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Yi JS, Ki HJ, Jeon YS, Park JJ, Lee TJ, Kwak JT, Lee SB, Lee HJ, Kim IS, Kim JH, Lee JS, Roh HG, Kim HJ. The collateral map: prediction of lesion growth and penumbra after acute anterior circulation ischemic stroke. Eur Radiol 2024; 34:1411-1421. [PMID: 37646808 PMCID: PMC10873223 DOI: 10.1007/s00330-023-10084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/03/2023] [Accepted: 07/15/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES This study evaluated the collateral map's ability to predict lesion growth and penumbra after acute anterior circulation ischemic strokes. METHODS This was a retrospective analysis of selected data from a prospectively collected database. The lesion growth ratio was the ratio of the follow-up lesion volume to the baseline lesion volume on diffusion-weighted imaging (DWI). The time-to-maximum (Tmax)/DWI ratio was the ratio of the baseline Tmax > 6 s volume to the baseline lesion volume. The collateral ratio was the ratio of the hypoperfused lesion volume of the phase_FU (phase with the hypoperfused lesions most approximate to the follow-up DWI lesion) to the hypoperfused lesion volume of the phase_baseline of the collateral map. Multiple logistic regression analyses were conducted to identify independent predictors of lesion growth. The concordance correlation coefficients of Tmax/DWI ratio and collateral ratio for lesion growth ratio were analyzed. RESULTS Fifty-two patients, including twenty-six males (mean age, 74 years), were included. Intermediate (OR, 1234.5; p < 0.001) and poor collateral perfusion grades (OR, 664.7; p = 0.006) were independently associated with lesion growth. Phase_FUs were immediately preceded phases of the phase_baselines in intermediate or poor collateral perfusion grades. The concordance correlation coefficients of the Tmax/DWI ratio and collateral ratio for the lesion growth ratio were 0.28 (95% CI, 0.17-0.38) and 0.88 (95% CI, 0.82-0.92), respectively. CONCLUSION Precise prediction of lesion growth and penumbra can be possible using collateral maps, allowing for personalized application of recanalization treatments. Further studies are needed to generalize the findings of this study. CLINICAL RELEVANCE STATEMENT Precise prediction of lesion growth and penumbra can be possible using collateral maps, allowing for personalized application of recanalization treatments. KEY POINTS • Cell viability in cerebral ischemia due to proximal arterial steno-occlusion mainly depends on the collateral circulation. • The collateral map shows salvageable brain extent, which can survive by recanalization treatments after acute anterior circulation ischemic stroke. • Precise estimation of salvageable brain makes it possible to make patient-specific treatment decision.
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Affiliation(s)
- Jin Seok Yi
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Hee Jong Ki
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Yoo Sung Jeon
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - Taek-Jun Lee
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Jin Tae Kwak
- School of Electrical Engineering, Korea University, Seoul, Republic of Korea
| | - Sang Bong Lee
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Hyung Jin Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - In Seong Kim
- Siemens Healthineers Ltd., Seoul, Republic of Korea
| | - Joo Hyun Kim
- Philips Healthcare Korea, Seoul, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Kwangjin-Gu, Seoul, 05030, Republic of Korea.
| | - Hyun Jeong Kim
- Department of Radiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Republic of Korea.
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Biose IJ, Oremosu J, Bhatnagar S, Bix GJ. Promising Cerebral Blood Flow Enhancers in Acute Ischemic Stroke. Transl Stroke Res 2023; 14:863-889. [PMID: 36394792 PMCID: PMC10640530 DOI: 10.1007/s12975-022-01100-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022]
Abstract
Ischemic stroke presents a major global economic and public health burden. Although recent advances in available endovascular therapies show improved functional outcome, a good number of stroke patients are either ineligible or do not have access to these treatments. Also, robust collateral flow during acute ischemic stroke independently predicts the success of endovascular therapies and the outcome of stroke. Hence, adjunctive therapies for cerebral blood flow (CBF) enhancement are urgently needed. A very clear overview of the pial collaterals and the role of genetics are presented in this review. We review available evidence and advancement for potential therapies aimed at improving CBF during acute ischemic stroke. We identified heme-free soluble guanylate cyclase activators; Sanguinate, remote ischemic perconditioning; Fasudil, S1P agonists; and stimulation of the sphenopalatine ganglion as promising potential CBF-enhancing therapeutics requiring further investigation. Additionally, we outline and discuss the critical steps required to advance research strategies for clinically translatable CBF-enhancing agents in the context of acute ischemic stroke models.
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Affiliation(s)
- Ifechukwude Joachim Biose
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, 131 S. Robertson, Ste 1300, Room 1349, New Orleans, LA, 70112, USA
| | - Jadesola Oremosu
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - Somya Bhatnagar
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - Gregory Jaye Bix
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, 131 S. Robertson, Ste 1300, Room 1349, New Orleans, LA, 70112, USA.
- Tulane Brain Institute, Tulane University, New Orleans, LA, 70112, USA.
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, 70112, USA.
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, 70112, USA.
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, 70122, USA.
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Galecio-Castillo M, Quispe-Orozco D, Farooqui M, Dajles A, Vivanco-Suarez J, Rodriguez-Calienes A, Prasad A, Begunova L, Petersen NH, Ortega-Gutierrez S. Association between intraprocedural drops in blood pressure and infarct growth rate patterns after acute large-vessel occlusions. J Neurointerv Surg 2023:jnis-2023-020899. [PMID: 37923382 PMCID: PMC11271969 DOI: 10.1136/jnis-2023-020899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Infarct growth rate (IGR) differs among patients with acute ischemic stroke due to large vessel occlusion (LVO-AIS), and this variability has critical clinical repercussions. We explored IGR patterns and their association with blood pressure during endovascular therapy (EVT). METHODS This is a two-center cohort observational study that included consecutive anterior circulation LVO-AIS patients who underwent EVT and achieved modified Thrombolysis in Cerebral Infarction (mTICI) 2 c-3. Initial and final infarct volumes (FIV) were defined using admission computed tomography perfusion (CTP) defined as relative cerebral blood flow (rCBF) <30%, and diffusion-weighted imaging-magnetic resonance imaging (DWI-MRI) at 24 hours post-EVT. We categorized IGR patterns as exponential (ExpIGR) and Non-exponential (NonExp) based on their growth curves. We then dichotomized ExpIGR clinical significance based on the association of infarct growth with 90-day Modified Rankin Score (mRS) as ExpIGR-A (>13 mL) and ExpIGR-B (<13 mL). Intraprocedural blood pressure (BP) drops were calculated as the difference between median arterial pressure (MAP) at admission and the lowest intraprocedural MAP reading before recanalization, and the area between admission MAP threshold and all lower measurements of intraprocedural MAP. Logistic and linear regression were used to investigate associations between variables of interest. RESULTS Of 159 modified Thrombolysis in Cerebral Infarction (mTICI) 2 c-3 patients, we found that 36% demonstrated ExpIGR-A, 31% ExpIGR-B, and 32.7% NonExp patterns. The Exp-A and Exp-B groups differed significantly in National Institutes of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT Score (ASPECTS), glucose, and FIV. The Exp-A and NonExp groups differed in rCBF <30% vol, and time of stroke onset (SO) to admission CTP; and the Exp-B and NonExp groups in NIHSS, rCBF <30%, Tmax <6 s volume, collateral flow measured by hypoperfusion intensity ratio (HIR), and FIV. Hypotensive MAP area (HMA) was independently associated with an ExpIGR-A pattern. Infarct volume increased by 1 mL per 100 units of hypotensive area and 4.2 mL per 0.1 units of HIR, with a significant interaction between both variables. CONCLUSION After an LVO-AIS, the IGR can be differentiated into two distinct exponential and non-exponential patterns. A subgroup of patients with the exponential pattern experienced clinically meaningful infarct growth rates between CTP acquisition and reperfusion and seem to be highly vulnerable to episodes of sustained intraprocedural BP drops during EVT.
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Affiliation(s)
| | | | - Mudassir Farooqui
- Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Andres Dajles
- Biostatistics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | - Ayush Prasad
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Liza Begunova
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nils H Petersen
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Santiago Ortega-Gutierrez
- Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Mohamed A, Shuaib A, Saqqur M, Fatima N. The impact of leptomeningeal collaterals in acute ischemic stroke: a systematic review and meta-analysis. Neurol Sci 2023; 44:471-489. [PMID: 36195701 DOI: 10.1007/s10072-022-06437-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/24/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Leptomeningeal collaterals provide an alternate pathway to maintain cerebral blood flow in stroke to prevent ischemia, but their role in predicting the outcome is still unclear. So, our study aims at assessing the significance of collateral blood flow (CBF) in acute stroke. METHODS Electronic databases were searched under different MeSH terms from January 2000 to February 2019. Studies were included if there was available data on good and poor CBF in acute ischemic stroke (AIS). The clinical outcomes included were modified Rankin scale (mRS), recanalization, mortality, and symptomatic intracranial hemorrhage (sICH) at 90 days. Data was analyzed using a random-effect model. RESULTS A total of 47 studies with 8194 patients were included. Pooled meta-analysis revealed that there exist twofold higher likelihood of favorable clinical outcome (mRS ≤ 2) at 90 days with good CBF compared with poor CBF (RR: 2.27; 95% CI: 1.94-2.65; p < 0.00001) irrespective of the thrombolytic therapy [RR with IVT: 2.90; 95% CI: 2.14-3.94; p < 0.00001, and RR with IAT/EVT: 1.99; 95% CI: 1.55-2.55; p < 0.00001]. Moreover, there exists onefold higher probability of successful recanalization with good CBF (RR: 1.31; 95% CI: 1.15-1.49; p < 0.00001). However, there was 54% and 64% lower risk of sICH and mortality respectively in patients with good CBF in AIS (p < 0.00001). CONCLUSIONS The relative risk of favorable clinical outcome is more in patients with good pretreatment CBF. This could be explained due to better chances of recanalization combined with a lesser risk of intracerebral hemorrhage with good CBF status.
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Affiliation(s)
- Ahmed Mohamed
- Department of Biology (Physiology), McMaster University, Hamilton, ON, Canada
| | - Ashfaq Shuaib
- Department of Neurology, University of Alberta, Edmonton, AB, Canada
| | - Maher Saqqur
- Department of Neuroscience, Institute for Better Health, MSK Trillium Hospital, University of Toronto at Mississauga, Mississauga, ON, Canada
| | - Nida Fatima
- Division of Neurosurgery, House Institute, Los Angeles, CA, USA.
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Collateral Status and Outcomes after Thrombectomy. Transl Stroke Res 2023; 14:22-37. [PMID: 35687300 DOI: 10.1007/s12975-022-01046-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 01/31/2023]
Abstract
Endovascular treatment (EVT) using novel mechanical thrombectomy devices has been the gold standard for patients with acute ischemic stroke caused by large vessel occlusion. Selection criteria of randomized control trials commonly include baseline infarct volume with or without penumbra evaluation. Although the collateral status has been studied and is known to modify imaging results and clinical course, it has not been commonly used for trials. Many post hoc studies, however, revealed that collateral status can help predict infarct growth, recanalization success, decreased hemorrhagic transformation after EVT, and extension of the therapeutic time window for revascularization. Here, we systematically review the recent literature and summarized the outcomes of EVT according to the collateral status of patients with acute ischemic stroke caused by large vessel occlusion. The studies reviewed indicate that pretreatment collateral circulation is associated with both clinical and imaging outcomes after EVT in patients with acute ischemic stroke due to large vessel occlusion although most patients were already selected by other imaging or clinical criteria. However, treatment decisions using information on patients' collateral status have not progressed in clinical practice. Further randomized trials are needed to evaluate the risks and benefits of EVT in consideration of collateral status.
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6
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Legrand L, Le Berre A, Seners P, Benzakoun J, Ben Hassen W, Lion S, Boulouis G, Cottier JP, Costalat V, Bracard S, Berthezene Y, Ozsancak C, Provost C, Naggara O, Baron JC, Turc G, Oppenheim C. FLAIR Vascular Hyperintensities as a Surrogate of Collaterals in Acute Stroke: DWI Matters. AJNR Am J Neuroradiol 2023; 44:26-32. [PMID: 36521962 PMCID: PMC9835925 DOI: 10.3174/ajnr.a7733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE FLAIR vascular hyperintensities are thought to represent leptomeningeal collaterals in acute ischemic stroke. However, whether all-FLAIR vascular hyperintensities or FLAIR vascular hyperintensities-DWI mismatch, ie, FLAIR vascular hyperintensities beyond the DWI lesion, best reflects collaterals remains debated. We aimed to compare the value of FLAIR vascular hyperintensities-DWI mismatch versus all-FLAIR vascular hyperintensities for collateral assessment using PWI-derived collateral flow maps as a reference. MATERIALS AND METHODS We retrospectively reviewed the registries of 6 large stroke centers and included all patients with acute stroke with anterior circulation large-vessel occlusion who underwent MR imaging with PWI before thrombectomy. Collateral status was graded from 1 to 4 on PWI-derived collateral flow maps and dichotomized into good (grades 3-4) and poor (grades 1-2). The extent of all-FLAIR vascular hyperintensities and FLAIR vascular hyperintensities-DWI mismatch was assessed on the 7 cortical ASPECTS regions, ranging from 0 (absence) to 7 (extensive), and associations with good collaterals were compared using receiver operating characteristic curves. RESULTS Of the 209 included patients, 133 (64%) and 76 (36%) had good and poor collaterals, respectively. All-FLAIR vascular hyperintensity extent was similar between collateral groups (P = .76). Conversely, FLAIR vascular hyperintensities-DWI mismatch extent was significantly higher in patients with good compared with poor collaterals (P < .001). The area under the curve was 0.80 (95% CI, 0.74-0.87) for FLAIR vascular hyperintensities-DWI mismatch and 0.52 (95% CI, 0.44-0.60) for all-FLAIR vascular hyperintensities (P < .001 for the comparison), to predict good collaterals. Variables independently associated with good collaterals were smaller DWI lesion volume (P < .001) and larger FLAIR vascular hyperintensities-DWI mismatch (P = .02). CONCLUSIONS In acute ischemic stroke with large-vessel occlusion, the extent of FLAIR vascular hyperintensities does not reliably reflect collateral status unless one accounts for DWI.
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Affiliation(s)
- L Legrand
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - A Le Berre
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - P Seners
- Department of Neurology (P.S.), Hôpital Fondation Rothschild, Paris, France
| | - J Benzakoun
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - W Ben Hassen
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - S Lion
- Edmus Services (S.L.), Fondation Edmus, Lyon, France
| | - G Boulouis
- Department of Diagnostic and Interventional Neuroradiology (G.B., J-.P.C.), Bretonneau Hospital, University of Tours, Institut National de la Santé et de la Recherche Médicale 1253 iBrain, Tours, France
| | - J-P Cottier
- Department of Diagnostic and Interventional Neuroradiology (G.B., J-.P.C.), Bretonneau Hospital, University of Tours, Institut National de la Santé et de la Recherche Médicale 1253 iBrain, Tours, France
| | - V Costalat
- Department of Interventional Neuroradiology (V.C.), Centre Hospitalier Regional Universitaire Gui de Chauliac, Montpellier, France
| | - S Bracard
- Department of Diagnostic and Interventional Neuroradiology (S.B.), University Hospital of Nancy, Institut National de la Santé et de la Recherche Médicale U947, Nancy, France
| | - Y Berthezene
- Department of Neuroradiology (Y.B.), Hospices Civils de Lyon, Lyon, France
| | - C Ozsancak
- Department of Neurology (C. Ozsancak), Orleans Hospital, Orleans, France
| | - C Provost
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - O Naggara
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
| | - J-C Baron
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Neurology (J.-C.B., G.T.), Groupe Hospitalier Universitaire-Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - G Turc
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Neurology (J.-C.B., G.T.), Groupe Hospitalier Universitaire-Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - C Oppenheim
- From the Institute of Psychiatry and Neuroscience of Paris (L.L., A.L.B., J.B., W.B.H., C.P., O.N., J.-C.B., G.T., C. Oppenheim), Université Paris Cité, Institut National de la Santé et de la Recherche Médicale U1266, Federation Hospitalo-Universitaire NeuroVasc, Paris, France
- Departments of Neuroradiology (L.L., A.L.B., J.B., W.B.H., C.P., O.N., C. Oppenheim)
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Value of CT Perfusion for Collateral Status Assessment in Patients with Acute Ischemic Stroke. Diagnostics (Basel) 2022; 12:diagnostics12123014. [PMID: 36553021 PMCID: PMC9777468 DOI: 10.3390/diagnostics12123014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/04/2022] Open
Abstract
Good collateral status in acute ischemic stroke patients is an important indicator for good outcomes. Perfusion imaging potentially allows for the simultaneous assessment of local perfusion and collateral status. We combined multiple CTP parameters to evaluate a CTP-based collateral score. We included 85 patients with a baseline CTP and single-phase CTA images from the MR CLEAN Registry. We evaluated patients' CTP parameters, including relative CBVs and tissue volumes with several time-to-maximum ranges, to be candidates for a CTP-based collateral score. The score candidate with the strongest association with CTA-based collateral score and a 90-day mRS was included for further analyses. We assessed the association of the CTP-based collateral score with the functional outcome (mRS 0-2) by analyzing three regression models: baseline prognostic factors (model 1), model 1 including the CTA-based collateral score (model 2), and model 1 including the CTP-based collateral score (model 3). The model performance was evaluated using C-statistic. Among the CTP-based collateral score candidates, relative CBVs with a time-to-maximum of 6-10 s showed a significant association with CTA-based collateral scores (p = 0.02) and mRS (p = 0.05) and was therefore selected for further analysis. Model 3 most accurately predicted favorable outcomes (C-statistic = 0.86, 95% CI: 0.77-0.94) although differences between regression models were not statistically significant. We introduced a CTP-based collateral score, which is significantly associated with functional outcome and may serve as an alternative collateral measure in settings where MR imaging is not feasible.
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Multiphase arterial spin labeling imaging to predict early recurrent ischemic lesion in acute ischemic stroke. Sci Rep 2022; 12:1456. [PMID: 35087157 PMCID: PMC8795409 DOI: 10.1038/s41598-022-05465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/03/2021] [Indexed: 11/21/2022] Open
Abstract
In acute ischemic stroke (AIS), the hemodynamics around the lesion are important because they determine the recurrence or prognosis of the disease. This study evaluated the effects of perfusion deficits in multiphase arterial spin labeling (ASL) and related radiological parameters on the occurrence of early recurrent ischemic lesions (ERILs) in AIS. We assessed AIS patients who underwent multiphase ASL within 24 h of symptom onset and follow-up diffusion-weighted imaging within 7 days. ASL perfusion deficit, arterial transit artifact (ATA), and intra-arterial high-intensity signal (IAS) were manually rated as ASL parameters. A total of 134 patients were evaluated. In the multivariable analyses, ASL perfusion deficit [adjusted odds ratio (aOR) = 2.82, 95% confidence interval = 1.27–6.27] was positively associated with ERIL. Furthermore, when ATA was accompanied, the ASL perfusion deficit was not associated with ERIL occurrence. Meanwhile, IAS showed a synergistic effect with ASL perfusion deficit on the occurrence of ERIL. In conclusion, we demonstrated the association between perfusion deficits in multiphase ASL with ERIL in patients with AIS. This close association was attenuated by ATA and was enhanced by IAS. ASL parameters may help identify high-risk patients of ERIL occurrence during the acute period.
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Saber H, Liebeskind DS. Infarct Progression in the Early and Late Phases of Acute Ischemic Stroke. Neurology 2021; 97:S60-S67. [PMID: 34785605 DOI: 10.1212/wnl.0000000000012795] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF REVIEW To explore factors associated with infarct progression in the early and late phase of acute ischemic stroke in patients undergoing endovascular therapy. RECENT FINDINGS Following ischemic stroke, brain injury can progress at a variable rate, at the expense of "penumbral tissue," which is the ischemic tissue at risk of infarction. Despite dramatic advances in endovascular stroke therapies with early revascularization in more than 80% of cases, nearly half of patients do not achieve functional independence despite successful recanalization. This is largely attributed to the irreversible damage that is already extensive at the time of revascularization. SUMMARY The underlying pathophysiology and determinants of the core infarct progression are complex and multifactorial, depending on a balance between brain energy consumption and collateral perfusion supply. It is crucial to develop creative and individualized theranostics to predict infarct progression and to "freeze" the tissue at risk prior to recanalization.
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Affiliation(s)
- Hamidreza Saber
- From the Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - David S Liebeskind
- From the Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA.
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Broocks G, Faizy TD, Meyer L, Groffmann M, Elsayed S, Kniep H, Flottmann F, Bechstein M, Rusche T, Schön G, Nawabi J, Sporns P, Fiehler J, Kemmling A, Hanning U. Posterior circulation collateral flow modifies the effect of thrombectomy on outcome in acute basilar artery occlusion. Int J Stroke 2021; 17:761-769. [PMID: 34569885 DOI: 10.1177/17474930211052262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In basilar artery occlusion stroke, the impact of the collateral circulation on infarct progression in the context of endovascular treatment is yet poorly studied. AIM This study investigates the impact of the posterior circulation collateral score (PCCS) on functional outcome according to the extent of early ischemic changes and treatment. We hypothesized that the presence of collaterals, quantified by the PCCS, mediates the effect of endovascular treatment on functional outcome in patients with acute basilar artery occlusion. METHODS In this multicenter observational study, patients with basilar artery occlusion and admission computed tomography were analyzed. At baseline, Posterior circulation Acute Stroke Prognosis Early Computed Tomography score (pcASPECTS) was assessed and PCCS was quantified using an established 10-point grading system. Logistic regression analyses were performed to identify factors associated with good functional outcome (modified Rankin Scale scores 0-2 at day 90). RESULTS A total of 151 patients were included, of which 112 patients (74%) underwent endovascular treatment. In patients with a better PCCS (>5), the rate of good outcome was significantly higher (55% vs. 11%; p = 0.001). After adjusting for PCCS, vessel recanalization was significantly associated with improved functional outcome (aOR: 4.53, 95%CI: 1.25-16.4, p = 0.02), while there was no association between recanalization status and outcome in univariable analysis. Patients with low pcASPECTS generally showed very poor outcomes (mean modified Rankin Scale score 5.3, 95%CI: 4.9-5.8). CONCLUSION PCCS modified the effect of recanalization on functional outcome, particularly in patients with less pronounced ischemic changes in admission computed tomography. These results should be validated to improve patient selection for endovascular treatment in basilar artery occlusion, particularly in uncertain indications, or to triage patients at risk for very poor outcomes.
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Affiliation(s)
- Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Groffmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Elsayed
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thilo Rusche
- Department of Neuroradiology, Universitätsspital Basel, Basel, Switzerland.,Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jawed Nawabi
- Department of Radiology, Charité University Medical Center, Berlin, Germany
| | - Peter Sporns
- Department of Neuroradiology, Universitätsspital Basel, Basel, Switzerland
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andre Kemmling
- Department of Neuroradiology, 9377University of Marburg, Marburg, Germany.,Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Collateral and permeability imaging derived from dynamic contrast material-enhanced MR angiography in prediction of PH 2 hemorrhagic transformation after acute ischemic stroke: a pilot study. Neuroradiology 2021; 63:1471-1479. [PMID: 33533948 DOI: 10.1007/s00234-021-02655-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the role of collateral and permeability imaging derived from dynamic contrast material-enhanced magnetic resonance angiography to predict PH 2 hemorrhagic transformation in acute ischemic stroke. METHODS The secondary analysis of a published data from participants with acute ischemic stroke. The multiphase collateral map and permeability imaging were generated by using dynamic signals from dynamic contrast material-enhanced magnetic resonance angiography obtained at admission. To identify independent predictors of PH 2 hemorrhagic transformation, age, sex, risk factors, baseline National Institutes of Health Stoke Scale (NIHSS) score, baseline DWI lesion volume, collateral-perfusion status, mode of treatment, and successful early reperfusion were evaluated with multiple logistic regression analyses and the significance of permeability imaging in prediction of PH 2 hemorrhagic transformation was evaluated by subgroup analysis. RESULTS In 115 participants, including 70 males (mean (SD) age, 69 (12) years), PH 2 hemorrhagic transformation occurred in 6 participants with very poor collateral-perfusion status (MAC 0). MAC 0 (OR, 0.06; 95% CI, 0.01, 0.74; P = .03) was independently associated with PH 2 hemorrhagic transformation. In 22 participants with MAC 0, the permeable signal on Kep permeability imaging was the only significant characteristic associated with PH 2 hemorrhagic transformation (P = .009). The specificity of Kep permeability imaging was 93.8% (95% confidence interval: 69.8, 99.8) in predicting PH 2 hemorrhagic transformation. CONCLUSION Individual-based prediction of PH 2 hemorrhagic transformation in patients with acute ischemic stroke may be possible with multiphase collateral map and permeability imaging derived from dynamic contrast material-enhanced magnetic resonance angiography.
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12
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Ben Hassen W, Tordjman M, Boulouis G, Bretzner M, Bricout N, Legrand L, Benzakoun J, Edjlali M, Seners P, Cordonnier C, Oppenheim C, Turc G, Henon H, Naggara O. Benefit of first-pass complete reperfusion in thrombectomy is mediated by limited infarct growth. Eur J Neurol 2020; 28:124-131. [PMID: 32896067 DOI: 10.1111/ene.14490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/18/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE The number of clot retrieval attempts required to achieve complete reperfusion by mechanical thrombectomy impacts functional outcome in acute ischaemic stroke (AIS). Complete reperfusion [expanded Treatment In Cerebral Infarction (eTICI) score = 3] at first pass (FP), is associated with the highest rates of favorable outcome compared to complete reperfusion by multiple passes. The aim of the present study was to investigate the relationship between FP complete reperfusion and infarct growth (IG). METHODS Anterior AIS patients with baseline and 24-h diffusion-weighted magnetic resonance imaging were included from two prospective registries. IG was measured by voxel-based segmentation of initial and 24-h diffusion-weighted imaging lesions. IG and favorable 3-month modified Rankin Scale (mRS) score (≤ 2) were compared between patients in whom complete reperfusion (eTICI 3) was achieved with a single pass (FP group) and those for whom multiple passes were required (MP group), after matching for confounding factors. Mediation analysis was performed to examine the association between FP and 3-month mRS score, with IG as mediating variable. RESULTS A total of 200 patients were included, of whom 118 (28.9%) had FP complete reperfusion. In case-control analysis, the FP group had lower IG than the MP group [8.7 (5.4-12.9) ml vs. 15.2 (11-22.6) ml, respectively; P = 0.03). Favorable outcome was higher in the FP population compared to a matched MP population (70.9% vs. 53.2%, respectively; P = 0.04). FP compete reperfusion (eTICI 3) was independently associated with favorable outcome in multivariable regression analysis [odds ratio 1.86, 95% confidence interval (CI) 1.01-4.39; P = 0.04]. The effect of complete reperfusion at FP on functional outcome was explained by limited IG in mediation analysis [indirect effect: -0.32 (95% CI -0.47 to -0.09)]. CONCLUSION Complete reperfusion at FP is independently associated with significant decrease in IG compared to complete reperfusion by multiple attempts, explaining better functional outcomes.
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Affiliation(s)
- W Ben Hassen
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - M Tordjman
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - G Boulouis
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - M Bretzner
- Department of Interventional Neuroradiology, University of Lille, CHU Lille, Lille, France
| | - N Bricout
- Department of Interventional Neuroradiology, University of Lille, CHU Lille, Lille, France
| | - L Legrand
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - J Benzakoun
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - M Edjlali
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - P Seners
- Department of Neurology, CH Sainte-Anne, Paris, France
| | - C Cordonnier
- Department of Vascular Neurology, Stroke Unit, University of Lille, CHU Lille, Lille, France
| | - C Oppenheim
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
| | - G Turc
- Department of Neurology, CH Sainte-Anne, Paris, France
| | - H Henon
- Department of Vascular Neurology, Stroke Unit, University of Lille, CHU Lille, Lille, France
| | - O Naggara
- INSERM UMR 1266, Department of Neuroradiology, Université de Paris, Paris, France
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13
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Kim HJ, Lee SB, Choi JW, Jeon YS, Lee HJ, Park JJ, Kim EY, Kim IS, Lee TJ, Jung YJ, Ryu SY, Chun YI, Lee JS, Roh HG. Multiphase MR Angiography Collateral Map: Functional Outcome after Acute Anterior Circulation Ischemic Stroke. Radiology 2020; 295:192-201. [PMID: 32068506 DOI: 10.1148/radiol.2020191712] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Collateral circulation determines tissue fate and affects treatment result in acute ischemic stroke. A precise method for collateral estimation in an optimal imaging protocol is necessary to make an appropriate treatment decision for acute ischemic stroke. Purpose To verify the value of multiphase collateral imaging data sets (MR angiography collateral map) derived from dynamic contrast material-enhanced MR angiography for predicting functional outcomes after acute ischemic stroke. Materials and Methods This secondary analysis of an ongoing prospective observational study included data from participants with acute ischemic stroke due to occlusion or stenosis of the unilateral internal carotid artery and/or M1 segment of the middle cerebral artery who were evaluated within 8 hours of symptom onset. Data were obtained from March 2016 through August 2018. The collateral grading based on the MR angiography collateral map was estimated by using six-scale MR acute ischemic stroke collateral (MAC) scores. To identify independent predictors of favorable functional outcomes, age, sex, risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline diffusion-weighted imaging (DWI) lesion volume, site of steno-occlusion, collateral grade, mode of treatment, and early reperfusion were evaluated with multiple logistic regression analyses. Results One hundred fifty-four participants (mean age ± standard deviation, 69 years ± 13; 99 men) were evaluated. Younger age (odds ratio [OR], 0.45; 95% confidence interval [CI]: 0.29, 0.70; P < .001), lower baseline NIHSS score (OR, 0.85; 95% CI: 0.78, 0.94; P < .001), MAC score of 3 (OR, 27; 95% CI: 4.0, 179; P < .001), MAC score of 4 (OR, 17; 95% CI: 2.1, 134; P = .007), MAC score of 5 (OR, 27; 95% CI: 2.5, 306; P = .007), and successful early reperfusion (OR, 7.5; 95% CI: 2.6, 22; P < .001) were independently associated with favorable functional outcomes in multivariable analysis. There was a linear negative association between collateral perfusion grades and functional outcomes (P < .001). Conclusion An MR angiography collateral map was clinically reliable for collateral estimation in patients with acute ischemic stroke. This map provided patient-specific pacing information for ischemic progression. © RSNA, 2020.
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Affiliation(s)
- Hyun Jeong Kim
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Sang Bong Lee
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Jin Woo Choi
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Yoo Sung Jeon
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Hyung Jin Lee
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Jeong Jin Park
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Eung Yeop Kim
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - In Seong Kim
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Taek Jun Lee
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Yu Jin Jung
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Seon Young Ryu
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Young Il Chun
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Ji Sung Lee
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Hong Gee Roh
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
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Villringer K, Zimny S, Galinovic I, Nolte CH, Fiebach JB, Khalil AA. The Association Between Recanalization, Collateral Flow, and Reperfusion in Acute Stroke Patients: A Dynamic Susceptibility Contrast MRI Study. Front Neurol 2019; 10:1147. [PMID: 31708866 PMCID: PMC6823193 DOI: 10.3389/fneur.2019.01147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/14/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Collateral circulation in ischemic stroke patients plays an important role in infarct evolution und assessing patients' eligibility for endovascular treatment. By means of dynamic susceptibility contrast MRI, we aimed to investigate the effects of reperfusion, recanalization, and collateral flow on clinical and imaging outcomes after stroke. Methods: Retrospective analysis of 184 patients enrolled into the prospective observational 1000Plus study (clinicaltrials.org NCT00715533). Inclusion criteria were vessel occlusion on baseline MR-angiography, imaging within 24 h after stroke onset and follow-up perfusion imaging. Baseline Higashida score using subtracted dynamic MR perfusion source images was used to quantify collateral flow. The influence of these variables, and their interaction with vessel recanalization, on clinical and imaging outcomes was assessed using robust linear regression. Results: Ninety-eight patients (53.3%) showed vessel recanalization. Higashida score (p = 0.002), and recanalization (p = 0.0004) were independently associated with reperfusion. However, we found no evidence that the association between Higashida score and reperfusion relied on recanalization status (p = 0.2). NIHSS on admission (p < 0.0001) and recanalization (p = 0.001) were independently associated with long-term outcome at 3 months, however, Higashida score (p = 0.228) was not. Conclusion: Higashida score and recanalization were independently associated with reperfusion, but the association between recanalization and reperfusion was similar regardless of collateral flow quality. Recanalization was associated with long-term outcome. DSC-based measures of collateral flow were not associated with long-term outcome, possibly due to the complex dynamic nature of collateral recruitment, timing of imaging and the employed post-processing.
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Affiliation(s)
- Kersten Villringer
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sascha Zimny
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Ev.-Luth. Diakonissenanstalt zu Flensburg, Flensburg, Germany
| | - Ivana Galinovic
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Nolte
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ahmed A Khalil
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Mind, Brain, Body Institute, Berlin School of Mind and Brain, Humboldt-Universität Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
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Chung JW, Kim BJ, Jeong HG, Seo WK, Kim GM, Jung C, Han MK, Bae HJ, Bang OY. Selection of Candidates for Endovascular Treatment: Characteristics According to Three Different Selection Methods. J Stroke 2019; 21:332-339. [PMID: 31590477 PMCID: PMC6780015 DOI: 10.5853/jos.2019.01578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/03/2019] [Indexed: 12/18/2022] Open
Abstract
Background and Purpose To investigate the number and characteristics of patients eligible for endovascular treatment (EVT) determined using three different selection methods: clinical-core mismatch, target mismatch, and collateral status.
Methods Using the data of consecutive patients from two prospectively maintained registries of university medical centers, the number and characteristics of patients according to the three selection methods were investigated and their correlation was analyzed. Patients with anterior circulation stroke due to occlusion of the middle cerebral and/or internal carotid artery and a National Institute of Health Stroke Scale (NIHSS) score of ≥6 points, who arrived within 8 hours or between 6 and 12 hours of symptom onset and underwent magnetic resonance imaging prior to EVT, were included. Collateral status was assessed using magnetic resonance perfusion-derived collateral flow maps.
Results Three hundred thirty-five patients were investigated; the proportions of patients who were eligible and ineligible for EVT in all three selection methods were both small (n=85, 25.4%; n=54, 16.1%, respectively). The intercorrelation among the three selection methods was low (κ=0.235). The baseline NIHSS score and onset-to-selection time interval were associated with the presence of clinical-core mismatch, while the penumbra/core volume ratio and onset-to-selection time interval were related to target mismatch; none of these variables were associated with collateral status. The infarct core volume was associated with favorable profiles in all three selection methods.
Conclusions Although the application of individual selection methods resulted in favorable outcomes after EVT in clinical trials, there is a significant discrepancy in EVT eligibility depending on the selection method used.
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Affiliation(s)
- Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Han-Gil Jeong
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chung JW, Kim YC, Cha J, Choi EH, Kim BM, Seo WK, Kim GM, Bang OY. Characterization of clot composition in acute cerebral infarct using machine learning techniques. Ann Clin Transl Neurol 2019; 6:739-747. [PMID: 31019998 PMCID: PMC6469248 DOI: 10.1002/acn3.751] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 01/01/2023] Open
Abstract
Objective Clot characteristics can provide information on the cause of cerebral artery occlusion and may guide acute revascularization and secondary prevention strategies. We developed a rapid automated clot analysis system using machine learning (ML) and validated its accuracy in patients undergoing endovascular treatment. Methods Pre‐endovascular treatment gradient echo (GRE) images from consecutive patients with middle cerebral artery occlusion were utilized to develop and validate an ML system to predict whether atrial fibrillation (AF) was the underlying cause of ischemic stroke. The accuracy of the ML algorithm was compared with that of visual inspection by neuroimaging specialists for the presence of blooming artifact. Endovascular procedures and outcomes were compared in patients with and without AF. Results Of 67 patients, 29 (43.3%) had AF. Of these, 13 had known AF and 16 were newly diagnosed with cardiac monitoring. By visual inspection, interrater correlation for blooming artifact was 0.73 and sensitivity and specificity for AF were 0.79 and 0.63, respectively. For AF classification, the ML algorithms yielded an average accuracy of > 75.4% in fivefold cross‐validation with clot signal profiles obtained from 52 patients and an area under the curve >0.87 for the average AF probability from five signal profiles in external validation (n = 15). Analysis with an in‐house interface took approximately 3 min per patient. Absence of AF was associated with increased number of passes by stentriever, high reocclusion frequency, and additional use of rescue stenting and/or glycogen IIb/IIIa blocker for recanalization. Interpretation ML‐based rapid clot analysis is feasible and can identify AF with high accuracy, enabling selection of endovascular treatment strategy.
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Affiliation(s)
- Jong-Won Chung
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Yoon-Chul Kim
- Clinical Research Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jihoon Cha
- Department of Radiology Yonsei University Medical Center Yonsei University College of Medicine Seoul Republic of Korea
| | - Eun-Hyeok Choi
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Byung Moon Kim
- Department of Radiology Yonsei University Medical Center Yonsei University College of Medicine Seoul Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Gyeong-Moon Kim
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Oh Young Bang
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
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The Processing Time for Recanalization and Size of Ischemic Lesions on DWI is Related With Complete Reperfusion After Mechanical Thrombectomy. J Stroke Cerebrovasc Dis 2018; 27:3266-3271. [PMID: 30154050 DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 11/21/2022] Open
Abstract
Recent studies demonstrated that modified thrombolysis in cerebral infarction (TICI) 3 reperfusion have better functional outcomes than modified TICI 2b after mechanical thrombectomy in acute ischemic stroke with large vessel occlusion. The purpose of this study was to determine significant factors to forecast the presence of complete reperfusion after mechanical thrombectomy based on multimodal magnetic resonance imaging (MRI). We investigated 96 consecutive patients with acute large intracranial artery occlusion of anterior circulation who based on multimodal MRI. Also, we compared clinical and radiologic parameters between patients with modified TICI 3 and those with modified TICI 0-2b. Among 96 eligible subjects received mechanical thrombectomy, 39 patients (40.6%) showed complete reperfusion and 57 partial or nonreperfusion (mTICI 2b-26, mTICI 2a-9, mTICI 1-8, and mTICI 0-14) after mechanical thrombectomy. Patients with mTICI 3 had significantly smaller initial Diffusion weighted images (DWI) lesion volume (P < .01) and much shorter time interval from onset to reperfusion (P < .01) than those patients with mTICI (0-2b). In multivariate analysis, smaller initial DWI volume (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.23-2.57; P < .01) and faster reperfusion time (OR, 1.07; 95% CI 1.01-1.14; P = .015) had an independence significance for complete reperfusion after mechanical thrombectomy. In this study, the ischemic lesion volume on DWI and faster processing time are critical factor to predict the state of complete reperfusion after mechanical thrombectomy.
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Bang OY, Chung JW, Son JP, Ryu WS, Kim DE, Seo WK, Kim GM, Kim YC. Multimodal MRI-Based Triage for Acute Stroke Therapy: Challenges and Progress. Front Neurol 2018; 9:586. [PMID: 30087652 PMCID: PMC6066534 DOI: 10.3389/fneur.2018.00586] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/29/2018] [Indexed: 01/01/2023] Open
Abstract
Revascularization therapies have been established as the treatment mainstay for acute ischemic stroke. However, a substantial number of patients are either ineligible for revascularization therapy, or the treatment fails or is futile. At present, non-contrast computed tomography is the first-line neuroimaging modality for patients with acute stroke. The use of magnetic resonance imaging (MRI) to predict the response to early revascularization therapy and to identify patients for delayed treatment is desirable. MRI could provide information on stroke pathophysiologies, including the ischemic core, perfusion, collaterals, clot, and blood–brain barrier status. During the past 20 years, there have been significant advances in neuroimaging as well as in revascularization strategies for treating patients with acute ischemic stroke. In this review, we discuss the role of MRI and post-processing, including machine-learning techniques, and recent advances in MRI-based triage for revascularization therapies in acute ischemic stroke.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Pyo Son
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| | - Wi-Sun Ryu
- Stroke Center and Korean Brain MRI Data Center, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Dong-Eog Kim
- Stroke Center and Korean Brain MRI Data Center, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoon-Chul Kim
- Samsung Medical Center, Clinical Research Institute, Seoul, South Korea
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El Amki M, Wegener S. Improving Cerebral Blood Flow after Arterial Recanalization: A Novel Therapeutic Strategy in Stroke. Int J Mol Sci 2017; 18:ijms18122669. [PMID: 29232823 PMCID: PMC5751271 DOI: 10.3390/ijms18122669] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 11/30/2017] [Accepted: 12/06/2017] [Indexed: 12/14/2022] Open
Abstract
Ischemic stroke is caused by a disruption in blood supply to a region of the brain. It induces dysfunction of brain cells and networks, resulting in sudden neurological deficits. The cause of stroke is vascular, but the consequences are neurological. Decades of research have focused on finding new strategies to reduce the neural damage after cerebral ischemia. However, despite the incredibly huge investment, all strategies targeting neuroprotection have failed to demonstrate clinical efficacy. Today, treatment for stroke consists of dealing with the cause, attempting to remove the occluding blood clot and recanalize the vessel. However, clinical evidence suggests that the beneficial effect of post-stroke recanalization may be hampered by the occurrence of microvascular reperfusion failure. In short: recanalization is not synonymous with reperfusion. Today, clinicians are confronted with several challenges in acute stroke therapy, even after successful recanalization: (1) induce reperfusion, (2) avoid hemorrhagic transformation (HT), and (3) avoid early or late vascular reocclusion. All these parameters impact the restoration of cerebral blood flow after stroke. Recent advances in understanding the molecular consequences of recanalization and reperfusion may lead to innovative therapeutic strategies for improving reperfusion after stroke. In this review, we will highlight the importance of restoring normal cerebral blood flow after stroke and outline molecular mechanisms involved in blood flow regulation.
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Affiliation(s)
- Mohamad El Amki
- Department of Neurology, University Hospital Zurich and University of Zurich, 8091 Zürich, Switzerland.
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, 8091 Zürich, Switzerland.
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Jiang L, Su HB, Zhang YD, Zhou JS, Geng W, Chen H, Xu Q, Yin X, Chen YC. Collateral vessels on magnetic resonance angiography in endovascular-treated acute ischemic stroke patients associated with clinical outcomes. Oncotarget 2017; 8:81529-81537. [PMID: 29113412 PMCID: PMC5655307 DOI: 10.18632/oncotarget.21081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/03/2017] [Indexed: 12/03/2022] Open
Abstract
Purpose Collateral vessels were considered to be related with outcome in endovascular-treated acute ischemic stroke patients. This study aimed to evaluate whether the collateral vessels on magnetic resonance angiography (MRA) could predict the clinical outcome. Materials and Methods Acute stroke patients with internal carotid artery or middle cerebral artery occlusion within 6 hours of symptom onset were included. All patients underwent MRI and received endovascular treatment. The collateral circulations at the Sylvian fissure and the leptomeningeal convexity were evaluated. The preoperative and postoperative infarct volume was measured. The clinical outcome was evaluated by mRS score at 3 months after stroke. Results Of 55 patients, Cases with insufficient collateral circulation at the Sylvian fissure and leptomeningeal convexity showed that the NIHSS score at arrival and preoperative infarct volume were significantly lower in mRS score of 0–2 (both P < 0.05) than mRS score of 3–6. Multivariate testing revealed age and collateral status at the leptomeningeal convexity were independent of the clinical outcome at 3 months after stroke (odds ratio (95% confidence interval): 1.094 (1.025–1.168); 9.542 (1.812–50.245) respectively). The change of infarct volume in the group with mRS score of 0–2 was smaller than that with mRS score of 3–6. While multivariate logistic models showed that postoperative infarct volume was non-significant in predicting the clinical outcome after stroke. Conclusions The extent of collateral circulation at the leptomeningeal convexity may be useful for predicting the functional recovery while the relationship between postoperative infarct volume and clinical outcome still requires for further study.
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Affiliation(s)
- Liang Jiang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hao-Bo Su
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ying-Dong Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun-Shan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wen Geng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Quan Xu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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