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Palazzo P, Padlina G, Dobrocky T, Strambo D, Seners P, Mechtouff L, Turc G, Rosso C, Almiri W, Antonenko K, Laksiri N, Sibon I, Detante O, Mordasini P, Michel P, Heldner MR. Relevance of National Institutes of Health Stroke Scale subitems for best revascularization therapy in minor stroke patients with large vessel occlusion: An observational multicentric study. Eur J Neurol 2023; 30:3741-3750. [PMID: 37517048 DOI: 10.1111/ene.16009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/30/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND AND PURPOSE The best management of acute ischemic stroke patients with a minor stroke and large vessel occlusion is still uncertain. Specific clinical and radiological data may help to select patients who would benefit from endovascular therapy (EVT). We aimed to evaluate the relevance of National Institutes of Health Stroke Scale (NIHSS) subitems for predicting the potential benefit of providing EVT after intravenous thrombolysis (IVT; "bridging treatment") versus IVT alone. METHODS We extracted demographic, clinical, risk factor, radiological, revascularization and outcome data of consecutive patients with M1 or proximal M2 middle cerebral artery occlusion and admission NIHSS scores of 0-5 points, treated with IVT ± EVT between May 2005 and March 2021, from nine prospectively constructed stroke registries at seven French and two Swiss comprehensive stroke centers. Adjusted interaction analyses were performed between admission NIHSS subitems and revascularization modality for two primary outcomes at 3 months: non-excellent functional outcome (modified Rankin Scale score 2-6) and difference in NIHSS score between 3 months and admission. RESULTS Of the 533 patients included (median age 68.2 years, 46% women, median admission NIHSS score 3), 136 (25.5%) initially received bridging therapy and 397 (74.5%) received IVT alone. Adjusted interaction analysis revealed that only facial palsy on admission was more frequently associated with excellent outcome in patients treated by IVT alone versus bridging therapy (odds ratio 0.47, 95% confidence interval 0.24-0.91; p = 0.013). Regarding NIHSS difference at 3 months, no single NIHSS subitem interacted with type of revascularization. CONCLUSIONS This retrospective multicenter analysis found that NIHSS subitems at admission had little value in predicting patients who might benefit from bridging therapy as opposed to IVT alone. Further research is needed to identify better markers for selecting EVT responders with minor strokes.
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Affiliation(s)
- Paola Palazzo
- Department of Clinical Neurosciences, Neurology Service, Stroke Centre, Lausanne University Hospital, Lausanne, Switzerland
| | - Giovanna Padlina
- Stroke Research Center Bern, Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Davide Strambo
- Department of Clinical Neurosciences, Neurology Service, Stroke Centre, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Seners
- Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France
| | | | - Guillaume Turc
- Department of Neurology, Hopital Sainte-Anne, Universite de Paris and Department of Neurology, GHU Paris Psychiatrie et Neurosciences Inserm U1266, Universite Paris Cite FHU NeuroVasc, Paris, France
| | - Charlotte Rosso
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM) and APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - William Almiri
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Kateryna Antonenko
- Stroke Research Center Bern, Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Nadia Laksiri
- Neurology Department, La Timone University Hospital, Marseille, France
| | - Igor Sibon
- Department of Neurology, Stroke Unit, CHU Bordeaux, Bordeaux, France
| | - Olivier Detante
- Neurology Department, Stroke Unit, Inserm U1216, CHU Grenoble Alpes, University Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Department of Neuroradiology, St. Gallen Kantonsspital, St. Gallen, Switzerland
| | - Patrik Michel
- Department of Clinical Neurosciences, Neurology Service, Stroke Centre, Lausanne University Hospital, Lausanne, Switzerland
| | - Mirjam R Heldner
- Stroke Research Center Bern, Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Mattei C, Oevermann A, Schweizer D, Guevar J, Maddox TW, Fleming KL, Ricci E, Rosati M, Biserni R, Iv JFG, Rupp A, Gutierrez-Quintana R, Masseau I, Newkirk KM, Hecht S, Specchi S. MRI ischemic and hemorrhagic lesions in arterial and venous territories characterize central nervous system intravascular lymphoma in dogs. Vet Radiol Ultrasound 2023; 64:294-305. [PMID: 36329600 DOI: 10.1111/vru.13165] [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: 04/29/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 11/06/2022] Open
Abstract
Intravascular lymphoma (IVL) is characterized by the proliferation of large malignant lymphocytes within the lumen of blood vessels. This retrospective, multi-center, case series study aimed to describe the MRI features of confirmed central nervous system IVL in dogs and compare them with histopathological findings. Medical record databases from seven veterinary centers were searched for cases of histologically confirmed IVL. Dogs were included if an MRI was performed. The MRI studies and histopathology samples were reviewed to compare the MRI changes with the histopathological findings. Twelve dogs met the inclusion criteria (12 brains and three spinal cords). Imaging of the brains revealed multifocal T2-weighted/FLAIR hyperintense and T1-weighted iso-hypointense lesions, with variable contrast enhancement; areas of abnormal diffusion both in arterial and venous territories in diffusion-weighted imaging; and meningeal enhancement. On gradient echo images (GRE), the changes comprised tubular susceptibility artifacts, consistent with the "susceptibility vessel sign", and additional variably sized/shaped intraparenchymal susceptibility artifacts. Spinal cord lesions presented as fusiform T2-weighted hyperintensities with scattered susceptibility artifacts on GRE and variable parenchymal and meningeal contrast enhancement. On histopathology, subarachnoid hemorrhages and neuroparenchymal areas of edema and necrosis, with or without hemorrhage, indicating ischemic and hemorrhagic infarctions, were found. These lesions were concurrent with severely dilated meningeal and parenchymal arteries and veins plugged by neoplastic lymphocytes and fibrin. Due to the unique angiocentric distribution of IVL, ischemic and hemorrhagic infarcts of variable chronicity affecting both the arterial and venous territories associated with thrombi formation can be detected on MRI.
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Affiliation(s)
- Chiara Mattei
- Diagnostic Imaging Department (Mattei, Specchi) and Neurology Department (Biserni), Ospedale Veterinario "I Portoni Rossi", Anicura Italy, Zola Predosa, Italy
| | - Anna Oevermann
- Division of Neurological Sciences, Department of Clinical Research and Veterinary Public Health (Oevermann), Division of Clinical Radiology, Department of Clinical Veterinary Medicine (Schweizer), Division of Small Animal Surgery, Department of Clinical Veterinary Sciences (Guevar), Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Daniela Schweizer
- Division of Neurological Sciences, Department of Clinical Research and Veterinary Public Health (Oevermann), Division of Clinical Radiology, Department of Clinical Veterinary Medicine (Schweizer), Division of Small Animal Surgery, Department of Clinical Veterinary Sciences (Guevar), Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Julien Guevar
- Division of Neurological Sciences, Department of Clinical Research and Veterinary Public Health (Oevermann), Division of Clinical Radiology, Department of Clinical Veterinary Medicine (Schweizer), Division of Small Animal Surgery, Department of Clinical Veterinary Sciences (Guevar), Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Thomas W Maddox
- Department of Musculoskeletal and Ageing Sciences- Institute of Life Course and Medical Science- Faculty of Health & Life Sciences (Maddox), Department of Veterinary Science- School of Veterinary Science (Fleming), Department of Veterinary Anatomy- Physiology and Pathology- Institute of Infection- Veterinary and Ecological Sciences (Ricci), University of Liverpool, Neston, UK
| | - Kathryn L Fleming
- Department of Musculoskeletal and Ageing Sciences- Institute of Life Course and Medical Science- Faculty of Health & Life Sciences (Maddox), Department of Veterinary Science- School of Veterinary Science (Fleming), Department of Veterinary Anatomy- Physiology and Pathology- Institute of Infection- Veterinary and Ecological Sciences (Ricci), University of Liverpool, Neston, UK
| | - Emanuele Ricci
- Department of Musculoskeletal and Ageing Sciences- Institute of Life Course and Medical Science- Faculty of Health & Life Sciences (Maddox), Department of Veterinary Science- School of Veterinary Science (Fleming), Department of Veterinary Anatomy- Physiology and Pathology- Institute of Infection- Veterinary and Ecological Sciences (Ricci), University of Liverpool, Neston, UK
| | - Marco Rosati
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Roberta Biserni
- Diagnostic Imaging Department (Mattei, Specchi) and Neurology Department (Biserni), Ospedale Veterinario "I Portoni Rossi", Anicura Italy, Zola Predosa, Italy
| | - John F Griffin Iv
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Angie Rupp
- Small Animal Hospital (Gutierrez-Quintana), Division of Pathology, Public Health and Disease Investigation (Rupp), School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Rodrigo Gutierrez-Quintana
- Small Animal Hospital (Gutierrez-Quintana), Division of Pathology, Public Health and Disease Investigation (Rupp), School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Isabelle Masseau
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Kimberly M Newkirk
- Department of Biomedical and Diagnostic Sciences (Newkirk), Department of Small Animal Clinical Sciences (Hecht), University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Silke Hecht
- Department of Biomedical and Diagnostic Sciences (Newkirk), Department of Small Animal Clinical Sciences (Hecht), University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Swan Specchi
- Diagnostic Imaging Department (Mattei, Specchi) and Neurology Department (Biserni), Ospedale Veterinario "I Portoni Rossi", Anicura Italy, Zola Predosa, Italy
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Lee J, Lee HJ, Ha SY, Kim HC, Kang Y, Jin SC, Park S. Assessment of thrombus using susceptibility-weighted filtered-phase images in patients with acute ischemic stroke. J Neuroimaging 2023; 33:147-155. [PMID: 36068702 DOI: 10.1111/jon.13047] [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: 05/22/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Recognizing the location and length of the thrombus responsible for large vessel occlusion in patients with acute ischemic stroke can facilitate effective endovascular recanalization therapy (ERT). We hypothesized that the aliasing or dipole effect produced by filtered-phase susceptibility-weighted imaging (SWI) would facilitate thrombus delineation. METHODS Of the patients with middle cerebral artery occlusion who underwent ERT, we screened those who underwent noncontrast CT (NCCT), multiphase CT angiography (mCTA), and SWI before the endovascular procedure. We used an arbitrary index termed measurement of equivalence in thrombus assessed by digital subtraction angiography (METAD) defined as having the same location as the thrombus observed in the digital subtraction angiography (DSA) and length differing by less than 5 mm. For NCCT, mCTA, SWI_m (magnitude), and SWI_p (phase), the length of the thrombus and METAD were assessed. RESULTS The mean lengths of the thrombi determined using NCCT, mCTA, SWI_m, SWI_p, and DSA were 14.03, 13.47, 13.89, 9.93, and 8.96 mm, respectively. The absolute agreement for thrombus length was excellent for SWI_p and DSA (intraclass correlation coefficient [ICC] = .96), moderate for SWI_m and DSA (ICC = .53), and poor for mCTA and DSA (ICC = .14). The METADs were 26.7%, 40.0%, 33.3%, and 73.3% for NCCT, mCTA, SWI_m, and SWI_p, respectively. The METADs for NCCT and SWI_p were significantly different (p = .045) and those for mCTA and SWI_m were not (p = .537 and .093, respectively). CONCLUSIONS The SWI_p was best matched with the DSA for the measurement of the lengths and locations of thrombi. The use of pre-thrombectomy SWI_p imaging for acute ischemic stroke may facilitate a successful ERT strategy.
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Affiliation(s)
- Joonwon Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sam Yeol Ha
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyung Chan Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yeonah Kang
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sung-Chul Jin
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Seongho Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Simultaneous depiction of clot and MRA using 1 min phase contrast angiography in acute ischemic patients. Magn Reson Imaging 2022; 93:149-156. [PMID: 35977694 DOI: 10.1016/j.mri.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022]
Abstract
[Background and Purpose] Clot location and range predict clinical outcomes for acute ischemic stroke (AIS). We developed a new technique for visualizing occlusion clots, namely, the DEpicting blood clot and MRA using Phase contrast angiography with Image Calculation for Thrombectomy (DEPICT) method. The purpose of this study was to assess the clinical usefulness of DEPICT. [Methods] We used DEPICT in 36 AIS patients to obtain MRA and black blood images with 1-min phase contrast angiography (PCA). We created the black blood images by subtracting the MRA from the T1WI using the source image of PCA. We evaluated the motion artifact, detectability of clot, and precision in location and range compared these to that of susceptibility vessel sign in T2*WI and measured contrast ration (CR) of clot between the cistern and brain tissue. Motion artifact was visually evaluated using a 3-point scale. Detectability and precision of the location and range of occlusion clots were assessed by comparison with findings from digital subtraction angiography (DSA). Gwet's AC1 and kappa statistics were used to assess inter-observer agreement. [Results] DEPICT showed significant robustness for motion artifact compared with T2*WI (p = 0.0026, Wilcoxon signed-rank test). DEPICT showed 100% detectability for the clot. Further, DEPICT showed higher Gwet's AC1 and kappa statistic values with DSA than T2*WI. CR demonstrated a positive value. [Conclusions] DEPICT technique based on 1-min PCA offers both MRA and black blood T1W images that can be used to accurately evaluate both location and range of the clot.
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Philipps J, Erdlenbruch B, Kuschnerow M, Jagoda S, Salihaj B, Glahn J, Schellinger PD. Hyperacute treatment of childhood stroke in Lyme neuroborreliosis: report of two cases and systematic review of the literature. Ther Adv Neurol Disord 2022; 15:17562864221102842. [PMID: 36061261 PMCID: PMC9437258 DOI: 10.1177/17562864221102842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
The safety and efficacy of hyperacute reperfusion therapies in childhood stroke
due to focal cerebral arteriopathy (FCA) with an infectious and inflammatory
component is unknown. Lyme neuroborreliosis (LNB) is reported as a rare cause of
childhood stroke. Intravenous thrombolysis (IVT) and endovascular therapy (EVT)
have not been reported in LNB-associated stroke in children. We report two
children with acute stroke associated with LNB who underwent hyperacute stroke
treatment. A systematic review of the literature was performed to identify case
reports of LNB-associated childhood stroke over the last 20 years. Patient 1
received IVT within 73 min after onset of acute hemiparesis and dysarthria;
medulla oblongata infarctions were diagnosed on magnetic resonance imaging
(MRI). Patient 2 received successful EVT 6.5 hr after onset of progressive
tetraparesis, coma, and decerebrate posturing caused by basilar artery occlusion
with bilateral pontomesencephalic infarctions. Both patients exhibited a
lymphocytic cerebrospinal fluid (CSF) pleocytosis and elevated antibody index
(AI) to Borrelia burgdorferi. Antibiotic treatment, steroids,
and platelet inhibitors including tirofiban infusion in patient 2 were
administered. No side effects were observed. On follow-up, patient 1 showed good
recovery and patient 2 was asymptomatic. In the literature, 12 cases of
LNB-associated childhood stroke were reported. LNB-associated infectious and
inflammatory FCA is not a medical contraindication for reperfusion therapies in
acute childhood stroke. Steroids are discussed controversially in inflammatory
FCA due to LNB. Intensified antiplatelet regimes may be considered; secondary
prophylaxis with acetyl-salicylic acid (ASA) is recommended because of a high
risk of early stroke recurrence.
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Affiliation(s)
- Joerg Philipps
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Hans-Nolte-Str. 1, D-32429 Minden, Germany
| | - Bernhard Erdlenbruch
- Department of Pediatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Michael Kuschnerow
- Department of Diagnostic and Interventional Radiology, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Sunil Jagoda
- Department of Anesthesiology and Intensive Care, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Blerta Salihaj
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Joerg Glahn
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Peter Dieter Schellinger
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
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Sato T, Sakai K, Okumura M, Kitagawa T, Takatsu H, Tanabe M, Komatsu T, Sakuta K, Umehara T, Murakami H, Mitsumura H, Matsushima M, Iguchi Y. Low dihomo-γ-linolenic acid is associated with susceptibility vessel sign in cardioembolism. Thromb Res 2022; 213:84-90. [DOI: 10.1016/j.thromres.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/02/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
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Belachew NF, Dobrocky T, Meinel TR, Hakim A, Vynckier J, Arnold M, Seiffge DJ, Wiest R, Piechowiak EI, Fischer U, Gralla J, Mordasini P, Kaesmacher J. Risks of Undersizing Stent Retriever Length Relative to Thrombus Length in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2021; 42:2181-2187. [PMID: 34649917 DOI: 10.3174/ajnr.a7313] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Results regarding the association of thrombus length, stent retriever length, and recanalization success in patients with acute ischemic stroke are inconsistent. We hypothesized that the ratio of thrombus length to stent retriever length may be of particular relevance. MATERIALS AND METHODS Patients with acute ischemic stroke undergoing stent retriever thrombectomy at our institution between January 2010 and December 2018 were reviewed retrospectively. Thrombus length was assessed by measuring the susceptibility vessel sign on SWI using a 1.5T or 3T MR imaging scanner. Multivariable logistic regression models were used to determine the association between thrombus length, stent retriever length, and thrombus length/stent retriever length ratio with first-pass recanalization, overall recanalization, and embolization in new territories. Results are shown as adjusted ORs with 95% CIs. Additional mediation analyses were performed to test for indirect effects on first-pass recanalization and overall recanalization success. RESULTS The main analysis included 418 patients (mean age, 74.9 years). Increasing stent retriever length was associated with first-pass recanalization. Decreasing thrombus length and lower thrombus length/stent retriever length ratios were associated with first-pass recanalization and overall recanalization. Thrombus length and stent retriever length showed no association with first-pass recanalization or overall recanalization once thrombus length/stent retriever length ratio was factored in, while thrombus length/stent retriever length ratio remained a significant factor in both models (adjusted OR, 0.316 [95% CI, 0.112-0.892]; P = .030 and adjusted OR, = 0.366 [95% CI, 0.194-0.689]; P = .002). Mediation analyses showed that decreasing thrombus length and increasing stent retriever length had a significant indirect effect on first-pass recanalization mediated through thrombus length/stent retriever length ratio. The only parameter associated with embolization in new territories was an increasing thrombus length/stent retriever length ratio (adjusted OR, 5.079 [95% CI, 1.332-19.362]; P = .017). CONCLUSIONS Information about thrombus and stent length is more valuable when combined. High thrombus length/stent retriever length ratios, which may raise the risk of unsuccessful recanalization and embolization in new territories, should be avoided by adapting stent retriever selection to thrombus length whenever possible.
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Affiliation(s)
- N F Belachew
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - T Dobrocky
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - T R Meinel
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - A Hakim
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - J Vynckier
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - M Arnold
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - D J Seiffge
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - R Wiest
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - E I Piechowiak
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - U Fischer
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - J Gralla
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - P Mordasini
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - J Kaesmacher
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.).,Diagnostic, Interventional and Pediatric Radiology (J.K.), Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Ding Y, Abbasi M, Liu Y, Dai D, Kadirvel R, Kallmes DF, Brinjikji W. In Vitro Study of Blood Clot Identification and Composition Assessment by Different Magnetic Resonance Sequences. Cureus 2021; 13:e16229. [PMID: 34367828 PMCID: PMC8343555 DOI: 10.7759/cureus.16229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Growing data suggest that clot composition can impact revascularization outcomes and can potentially guide treatment strategies for stroke patients with large vessel occlusion. We performed an in vitro study to determine which magnetic resonance (MR) signaling characteristics correlate with clot compositions. Methodology A total of 25 clot analogs were prepared by mixing human plasma and red blood cells (RBCs) with five different combinations (five samples for each combination), namely, Group A, fibrin-rich (95% plasma:5% RBCs); Group B, fibrin-rich (75% plasma:25% RBCs); Group C, intermediate (50% plasma:50% RBCs); Group D, RBC-rich (25% plasma:75% RBCs), and Group E, RBC-rich (5% plasma:95% RBCs). The prepared samples were then scanned with quantitative T2* mapping, T2 fast spin-echo (FSE), T2 gradient-echo (GRE), fluid-attenuated inversion recovery (FLAIR), and susceptibility-weighted angiography (SWAN). Thrombus-T2* relaxation time (TT2*RT) and signal intensity (SI) from different scanning sequences were measured in all groups. SIs between different groups were compared using a one-way analysis of variance. Correlation between TT2*RT and SI was determined using the Pearson correlation test. Results The average TT2*RT decreased from 126 ms to 37 ms from fibrin-rich to RBC-rich clots (Groups A to E). Mean SIs of Groups D and E were lower than Groups A, B, and C on T2 mapping, T2 FSE, T2 GRE, FLAIR, and SWAN images (p < 0.00001). TT2*RT and SI were positively correlated on T2 mapping (R = 0.9628, p = 0.009). Conclusion Different compositions of blood clots can show different TT2*RT and SI on MR imaging. Quantitative T2* mapping and multicontrast MR scanning can help in the characterization of clots causing large vessel occlusion, which is useful to establish treatment strategies for stroke patients.
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Affiliation(s)
| | | | - Yang Liu
- Radiology, Mayo Clinic, Rochester, USA
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Alhazmi H, Bani-Sadr A, Bochaton T, Paccalet A, Da Silva CC, Buisson M, Amaz C, Ameli R, Berthezene Y, Eker OF, Ovize M, Cho TH, Nighoghossian N, Mechtouff L. Large vessel cardioembolic stroke and embolic stroke of undetermined source share a common profile of matrix metalloproteinase-9 level and susceptibility vessel sign length. Eur J Neurol 2021; 28:1977-1983. [PMID: 33682255 DOI: 10.1111/ene.14806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Embolic stroke of undetermined source (ESUS) accounts for up to 25% of ischemic strokes. Identification of biomarkers that could improve the prediction of stroke subtype and subsequently of stroke prevention still remains a major issue. METHODS The HIBISCUS-STROKE cohort includes ischemic stroke patients with large vessel occlusion treated with mechanical thrombectomy following admission magnetic resonance imaging. Presence and length of susceptibility vessel sign (SVS) were assessed by gradient-recalled echo T2*-weighted imaging. Matrix metalloproteinase-9 (MMP-9) was measured on sera collected at admission. A multiple logistic regression model was performed to detect independent markers distinguishing cardioembolic (CE) from large-artery atherosclerosis (LAA) subtype. RESULTS A total of 147 patients were included, of them the etiology was distributed as follows: 86 (58.5%) CE, 26 (17.7%) LAA, and 35 (23.8%) ESUS. The optimal cutoff for differentiating CE from LAA subtype was 14.5 mm for SVS length (sensitivity, 79.7%; specificity, 72.7%) and 1110 ng/ml for admission MMP-9 level (sensitivity, 85.3%; specificity, 52.2%). Multivariate analysis revealed that current smoking (odds ratio [OR] 0.07, 95% confidence interval [CI] 0.01-0.93), tandem occlusion (OR 0.01, 95% CI 0.01-0.21), SVS length (OR 0.78, 95% CI 0.63-0.97), and admission MMP-9 level (OR 0.99, 95% CI 0.99-1.00) were inversely associated with CE subtype. SVS length and MMP-9 level did not differ between ESUS and CE subtypes. CONCLUSION SVS length and admission MMP-9 level may improve the prediction of CE subtype whose profile is close to ESUS, thus suggesting a common cardiac embolic source.
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Affiliation(s)
- Hanan Alhazmi
- Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Alexandre Bani-Sadr
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Thomas Bochaton
- Cardiac Intensive Care Unit, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Alexandre Paccalet
- CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Claire Crola Da Silva
- CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Marielle Buisson
- Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Camille Amaz
- Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Roxana Ameli
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Yves Berthezene
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Omer Faruk Eker
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Michel Ovize
- CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France.,Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Tae-Hee Cho
- Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Norbert Nighoghossian
- Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Laura Mechtouff
- Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
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10
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Seners P, Ben Hassen W, Lapergue B, Arquizan C, Heldner MR, Henon H, Perrin C, Strambo D, Cottier JP, Sablot D, Girard Buttaz I, Tamazyan R, Preterre C, Agius P, Laksiri N, Mechtouff L, Béjot Y, Duong DL, Mounier-Vehier F, Mione G, Rosso C, Lucas L, Papassin J, Aignatoaie A, Triquenot A, Carrera E, Niclot P, Obadia A, Lyoubi A, Garnier P, Crainic N, Wolff V, Tracol C, Philippeau F, Lamy C, Soize S, Baron JC, Turc G. Prediction of Early Neurological Deterioration in Individuals With Minor Stroke and Large Vessel Occlusion Intended for Intravenous Thrombolysis Alone. JAMA Neurol 2021; 78:321-328. [PMID: 33427887 DOI: 10.1001/jamaneurol.2020.4557] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance The best reperfusion strategy in patients with acute minor stroke and large vessel occlusion (LVO) is unknown. Accurately predicting early neurological deterioration of presumed ischemic origin (ENDi) following intravenous thrombolysis (IVT) in this population may help to select candidates for immediate transfer for additional thrombectomy. Objective To develop and validate an easily applicable predictive score of ENDi following IVT in patients with minor stroke and LVO. Design, Setting, and Participants This multicentric retrospective cohort included 729 consecutive patients with minor stroke (National Institutes of Health Stroke Scale [NIHSS] score of 5 or less) and LVO (basilar artery, internal carotid artery, first [M1] or second [M2] segment of middle cerebral artery) intended for IVT alone in 45 French stroke centers, ie, including those who eventually received rescue thrombectomy because of ENDi. For external validation, another cohort of 347 patients with similar inclusion criteria was collected from 9 additional centers. Data were collected from January 2018 to September 2019. Main Outcomes and Measures ENDi, defined as 4 or more points' deterioration on NIHSS score within the first 24 hours without parenchymal hemorrhage on follow-up imaging or another identified cause. Results Of the 729 patients in the derivation cohort, 335 (46.0%) were male, and the mean (SD) age was 70 (15) years; of the 347 patients in the validation cohort, 190 (54.8%) were male, and the mean (SD) age was 69 (15) years. In the derivation cohort, the median (interquartile range) NIHSS score was 3 (1-4), and the occlusion site was the internal carotid artery in 97 patients (13.3%), M1 in 207 (28.4%), M2 in 395 (54.2%), and basilar artery in 30 (4.1%). ENDi occurred in 88 patients (12.1%; 95% CI, 9.7-14.4) and was strongly associated with poorer 3-month outcomes, even in patients who underwent rescue thrombectomy. In multivariable analysis, a more proximal occlusion site and a longer thrombus were independently associated with ENDi. A 4-point score derived from these variables-1 point for thrombus length and 3 points for occlusion site-showed good discriminative power for ENDi (C statistic = 0.76; 95% CI, 0.70-0.82) and was successfully validated in the validation cohort (ENDi rate, 11.0% [38 of 347]; C statistic = 0.78; 95% CI, 0.70-0.86). In both cohorts, ENDi probability was approximately 3%, 7%, 20%, and 35% for scores of 0, 1, 2 and 3 to 4, respectively. Conclusions and Relevance The substantial ENDi rates observed in these cohorts highlights the current debate regarding whether to directly transfer patients with IVT-treated minor stroke and LVO for additional thrombectomy. Based on the strong associations observed, an easily applicable score for ENDi risk prediction that may assist decision-making was derived and externally validated.
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Affiliation(s)
- Pierre Seners
- Neurology Department, GHU Paris psychiatrie et neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Wagih Ben Hassen
- Radiology Department, GHU Paris psychiatrie et neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | | | | | - Mirjam R Heldner
- Neurology Department, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Hilde Henon
- Neurology Department, CHU Lille, Université de Lille, INSERM U1171, Lille, France
| | - Claire Perrin
- Neurology Department, GHU Paris psychiatrie et neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Davide Strambo
- Stroke Center, Neurology Service, CHU Vaudois, Lausanne University, Lausanne, Switzerland
| | | | - Denis Sablot
- Neurology Department, Perpignan Hospital, Perpignan, France
| | | | - Ruben Tamazyan
- Neurology Department, Saint Joseph Hospital, Paris, France
| | - Cécile Preterre
- Neurology Department, Nantes University Hospital, Nantes, France
| | - Pierre Agius
- Neurology Department, Nantes University Hospital, Nantes, France.,Neurology Department, St Nazaire Hospital, Saint-Nazaire, France
| | - Nadia Laksiri
- Neurology Department, La Timone University Hospital, Marseille, France
| | - Laura Mechtouff
- Department of Stroke Medicine, Hospices Civils de Lyon, Lyon, France
| | - Yannick Béjot
- Neurology Department, Dijon University Hospital, Dijon, France
| | - Duc-Long Duong
- Neurology Department, Versailles University Hospital, Versailles, France
| | | | - Gioia Mione
- Neurology Department, Nancy University Hospital, Nancy, France
| | - Charlotte Rosso
- Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, INSERM U 1127, CNRS UMR 7225, AP-HP, Urgences Cérébro-Vasculaires, ICM Infrastructure Stroke Network, Hôpital Pitié-Salpêtrière, Paris, France
| | - Ludovic Lucas
- Stroke Unit, Bordeaux University Hospital, Bordeaux, France
| | - Jérémie Papassin
- Stroke Unit, Grenoble University Hospital, Grenoble, France.,Neurology Department, Centre Hospitalier Metropole-Savoie, Chambery, France
| | - Andreea Aignatoaie
- Neurology Department, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | - Emmanuel Carrera
- Neurology Department, Geneve University Hospital, Geneve, Switzerland
| | | | - Alexandre Obadia
- Neurology Department, Fondation Adolphe de Rothschild, Paris, France
| | - Aïcha Lyoubi
- Neurology Department, Delafontaine Hospital, Saint-Denis, France
| | - Pierre Garnier
- Stroke Unit, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Nicolae Crainic
- Neurology Department, Brest University Hospital, Brest, France
| | - Valérie Wolff
- Neurology Department, Strasbourg University Hospital, Strasbourg, France
| | - Clément Tracol
- Neurology Department, Rennes University Hospital, Rennes, France
| | | | - Chantal Lamy
- Neurology Department, Amiens University Hospital, Amiens, France
| | - Sébastien Soize
- Neuroradiology Department, Reims University Hospital, Reims, France
| | - Jean-Claude Baron
- Neurology Department, GHU Paris psychiatrie et neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
| | - Guillaume Turc
- Neurology Department, GHU Paris psychiatrie et neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France
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11
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Guenego A, Fahed R, Sussman ES, Leipzig M, Albers GW, Martin BW, Marcellus DG, Kuraitis G, Marks MP, Lansberg MG, Wintermark M, Heit JJ. Impact of Clot Shape on Successful M1 Endovascular Reperfusion. Front Neurol 2021; 12:642877. [PMID: 33597919 PMCID: PMC7882685 DOI: 10.3389/fneur.2021.642877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/08/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: The susceptibility-vessel-sign (SVS) allows thrombus visualization, length estimation and composition, and it may impact reperfusion during mechanical thrombectomy (MT). SVS can also describe thrombus shape in the occluded artery: in the straight M1-segment (S-shaped), or in an angulated/traversing a bifurcation segment (A-shaped). We determined whether SVS clot shape influenced reperfusion and outcomes after MT for proximal middle-cerebral-artery (M1) occlusions. Methods: Between May 2015 and March 2018, consecutive patients who underwent MT at one comprehensive stroke center and who had a baseline MRI with a T2* sequence were included. Clinical, procedural and radiographic data, including clot shape on SVS [angulated/bifurcation (A-SVS) vs. straight (S-SVS)] and length were assessed. Primary outcome was successful reperfusion (TICI 2b-3). Secondary outcome were MT complication rates, MT reperfusion time, and clinical outcome at 90-days. Predictors of outcome were assessed with univariate and multivariate analyses. Results: A total of 62 patients were included. 56% (35/62) had an A-SVS. Clots were significantly longer in the A-SVS group (19 mm vs. 8 mm p = 0.0002). Groups were otherwise well-matched with regard to baseline characteristics. There was a significantly lower rate of successful reperfusion in the A-SVS cohort (83%) compared to the S-SVS cohort (96%) in multivariable analysis [OR 0.04 (95% CI, 0.002–0.58), p = 0.02]. There was no significant difference in long term clinical outcome between groups. Conclusion: Clot shape as determined on T2* imaging, in patients presenting with M1 occlusion appears to be a predictor of successful reperfusion after MT. Angulated and bifurcating clots are associated with poorer rates of successful reperfusion.
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Affiliation(s)
- Adrien Guenego
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Robert Fahed
- Division of Neurology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Eric S Sussman
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Matthew Leipzig
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Gregory W Albers
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Blake W Martin
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - David G Marcellus
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Gabriella Kuraitis
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Michael P Marks
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Maarten G Lansberg
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Max Wintermark
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Jeremy J Heit
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
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12
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Role of neuroimaging before reperfusion therapy. Part 1 - IV thrombolysis - Review. Rev Neurol (Paris) 2021; 177:908-918. [PMID: 33455833 DOI: 10.1016/j.neurol.2020.10.007] [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: 06/18/2020] [Revised: 09/25/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
Abstract
This review paper summarises the yield of the different imaging modalities in the evaluation of patients for IV thrombolysis. Non-contrast CT and CTA or brain MRI combined with MRA are the recommended sequences for the evaluation of patients within the 4.5 hours time window. Multimodal MRI (DWI/PWI), and more recently, CT perfusion, offer reliable surrogate of salvageable penumbra, the target mismatch, which is now currently used as selection criteria for revascularisation treatment in an extended time window. Those sequences may also help the physician for the management of other limited cases when the diagnosis of acute ischemic stroke is difficult. Another approach the DWI/FLAIR mismatch has been proposed to identify among wake-up stroke patients those who have been experiencing an acute ischemic stroke evolving from less than 4.5hrs. Other biomarkers, such as the clot imaging on MRI and CT, help to predict the recanalisation rate after IVT, while the impact of the presence microbleeds on MRI remains to be determined.
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13
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Seners P, Turc G, Lion S, Cottier JP, Cho TH, Arquizan C, Bracard S, Ozsancak C, Legrand L, Naggara O, Debiais S, Berthezene Y, Costalat V, Richard S, Magni C, Nighoghossian N, Narata AP, Dargazanli C, Gory B, Mas JL, Oppenheim C, Baron JC. Relationships between brain perfusion and early recanalization after intravenous thrombolysis for acute stroke with large vessel occlusion. J Cereb Blood Flow Metab 2020; 40:667-677. [PMID: 30890074 PMCID: PMC7026851 DOI: 10.1177/0271678x19836288] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In large vessel occlusion (LVO) stroke, it is unclear whether severity of ischemia is involved in early post-thrombolysis recanalization over and above thrombus site and length. Here we assessed the relationships between perfusion parameters and early recanalization following intravenous thrombolysis administration in LVO patients. From a multicenter registry, we identified 218 thrombolysed LVO patients referred for thrombectomy with both (i) pre-thrombolysis MRI, including diffusion-weighted imaging (DWI), T2*-imaging, MR-angiography and dynamic susceptibility-contrast perfusion-weighted imaging (PWI); and (ii) evaluation of recanalization on first angiographic run or non-invasive imaging ≤ 3 h from thrombolysis start. Infarct core volume on DWI, PWI-DWI mismatch volume and hypoperfusion intensity ratio (HIR; defined as Tmax ≥ 10 s volume/ Tmax ≥ 6 s volume, low HIR indicating milder hypoperfusion) were determined using a commercially available software. Early recanalization occurred in 34 (16%) patients, and multivariable analysis was associated with lower HIR (P = 0.006), shorter thrombus on T2*-imaging (P < 0.001) and more distal occlusion (P = 0.006). However, the relationship between HIR and early recanalization was robust only for thrombus length <14 mm. In summary, the present study disclosed an association between lower HIR and early post-thrombolysis recanalization. Early post-thrombolysis recanalization is therefore determined not only by thrombus site and length but also by severity of ischemia.
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Affiliation(s)
- Pierre Seners
- Neurology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Guillaume Turc
- Neurology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Stéphanie Lion
- Radiology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Jean-Philippe Cottier
- Department of Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Tae-Hee Cho
- Department of Stroke Medicine, Hospices Civils de Lyon, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSALyon, Lyon, France
| | | | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, INSERM U 947, Nancy, France
| | | | - Laurence Legrand
- Radiology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Olivier Naggara
- Radiology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Séverine Debiais
- Department of Neurology, Bretonneau Hospital, University of Tours, Tours, France
| | - Yves Berthezene
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Vincent Costalat
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | | | | | - Norbert Nighoghossian
- Department of Stroke Medicine, Hospices Civils de Lyon, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSALyon, Lyon, France
| | - Ana-Paula Narata
- Department of Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, INSERM U 947, Nancy, France
| | - Jean-Louis Mas
- Neurology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Catherine Oppenheim
- Radiology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
| | - Jean-Claude Baron
- Neurology Department, Sainte-Anne Hospital, Université Paris Descartes, INSERM UMR 1266, Paris, France
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14
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Huang SJ, Diao SS, Lu Y, Li T, Zhang LL, Ding YP, Fang Q, Cai XY, Xu Z, Kong Y. Value of thrombus imaging in predicting the outcomes of patients with large-vessel occlusive strokes after endovascular therapy. Neurol Sci 2020; 41:1451-1458. [PMID: 32086687 DOI: 10.1007/s10072-020-04296-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute ischemic stroke leads to serious long-term disability and high mortality, especially in patients with large-vessel occlusive strokes. Nowadays, endovascular therapy is considered as an alternative treatment for these patients. Several studies have used thrombus characteristics based on non-contrast computed tomography (NCCT) and computed tomography angiography (CTA) to predict prognosis in ischemic stroke. We conducted a systematic review to identify potential imaging predictive factors for successful recanalization and improved clinical outcome after endovascular therapy in patients with large-vessel occlusion (LVO) in anterior arterial circulation. METHODS The PubMed databases were searched for related studies reported between September 18, 2009, and September 18, 2019. RESULTS We selected 11 studies on revascularization and 12 studies on clinical outcome. Patients with thrombus of higher Hounsfield unit (HU), shorter length, higher clot burden score, and increased thrombus permeability may achieve higher recanalization and improved clinical outcome, but the matter is still under debate. CONCLUSION Imaging of thrombus can be used as an aseessment tool to predict the outcomes and it needs further studies in the future.
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Affiliation(s)
- Shuang-Jiao Huang
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Shan-Shan Diao
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Yue Lu
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Tan Li
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Lu-Lu Zhang
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Yi-Ping Ding
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Qi Fang
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Xiu-Ying Cai
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China.
| | - Zhuan Xu
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China.
| | - Yan Kong
- Department of neurology, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou, 215000, Jiangsu, China.
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15
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Romero JM, Liberato ACP, Montes D, Barnaure I, Xu J, Maza N, Gonzalez RG. Accuracy of MRI T2*-weighted sequences (GRE-EPI) compared to CTA for detection of anterior circulation large vessel thrombus. Emerg Radiol 2020; 27:269-275. [DOI: 10.1007/s10140-020-01754-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/09/2020] [Indexed: 01/02/2023]
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16
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Chung GH, Hwang SB, Kwak HS. Use of 3-Dimensional, Black-Blood, Contrast-Enhanced, T1-Weighted Magnetic Resonance Imaging to Identify Vascular Occlusion in the Posterior Circulation After Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2019; 28:104373. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/21/2019] [Accepted: 08/26/2019] [Indexed: 11/30/2022] Open
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17
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Janot K, Oliveira TR, Fromont-Hankard G, Annan M, Filipiak I, Barantin L, Guibon R, Duffy S, Gilvarry M, Cottier JP, Narata AP. Quantitative estimation of thrombus-erythrocytes using MRI. A phantom study with clot analogs and analysis by statistic regression models. J Neurointerv Surg 2019; 12:181-185. [PMID: 31273071 DOI: 10.1136/neurintsurg-2019-014950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Thrombus composition has the potential to affect acute ischemic stroke (AIS) treatment. OBJECTIVE To evaluate in an in vitro test the correlation of clot composition, especially erythrocytes (red blood cells (RBCs)), with the variation of signal intensity ratio (SIR) obtained with MRI sequences used for AIS, and qualification of the susceptibility vessel sign effect using clot analogs. MATERIALS AND METHODS Nine ovine clots were fixed in a gelatin-manganese solution and studied by MRI (T2GE, T2-weighted gradient echo; SWI, susceptibility-weighted imaging; FLAIR, fluid attenuated inversion recovery). RBC concentration was estimated using regression models (SLR, single linear regression; MLR, multiple linear regression; RF, random Forest; and ANN, artificial neural networking), which combined the SIR-histology relationship of three MRI sequences. RESULTS Negative correlation was found between SIR and RBC concentration. T2GE SWI could not statistically distinguish clots with RBC content >54% and <23%. SLR was applied only to FLAIR images since T2GE and SWI demonstrated signal saturation. All four regression models showed a correlation between MRI and histology: SLR=0.981; MLR=0.986; RF=0.994, and ANN=0.971. One unknown clot was studied and agreement between SIR and histological analyses was found in all models. CONCLUSIONS We presented a method to quantify RBC concentration in clot analogs, combining SWI, T2GE, and FLAIR. This in vitro study has some limitations, so clot collection after thrombectomy with simultaneous imaging analysis is necessary to validate this model.
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Affiliation(s)
- Kevin Janot
- Neuroradiology, Regional University Hospital Centre Tours, Tours, France
| | - Tiago Ribeiro Oliveira
- Center for Engineering, Modeling and Applied Social Sciences, Federal University of the ABC, Sao Bernardo do Campo, Brazil
| | | | - Mariam Annan
- Neurology, Regional University Hospital Centre Tours, Tours, France
| | - Isabelle Filipiak
- Inserm U1253 'Imaging and Brain: iBrain'', Regional University Hospital Centre Tours, Tours, France
| | - Laurent Barantin
- Inserm U1253 'Imaging and Brain: iBrain'', Regional University Hospital Centre Tours, Tours, France
| | - Roseline Guibon
- Pathology, Regional University Hospital Centre Tours, Tours, France
| | - Sharon Duffy
- Cerenovus, Galway Neuro Technology Centre, Galway, Ireland
| | | | | | - Ana Paula Narata
- Neuroradiology, Regional University Hospital Centre Tours, Tours, France
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18
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Seners P, Roca P, Legrand L, Turc G, Cottier JP, Cho TH, Arquizan C, Bracard S, Ozsancak C, Ben Hassen W, Naggara O, Lion S, Debiais S, Berthezene Y, Costalat V, Richard S, Magni C, Mas JL, Baron JC, Oppenheim C. Better Collaterals Are Independently Associated With Post-Thrombolysis Recanalization Before Thrombectomy. Stroke 2019; 50:867-872. [DOI: 10.1161/strokeaha.118.022815] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
In acute stroke patients with large vessel occlusion, the goal of intravenous thrombolysis (IVT) is to achieve early recanalization (ER). Apart from occlusion site and thrombus length, predictors of early post-IVT recanalization are poorly known. Better collaterals might also facilitate ER, for instance, by improving delivery of the thrombolytic agent to both ends of the thrombus. In this proof-of-concept study, we tested the hypothesis that good collaterals independently predict post-IVT recanalization before thrombectomy.
Methods—
Patients from the registries of 6 French stroke centers with the following criteria were included: (1) acute stroke with large vessel occlusion treated with IVT and referred for thrombectomy between May 2015 and March 2017; (2) pre-IVT brain magnetic resonance imaging, including diffusion-weighted imaging, T2*, MR angiography, and dynamic susceptibility contrast perfusion-weighted imaging; and (3) ER evaluated ≤3 hours from IVT start on either first angiographic run or noninvasive imaging. A collateral flow map derived from perfusion-weighted imaging source data was automatically generated, replicating a previously validated method. Thrombus length was measured on T2*-based susceptibility vessel sign.
Results—
Of 224 eligible patients, 37 (16%) experienced ER. ER occurred in 10 of 83 (12%), 17 of 116 (15%), and 10 of 25 (40%) patients with poor/moderate, good, and excellent collaterals, respectively. In multivariable analysis, better collaterals were independently associated with ER (
P
=0.029), together with shorter thrombus (
P
<0.001) and more distal occlusion site (
P
=0.010).
Conclusions—
In our sample of patients with stroke imaged with perfusion-weighted imaging before IVT and intended for thrombectomy, better collaterals were independently associated with post-IVT recanalization, supporting our hypothesis. These findings strengthen the idea that advanced imaging may play a key role for personalized medicine in identifying patients with large vessel occlusion most likely to benefit from IVT in the thrombectomy era.
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Affiliation(s)
- Pierre Seners
- From the Department of Neurology (P.S., G.T., J.-L.M., J.-C.B.), Sainte-Anne Hospital, INSERM U894, University Paris Descartes, France
| | - Pauline Roca
- Department of Radiology (P.R., L.L., W.B.H., O.N., S.L., C. Oppenheim), Sainte-Anne Hospital, INSERM U894, University Paris Descartes, France
| | - Laurence Legrand
- Department of Radiology (P.R., L.L., W.B.H., O.N., S.L., C. Oppenheim), Sainte-Anne Hospital, INSERM U894, University Paris Descartes, France
| | - Guillaume Turc
- From the Department of Neurology (P.S., G.T., J.-L.M., J.-C.B.), Sainte-Anne Hospital, INSERM U894, University Paris Descartes, France
| | - Jean-Philippe Cottier
- Department of Neuroradiology (J.-P.C.), Bretonneau Hospital, University of Tours, France
| | - Tae-Hee Cho
- Department of Stroke Medicine (T.-H.C.), Hospices Civils de Lyon, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, France
| | - Caroline Arquizan
- Department of Neurology (C.A.), CHRU Gui de Chauliac, Montpellier, France
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, INSERM U947, France (S.B.)
| | - Canan Ozsancak
- Department of Neurology (C. Ozsancak), Orleans Hospital, France
| | - Wagih Ben Hassen
- Department of Radiology (P.R., L.L., W.B.H., O.N., S.L., C. Oppenheim), Sainte-Anne Hospital, INSERM U894, University Paris Descartes, France
| | - Olivier Naggara
- Department of Radiology (P.R., L.L., W.B.H., O.N., S.L., C. Oppenheim), Sainte-Anne Hospital, INSERM U894, University Paris Descartes, France
| | - Stéphanie Lion
- Department of Radiology (P.R., L.L., W.B.H., O.N., S.L., C. Oppenheim), Sainte-Anne Hospital, INSERM U894, University Paris Descartes, France
| | - Séverine Debiais
- Department of Neurology (S.D.), Bretonneau Hospital, University of Tours, France
| | - Yves Berthezene
- Department of Neuroradiology (Y.B.), Hospices Civils de Lyon, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, France
| | - Vincent Costalat
- Department of Interventional Neuroradiology (V.C.), CHRU Gui de Chauliac, Montpellier, France
| | - Sébastien Richard
- Department of Neurology, University Hospital of Nancy, France (S.R.)
| | | | - Jean-Louis Mas
- From the Department of Neurology (P.S., G.T., J.-L.M., J.-C.B.), Sainte-Anne Hospital, INSERM U894, University Paris Descartes, France
| | - Jean-Claude Baron
- From the Department of Neurology (P.S., G.T., J.-L.M., J.-C.B.), Sainte-Anne Hospital, INSERM U894, University Paris Descartes, France
| | - Catherine Oppenheim
- Department of Radiology (P.R., L.L., W.B.H., O.N., S.L., C. Oppenheim), Sainte-Anne Hospital, INSERM U894, University Paris Descartes, France
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19
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Chung JW, Kim YC, Cha J, Choi EH, Kim BM, Seo WK, Kim GM, Bang OY. Characterization of clot composition in acute cerebral infarct using machine learning techniques. Ann Clin Transl Neurol 2019; 6:739-747. [PMID: 31019998 PMCID: PMC6469248 DOI: 10.1002/acn3.751] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 01/01/2023] Open
Abstract
Objective Clot characteristics can provide information on the cause of cerebral artery occlusion and may guide acute revascularization and secondary prevention strategies. We developed a rapid automated clot analysis system using machine learning (ML) and validated its accuracy in patients undergoing endovascular treatment. Methods Pre‐endovascular treatment gradient echo (GRE) images from consecutive patients with middle cerebral artery occlusion were utilized to develop and validate an ML system to predict whether atrial fibrillation (AF) was the underlying cause of ischemic stroke. The accuracy of the ML algorithm was compared with that of visual inspection by neuroimaging specialists for the presence of blooming artifact. Endovascular procedures and outcomes were compared in patients with and without AF. Results Of 67 patients, 29 (43.3%) had AF. Of these, 13 had known AF and 16 were newly diagnosed with cardiac monitoring. By visual inspection, interrater correlation for blooming artifact was 0.73 and sensitivity and specificity for AF were 0.79 and 0.63, respectively. For AF classification, the ML algorithms yielded an average accuracy of > 75.4% in fivefold cross‐validation with clot signal profiles obtained from 52 patients and an area under the curve >0.87 for the average AF probability from five signal profiles in external validation (n = 15). Analysis with an in‐house interface took approximately 3 min per patient. Absence of AF was associated with increased number of passes by stentriever, high reocclusion frequency, and additional use of rescue stenting and/or glycogen IIb/IIIa blocker for recanalization. Interpretation ML‐based rapid clot analysis is feasible and can identify AF with high accuracy, enabling selection of endovascular treatment strategy.
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Affiliation(s)
- Jong-Won Chung
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Yoon-Chul Kim
- Clinical Research Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jihoon Cha
- Department of Radiology Yonsei University Medical Center Yonsei University College of Medicine Seoul Republic of Korea
| | - Eun-Hyeok Choi
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Byung Moon Kim
- Department of Radiology Yonsei University Medical Center Yonsei University College of Medicine Seoul Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Gyeong-Moon Kim
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Oh Young Bang
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
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20
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Liu M, Li L, Li G. The different clinical value of susceptibility vessel sign in acute ischemic stroke patients under different interventional therapy: A systematic review and meta-analysis. J Clin Neurosci 2019; 62:72-79. [PMID: 30712778 DOI: 10.1016/j.jocn.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/08/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
Abstract
Acute ischemic stroke (AIS) subtype, one of the most important factors for selecting therapeutic strategies, is difficult to be accurately diagnosed at admission sometimes. The magnetic susceptibility effect of deoxygenated hemoglobin in red thrombi appeared as hypointense signals in magnetic resonance imaging (MRI) scans. The prognostic value of susceptibility vessel sign (SVS) for stroke subtype, recanalization and outcomes in AIS patients will be comprehensively determined in the present study. A comprehensive search of databases was conducted including the PubMed, Embase, and Cochrane Library from inception up to August 2017. Statistical tests were performed to check for heterogeneity and publication bias. Subgroup and sensitivity analysis were also conducted to evaluate the robustness of the conclusions. Overall, 21 studies including 1832 patients were identified. The presence of SVS was significantly associated with cardioembolic stroke than absence of SVS (RR = 1.53, 95% CI = 1.30-1.81, p < 0.001). The patients with SVS were less likely to achieve recanalization (RR = 0.70, 95% CI = 0.56-0.88, p = 0.002) and poor functional outcome (RR = 1.68, 95% CI = 1.44-1.97, p < 0.001) after intravenous thrombolysis (IVT), whereas it was similar between two group after endovascular treatment (EVT) (p = 0.990 and p = 0.335). The SVS length was smaller in recanalization group than that in non-recanalization group (RR = -0.49, 95% CI = -0.72 to -0.27, p < 0.001), however, no significant difference between SVS width and recanalization rate was found. The presence of SVS appears to be a stronger predictor of cardioembolic stroke. Furthermore, the SVS was associated with a decreasing recanalization rate and poor outcome in AIS patients after IVT but not after EVT. Which offered a practical information to select optimal therapeutic strategies for stroke patients with SVS though the level of evidence seems to be quite shaky.
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Affiliation(s)
- Mingsu Liu
- Department of Neurology, The First Affiliated Hospital of ChongQing Medical University, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Lin Li
- Department of Neurology, The First Affiliated Hospital of ChongQing Medical University, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Guangqin Li
- Department of Neurology, The First Affiliated Hospital of ChongQing Medical University, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing, China.
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21
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Derraz I, Bourcier R, Soudant M, Soize S, Hassen WB, Hossu G, Clarencon F, Derelle AL, Tisserand M, Raoult H, Legrand L, Bracard S, Oppenheim C, Naggara O. Does Clot Burden Score on Baseline T2*-MRI Impact Clinical Outcome in Acute Ischemic Stroke Treated with Mechanical Thrombectomy? J Stroke 2019; 21:91-100. [PMID: 30732444 PMCID: PMC6372898 DOI: 10.5853/jos.2018.01921] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/02/2018] [Indexed: 12/20/2022] Open
Abstract
Background and Purpose A long clot, defined by a low (0-6) clot burden score (CBS) assessed by T2*-MR sequence, is associated with worse clinical outcome after intravenous thrombolysis (IVT) for acute ischemic stroke than is a small clot (CBS, 7-10). The added benefit of mechanical thrombectomy (MT) might be higher in patients with long clot. The aim of this pre-specified post hoc analysis of the THRombectomie des Artères CErebrales (THRACE) trial was to assess the association between T2*-CBS, successful recanalization and clinical outcome.
Methods Of 414 patients randomized in the THRACE trial, 281 patients were included in this analysis. Associations between T2*-CBS and clinical outcome on the modified Rankin Scale (mRS) at 3 months were tested.
Results High T2*-CBS, i.e., small clot, was associated with a shift toward better outcome on the mRS; proportional odds ratio (POR) per point CBS was 1.19 (95% confidence interval [CI], 1.05 to 1.34) in the whole population, 1.34 (95% CI, 1.13 to 1.59) in IVT group, and 1.04 (95% CI, 0.87 to 1.23) in IVTMT group. After adjustment for baseline prognostic variables, the effect of the full scale T2*-CBS was not statistically significant in the whole population and for the IVTMT group but remains significant for the IVT group (POR, 1.32; 95% CI, 1.11 to 1.58).
Conclusions A small clot, as assessed using T2*-CBS, is associated with improved outcome and may be used as a prognostic marker. Despite the worst outcome with long clot, the relative benefit of MT over IVT seemed to increase with low T2*-CBS and longer clot.
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Affiliation(s)
- Imad Derraz
- Department of Neuroradiology, CHRU Nancy, INSERM, University of Lorraine, Nancy, France
| | | | - Marc Soudant
- Department of Biostatistics, CHRU Nancy, INSERM, University of Lorraine, Nancy, France
| | | | - Wagih Ben Hassen
- Paris Descartes University, INSERM UMR 894 and Department of Neuroradiology, Sainte-Anne Hospital Center, Paris, France
| | - Gabriella Hossu
- Department of CIC1433 Innovative Technology, CHRU Nancy, INSERM, University of Lorraine, Nancy, France
| | | | - Anne Laure Derelle
- Department of Neuroradiology, CHRU Nancy, INSERM, University of Lorraine, Nancy, France
| | - Marie Tisserand
- Department of Neuroradiology, Foch Hospital, Suresnes, France
| | - Helene Raoult
- Department of Neuroradiology, CHU Rennes, Rennes, France
| | - Laurence Legrand
- Paris Descartes University, INSERM UMR 894 and Department of Neuroradiology, Sainte-Anne Hospital Center, Paris, France
| | - Serge Bracard
- Department of Neuroradiology, CHRU Nancy, INSERM, University of Lorraine, Nancy, France
| | - Catherine Oppenheim
- Paris Descartes University, INSERM UMR 894 and Department of Neuroradiology, Sainte-Anne Hospital Center, Paris, France
| | - Olivier Naggara
- Paris Descartes University, INSERM UMR 894 and Department of Neuroradiology, Sainte-Anne Hospital Center, Paris, France
| | -
- Department of Neuroradiology, CHRU Nancy, INSERM, University of Lorraine, Nancy, France
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22
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Bourcier R, Pautre R, Mirza M, Castets C, Darcourt J, Labreuche J, Detraz L, Desal H, Serfaty JM, Toquet C. MRI Quantitative T2* Mapping to Predict Dominant Composition of In Vitro Thrombus. AJNR Am J Neuroradiol 2019; 40:59-64. [PMID: 30635330 DOI: 10.3174/ajnr.a5938] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/21/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging quantitative T2* mapping, which provides information about thrombus composition and specifically the red blood cell content, may be obtained in the setting of acute ischemic stroke before treatment. This could be useful to adapt the endovascular strategy. We aimed to analyze the red blood cell content of in vitro thrombi in relation to the thrombus-T2* relaxation time. MATERIALS AND METHODS Thirty-five thrombus analogs of different compositions were scanned with an MR imaging quantitative T2* mapping sequence. Two radiologists, blinded to thrombus composition, measured the thrombus-T2* relaxation time twice at an interval of 2 weeks. Quantitative histologic evaluations of red blood cell content were performed. Inter- and intraobserver reproducibility of the thrombus-T2* relaxation time was assessed by calculating intraclass correlation coefficients. Finally, a Spearman product moment correlation between the thrombus-T2* relaxation time and red blood cell content was performed. RESULTS The median thrombus-T2* relaxation time was 78.5 ms (range, 16-268 ms; interquartile range, 60.5 ms). The median red blood cell content was 55% (range, 0%-100%; interquartile range, 75%). Inter- and intraobserver reproducibility of the thrombus-T2* relaxation time was excellent (>0.9). The Spearman rank correlation test found a significant inverse correlation between thrombus-T2* relaxation time and red blood cell content (ρ = -0.834, P < .001). CONCLUSIONS MR imaging quantitative T2* mapping can reliably identify the thrombus red blood cell content in vitro. This fast, easy-to-use sequence could be implemented in routine practice to predict stroke etiology and adapt devices or techniques for endovascular treatment of acute ischemic stroke.
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Affiliation(s)
- R Bourcier
- From the Departments of Neuroradiology (R.B., R.P., L.D., H.D.) romain.bourcier@chu-nantes
| | - R Pautre
- From the Departments of Neuroradiology (R.B., R.P., L.D., H.D.)
| | - M Mirza
- Neuravi Thromboembolic Initiative (M.M.), Galway, Ireland
| | - C Castets
- Siemens Healthineers France (C.C.), Saint-Denis, France
| | - J Darcourt
- Department of Neuroradiology (J.D.), Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - J Labreuche
- Department of Biostatistics (J.L.), Université de Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - L Detraz
- From the Departments of Neuroradiology (R.B., R.P., L.D., H.D.)
| | - H Desal
- From the Departments of Neuroradiology (R.B., R.P., L.D., H.D.)
| | - J-M Serfaty
- Cardiac and Vascular Imaging (J.-M.S.), Hôpital René et Guillaume Laennec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - C Toquet
- Department of Pathology (C.T.), Hôtel Dieu, Centre Hospitalier Universitaire de Nantes, Nantes, France
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23
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Seners P, Turc G, Naggara O, Henon H, Piotin M, Arquizan C, Cho TH, Narata AP, Lapergue B, Richard S, Legrand L, Bricout N, Blanc R, Dargazanli C, Gory B, Debiais S, Tisserand M, Bracard S, Leclerc X, Obadia M, Costalat V, Berner LP, Cottier JP, Consoli A, Ducrocq X, Mas JL, Oppenheim C, Baron JC, Abrivard M, Alamowitch S, Ben Hassen W, Berthezene Y, Blanc-Lasserre K, Boulin A, Boulouis G, Bouly S, Bourdain F, Calvet D, Charron V, Chbicheb M, Condette-Auliac S, Corabianu O, Cordonnier C, Coskun O, De Broucker T, Decroix JP, Di Maria F, Evrard S, Fissellier M, Girard I, Lalu T, Le Coz P, Le Guen M, Ille O, Leys D, Magni C, Manchon E, Mazighi M, Mounier-Vehier F, Moynier M, Muresan IP, Nighoghossian N, Ong E, Ozsancak C, Philippeau F, Pico F, Rodesch G, Rosolacci T, Sabben C, Sablot D, Tassan P, Tchikviladze M, Turjman F, Vallet AE, Wang A, Zins M, Zuber M. Post-Thrombolysis Recanalization in Stroke Referrals for Thrombectomy. Stroke 2018; 49:2975–2982. [DOI: 10.1161/strokeaha.118.022335] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background and Purpose—
Whether all acute stroke patients with large vessel occlusion need to undergo intravenous thrombolysis before mechanical thrombectomy (MT) is debated as (1) the incidence of post-thrombolysis early recanalization (ER) is still unclear; (2) thrombolysis may be harmful in patients unlikely to recanalize; and, conversely, (3) transfer for MT may be unnecessary in patients highly likely to recanalize. Here, we determined the incidence and predictors of post-thrombolysis ER in patients referred for MT and derive ER prediction scores for trial design.
Methods—
Registries from 4 MT-capable centers gathering patients referred for MT and thrombolyzed either on site (mothership) or in a non MT-capable center (drip-and-ship) after magnetic resonance– or computed tomography–based imaging between 2015 and 2017. ER was identified on either first angiographic run or noninvasive imaging. In the magnetic resonance imaging subsample, thrombus length was determined on T2*-based susceptibility vessel sign. Independent predictors of no-ER were identified using multivariable logistic regression models, and scores were developed according to the magnitude of regression coefficients. Similar registries from 4 additional MT-capable centers were used as validation cohort.
Results—
In the derivation cohort (N=633), ER incidence was ≈20%. In patients with susceptibility vessel sign (n=498), no-ER was independently predicted by long thrombus, proximal occlusion, and mothership paradigm. A 6-point score derived from these variables showed strong discriminative power for no-ER (C statistic, 0.854) and was replicated in the validation cohort (n=353; C statistic, 0.888). A second score derived from the whole sample (including negative T2* or computed tomography–based imaging) also showed good discriminative power and was similarly validated. Highest grades on both scores predicted no-ER with >90% specificity, whereas low grades did not reliably predict ER.
Conclusions—
The substantial ER rate underlines the benefits derived from thrombolysis in bridging populations. Both prediction scores afforded high specificity for no-ER, but not for ER, which has implications for trial design.
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Affiliation(s)
- Pierre Seners
- From the Neurology Department (P.S., G.T., J.-L.M., J.-C.B.), INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, Paris, France
| | - Guillaume Turc
- From the Neurology Department (P.S., G.T., J.-L.M., J.-C.B.), INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, Paris, France
| | - Olivier Naggara
- Radiology Department (O.N., L.L., C.O.), INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, Paris, France
| | - Hilde Henon
- Stroke Unit, Neurology Department (H.H.), Roger Salengro Hospital, Lille, France
| | - Michel Piotin
- Interventional Neuroradiology Department (M.P., R.B.), Fondation Adolphe de Rothschild, Paris, France
| | - Caroline Arquizan
- Neurology Department (C.A.), CHRU Gui de Chauliac, Montpellier, France
| | - Tae-Hee Cho
- Stroke Medicine Department (T.-H.C.), Hospices Civils de Lyon, France
| | - Ana-Paula Narata
- Neuroradiology Department (A.-P.N., J.-P.C.), Bretonneau Hospital, Tours, France
| | | | | | - Laurence Legrand
- Radiology Department (O.N., L.L., C.O.), INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, Paris, France
| | - Nicolas Bricout
- Neuroradiology Department (N.B., X.L.), Roger Salengro Hospital, Lille, France
- Neuroradiology Department, CHU Lille, France (N.B., X.L.)
| | - Raphaël Blanc
- Interventional Neuroradiology Department (M.P., R.B.), Fondation Adolphe de Rothschild, Paris, France
| | - Cyril Dargazanli
- Neuroradiology Department (C.D., V.C.), CHRU Gui de Chauliac, Montpellier, France
| | - Benjamin Gory
- Stroke Medicine Department (T.-H.C.), Hospices Civils de Lyon, France
- Neuroradiology Department (B.G., S.B.), University Hospital of Nancy, France
| | | | - Marie Tisserand
- Neuroradiology Department (A.C., M.T.), Foch Hospital, Suresnes, France
| | - Serge Bracard
- Stroke Medicine Department (T.-H.C.), Hospices Civils de Lyon, France
- Neuroradiology Department (B.G., S.B.), University Hospital of Nancy, France
| | - Xavier Leclerc
- Neuroradiology Department (N.B., X.L.), Roger Salengro Hospital, Lille, France
- Neurology Department (C.A.), CHRU Gui de Chauliac, Montpellier, France
| | - Michael Obadia
- Neurology Department (M.O.), Fondation Adolphe de Rothschild, Paris, France
| | - Vincent Costalat
- Neuroradiology Department (C.D., V.C.), CHRU Gui de Chauliac, Montpellier, France
| | - Lise-Prune Berner
- Neuroradiology Department (L.-P.B.), Hospices Civils de Lyon, France
| | | | - Arturo Consoli
- Neuroradiology Department (A.C., M.T.), Foch Hospital, Suresnes, France
| | - Xavier Ducrocq
- Neurology Department, Metz-Thionville Hospital, France (X.D.)
| | - Jean-Louis Mas
- From the Neurology Department (P.S., G.T., J.-L.M., J.-C.B.), INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, Paris, France
| | - Catherine Oppenheim
- From the Neurology Department (P.S., G.T., J.-L.M., J.-C.B.), INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, Paris, France
- Radiology Department (O.N., L.L., C.O.), INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, Paris, France
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Bourcier R, Legrand L, Soize S, Labreuche J, Beaumont M, Desal H, Derraz I, Bracard S, Oppenheim C, Naggara O. Validation of overestimation ratio and TL-SVS as imaging biomarker of cardioembolic stroke and time from onset to MRI. Eur Radiol 2018; 29:2624-2631. [PMID: 30421018 DOI: 10.1007/s00330-018-5835-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/17/2018] [Accepted: 10/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to determine in the "THRACE" trial, the clinical and MRI technical parameters associated with the two-layered susceptibility vessel sign (TL-SVS) and the overestimation ratio (overR). MATERIALS AND METHODS Patients with pre-treatment brain gradient echo (GRE) sequence and an etiological work-up were identified. Two readers reviewed TL-SVS, i.e., a SVS with a linear low-intense signal core surrounded by a higher intensity and measured the overR as the width of SVS divided by the width of the artery. Binomial and ordinal logistic regression respectively tested the association between TL-SVS and quartiles of overR with patient characteristics, cardioembolic stroke (CES), time from onset to imaging, and GRE sequence parameters (inter slice gap, slice thickness, echo time, flip angle, voxel size, and field strength). RESULTS Among 258 included patients, 102 patients were examined by 3 Tesla MRI and 156 by 1.5 Tesla MRI. Intra- and inter-reader agreements for quartiles of overR and TL-SVS were good to excellent. The median overR was 1.59 (IQR, 1.30 to 1.86). TL-SVS was present in 101 patients (39.2%, 95%CI, 33.1 to 45.1%). In multivariate analysis, only CES was associated with overR quartiles (OR, 1.83; 95%CI, 1.11 to 2.99), and every 60 min increase from onset to MRI time was associated with TL-SVS (OR, 1.72; 95%CI, 1.10 to 2.67). MRI technical parameters were statistically associated with neither overR nor TL-SVS. CONCLUSION Independent of GRE sequence parameters, an increased overR was associated to CES, while the TL-SVS is independently related to a longer time from onset to MRI. KEY POINTS • An imaging biomarker would be useful to predict the etiology of stroke in order to adapt secondary prevention of stroke. • The two-layered susceptibility vessel sign and the overestimation ratio are paramagnetic effect derived markers that vary according to the MRI machines and sequence parameters. • Independent of sequence parameters, an increased overestimation ratio was associated to cardioembolic stroke, while the two-layered susceptibility vessel sign is independently related to a longer time from onset to MRI.
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Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France.
| | - Laurence Legrand
- Department of Neuroradiology, Université Paris-Descartes. INSERM U894, Sainte-Anne Hospital, Paris, France
| | - Sébastien Soize
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Reims, Reims, France.,INSERM UMR-S 1237 Physiopathology and imaging of neurological disorders, Université Caen Normandie, Caen, France
| | - Julien Labreuche
- Centre Hospitalier Regional Universitaire de Lille, Biostatistics, Lille, Hauts-de-France, France
| | - Marine Beaumont
- CIC1433, INSERM, IADI, U1254, Université de Lorraine, INSERM, CHRU de Nancy CIC-IT Nancy, Nancy, France
| | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Imad Derraz
- Department of Diagnostic and Interventional Neuroradiology, Hopital Gui de Chauillac, Montpellier, France
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Catherine Oppenheim
- Department of Neuroradiology, Université Paris-Descartes. INSERM U894, Sainte-Anne Hospital, Paris, France
| | - Olivier Naggara
- Department of Neuroradiology, Université Paris-Descartes. INSERM U894, Sainte-Anne Hospital, Paris, France.,Pediatric Radiology Department, Necker Enfants Malades, Paris, France
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25
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Pruvo JP, Berge J, Kuchcinski G, Bretzner M, Leclerc X, Hacein-Bey L. Health Care Organization for the Management of Stroke. Neuroimaging Clin N Am 2018; 28:691-698. [DOI: 10.1016/j.nic.2018.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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26
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Ko HC, Ryu CW, Yun SJ, Koh JS, Shin HS, Kim EJ. Characteristic Signs on T2*-Based Imaging and Their Relationship with Results of Reperfusion Therapy for Acute Ischemic Stroke: A Systematic Review and Evidence to Date. Neurointervention 2018; 13:90-99. [PMID: 30196679 PMCID: PMC6132033 DOI: 10.5469/neuroint.2018.01039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/23/2018] [Accepted: 08/25/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Characteristic signs - the susceptibility vessel sign (SVS) and the prominent hypointense vessel sign (PHVS) - on T2*-based magnetic resonance imaging (T2*MRI) can be seen for acute ischemic stroke with large artery occlusion. In this study, we investigated the evidence to support our hypothesis that these findings may help to predict outcomes after reperfusion therapy. MATERIALS AND METHODS We searched for papers describing SVS and PHVS in patients treated with reperfusion therapy for acute ischemic stroke, and their functional/radiologic outcomes were systematically reviewed. RESULTS Nine studies on the SVS and six studies on the PHVS were included. The pooled odds ratio (OR) of recanalization after intravenous thrombolysis or mechanical thrombectomy was not significantly different with the presence of SVS (OR, 0.615; 95% confidence interval [CI], 0.335-1.131 and OR, 0.993; 95% CI, 0.629-1.567). The OR of favorable functional outcome after reperfusion therapy in terms of the presence of PHVS varied (0.083 to 1.831) by study. CONCLUSION Our meta-analysis of the published data showed that a SVS was not a predictive factor for recanalization after reperfusion therapy for acute ischemic stroke. Currently, the data available on T2*MRI are too limited to warrant reperfusion therapy in routine practice. More data are needed from studies with randomized treatment allocation to determine the role of T2*MRI.
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Affiliation(s)
- Hak Cheol Ko
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jun Seok Koh
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hee Sup Shin
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Eui Jong Kim
- Department of Radiology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
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27
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Bourcier R, Hassen WB, Soize S, Roux P, Labreuche J, Kyheng M, Tisserand M, Rosso C, Blanc R, Piotin M, Derraz I, Boulouis G, Oppenheim C, Desal H, Bracard S, Lapergue B, Naggara O. Susceptibility vessel sign on MRI predicts better clinical outcome in patients with anterior circulation acute stroke treated with stent retriever as first-line strategy. J Neurointerv Surg 2018; 11:328-333. [PMID: 30154254 DOI: 10.1136/neurintsurg-2018-014217] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Susceptibility vessel sign (SVS) can be a useful MRI biomarker of an occlusion but its relationship with clinical outcomes of acute ischemic stroke (AIS) is yet to be fully elucidated. OBJECTIVE To investigate SVS in relation to the clinical outcomes after mechanical thrombectomy using a stent retriever (SR) as first-line approach in patients with AIS. MATERIAL AND METHODS We included patients with a first-line SR approach for anterior AIS from the the Contact Aspiration vs Stent Retriever for Successful Revascularization (ASTER) and THRombectomie des Artères CErebrales (THRACE) trials when both baseline imaging of SVS and 90-day modified Rankin Scale (mRS) scores were available. Patients were assigned to two groups based on the presence of an SVS (independent core laboratory), and the overall distributions of the mRS score at 90 days (shift analysis) and clinical independence (mRS score ≤2) were compared. RESULTS 217 patients were included and SVS was diagnosed in 76.0% of cases (n=165, 95% CI 70.4% to 81.7%). After adjustment for potential confounders, SVS+ was significantly associated with 90-day mRS improvement (adjusted common OR=2.75; 95% CI 1.44 to 5.26) and favorable outcome (adjusted common OR=2.76; 95% CI 1.18 to 6.45). CONCLUSION Based on results for patients of the ASTER and THRACE trials receiving first-line SR treatment, SVS was associated with lower disability at 3 months. Large prospective studies using MRI-based thrombus evaluation are warranted.
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Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | | | - Sébastien Soize
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Reims, Reims, France.,INSERM UMR
| | - Pascal Roux
- Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Julien Labreuche
- Department of Biostatistics, University Lille, CHU Lille, EA 2694-Santé Publique: Epidémiologie et Qualité des Soins, Lille, France
| | - Maeva Kyheng
- Department of Biostatistics, University Lille, CHU Lille, EA 2694-Santé Publique: Epidémiologie et Qualité des Soins, Lille, France
| | - Marie Tisserand
- Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Charlotte Rosso
- Urgences cérébro-vasculaires, Sorbonne Université, UPMC Univ Paris 06, Hôpital Pitié
| | - Raphael Blanc
- Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Michel Piotin
- Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Imad Derraz
- Department of Diagnostic and Interventional Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | | | | | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Bertrand Lapergue
- Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
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28
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AL-ZGHLOUL MANSOUR, WENZ HOLGER, MAROS MÁTÉ, BÖHME JOHANNES, GRODEN CHRISTOPH, FÖRSTER ALEX. Susceptibility Vessel Sign on T2*-Weighted Gradient Echo Imaging in Lacunar Infarction. In Vivo 2018. [PMID: 29936488 PMCID: PMC6117771 DOI: 10.21873/invivo.112337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND/AIM In stroke due to large vessel occlusion, thrombotic material can be demonstrated by the susceptibility vessel sign (SVS), a hypointense signal on T2*-weighted gradient echo magnetic resonance (GRE) images. In the present study, we evaluated the value of GRE for the detection of perforating artery occlusion in hyperacute lacunar infarction (LI). MATERIALS AND METHODS The presence of SVS on GRE in 58 patients with LI who underwent magnetic resonance imaging within 24 hours after symptom onset was analyzed. RESULTS On diffusion-weighted images (DWI), LI was found in the basal ganglia in 17.2%, internal capsule in 25.9%, corona radiata in 19.0%, thalamus in 32.8%, and brainstem in 5.2%. On GRE a subtle circumscribed hypointense signal at the lower edge of the LI consistent with SVS was detected in 11/58 (19%) patients. Patients with SVS had larger ischemic lesions on DWI (p=0.045). CONCLUSION SVS on GRE may be useful for detection of perforating artery occlusion in a subset of patients with hyperacute LI.
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29
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Al-Zghloul M, Wenz H, Maros M, Böhme J, Groden C, Förster A. Susceptibility Vessel Sign on T2*-Weighted Gradient Echo Imaging in Lacunar Infarction. In Vivo 2018; 32:973-976. [PMID: 29936488 DOI: 10.21873/invivo.11337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM In stroke due to large vessel occlusion, thrombotic material can be demonstrated by the susceptibility vessel sign (SVS), a hypointense signal on T2*-weighted gradient echo magnetic resonance (GRE) images. In the present study, we evaluated the value of GRE for the detection of perforating artery occlusion in hyperacute lacunar infarction (LI). MATERIALS AND METHODS The presence of SVS on GRE in 58 patients with LI who underwent magnetic resonance imaging within 24 hours after symptom onset was analyzed. RESULTS On diffusion-weighted images (DWI), LI was found in the basal ganglia in 17.2%, internal capsule in 25.9%, corona radiata in 19.0%, thalamus in 32.8%, and brainstem in 5.2%. On GRE a subtle circumscribed hypointense signal at the lower edge of the LI consistent with SVS was detected in 11/58 (19%) patients. Patients with SVS had larger ischemic lesions on DWI (p=0.045). CONCLUSION SVS on GRE may be useful for detection of perforating artery occlusion in a subset of patients with hyperacute LI.
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Affiliation(s)
- Mansour Al-Zghloul
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Holger Wenz
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Máté Maros
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Johannes Böhme
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Alex Förster
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
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Li L, Liu MS, Li GQ, Zheng Y, Guo TL, Kang X, Yuan MT. Susceptibility-weighted Imaging in Thrombolytic Therapy of Acute Ischemic Stroke. Chin Med J (Engl) 2018; 130:2489-2497. [PMID: 29052571 PMCID: PMC5684633 DOI: 10.4103/0366-6999.216401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: To provide a comprehensive and latest overview of susceptibility-weighted imaging (SWI) in the application of thrombolysis in acute ischemic stroke, and to update the decision-making effect and clinical value of SWI on identifying stroke patients suitable for thrombolytic therapy and possible benefits and risks followed. Data Sources: Literatures referred to this review were collected from PubMed, Medline, and EMBASE published till May 2017, using the search terms including susceptibility-weighted imaging, gradient-echo, T2*, thrombolysis, recombinant tissue plasminogen activator (rt-PA), thrombolytic therapy, and stroke. Study Selection: Papers in English or with available English abstracts were considered, with no limitation of study design. References were also identified from the bibliographies of identified articles and the authors’ files. Results: SWI is of guiding significance for thrombolytic therapy in stroke patients, it can predict the location and length of thrombus and ischemic penumbra. It is worthy of noting that susceptibility vessel sign (SVS) on SWI can be used to predict recanalization after thrombolytic therapy and whether it is better to implement endovascular thrombolectomy in combination or alone. SWI is sensitive in detecting cerebral microbleed (CMB), and CMB might not be a contraindication for thrombolytic therapy, yet CMBs in multiple foci could possibly be related to intracranial hemorrhage (ICH) after thrombolysis. SVS and CMB on SWI sequence are of instructive value in performing antiplatelet therapy after thrombolytic therapy. Cerebral venous change on SWI is related to lower recanalization rate and poor outcome after thrombolysis. Conclusions: It seems that SWI can be applied to guide individualized thrombolytic therapies and assist clinicians in making better decisions by weighing benefits and risks. However, there still exist controversies about the relationship between signs on SWI and thrombolytic therapy.
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Affiliation(s)
- Lin Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Ming-Su Liu
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Guang-Qin Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Yang Zheng
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Tong-Li Guo
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Xin Kang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Mao-Ting Yuan
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
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31
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Bourcier R, Derraz I, Delasalle B, Beaumont M, Soize S, Legrand L, Desal H, Bracard S, Naggara O, Oppenheim C. Susceptibility Vessel Sign and Cardioembolic Etiology in the THRACE Trial. Clin Neuroradiol 2018; 29:685-692. [PMID: 29947813 DOI: 10.1007/s00062-018-0699-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/28/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE The susceptibility vessel sign (SVS) has been described on gradient echo (GRE) magnetic resonance imaging (MRI) in acute ischemic stroke patients by large vessel occlusion. The presence of SVS (SVS+) was associated with treatment outcome and stroke etiology with conflicting results. Based on multicenter data from the THRombectomie des Artères CErebrales (THRACE) study, we aimed to determine if the association between SVS and cardioembolic etiology (CE) was independent of GRE sequence parameters. MATERIAL AND METHODS Patients with a pretreatment brain GRE sequence were identified. Logistic regression tested the association between SVS+, CE, time from onset to imaging and GRE sequence parameters (e.g. echo time, voxel size, field strength). We calculated the sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the SVS to predict a stroke from a CE. RESULTS An SVS+ was observed in 237 out of 287 (83%) patients. In the univariate analysis, there was a significant association between SVS+ and a CE with an odds ratio (OR) and 95% confidence interval (95% CI) of 2.10 (1.02-4.29), respectively (p = 0.04) but not with GRE sequence parameters. In multivariate analysis, there was an independent relationship between SVS+ and CE (OR [95% CI]: 2.14 [1.02-4.45], p = 0.04). Sensitivity and specificity of SVS+ to predict CE were 0.89 and 0.21, respectively. The PPV and NPV of SVS+ were 0.44 and 0.78, respectively. CONCLUSION The presence of SVS is associated to CE, independent of GRE sequence parameters. While the specificity and the PPV of the sign were low, CE seems less likely in the absence of an SVS.
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Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France.
| | - Imad Derraz
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Montpellier, Montpellier, France
| | - Béatrice Delasalle
- L'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France.,UMR1087, Institut National de la Santé et de la Recherche Médicale, Nantes, France
| | - Marine Beaumont
- CIC1433, INSERM, Université de Lorraine, Nancy, France.,IADI, U1254, Université de Lorraine, Nancy, France.,CHRU de Nancy CIC-IT, INSERM, Nancy, France
| | - Sebastien Soize
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Reims, Reims, France.,INSERM UMR-S 1237 Physiopathology and imaging of neurological disorders, Université Caen Normandie, Caen, France
| | - Laurence Legrand
- Department of Neuroradiology, Université Paris-Descartes, Paris, France.,INSERM U894, Sainte-Anne Hospital, Paris, France
| | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Montpellier, Montpellier, France
| | - Olivier Naggara
- Department of Neuroradiology, Université Paris-Descartes, Paris, France.,Pediatric Radiology Department, Necker Enfants Malades, Paris, France.,INSERM U894, Sainte-Anne Hospital, Paris, France
| | - Catherine Oppenheim
- Department of Neuroradiology, Université Paris-Descartes, Paris, France.,INSERM U894, Sainte-Anne Hospital, Paris, France
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32
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Ganeshan R, Nave AH, Scheitz JF, Schindlbeck KA, Haeusler KG, Nolte CH, Villringer K, Fiebach JB. Assessment of thrombus length in acute ischemic stroke by post-contrast magnetic resonance angiography. J Neurointerv Surg 2017; 10:756-760. [PMID: 29151041 DOI: 10.1136/neurintsurg-2017-013454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Post-contrast magnetic resonance angiography (PC-MRA) enables visualization of vessel segments distal to an intra-arterial thrombus in acute ischemic stroke. We hypothesized that PC-MRA also allows clot length measurement in different intracranial vessels. METHODS Patients with MRI-confirmed ischemic stroke and intracranial artery occlusion within 24 hours of symptom onset were prospectively evaluated. PC-MRA was added to a standard stroke MRI protocol. Thrombus length was measured on thick slab maximum intensity projection images. Clinical outcome at hospital discharge was assessed by modified Rankin Scale (mRS). RESULTS Thirty-four patients (median age 72 years) presenting with a median National Institutes of Health Stroke Scale score of 11 and a median onset to imaging time of 116 min were included. PC-MRA enabled precise depiction of proximal and distal terminus of the thrombus in 31 patients (91%), whereas in three patients (9%) PC-MRA presented a partial occlusion. Median thrombus length in patients with complete occlusion was 9.9 mm. In patients with poor outcome (mRS ≥3) median thrombus length was significantly longer than in those with good outcome (mRS ≤2;P=0.011). CONCLUSIONS PC-MRA demonstrates intra-arterial thrombus length at different vessel occlusion sites. Longer thrombus length is associated with poor clinical outcome. CLINICAL TRIAL REGISTRATION NCT02077582; Results.
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Affiliation(s)
- Ramanan Ganeshan
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander H Nave
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jan F Scheitz
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Katharina A Schindlbeck
- Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Karl Georg Haeusler
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Christian H Nolte
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Kersten Villringer
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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33
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Liu H, Mei W, Huang Y, Li Y, Chen Z, Li D, Ye H, Zhang J. Susceptibility vessel sign predicts poor clinical outcome for acute stroke patients untreated by thrombolysis. Exp Ther Med 2017; 14:5207-5213. [PMID: 29201238 DOI: 10.3892/etm.2017.5195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 06/02/2017] [Indexed: 12/13/2022] Open
Abstract
The location and length of the susceptibility vessel sign (SVS) predicts poor outcome for patients having received reperfusion therapy. The aim of the present study was to assess the predictive value of SVS regarding the clinical outcome for patients untreated with thrombolysis. A retrospective study on acute stroke patients who underwent multimodal magnetic resonance imaging within 3 days from the onset of symptoms was performed. None of the patients had received thrombolysis therapy. The presence, location and length of the SVS were assessed. Uni- and multivariate analyses were used to examine the association between SVS and clinical outcome. A total of 43 SVS+ and 73 SVS- patients were included in the study. A modified Rankin Scale (mRS) of ≤2 at 3 months was determined in 41.9% of patients in the SVS+ group and 79.4% in the SVS- group (P<0.001). Multivariate analysis revealed that the presence of SVS was an independent parameter to predict mRS >2 at 3 months (odds ratio, 3.390; 95% confidence interval, 1.122-10.240; P=0.030). For patients with SVS+ status, the location and length of the SVS were not independent predictors of the clinical outcome. In conclusion, the presence of SVS may predict poor clinical outcome for acute stroke patients untreated with thrombolysis.
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Affiliation(s)
- Huiqin Liu
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Wenli Mei
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Yue Huang
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Yongli Li
- Department of Radiology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Zuzhi Chen
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Dongdong Li
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 453100, P.R. China
| | - Hong Ye
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Jiewen Zhang
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
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Bourcier R, Détraz L, Serfaty JM, Delasalle BG, Mirza M, Derraz I, Toulgoat F, Naggara O, Toquet C, Desal H. MRI Interscanner Agreement of the Association between the Susceptibility Vessel Sign and Histologic Composition of Thrombi. J Neuroimaging 2017; 27:577-582. [DOI: 10.1111/jon.12464] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Romain Bourcier
- Department of Neuroradiology, CHU de Nantes; Hôpital René et Guillaume Laennec; Saint Herblain France
| | - Lili Détraz
- Department of Neuroradiology, CHU de Nantes; Hôpital René et Guillaume Laennec; Saint Herblain France
| | - Jean Michel Serfaty
- CHU de Nantes, Hôpital René et Guillaume Laennec; Imagerie Cardiaque et Vasculaire; Nantes France
- Institut Nationale de la Santé et de la Recherche Médicale, UMR 1087; l'institut du thorax; Paris France
| | - Beatrice Guyomarch Delasalle
- CHU de Nantes, Hôpital René et Guillaume Laennec, L'institut du thorax, INSERM, CNRS; UNIV Nantes; Nantes France
| | | | - Imad Derraz
- Department of Neuroradiology; CHU de Nancy; Nancy France
| | - Frédérique Toulgoat
- Central Department of Radiology and Medical Imaging, CHU de Nantes; Hôtel Dieu; Nantes France
| | - Olivier Naggara
- Department of Neuroradiology; Centre Hospitalier Sainte-Anne
- Université Paris-Descartes; INSERM U 894 Paris France
| | - Claire Toquet
- Department of Pathology, CHU de Nantes; Hôtel Dieu; Nantes France
| | - Hubert Desal
- Department of Neuroradiology, CHU de Nantes; Hôpital René et Guillaume Laennec; Saint Herblain France
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Zhang R, Zhou Y, Liu C, Zhang M, Yan S, Liebeskind DS, Lou M. Overestimation of Susceptibility Vessel Sign. Stroke 2017; 48:1993-1996. [DOI: 10.1161/strokeaha.117.016727] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The extent of blooming artifact may reflect the amount of paramagnetic material. We thus assessed the overestimation ratio of susceptibility vessel sign (SVS) on susceptibility-weighted imaging, defined as the extent of SVS width beyond the lumen and examined its value for predicting the stroke cause in acute ischemic stroke patients.
Methods—
We included consecutive acute ischemic stroke patients with proximal large artery occlusion who underwent both susceptibility-weighted imaging and time-of-flight magnetic resonance angiography within 8 hours poststroke onset. We calculated the length, width, and overestimation ratio of SVS on susceptibility-weighted imaging and then investigated their values for predicting the stroke cause, respectively.
Results—
One-hundred eleven consecutive patients (72 female; mean age, 66.6±13.4 years) were enrolled, among whom 39 (35.1%) were diagnosed with cardiogenic embolism, 43 (38.7%) with large artery atherosclerosis, and 29 (26.1%) with undetermined cause. The presence, length, width, and overestimation ratio of SVS were all independently associated with the cause of cardiogenic embolism after adjusting for baseline National Institute of Health Stroke Scale and infarct volume. After excluded patients with undetermined cause, the sensitivity and specificity of overestimation ratio of SVS for cardiogenic embolism were 0.971 and 0.913; for the length of SVS, they were 0.629 and 0.739; for the width of SVS, they were 0.829 and 0.826, respectively.
Conclusions—
The overestimation ratio of SVS can predict cardiogenic embolism, with both high sensitivity and specificity, which can be helpful for the management of acute ischemic stroke patients in hyperacute stage.
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Affiliation(s)
- Ruiting Zhang
- From the Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (R.Z., Y.Z., C.L., M.Z., S.Y., M.L.); and Department of Neurology, University of California-Los Angeles Stroke Center (D.S.L.)
| | - Ying Zhou
- From the Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (R.Z., Y.Z., C.L., M.Z., S.Y., M.L.); and Department of Neurology, University of California-Los Angeles Stroke Center (D.S.L.)
| | - Chang Liu
- From the Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (R.Z., Y.Z., C.L., M.Z., S.Y., M.L.); and Department of Neurology, University of California-Los Angeles Stroke Center (D.S.L.)
| | - Meixia Zhang
- From the Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (R.Z., Y.Z., C.L., M.Z., S.Y., M.L.); and Department of Neurology, University of California-Los Angeles Stroke Center (D.S.L.)
| | - Shenqiang Yan
- From the Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (R.Z., Y.Z., C.L., M.Z., S.Y., M.L.); and Department of Neurology, University of California-Los Angeles Stroke Center (D.S.L.)
| | - David S. Liebeskind
- From the Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (R.Z., Y.Z., C.L., M.Z., S.Y., M.L.); and Department of Neurology, University of California-Los Angeles Stroke Center (D.S.L.)
| | - Min Lou
- From the Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (R.Z., Y.Z., C.L., M.Z., S.Y., M.L.); and Department of Neurology, University of California-Los Angeles Stroke Center (D.S.L.)
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Revisiting ‘progressive stroke’: incidence, predictors, pathophysiology, and management of unexplained early neurological deterioration following acute ischemic stroke. J Neurol 2017; 265:216-225. [DOI: 10.1007/s00415-017-8490-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/07/2017] [Accepted: 04/07/2017] [Indexed: 12/22/2022]
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Kang DW, Jeong HG, Kim DY, Yang W, Lee SH. Prediction of Stroke Subtype and Recanalization Using Susceptibility Vessel Sign on Susceptibility-Weighted Magnetic Resonance Imaging. Stroke 2017; 48:1554-1559. [PMID: 28432264 PMCID: PMC5436734 DOI: 10.1161/strokeaha.116.016217] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/20/2017] [Accepted: 03/14/2017] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— The susceptibility vessel sign (SVS) is a hypointense signal visualized because of the susceptibility effect of thrombi, sensitively detected on susceptibility-weighted magnetic resonance imaging. The relationship of SVS parameters with the stroke subtype and recanalization status after endovascular treatment remains uncertain. Methods— The data from 89 patients with acute stroke caused by anterior circulation infarcts who underwent susceptibility-weighted magnetic resonance imaging before endovascular treatment were examined. Independent reviewers, blinded to the stroke subtype and recanalization status, measured the SVS diameter, length, and estimated volume. The intra- and interrater agreements of the SVS parameters were assessed. Results— The SVS was identified in 78% of the patients. SVS was more commonly associated with cardioembolism than with noncardioembolism (P=0.01). The SVS diameter (P<0.01) and length (P=0.01) were larger in the cardioembolism group. The SVS diameter was larger in the recanalization group (thrombolysis in cerebral infarction ≥2b) than in the nonrecanalization group (P=0.04). Multivariable analysis revealed that the SVS diameter was an independent predictor of cardioembolism (adjusted odds ratio, 1.97; 95% confidence interval, 1.34–2.90; P<0.01). There was no significant association between the SVS volume and the recanalization status (adjusted odds ratio, 1.003; 95% confidence interval, 0.999–1.006; P=0.12). The optimal cutoff value of the SVS diameter for the cardioembolism was 5.5 mm (sensitivity, 45.6%; specificity, 93.8%). Conclusions— Increased SVS diameter on susceptibility-weighted magnetic resonance imaging may predict cardioembolism. No clear association was found between SVS volume and endovascular recanalization.
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Affiliation(s)
- Dong-Wan Kang
- From the Department of Neurology, Seoul National University Hospital, Republic of Korea
| | - Han-Gil Jeong
- From the Department of Neurology, Seoul National University Hospital, Republic of Korea
| | - Do Yeon Kim
- From the Department of Neurology, Seoul National University Hospital, Republic of Korea
| | - Wookjin Yang
- From the Department of Neurology, Seoul National University Hospital, Republic of Korea
| | - Seung-Hoon Lee
- From the Department of Neurology, Seoul National University Hospital, Republic of Korea.
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Abstract
Advances in mechanical thrombectomy techniques have resulted in improved, recanalization and functional outcomes in acute stroke, as demonstrated in recent, randomized trials comparing mechanical thrombectomy with thrombolysis. In conjunction with the technological advancements in thrombectomy devices, there has been better appreciation of stricter patient selection criteria for endovascular therapy based on pre-procedural imaging, including clot location, infarct volume, and penumbral territory at risk. Pre-procedural imaging performed to assess suitability for endovascular therapy commonly provides information on clot characteristics, such as clot location, length, density, and susceptibility, which can influence and may predict the efficacy of intravenous and endovascular treatments. The purpose of this review is to evaluate the role of clot imaging in acute large vessel occlusion strokes and discuss the relevance of clot imaging to thrombolytic and endovascular therapy.
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39
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Payabvash S, Benson J, Taleb S, Rykken J, Hoffman B, McKinney A, Oswood M. Susceptible vessel sign: identification of arterial occlusion and clinical implications in acute ischaemic stroke. Clin Radiol 2017; 72:116-122. [DOI: 10.1016/j.crad.2016.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
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Seners P, Hurford R, Tisserand M, Turc G, Legrand L, Naggara O, Mas JL, Oppenheim C, Baron JC. Is Unexplained Early Neurological Deterioration After Intravenous Thrombolysis Associated With Thrombus Extension? Stroke 2017; 48:348-352. [DOI: 10.1161/strokeaha.116.015414] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/29/2016] [Accepted: 12/02/2016] [Indexed: 01/01/2023]
Abstract
Background and Purpose—
Early neurological deterioration (END) after anterior circulation stroke is strongly associated with poor outcome. Apart from straightforward causes, such as intracerebral hemorrhage and malignant edema, the mechanism of END occurring after intravenous thrombolysis remains unclear in most instances. We tested the hypothesis that unexplained END is associated with thrombus extension.
Methods—
From our database of consecutively thrombolysed patients, we identified anterior circulation stroke patients who had both admission and 24-hour T2* magnetic resonance imaging, visible occlusion on admission magnetic resonance angiography and no recanalization on 24-hour magnetic resonance angiography. END was defined as ≥4 National Institutes of Health Stroke Scale–point deterioration on 24-hour clinical assessment and unexplained END as END without clear cause. The incidence of susceptibility vessel sign extension on T2* imaging, defined as any new occurrence or extension of susceptibility vessel sign from admission to 24-hour follow-up magnetic resonance, was compared between patients with unexplained END and those without END.
Results—
Of 120 eligible patients for the present study, 22 experienced unexplained END. Susceptibility vessel sign extension was present in 41 (34%) patients and was significantly more frequent in the unexplained END than in the no-END group (59% versus 29%, respectively; adjusted odds ratio=3.96; 95% confidence interval, 1.25–12.53;
P
=0.02).
Conclusions—
In this study, unexplained END occurring after thrombolysis was independently associated with susceptibility vessel sign extension, suggesting in situ thrombus extension or re-embolization. These findings strengthen the need to further investigate early post-thrombolysis administration of antithrombotics to reduce the risk of this ominous clinical event.
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Affiliation(s)
- Pierre Seners
- From the Departments of Neurology (P.S., G.T., J.-L.M., J.-C.B.) and Radiology (L.L., O.N., C.O.), Hôpital Sainte-Anne, Paris, France; Université Paris Descartes, Sorbonne Paris Citeé, INSERM UMR S894, DHU Neurovasc, France (P.S., G.T., L.L., O.N., J.-L.M., C.O., J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, United Kingdom (R.H.); and Service de Radiologie, Hoôpital Foch, Suresnes, France (M.T.)
| | - Robert Hurford
- From the Departments of Neurology (P.S., G.T., J.-L.M., J.-C.B.) and Radiology (L.L., O.N., C.O.), Hôpital Sainte-Anne, Paris, France; Université Paris Descartes, Sorbonne Paris Citeé, INSERM UMR S894, DHU Neurovasc, France (P.S., G.T., L.L., O.N., J.-L.M., C.O., J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, United Kingdom (R.H.); and Service de Radiologie, Hoôpital Foch, Suresnes, France (M.T.)
| | - Marie Tisserand
- From the Departments of Neurology (P.S., G.T., J.-L.M., J.-C.B.) and Radiology (L.L., O.N., C.O.), Hôpital Sainte-Anne, Paris, France; Université Paris Descartes, Sorbonne Paris Citeé, INSERM UMR S894, DHU Neurovasc, France (P.S., G.T., L.L., O.N., J.-L.M., C.O., J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, United Kingdom (R.H.); and Service de Radiologie, Hoôpital Foch, Suresnes, France (M.T.)
| | - Guillaume Turc
- From the Departments of Neurology (P.S., G.T., J.-L.M., J.-C.B.) and Radiology (L.L., O.N., C.O.), Hôpital Sainte-Anne, Paris, France; Université Paris Descartes, Sorbonne Paris Citeé, INSERM UMR S894, DHU Neurovasc, France (P.S., G.T., L.L., O.N., J.-L.M., C.O., J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, United Kingdom (R.H.); and Service de Radiologie, Hoôpital Foch, Suresnes, France (M.T.)
| | - Laurence Legrand
- From the Departments of Neurology (P.S., G.T., J.-L.M., J.-C.B.) and Radiology (L.L., O.N., C.O.), Hôpital Sainte-Anne, Paris, France; Université Paris Descartes, Sorbonne Paris Citeé, INSERM UMR S894, DHU Neurovasc, France (P.S., G.T., L.L., O.N., J.-L.M., C.O., J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, United Kingdom (R.H.); and Service de Radiologie, Hoôpital Foch, Suresnes, France (M.T.)
| | - Olivier Naggara
- From the Departments of Neurology (P.S., G.T., J.-L.M., J.-C.B.) and Radiology (L.L., O.N., C.O.), Hôpital Sainte-Anne, Paris, France; Université Paris Descartes, Sorbonne Paris Citeé, INSERM UMR S894, DHU Neurovasc, France (P.S., G.T., L.L., O.N., J.-L.M., C.O., J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, United Kingdom (R.H.); and Service de Radiologie, Hoôpital Foch, Suresnes, France (M.T.)
| | - Jean-Louis Mas
- From the Departments of Neurology (P.S., G.T., J.-L.M., J.-C.B.) and Radiology (L.L., O.N., C.O.), Hôpital Sainte-Anne, Paris, France; Université Paris Descartes, Sorbonne Paris Citeé, INSERM UMR S894, DHU Neurovasc, France (P.S., G.T., L.L., O.N., J.-L.M., C.O., J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, United Kingdom (R.H.); and Service de Radiologie, Hoôpital Foch, Suresnes, France (M.T.)
| | - Catherine Oppenheim
- From the Departments of Neurology (P.S., G.T., J.-L.M., J.-C.B.) and Radiology (L.L., O.N., C.O.), Hôpital Sainte-Anne, Paris, France; Université Paris Descartes, Sorbonne Paris Citeé, INSERM UMR S894, DHU Neurovasc, France (P.S., G.T., L.L., O.N., J.-L.M., C.O., J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, United Kingdom (R.H.); and Service de Radiologie, Hoôpital Foch, Suresnes, France (M.T.)
| | - Jean-Claude Baron
- From the Departments of Neurology (P.S., G.T., J.-L.M., J.-C.B.) and Radiology (L.L., O.N., C.O.), Hôpital Sainte-Anne, Paris, France; Université Paris Descartes, Sorbonne Paris Citeé, INSERM UMR S894, DHU Neurovasc, France (P.S., G.T., L.L., O.N., J.-L.M., C.O., J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, United Kingdom (R.H.); and Service de Radiologie, Hoôpital Foch, Suresnes, France (M.T.)
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Acute stroke with major intracranial vessel occlusion: Characteristics of cardioembolism and atherosclerosis-related in situ stenosis/occlusion. J Clin Neurosci 2016; 32:24-9. [DOI: 10.1016/j.jocn.2015.12.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/26/2015] [Accepted: 12/06/2015] [Indexed: 11/23/2022]
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Chung YS, Lee WJ, Hong J, Byun JS, Kim JK, Chae SA. Mechanical thrombectomy in cardiac myxoma stroke: a case report and review of the literature. Acta Neurochir (Wien) 2016; 158:1083-8. [PMID: 27040551 DOI: 10.1007/s00701-016-2780-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
Cardiac myxoma is the most common primary tumor of the heart. It is a rare cause of acute ischemic stroke and commonly not detected until after the stroke. There is no current guideline for the treatment of cardiac myxoma stroke and only a few cases of mechanical thrombectomy have been reported. We present a case of cardiac myxoma stroke in a 4-year-old boy treated with a stent-retrieval device and review the literature describing the safety and efficacy of mechanical thrombectomy in cardiac myxoma stroke. We also describe imaging features of the myxoma clot on susceptibility weighted images.
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43
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Facing the Time Window in Acute Ischemic Stroke: The Infarct Core. Clin Neuroradiol 2016; 26:153-8. [DOI: 10.1007/s00062-016-0501-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/19/2016] [Indexed: 11/25/2022]
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44
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Yan S, Chen Q, Xu M, Sun J, Liebeskind DS, Lou M. Thrombus Length Estimation on Delayed Gadolinium-Enhanced T1. Stroke 2016; 47:756-61. [PMID: 26768206 DOI: 10.1161/strokeaha.115.011401] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/18/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies revealed a close relationship between thrombus length and recanalization rate after intravenous thrombolysis (IVT). As a novel approach, we prospectively adjusted the order of sequence acquisition to obtain delayed gadolinium-enhanced T1 (dGE-T1) and thereby assess thrombus length on dGE-T1 to evaluate its predictive value for recanalization after IVT. METHODS We reviewed prospectively collected clinical and imaging data from acute ischemic stroke patients with middle cerebral artery occlusion who underwent multimodal magnetic resonance imaging before and 24 hours after IVT. Perfusion-weighted imaging was performed followed by conventional T1. We measured thrombus length on dGE-T1 and examined its association with middle cerebral artery recanalization. RESULTS Of the included 74 patients, the median age was 66 years and 28 (37.8%) were women. Thrombus length was 8.18±4.56 mm on dGE-T1, which was an acceptable predictor for no recanalization (odds ratio, 1.196; 95% confidence interval, 1.015-1.409; P=0.033), with a receiver-operator characteristic of 0.732 (95% confidence interval, 0.619-0.845; P=0.001). The optimal cut-off point was identified at 6.77 mm, which yielded a sensitivity of 77.8%, a specificity of 57.9%, and an odds ratio of 4.81 (95% confidence interval, 1.742-13.292; P=0.002). Moreover, no one achieved recanalization after IVT when length of thrombus exceeded 14 mm on dGE-T1. CONCLUSIONS The dGE-T1, obtained by simply adjusting scanning order in multimodal magnetic resonance imaging protocol, is a useful tool for thrombus length estimation and middle cerebral artery recanalization prediction after IVT.
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Affiliation(s)
- Shenqiang Yan
- From the Department of Neurology (S.Y., Q.C., M.X., M.L.) and Radiology (J.S.), The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; and Department of Neurology, University of California-Los Angeles Stroke Center (D.S.L.)
| | - Qingmeng Chen
- From the Department of Neurology (S.Y., Q.C., M.X., M.L.) and Radiology (J.S.), The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; and Department of Neurology, University of California-Los Angeles Stroke Center (D.S.L.)
| | - Mengjun Xu
- From the Department of Neurology (S.Y., Q.C., M.X., M.L.) and Radiology (J.S.), The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; and Department of Neurology, University of California-Los Angeles Stroke Center (D.S.L.)
| | - Jianzhong Sun
- From the Department of Neurology (S.Y., Q.C., M.X., M.L.) and Radiology (J.S.), The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; and Department of Neurology, University of California-Los Angeles Stroke Center (D.S.L.)
| | - David S Liebeskind
- From the Department of Neurology (S.Y., Q.C., M.X., M.L.) and Radiology (J.S.), The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; and Department of Neurology, University of California-Los Angeles Stroke Center (D.S.L.)
| | - Min Lou
- From the Department of Neurology (S.Y., Q.C., M.X., M.L.) and Radiology (J.S.), The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; and Department of Neurology, University of California-Los Angeles Stroke Center (D.S.L.).
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Ritzenthaler T, Lacalm A, Cho TH, Maucort-Boulch D, Klaerke Mikkelsen I, Ribe L, Østergaard L, Hjort N, Fiehler J, Pedraza S, Louis Tisserand G, Baron JC, Berthezene Y, Nighoghossian N. Sequential MR Assessment of the Susceptibility Vessel Sign and Arterial Occlusion in Acute Stroke. J Neuroimaging 2015; 26:355-9. [DOI: 10.1111/jon.12312] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/23/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Thomas Ritzenthaler
- Cerebrovascular Unit; Hôpital Neurologique Pierre Wertheimer; Hospices Civils de Lyon 69677 Bron Cedex France
- Université de Lyon CREATIS; CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Lyon 1; Hospices Civils de Lyon France
| | - Audrey Lacalm
- Neuroradiology Department; Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; 69677 Bron Cedex France
| | - Tae-Hee Cho
- Cerebrovascular Unit; Hôpital Neurologique Pierre Wertheimer; Hospices Civils de Lyon 69677 Bron Cedex France
- Université de Lyon CREATIS; CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Lyon 1; Hospices Civils de Lyon France
| | - Delphine Maucort-Boulch
- Service de Biostatistiques; Hospices Civils de Lyon, Lyon 69003, France; CNRS UMR 5558, Equipe Biostatistique Santé; Pierre-Bénite, F-69310, France; Université Lyon I, Villeurbanne F-69100 France
| | - Irene Klaerke Mikkelsen
- Department of Clinical Medicine; Center of Functionally Integrative Neuroscience, Aarhus University; Aarhus Denmark
| | - Lars Ribe
- Department of Clinical Medicine; Center of Functionally Integrative Neuroscience, Aarhus University; Aarhus Denmark
| | - Leif Østergaard
- Department of Clinical Medicine; Center of Functionally Integrative Neuroscience, Aarhus University; Aarhus Denmark
| | - Niels Hjort
- Department of Clinical Medicine; Center of Functionally Integrative Neuroscience, Aarhus University; Aarhus Denmark
| | - Jens Fiehler
- Departments of Diagnostic and Interventional Neuroradiology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Salvador Pedraza
- Department of Radiology (IDI); Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta; Girona Spain
| | - Guy Louis Tisserand
- Neuroradiology Department; Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; 69677 Bron Cedex France
| | | | - Yves Berthezene
- Neuroradiology Department; Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; 69677 Bron Cedex France
- Université de Lyon CREATIS; CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Lyon 1; Hospices Civils de Lyon France
| | - Norbert Nighoghossian
- Cerebrovascular Unit; Hôpital Neurologique Pierre Wertheimer; Hospices Civils de Lyon 69677 Bron Cedex France
- Université de Lyon CREATIS; CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Lyon 1; Hospices Civils de Lyon France
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Bourcier R, Volpi S, Guyomarch B, Daumas-Duport B, Lintia-Gaultier A, Papagiannaki C, Serfaty JM, Desal H. Susceptibility Vessel Sign on MRI Predicts Favorable Clinical Outcome in Patients with Anterior Circulation Acute Stroke Treated with Mechanical Thrombectomy. AJNR Am J Neuroradiol 2015; 36:2346-53. [PMID: 26316570 DOI: 10.3174/ajnr.a4483] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/18/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The susceptibility vessel sign on MR imaging has been reported to indicate acute occlusion from erythrocyte-rich thrombus. The purpose of this study was to evaluate the influence of the susceptibility vessel sign seen on MR imaging before treatment on the clinical outcome after mechanical thrombectomy for anterior circulation acute stroke. MATERIALS AND METHODS We retrospectively included 73 consecutive patients who were treated for anterior circulation acute stroke by mechanical thrombectomy from December 2009 to September 2013. Each patient underwent MR imaging before mechanical thrombectomy. The presence (susceptibility vessel sign+) or absence of the susceptibility vessel sign (susceptibility vessel sign-) was recorded. Mechanical thrombectomy was performed either alone or in association with IV tPA according to the site and time after occlusion. Good functional outcome was defined by an mRS ≤ 2 at 3 months in susceptibility vessel sign+ and susceptibility vessel sign- groups. Patient clinical characteristics, initial NIHSS score and ASPECTS, site of occlusion, time between onset to groin puncture, TICI after mechanical thrombectomy, NIHSS score at day 1, and spontaneous hyperattenuation on CT at day 1 were also analyzed. RESULTS Fifty-three patients with susceptibility vessel sign+ and 20 with susceptibility vessel sign- were included in our study. mRS ≤ 2 at 3 months occurred in 65% patients in the susceptibility vessel sign+ group and 26% in the susceptibility vessel sign- group (P = .004). On multivariate analysis, the susceptibility vessel sign was the only parameter before treatment that could predict mRS ≤ 2 at 3 months (OR, 8.7; 95% CI, 1.1-69.4; P = .04). CONCLUSIONS Our study strongly suggests that the susceptibility vessel sign on MR imaging before treatment is predictive of favorable clinical outcome for patients presenting with anterior circulation acute stroke and treated with mechanical thrombectomy.
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Affiliation(s)
- R Bourcier
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.)
| | - S Volpi
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.)
| | - B Guyomarch
- Centre d'investigation clinique Thorax (B.G.), l'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France Institut National de la Santé et de la Recherche Médicale, UMR1087 (B.G., J.M.S., H.D.), l'institut du thorax, Nantes, France Centre national de la recherche scientifique (B.G,), UMR 6291, Nantes, France
| | - B Daumas-Duport
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.)
| | - A Lintia-Gaultier
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.)
| | - C Papagiannaki
- Department of Diagnostic and Interventional Neuroradiology (C.P.), Centre Hospitalier Régional Universitaire de Tours, Bretonneau Hospital, Tours, France
| | - J M Serfaty
- Diagnostic Cardiac and Vascular Imaging (J.M.S.), Centre Hospitalier Universitaire Nantes Hôpital G et R Laënnec, Nantes, France Institut National de la Santé et de la Recherche Médicale, UMR1087 (B.G., J.M.S., H.D.), l'institut du thorax, Nantes, France
| | - H Desal
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.) Institut National de la Santé et de la Recherche Médicale, UMR1087 (B.G., J.M.S., H.D.), l'institut du thorax, Nantes, France
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Distance to thrombus on MR angiography predicts outcome of middle cerebral artery occlusion treated with IV thrombolysis. Neuroradiology 2015; 57:991-7. [DOI: 10.1007/s00234-015-1558-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
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Kim SK, Yoon W, Heo TW, Park MS, Kang HK. Negative Susceptibility Vessel Sign and Underlying Intracranial Atherosclerotic Stenosis in Acute Middle Cerebral Artery Occlusion. AJNR Am J Neuroradiol 2015; 36:1266-71. [PMID: 25814657 DOI: 10.3174/ajnr.a4280] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/14/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE The role of MR imaging in predicting underlying intracranial atherosclerotic stenosis before endovascular stroke therapy has not been studied. Our aim was to determine the diagnostic value of the negative susceptibility vessel sign on T2*-weighted gradient-echo MR imaging for predicting underlying intracranial atherosclerotic stenosis in patients with acute MCA occlusion. MATERIALS AND METHODS Ninety-one consecutive patients with acute stroke because of MCA occlusion underwent gradient-echo MR imaging and MRA before endovascular therapy. The negative susceptibility vessel sign was defined as an absence of a hypointense signal change within the occluded MCA on gradient-echo imaging. Underlying intracranial atherosclerotic stenosis was determined by conventional angiography. The sensitivity, specificity, predictive values, and accuracy of the negative susceptibility vessel sign for predicting the presence of underlying intracranial atherosclerotic stenosis were assessed. RESULTS The negative susceptibility vessel sign was identified in 42 (46.1%) of 91 patients, and 18 (19.8%) patients had an underlying intracranial atherosclerotic stenosis responsible for acute ischemic symptoms. The negative susceptibility vessel sign was more frequently observed in patients with intracranial atherosclerotic stenosis than in those without it (100% versus 32.9%, P < .001). In the prediction of an underlying intracranial atherosclerotic stenosis, the negative susceptibility vessel sign had 100% sensitivity, 67.1% specificity, 42.9% positive predictive value, 100% negative predictive value, and an accuracy of 73.6%. CONCLUSIONS The negative susceptibility vessel sign on gradient-echo MR imaging is a sensitive marker with a high negative predictive value for the presence of an underlying intracranial atherosclerotic stenosis in patients with acute ischemic stroke because of MCA occlusions. The susceptibility vessel sign can be used in decision-making when performing subsequent endovascular revascularization therapy in patients with acute MCA occlusions.
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Affiliation(s)
- S K Kim
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., H.K.K.)
| | - W Yoon
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., H.K.K.)
| | - T W Heo
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., H.K.K.)
| | - M S Park
- Neurology (M.S.P.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - H K Kang
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., H.K.K.)
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49
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Soize S, Batista AL, Rodriguez Regent C, Trystram D, Tisserand M, Turc G, Serre I, Ben Hassen W, Zuber M, Calvet D, Mas JL, Meder JF, Raymond J, Pierot L, Oppenheim C, Naggara O. Susceptibility vessel sign on T2* magnetic resonance imaging and recanalization results of mechanical thrombectomy with stent retrievers: a multicentre cohort study. Eur J Neurol 2015; 22:967-72. [PMID: 25786977 DOI: 10.1111/ene.12693] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/13/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The susceptibility vessel sign (SVS) on T2*-weighted magnetic resonance imaging has been reported in several studies as a negative predictor of early recanalization after intravenous thrombolysis. The meaning of SVS regarding the results of mechanical thrombectomy with stent retrievers was investigated. METHODS Susceptibility vessel sign presence and length were studied in 153 acute ischaemic stroke patients (82 men; mean ± SD age 59 ± 17 years, baseline National Institutes of Health Stroke Scale score 17.2 ± 6.5) from three stroke centres, treated with either mechanical thrombectomy alone (n = 84) or bridging therapy (n = 69). Variables were compared between recanalizers, defined as thrombolysis in cerebral infarction (TICI) scores ≥2b, and non-recanalizers (TICI<2b). RESULTS The SVS was present in 113 (73.8%) patients. There was no association between the presence of SVS and recanalization, obtained in 86 (56.2%) patients, in the whole population [odds ratio (OR) 1.24, 95% confidence interval (CI) 0.53-2.92, P = 0.84) and in treatment subgroups (bridging: OR = 0.91, 95% CI 0.29-2.87, P = 1.0; thrombectomy alone: OR = 1.85, 95% CI 0.48-7.16, P = 0.54). However, in SVS+ patients, recanalization decreased with SVS length (OR 0.94 for each additional mm, 95% CI 0.89-0.99; P = 0.02). CONCLUSIONS The success of recanalization in acute stroke patients treated with stent retrievers was related to thrombus length but not to the presence of SVS.
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Affiliation(s)
- S Soize
- Department of Neuroradiology, INSERM UMR S894, Université Paris Descartes, Sorbonne Paris Cité, Hôpital Sainte-Anne, Paris, France; Department of Neuroradiology, CHU Reims, Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
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50
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Le Bras A, Raoult H, Ferré JC, Ronzière T, Gauvrit JY. Optimal MRI sequence for identifying occlusion location in acute stroke: which value of time-resolved contrast-enhanced MRA? AJNR Am J Neuroradiol 2015; 36:1081-8. [PMID: 25767186 DOI: 10.3174/ajnr.a4264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/21/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Identifying occlusion location is crucial for determining the optimal therapeutic strategy during the acute phase of ischemic stroke. The purpose of this study was to assess the diagnostic efficacy of MR imaging, including conventional sequences plus time-resolved contrast-enhanced MRA in comparison with DSA for identifying arterial occlusion location. MATERIALS AND METHODS Thirty-two patients with 34 occlusion levels referred for thrombectomy during acute cerebral stroke events were consecutively included from August 2010 to December 2012. Before thrombectomy, we performed 3T MR imaging, including conventional 3D-TOF and gradient-echo T2 sequences, along with time-resolved contrast-enhanced MRA of the extra- and intracranial arteries. The 3D-TOF, gradient-echo T2, and time-resolved contrast-enhanced MRA results were consensually assessed by 2 neuroradiologists and compared with prethrombectomy DSA results in terms of occlusion location. The Wilcoxon test was used for statistical analysis to compare MR imaging sequences with DSA, and the κ coefficient was used to determine intermodality agreement. RESULTS The occlusion level on the 3D-TOF and gradient-echo T2 images differed significantly from that of DSA (P < .001 and P = .002, respectively), while no significant difference was observed between DSA and time-resolved contrast-enhanced MRA (P = .125). κ coefficients for intermodality agreement with DSA (95% CI, percentage agreement) were 0.43 (0.3%-0.6; 62%), 0.32 (0.2%-0.5; 56%), and 0.81 (0.6%-1.0; 88%) for 3D-TOF, gradient-echo T2, and time-resolved contrast-enhanced MRA, respectively. CONCLUSIONS The time-resolved contrast-enhanced MRA sequence proved reliable for identifying occlusion location in acute stroke with performance superior to that of 3D-TOF and gradient-echo T2 sequences.
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Affiliation(s)
- A Le Bras
- From the Departments of Neuroradiology (A.L.B., H.R., J.-C.F., J.-Y.G.)
| | - H Raoult
- From the Departments of Neuroradiology (A.L.B., H.R., J.-C.F., J.-Y.G.) Unité VISAGE U746 INSERM-INRIA, IRISA UMR CNRS 6074 (H.R., J.-C.F., J.-Y.G.), University of Rennes, Rennes, France
| | - J-C Ferré
- From the Departments of Neuroradiology (A.L.B., H.R., J.-C.F., J.-Y.G.) Unité VISAGE U746 INSERM-INRIA, IRISA UMR CNRS 6074 (H.R., J.-C.F., J.-Y.G.), University of Rennes, Rennes, France
| | - T Ronzière
- Neurology (T.R.), Centre Hospitalier Universitaire Rennes, Rennes, France
| | - J-Y Gauvrit
- From the Departments of Neuroradiology (A.L.B., H.R., J.-C.F., J.-Y.G.) Unité VISAGE U746 INSERM-INRIA, IRISA UMR CNRS 6074 (H.R., J.-C.F., J.-Y.G.), University of Rennes, Rennes, France
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