3-4). FVH score was independently associated with good functional outcome (adjusted OR = 1.96 [95% CI, 1.16-3.32]; p = 0.01 per 1-point increase) and mortality (adjusted OR = 0.54 [95% CI, 0.34-0.85]; p = 0.007 per 1-point increase). Ischemic core and mismatch volumes were associated with neither good outcome nor mortality. CONCLUSIONS In nonagenarians with anterior circulation large-vessel ischemic stroke, good collaterals as measured by the FVH-ASPECTS rating system are independently associated with improved outcomes and may help select patients for reperfusion therapy in this frail population. KEY POINTS • Endovascular thrombectomy can allow at least 1 in 3 patients older than 90 years of age to achieve good functional outcome (modified Rankin scale of 0-3) at 3 months. • Functional outcome at 3 months is associated with pre-stroke status (number and severity of patients' comorbidities). • A higher FVH score (as reflected by higher FLAIR vascular hyperintensity [FVH]-Alberta Stroke Program Early CT Score [ASPECTS] values) is independently associated with better 3-month functional outcome and mortality in nonagenarians with anterior circulation ischemic stroke.
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Affiliation(s)
- Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France.
| | - Raed Ahmed
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Amel Benali
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Lucas Corti
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Alain Bonafe
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
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16
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Wang E, Wu C, Yang D, Zhao X, Zhao J, Chang H, Yang Q. Association between fluid-attenuated inversion recovery vascular hyperintensity and outcome varies with different lesion patterns in patients with intravenous thrombolysis. Stroke Vasc Neurol 2021; 6:449-457. [PMID: 33593984 PMCID: PMC8485239 DOI: 10.1136/svn-2020-000641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/23/2020] [Accepted: 01/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background and purpose To evaluate relationship between fluid-attenuated inversion recovery vascular hyperintensity (FVH) after intravenous thrombolysis and outcomes in different lesion patterns on diffusion-weighted imaging (DWI). Methods Patients with severe internal carotid or intracranial artery stenosis who received intravenous thrombolysis from March 2012 to April 2019 were analysed. They were divided into four groups by DWI lesion patterns: border-zone infarct (BZ group), multiple lesions infarct (ML group), large territory infarct (LT group), and single cortical or subcortical lesion infarct (SL group). Logistic regression was performed to identify risk factors for outcome (unfavourable outcome, modified Rankin Scale (mRS) ≥2; poor outcome, mRS ≥3). Results Finally, 203 participants (63.3±10.2 years old; BZ group, n=72; ML group, n=64; LT group, n=37; SL group, n=30) from 1190 patient cohorts were analysed. After adjusting for confounding factors, FVH (+) was associated with unfavourable outcome in total group (OR 3.02; 95% CI 1.49 to 6.13; p=0.002), BZ group (OR 4.22; 95% CI 1.25 to 14.25; p=0.021) and ML group (OR 5.44; 95% CI 1.41 to 20.92; p=0.014) patients. FVH (+) was associated with poor outcome in total group (OR 2.25; 95% CI 1.01 to 4.97; p=0.046), BZ group (OR 5.52; 95% CI 0.98 to 31.07; p=0.053) and ML group (OR 4.09; 95% CI 1.04 to 16.16; p=0.045) patients, which was marginal significance. FVH (+) was not associated with unfavourable or poor outcome in LT and SL groups. Conclusion This study suggests that association between FVH and outcome varies with different lesion patterns on DWI. The presence of FVH after intravenous thrombolysis may help to identify patients who require close observations in the hospitalisation in patients with border-zone and multiple lesion infarcts.
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Affiliation(s)
- Erling Wang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dandan Yang
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Jie Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong Chang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China .,Key Laboratory of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing, China
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17
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Grosch AS, Kufner A, Boutitie F, Cheng B, Ebinger M, Endres M, Fiebach JB, Fiehler J, Königsberg A, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Siemonsen CZ, Thijs V, Wouters A, Gerloff C, Thomalla G, Galinovic I. Extent of FLAIR Hyperintense Vessels May Modify Treatment Effect of Thrombolysis: A Post hoc Analysis of the WAKE-UP Trial. Front Neurol 2021; 11:623881. [PMID: 33613422 PMCID: PMC7890254 DOI: 10.3389/fneur.2020.623881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background and Aims: Fluid-attenuated inversion recovery (FLAIR) hyperintense vessels (FHVs) on MRI are a radiological marker of vessel occlusion and indirect sign of collateral circulation. However, the clinical relevance is uncertain. We explored whether the extent of FHVs is associated with outcome and how FHVs modify treatment effect of thrombolysis in a subgroup of patients with confirmed unilateral vessel occlusion from the randomized controlled WAKE-UP trial. Methods: One hundred sixty-five patients were analyzed. Two blinded raters independently assessed the presence and extent of FHVs (defined as the number of slices with visible FHV multiplied by FLAIR slice thickness). Patients were then separated into two groups to distinguish between few and extensive FHVs (dichotomization at the median <30 or ≥30). Results: Here, 85% of all patients (n = 140) and 95% of middle cerebral artery (MCA) occlusion patients (n = 127) showed FHVs at baseline. Between MCA occlusion patients with few and extensive FHVs, no differences were identified in relative lesion growth (p = 0.971) and short-term [follow-up National Institutes of Health Stroke Scale (NIHSS) score; p = 0.342] or long-term functional recovery [modified Rankin Scale (mRS) <2 at 90 days poststroke; p = 0.607]. In linear regression analysis, baseline extent of FHV (defined as a continuous variable) was highly associated with volume of hypoperfused tissue (β = 2.161; 95% CI 0.96–3.36; p = 0.001). In multivariable regression analysis adjusted for treatment group, stroke severity, lesion volume, occlusion site, and recanalization, FHV did not modify functional recovery. However, in patients with few FHVs, the odds for good functional outcome (mRS) were increased in recombinant tissue plasminogen activator (rtPA) patients compared to those who received placebo [odds ratio (OR) = 5.3; 95% CI 1.2–24.0], whereas no apparent benefit was observed in patients with extensive FHVs (OR = 1.1; 95% CI 0.3–3.8), p-value for interaction was 0.11. Conclusion: While the extent of FHVs on baseline did not alter the evolution of stroke in terms of lesion progression or functional recovery, it may modify treatment effect and should therefore be considered relevant additional information in those patients who are eligible for intravenous thrombolysis. Clinical Trial Registration: Main trial (WAKE-UP): ClinicalTrials.gov, NCT01525290; and EudraCT, 2011-005906-32. Registered February 2, 2012.
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Affiliation(s)
- Anne Sophie Grosch
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Kufner
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Bastian Cheng
- Department of Neurology, Head and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ebinger
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Excellence Cluster NeuroCure, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Königsberg
- Department of Neurology, Head and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, Experimental Neurology, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium.,Laboratory of Neurobiology, Center for Brain & Disease Research, Flanders Institute for Biotechnology, Leuven, Belgium
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Claude Bernard University Lyon 1, CREATIS National Center for Scientific Research Mixed Unit of Research 5220-National Institute of Health and Medical Research U1206, National Institute of Applied Sciences of Lyon, Lyon Civil Hospices, Lyon, France
| | - Salvador Pedraza
- Department of Radiology, Girona Institute of Biomedical Research, Institute of Diagnostic Imaging, Dr. Josep Trueta Hospital, Girona, Spain
| | - Claus Z Siemonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Vincent Thijs
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia.,Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Anke Wouters
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, Experimental Neurology, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium.,Laboratory of Neurobiology, Center for Brain & Disease Research, Flanders Institute for Biotechnology, Leuven, Belgium
| | - Christian Gerloff
- Department of Neurology, Head and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, Head and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivana Galinovic
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
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18
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Interpretation of fluid-attenuated inversion recovery vascular hyperintensity in stroke. J Neuroradiol 2021; 49:258-266. [PMID: 33515596 DOI: 10.1016/j.neurad.2021.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 01/01/2023]
Abstract
Fluid-attenuation inversion recovery (FLAIR) vascular hyperintensity (FVH) is a common presentation on brain magnetic resonance images of patients with acute ischemic stroke. This sign is known as a sluggish collateral flow. Although FVH represents the large ischemic penumbra and collateral circulation, the clinical significance of FVH has not been established. Varying protocols for FLAIR, treatment differences, and heterogeneity of endpoints across studies have complicated the interpretation of FVH in patients with acute stroke. In this review article, we describe the mechanism of FVH, as well as its association with functional outcome, perfusion-weighted images, and large artery stenosis. In addition, we review the technological variables that affect FVH and discuss the future perspectives.
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19
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Derraz I, Pou M, Labreuche J, Legrand L, Soize S, Tisserand M, Rosso C, Piotin M, Boulouis G, Oppenheim C, Naggara O, Bracard S, Clarençon F, Lapergue B, Bourcier R. Clot Burden Score and Collateral Status and Their Impact on Functional Outcome in Acute Ischemic Stroke. AJNR Am J Neuroradiol 2021; 42:42-48. [PMID: 33184069 DOI: 10.3174/ajnr.a6865] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Collateral status and thrombus length have been independently associated with functional outcome in patients with acute ischemic stroke. It has been suggested that thrombus length would influence functional outcome via interaction with the collateral circulation. We investigated the individual and combined effects of thrombus length assessed by the clot burden score and collateral status assessed by a FLAIR vascular hyperintensity-ASPECTS rating system on functional outcome (mRS). MATERIALS AND METHODS Patients with anterior circulation acute ischemic stroke due to large-vessel occlusion from the ASTER and THRACE trials treated with endovascular thrombectomy were pooled. The clot burden score and FLAIR vascular hyperintensity score were determined on MR imaging obtained before endovascular thrombectomy. Favorable outcome was defined as an mRS score of 0-2 at 90 days. Association of the clot burden score and the FLAIR vascular hyperintensity score with favorable outcome (individual effect and interaction) was examined using logistic regression models. RESULTS Of the 326 patients treated by endovascular thrombectomy with both the clot burden score and FLAIR vascular hyperintensity assessment, favorable outcome was observed in 165 (51%). The rate of favorable outcome increased with clot burden score (smaller clots) and FLAIR vascular hyperintensity (better collaterals) values. The association between clot burden score and functional outcome was significantly modified by the FLAIR vascular hyperintensity score, and this association was stronger in patients with good collaterals, with an adjusted OR = 6.15 (95% CI, 1.03-36.81). CONCLUSIONS The association between the clot burden score and functional outcome varied for different collateral scores. The FLAIR vascular hyperintensity score might be a valuable prognostic factor, especially when contrast-based vascular imaging is not available.
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Affiliation(s)
- I Derraz
- From the Department of Neuroradiology (I.D.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - M Pou
- Department of Neuroradiology (M.P., F.C.)
| | - J Labreuche
- Santé publique: épidémiologie et qualité des soins (J.L.), University of Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - L Legrand
- Department of Neuroradiology (L.L., G.B., C.O., O.N.), Groupe Hospitalier Universitaire site Sainte-Anne, Institut de Psychiatrie et Neurosciences de Paris, National Institute for Health and Medical Research, Université de Paris, Paris, France
| | - S Soize
- Department of Neuroradiology (S.S.), Centre Hospitalier Universitaire Reims, Reims, France
| | | | - C Rosso
- Institut du Cerveau et de la Moelle épinière (C.R.), Sorbonne Université, Institut du Cerveau, National Institute for Health and Medical Research U 1127, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - M Piotin
- Department of Interventional Neuroradiology (M.P.), Rothschild Fondation, Paris, France
| | - G Boulouis
- Department of Neuroradiology (L.L., G.B., C.O., O.N.), Groupe Hospitalier Universitaire site Sainte-Anne, Institut de Psychiatrie et Neurosciences de Paris, National Institute for Health and Medical Research, Université de Paris, Paris, France
| | - C Oppenheim
- Department of Neuroradiology (L.L., G.B., C.O., O.N.), Groupe Hospitalier Universitaire site Sainte-Anne, Institut de Psychiatrie et Neurosciences de Paris, National Institute for Health and Medical Research, Université de Paris, Paris, France
| | - O Naggara
- Department of Neuroradiology (L.L., G.B., C.O., O.N.), Groupe Hospitalier Universitaire site Sainte-Anne, Institut de Psychiatrie et Neurosciences de Paris, National Institute for Health and Medical Research, Université de Paris, Paris, France
| | - S Bracard
- Department of Neuroradiology (S.B.), Regional and University Hospital Centre Nancy, Nancy, France
| | | | - B Lapergue
- Stroke Center (B.L.), Foch Hospital, Suresnes, France
| | - R Bourcier
- Department of Diagnostic and Interventional Neuroradiology (R.B.), Guillaume et René Laennec University Hospital, Nantes, France
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20
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Maruyama D, Yamada T, Murakami M, Fujiwara G, Komaru Y, Nagakane Y, Murakami N, Hashimoto N. FLAIR vascular hyperintensity with DWI for regional collateral flow and tissue fate in recanalized acute middle cerebral artery occlusion. Eur J Radiol 2020; 135:109490. [PMID: 33360270 DOI: 10.1016/j.ejrad.2020.109490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/05/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) extent or FVH-DWI mismatch as a primary influencing factor of clinical outcome in acute ischemic stroke is controversial. This study elucidated the regional pathophysiology and tissue fate in four types of cortical territories classified by the initial FVH and DWI findings in patients with acute proximal middle cerebral artery (M1) occlusion successfully recanalized using mechanical thrombectomy. METHODS We retrospectively evaluated 35 patients successfully recanalized within 24 h of acute M1 occlusion onset between 2016 and 2019. Each Alberta stroke program early CT score area of M1-M6 were categorized as group A (DWI-, FVH-), B (DWI-, FVH+), C (DWI+, FVH+), or D (DWI+, FVH-). Territorial collateral status was graded on a 4-point scale by initial angiogram. Follow-up head computed tomography (CT) findings on days 2-9 were assessed for the territorial outcome. RESULTS Overall, 210 cortical territories were identified; of these, 88 (41.9 %) were categorized into group A; 72 (34.3 %), group B; 37 (17.6 %), group C; and 13 (6.2 %), group D. The rate of territories with good collaterals (grade 2 or 3) significantly decreased in the order of groups as 78.3 %, 62.7 %, 27.6 %, and 0%, respectively (Ptrend <.001). Conversely, the rate of territories with any hypo- or hyper-density on follow-up CT significantly increased in the order of groups as 13.4 %, 23.1 %, 88.5 %, and 85.7 %, respectively (Ptrend <.001). CONCLUSION Categorization of cortical areas based on the FVH and DWI findings can stratify territorial collateral status and tissue fate.
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Affiliation(s)
- Daisuke Maruyama
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
| | - Takehiro Yamada
- Department of Neurology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Mamoru Murakami
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Gaku Fujiwara
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Yujiro Komaru
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Yoshinari Nagakane
- Department of Neurology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Nobukuni Murakami
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
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21
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Riou-Comte N, Guillemin F, Gory B, Lapergue B, Zhu F, Soudant M, Piotin M, Humbertjean L, Mione G, Lacour JC, Anxionnat R, Hossu G, Bracard S, Richard S. Predictive factors of functional independence after optimal reperfusion in anterior circulation ischaemic stroke with indication for intravenous thrombolysis plus mechanical thrombectomy. Eur J Neurol 2020; 28:141-151. [PMID: 32916042 DOI: 10.1111/ene.14509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Intravenous thrombolysis plus mechanical thrombectomy (IVT + MT) is the best current management of acute stroke due to large-vessel occlusion and results in optimal reperfusion for most patients. Nevertheless, some of these patients do not subsequently achieve functional independence. The aim was to identify baseline factors associated with 3-month independence after optimal reperfusion and to validate a prediction model. METHODS All consecutive patients with intracranial anterior large-vessel occlusion, with indication for IVT + MT and achieving optimal reperfusion (defined as modified Treatment in Cerebral Ischaemia score 2b-3), from the THRACE trial and the ETIS registry, were included in order to identify a prediction model. The primary outcome was 3-month independence [modified Rankin Scale (mRS) score ≤ 2]. Multivariate inferences invoked forward logistic regression, multiple imputation and bootstrap resampling. Predictive performance was assessed by c-statistic. Model validation was conducted on patients from the ASTER trial. RESULTS Amongst 139 patients (mean age 65.5 years; 54.3% female), predictors of 3-month mRS ≤ 2 (n = 82) were younger age [odds ratio 0.62 per 10-year increase; 95% confidence interval (CI) 0.53-0.72] and higher Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (odds ratio 1.65 per 1-point increase; 95% CI 1.47-1.86) with c-statistic 0.77. Model validation (n = 104/181 patients with 3-month mRS ≤ 2) demonstrated a moderate discrimination (c-statistic 0.74; 95% CI 0.66-0.81) combining age and ASPECTS. The validation model was improved by the adjunction of three candidate variables that were found to be predictors. Addition of baseline National Institutes of Health Stroke Scale (NIHSS) score, history of vascular risk factor and onset-to-reperfusion time significantly improved discrimination (c-statistic 0.85; 95% CI 0.83-0.87). CONCLUSIONS After optimal reperfusion, younger age, higher ASPECTS, lower NIHSS score, shorter onset-to-reperfusion time and absence of vascular risk factor were predictive of independence and could help to guide patient management.
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Affiliation(s)
| | - F Guillemin
- Clinical Investigation Centre 1433, INSERM, University Hospital, Université de Lorraine, Nancy, France
| | - B Gory
- Neuroradiology, INSERM U1254, IADI, University Hospital, Nancy, France
| | - B Lapergue
- Stroke Center, Foch Hospital, Suresnes, France
| | - F Zhu
- Neuroradiology, INSERM U1254, IADI, University Hospital, Nancy, France
| | - M Soudant
- Clinical Investigation Centre 1433, INSERM, University Hospital, Université de Lorraine, Nancy, France
| | - M Piotin
- Neuroradiology, Fondation Ophtalmologique Rothschild, Paris, France
| | | | - G Mione
- Stroke Unit, University Hospital, Nancy, France
| | - J-C Lacour
- Stroke Unit, University Hospital, Nancy, France
| | - R Anxionnat
- Neuroradiology, INSERM U1254, IADI, University Hospital, Nancy, France
| | - G Hossu
- Clinical Investigation Centre 1433, INSERM, University Hospital, Université de Lorraine, Nancy, France.,Neuroradiology, INSERM U1254, IADI, University Hospital, Nancy, France
| | - S Bracard
- Neuroradiology, INSERM U1254, IADI, University Hospital, Nancy, France
| | - S Richard
- Stroke Unit, University Hospital, Nancy, France
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22
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Shang WJ, Shu LM, Zhou X, Liao HQ, Chen XH, Hong H, Chen HB. Association of FLAIR vascular hyperintensity and acute MCA stroke outcome changes with the severity of leukoaraiosis. Neurol Sci 2020; 41:3209-3218. [PMID: 32372196 DOI: 10.1007/s10072-020-04411-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The clinical significance of FLAIR vascular hyperintensity (FVH), a marker of collateral circulation in ischaemic stroke, remains controversial. We hypothesised that the association between FVH and outcomes varies with the severity of leukoaraiosis (LA), another marker of collaterals, and that their combined significance may vary with time. METHODS We included 459 consecutive patients with middle cerebral artery (MCA) stroke. Proximal and distal FVHs were distinguished based on location. LA was divided into two grades, according to Fazekas scores of 0-2 and 3-6. Symptom-to-MRI time was divided into two categories: ≤ 14 days and ≥ 15 days. RESULTS We found no difference in FVH proportion according to LA grade. Multivariate analysis revealed that LA and FVH status were independently associated with unfavourable outcomes (modified Rankin scale ≥ 2) in patients with symptom-to-MRI times ≤ 14 days (P = 0.008), but not in those with symptom-to-MRI times ≥15 days (P = 0.61). In the group with symptom-to-MRI times ≤14 days, patients with LA 3-6 and FVH(+) (OR, 3.044; 95% CI, 1.116-8.305) were more likely to have unfavourable clinical outcomes compared with patients with LA 0-2 and FVH(+) but not compared with those with LA 0-2 and FVH(-) or LA 3-6 and FVH(-). In addition, FVH location did not influence the relationship between FVH and outcomes. CONCLUSIONS The association between FVH and outcomes was influenced by the degree of LA in the acute but not in the subacute and chronic stages of MCA infarction. FVH predicts clinical outcomes independently only in those with more extensive LA.
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Affiliation(s)
- W J Shang
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong Province, China
| | - L M Shu
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong Province, China.,Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, NO. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - X Zhou
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, No. 2nd Zhongshan Road, Guangzhou, 510080, China
| | - H Q Liao
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, NO. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - X H Chen
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong Province, China
| | - H Hong
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong Province, China
| | - H B Chen
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong Province, China.
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23
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Zhou Z, Malavera A, Yoshimura S, Delcourt C, Mair G, Al-Shahi Salman R, Demchuk AM, Wardlaw JM, Lindley RI, Anderson CS. Clinical prognosis of FLAIR hyperintense arteries in ischaemic stroke patients: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2020; 91:475-482. [PMID: 32217786 DOI: 10.1136/jnnp-2019-322625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/18/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We performed a systematic review and meta-analysis to determine the association of fluid-attenuated inversion recovery (FLAIR) hyperintense arteries (FLAIR-HAs) on brain MRI and prognosis after acute ischaemic stroke (AIS). METHODS We searched Medline, Embase and Cochrane Central Register of Controlled Trials for studies reporting clinical or imaging outcomes with presence of FLAIR-HAs after AIS. Two researchers independently assessed eligibility of retrieved studies and extracted data, including from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Outcomes were unfavourable functional outcome (primary, modified Rankin scale scores 3-6 or 2-6), death, intermediate clinical and imaging outcomes. We performed subgroup analyses by treatment or types of FLAIR-HAs defined by location (at proximal/distal middle cerebral artery (MCA), within/beyond diffusion-weighted imaging (DWI) lesion) or extent. RESULTS We included 36 cohort studies (33 prospectively collected) involving 3577 patients. FLAIR-HAs were not associated with functional outcome overall (pooled risk ratio 0.87, 95% CI 0.71 to 1.06), but were significantly associated with better outcome in those receiving endovascular therapy (0.56, 95% CI 0.41 to 0.75). Contrary to FLAIR-HAs at proximal MCA or within DWI lesions, FLAIR-HAs beyond DWI lesions were associated with better outcome (0.67, 95% CI 0.57 to 0.79). FLAIR-HAs favoured recanalisation (1.21, 95% CI 1.06 to 1.38) with increased risk of intracerebral haemorrhage (2.07, 95% CI 1.37 to 3.13) and early neurological deterioration (1.93, 95% CI 1.30 to 2.85). CONCLUSIONS FLAIR-HAs were not associated with functional outcome overall but were associated with outcome after endovascular therapy for AIS. FLAIR-HAs were also associated with early recanalisation or haemorrhagic complications, and early neurologic deterioration. PROSPERO REGISTRATION NUMBER CRD42019131168.
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Affiliation(s)
- Zien Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China .,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Alejandra Malavera
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sohei Yoshimura
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Candice Delcourt
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Grant Mair
- Division of Neuroimaging Science, Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Andrew M Demchuk
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joanna M Wardlaw
- Division of Neuroimaging Science, Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Richard I Lindley
- The George Institute for Global Health and University of Sydney, Sydney, New South Wales, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, New South Wales, Australia.,The George Institute China at Peking University Health Science Center, Beijing, PR China
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Wang Y, Zhou Z, Ding S. FLAIR vascular hyperintensity-DWI mismatch most likely to benefit from recanalization and good outcome after stroke. Medicine (Baltimore) 2020; 99:e18665. [PMID: 31914055 PMCID: PMC6959955 DOI: 10.1097/md.0000000000018665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/17/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022] Open
Abstract
We assessed the value of fluid-attenuated inversion recovery vascular hyperintensity (FVH)-diffusion-weighted imaging (DWI) mismatch in predicting revascularization and functional outcome in stroke patients with large vessel occlusion (LVO) after endovascular thrombectomy (EVT).Seventy-two acute stroke patients within 6 hour of stroke onset who received EVT were enrolled. FVH-DWI mismatch, revascularization (mTICI score), functional outcome (mRS at 3 months) and other clinical data were collected. Statistical analysis was performed to predict revascularization and functional outcome after stroke.Twenty-nine patients (60.42%) had FVH-DWI mismatch in patients with complete revascularization and 8 patients (33.33%) had FVH-DWI mismatch in patients with no/partial revascularization, and there was significant difference in 2 groups (t = 4.698; P = .045). The good functional outcome group (37/72; 51.39%) had higher FVH score (4.38 ± 1.53 vs 3.49 ± 1.52; t = 2.478; P = .016), higher FVH-DWI mismatch ratio (81.25% vs 48.15%; t = 10.862; P = .002), higher complete revascularization ratio (83.78% vs 48.57%; t = 10.036; P = .002) than the poor functional outcome group (35/72; 48.61%). Spearman's rank correlation analysis revealed that FVH-DWI mismatch was positively correlated with complete revascularization (r = 0.255; P = .030) and good functional outcome (r = 0.417; P = .000). Multivariable logistic regression analysis demonstrated that FVH-DWI mismatch was independently associated with complete revascularization (OR, 0.328; 95% CI, 0.117-0.915; P = .033) and good functional outcome (OR, 0.169; 95% CI, 0.061-0.468; P = .001).Assessments of FVH-DWI mismatch before thrombectomy therapy might be useful for predicting revascularization and functional outcome in stroke patients with LVO.
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Topography of the hyperintense vessel sign on fluid-attenuated inversion recovery represents cerebral hemodynamics in middle cerebral artery occlusion: a CT perfusion study. Neuroradiology 2019; 61:1123-1130. [PMID: 31154469 DOI: 10.1007/s00234-019-02231-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Whether the topography of fluid-attenuated inversion recovery hyperintense vessel sign (FHVs) can serve as a measure of cerebral hemodynamic stress remains unclear. We hypothesized that FHVs topography represents different cerebral hemodynamic status, as assessed by CT perfusion (CTP). METHODS We retrospectively reviewed 75 patients with acute middle cerebral artery (MCA) occlusion who underwent MR imaging and CTP. The FHVs topography included FHVs inside the diffusion-weighted imaging (DWI) lesion (FHVs in-group), FHVs outside the DWI lesion (FHVs out-group), and FHVs distributed inside and outside the DWI lesion (FHVs all-group). FHVs scores were assessed by the Alberta stroke program early computed tomography score (ASPECT) territories. Cerebral hemodynamic status was evaluated by relative (r) CTP parameters. Cerebral hemodynamic status was analyzed with respect to different FHVs topographies and FHVs scores. RESULTS Hemodynamic impairment was present in all patients, with the following mean rCTP parameters: rCBF, 0.77 ± 0.23; rCBV, 1.06 ± 0.32; and rMTT, 1.52 ± 0.60. Comparison of the rCTP parameters among the three groups, rCBF and rCBV (rCBF, P < 0.001; rCBV, P < 0.001) in the FHVs out-group and the FHVs all-group (rCBF, P = 0.001; rCBV, P < 0.001), were significantly higher than that in the FHVs in-group. Similarly, CTA collateral grade in the FHVs in-group was significantly lower than those in the FHVs out-group and FHVs all-group (P < 0.001). No significant difference was found in rCTP parameters between different FHVs scores. CONCLUSION The different FHVs topographies represented different cerebral hemodynamic status. FHVs topography may serve as a surrogate for patient selection for reperfusion therapy whenever perfusion data are unavailable.
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Shang WJ, Chen HB, Shu LM, Liao HQ, Huang XY, Xiao S, Hong H. The Association between FLAIR Vascular Hyperintensity and Stroke Outcome Varies with Time from Onset. AJNR Am J Neuroradiol 2019; 40:1317-1322. [PMID: 31371355 DOI: 10.3174/ajnr.a6142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/17/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE FLAIR vascular hyperintensity has been recognized as a marker of collaterals in ischemic stroke, but the impact on outcome is still controversial. We hypothesized that the association between FLAIR vascular hyperintensity and outcome varies with time. MATERIALS AND METHODS We included 459 consecutive patients with middle cerebral artery stroke and divided them into 3 groups by symptom-to-MR imaging time (group 1, ≤7 days; group 2, 8-14 days; group 3, ≥15 days). The FLAIR vascular hyperintensity score, ranging from 0 to 3 points, was based on territory distributions of different MCA segments. The associations between FLAIR vascular hyperintensity and outcome with time were analyzed qualitatively and quantitatively. RESULTS No patients underwent MR imaging within 6 hours of onset. The proportion of FLAIR vascular hyperintensity (+) and severe stenosis or occlusion of MCA was not significantly dependent on time. In groups 1 and 2, FLAIR vascular hyperintensity (+) was significantly associated with larger lesions, the prevalence of flow injury, and unfavorable outcome (mRS ≥ 2). There were no such associations in group 3. Multiple logistic regressions demonstrated that FLAIR vascular hyperintensity (+) was an independent risk factor for unfavorable outcome in group 2. Infarction volume tended to increase with the increase of the distal FLAIR vascular hyperintensity score in groups 1 and 2, while declining in group 3. CONCLUSIONS FLAIR vascular hyperintensity is associated with unfavorable outcome within 6 hours to 14 days of onset, while the wider distribution of distal FLAIR vascular hyperintensity may be favorable beyond 14 days of onset in MCA infarction. Symptom-to-MR imaging time should be considered when assessing the prognostic value of FLAIR vascular hyperintensity.
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Affiliation(s)
- W J Shang
- From the Department of Neurology (W.J.S., H.B.C., L.M.S., S.X., H.H.), National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - H B Chen
- From the Department of Neurology (W.J.S., H.B.C., L.M.S., S.X., H.H.), National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - L M Shu
- From the Department of Neurology (W.J.S., H.B.C., L.M.S., S.X., H.H.), National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Neurology (L.M.S., H.Q.L., X.Y.H.), The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - H Q Liao
- Department of Neurology (L.M.S., H.Q.L., X.Y.H.), The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - X Y Huang
- Department of Neurology (L.M.S., H.Q.L., X.Y.H.), The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - S Xiao
- From the Department of Neurology (W.J.S., H.B.C., L.M.S., S.X., H.H.), National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - H Hong
- From the Department of Neurology (W.J.S., H.B.C., L.M.S., S.X., H.H.), National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Kim DH, Lee YK, Cha JK. Prominent FLAIR Vascular Hyperintensity Is a Predictor of Unfavorable Outcomes in Non-thrombolysed Ischemic Stroke Patients With Mild Symptoms and Large Artery Occlusion. Front Neurol 2019; 10:722. [PMID: 31312181 PMCID: PMC6614286 DOI: 10.3389/fneur.2019.00722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/18/2019] [Indexed: 01/01/2023] Open
Abstract
Background and objective: The aim was to evaluate the clinical significance of prominent fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) on the prognosis of mild acute ischemic stroke with middle cerebral artery (MCA) occlusion. Methods: We recruited consecutive stroke patients with initial National Institutes of Health Stroke Scale (NIHSS) scores ≤5 and MCA occlusion on magnetic resonance angiography within 24 h of stroke onset. Prominent distal FVH was defined as an extension to more than one-third of the MCA territory. We compared clinical outcomes between prominent and non-prominent FVH groups in patients who had and had not received reperfusion therapy. Results: Of 112 participants [43 women; median age, 67 years [Interquartile range, 54–79]], prominent FVH was identified in 80 (71.4%). For 75 patients who had not received reperfusion therapy, the prominent FVH group had a more unfavorable outcome (modified Rankin Scale score >1) at 3 months than the non-prominent FVH group (44.4 vs. 15.0%, P = 0.029). In multivariate analysis, a higher NIHSS score [odd ratio [OR] = 1.67; 95% confidence interval [CI], 1.16–2.41; P = 0.006], proximal MCA occlusion [OR = 7.31; 95% CI, 1.68–31.9; P = 0.008], and prominent FVH [OR = 5.49; 95% CI, 1.29–23.4; P = 0.021], were independently associated with an unfavorable outcome. There was no association between prominent FVH and the clinical outcome in the reperfusion therapy group. Conclusions: For acute stroke patients with mild symptoms and MCA occlusion who do not receive reperfusion therapy, prominent FVH and proximal MCA occlusion may be independent predictors of an unfavorable outcome.
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Affiliation(s)
- Dae-Hyun Kim
- Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, South Korea.,Department of Neurology, College of Medicine, Dong-A University, Busan, South Korea
| | - Yoon-Kyung Lee
- Department of Neurology, College of Medicine, Dong-A University, Busan, South Korea
| | - Jae-Kwan Cha
- Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, South Korea.,Department of Neurology, College of Medicine, Dong-A University, Busan, South Korea
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28
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FLAIR hyperintensities-DWI mismatch in acute stroke: associations with DWI volume and functional outcome. Brain Imaging Behav 2019; 14:1230-1237. [DOI: 10.1007/s11682-019-00156-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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29
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Legrand L, Turc G, Edjlali M, Beaumont M, Gautheron V, Ben Hassen W, Charron S, Trystram D, Boulouis G, Bourcier R, Benzakoun J, Naggara O, Clarençon F, Bracard S, Oppenheim C. Benefit from revascularization after thrombectomy according to FLAIR vascular hyperintensities–DWI mismatch. Eur Radiol 2019; 29:5567-5576. [DOI: 10.1007/s00330-019-06094-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/28/2019] [Accepted: 02/08/2019] [Indexed: 11/25/2022]
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30
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Jiang L, Chen YC, Zhang H, Peng M, Chen H, Geng W, Xu Q, Yin X, Ma Y. FLAIR vascular hyperintensity in acute stroke is associated with collateralization and functional outcome. Eur Radiol 2019; 29:4879-4888. [PMID: 30762112 DOI: 10.1007/s00330-019-06022-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/05/2018] [Accepted: 01/18/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Fluid-attenuated inversion recovery vascular hyperintensity (FVH) is frequently found in stroke patients after intracranial arterial occlusion, but the prognostic value of FVH findings is unclear. We assessed whether FVH is associated with cerebral collateral status and functional outcome in patients with acute stroke patients receiving endovascular therapy. METHODS FVH score, American Society of Interventional and Therapeutic Neuroradiology (ASITN) grade, the functional outcome at 3 months (modified Rankin Scale (mRS)), and other clinical data were collected for 37 acute stroke patients with large vessel occlusion (LVO) receiving MRI before and after endovascular therapy. Statistical analysis was performed to predict functional outcome after stroke. RESULTS The good functional outcome group (n = 16) had a higher FVH1 (FVH before therapy) score (4.63 ± 1.20 vs 3.14 ± 1.15; p = 0.001) and ASITN grade (3.31 ± 0.48 vs 2.00 ± 1.22; p < 0.001) and a lower FVH2 (FVH after therapy) score than the poor functional outcome group (n = 21; 0.125 ± 0.50 vs 1.44 ± 2.16; p = 0.030). mRS at 3 months was negatively correlated with FVH1 (r = - 0.525, p = 0.001) and the ASITN grade (r = - 0.478, p = 0.003) and positively correlated with FVH2 (r = 0.376, p = 0.034). FVH1 (OR, 0.085; 95% CI, 0.013-0.577; p = 0.012) and FVH2 (OR, 2.724; 95% CI, 1.061-6.996; p = 0.037) were independently associated with functional outcome in multivariable logistic regression analysis. CONCLUSIONS Assessing FVH before and after therapy in acute stroke patients with LVO might be useful for predicting functional outcome after stroke. KEY POINTS • Fluid-attenuated inversion recovery vascular hyperintensity is a circular or serpentine brightening in the brain parenchyma or cortical surface bordering the subarachnoid space on MR imaging. • A prospective study showed that fluid-attenuated inversion recovery vascular hyperintensity is associated with cerebral collateral circulation and prognosis. • Fluid-attenuated inversion recovery vascular hyperintensity helps clinicians to predict the prognosis of patients with acute stroke.
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Affiliation(s)
- Liang Jiang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Mingyang Peng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Wen Geng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Quan Xu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China.
| | - Yuehu Ma
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China.
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Caroff J, King RM, Arslanian R, Marosfoi M, Langan ET, Gounis MJ, Chueh JY. Microcatheter navigation through the clot: does size matter? J Neurointerv Surg 2018; 11:271-274. [PMID: 30177546 DOI: 10.1136/neurintsurg-2018-014105] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/13/2018] [Accepted: 07/24/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite high recanalization rates achieved with endovascular treatment of acute ischemic strokes, around 50% of eligible patients will not achieve a good outcome. Parameters that may determine patient outcomes include: time from puncture to recanalization, the collateral status, the anesthesia regimen, blood pressure management, and distal emboli. Characterization of distal emboli generated during mechanical thrombectomy has been performed in previous studies. OBJECTIVE To further investigate the risk of distal embolization associated with microcatheter navigation across the clot. METHODS A contrast-enhanced clot analog was used in an in vitro model that mimicked a middle cerebral artery occlusion within a complete circle of Willis vascular replica. The clot was crossed with one of the following microcatheters: Pro18, XT-27 or 3MAX. The emboli generated during the procedure were collected and measured. RESULTS The use of Pro18 and XT-27 resulted in a significant reduction of visible particles (size ≥500 µm) as compared with the 3MAX catheter (P<0.003). For the size range between 8 and 200 µm, there was a trend for Pro18 to generate fewer particles (-18%) than XT-27 but without statistical significance (P>0.05). In comparison with previously published data, acquired under the same conditions, it was found that the clot crossing maneuver accounts approximately for 12% of the total number of small emboli (<200 µm) induced during a stent retriever-mediated mechanical thrombectomy procedure via a balloon guide catheter. CONCLUSIONS The clot crossing maneuver has a significant effect on the total number of small particles induced during mechanical thrombectomy. Smaller microcatheter sizes should be favored when possible.
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Affiliation(s)
- Jildaz Caroff
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Interventional Neuroradiology, NEURI Center, Bicêtre Hospital, Clichy, France
| | - Robert M King
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Rose Arslanian
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Miklos Marosfoi
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Erin T Langan
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ju-Yu Chueh
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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