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Predicting a Favorable (mRS 0-2) or Unfavorable (mRS 3-6) Stroke Outcome by Arterial Spin Labeling and Amide Proton Transfer Imaging in Post-Thrombolysis Stroke Patients. J Pers Med 2023; 13:jpm13020248. [PMID: 36836482 PMCID: PMC9962289 DOI: 10.3390/jpm13020248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023] Open
Abstract
(1) Background: The objective of this study was to determine whether arterial spin labeling (ASL), amide proton transfer (APT), or their combination could distinguish between patients with a low and high modified Rankin Scale (mRS) and forecast the effectiveness of the therapy; (2) Methods: Fifty-eight patients with subacute phase ischemic stroke were included in this study. Based on cerebral blood flow (CBF) and asymmetry magnetic transfer ratio (MTRasym) images, histogram analysis was performed on the ischemic area to acquire imaging biomarkers, and the contralateral area was used as a control. Imaging biomarkers were compared between the low (mRS 0-2) and high (mRS 3-6) mRS score groups using the Mann-Whitney U test. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of the potential biomarkers in differentiating between the two groups; (3) Results: The rAPT 50th had an area under the ROC curve (AUC) of 0.728, with a sensitivity of 91.67% and a specificity of 61.76% for differentiating between patients with low and high mRS scores. Moreover, the AUC, sensitivity, and specificity of the rASL max were 0.926, 100%, and 82.4%, respectively. Combining the parameters with logistic regression could further improve the performance in predicting prognosis, leading to an AUC of 0.968, a sensitivity of 100%, and a specificity of 91.2%; (4) Conclusions: The combination of APT and ASL may be a potential imaging biomarker to reflect the effectiveness of thrombolytic therapy for stroke patients, assisting in guiding treatment approaches and identifying high-risk patients such as those with severe disability, paralysis, and cognitive impairment.
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Hernández-Pérez M, Werner M, Remollo S, Martín C, Cortés J, Valls A, Ramos A, Dorado L, Serena J, Munuera J, Puig J, Pérez de la Ossa N, Gomis M, Carbonell J, Castaño C, Muñoz-Narbona L, Palomeras E, Domenech S, Massuet A, Terceño M, Davalos A, Millán M. Early and Delayed Infarct Growth in Patients Undergoing Mechanical Thrombectomy: A Prospective, Serial MRI Study. Stroke 2023; 54:217-225. [PMID: 36325911 DOI: 10.1161/strokeaha.122.039090] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND We studied the evolution over time of diffusion weighted imaging (DWI) lesion volume and the factors involved on early and late infarct growth (EIG and LIG) in stroke patients undergoing endovascular treatment (EVT) according to the final revascularization grade. METHODS This is a prospective cohort of patients with anterior large artery occlusion undergoing EVT arriving at 1 comprehensive stroke center. Magnetic resonance imaging was performed on arrival (pre-EVT), <2 hours after EVT (post-EVT), and on day 5. DWI lesions and perfusion maps were evaluated. Arterial revascularization was assessed according to the modified Thrombolysis in Cerebral Infarction (mTICI) grades. We recorded National Institutes of Health Stroke Scale at arrival and at day 7. EIG was defined as (DWI volume post-EVT-DWI volume pre-EVT), and LIG was defined as (DWI volume at 5d-DWI volume post-EVT). Factors involved in EIG and LIG were tested via multivariable lineal models. RESULTS We included 98 patients (mean age 70, median National Institutes of Health Stroke Scale score 17, final mTICI≥2b 86%). Median EIG and LIG were 48 and 63.3 mL in patients with final mTICI<2b, and 3.6 and 3.9 cc in patients with final mTICI≥2b. Both EIG and LIG were associated with higher National Institutes of Health Stroke Scale at day 7 (ρ=0.667; P<0.01 and ρ=0.614; P<0.01, respectively). In patients with final mTICI≥2b, each 10% increase in the volume of DWI pre-EVT and each extra pass leaded to growths of 9% (95% CI, 7%-10%) and 14% (95% CI, 2%-28%) in the DWI volume post-EVT, respectively. Furthermore, each 10% increase in the volume of DWI post-EVT, each extra pass, and each 10 mL increase in TMax6s post-EVT were associated with growths of 8% (95% CI, 6%-9%), 9% (95% CI, 0%-19%), and 12% (95% CI, 5%-20%) in the volume of DWI post-EVT, respectively. CONCLUSIONS Infarct grows during and after EVT, especially in nonrecanalizers but also to a lesser extent in recanalizers. In recanalizers, number of passes and DWI volume influence EIG, while number of passes, DWI, and hypoperfused volume after the procedure determine LIG.
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Affiliation(s)
- María Hernández-Pérez
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Mariano Werner
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Sebastián Remollo
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Carlota Martín
- Universitat Politècnica de Catalunya, Statistics Faculty, Badalona, Spain (C.M., J.C.)
| | - Jordi Cortés
- Universitat Politècnica de Catalunya, Statistics Faculty, Badalona, Spain (C.M., J.C.)
| | - Adrian Valls
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Anna Ramos
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Laura Dorado
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Joaquin Serena
- Department of Neurology, Stroke Unit, Dr Josep Trueta University Hospital, Girona, Spain (J.S., M.T.)
| | - Josep Munuera
- Diagnostic Imaging, Sant Joan de Dèu Hospital, Esplugues de Llobregat, Barcelona, Spain (J.M.)
| | - Josep Puig
- Department of Radiology, IDIBGI Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain (J.P.)
| | - Natalia Pérez de la Ossa
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Meritxell Gomis
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Jaime Carbonell
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Carlos Castaño
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Lucia Muñoz-Narbona
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Ernest Palomeras
- Department of Medicine, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain (E.P.)
| | - Sira Domenech
- Diagnostic Imaging Institute, Germans Trias i Pujol University Hospital, Spain (S.D., A.M.)
| | - Anna Massuet
- Diagnostic Imaging Institute, Germans Trias i Pujol University Hospital, Spain (S.D., A.M.)
| | - Mikel Terceño
- Department of Neurology, Stroke Unit, Dr Josep Trueta University Hospital, Girona, Spain (J.S., M.T.)
| | - Antoni Davalos
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Monica Millán
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
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Kerleroux B, Janot K, Hak JF, Kaesmacher J, Hassen WB, Benzakoun J, Oppenheim C, Herbreteau D, Ifergan H, Bricout N, Henon H, Yoshimoto T, Inoue M, Consoli A, Costalat V, Naggara O, Lapergue B, Cagnazzo F, Boulouis G. Mechanical Thrombectomy in Patients with a Large Ischemic Volume at Presentation: Systematic Review and Meta-Analysis. J Stroke 2021; 23:358-366. [PMID: 34649380 PMCID: PMC8521249 DOI: 10.5853/jos.2021.00724] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/12/2021] [Indexed: 12/25/2022] Open
Abstract
The benefits of mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) and a large ischemic core (LIC) at presentation are uncertain. We aimed to obtain up-to-date aggregate estimates of the outcomes following MT in patients with volumetrically assessed LIC. We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-conformed, PROSPERO-registered, systematic review and meta-analysis of studies that included patients with AIS and a baseline LIC treated with MT, reported ischemic core volume quantitatively, and included patients with a LIC defined as a core volume ≥50 mL. The search was restricted to studies published between January 2015 and June 2020. Random-effects-meta-analysis was used to assess the effect of MT on 90-day unfavorable outcome (i.e., modified Rankin Scale [mRS] 3–6), mortality, and symptomatic intracranial hemorrhage (sICH) occurrence. Sensitivity analyses were performed for imaging-modality (computed tomography-perfusion or magnetic resonance-diffusion weighted imaging) and LIC-definition (≥50 or ≥70 mL). We analyzed 10 studies (954 patients), including six (682 patients) with a control group, allowing to compare 332 patients with MT to 350 who received best-medical-management alone. Overall, after MT the rate of patients with mRS 3–6 at 90 days was 74% (99% confidence interval [CI], 67 to 84; Z-value=7.04; I2=92.3%) and the rate of 90-day mortality was 36% (99% CI, 33 to 40; Z-value=–7.07; I2=74.5). Receiving MT was associated with a significant decrease in mRS 3–6 odds ratio (OR) 0.19 (99% CI, 0.11 to 0.33; P<0.01; Z-value=–5.92; I2=62.56) and in mortality OR 0.60 (99% CI, 0.34 to 1.06; P=0.02; Z-value=–2.30; I2=58.72). Treatment group did not influence the proportion of patients experiencing sICH, OR 0.96 (99% CI, 0.2 to 1.49; P=0.54; Z-value=–0.63; I2=64.74). Neither imaging modality for core assessment, nor LIC definition influenced the aggregated outcomes. Using aggregate estimates, MT appeared to decrease the risk of unfavorable functional outcome in patients with a LIC assessed volumetrically at baseline.
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Affiliation(s)
- Basile Kerleroux
- Department of Neuroradiology, GHU Paris, Sainte Anne Hospital Pscyhiatry and Neurosciences Institute (IPNP), UMR_S1266, INSERM, University of Paris, Tours, France
| | - Kevin Janot
- Department of Neuroradiology, University Hospital of Tours, Tours, France
| | - Jean François Hak
- Department of Neuroradiology, University Hospital of Marseille La Timone, Marseille, France
| | - Johannes Kaesmacher
- Institute of Diagnostic, Interventional and Pediatric Radiology and Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Wagih Ben Hassen
- Department of Neuroradiology, GHU Paris, Sainte Anne Hospital Pscyhiatry and Neurosciences Institute (IPNP), UMR_S1266, INSERM, University of Paris, Tours, France
| | - Joseph Benzakoun
- Department of Neuroradiology, GHU Paris, Sainte Anne Hospital Pscyhiatry and Neurosciences Institute (IPNP), UMR_S1266, INSERM, University of Paris, Tours, France
| | - Catherine Oppenheim
- Department of Neuroradiology, GHU Paris, Sainte Anne Hospital Pscyhiatry and Neurosciences Institute (IPNP), UMR_S1266, INSERM, University of Paris, Tours, France
| | - Denis Herbreteau
- Department of Neuroradiology, University Hospital of Tours, Tours, France
| | - Heloise Ifergan
- Department of Neuroradiology, University Hospital of Tours, Tours, France
| | - Nicolas Bricout
- Diagnostic and Interventional Neuroradiology, University Hospital of Lille, Lille, France
| | - Hilde Henon
- Neuroradiology Department and Stroke Unit, University Hospital of Lille, Lille, France
| | - Takeshi Yoshimoto
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center, Suita, Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center, Suita, Japan
| | - Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - Vincent Costalat
- Neuroradiology Department, University Hospital of Gui de Chauliac, Montpellier, France
| | - Olivier Naggara
- Department of Neuroradiology, GHU Paris, Sainte Anne Hospital Pscyhiatry and Neurosciences Institute (IPNP), UMR_S1266, INSERM, University of Paris, Tours, France
| | - Bertrand Lapergue
- Department of Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - Federico Cagnazzo
- Neuroradiology Department, University Hospital of Gui de Chauliac, Montpellier, France
| | - Grégoire Boulouis
- Department of Neuroradiology, GHU Paris, Sainte Anne Hospital Pscyhiatry and Neurosciences Institute (IPNP), UMR_S1266, INSERM, University of Paris, Tours, France.,Department of Neuroradiology, University Hospital of Tours, Tours, France
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4
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Ben Hassen W, Touloupas C, Benzakoun J, Boulouis G, Bretzner M, Bricout N, Legrand L, Rodriguez C, Le Berre A, Seners P, Turc G, Cordonnier C, Oppenheim C, Henon H, Naggara O. Impact of Repeated Clot Retrieval Attempts on Infarct Growth and Outcome After Ischemic Stroke. Neurology 2021; 97:e444-e453. [PMID: 34162721 DOI: 10.1212/wnl.0000000000012321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/23/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether the association between increasing number of clot retrieval attempts (CRA) and unfavorable outcome is due to an increase in emboli to new territory (ENT) and greater infarct growth (IG) in successfully recanalized patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). METHODS Data were extracted from 2 pooled multicentric prospective registries of consecutive patients with anterior AIS-LVO treated with mechanical thrombectomy (MT) between January 2016 and 2019. Patients with pretreatment and 24-hour posttreatment diffusion-weighted imaging (DWI) achieving successful recanalization, defined as expanded Thrombolysis in Cerebral Infarction Scale score of 2B, 2C, or 3, were included. ENT were assessed and IG was measured by voxel-based segmentation after DWI coregistration. Associations between number of CRA, ENT, IG, and 3-month outcome were analyzed. RESULTS Four hundred nineteen patients achieving successful recanalization were included. ENT occurrence was strongly correlated with increasing CRA (ρ = 0.73, p = 10-4). In multivariable linear analysis, IG was independently associated with CRA (β = 1.6 per retrieval attempt, 95% confidence interval [CI] 0.97-9.74, p = 0.03) and ENT (β = 2.7 [95% CI 1.21-4.1], p = 0.03). Unfavorable functional outcome (3-month modified Rankin Scale score >2) increased with each additional CRA. IG was an independent predictor of unfavorable outcome (odds ratio 1.05 [95% CI 1.02-1.07] per 1-mL IG increase, p = 10-4) in binary logistic regression analysis. CONCLUSIONS Increasing number of CRA in acute stroke is correlated with an increased ENT rate and increased IG volume, affecting functional outcome even when successful recanalization is achieved. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that, for patients with acute stroke undergoing successful recanalization, an increasing number of CRA is associated with poorer functional outcome.
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Affiliation(s)
- Wagih Ben Hassen
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France.
| | - Caroline Touloupas
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
| | - Joseph Benzakoun
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
| | - Gregoire Boulouis
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
| | - Martin Bretzner
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
| | - Nicolas Bricout
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
| | - Laurence Legrand
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
| | - Christine Rodriguez
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
| | - Alice Le Berre
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
| | - Pierre Seners
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
| | - Guillaume Turc
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
| | - Charlotte Cordonnier
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
| | - Catherine Oppenheim
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
| | - Hilde Henon
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
| | - Olivier Naggara
- From GHU Paris (W.B.H., C.T., J.B., G.B., L.L., C.R., P.S., G.T., C.O., O.N.), Université de Paris, INSERM UMR 1266, Department of Neuroradiology; Department of Interventional Neuroradiology (M.B., N.B.), CHU Lille; Hôpital Saint Joseph (A.L.B.), Department of Radiology, Paris; and Department of Neurology (C.C., H.H.), Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France
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5
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Pruvost-Robieux E, Benzakoun J, Turc G, Marchi A, Mancusi RL, Lamy C, Domigo V, Oppenheim C, Calvet D, Baron JC, Mas JL, Gavaret M. Cathodal Transcranial Direct Current Stimulation in Acute Ischemic Stroke: Pilot Randomized Controlled Trial. Stroke 2021; 52:1951-1960. [PMID: 33866820 DOI: 10.1161/strokeaha.120.032056] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Estelle Pruvost-Robieux
- Neurophysiology Department (E.P.-R., A.M., M.G.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Joseph Benzakoun
- Neuroradiology Department (J.B., C.O.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Guillaume Turc
- Neurology Department (G.T., C.L., V.D., D.C., J.-C.B., J.-L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Angela Marchi
- Neurophysiology Department (E.P.-R., A.M., M.G.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Rossella Letizia Mancusi
- Délégation à la Recherche Clinique et à l'Innovation (R.L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris
| | - Catherine Lamy
- Neurology Department (G.T., C.L., V.D., D.C., J.-C.B., J.-L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris
| | - Valérie Domigo
- Neurology Department (G.T., C.L., V.D., D.C., J.-C.B., J.-L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris
| | - Catherine Oppenheim
- Neuroradiology Department (J.B., C.O.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - David Calvet
- Neurology Department (G.T., C.L., V.D., D.C., J.-C.B., J.-L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Jean-Claude Baron
- Neurology Department (G.T., C.L., V.D., D.C., J.-C.B., J.-L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Jean-Louis Mas
- Neurology Department (G.T., C.L., V.D., D.C., J.-C.B., J.-L.M.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
| | - Martine Gavaret
- Neurophysiology Department (E.P.-R., A.M., M.G.), GHU Paris Psychiatrie et Neurosciences, Sainte Anne Hospital, Paris.,Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France (E.P.-R., J.B., G.T., C.O., D.C., J.-C.B., J.-L.M., M.G.).,FHU Neurovasc, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR 1266 (E.P.-R., J.B., G.T., A.M., C.O., D.C., J.-C.B., J.-L.M., M.G.)
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6
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Lin L, Yang J, Chen C, Tian H, Bivard A, Spratt NJ, Levi CR, Parsons MW. Association of Collateral Status and Ischemic Core Growth in Patients With Acute Ischemic Stroke. Neurology 2020; 96:e161-e170. [PMID: 33262233 DOI: 10.1212/wnl.0000000000011258] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 08/12/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that patients with acute ischemic stroke with poorer collaterals would have faster ischemic core growth, we included 2 cohorts in the study: cohort 1 of 342 patients for derivation and cohort 2 of 414 patients for validation. METHODS Patients with acute ischemic stroke with large vessel occlusion were included. Core growth rate was calculated by the following equation: core growth rate = acute core volume on CT perfusion (CTP)/time from stroke onset to CTP. Collateral status was assessed by the ratio of severe hypoperfusion volume within the hypoperfusion region of CTP. The CTP collateral index was categorized in tertiles; for each tertile, core growth rate was summarized as median and interquartile range. Simple linear regressions were then performed to measure the predictive power of CTP collateral index in core growth rate. RESULTS For patients allocated to good collateral on CTP (tertile 1 of collateral index), moderate collateral (tertile 2), and poor collateral (tertile 3), the median core growth rate was 2.93 mL/h (1.10-7.94), 8.65 mL/h (4.53-18.13), and 25.41 mL/h (12.83-45.07), respectively. Increments in the collateral index by 1% resulted in an increase of core growth by 0.57 mL/h (coefficient 0.57, 95% confidence interval [0.46, 0.68], p < 0.001). The relationship of core growth and CTP collateral index was validated in cohort 2. An increment in collateral index by 1% resulted in an increase of core growth by 0.59 mL/h (coefficient 0.59 [0.48-0.71], p < 0.001) in cohort 2. CONCLUSION Collateral status is a major determinant of ischemic core growth.
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Affiliation(s)
- Longting Lin
- From the Department of Neurology (L.L., J.Y.), Ningbo First Hospital, China; School of Medicine and Public Health (L.L., C.C., H.T., N.J.S., C.R.L., M.W.P.), University of Newcastle; Melbourne Brain Centre at Royal Melbourne Hospital (A.B., M.W.P.), University of Melbourne; and The Sydney Partnership for Health, Education, Research and Enterprise (C.R.L.), Australia
| | - Jianhong Yang
- From the Department of Neurology (L.L., J.Y.), Ningbo First Hospital, China; School of Medicine and Public Health (L.L., C.C., H.T., N.J.S., C.R.L., M.W.P.), University of Newcastle; Melbourne Brain Centre at Royal Melbourne Hospital (A.B., M.W.P.), University of Melbourne; and The Sydney Partnership for Health, Education, Research and Enterprise (C.R.L.), Australia
| | - Chushuang Chen
- From the Department of Neurology (L.L., J.Y.), Ningbo First Hospital, China; School of Medicine and Public Health (L.L., C.C., H.T., N.J.S., C.R.L., M.W.P.), University of Newcastle; Melbourne Brain Centre at Royal Melbourne Hospital (A.B., M.W.P.), University of Melbourne; and The Sydney Partnership for Health, Education, Research and Enterprise (C.R.L.), Australia
| | - Huiqiao Tian
- From the Department of Neurology (L.L., J.Y.), Ningbo First Hospital, China; School of Medicine and Public Health (L.L., C.C., H.T., N.J.S., C.R.L., M.W.P.), University of Newcastle; Melbourne Brain Centre at Royal Melbourne Hospital (A.B., M.W.P.), University of Melbourne; and The Sydney Partnership for Health, Education, Research and Enterprise (C.R.L.), Australia
| | - Andrew Bivard
- From the Department of Neurology (L.L., J.Y.), Ningbo First Hospital, China; School of Medicine and Public Health (L.L., C.C., H.T., N.J.S., C.R.L., M.W.P.), University of Newcastle; Melbourne Brain Centre at Royal Melbourne Hospital (A.B., M.W.P.), University of Melbourne; and The Sydney Partnership for Health, Education, Research and Enterprise (C.R.L.), Australia
| | - Neil J Spratt
- From the Department of Neurology (L.L., J.Y.), Ningbo First Hospital, China; School of Medicine and Public Health (L.L., C.C., H.T., N.J.S., C.R.L., M.W.P.), University of Newcastle; Melbourne Brain Centre at Royal Melbourne Hospital (A.B., M.W.P.), University of Melbourne; and The Sydney Partnership for Health, Education, Research and Enterprise (C.R.L.), Australia
| | - Christopher R Levi
- From the Department of Neurology (L.L., J.Y.), Ningbo First Hospital, China; School of Medicine and Public Health (L.L., C.C., H.T., N.J.S., C.R.L., M.W.P.), University of Newcastle; Melbourne Brain Centre at Royal Melbourne Hospital (A.B., M.W.P.), University of Melbourne; and The Sydney Partnership for Health, Education, Research and Enterprise (C.R.L.), Australia
| | - Mark W Parsons
- From the Department of Neurology (L.L., J.Y.), Ningbo First Hospital, China; School of Medicine and Public Health (L.L., C.C., H.T., N.J.S., C.R.L., M.W.P.), University of Newcastle; Melbourne Brain Centre at Royal Melbourne Hospital (A.B., M.W.P.), University of Melbourne; and The Sydney Partnership for Health, Education, Research and Enterprise (C.R.L.), Australia.
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7
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Ben Hassen W, Tordjman M, Boulouis G, Bretzner M, Bricout N, Legrand L, Benzakoun J, Edjlali M, Seners P, Cordonnier C, Oppenheim C, Turc G, Henon H, Naggara O. Benefit of first-pass complete reperfusion in thrombectomy is mediated by limited infarct growth. Eur J Neurol 2020; 28:124-131. [PMID: 32896067 DOI: 10.1111/ene.14490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/18/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE The number of clot retrieval attempts required to achieve complete reperfusion by mechanical thrombectomy impacts functional outcome in acute ischaemic stroke (AIS). Complete reperfusion [expanded Treatment In Cerebral Infarction (eTICI) score = 3] at first pass (FP), is associated with the highest rates of favorable outcome compared to complete reperfusion by multiple passes. The aim of the present study was to investigate the relationship between FP complete reperfusion and infarct growth (IG). METHODS Anterior AIS patients with baseline and 24-h diffusion-weighted magnetic resonance imaging were included from two prospective registries. IG was measured by voxel-based segmentation of initial and 24-h diffusion-weighted imaging lesions. IG and favorable 3-month modified Rankin Scale (mRS) score (≤ 2) were compared between patients in whom complete reperfusion (eTICI 3) was achieved with a single pass (FP group) and those for whom multiple passes were required (MP group), after matching for confounding factors. Mediation analysis was performed to examine the association between FP and 3-month mRS score, with IG as mediating variable. RESULTS A total of 200 patients were included, of whom 118 (28.9%) had FP complete reperfusion. In case-control analysis, the FP group had lower IG than the MP group [8.7 (5.4-12.9) ml vs. 15.2 (11-22.6) ml, respectively; P = 0.03). Favorable outcome was higher in the FP population compared to a matched MP population (70.9% vs. 53.2%, respectively; P = 0.04). FP compete reperfusion (eTICI 3) was independently associated with favorable outcome in multivariable regression analysis [odds ratio 1.86, 95% confidence interval (CI) 1.01-4.39; P = 0.04]. The effect of complete reperfusion at FP on functional outcome was explained by limited IG in mediation analysis [indirect effect: -0.32 (95% CI -0.47 to -0.09)]. CONCLUSION Complete reperfusion at FP is independently associated with significant decrease in IG compared to complete reperfusion by multiple attempts, explaining better functional outcomes.
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Affiliation(s)
- W Ben Hassen
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - M Tordjman
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - G Boulouis
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - M Bretzner
- Department of Interventional Neuroradiology, University of Lille, CHU Lille, Lille, France
| | - N Bricout
- Department of Interventional Neuroradiology, University of Lille, CHU Lille, Lille, France
| | - L Legrand
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - J Benzakoun
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - M Edjlali
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - P Seners
- Department of Neurology, CH Sainte-Anne, Paris, France
| | - C Cordonnier
- Department of Vascular Neurology, Stroke Unit, University of Lille, CHU Lille, Lille, France
| | - C Oppenheim
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - G Turc
- Department of Neurology, CH Sainte-Anne, Paris, France
| | - H Henon
- Department of Vascular Neurology, Stroke Unit, University of Lille, CHU Lille, Lille, France
| | - O Naggara
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
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8
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Pruvost-Robieux E, Calvet D, Ben Hassen W, Turc G, Marchi A, Mélé N, Seners P, Oppenheim C, Baron JC, Mas JL, Gavaret M. Design and Methodology of a Pilot Randomized Controlled Trial of Transcranial Direct Current Stimulation in Acute Middle Cerebral Artery Stroke (STICA). Front Neurol 2018; 9:816. [PMID: 30356889 PMCID: PMC6190876 DOI: 10.3389/fneur.2018.00816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/10/2018] [Indexed: 01/01/2023] Open
Abstract
Background: Stroke is a major cause of death and disability worldwide. The related burden is expected to further increase due to aging populations, calling for more efficient treatment. Ischemic stroke results from a focal reduction in cerebral blood flow due to the sudden occlusion of a brain artery. Ischemic brain injury results from a sequence of pathophysiological events that evolve over time and space. This cascade includes excitotoxicity and peri-infarct depolarizations (PIDs). Focal impairment of cerebral blood flow restricts the delivery of energetics substrates and impairs ionic gradients. Membrane potential is eventually lost, and neurons depolarize. Although recanalization therapies target the ischemic penumbra, they can only rescue the penumbra still present at the time of reperfusion. A promising novel approach is to "freeze" the penumbra until reperfusion occurs. Transcranial direct current stimulation (tDCS) is a non-invasive method of neuromodulation. Based on preclinical evidence, we propose to test the penumbra freezing concept in a clinical phase IIa trial assessing whether cathodal tDCS-shown in rodents to reduce infarction volume-prevents early infarct growth in human acute Middle Cerebral Artery (MCA) stroke, in adjunction to conventional revascularization methods. Methods: This is a monocentric randomized, double-blind, and placebo-controlled trial performed in patients with acute MCA stroke eligible to revascularization procedures. Primary outcome is infarct volume growth on diffusion weighted imaging (DWI) at day 1 relative to baseline. Secondary outcomes include safety and clinical efficacy. Significance: Results from this clinical trial are expected to provide rationale for a phase III study. Clinical trial registration-EUDRACT: 2016-A00160-51.
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Affiliation(s)
- Estelle Pruvost-Robieux
- Department of Neurophysiology, Sainte-Anne Hospital, Paris, France.,Faculty of Medicine, Paris Descartes University, Paris, France
| | - David Calvet
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neurology, Sainte-Anne Hospital, Paris, France
| | - Wagih Ben Hassen
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neuroradiology, Sainte-Anne Hospital, Paris, France
| | - Guillaume Turc
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neurology, Sainte-Anne Hospital, Paris, France
| | - Angela Marchi
- Department of Neurophysiology, Sainte-Anne Hospital, Paris, France
| | - Nicolas Mélé
- Department of Neurology, Sainte-Anne Hospital, Paris, France
| | - Pierre Seners
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neurology, Sainte-Anne Hospital, Paris, France
| | - Catherine Oppenheim
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neuroradiology, Sainte-Anne Hospital, Paris, France
| | - Jean-Claude Baron
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neurology, Sainte-Anne Hospital, Paris, France
| | - Jean-Louis Mas
- Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France.,Department of Neurology, Sainte-Anne Hospital, Paris, France
| | - Martine Gavaret
- Department of Neurophysiology, Sainte-Anne Hospital, Paris, France.,Faculty of Medicine, Paris Descartes University, Paris, France.,INSERM UMR S894, Paris, France
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9
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Harston GWJ, Carone D, Sheerin F, Jenkinson M, Kennedy J. Quantifying Infarct Growth and Secondary Injury Volumes: Comparing Multimodal Image Registration Measures. Stroke 2018; 49:1647-1655. [PMID: 29895538 PMCID: PMC6023577 DOI: 10.1161/strokeaha.118.020788] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/01/2018] [Accepted: 05/14/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Lesion expansion in the week after acute stroke involves both infarct growth (IG) and anatomic distortion (AD) because of edema and hemorrhage. Enabling separate quantification would allow clinical trials targeting these distinct pathological processes. We developed an objective and automated approach to quantify these processes at 24 hours and 1 week. METHODS Patients with acute ischemic stroke were scanned at presentation, 24 hours, and 1 week in a magnetic resonance imaging (MRI) cohort study. IG and AD were calculated from follow-up lesion masks after linear and nonlinear registration to a presenting MRI scan. Performance of IG and AD was compared with edema quantified using cerebrospinal fluid displacement. The use of alternative reference images to define AD, including template MRI, mirrored MRI, and presenting computed tomographic scan, was explored. RESULTS Thirty-seven patients with nonlacunar stroke were included. AD was responsible for 20% and 36% of lesion expansion at 24 hours (n=30) and 1 week (n=28). Registration-defined IG and AD compared favorably with edema quantified using cerebrospinal fluid displacement, particularly at smaller infarct volumes. Presenting computed tomographic imaging was the preferred alternative reference image to presenting MRI for measuring AD. CONCLUSIONS The contributions of IG and AD to lesion expansion can be measured separately over time through the use of image registration. This approach can be used to combine imaging outcome data from computed tomography and MRI.
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Affiliation(s)
- George W J Harston
- From the Radcliffe Department of Medicine, Acute Vascular Imaging Centre (G.W.J.H., D.C., F.S., J.K.)
| | - Davide Carone
- From the Radcliffe Department of Medicine, Acute Vascular Imaging Centre (G.W.J.H., D.C., F.S., J.K.)
| | - Fintan Sheerin
- From the Radcliffe Department of Medicine, Acute Vascular Imaging Centre (G.W.J.H., D.C., F.S., J.K.)
| | - Mark Jenkinson
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (M.J.), University of Oxford, United Kingdom
| | - James Kennedy
- From the Radcliffe Department of Medicine, Acute Vascular Imaging Centre (G.W.J.H., D.C., F.S., J.K.)
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10
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Mahdjoub E, Turc G, Legrand L, Benzakoun J, Edjlali M, Seners P, Charron S, Ben Hassen W, Naggara O, Meder JF, Mas JL, Baron JC, Oppenheim C. Do Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Represent Good Collaterals before Reperfusion Therapy? AJNR Am J Neuroradiol 2017; 39:77-83. [PMID: 29074634 DOI: 10.3174/ajnr.a5431] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 08/24/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In acute ischemic stroke, whether FLAIR vascular hyperintensities represent good or poor collaterals remains controversial. We hypothesized that extensive FLAIR vascular hyperintensities correspond to good collaterals, as indirectly assessed by the hypoperfusion intensity ratio. MATERIALS AND METHODS We included 244 consecutive patients eligible for reperfusion therapy with MCA stroke and pretreatment MR imaging with both FLAIR and PWI. The FLAIR vascular hyperintensity score was based on ASPECTS, ranging from 0 (no FLAIR vascular hyperintensity) to 7 (FLAIR vascular hyperintensities abutting all ASPECTS cortical areas). The hypoperfusion intensity ratio was defined as the ratio of the time-to-maximum >10-second over time-to-maximum >6-second lesion volumes. The median hypoperfusion intensity ratio was used to dichotomize good (low hypoperfusion intensity ratio) versus poor (high hypoperfusion intensity ratio) collaterals. We then studied the association between FLAIR vascular hyperintensity extent and hypoperfusion intensity ratio. RESULTS Hypoperfusion was present in all patients, with a median hypoperfusion intensity ratio of 0.35 (interquartile range, 0.19-0.48). The median FLAIR vascular hyperintensity score was 4 (interquartile range, 3-5). The FLAIR vascular hyperintensities were more extensive in patients with good collaterals (hypoperfusion intensity ratio ≤0.35) than with poor collaterals (hypoperfusion intensity ratio >0.35; P for Trend = .016). The FLAIR vascular hyperintensity score was independently associated with good collaterals (P for Trend = .002). CONCLUSIONS In patients eligible for reperfusion therapy, FLAIR vascular hyperintensity extent was associated with good collaterals, as assessed by the pretreatment hypoperfusion intensity ratio. The ASPECTS assessment of FLAIR vascular hyperintensities could be used to rapidly identify patients more likely to benefit from reperfusion therapy.
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Affiliation(s)
- E Mahdjoub
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - G Turc
- Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes, Institut national de la santé et de la recherche médicale S894, Département Hospitalo-Universitaire Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - L Legrand
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - J Benzakoun
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - M Edjlali
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - P Seners
- Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes, Institut national de la santé et de la recherche médicale S894, Département Hospitalo-Universitaire Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - S Charron
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - W Ben Hassen
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - O Naggara
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - J-F Meder
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
| | - J-L Mas
- Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes, Institut national de la santé et de la recherche médicale S894, Département Hospitalo-Universitaire Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - J-C Baron
- Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes, Institut national de la santé et de la recherche médicale S894, Département Hospitalo-Universitaire Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - C Oppenheim
- From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.)
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11
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Diffusion-Weighted MRI Stroke Volume Following Recanalization Treatment is Threshold-Dependent. Clin Neuroradiol 2017; 29:135-141. [PMID: 29051996 DOI: 10.1007/s00062-017-0634-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/21/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE Infarct lesion segmentation has been problematic as there are a wide range of relative and absolute diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) thresholds that have been used for this purpose. We examined differences of stroke lesion volume and evolution evaluated by magnetic resonance imaging (MRI) during the immediate post-treatment phase (<5 h) and at 24 h. METHODS In this study 33 acute ischemic stroke patients were imaged with MRI <5 h and 24 h post-reperfusion treatment. Lesion volumes were segmented on ADC maps and average DWI using literature cited absolute ADC and relative DWI thresholds. The segmented lesion volumes within both time points were compared and the absolute change in lesion volume (infarct growth) between the two time points was calculated and compared using Bland-Altman analysis. RESULTS Lesion volumes differed significantly when different relative DWI or absolute ADC thresholds were used (p < 0.05), which held true for baseline as well as follow-up lesions. The median absolute changes in lesion volume from baseline to follow-up for ADC thresholds of 550 × 10-6 mm2/s, 600 × 10-6 mm2/s, 630 × 10-6 mm2/s and 650 × 10-6 mm2/s were 3.5 ml, 4.2 ml, 4.5 ml, and 6.5 ml, respectively (p < 0.05). Likewise, the median absolute changes in lesion volume from baseline to follow-up for DWI thresholds, k = 0.85, 1.28, 1.64, 1.96, and 2.7 were 10.1 ml, 7.3 ml, 5.7 ml, 5.4 ml and 4.2 ml, respectively (p < 0.05). CONCLUSION Absolute lesion volumes and changes in lesion volumes (infarct growth) measured after recanalization treatment were dependent on absolute ADC and relative DWI thresholds, which may have clinical significance. Standardization of techniques for measuring DWI lesion volumes requires immediate attention.
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Harston GWJ, Minks D, Sheerin F, Payne SJ, Chappell M, Jezzard P, Jenkinson M, Kennedy J. Optimizing image registration and infarct definition in stroke research. Ann Clin Transl Neurol 2017; 4:166-174. [PMID: 28275650 PMCID: PMC5338168 DOI: 10.1002/acn3.388] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/07/2016] [Accepted: 12/17/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Accurate representation of final infarct volume is essential for assessing the efficacy of stroke interventions in imaging-based studies. This study defines the impact of image registration methods used at different timepoints following stroke, and the implications for infarct definition in stroke research. METHODS Patients presenting with acute ischemic stroke were imaged serially using magnetic resonance imaging. Infarct volume was defined manually using four metrics: 24-h b1000 imaging; 1-week and 1-month T2-weighted FLAIR; and automatically using predefined thresholds of ADC at 24 h. Infarct overlap statistics and volumes were compared across timepoints following both rigid body and nonlinear image registration to the presenting MRI. The effect of nonlinear registration on a hypothetical trial sample size was calculated. RESULTS Thirty-seven patients were included. Nonlinear registration improved infarct overlap statistics and consistency of total infarct volumes across timepoints, and reduced infarct volumes by 4.0 mL (13.1%) and 7.1 mL (18.2%) at 24 h and 1 week, respectively, compared to rigid body registration. Infarct volume at 24 h, defined using a predetermined ADC threshold, was less sensitive to infarction than b1000 imaging. 1-week T2-weighted FLAIR imaging was the most accurate representation of final infarct volume. Nonlinear registration reduced hypothetical trial sample size, independent of infarct volume, by an average of 13%. INTERPRETATION Nonlinear image registration may offer the opportunity of improving the accuracy of infarct definition in serial imaging studies compared to rigid body registration, helping to overcome the challenges of anatomical distortions at subacute timepoints, and reducing sample size for imaging-based clinical trials.
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Affiliation(s)
- George W J Harston
- Acute Vascular Imaging Centre Radcliffe Department of Medicine University of Oxford Level 2, John Radcliffe Hospital Oxford OX3 9DU United Kingdom
| | - David Minks
- Department of Neuroradiology Oxford University Hospitals NHS Trust John Radcliffe Hospital Oxford OX3 9DU United Kingdom
| | - Fintan Sheerin
- Department of Neuroradiology Oxford University Hospitals NHS Trust John Radcliffe Hospital Oxford OX3 9DU United Kingdom
| | - Stephen J Payne
- Department of Engineering Science Institute of Biomedical Engineering University of Oxford Old Road Campus Research Building Oxford OX3 7DQ United Kingdom
| | - Michael Chappell
- Department of Engineering Science Institute of Biomedical Engineering University of Oxford Old Road Campus Research Building Oxford OX3 7DQ United Kingdom
| | - Peter Jezzard
- Oxford Centre for Functional MRI of the Brain Nuffield Department of Clinical Neurosciences University of Oxford John Radcliffe Hospital Level 6, West Wing Oxford OX3 7DQ United Kingdom
| | - Mark Jenkinson
- Oxford Centre for Functional MRI of the Brain Nuffield Department of Clinical Neurosciences University of Oxford John Radcliffe Hospital Level 6, West Wing Oxford OX3 7DQ United Kingdom
| | - James Kennedy
- Acute Vascular Imaging Centre Radcliffe Department of Medicine University of Oxford Level 2, John Radcliffe Hospital Oxford OX3 9DU United Kingdom
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Tisserand M, Turc G, Charron S, Legrand L, Edjlali M, Seners P, Roca P, Lion S, Naggara O, Mas JL, Méder JF, Baron JC, Oppenheim C. Does Diffusion Lesion Volume Above 70 mL Preclude Favorable Outcome Despite Post-Thrombolysis Recanalization? Stroke 2016; 47:1005-11. [DOI: 10.1161/strokeaha.115.012518] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/12/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Marie Tisserand
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Guillaume Turc
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Sylvain Charron
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Laurence Legrand
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Myriam Edjlali
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Pierre Seners
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Pauline Roca
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Stéphanie Lion
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Olivier Naggara
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-Louis Mas
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-François Méder
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-Claude Baron
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Catherine Oppenheim
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
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