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Li J, Bian Y, Wu F, Fan Z, Zhang C, Zhao X, Ji X, Yang Q. Association of Morphology of Lenticulostriate Arteries and Proximal Plaque Characteristics With Single Subcortical Infarction: A Whole-Brain High-Resolution Vessel Wall Imaging Study. J Am Heart Assoc 2024; 13:e032856. [PMID: 38726896 PMCID: PMC11179825 DOI: 10.1161/jaha.123.032856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/15/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND We aimed to investigate the association of characteristics of lenticulostriate artery (LSA) morphology and parental atheromatous disease (PAD) with single subcortical infarction (SSI) and to explore whether the LSA morphology is correlated with proximal plaque features in asymptomatic PAD. METHODS AND RESULTS Patients with acute SSI were prospectively enrolled and classified as large- and small-SSI groups. The clinical data and imaging features of LSA morphology (branches, length, dilation, and tortuosity) and middle cerebral artery plaques (normalized wall index, remodeling index, enhancement degree, and hyperintense plaques) were evaluated. Logistic regression was performed to determine the association of large SSIs with morphologic features of LSAs and plaques. The Spearman correlation between the morphologic characteristics of LSAs and plaque features in asymptomatic PAD was analyzed. Of the 121 patients recruited with symptomatic PAD, 102 had coexisting asymptomatic contralateral PAD. The mean length of LSAs (odds ratio, 0.84 [95% CI, 0.73-0.95]; P=0.007), mean tortuosity of LSAs (odds ratio, 1.13 [95% CI, 1.05-1.22]; P=0.002), dilated LSAs (odds ratio, 22.59 [95% CI, 2.46-207.74]; P=0.006), and normalized wall index (odds ratio, 1.08 [95% CI, 1.01-1.15]; P=0.022) were significantly associated with large SSIs. Moreover, the normalized wall index was negatively correlated with the mean length of LSAs (r=-0.348, P<0.001), and the remodeling index was negatively correlated with the mean tortuosity of LSAs (r=-0.348, P<0.001) in asymptomatic PAD. CONCLUSIONS Our findings suggest that mean length of LSAs, mean tortuosity of LSAs, dilated LSAs, and normalized wall index are associated with large SSIs. Moreover, plaque features in asymptomatic PAD are correlated with morphologic features of LSAs.
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Affiliation(s)
- Jin Li
- Department of Radiology Beijing Chaoyang Hospital, Capital Medical University Beijing China
| | - Yueyan Bian
- Department of Radiology Beijing Chaoyang Hospital, Capital Medical University Beijing China
| | - Fang Wu
- Department of Radiology Xuanwu Hospital, Capital Medical University Beijing China
| | - Zhaoyang Fan
- Department of Radiology, Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Chen Zhang
- MR Research Collaboration, Siemens Healthineers Beijing China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering Tsinghua University School of Medicine Beijing China
| | - Xunming Ji
- Department of Neurology Xuanwu Hospital, Capital Medical University Beijing China
- Beijing Institute of Brain Disorders, Capital Medical University Beijing China
| | - Qi Yang
- Department of Radiology Beijing Chaoyang Hospital, Capital Medical University Beijing China
- Key Lab of Medical Engineering for Cardiovascular Disease Ministry of Education Beijing China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine Beijing China
- Laboratory for Clinical Medicine Capital Medical University Beijing China
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Peretz S, Pardo K, Naftali J, Findler M, Raphaeli G, Barnea R, Khasminsky V, Auriel E. Delayed CTP-Derived Deep Venous Outflow: A Novel Predictor of Striatocapsular Infarction after M1 Thrombectomy. AJNR Am J Neuroradiol 2022; 43:1608-1614. [PMID: 36265892 PMCID: PMC9731248 DOI: 10.3174/ajnr.a7670] [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: 07/12/2022] [Accepted: 09/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Isolated striatocapsular infarction occurs commonly in patients with ischemic stroke following M1 thrombectomy. We aimed to explore the correlation between CTP-derived parameters of deep venous outflow at presentation and subsequent striatocapsular infarction in a retrospective cohort of such patients. MATERIALS AND METHODS TTP and peak enhancement were measured on CTP-derived time-attenuation curves of the internal cerebral and thalamostriate veins bilaterally. The difference in TTP (ΔTTP) and the relative decrease in venous enhancement between the ischemic and normal sides were calculated. NCCT performed 24 (SD, 12) hours postthrombectomy was used to determine tissue fate in the caudate head, caudate body, lentiform nucleus, and internal capsule. Striatocapsular ischemia (striatocapsular infarction-positive) was defined as infarction and striatocapsular injury as either infarction, contrast enhancement, or hemorrhagic transformation in ≥1 of these regions. A striatocapsular ischemia score was calculated (0 = no ischemic region, 1 = 1 ischemic region, 2 = ≥2 ischemic regions). RESULTS One hundred sixteen patients were included in the analysis. Sixty-one patients had striatocapsular infarction (striatocapsular infarction-positive). The mean thalamostriate ΔTTP was 1.95 (SD, 1.9) seconds for patients positive for striatocapsular infarction and 0.79 (SD, 2.1) for patients negative for it (P = .010). Results were similar for striatocapsular injury. The mean thalamostriate ΔTTP was 0.79 (SD, 2.1), 1.68 (SD, 1.4), and 2.05 (SD, 2) for striatocapsular infarction scores of 0, 1, and 2, respectively (P = .030). CONCLUSIONS CTP-derived thalamostriate ΔTTP is an excellent surrogate marker for striatocapsular infarction in patients post-M1 thrombectomy. The novel approach of extracting venous outflow parameters from CTP has numerous potential applications and should be further explored.
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Affiliation(s)
- S Peretz
- From the Departments of Neurology (S.P., K.P., J.N., M.F., G.R., R.B., E.A.)
- Sackler School of Medicine (S.P., K.P., J.N., M.F., G.R., R.B., V.K., E.A.), Tel-Aviv University, Tel-Aviv, Israel
| | - K Pardo
- From the Departments of Neurology (S.P., K.P., J.N., M.F., G.R., R.B., E.A.)
- Sackler School of Medicine (S.P., K.P., J.N., M.F., G.R., R.B., V.K., E.A.), Tel-Aviv University, Tel-Aviv, Israel
| | - J Naftali
- From the Departments of Neurology (S.P., K.P., J.N., M.F., G.R., R.B., E.A.)
- Sackler School of Medicine (S.P., K.P., J.N., M.F., G.R., R.B., V.K., E.A.), Tel-Aviv University, Tel-Aviv, Israel
| | - M Findler
- From the Departments of Neurology (S.P., K.P., J.N., M.F., G.R., R.B., E.A.)
- Sackler School of Medicine (S.P., K.P., J.N., M.F., G.R., R.B., V.K., E.A.), Tel-Aviv University, Tel-Aviv, Israel
| | - G Raphaeli
- From the Departments of Neurology (S.P., K.P., J.N., M.F., G.R., R.B., E.A.)
- Sackler School of Medicine (S.P., K.P., J.N., M.F., G.R., R.B., V.K., E.A.), Tel-Aviv University, Tel-Aviv, Israel
| | - R Barnea
- From the Departments of Neurology (S.P., K.P., J.N., M.F., G.R., R.B., E.A.)
- Sackler School of Medicine (S.P., K.P., J.N., M.F., G.R., R.B., V.K., E.A.), Tel-Aviv University, Tel-Aviv, Israel
| | - V Khasminsky
- Radiology (V.K.), Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine (S.P., K.P., J.N., M.F., G.R., R.B., V.K., E.A.), Tel-Aviv University, Tel-Aviv, Israel
| | - E Auriel
- From the Departments of Neurology (S.P., K.P., J.N., M.F., G.R., R.B., E.A.)
- Sackler School of Medicine (S.P., K.P., J.N., M.F., G.R., R.B., V.K., E.A.), Tel-Aviv University, Tel-Aviv, Israel
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3
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Yajima H, Koizumi S, Miyawaki S, Saito N. Mechanical Thrombectomy for M1 Subocclusive Thrombus With Lateral Lenticulostriate Artery Occlusion: A Case Report and Literature Review. Front Neurol 2022; 13:828245. [PMID: 35197924 PMCID: PMC8858843 DOI: 10.3389/fneur.2022.828245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022] Open
Abstract
The treatment for middle cerebral artery subocclusive thrombi is not standardized. Here, we report a case of M1 subocclusive thrombus with lateral lenticulostriate artery occlusion that was successfully treated with mechanical thrombectomy. This article describes a treatment strategy for M1 subocclusive thrombus, focusing on the indications for mechanical thrombectomy. A 58-year-old male on admission for pneumonia had a sudden onset of dysarthria and motor deficits. He has a history of dilated cardiomyopathy and underwent left ventricular assist device implantation 3 years ago. At onset, his National Institutes of Health Stroke Scale (NIHSS) score was nine. Computed tomography angiography demonstrated a filling defect in the distal right M1 segment of the middle cerebral artery. Angiography confirmed the presence of a subocclusive thrombus within the distal right M1 segment, although peripheral blood flow was maintained. Mechanical thrombectomy was performed for the M1 subocclusive thrombus using a direct aspiration first-pass technique, resulting in successful aspiration of the thrombus on the first pass. After the procedure, recanalization of the lateral lenticulostriate artery was detected, and the patient demonstrated full recovery (NIHSS score 0). Mechanical thrombectomy can be considered as a treatment option in cases of acute ischemic stroke caused by M1 subocclusive thrombus with lateral lenticulostriate artery occlusion, which presents with a high NIHSS score or neurological deterioration.
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Yu Z, Li W, Lan J, Hayakawa K, Ji X, Lo EH, Wang X. EphrinB2-EphB2 signaling for dendrite protection after neuronal ischemia in vivo and oxygen-glucose deprivation in vitro. J Cereb Blood Flow Metab 2021; 41:1744-1755. [PMID: 33325764 PMCID: PMC8221775 DOI: 10.1177/0271678x20973119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In order to rescue neuronal function, neuroprotection should be required not only for the neuron soma but also the dendrites. Here, we propose the hypothesis that ephrin-B2-EphB2 signaling may be involved in dendritic degeneration after ischemic injury. A mouse model of focal cerebral ischemia with middle cerebral artery occlusion (MCAO) method was used for EphB2 signaling test in vivo. Primary cortical neuron culture and oxygen-glucose deprivation were used to assess EphB2 signaling in vitro. siRNA and soluble ephrin-B2 ectodomain were used to block ephrin-B2-Ephb2 signaling. In the mouse model of focal cerebral ischemia and in neurons subjected to oxygen-glucose deprivation, clustering of ephrin-B2 with its receptor EphB2 was detected. Phosphorylation of EphB2 suggested activation of this signaling pathway. RNA silencing of EphB2 prevented neuronal death and preserved dendritic length. To assess therapeutic potential, we compared the soluble EphB2 ectodomain with the NMDA antagonist MK801 in neurons after oxygen-glucose deprivation. Both agents equally reduced lactate dehydrogenase release as a general marker of neurotoxicity. However, only soluble EphB2 ectodomain protected the dendrites. These findings provide a proof of concept that ephrin-B2-EphB2 signaling may represent a novel therapeutic target to protect both the neuron soma as well as dendrites against ischemic injury.
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Affiliation(s)
- Zhanyang Yu
- Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Wenlu Li
- Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jing Lan
- 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.,Cerebrovascular Research Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kazuhide Hayakawa
- Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Xunming Ji
- 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.,Cerebrovascular Research Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Eng H Lo
- Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Xiaoying Wang
- Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Clinical Neuroscience Research Center, Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
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5
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Lin YH, Tang SC, Chen CH, Lee CW, Lu CJ, Tsai LK, Jeng JS. Angiographic early hyperemia in the middle cerebral artery territory after thrombectomy is associated with favorable clinical outcome in anterior circulation stroke. Eur Radiol 2021; 31:5281-5288. [PMID: 33399907 DOI: 10.1007/s00330-020-07578-y] [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: 08/12/2020] [Revised: 10/20/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Angiographic cortical early hyperemia (EH) is frequently observed after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke. The aim of the study is to investigate the relationship between EH and clinical outcomes. METHODS Between January 2015 and September 2018, consecutive patients who underwent EVT for anterior circulation LVO stroke with optimal recanalization (modified thrombolysis in cerebral infarction 2b or 3) were included. Angiographic studies after immediate reperfusion were used for analysis for cortical EH sign. Clinical functional outcomes were evaluated with the modified Rankin Scale (mRS) at 90 days. Safety outcomes, including mortality and intracerebral hemorrhage, were assessed. The association of EH between clinical functional and safety outcomes was analyzed. RESULTS A total of 143 patients were analyzed (mean age: 71 years; median National Institutes of Health Stroke Scale score: 18). A positive EH sign was observed in 88 (62%) patients. Good functional outcome at 90 days was significantly different between the EH+ and EH- groups (p = .0157). Intracerebral hemorrhage and mortality did not differ between groups. In multivariate logistic regression analysis, EH was an independent predictor for good clinical outcome (mRS ≤ 2, odds ratio: 3.49, p = .0034) in addition to young age. CONCLUSION Results revealed that the presence of EH is associated with better clinical outcome at 90 days, but not associated with increased hemorrhagic complication. These findings with clinically relevant implications require further validation. KEY POINTS • Angiographic cortical hyperemia is a common finding immediately after endovascular thrombectomy. • Presence of cortical hyperemia is an independent prognostic factor for good clinical outcome. • Hemorrhagic complication is not associated with cortical hyperemia.
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Affiliation(s)
- Yen-Heng Lin
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10055, Taiwan
| | - Sung-Chun Tang
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hao Chen
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Wei Lee
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10055, Taiwan.
| | - Chi-Ju Lu
- Department of Medical Imaging, National Taiwan University Hospital Yunlin Branch, Douliu City, Yunlin, Taiwan
| | - Li-Kai Tsai
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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6
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Kühn AL, Vardar Z, Kraitem A, King RM, Anagnostakou V, Puri AS, Gounis MJ. Biomechanics and hemodynamics of stent-retrievers. J Cereb Blood Flow Metab 2020; 40:2350-2365. [PMID: 32428424 PMCID: PMC7820689 DOI: 10.1177/0271678x20916002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/29/2022]
Abstract
In 2015, multiple randomized clinical trials showed an unparalleled treatment benefit of stent-retriever thrombectomy as compared to standard medical therapy for the treatment of a large artery occlusion causing acute ischemic stroke. A short time later, the HERMES collaborators presented the patient-level pooled analysis of five randomized clinical trials, establishing class 1, level of evidence A for stent-retriever thrombectomy, in combination with intravenous thrombolysis when indicated to treat ischemic stroke. In the years following, evidence continues to mount for expanded use of this therapy for a broader category of patients. The enabling technology that changed the tide to support endovascular treatment of acute ischemic stroke is the stent-retriever. This review summarizes the history of intra-arterial treatment of stroke, introduces the biomechanics of embolus extraction with stent-retrievers, describes technical aspects of the intervention, provides a description of hemodynamic implications of stent-retriever embolectomy, and proposes future directions for a more comprehensive, multi-modal endovascular approach for the treatment of acute ischemic stroke.
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Affiliation(s)
- Anna Luisa Kühn
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Zeynep Vardar
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Afif Kraitem
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert M King
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Vania Anagnostakou
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ajit S Puri
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
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Yang W, Zhang L, Yao Q, Chen W, Yang W, Zhang S, He L, Li H, Zhang Y. Endovascular treatment or general treatment: how should acute ischemic stroke patients choose to benefit from them the most?: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20187. [PMID: 32443338 PMCID: PMC7254577 DOI: 10.1097/md.0000000000020187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Acute ischemic stroke due to large-vessel occlusion is a leading cause of death and disability, and therapeutic time window was limited to 4.5 hour when treated with intravenous thrombolysis. It has been acknowledged that endovascular treatment (EVT) is superior to general treatment (only medication, including intravenous recombinant tissue plasminogen activator (rt-PA)) in improving the outcome of AIS since 2015. However, the benefits were limited to improvement of functional outcomes and functional independence. Hence, this meta-analysis was conducted to summarize the benefits of EVT for acute ischemic stroke, explore underlying indications of EVT for AIS patients and suggest implications for clinical practice and future research. METHODS A search was performed to identify eligible studies in PubMed, Scopus and Web of Science updated to February 5, 2019. Functional outcomes, the modified Rankin Scale (mRS) 0-1, mRS 0-2, all-cause mortality, symptomatic intracerebral hemorrhage and asymptomatic intracerebral hemorrhage (aICH) at 90 days were selected as outcomes. Data was pooled to calculate the odds ratio (OR) and 95% confidence interval (CI). Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were also performed in this meta-analysis. RESULTS Eighteen studies comprising 3831 patients were included and analyzed in this meta-analysis. In comparison with general treatment, improved functional outcomes (mRS 0-1: OR = 1.68, 95% CI = 1.43-1.97, inconsistency index [I = 57%, P < .00001; mRS 0-2: OR = 1.78, 95% CI = 1.55-2.03, I = 69%, P < .00001), reduced risk of all-cause mortality (OR = 0.82, 95% CI = 0.70-0.98, I = 27%, P = .03) but higher risk of aICH (OR = 1.43, 95% CI = 1.05-1.95, I = 0%, P = .02) at 90 days were found in AIS patients treated with EVT. Age < 70, National Institutes of Health Stroke Scale ≥20 and maximum delay for invention>5 hours could improve clinical outcomes following EVT. In sensitivity analysis, it showed that 2 studies had a great influence on the pooled ORs. No potential publication bias was found in this meta-analysis. CONCLUSION Taken together, EVT, which led to improved functional outcomes and decreased risk of death, is superior to general treatment for AIS patients with age < 70, National Institutes of Health Stroke Scale ≥20 and maximum delay for invention>5 hours. Moreover, it suggests that "with mechanical thrombectomy" is potential favorable factor for improving aICH in comparison with general treatment.
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Affiliation(s)
| | | | | | | | - Weiji Yang
- College of Life Sciences, Zhejiang Chinese Medical University
| | | | - Lan He
- Second Clinical Medical College
| | - Hong Li
- School of Stomatology, Zhejiang Chinese Medical University, Zhejiang, China
| | - Yuyan Zhang
- College of Life Sciences, Zhejiang Chinese Medical University
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Liu F, Chen C, Hong L, Shen H, Cao W, Dong Q, Yang X, Guo M, Li Y, Xiao Y, Cheng X, Li G. Lenticulostriate arteries appearance before thrombectomy predicts good outcome in acute middle cerebral artery occlusion. BMC Neurol 2020; 20:139. [PMID: 32299387 PMCID: PMC7161229 DOI: 10.1186/s12883-020-01716-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 04/02/2020] [Indexed: 12/27/2022] Open
Abstract
Background Endovascular therapy is widely used in acute large vessel occlusion. This study investigated whether imaging of lateral lenticulostriate arteries (LSAs) before thrombectomy would potentially be helpful for predicting prognosis of patients with acute M1 segment of middle cerebral artery occlusion (MCAO). Methods 59 consecutive patients with acute M1 segment of MCAO treated with mechanical thrombectomy at two comprehensive stroke centers were analyzed. Patients were categorized into LSA+ (appearing of lateral LSAs) and LSA- (sparing of lateral LSAs) group according to preprocedural digital substraction angiography (DSA). Baseline data and clinical outcomes were compared. A good clinical outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The association between clinical and imaging parameters and functional outcome was evaluated with logistic regression analysis. Results LSA+ was shown in 36 patients (61%). LSA+ group had a significantly higher proportion of good outcome (72.2% vs. 8.7%, OR 27.3,95% CI 5.38–138.4, P < 0.001), lower risk of symptomatic intracranial haemorrhages (sICH) (8.3% vs. 47.8%,OR 0.10,95% CI 0.02–0.42, P = 0.001) and lower mortality in hospital (5.6% vs. 34.8%, OR 0.11,95% CI 0.02–0.58, P < 0.004) compared with LSA- group. Patients in LSA+ group had lower baseline NIHSS score(P < 0.01) and NIHSS score at 14 days(P < 0.01) and smaller infarct core volume (P = 0.016) on computed tomography perfusion imaging (CTP) compared to the LSA- group. Multivariate logistic regression analysis showed that a small infarct core volume (OR 6.74,95% CI 1.148–39.569, P = 0.035) and LSA+(OR 22.114,95% CI 3.339–146.470, P = 0.001) were associated with a good clinical outcome. Conclusions Our data suggest that appearance of lateral LSAs before mechanical thrombectomy would be potentially helpful for predicting favorable prognosis of patients with acute M1 segment of MCAO.
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Affiliation(s)
- Feifeng Liu
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Chen Chen
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Lan Hong
- Department of Neurology, Shanghai huashan hospital, Fudan University, Shanghai, China
| | - Hao Shen
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Wenjie Cao
- Department of Neurology, Shanghai huashan hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Shanghai huashan hospital, Fudan University, Shanghai, China
| | - Xinyi Yang
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Mengruo Guo
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Ying Li
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Yaping Xiao
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Xin Cheng
- Department of Neurology, Shanghai huashan hospital, Fudan University, Shanghai, China
| | - Gang Li
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, China.
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9
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Xiong YJ, Gong JM, Zhang YC, Zhao XL, Xu SB, Pan DJ, Qu WS, Tian DS. Endovascular thrombectomy versus medical treatment for large vessel occlusion stroke with mild symptoms: A meta-analysis. PLoS One 2018; 13:e0203066. [PMID: 30138460 PMCID: PMC6107239 DOI: 10.1371/journal.pone.0203066] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/14/2018] [Indexed: 01/01/2023] Open
Abstract
It remains controversial as to whether mechanical thrombectomy (MT) is safer and more beneficial in patients with large vessel occlusion stroke (LVOS) presenting with a National Institutes of Health Stroke Scale score ≤ 8. We therefore conducted a meta-analysis of the published data.We searched PubMed and Embase and pooled relevant data in the meta-analyses using fixed effects models. Only studies that directly compared best medical therapy alone (BMT) with MT were included. We used odds ratios to analyze the associations between MT and 90-day functional outcome (evaluated using the modified Rankin Scale (mRS)), mortality, and rates of symptomatic intracerebral hemorrhage (sICH) in patients with LVOS and minor symptoms. Five studies including a total of 581 patients met our inclusion criteria. A significant difference was found that the patients treated with MT were associated with improved 90-day mRS score (OR, 1.68; 95% CI, 1.08-2.61) compared with BMT group. There was no difference in 90-day mortality between the two groups. However, sICH occurred more frequently in the MT group than the BMT group (OR, 3.89; 95% CI, 1.83-8.27). Patients with LVOS with minor or mild symptoms who underwent primary thrombectomy had a significantly improved 90-day mRS score compared to those who received BMT alone. Meanwhile, the risk of sICH was higher in the MT group than that in BMT group. Future randomized clinical controlled trials evaluating the role of endovascular reperfusion for LVOS with minimal symptoms are warranted.
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Affiliation(s)
- Yong-Jie Xiong
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Jia-Ming Gong
- Department of Neurology, Central Hospital of Ankang City, Shanxi, P.R. China
| | - Yi-Chi Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Xin-ling Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Sha-Bei Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Deng-Ji Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Wen-Sheng Qu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Dai-Shi Tian
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
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