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Wouters A, Seners P, Yuen N, Mlynash M, Heit JJ, Kemp S, Demeestere J, Christensen S, Albers GW, Lemmens R, Lansberg MG. Clinical and Imaging Features Associated With Fast Infarct Growth During Interhospital Transfers of Patients With Large Vessel Occlusions. Neurology 2024; 103:e209814. [PMID: 39173104 PMCID: PMC11343586 DOI: 10.1212/wnl.0000000000209814] [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: 04/04/2024] [Accepted: 07/05/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Acute ischemic stroke patients with a large vessel occlusion (LVO) who present to a primary stroke center (PSC) often require transfer to a comprehensive stroke center (CSC) for thrombectomy. Not much is known about specific characteristics at the PSC that are associated with infarct growth during transfer. Gaining more insight into these features could aid future trials with cytoprotective agents targeted at slowing infarct growth. We aimed to identify baseline clinical and imaging characteristics that are associated with fast infarct growth rate (IGR) during interhospital transfer. METHODS We included patients from the CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project, a prospective multicenter study. Patients with an anterior circulation LVO who were transferred from a PSC to a CSC for consideration of thrombectomy were eligible if imaging criteria were fulfilled. A CT perfusion (CTP) needed to be obtained at the PSC followed by an MRI at the CSC, before consideration of thrombectomy. The interhospital IGR was defined as the difference between the infarct volumes on MRI and CTP, divided by the time between the scans. Multivariable logistic regression was used to determine characteristics associated with fast IGR (≥5 mL/h). RESULTS A total of 183 patients with a median age of 74 years (interquartile range 61-82), of whom 99 (54%) were male and 82 (45%) were fast progressors, were included. At baseline, fast progressors had a higher NIH Stroke Scale score (median 16 vs 13), lower cerebral blood volume index (median 0.80 vs 0.89), more commonly poor collaterals on CT angiography (35% vs 13%), higher hypoperfusion intensity ratios (HIRs) (median 0.51 vs 0.34), and larger core volumes (median 11.80 mL vs 0.00 mL). In multivariable analysis, higher HIR (adjusted odds ratio [aOR] for every 0.10 increase 1.32 [95% CI 1.10-1.59]) and larger core volume (aOR for every 10 mL increase 1.54 [95% CI 1.20-2.11]) remained independently associated with fast IGR. DISCUSSION Fast infarct growth during interhospital transfer of acute stroke patients is associated with imaging markers of poor collaterals on baseline imaging. These markers are promising targets for patient selection in cytoprotective trials aimed at reducing interhospital infarct growth.
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Affiliation(s)
- Anke Wouters
- From the Division of Experimental Neurology, Department of Neurosciences (A.W., J.D., R.L.), KU Leuven; Stanford Stroke Center (A.W., P.S., N.Y., M.M., S.K., S.C., G.W.A., M.G.L.), Palo Alto, CA; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM; Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Paris, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; and Department of Neurology (J.D., R.L.), University Hospitals Leuven, Belgium
| | - Pierre Seners
- From the Division of Experimental Neurology, Department of Neurosciences (A.W., J.D., R.L.), KU Leuven; Stanford Stroke Center (A.W., P.S., N.Y., M.M., S.K., S.C., G.W.A., M.G.L.), Palo Alto, CA; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM; Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Paris, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; and Department of Neurology (J.D., R.L.), University Hospitals Leuven, Belgium
| | - Nicole Yuen
- From the Division of Experimental Neurology, Department of Neurosciences (A.W., J.D., R.L.), KU Leuven; Stanford Stroke Center (A.W., P.S., N.Y., M.M., S.K., S.C., G.W.A., M.G.L.), Palo Alto, CA; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM; Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Paris, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; and Department of Neurology (J.D., R.L.), University Hospitals Leuven, Belgium
| | - Michael Mlynash
- From the Division of Experimental Neurology, Department of Neurosciences (A.W., J.D., R.L.), KU Leuven; Stanford Stroke Center (A.W., P.S., N.Y., M.M., S.K., S.C., G.W.A., M.G.L.), Palo Alto, CA; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM; Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Paris, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; and Department of Neurology (J.D., R.L.), University Hospitals Leuven, Belgium
| | - Jeremy J Heit
- From the Division of Experimental Neurology, Department of Neurosciences (A.W., J.D., R.L.), KU Leuven; Stanford Stroke Center (A.W., P.S., N.Y., M.M., S.K., S.C., G.W.A., M.G.L.), Palo Alto, CA; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM; Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Paris, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; and Department of Neurology (J.D., R.L.), University Hospitals Leuven, Belgium
| | - Stephanie Kemp
- From the Division of Experimental Neurology, Department of Neurosciences (A.W., J.D., R.L.), KU Leuven; Stanford Stroke Center (A.W., P.S., N.Y., M.M., S.K., S.C., G.W.A., M.G.L.), Palo Alto, CA; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM; Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Paris, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; and Department of Neurology (J.D., R.L.), University Hospitals Leuven, Belgium
| | - Jelle Demeestere
- From the Division of Experimental Neurology, Department of Neurosciences (A.W., J.D., R.L.), KU Leuven; Stanford Stroke Center (A.W., P.S., N.Y., M.M., S.K., S.C., G.W.A., M.G.L.), Palo Alto, CA; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM; Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Paris, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; and Department of Neurology (J.D., R.L.), University Hospitals Leuven, Belgium
| | - Soren Christensen
- From the Division of Experimental Neurology, Department of Neurosciences (A.W., J.D., R.L.), KU Leuven; Stanford Stroke Center (A.W., P.S., N.Y., M.M., S.K., S.C., G.W.A., M.G.L.), Palo Alto, CA; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM; Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Paris, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; and Department of Neurology (J.D., R.L.), University Hospitals Leuven, Belgium
| | - Gregory W Albers
- From the Division of Experimental Neurology, Department of Neurosciences (A.W., J.D., R.L.), KU Leuven; Stanford Stroke Center (A.W., P.S., N.Y., M.M., S.K., S.C., G.W.A., M.G.L.), Palo Alto, CA; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM; Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Paris, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; and Department of Neurology (J.D., R.L.), University Hospitals Leuven, Belgium
| | - Robin Lemmens
- From the Division of Experimental Neurology, Department of Neurosciences (A.W., J.D., R.L.), KU Leuven; Stanford Stroke Center (A.W., P.S., N.Y., M.M., S.K., S.C., G.W.A., M.G.L.), Palo Alto, CA; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM; Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Paris, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; and Department of Neurology (J.D., R.L.), University Hospitals Leuven, Belgium
| | - Maarten G Lansberg
- From the Division of Experimental Neurology, Department of Neurosciences (A.W., J.D., R.L.), KU Leuven; Stanford Stroke Center (A.W., P.S., N.Y., M.M., S.K., S.C., G.W.A., M.G.L.), Palo Alto, CA; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM; Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Paris, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; and Department of Neurology (J.D., R.L.), University Hospitals Leuven, Belgium
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Verhey LH, Lyons L, Sewell A, Grandfield RM, Khan M, Mazaris P, Singer JA. Aspiration tubing diameter is a key determinant of vacuum pressure and is associated with procedural outcome in mechanical thrombectomy for large vessel occlusion: An experimental and cohort study. Interv Neuroradiol 2024:15910199241272715. [PMID: 39165187 DOI: 10.1177/15910199241272715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND We (1) evaluated the effect of aspiration tubing diameter on intraluminal pressure and (2) compared thrombectomy outcomes in patients treated using small diameter tubing versus those treated using large diameter vacuum tubing. METHODS Intraluminal negative pressure was measured in a validated benchtop set up where consistency of negative pressure (inHg) was measured between static and dynamic aspiration. Static aspiration refers to activation of vacuum once the catheter is engaged with the clot. Dynamic aspiration refers to activation of vacuum when the catheter is slightly proximal to the clot. Four different sizes of vacuum tubing were trialed. We performed a retrospective analysis of consecutive patients who underwent mechanical thrombectomy. Procedural and functional outcomes were compared. RESULTS The large diameter aspiration tubing held a consistent high negative pressure in static and dynamic aspiration (p = 0.152). Tubing types I to III were associated with a significant fall off in negative pressure between static and dynamic technique (p < 0.05). Two-hundred and five patients were included in the retrospective analysis; 124 (60%) underwent thrombectomy using small diameter vacuum tubing, and 81 (40%) using the large tubing. Mean thrombectomy time was shorter with the larger tubing [25.9 (17.9) minutes] versus the small tubing [37.5 (28.5) minutes, p = 0.002]. A greater proportion of patients had a thrombolysis in cerebral infarction score ≥2b in the group treated using the large tubing (78, 99%) than those with the small tubing (96, 78%, p < 0.001). CONCLUSION Vacuum tubing diameter is linearly associated with intraluminal aspiration pressure. These findings have clinical significance as shown by increased recanalization rates and decreased thrombectomy times when large-diameter aspiration tubing is used. Shifting the paradigm toward a flow-based technique using large-bore vacuum tubing ought to be considered.
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Affiliation(s)
- Leonard H Verhey
- Division of Neurological Surgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, MI, USA
- College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Leah Lyons
- Division of Neurological Surgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, MI, USA
| | - Andrea Sewell
- Division of Neurological Surgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, MI, USA
| | | | - Muhib Khan
- College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Division of Neurology, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, MI, USA
| | - Paul Mazaris
- Division of Neurological Surgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, MI, USA
- College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Justin A Singer
- Division of Neurological Surgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, MI, USA
- College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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Miller MM, Wideman B, Khan M, Henninger N. Hypoperfusion Intensity Ratio Is Associated with Early Neurologic Deficit Severity and Deterioration after Mechanical Thrombectomy in Large-Vessel Occlusion Ischemic Stroke. AJNR Am J Neuroradiol 2024; 45:879-886. [PMID: 38816020 DOI: 10.3174/ajnr.a8234] [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: 11/30/2023] [Accepted: 02/09/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND AND PURPOSE The hypoperfusion intensity ratio is a surrogate marker for collateral status and a predictor of infarct growth, malignant cerebral edema, and hemorrhagic transformation. Its utility to predict a poor NIHSS score and early neurologic deterioration after mechanical thrombectomy for large vessel (LVO) versus distal and medium vessel occlusions (DMVO) has not been investigated. The objective of this study was to determine whether the higher hypoperfusion intensity ratio is associated with a worse NIHSS score at 24 hours post-mechanical thrombectomy and early neurologic deterioration in LVO versus DMVO acute ischemic stroke. MATERIALS AND METHODS This was a retrospective study of 231 patients with acute ischemic stroke with LVO or DMVO amenable for mechanical thrombectomy and available CTP for hypoperfusion intensity ratio assessment pre-mechanical thrombectomy. Clinical and imaging characteristics were abstracted from the medical records. The primary outcome was the NIHSS score at 24 hours post-mechanical thrombectomy. The secondary outcome was early neurologic deterioration, defined as a >4-point increase in the NIHSS score between the initial assessment and 24 hours post-mechanical thrombectomy. All analyses were first conducted in the entire cohort and then separately for the LVO versus DMVO groups. RESULTS The optimal hypoperfusion intensity ratio threshold to detect early neurologic deterioration was 0.54. A hypoperfusion intensity ratio ≥ 0.54 was more frequently present in LVO versus DMVO (n = 37 [77.1%] versus n = 11 [22.9%]; P < .001). On multivariable linear regression, the hypoperfusion intensity ratio ≥ 0.54 was independently associated with a worse NIHSS score at 24 hours post-mechanical thrombectomy in the entire cohort (β = 0.163; P = .002) and the LVO group (β = 0.210; P = .005), but not in the DMVO group. The early neurologic deterioration occurred in 26 (11.3%) subjects. On multivariable logistic regression, there was no association of the hypoperfusion intensity ratio ≥ 0.54 with early neurologic deterioration in the entire cohort. However, when analyzed separately, a hypoperfusion intensity ratio ≥ 0.54 significantly increased the odds of early neurologic deterioration in subjects with LVO (OR = 5.263; 95% CI, 1.170-23.674; P = .030) but not in the DMVO group. CONCLUSIONS The hypoperfusion intensity ratio ≥ 0.54 was independently associated with a worse 24-hour post-mechanical thrombectomy NIHSS score and early neurologic deterioration in LVO, but not in DMVO acute ischemic stroke. Pending confirmation in future, prospective studies assessing the hypoperfusion intensity ratio may help identify patients at risk of secondary decline to improve peri-thrombectomy care and clinical decision-making.
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Affiliation(s)
- Małgorzata M Miller
- From the Department of Neurosciences (M.M.M., B.W.), Corewell Health West, Grand Rapids, Michigan
- College of Human Medicine (M.M.M.), Michigan State University, Grand Rapids, Michigan
| | - Brian Wideman
- From the Department of Neurosciences (M.M.M., B.W.), Corewell Health West, Grand Rapids, Michigan
| | - Muhib Khan
- Department of Neurology (M.K.), Mayo Clinic, Rochester, Minnesota
| | - Nils Henninger
- Department of Neurology (N.H.), University of Massachusetts, Chan Medical School Worcester, Massachusetts
- Department of Psychiatry (N.H.), University of Massachusetts, Chan Medical School Worcester, Massachusetts
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Munsch F, Planes D, Fukutomi H, Marnat G, Courret T, Micard E, Chen B, Seners P, Dubos J, Planche V, Coupé P, Dousset V, Lapergue B, Olivot JM, Sibon I, Thiebaut De Schotten M, Tourdias T. Dynamic Evolution of Infarct Volumes at MRI in Ischemic Stroke Due to Large Vessel Occlusion. Neurology 2024; 102:e209427. [PMID: 38815232 DOI: 10.1212/wnl.0000000000209427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The typical infarct volume trajectories in stroke patients, categorized as slow or fast progressors, remain largely unknown. This study aimed to reveal the characteristic spatiotemporal evolutions of infarct volumes caused by large vessel occlusion (LVO) and show that such growth charts help anticipate clinical outcomes. METHODS We conducted a secondary analysis from prospectively collected databases (FRAME, 2017-2019; ETIS, 2015-2022). We selected acute MRI data from anterior LVO stroke patients with witnessed onset, which were divided into training and independent validation datasets. In the training dataset, using Gaussian mixture analysis, we classified the patients into 3 growth groups based on their rate of infarct growth (diffusion volume/time-to-imaging). Subsequently, we extrapolated pseudo-longitudinal models of infarct growth for each group and generated sequential frequency maps to highlight the spatial distribution of infarct growth. We used these charts to attribute a growth group to the independent patients from the validation dataset. We compared their 3-month modified Rankin scale (mRS) with the predicted values based on a multivariable regression model from the training dataset that used growth group as an independent variable. RESULTS We included 804 patients (median age 73.0 years [interquartile range 61.2-82.0 years]; 409 men). The training dataset revealed nonsupervised clustering into 11% (74/703) slow, 62% (437/703) intermediate, and 27% (192/703) fast progressors. Infarct volume evolutions were best fitted with a linear (r = 0.809; p < 0.001), cubic (r = 0.471; p < 0.001), and power (r = 0.63; p < 0.001) function for the slow, intermediate, and fast progressors, respectively. Notably, the deep nuclei and insular cortex were rapidly affected in the intermediate and fast groups with further cortical involvement in the fast group. The variable growth group significantly predicted the 3-month mRS (multivariate odds ratio 0.51; 95% CI 0.37-0.72, p < 0.0001) in the training dataset, yielding a mean area under the receiver operating characteristic curve of 0.78 (95% CI 0.66-0.88) in the independent validation dataset. DISCUSSION We revealed spatiotemporal archetype dynamic evolutions following LVO stroke according to 3 growth phenotypes called slow, intermediate, and fast progressors, providing insight into anticipating clinical outcome. We expect this could help in designing neuroprotective trials aiming at modulating infarct growth before EVT.
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Affiliation(s)
- Fanny Munsch
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - David Planes
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Hikaru Fukutomi
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Gaultier Marnat
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Thomas Courret
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Emilien Micard
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Bailiang Chen
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Pierre Seners
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Johanna Dubos
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Vincent Planche
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Pierrick Coupé
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Vincent Dousset
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Bertrand Lapergue
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Jean Marc Olivot
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Igor Sibon
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Michel Thiebaut De Schotten
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
| | - Thomas Tourdias
- From the Institut de Bio-imagerie IBIO (F.M., J.D., V.D., T.T.), University Bordeaux; Neuroimagerie Diagnostique et Thérapeutique (D.P., G.M., T.C., V.D., T.T.), CHU de Bordeaux, France; Kansai Electric Power Hospital (H.F.), Osaka, Japan; Inserm CIC-IT U1433 (E.M., B.C.), CHRU Nancy; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), INSERM U1266; Département de Neurologie (P.S.), Hopital Fondation Rothschild, Paris; Institut des Maladies Neurodégénératives (V.P.), CNRS, UMR 5293, Bordeaux INP (P.C.), LABRI, CNRS, UMR5800, and Neurocentre Magendie (V.D., T.T.), INSERM U1215, Univ. Bordeaux; Service de Neurologie et Unité de Neuro Vasculaire (B.L.), Hôpital FOCH, Suresnes; Unité Neurovasculaire (J.M.O.), CHU de Toulouse; Unité Neurovasculaire (I.S.), CHU de Bordeaux; CNRS (M.T.D.S.), UMR-5293, Univ. Bordeaux; and Brain Connectivity and Behaviour Laboratory (M.T.D.S.), Paris, France
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5
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Sablić S, Dolić K, Budimir Mršić D, Čičmir-Vestić M, Matana A, Lovrić Kojundžić S, Marinović Guić M. Communicating Arteries and Leptomeningeal Collaterals: A Synergistic but Independent Effect on Patient Outcomes after Stroke. Neurol Int 2024; 16:620-630. [PMID: 38921950 PMCID: PMC11206870 DOI: 10.3390/neurolint16030046] [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: 04/25/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
The collateral system is a compensatory mechanism activated in the acute phase of an ischemic stroke. It increases brain perfusion to the hypoperfused area. Arteries of the Willis' circle supply antegrade blood flow, while pial (leptomeningeal) arteries direct blood via retrograde flow. The aim of our retrospective study was to investigate the relationship between both collateral systems, computed tomography perfusion (CTP) values, and functional outcomes in acute stroke patients. Overall, 158 patients with anterior circulation stroke who underwent mechanical thrombectomy were included in the study. We analyzed the presence of communicating arteries and leptomeningeal arteries on computed tomography angiography. Patients were divided into three groups according to their collateral status. The main outcomes were the rate of functional independence 3 months after stroke (modified Rankin scale score, mRS) and mortality rate. Our study suggests that the collateral status, as indicated by the three groups (unfavorable, intermediate, and favorable), is linked to CT perfusion parameters, potential recuperation ratio, and stroke outcomes. Patients with favorable collateral status exhibited smaller core infarct and penumbra volumes, higher mismatch ratios, better potential for recuperation, and improved functional outcomes compared to patients with unfavorable or intermediate collateral status.
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Affiliation(s)
- Sara Sablić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia; (S.S.); (K.D.); (D.B.M.); (S.L.K.)
| | - Krešimir Dolić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia; (S.S.); (K.D.); (D.B.M.); (S.L.K.)
- School of Medicine, University of Split, 21000 Split, Croatia
- University Department of Health Studies, University of Split, 21000 Split, Croatia;
| | - Danijela Budimir Mršić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia; (S.S.); (K.D.); (D.B.M.); (S.L.K.)
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Mate Čičmir-Vestić
- Department of Neurology, University Hospital of Split, 21000 Split, Croatia;
| | - Antonela Matana
- University Department of Health Studies, University of Split, 21000 Split, Croatia;
| | - Sanja Lovrić Kojundžić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia; (S.S.); (K.D.); (D.B.M.); (S.L.K.)
- School of Medicine, University of Split, 21000 Split, Croatia
- University Department of Health Studies, University of Split, 21000 Split, Croatia;
| | - Maja Marinović Guić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia; (S.S.); (K.D.); (D.B.M.); (S.L.K.)
- School of Medicine, University of Split, 21000 Split, Croatia
- University Department of Health Studies, University of Split, 21000 Split, Croatia;
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6
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Rodrigo-Gisbert M, García-Tornel A, Requena M, Vielba-Gómez I, Bashir S, Rubiera M, De Dios Lascuevas M, Olivé-Gadea M, Piñana C, Rizzo F, Muchada M, Rodriguez-Villatoro N, Rodríguez-Luna D, Juega J, Pagola J, Hernández D, Molina CA, Terceño M, Tomasello A, Ribo M. Clinico-radiological features of intracranial atherosclerosis-related large vessel occlusion prior to endovascular treatment. Sci Rep 2024; 14:2945. [PMID: 38316891 PMCID: PMC10844212 DOI: 10.1038/s41598-024-53354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/31/2024] [Indexed: 02/07/2024] Open
Abstract
The identification of large vessel occlusion with underlying intracranial atherosclerotic disease (ICAS-LVO) before endovascular treatment (EVT) continues to be a challenge. We aimed to analyze baseline clinical-radiological features associated with ICAS-LVO that could lead to a prompt identification. We performed a retrospective cross-sectional study of consecutive patients with stroke treated with EVT from January 2020 to April 2022. We included anterior LVO involving intracranial internal carotid artery and middle cerebral artery. We analyzed baseline clinical and radiological variables associated with ICAS-LVO and evaluated the diagnostic value of a multivariate logistic regression model to identify ICAS-LVO before EVT. ICAS-LVO was defined as presence of angiographic residual stenosis or a trend to re-occlusion during EVT procedure. A total of 338 patients were included in the study. Of them, 28 patients (8.3%) presented with ICAS-LVO. After adjusting for confounders, absence of atrial fibrillation (OR 9.33, 95% CI 1.11-78.42; p = 0.040), lower hypoperfusion intensity ratio (HIR [Tmax > 10 s/Tmax > 6 s ratio], (OR 0.69, 95% CI 0.50-0.95; p = 0.025), symptomatic intracranial artery calcification (IAC, OR .15, 95% CI 1.64-26.42, p = 0.006), a more proximal occlusion (ICA, MCA-M1: OR 4.00, 95% CI 1.23-13.03; p = 0.021), and smoking (OR 2.91, 95% CI 1.08-7.90; p = 0.035) were associated with ICAS-LVO. The clinico-radiological model showed an overall well capability to identify ICAS-LVO (AUC = 0.88, 95% CI 0.83-0.94; p < 0.001). In conclusion, a combination of clinical and radiological features available before EVT can help to identify an ICAS-LVO. This approach could be useful to perform a rapid assessment of underlying etiology and suggest specific pathophysiology-based measures. Prospective studies are needed to validate these findings in other populations.
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Affiliation(s)
- Marc Rodrigo-Gisbert
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alvaro García-Tornel
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Isabel Vielba-Gómez
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Saima Bashir
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Marta Olivé-Gadea
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Piñana
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Federica Rizzo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marian Muchada
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Noelia Rodriguez-Villatoro
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Rodríguez-Luna
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesus Juega
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Hernández
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mikel Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Alejandro Tomasello
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
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7
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Seners P, Yuen N, Olivot JM, Mlynash M, Heit JJ, Christensen S, Escribano-Paredes JB, Carrera E, Strambo D, Michel P, Salerno A, Wintermark M, Chen H, Albucher JF, Cognard C, Sibon I, Obadia M, Savatovsky J, Lansberg MG, Albers GW. Factors Associated With Fast Early Infarct Growth in Patients With Acute Ischemic Stroke With a Large Vessel Occlusion. Neurology 2023; 101:e2126-e2137. [PMID: 37813579 PMCID: PMC10663035 DOI: 10.1212/wnl.0000000000207908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/15/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The optimal methods for predicting early infarct growth rate (EIGR) in acute ischemic stroke with a large vessel occlusion (LVO) have not been established. We aimed to study the factors associated with EIGR, with a focus on the collateral circulation as assessed by the hypoperfusion intensity ratio (HIR) on perfusion imaging, and determine whether the associations found are consistent across imaging modalities. METHODS Retrospective multicenter international study including patients with anterior circulation LVO-related acute stroke with witnessed stroke onset and baseline perfusion imaging (MRI or CT) performed within 24 hours from symptom onset. To avoid selection bias, patients were selected from (1) the prospective registries of 4 comprehensive stroke centers with systematic use of perfusion imaging and including both thrombectomy-treated and untreated patients and (2) 1 prospective thrombectomy study where perfusion imaging was acquired per protocol, but treatment decisions were made blinded to the results. EIGR was defined as infarct volume on baseline imaging divided by onset-to-imaging time and fast progressors as EIGR ≥10 mL/h. The HIR, defined as the proportion of time-to-maximum (Tmax) >6 second with Tmax >10 second volume, was measured on perfusion imaging using RAPID software. The factors independently associated with fast progression were studied using multivariable logistic regression models, with separate analyses for CT- and MRI-assessed patients. RESULTS Overall, 1,127 patients were included (CT, n = 471; MRI, n = 656). Median age was 74 years (interquartile range [IQR] 62-83), 52% were male, median NIH Stroke Scale was 16 (IQR 9-21), median HIR was 0.42 (IQR 0.26-0.58), and 415 (37%) were fast progressors. The HIR was the primary factor associated with fast progression, with very similar results across imaging modalities: The proportion of fast progressors was 4% in the first HIR quartile (i.e., excellent collaterals), ∼15% in the second, ∼50% in the third, and ∼77% in the fourth (p < 0.001 for each imaging modality). Fast progression was independently associated with poor 3-month functional outcome in both the CT and MRI cohorts (p < 0.001 and p = 0.030, respectively). DISCUSSION The HIR is the primary factor associated with fast infarct progression, regardless of imaging modality. These results have implication for neuroprotection trial design, as well as informing triage decisions at primary stroke centers.
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Affiliation(s)
- Pierre Seners
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France.
| | - Nicole Yuen
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Jean-Marc Olivot
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Michael Mlynash
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Jeremy J Heit
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Soren Christensen
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - José Bernardo Escribano-Paredes
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Emmanuel Carrera
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Davide Strambo
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Patrik Michel
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Alexander Salerno
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Max Wintermark
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Hui Chen
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Jean-François Albucher
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Christophe Cognard
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Igor Sibon
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Michael Obadia
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Julien Savatovsky
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Maarten G Lansberg
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
| | - Gregory W Albers
- From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France
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Seners P, Scheldeman L, Christensen S, Mlynash M, Ter Schiphorst A, Arquizan C, Costalat V, Henon H, Bretzner M, Heit JJ, Olivot JM, Lansberg MG, Albers GW. Determinants of Infarct Core Growth During Inter-hospital Transfer for Thrombectomy. Ann Neurol 2023; 93:1117-1129. [PMID: 36748945 DOI: 10.1002/ana.26613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/09/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Patients with acute ischemic stroke harboring a large vessel occlusion who present to primary stroke centers often require inter-hospital transfer for thrombectomy. We aimed to determine clinical and imaging factors independently associated with fast infarct growth (IG) during inter-hospital transfer. METHODS We retrospectively analyzed data from acute stroke patients with a large vessel occlusion transferred for thrombectomy from a primary stroke center to one of three French comprehensive stroke centers, with an MRI obtained at both the primary and comprehensive center before thrombectomy. Inter-hospital IG rate was defined as the difference in infarct volumes on diffusion-weighted imaging between the primary and comprehensive center, divided by the delay between the two MRI scans. The primary outcome was identification of fast progressors, defined as IG rate ≥5 mL/hour. The hypoperfusion intensity ratio (HIR), a surrogate marker of collateral blood flow, was automatically measured on perfusion imaging. RESULTS A total of 233 patients were included, of whom 27% patients were fast progressors. The percentage of fast progressors was 3% among patients with HIR < 0.40 and 71% among those with HIR ≥ 0.40. In multivariable analysis, fast progression was independently associated with HIR, intracranial carotid artery occlusion, and exclusively deep infarct location at the primary center (C-statistic = 0.95; 95% confidence interval [CI], 0.93-0.98). IG rate was independently associated with good functional outcome (adjusted OR = 0.91; 95% CI, 0.83-0.99; P = 0.037). INTERPRETATION Our findings show that a HIR > 0.40 is a powerful indicator of fast inter-hospital IG. These results have implication for neuroprotection trial design, as well as informing triage decisions at primary stroke centers. ANN NEUROL 2023.
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Affiliation(s)
- Pierre Seners
- Stanford Stroke Center, Stanford University, Palo Alto, CA.,Neurology Department, A. de Rothschild Foundation Hospital, Paris, France.,Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris, Paris, France
| | - Lauranne Scheldeman
- Stanford Stroke Center, Stanford University, Palo Alto, CA.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, Experimental Neurology KU Leuven, University of Leuven, Leuven, Belgium.,Center for Brain and Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
| | | | | | | | | | - Vincent Costalat
- Neuroradiology Department, CHRU Gui de Chauliac, Montpellier, France
| | - Hilde Henon
- Stroke Center, University of Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, Lille, France
| | | | - Jeremy J Heit
- Neuroradiology Department, Stanford University, Palo Alto, CA
| | - Jean-Marc Olivot
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse and Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
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Mohammaden MH, Doheim MF, Elfil M, Al-Bayati AR, Pinheiro A, Nguyen TN, Bhatt NR, Haussen DC, Nogueira RG. Direct to Angiosuite Versus Conventional Imaging in Suspected Large Vessel Occlusion: A Systemic Review and Meta-Analysis. Stroke 2022; 53:2478-2487. [PMID: 35593152 DOI: 10.1161/strokeaha.121.038221] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is growing evidence to suggest that the direct transfer to angiography suite (DTAS) approach for patients with suspected large vessel occlusion stroke potentially requiring mechanical thrombectomy shortens treatment times and improves outcomes compared with the direct transfer to conventional imaging (DTCI) model. Therefore, we conducted this meta-analysis to compare both approaches to build more concrete evidence to support this innovative treatment concept. METHODS All potentially relevant studies published in 4 electronic databases/search engines (PubMed, Web of Science, Cochrane Library, and Scopus) from inception to November 2021 were reviewed. Eligible studies were included if they enrolled ≥10 patients in both groups, were published in English, and reported baseline and procedural characteristics and outcomes. Relevant data were then extracted and analyzed. RESULTS Among 4514 searched studies, 7 qualified for the analysis with 1971 patients (DTAS=675, DTCI=1296). Times from door to puncture (mean difference, -30.76 minutes [95% CI, -43.70 to -17.82]; P<0.001) as well as door-to-reperfusion (mean difference=-33.24 minutes [95% CI, -51.82 to -14.66]; P<0.001) were significantly shorter and the rates of functional independence (modified Rankin Scale score, 0-2: risk ratio [RR], 1.25 [95% CI, 1.02-1.53]; P=0.03) at 90 days were higher in the DTAS versus the DTCI approach. There was no difference across the DTAS and DTCI groups in terms of the rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2B-3: RR, 1.03 [95% CI, 0.95-1.12]; P=0.42), near-complete/full reperfusion (modified Thrombolysis in Cerebral Infarction 2C-3: RR, 0.89 [95% CI, 0.74-1.08]; P=0.23), symptomatic intracranial hemorrhage (RR, 0.81 [95% CI, 0.56-1.17]; P=0.26), or fair outcomes (modified Rankin Scale score, 0-3: RR, 1.14 [95% CI, 0.88-1.47]; P=0.32) or mortality (RR, 0.98 [95% CI, 0.67-1.44]; P=0.93) at 90 days. Subgroup analysis showed no significant difference in 90-day functional independence across approaches in transfer patients (RR, 1.20 [95% CI, 0.96-1.51]; P=0.11). CONCLUSIONS Our meta-analysis showed that the DTAS approach seems to be associated with improved time metrics and functional outcomes with comparable safety to the DTCI approach. Ongoing multicenter randomized clinical trials will hopefully provide more definite data about this promising approach.
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Affiliation(s)
- Mahmoud H Mohammaden
- Department of Neurology, Marcus Stroke & Neuroscience Center, Emory University School of Medicine (M.H.M., A.R.A.-B., A.P., N.R.B., D.C.H., R.G.N.).,Grady Memorial Hospital, Atlanta, GA (M.H.M., A.R.A.-B., A.P., N.R.B., D.C.H., R.G.N.)
| | | | - Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha (M.E.)
| | - Alhamza R Al-Bayati
- Department of Neurology, Marcus Stroke & Neuroscience Center, Emory University School of Medicine (M.H.M., A.R.A.-B., A.P., N.R.B., D.C.H., R.G.N.).,Grady Memorial Hospital, Atlanta, GA (M.H.M., A.R.A.-B., A.P., N.R.B., D.C.H., R.G.N.)
| | - Agostinho Pinheiro
- Department of Neurology, Marcus Stroke & Neuroscience Center, Emory University School of Medicine (M.H.M., A.R.A.-B., A.P., N.R.B., D.C.H., R.G.N.).,Grady Memorial Hospital, Atlanta, GA (M.H.M., A.R.A.-B., A.P., N.R.B., D.C.H., R.G.N.)
| | - Thanh N Nguyen
- Department of Neurology, Boston University School of Medicine, MA (T.N.N.)
| | - Nirav R Bhatt
- Department of Neurology, Marcus Stroke & Neuroscience Center, Emory University School of Medicine (M.H.M., A.R.A.-B., A.P., N.R.B., D.C.H., R.G.N.).,Grady Memorial Hospital, Atlanta, GA (M.H.M., A.R.A.-B., A.P., N.R.B., D.C.H., R.G.N.)
| | - Diogo C Haussen
- Department of Neurology, Marcus Stroke & Neuroscience Center, Emory University School of Medicine (M.H.M., A.R.A.-B., A.P., N.R.B., D.C.H., R.G.N.).,Grady Memorial Hospital, Atlanta, GA (M.H.M., A.R.A.-B., A.P., N.R.B., D.C.H., R.G.N.)
| | - Raul G Nogueira
- Department of Neurology, Marcus Stroke & Neuroscience Center, Emory University School of Medicine (M.H.M., A.R.A.-B., A.P., N.R.B., D.C.H., R.G.N.).,Grady Memorial Hospital, Atlanta, GA (M.H.M., A.R.A.-B., A.P., N.R.B., D.C.H., R.G.N.)
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