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Yu P, Dong R, Wang X, Tang Y, Liu Y, Wang C, Zhao L. Neuroimaging of motor recovery after ischemic stroke - functional reorganization of motor network. Neuroimage Clin 2024; 43:103636. [PMID: 38950504 PMCID: PMC11267109 DOI: 10.1016/j.nicl.2024.103636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/01/2024] [Accepted: 06/27/2024] [Indexed: 07/03/2024]
Abstract
The long-term motor outcome of acute stroke patients may be correlated to the reorganization of brain motor network. Abundant neuroimaging studies contribute to understand the pathological changes and recovery of motor networks after stroke. In this review, we summarized how current neuroimaging studies have increased understanding of reorganization and plasticity in post stroke motor recovery. Firstly, we discussed the changes in the motor network over time during the motor-activation and resting states, as well as the overall functional integration trend of the motor network. These studies indicate that the motor network undergoes dynamic bilateral hemispheric functional reorganization, as well as a trend towards network randomization. In the second part, we summarized the current study progress in the application of neuroimaging technology to early predict the post-stroke motor outcome. In the third part, we discuss the neuroimaging techniques commonly used in the post-stroke recovery. These methods provide direct or indirect visualization patterns to understand the neural mechanisms of post-stroke motor recovery, opening up new avenues for studying spontaneous and treatment-induced recovery and plasticity after stroke.
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Affiliation(s)
- Pei Yu
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ruoyu Dong
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiao Wang
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuqi Tang
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yaning Liu
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Can Wang
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ling Zhao
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
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Pei C, He C, Li H, Li X, Huang W, Liu J, Yin J. Clinical and imaging markers for the prognosis of acute ischemic stroke. Front Neurol 2024; 15:1345914. [PMID: 38487321 PMCID: PMC10937465 DOI: 10.3389/fneur.2024.1345914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Background and purpose Significant differences in the outcomes observed in patients with acute ischemic stroke (AIS) have led to research investigations for identifying the predictors. In this retrospective study, we aimed to investigate the relationship of different clinical and imaging factors with the prognosis of AIS. Materials and methods All clinical and imaging metrics were compared between the good and poor prognosis groups according to the modified Rankin Scale (mRS) score at 90 days after discharge. Clinical factors included gender, age, NIHSS scores at admission, and other medical history risk factors. Imaging markers included the lesion's size and location, diffusion, and perfusion metrics of infarction core and peripheral regions, and the state of collateral circulation. Spearman's correlations were analyzed for age and imaging markers between the different groups. The Chi-square test and Cramer's V coefficient analysis were performed for gender, collateral circulation status, NIHSS score, and other stroke risk factors. Results A total of 89 patients with AIS were divided into the good (mRS score ≤ 2) and poor prognosis groups (mRS score ≥ 3). There were differences in NIHSS score at the admission; relative MK (rMK), relative MD (rMD), relative CBF (rCBF) of the infarction core; relative mean transit time (rMTT), relative time to peak (rTTP), and relative CBF (rCBF) of peripheral regions; and collateral circulation status between the two groups (p < 0.05). Among them, the rMK of infarction lesions had the strongest correlation with the mRS score at 90 days after discharge (r = 0.545, p < 0.001). Conclusion Perfusion and diffusion metrics could reflect the microstructure and blood flow characteristics of the lesion, which were the key factors for the salvage ability and prognosis of the infarction tissue. The characteristics of the infarction core and peripheral regions have different effects on the outcomes. Diffusion of infarction core has strong relations with the prognosis, whereas the time metrics (MTT, TTP) were more important for peripheral regions. MK had a more significant association with prognosis than MD. These factors were the primary markers influencing the prognosis of cerebral infarction patients.
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Affiliation(s)
- Chenyang Pei
- Tianjin Medical University, Tianjin, China
- Department of Radiology, Haikou People's Hospital, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, Hainan, China
| | - Che He
- Medical Imaging Center, The First People's Hospital of Qujing, Qujing, Yunnan, China
| | - Han Li
- Tianjin Medical University, Tianjin, China
| | - Xiangying Li
- Department of Radiology, Haikou People's Hospital, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, Hainan, China
| | - Weihui Huang
- Department of Neurology, Tianjin First Central Hospital, Tianjin, China
| | - Jun Liu
- Department of Radiology, Tianjin Fourth Central Hospital, Tianjin, China
| | - Jianzhong Yin
- Department of Radiology, Haikou People's Hospital, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, Hainan, China
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Tsui B, Chen IE, Nour M, Kihira S, Tavakkol E, Polson J, Zhang H, Qiao J, Bahr-Hosseini M, Arnold C, Tateshima S, Salamon N, Villablanca JP, Colby GP, Jahan R, Duckwiler G, Saver JL, Liebeskind DS, Nael K. Perfusion Collateral Index versus Hypoperfusion Intensity Ratio in Assessment of Collaterals in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2023; 44:1249-1255. [PMID: 37827719 PMCID: PMC10631520 DOI: 10.3174/ajnr.a8002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/20/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND PURPOSE Perfusion-based collateral indices such as the perfusion collateral index and the hypoperfusion intensity ratio have shown promise in the assessment of collaterals in patients with acute ischemic stroke. We aimed to compare the diagnostic performance of the perfusion collateral index and the hypoperfusion intensity ratio in collateral assessment compared with angiographic collaterals and outcome measures, including final infarct volume, infarct growth, and functional independence. MATERIALS AND METHODS Consecutive patients with acute ischemic stroke with anterior circulation proximal arterial occlusion who underwent endovascular thrombectomy and had pre- and posttreatment MRI were included. Using pretreatment MR perfusion, we calculated the perfusion collateral index and the hypoperfusion intensity ratio for each patient. The angiographic collaterals obtained from DSA were dichotomized to sufficient (American Society of Interventional and Therapeutic Neuroradiology [ASITN] scale 3-4) versus insufficient (ASITN scale 0-2). The association of collateral status determined by the perfusion collateral index and the hypoperfusion intensity ratio was assessed against angiographic collaterals and outcome measures. RESULTS A total of 98 patients met the inclusion criteria. Perfusion collateral index values were significantly higher in patients with sufficient angiographic collaterals (P < .001), while there was no significant (P = .46) difference in hypoperfusion intensity ratio values. Among patients with good (mRS 0-2) versus poor (mRS 3-6) functional outcome, the perfusion collateral index of ≥ 62 was present in 72% versus 31% (P = .003), while the hypoperfusion intensity ratio of ≤0.4 was present in 69% versus 56% (P = .52). The perfusion collateral index and the hypoperfusion intensity ratio were both significantly predictive of final infarct volume, but only the perfusion collateral index was significantly (P = .03) associated with infarct growth. CONCLUSIONS Results show that the perfusion collateral index outperforms the hypoperfusion intensity ratio in the assessment of collateral status, infarct growth, and determination of functional outcomes.
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Affiliation(s)
- Brian Tsui
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Iris E Chen
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - May Nour
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Department of Neurology (M.N., M.B.-H., J.L.S., D.S.L.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Shingo Kihira
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Elham Tavakkol
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jennifer Polson
- Department of Bioengineering (J.P., H.Z., C.A.), University of California, Los Angeles, Los Angeles, California
| | - Haoyue Zhang
- Department of Bioengineering (J.P., H.Z., C.A.), University of California, Los Angeles, Los Angeles, California
| | - Joe Qiao
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Mersedeh Bahr-Hosseini
- Department of Neurology (M.N., M.B.-H., J.L.S., D.S.L.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Corey Arnold
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Department of Bioengineering (J.P., H.Z., C.A.), University of California, Los Angeles, Los Angeles, California
| | - Satoshi Tateshima
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Noriko Salamon
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - J Pablo Villablanca
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Geoffrey P Colby
- Department of Neurosurgery (G.P.C.), University of California, Los Angeles, Los Angeles, California
| | - Reza Jahan
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Gary Duckwiler
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jeffrey L Saver
- Department of Neurology (M.N., M.B.-H., J.L.S., D.S.L.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - David S Liebeskind
- Department of Neurology (M.N., M.B.-H., J.L.S., D.S.L.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Kambiz Nael
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Gu Y, Ding Y, Hang Y, Cao Y, Jia Z, Zhao L, Liu Y, Liu S. Smaller baseline subcortical infarct volume predicts good outcomes in patients with a large core in early acute ischemic stroke after endovascular treatment. Front Neurosci 2023; 17:1063478. [PMID: 36814786 PMCID: PMC9939504 DOI: 10.3389/fnins.2023.1063478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/16/2023] [Indexed: 02/09/2023] Open
Abstract
Background Patients with acute ischemic stroke (AIS) and a large core may benefit from endovascular treatment (EVT) in the early time window. Purpose To examine the prognostic factors for good outcomes in patients with a large core (70-130 ml) after EVT. Materials and methods We retrospectively reviewed 40 patients who met the criteria from October 2019 to April 2021. Based on the modified Rankin Score (mRS) at 90 days, the patients were divided into a good outcome group (mRS 0-2) and a poor outcome group (mRS 3-6). Baseline and procedural characteristics were collected for unilateral and multivariate regression analyses to explore the factors that influence good outcomes. In particular, the infarct territories were quantified as subcortical infarct volume (SIV) and cortical infarct volume (CIV). Results Of the 40 patients included, good outcomes were observed in 11 (27.5%) patients. Younger age, smaller SIV and larger mismatch volume were noted in the good outcome group than in the poor outcome group (all P < 0.05). Multivariate logistic regression analysis showed that only a smaller SIV [odds ratio (OR) 0.801; 95% CI 0.644-0.996; P = 0.046] was an independent predictor for good outcomes. The receiver operating characteristic curve indicated a moderate value of SIV for predicting good outcomes, with an area under the receiver operating characteristic curve of 0.735 (95% CI 0.572-0.862; P = 0.007). Conclusion Subcortical infarct volume was a potential useful predictor of good outcomes in patients with a large core after EVT in the early time window.
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Affiliation(s)
- Yiming Gu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Department of Interventional Radiology, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Suzhou, China
| | - Yasuo Ding
- Department of Neurosurgery, Taizhou People's Hospital, Taizhou, China
| | - Yu Hang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuezhou Cao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhenyu Jia
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Linbo Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Liu
- Department of Neurology, Taizhou People's Hospital, Taizhou, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Winder AJ, Wilms M, Amador K, Flottmann F, Fiehler J, Forkert ND. Predicting the tissue outcome of acute ischemic stroke from acute 4D computed tomography perfusion imaging using temporal features and deep learning. Front Neurosci 2022; 16:1009654. [PMID: 36408399 PMCID: PMC9672821 DOI: 10.3389/fnins.2022.1009654] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/12/2022] [Indexed: 12/27/2023] Open
Abstract
Predicting follow-up lesions from baseline CT perfusion (CTP) datasets in acute ischemic stroke patients is important for clinical decision making. Deep convolutional networks (DCNs) are assumed to be the current state-of-the-art for this task. However, many DCN classifiers have not been validated against the methods currently used in research (random decision forests, RDF) and clinical routine (Tmax thresholding). Specialized DCNs have even been designed to extract complex temporal features directly from spatiotemporal CTP data instead of using standard perfusion parameter maps. However, the benefits of applying deep learning to source or deconvolved CTP data compared to perfusion parameter maps have not been formally investigated so far. In this work, a modular UNet-based DCN is proposed that separates temporal feature extraction from tissue outcome prediction, allowing for both model validation using perfusion parameter maps as well as end-to-end learning from spatiotemporal CTP data. 145 retrospective datasets comprising baseline CTP imaging, perfusion parameter maps, and follow-up non-contrast CT with manual lesion segmentations were assembled from acute ischemic stroke patients treated with intravenous thrombolysis alone (IV; n = 43) or intra-arterial mechanical thrombectomy (IA; n = 102) with or without combined IV. Using the perfusion parameter maps as input, the proposed DCN (mean Dice: 0.287) outperformed the RDF (0.262) and simple Tmax-thresholding (0.249). The performance of the proposed DCN was approximately equal using features optimized from the deconvolved residual curves (0.286) compared to perfusion parameter maps (0.287), while using features optimized from the source concentration-time curves (0.296) provided the best tissue outcome predictions.
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Affiliation(s)
- Anthony J. Winder
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Matthias Wilms
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Kimberly Amador
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nils D. Forkert
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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Tsui B, Nour M, Chen I, Qiao JX, Salehi B, Yoo B, Colby GP, Salamon N, Villablanca P, Jahan R, Duckwiler G, Saver JL, Liebeskind DS, Nael K. MR Angiography in Assessment of Collaterals in Patients with Acute Ischemic Stroke: A Comparative Analysis with Digital Subtraction Angiography. Brain Sci 2022; 12:brainsci12091181. [PMID: 36138917 PMCID: PMC9497115 DOI: 10.3390/brainsci12091181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/20/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Collateral status has prognostic and treatment implications in acute ischemic stroke (AIS) patients. Unlike CTA, grading collaterals on MRA is not well studied. We aimed to evaluate the accuracy of assessing collaterals on pretreatment MRA in AIS patients against DSA. AIS patients with anterior circulation proximal arterial occlusion with baseline MRA and subsequent endovascular treatment were included. MRA collaterals were evaluated by two neuroradiologists independently using the Tan and Maas scoring systems. DSA collaterals were evaluated by using the American Society of Interventional and Therapeutic Neuroradiology grading system and were used as the reference for comparative analysis against MRA. A total of 104 patients met the inclusion criteria (59 female, age (mean ± SD): 70.8 ± 18.1). The inter-rater agreement (k) for collateral scoring was 0.49, 95% CI 0.37–0.61 for the Tan score and 0.44, 95% CI 0.26–0.62 for the Maas score. Total number (%) of sufficient vs. insufficient collaterals based on DSA was 49 (47%) and 55 (53%) respectively. Using the Tan score, 45% of patients with sufficient collaterals and 64% with insufficient collaterals were correctly identified in comparison to DSA, resulting in a poor agreement (0.09, 95% CI 0.1–0.28). Using the Maas score, only 4% of patients with sufficient collaterals and 93% with insufficient collaterals were correctly identified against DSA, resulting in poor agreement (0.03, 95% CI 0.06–0.13). Pretreatment MRA in AIS patients has limited concordance with DSA when grading collaterals using the Tan and Maas scoring systems.
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Affiliation(s)
- Brian Tsui
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Correspondence:
| | - May Nour
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Iris Chen
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Joe X. Qiao
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Banafsheh Salehi
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Bryan Yoo
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Geoffrey P. Colby
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Pablo Villablanca
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Reza Jahan
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Gary Duckwiler
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Jeffrey L. Saver
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - David S. Liebeskind
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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Kniep H, Meyer L, Bechstein M, Broocks G, Guerreiro H, van Horn N, Brekenfeld C, Flottmann F, Deb-Chatterji M, Alegiani A, Thomalla G, Hanning U, Fiehler J, Gellißen S. How Much of the Thrombectomy Related Improvement in Functional Outcome Is Already Apparent at 24 Hours and at Hospital Discharge? Stroke 2022; 53:2828-2837. [PMID: 35549377 DOI: 10.1161/strokeaha.121.037888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early neurological status has been described as predictor of functional outcome in patients with anterior circulation stroke after mechanical thrombectomy. It remains unclear to what proportion the improvement of functional outcome at day 90 is already apparent at 24 hours and at hospital discharge and how later factors impact outcome. METHODS All patients enrolled in the German Stroke Registry (June 2015-December 2019) with anterior circulation stroke and availability of baseline data and neurological status were included. A mediation analysis was conducted to investigate the effect of successful recanalization (Thrombolysis in Cerebral Infarction scale score ≥2b) on good functional outcome (modified Rankin Scale score ≤2 at day 90) with mediation through neurological status (National Institutes of Health Stroke Scale [NIHSS] at 24 hours and at hospital discharge). RESULTS Three thousand fifty-seven patients fulfilled the inclusion criteria, thereof 2589 (85%) with successful recanalization and 1180 (39%) with good functional outcome. In a multivariate logistic regression analysis, probability of good outcome was significantly associated with age (odds ratio [95% CI], 0.95 [0.94-0.96]), prestroke modified Rankin Scale (0.48 [0.42-0.55]), admission-NIHSS (0.96 [0.94-0.98]), 24-hour NIHSS (0.83 [0.81-0.84]), diabetes (0.56 [0.43-0.72]), proximal middle cerebral artery occlusions (0.78 [0.62-0.97]), passes (0.88 [0.82-0.95]), Alberta Stroke Program Early CT Score (1.07 [1.00-1.14]), successful recanalization (2.39 [1.68-3.43]), intracerebral hemorrhage (0.51 [0.35-0.73]), and recurrent strokes (0.54 [0.32-0.92]). Mediation analysis showed a 20 percentage points (95% CI' 17-24 percentage points) increase of probability of good functional outcome after successful recanalization. Fifty-four percent (95% CI' 44%-66%) of the improvement in functional outcome was explained by 24-hour NIHSS and 75% (95% CI' 62%-90%) by NIHSS at hospital discharge. CONCLUSIONS Fifty-four percent of the improvement in functional outcome after successful recanalization is apparent in NIHSS at 24 hours, 75% in NIHSS at hospital discharge. Other unknown factors not apparent in NIHSS at the 2 time points investigated account for the remaining effect on long term outcome, suggesting, among others, clinical relevance of delayed neurological improvement and deterioration. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03356392.
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Affiliation(s)
- Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany. (H.K., L.M., M.B., G.B., H.G., N.v.H., C.B., F.F., U.H., J.F., S.G.)
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany. (H.K., L.M., M.B., G.B., H.G., N.v.H., C.B., F.F., U.H., J.F., S.G.)
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany. (H.K., L.M., M.B., G.B., H.G., N.v.H., C.B., F.F., U.H., J.F., S.G.)
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany. (H.K., L.M., M.B., G.B., H.G., N.v.H., C.B., F.F., U.H., J.F., S.G.)
| | - Helena Guerreiro
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany. (H.K., L.M., M.B., G.B., H.G., N.v.H., C.B., F.F., U.H., J.F., S.G.)
| | - Noel van Horn
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany. (H.K., L.M., M.B., G.B., H.G., N.v.H., C.B., F.F., U.H., J.F., S.G.)
| | - Caspar Brekenfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany. (H.K., L.M., M.B., G.B., H.G., N.v.H., C.B., F.F., U.H., J.F., S.G.)
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany. (H.K., L.M., M.B., G.B., H.G., N.v.H., C.B., F.F., U.H., J.F., S.G.)
| | - Milani Deb-Chatterji
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany. (M.D.-C., A.A., G.T.)
| | - Anna Alegiani
- Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany (A.A)
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany. (M.D.-C., A.A., G.T.)
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany. (H.K., L.M., M.B., G.B., H.G., N.v.H., C.B., F.F., U.H., J.F., S.G.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany. (H.K., L.M., M.B., G.B., H.G., N.v.H., C.B., F.F., U.H., J.F., S.G.)
| | - Susanne Gellißen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany. (H.K., L.M., M.B., G.B., H.G., N.v.H., C.B., F.F., U.H., J.F., S.G.)
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8
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Yang N, He X, Yin C, Zhao L. Clinical analysis of 33 cases with neonatal cerebral infarction. Pak J Med Sci 2021; 37:1800-1807. [PMID: 34912398 PMCID: PMC8613021 DOI: 10.12669/pjms.37.7.4720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/17/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: To investigate the etiology, clinical manifestations, diagnosis, treatment and prognosis of neonatal cerebral infarction (NCI) to further improve the understanding of the disease. Methods: Clinical data and follow-up results of 33 cases of NCI in neonatal intensive care unit of a first-class hospital from September 2009 to September 2019 were retrospectively analyzed. Results: All 33 patients were diagnosed with NCI by MRI. Among them, 31 cases (93.94%) were full-term infants, 25 cases (75.76%) were mother’s first birth, and 18 (54.55%) cases were males. Pregnancy complications were reported in 18 cases (54.55%), and 19 cases (57.58%) had perinatal hypoxia history. Seizures were the most common first symptom and clinical manifestation in the course of disease (81.8%). There were 27 cases (81.82%) of patent foramen ovale (PFO) among NCI cohort. Ischemic cerebral infarction occurred in 32 cases (96.97%). The middle cerebral artery and its branches were more frequently involved, mainly on the left side. The acute stage of NCI was managed by symptomatic support treatment, and the recovery stage involved mainly rehabilitation treatment. Among the 33 cases, five cases were lost to follow-up, two patients died, 26 patients survived without complications, one case had cerebral palsy, one case had language retardation, and six cases had dyskinesia. Poor prognosis was associated with the involvement of deep gray matter nuclei or multiple lobes, and intrapartum complications. Vaginal mode of delivery and longer hospital stay were associated with better prognosis. Conclusions: Complications leading to placental circulation disorder during pregnancy and perinatal hypoxia are common high-risk factors of NCI. The seizure is the most common clinical manifestation. There is a possible correlation between PFO and NCI. Involvement of deep gray matter or multiple lobes and intrapartum complications may indicate poor prognosis, while vaginal delivery and prolonged hospitalizations are associated with better prognosis of NCI.
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Affiliation(s)
- Ning Yang
- Ning Yang, Neonatal Department, Dezhou People's Hospital, Dezhou 253000, Shandong, China
| | - Xiaojun He
- Xiaojun He, Neonate Department, Ningjin County People's Hospital, Dezhou 253400, Shandong, China
| | - Cuixia Yin
- Cuixia Yin, Neonate Department, Ningjin County People's Hospital, Dezhou 253400, Shandong, China
| | - Lihua Zhao
- Lihua Zhao, Neonate Department, Ningjin County People's Hospital, Dezhou 253400, Shandong, China
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9
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Jing M, Yeo JYP, Holmin S, Andersson T, Arnberg F, Bhogal P, Yang C, Gopinathan A, Tu TM, Tan BYQ, Sia CH, Teoh HL, Paliwal PR, Chan BPL, Sharma V, Yeo LLL. Preprocedural Imaging : A Review of Different Radiological Factors Affecting the Outcome of Thrombectomy. Clin Neuroradiol 2021; 32:13-24. [PMID: 34709411 DOI: 10.1007/s00062-021-01095-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/25/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endovascular treatment (EVT) has strong evidence for its effectiveness in treatment of acute ischemic stroke (AIS); however, up to half of the patients who undergo EVT still do not have good functional outcomes. Various prethrombectomy radiological factors have been shown to be associated with good clinical outcomes and may be the key to better functional outcomes, reduced complications, and reduced mortality. In this paper, we reviewed the current literature on these imaging parameters so they can be employed to better estimate the probability of procedural success, therefore allowing for more effective preprocedural planning of EVT strategies. We reviewed articles in the literature related to imaging factors which have been shown to be associated with EVT success. The factors which are reviewed in this paper included: anatomical factors such as 1) the type of aortic arch and its characteristics, 2) the characteristics of the thrombus such as length, clot burden, permeability, location, 3) the middle cerebral artery features including the tortuosity and underlying intracranial stenosis, 4) perfusion scans estimating the volume of infarct and the penumbra and 5) the effect of collaterals on the procedure. The prognostic effect of each factor on the successful outcome of EVT is described. The identification of preprocedural thrombectomy imaging factors can help to improve the chances of recanalization, functional outcomes, and mortality. It allows the interventionist to make time-sensitive decisions in the treatment of acute ischemic stroke.
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Affiliation(s)
- Mingxue Jing
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joshua Y P Yeo
- Department of Medicine, National University Health System, Singapore, Singapore
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Tommy Andersson
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Department of Medical Imaging, AZ Groeninge, 8500, Kortrijk, Belgium
| | - Fabian Arnberg
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Paul Bhogal
- Department of Neuroradiology, St.Bartholomew's and the Royal London Hospital, London, UK
| | - Cunli Yang
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anil Gopinathan
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Benjamin Yong Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching Hui Sia
- National University Heart Centre, National University Health System, Singapore, Singapore
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Prakash R Paliwal
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bernard P L Chan
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vijay Sharma
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore.
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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10
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Abstract
Multimodal MR imaging provides valuable information in the management of patients with acute ischemic stroke (AIS), with diagnostic, therapeutic, and prognostic implications. MR imaging plays a critical role in treatment decision making for (1) thrombolytic treatment of AIS patients with unknown symptom-onset and (2) endovascular treatment of patients with large vessel occlusion presenting beyond 6 hours from the symptom onset. MR imaging provides the most accurate information for detection of ischemic brain and is invaluable for differentiating AIS from stroke mimics.
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11
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Ravindran AV, Killingsworth MC, Bhaskar S. Cerebral collaterals in acute ischaemia: Implications for acute ischaemic stroke patients receiving reperfusion therapy. Eur J Neurosci 2020; 53:1238-1261. [PMID: 32871623 DOI: 10.1111/ejn.14955] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 12/21/2022]
Abstract
The cerebral collaterals play an important role in penumbral tissue sustenance after an acute ischaemic stroke. Recent studies have demonstrated the potential role of collaterals in the selection of acute ischaemic stroke patients eligible for reperfusion therapy. However, the understanding of the significance and evidence around the role of collateral status in predicting outcomes in acute ischaemic stroke patients treated with reperfusion therapy is still unclear. Moreover, the use of pre-treatment collaterals in patient selection and prognosis is relatively underappreciated in clinical settings. A focused review of the literature was performed on the various methods of collateral evaluation and the role of collateral status in acute ischaemic stroke patients receiving reperfusion therapy. We discuss the methods of evaluating pre-treatment collaterals in clinical settings. The patient selection based on collateral status as well as the prognostic and therapeutic value of collaterals in acute ischaemic stroke, in settings of intravenous thrombolysis or endovascular therapy alone, and bridge therapy, are summarized. Recommendations for future research and possible pharmacological intervention strategies aimed at collateral enhancement are also discussed. Collaterals may play an important role in identifying acute ischaemic stroke patients who are likely to benefit from endovascular treatment in an extended time window. Future neuroscientific efforts to better improve our understanding of the role of collaterals in acute ischaemia as well as clinical studies to delineate its role in patient selection and acute stroke prognosis are warranted.
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Affiliation(s)
- Abina Vishni Ravindran
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia.,Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,Thrombolysis and Endovascular WorkFLOw Network (TEFLON), Sydney, NSW, Australia
| | - Murray C Killingsworth
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia.,NSW Brain Clot Bank, NSW Health Statewide Biobank and NSW Health Pathology, Sydney, NSW, Australia.,Correlative Microscopy Facility, Ingham Institute for Applied Medical Research and Department of Anatomical Pathology, NSW Health Pathology and Liverpool Hospital, Liverpool, NSW, Australia
| | - Sonu Bhaskar
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia.,Department of Neurology & Neurophysiology, Liverpool Hospital & South West Sydney Local Health District (SWSLHD), Sydney, NSW, Australia.,Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,Stroke & Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,NSW Brain Clot Bank, NSW Health Statewide Biobank and NSW Health Pathology, Sydney, NSW, Australia.,Thrombolysis and Endovascular WorkFLOw Network (TEFLON), Sydney, NSW, Australia
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12
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Seiler A, Lauer A, Deichmann R, Nöth U, Herrmann E, Berkefeld J, Singer OC, Pfeilschifter W, Klein JC, Wagner M. Signal variance-based collateral index in DSC perfusion: A novel method to assess leptomeningeal collateralization in acute ischaemic stroke. J Cereb Blood Flow Metab 2020; 40:574-587. [PMID: 30755069 PMCID: PMC7025396 DOI: 10.1177/0271678x19831024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As a determinant of the progression rate of the ischaemic process in acute large-vessel stroke, the degree of collateralization is a strong predictor of the clinical outcome after reperfusion therapy and may influence clinical decision-making. Therefore, the assessment of leptomeningeal collateralization is of major importance. The purpose of this study was to develop and evaluate a quantitative and observer-independent method for assessing leptomeningeal collateralization in acute large-vessel stroke based on signal variance characteristics in T2*-weighted dynamic susceptibility contrast (DSC) perfusion-weighted MR imaging (PWI). Voxels representing leptomeningeal collateral vessels were extracted according to the magnitude of signal variance in the PWI raw data time series in 55 patients with proximal large-artery occlusion and an intra-individual collateral vessel index (CVIPWI) was calculated. CVIPWI correlated significantly with the initial ischaemic core volume (rho = -0.459, p = 0.0001) and the PWI/DWI mismatch ratio (rho = 0.494, p = 0.0001) as an indicator of the amount of salvageable tissue. Furthermore, CVIPWI was significantly negatively correlated with NIHSS and mRS at discharge (rho = -0.341, p = 0.015 and rho = -0.305, p = 0.023). In multivariate logistic regression, CVIPWI was an independent predictor of favourable functional outcome (mRS 0-2) (OR = 16.39, 95% CI 1.42-188.7, p = 0.025). CVIPWI provides useful rater-independent information on the leptomeningeal collateral supply in acute stroke.
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Affiliation(s)
- Alexander Seiler
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | - Arne Lauer
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Frankfurt, Germany
| | - Joachim Berkefeld
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Oliver C Singer
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Johannes C Klein
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
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13
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Boers AMM, Jansen IGH, Brown S, Lingsma HF, Beenen LFM, Devlin TG, Román LS, Heo JH, Ribó M, Almekhlafi MA, Liebeskind DS, Teitelbaum J, Cuadras P, du Mesnil de Rochemont R, Beaumont M, Brown MM, Yoo AJ, Donnan GA, Mas JL, Oppenheim C, Dowling RJ, Moulin T, Agrinier N, Lopes DK, Aja Rodríguez L, Compagne KCJ, Al-Ajlan FS, Madigan J, Albers GW, Soize S, Blasco J, Davis SM, Nogueira RG, Dávalos A, Menon BK, van der Lugt A, Muir KW, Roos YBWEM, White P, Mitchell PJ, Demchuk AM, van Zwam WH, Jovin TG, van Oostenbrugge RJ, Dippel DWJ, Campbell BCV, Guillemin F, Bracard S, Hill MD, Goyal M, Marquering HA, Majoie CBLM. Mediation of the Relationship Between Endovascular Therapy and Functional Outcome by Follow-up Infarct Volume in Patients With Acute Ischemic Stroke. JAMA Neurol 2019; 76:194-202. [PMID: 30615038 DOI: 10.1001/jamaneurol.2018.3661] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Importance The positive treatment effect of endovascular therapy (EVT) is assumed to be caused by the preservation of brain tissue. It remains unclear to what extent the treatment-related reduction in follow-up infarct volume (FIV) explains the improved functional outcome after EVT in patients with acute ischemic stroke. Objective To study whether FIV mediates the relationship between EVT and functional outcome in patients with acute ischemic stroke. Design, Setting, and Participants Patient data from 7 randomized multicenter trials were pooled. These trials were conducted between December 2010 and April 2015 and included 1764 patients randomly assigned to receive either EVT or standard care (control). Follow-up infarct volume was assessed on computed tomography or magnetic resonance imaging after stroke onset. Mediation analysis was performed to examine the potential causal chain in which FIV may mediate the relationship between EVT and functional outcome. A total of 1690 patients met the inclusion criteria. Twenty-five additional patients were excluded, resulting in a total of 1665 patients, including 821 (49.3%) in the EVT group and 844 (50.7%) in the control group. Data were analyzed from January to June 2017. Main Outcome and Measure The 90-day functional outcome via the modified Rankin Scale (mRS). Results Among 1665 patients, the median (interquartile range [IQR]) age was 68 (57-76) years, and 781 (46.9%) were female. The median (IQR) time to FIV measurement was 30 (24-237) hours. The median (IQR) FIV was 41 (14-120) mL. Patients in the EVT group had significantly smaller FIVs compared with patients in the control group (median [IQR] FIV, 33 [11-99] vs 51 [18-134] mL; P = .007) and lower mRS scores at 90 days (median [IQR] score, 3 [1-4] vs 4 [2-5]). Follow-up infarct volume was a predictor of functional outcome (adjusted common odds ratio, 0.46; 95% CI, 0.39-0.54; P < .001). Follow-up infarct volume partially mediated the relationship between treatment type with mRS score, as EVT was still significantly associated with functional outcome after adjustment for FIV (adjusted common odds ratio, 2.22; 95% CI, 1.52-3.21; P < .001). Treatment-reduced FIV explained 12% (95% CI, 1-19) of the relationship between EVT and functional outcome. Conclusions and Relevance In this analysis, follow-up infarct volume predicted functional outcome; however, a reduced infarct volume after treatment with EVT only explained 12% of the treatment benefit. Follow-up infarct volume as measured on computed tomography and magnetic resonance imaging is not a valid proxy for estimating treatment effect in phase II and III trials of acute ischemic stroke.
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Affiliation(s)
- Anna M M Boers
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands
| | - Ivo G H Jansen
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Scott Brown
- Altair Biostatistics, Mooresville, North Carolina
| | - Hester F Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ludo F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Thomas G Devlin
- Department of Neurology, Erlanger Hospital, University of Tennessee at Chattanooga
| | - Luis San Román
- Department of Interventional Neuroradiology, Hospital Clinic of Barcelona, Barcelona, Catalonia, Spain
| | - Ji-Hoe Heo
- Department of Neurology, Yonsei University, Seoul, South Korea
| | - Marc Ribó
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalonia, Spain
| | - Mohammed A Almekhlafi
- Department of Neurology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Jeanne Teitelbaum
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Patricia Cuadras
- Department of Radiology, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | | | - Marine Beaumont
- Inserm CIC-IT 1433, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Martin M Brown
- Institute of Neurology, University College London, London, United Kingdom
| | - Albert J Yoo
- Division of Neurointervention, Texas Stroke Institute, Dallas
| | - Geoffrey A Donnan
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Jean Louis Mas
- Department of Neurology, Sainte-Anne Hospital and Paris-Descartes University, INSERM U894, Paris, France
| | - Catherine Oppenheim
- Department of Neuroradiology, Sainte-Anne Hospital and Paris-Descartes University, INSERM U894, Paris, France
| | - Richard J Dowling
- Department of Radiology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Thierry Moulin
- Department of Neurology, University Hospital of Besançon, University of Franche-Comté, Besançon, France
| | - Nelly Agrinier
- Inserm, Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, CIC1433-Epidémiologie Clinique, Nancy, France
| | - Demetrius K Lopes
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
| | - Lucía Aja Rodríguez
- Neuroradiology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Kars C J Compagne
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fahad S Al-Ajlan
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Gregory W Albers
- Department of Neurology, Stanford Stroke Center, Palo Alto, California
| | - Sebastien Soize
- Department of Neuroradiology, University Hospital of Reims, Reims, France
| | - Jordi Blasco
- Department of Interventional Neuroradiology, Hospital Clinic of Barcelona, Barcelona, Catalonia, Spain
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Raul G Nogueira
- Department of Neurology, Neurosurgery and Radiology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - Antoni Dávalos
- Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Phil White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Peter J Mitchell
- Department of Radiology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - Wim H van Zwam
- Department of Radiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Tudor G Jovin
- Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Robert J van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Francis Guillemin
- Inserm, Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, CIC1433-Epidémiologie Clinique, Nancy, France
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, INSERM U947, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
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14
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Nael K, Sakai Y, Khatri P, Prestigiacomo CJ, Puig J, Vagal A. Imaging-based Selection for Endovascular Treatment in Stroke. Radiographics 2019; 39:1696-1713. [DOI: 10.1148/rg.2019190030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Advanced Neuroimaging of Acute Ischemic Stroke: Penumbra and Collateral Assessment. Neuroimaging Clin N Am 2018; 28:585-597. [PMID: 30322595 DOI: 10.1016/j.nic.2018.06.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acute ischemic stroke (AIS) occurs when there is a sudden loss in cerebral blood flow due to embolic or thromboembolic occlusion of a cerebral or cervical artery. Patients with AIS require emergent neuroimaging to guide treatment, which includes intravenous thrombolysis and endovascular mechanical thrombectomy (EMT). Recent advances in AIS treatment by EMT has been driven in part by advances in computed tomography (CT) and MR imaging neuroimaging evaluation of ischemic penumbra and pial collateral vessels. The authors review advanced noninvasive brain imaging by CT and MR imaging for the evaluation of AIS focusing on penumbral and collateral imaging.
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16
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Boujan T, Neuberger U, Pfaff J, Nagel S, Herweh C, Bendszus M, Möhlenbruch MA. Value of Contrast-Enhanced MRA versus Time-of-Flight MRA in Acute Ischemic Stroke MRI. AJNR Am J Neuroradiol 2018; 39:1710-1716. [PMID: 30115678 DOI: 10.3174/ajnr.a5771] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/17/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vessel imaging in acute ischemic stroke is essential to select patients with large-vessel occlusion for mechanical thrombectomy. Our aim was to compare the diagnostic accuracy of time-of-flight MR angiography and contrast-enhanced MR angiography for identification of vessel occlusion and collateral status in acute ischemic stroke. MATERIALS AND METHODS One hundred twenty-three patients with stroke with large-vessel occlusion before thrombectomy were included in this retrospective study. Before thrombectomy, 3T MR imaging, including conventional 3D TOF-MRA of the intracranial arteries and contrast-enhanced MRA of intra- and extracranial arteries, was performed. Both techniques were assessed independently by 2 neuroradiologists for location of the occlusion, imaging quality, and collateral status. Findings were compared, with subsequent DSA as the reference standard. RESULTS Both techniques had good interrater agreement of κ = 0.74 (95% CI, 0.66-0.83) for TOF-MRA and κ = 0.72 (95% CI, 0.63-0.80) for contrast-enhanced MRA. Occlusion localization differed significantly on TOF-MRA compared with DSA (P < .001), while no significant difference was observed between DSA and contrast-enhanced MRA (P = .75). Assessment of collaterals showed very good agreement between contrast-enhanced MRA and DSA (94.9% with P = .25), but only fair agreement between TOF-MRA and DSA (23.2% with P < .001). CONCLUSIONS Contrast-enhanced MRA offers better diagnostic accuracy than TOF-MRA in acute ischemic stroke. Contrast-enhanced MRA was superior in localizing vessel occlusion within a shorter acquisition time while providing a larger coverage, including extracranial vessels, and a more accurate assessment of collateral status. These results support inclusion of contrast-enhanced MRA in acute stroke MR imaging, perhaps making TOF-MRA superfluous.
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Affiliation(s)
- T Boujan
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - U Neuberger
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - J Pfaff
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - S Nagel
- Neurology (S.N.), University of Heidelberg Medical Center, Heidelberg, Germany
| | - C Herweh
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - M Bendszus
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - M A Möhlenbruch
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
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17
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Boers AMM, Sales Barros R, Jansen IGH, Berkhemer OA, Beenen LFM, Menon BK, Dippel DWJ, van der Lugt A, van Zwam WH, Roos YBWEM, van Oostenbrugge RJ, Slump CH, Majoie CBLM, Marquering HA. Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2018; 39:1074-1082. [PMID: 29674417 DOI: 10.3174/ajnr.a5623] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/09/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Many studies have emphasized the relevance of collateral flow in patients presenting with acute ischemic stroke. Our aim was to evaluate the relationship of the quantitative collateral score on baseline CTA with the outcome of patients with acute ischemic stroke and test whether the timing of the CTA acquisition influences this relationship. MATERIALS AND METHODS From the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) data base, all baseline thin-slice CTA images of patients with acute ischemic stroke with intracranial large-vessel occlusion were retrospectively collected. The quantitative collateral score was calculated as the ratio of the vascular appearance of both hemispheres and was compared with the visual collateral score. Primary outcomes were 90-day mRS score and follow-up infarct volume. The relation with outcome and the association with treatment effect were estimated. The influence of the CTA acquisition phase on the relation of collateral scores with outcome was determined. RESULTS A total of 442 patients were included. The quantitative collateral score strongly correlated with the visual collateral score (ρ = 0.75) and was an independent predictor of mRS (adjusted odds ratio = 0.81; 95% CI, .77-.86) and follow-up infarct volume (exponent β = 0.88; P < .001) per 10% increase. The quantitative collateral score showed areas under the curve of 0.71 and 0.69 for predicting functional independence (mRS 0-2) and follow-up infarct volume of >90 mL, respectively. We found significant interaction of the quantitative collateral score with the endovascular therapy effect in unadjusted analysis on the full ordinal mRS scale (P = .048) and on functional independence (P = .049). Modification of the quantitative collateral score by acquisition phase on outcome was significant (mRS: P = .004; follow-up infarct volume: P < .001) in adjusted analysis. CONCLUSIONS Automated quantitative collateral scoring in patients with acute ischemic stroke is a reliable and user-independent measure of the collateral capacity on baseline CTA and has the potential to augment the triage of patients with acute stroke for endovascular therapy.
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Affiliation(s)
- A M M Boers
- From the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.) .,Radiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.).,Department of Robotics and Mechatronics (A.M.M.B., C.H.S.)
| | - R Sales Barros
- From the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.)
| | - I G H Jansen
- From the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.).,Radiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
| | - O A Berkhemer
- Radiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
| | - L F M Beenen
- Radiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
| | - B K Menon
- Department of Clinical Neurosciences (B.K.M.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | | | - A van der Lugt
- Radiology (A.v.d.L.), Erasmus MC, Rotterdam, the Netherlands
| | - W H van Zwam
- Department of Radiology (W.H.v.Z.), Maastricht UMC, Maastricht, the Netherlands
| | - Y B W E M Roos
- Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands
| | - R J van Oostenbrugge
- Department of Neurology (R.J.v.O.), Maastricht UMC and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - C H Slump
- Department of Robotics and Mechatronics (A.M.M.B., C.H.S.).,MIRA Institute for Biomedical Engineering and Technical Medicine (C.H.S.), University of Twente, Enschede, the Netherlands
| | - C B L M Majoie
- Radiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
| | - H A Marquering
- From the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.).,Radiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
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18
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Nael K, Doshi A, De Leacy R, Puig J, Castellanos M, Bederson J, Naidich TP, Mocco J, Wintermark M. MR Perfusion to Determine the Status of Collaterals in Patients with Acute Ischemic Stroke: A Look Beyond Time Maps. AJNR Am J Neuroradiol 2017; 39:219-225. [PMID: 29217747 DOI: 10.3174/ajnr.a5454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 09/14/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients with acute stroke with robust collateral flow have better clinical outcomes and may benefit from endovascular treatment throughout an extended time window. Using a multiparametric approach, we aimed to identify MR perfusion parameters that can represent the extent of collaterals, approximating DSA. MATERIALS AND METHODS Patients with anterior circulation proximal arterial occlusion who had baseline MR perfusion and DSA were evaluated. The volume of arterial tissue delay (ATD) at thresholds of 2-6 seconds (ATD2-6 seconds) and >6 seconds (ATD>6 seconds) in addition to corresponding values of normalized CBV and CBF was calculated using VOI analysis. The association of MR perfusion parameters and the status of collaterals on DSA were assessed by multivariate analyses. Receiver operating characteristic analysis was performed. RESULTS Of 108 patients reviewed, 39 met our inclusion criteria. On DSA, 22/39 (56%) patients had good collaterals. Patients with good collaterals had significantly smaller baseline and final infarct volumes, smaller volumes of severe hypoperfusion (ATD>6 seconds), larger volumes of moderate hypoperfusion (ATD2-6 seconds), and higher relative CBF and relative CBV values than patients with insufficient collaterals. Combining the 2 parameters into a Perfusion Collateral Index (volume of ATD2-6 seconds × relative CBV2-6 seconds) yielded the highest accuracy for predicting collateral status: At a threshold of 61.7, this index identified 15/17 (88%) patients with insufficient collaterals and 22/22 (100%) patients with good collaterals, for an overall accuracy of 94.1%. CONCLUSIONS The Perfusion Collateral Index can predict the baseline collateral status with 94% diagnostic accuracy compared with DSA.
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Affiliation(s)
- K Nael
- From the Departments of Radiology (K.N., A.D., T.P.N.)
| | - A Doshi
- From the Departments of Radiology (K.N., A.D., T.P.N.)
| | - R De Leacy
- Neurosurgery (R.D.L., J.B., JM.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - J Puig
- Department of Radiology (J.P.), Girona Biomedical Research Institute, Diagnostic Imaging Institute, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - M Castellanos
- Department of Neurology (M.C.), A Coruña University Hospital, A Coruña Biomedical Research Institute, A Coruña, Spain
| | - J Bederson
- Neurosurgery (R.D.L., J.B., JM.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - T P Naidich
- From the Departments of Radiology (K.N., A.D., T.P.N.)
| | - J Mocco
- Neurosurgery (R.D.L., J.B., JM.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - M Wintermark
- Department of Radiology (M.W.), Neuroradiology Section, Stanford University, Palo Alto, California
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19
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Wufuer A, Wubuli A, Mijiti P, Zhou J, Tuerxun S, Cai J, Ma J, Zhang X. Impact of collateral circulation status on favorable outcomes in thrombolysis treatment: A systematic review and meta-analysis. Exp Ther Med 2017; 15:707-718. [PMID: 29399075 PMCID: PMC5772565 DOI: 10.3892/etm.2017.5486] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/01/2017] [Indexed: 12/21/2022] Open
Abstract
Collateral circulation affects the prognosis of patients with acute ischemic stroke (AIS) treated by thrombolysis. The present study performed a systematic assessment of the impact of the collateral circulation status on the outcomes of patients receiving thrombolysis treatment. Relevant full-text articles from the Cochrane Library, Ovid, Medline, Embase and PubMed databases published from January 1, 2000 to November 1, 2016 were retrieved. The quality of the studies was assessed and data were extracted by 2 independent investigators. The random-effects model was used to estimate the impact of good vs. poor collateral circulation, as well as baseline characteristics, on the outcome within the series presented as risk ratios. Subgroup analyses explored the potential factors that may interfere with the effects of the collateral circulation status on the outcome. A total of 29 studies comprising 4,053 patients were included in the present meta-analysis. A good collateral circulation status was revealed to have a beneficial effect on favorable functional outcome (modified Rankin scale, 0–3 at 3–6 months; P<0.001) and a higher rate of recanalization (P<0.001) compared with poor collateral circulation. Good collateral circulation was also associated with a lower rate of symptomatic intracranial hemorrhage (P<0.01), a lower rate of mortality (P<0.01) and a smaller infarct size (P<0.01). In conclusion, good collateral circulation was demonstrated to have a favorable prognostic value regarding the outcome for patients with AIS receiving thrombolysis treatment. Assessment of collateral circulation and penumbra area during pre-treatment imaging within an appropriate time-window prior to thrombolytic therapy will therefore improve the identification of AIS patients who may benefit from thrombolysis treatment.
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Affiliation(s)
- Alimu Wufuer
- Department of Neurology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Atikaimu Wubuli
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China
| | - Peierdun Mijiti
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China
| | - Jun Zhou
- Department of Neurology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Shabier Tuerxun
- Department of Neurology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Jian Cai
- Department of Neurology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Jianhua Ma
- Department of Neurology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Xiaoning Zhang
- Department of Neurology, The Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine, Urumqi, Xinjiang 830054, P.R. China
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20
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Boers AM, Jansen IG, Berkhemer OA, Yoo AJ, Lingsma HF, Slump CH, Roos YB, van Oostenbrugge RJ, Dippel DW, van der Lugt A, van Zwam WH, Marquering HA, Majoie CB. Collateral status and tissue outcome after intra-arterial therapy for patients with acute ischemic stroke. J Cereb Blood Flow Metab 2017; 37:3589-3598. [PMID: 27864462 PMCID: PMC5669341 DOI: 10.1177/0271678x16678874] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intra-arterial therapy (IAT) for ischemic stroke aims to save brain tissue. Collaterals are thought to contribute to prolonged penumbra sustenance. In this study, we investigate the effect of collateral status on brain tissue salvage with IAT. In 500 patients randomized between IAT and standard care, collateral status was graded from 0 (absent) to 3 (good). Final infarct volumes (FIV) were calculated on post-treatment CT. FIVs were compared between treatment groups per collateral grade. Multivariable linear regression with interaction terms was performed to study whether collaterals modified IAT effect on FIV. Four-hundred-forty-nine patients were included in the analysis. Median FIV for the IAT group was significantly lower with 54.5 mL (95% IQR: 21.8-145.0) than for the controls with 81.8 mL (95% IQR: 40.0-154.0) ( p = 0.020). Treatment effect differed across collateral grades, although there was no significant interaction (unadjusted p = 0.054; adjusted p = 0.105). For grade 3, IAT resulted in a FIV reduction of 30.1 mL ( p = 0.024). For grade 2 and 1, this difference was, respectively, 28.4 mL ( p = 0.028) and 28.4 mL ( p = 0.29). For grade 0, this was 88.6 mL ( p = 0.28) in favour of controls. IAT saves substantially more brain tissue as compared to standard care. We observed a trend of increasing effect of IAT with higher collateral grades.
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Affiliation(s)
- Anna Mm Boers
- 1 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.,2 Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands.,3 Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | - Ivo Gh Jansen
- 1 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.,3 Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | - Olvert A Berkhemer
- 1 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.,4 Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,5 Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Albert J Yoo
- 6 Division of Neurointervention, Texas Stroke Institute, Dallas, TX, USA
| | - Hester F Lingsma
- 7 Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Cornelis H Slump
- 2 Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands.,8 MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Yvo Bwem Roos
- 9 Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | - Robert J van Oostenbrugge
- 10 Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Diederik Wj Dippel
- 4 Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Aad van der Lugt
- 11 Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Wim H van Zwam
- 5 Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands.,10 Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Henk A Marquering
- 1 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.,3 Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | - Charles Blm Majoie
- 1 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
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21
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Raymond SB, Schaefer PW. Imaging Brain Collaterals: Quantification, Scoring, and Potential Significance. Top Magn Reson Imaging 2017; 26:67-75. [PMID: 28277461 DOI: 10.1097/rmr.0000000000000123] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Leptomeningeal collaterals provide the primary source of perfusion to ischemic brain tissue following the onset of acute ischemic stroke and are becoming an important imaging biomarker for stroke therapy triage. Collateral circulation is predictive of infarct growth, end infarct volume, and response to endovascular therapy. The strength of the collateral circulation varies among patients and is partially dependent on genetic and modifiable risk factors. Collateral circulation may be assessed by standard angiographic techniques, including digital subtraction angiography, computed tomography and magnetic resonance (MR) angiography, as well as a growing array of advanced MR techniques including arterial spin labeling and dynamic MR angiography. Simple scoring systems are used to estimate the relative strength of the collateral circulation for a given patient, although there are some discrepancies in the predictive value of these systems. In this review, we discuss methods and techniques for determining the robustness of the collateral circulation and the role of the collateral circulation in acute ischemic stroke assessment and triage.
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Affiliation(s)
- Scott B Raymond
- Department of Radiology, Massachusetts General Hospital, Boston, MA
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22
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García-Tornel A, Carvalho V, Boned S, Flores A, Rodríguez-Luna D, Pagola J, Muchada M, Sanjuan E, Coscojuela P, Juega J, Rodriguez-Villatoro N, Menon B, Goyal M, Ribó M, Tomasello A, Molina CA, Rubiera M. Improving the Evaluation of Collateral Circulation by Multiphase Computed Tomography Angiography in Acute Stroke Patients Treated with Endovascular Reperfusion Therapies. INTERVENTIONAL NEUROLOGY 2016; 5:209-217. [PMID: 27781051 DOI: 10.1159/000448525] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Good collateral circulation (CC) is associated with favorable outcomes in acute stroke, but the best technique to evaluate collaterals is controversial. Single-phase computed tomography angiography (sCTA) is widely used but lacks temporal resolution. We aim to compare CC evaluation by sCTA and multiphase CTA (mCTA) as predictors of outcome in endovascular treated patients. METHODS Consecutive endovascular treated patients with M1 middle cerebral artery (MCA) or terminal intracranial carotid artery (TICA) occlusion confirmed by sCTA were included. Two more CTA acquisitions with 8- and 16-second delays were performed for mCTA. Endovascular thrombectomy was performed independently of the CC status according to a local protocol [Alberta Stroke Program Early CT score (ASPECTS) >6, modified Rankin scale (mRS) score <3]. CC on sCTA and mCTA were compared. RESULTS 108 patients were included. Their mean age was 69.6 ± 13 years and their median National Institutes of Health Stroke Scale (NIHSS) score was 17 (interquartile range 8). 79 (73.1%) had M1 MCA and 29 (26.9%) TICA occlusions. The mean time from symptom onset to CTA was 146.8 ± 96.5 min. On sCTA, 50.9% patients presented good CC vs. 57.5% on mCTA. Good CC status in both sCTA and mCTA had a lower 24-hour infarct volume (27.4 vs. 74.8 cm3 on sCTA, p = 0.04; 17.2 vs. 97.8 cm3 on mCTA, p < 0.01). However, only good CC on mCTA was associated with lower 24-hour (5 vs. 8.5, p = 0.04) and median discharge NIHSS (2 vs. 4.5, p = 0.04) scores and functional independency (mRS score <3) at 3 months (76.9 vs. 23.1%, p < 0.01). In a logistic regression model including age, NIHSS, ASPECTS and recanalization, only age (OR 0.96, 95% CI 0.93-0.99, p = 0.02) and good CC on mCTA (OR 5, 95% CI 1.99-12.6, p < 0.01) were independent predictors of functional outcome at 3 months. CONCLUSION CC evaluation by mCTA is a better prognostic marker than CC evaluation by sCTA for clinical and functional endpoints in acute stroke patients treated with endovascular thrombectomy.
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Affiliation(s)
- Alvaro García-Tornel
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Alta., Canada
| | - Vanessa Carvalho
- Internal Medicine, Hospital Luz, Lisboa, Portugal, Alta., Canada
| | - Sandra Boned
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Alta., Canada
| | - Alan Flores
- Neurology Department, Hospital de Clínicas U.N.A. Instituto Randall, Asunción, Paraguay, Alta., Canada
| | - David Rodríguez-Luna
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Alta., Canada
| | - Jorge Pagola
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Alta., Canada
| | - Marian Muchada
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Alta., Canada
| | - Estela Sanjuan
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Alta., Canada
| | - Pilar Coscojuela
- Interventional Neuroradiology Unit, Radiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Alta., Canada
| | - Jesus Juega
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Alta., Canada
| | | | - Bijoy Menon
- Interventional Neuroradiology, Radiology Department, University of Calgary, Calgary, Alta., Canada
| | - Mayank Goyal
- Interventional Neuroradiology, Radiology Department, University of Calgary, Calgary, Alta., Canada
| | - Marc Ribó
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Alta., Canada
| | - Alejandro Tomasello
- Interventional Neuroradiology Unit, Radiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Alta., Canada
| | - Carlos A Molina
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Alta., Canada
| | - Marta Rubiera
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Alta., Canada
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23
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Kurz KD, Ringstad G, Odland A, Advani R, Farbu E, Kurz MW. Radiological imaging in acute ischaemic stroke. Eur J Neurol 2016; 23 Suppl 1:8-17. [PMID: 26563093 DOI: 10.1111/ene.12849] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Abstract
Patients who suffer acute ischaemic stroke can be treated with thrombolysis if therapy is initiated early. Radiological evaluation of the intracranial tissue before such therapy can be given is mandatory. In this review current radiological diagnostic strategies are discussed for this patient group. Beyond non-enhanced computed tomography (CT), the standard imaging method for many years, more sophisticated CT stroke protocols including CT angiography and CT perfusion have been developed, and additionally an increasing number of patients are examined with magnetic resonance imaging as the first imaging method used. Advantages and challenges of the different methods are discussed.
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Affiliation(s)
- K D Kurz
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway.,Radiologic Research Group, Stavanger University Hospital, Stavanger, Norway
| | - G Ringstad
- Department of Radiology and Nuclear Imaging, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - A Odland
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway.,Radiologic Research Group, Stavanger University Hospital, Stavanger, Norway
| | - R Advani
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway
| | - E Farbu
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, Haukeland University Hospital, Bergen, Norway
| | - M W Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway
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24
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Alves HCBR, Pacheco FT, Rocha AJ. Collateral blood vessels in acute ischemic stroke: a physiological window to predict future outcomes. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:662-70. [PMID: 27224313 DOI: 10.1590/0004-282x20160050] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 02/08/2016] [Indexed: 12/20/2022]
Abstract
Collateral circulation is a physiologic pathway that protects the brain against ischemic injury and can potentially bypass the effect of a blocked artery, thereby influencing ischemic lesion size and growth. Several recent stroke trials have provided information about the role of collaterals in stroke pathophysiology, and collateral perfusion has been recognized to influence arterial recanalization, reperfusion, hemorrhagic transformation, and neurological outcomes after stroke. Our current aim is to summarize the anatomy and physiology of the collateral circulation and to present and discuss a comprehensible review of the related knowledge, particularly the effects of collateral circulation on the time course of ischemic injury and stroke severity, as well as imaging findings and therapeutic implications.
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Affiliation(s)
- Heitor Castelo Branco Rodrigues Alves
- Santa Casa de São Paulo, Faculdade de Ciências Médicas, Divisao de Neuroradiologia, São Paulo SP, Brasil;,Fleury Medicina e Saúde, Divisao de Neuroradiologia, São Paulo SP, Brasil
| | - Felipe Torres Pacheco
- Santa Casa de São Paulo, Faculdade de Ciências Médicas, Divisao de Neuroradiologia, São Paulo SP, Brasil;,Fleury Medicina e Saúde, Divisao de Neuroradiologia, São Paulo SP, Brasil
| | - Antonio J Rocha
- Santa Casa de São Paulo, Faculdade de Ciências Médicas, Divisao de Neuroradiologia, São Paulo SP, Brasil;,Fleury Medicina e Saúde, Divisao de Neuroradiologia, São Paulo SP, Brasil
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Sun J, Tao S, Liu L, Guo D, Xia Z, Huang M. miR‑140‑5p regulates angiogenesis following ischemic stroke by targeting VEGFA. Mol Med Rep 2016; 13:4499-505. [PMID: 27035554 DOI: 10.3892/mmr.2016.5066] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 02/22/2016] [Indexed: 11/06/2022] Open
Abstract
MicroRNA (miRNA or miR) expression profiles are altered in tissues under hypoxic-ischemic conditions. The expression of miR‑140 is downregulated >2-fold following hypoxic-ischemic brain damage, however, its role in angiogenesis subsequent to cerebral ischemia is not fully understood. The present study aimed to investigate the role of miR-140-5p in angiogenesis and the molecular mechanism mediated by vascular endothelial growth factor A (VEGFA) in an in vitro model for brain ischemia. A rat middle cerebral artery occlusion (MCAO) model was constructed, and the results from reverse transcription-quantitative polymerase chain reaction and western blot analysis demonstrated that the expression levels of miR-140‑5p were significantly decreased, while the expression levels of VEGFA were significantly increased between 12 and 48 h in the rat cerebral following MCAO. Furthermore, human umbilical vein endothelial cells (HUVECs) were exposed to low oxygen conditions and it was demonstrated that hypoxia downregulated miR-140-5p and upregulated VEGFA expression levels. The miR-140-5p mimic was transfected into the normoxic and hypoxic HUVECs and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, Transwell migration and tube formation assays were performed. The results indicated that miR‑140‑5p inhibited angiogenesis by decreasing cell proliferation, migration and tube formation. Additionally, in human embryonic kidney 293 cells, results from the luciferase reporter assay revealed that miR‑140‑5p directly targeted the 3' untranslated region of VEGFA and that miR‑140‑5p regulated the protein expression of VEGFA. To further analyze this effect, a VEGFA‑pEGFP‑C1 plasmid was transfected into the normoxic and hypoxic HUVECs, and it was revealed that the inhibitory effect of miR‑140‑5p on angiogenesis was attenuated by the overexpression of VEGFA. In conclusion, to the best of our knowledge, the present study is the first to suggest that miR‑140‑5p exerts an inhibitory effect on angiogenesis in an in vitro model of ischemia, and this effect is achieved partially by targeting VEGFA. The present study provided a novel biomarker for the treatment of cerebral ischemia.
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Affiliation(s)
- Jijun Sun
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, P.R. China
| | - Shuxin Tao
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, P.R. China
| | - Lifeng Liu
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, P.R. China
| | - Dong Guo
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, P.R. China
| | - Zhangyong Xia
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, P.R. China
| | - Min Huang
- Department of Neurology, Jinan University, Guangzhou, Guangdong 510632, P.R. China
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Liebeskind DS, Feldmann E. Imaging of cerebrovascular disorders: precision medicine and the collaterome. Ann N Y Acad Sci 2015; 1366:40-8. [PMID: 25922154 DOI: 10.1111/nyas.12765] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 12/29/2022]
Abstract
Imaging of stroke and neurovascular disorders has profoundly enhanced clinical practice and related research during the last 40 years since the introduction of computed tomography (CT) and magnetic resonance imaging (MRI) enabled mapping of the brain. We highlight recent advances in neurovascular imaging. We describe how the convergence of readily available data and new clinical trial paradigms will recast our methods for studying the neurovascular patient. The application of a precision medicine approach to the collaterome, a comprehensive synthesis of neurovascular pathophysiology, will entail novel methods for clinical trial randomization, collection of routine and clinical trial imaging results, data archiving, and analysis.
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Affiliation(s)
- David S Liebeskind
- Neurovascular Imaging Research Core and the University of California, Los Angeles Stroke Center, Los Angeles, California
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