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Bellomo J, Sebök M, Stumpo V, van Niftrik CHB, Meisterhans D, Piccirelli M, Michels L, Reolon B, Esposito G, Schubert T, Kulcsar Z, Luft AR, Wegener S, Regli L, Fierstra J. Blood Oxygenation Level-Dependent Cerebrovascular Reactivity-Derived Steal Phenomenon May Indicate Tissue Reperfusion Failure After Successful Endovascular Thrombectomy. Transl Stroke Res 2023:10.1007/s12975-023-01203-y. [PMID: 37880561 DOI: 10.1007/s12975-023-01203-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/25/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
In acute ischemic stroke due to large-vessel occlusion (LVO), the clinical outcome after endovascular thrombectomy (EVT) is influenced by the extent of autoregulatory hemodynamic impairment, which can be derived from blood oxygenation level-dependent cerebrovascular reactivity (BOLD-CVR). BOLD-CVR imaging identifies brain areas influenced by hemodynamic steal. We sought to investigate the presence of steal phenomenon and its relationship to DWI lesions and clinical deficit in the acute phase of ischemic stroke following successful vessel recanalization.From the prospective longitudinal IMPreST (Interplay of Microcirculation and Plasticity after ischemic Stroke) cohort study, patients with acute ischemic unilateral LVO stroke of the anterior circulation with successful endovascular thrombectomy (EVT; mTICI scale ≥ 2b) and subsequent BOLD-CVR examination were included for this analysis. We analyzed the spatial correlation between brain areas exhibiting BOLD-CVR-associated steal phenomenon and DWI infarct lesion as well as the relationship between steal phenomenon and NIHSS score at hospital discharge.Included patients (n = 21) exhibited steal phenomenon to different extents, whereas there was only a partial spatial overlap with the DWI lesion (median 19%; IQR, 8-59). The volume of steal phenomenon outside the DWI lesion showed a positive correlation with overall DWI lesion volume and was a significant predictor for the NIHSS score at hospital discharge.Patients with acute ischemic unilateral LVO stroke exhibited hemodynamic steal identified by BOLD-CVR after successful EVT. Steal volume was associated with DWI infarct lesion size and with poor clinical outcome at hospital discharge. BOLD-CVR may further aid in better understanding persisting hemodynamic impairment following reperfusion therapy.
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Affiliation(s)
- Jacopo Bellomo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland.
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland.
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Vittorio Stumpo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Christiaan H B van Niftrik
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Darja Meisterhans
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Marco Piccirelli
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Lars Michels
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Beno Reolon
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Tilman Schubert
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Zsolt Kulcsar
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas R Luft
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
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Marnat G, Gory B, Sibon I, Kyheng M, Labreuche J, Boulouis G, Liegey JS, Caroff J, Eugène F, Naggara O, Consoli A, Mazighi M, Maier B, Richard S, Denier C, Turc G, Lapergue B, Bourcier R. Mechanical thrombectomy failure in anterior circulation strokes: Outcomes and predictors of favorable outcome. Eur J Neurol 2022; 29:2701-2707. [PMID: 35648445 PMCID: PMC9541042 DOI: 10.1111/ene.15429] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2022]
Abstract
Background and purpose Despite continuous improvement and growing knowledge in the endovascular therapy of large vessel occlusion stroke (LVOS), mechanical thrombectomy (MT) still fails to obtain satisfying intracranial recanalization in 10% to 15% of cases. However, little is known regarding clinical and radiological outcomes among this singularly underexplored subpopulation undergoing failed MT. We aimed to investigate the outcome after failed MT and identify predictive factors of favorable outcome despite recanalization failure. Methods We conducted a retrospective analysis of consecutive patients prospectively included in the ongoing observational multicenter Endovascular Treatment in Ischemic Stroke registry from January 2015 to September 2020. Patients presenting with anterior circulation LVOS treated with MT but experiencing failed intracranial recanalization defined as final modified Thrombolysis In Cerebral Infarction (mTICI) score of 0, 1 and 2a were included. Clinical and radiological outcomes were assessed along with the exploration of predictive factors of Day‐90 favorable outcome. Results The study population comprised 533 patients. Mean age was 68.8 ± 16 years, and median admission National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were 17 (IQR 12–21) and 7 (IQR 5–8), respectively. Favorable outcomes were observed in 85 patients (18.2%) and 186 died (39.0%). The rate of symptomatic intracranial hemorrhage was 14.1%. In multivariable analysis, younger age (odds ratio [OR] 0.96, 95% CI 0.94–0.98, p < 0.001), a lower admission NIHSS (OR 0.87, 95% CI 0.83–0.91, p < 0.001), a lower number of MT passes (OR 0.77, 95% CI 0.77–0.87, p < 0.001), a lower delta ASPECTS between initial and Day‐1 imaging (OR 0.83, 95% CI 0.71–0.98, p = 0.026) and stroke etiology [significant difference among etiological subtypes (p = 0.024) with a tendency toward more favorable outcomes for dissection (OR 2.01, 95% CI 0.71–5.67)] were significantly associated with a 90‐day favorable outcome. Conclusions In this large retrospective analysis of a multicenter registry, we quantified the poor outcome after MT failure. We also identified factors associated with favorable outcome despite recanalization failure that might influence therapeutic management.
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Affiliation(s)
- Gaultier Marnat
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Gory
- CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, Nancy, France.,IADI, INSERM-U1254, Université de Lorraine, Nancy, France
| | - Igor Sibon
- Neurology Department, Bordeaux University Hospital, Bordeaux, France
| | - Maeva Kyheng
- CHU Lille, Department of Biostatistics, Lille, France
| | | | | | | | - Jildaz Caroff
- Neuroradiolology Department, CHU Kremlin Bicêtre, Paris, France
| | - François Eugène
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Rennes, Rennes, France
| | - Olivier Naggara
- Department of Neuroradiology, GHU Paris, Centre Hospitalier Sainte-Anne, Université de Paris, INSERM-UMR-894, Paris, France
| | - Arturo Consoli
- Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin-en-Yvelines, Foch Hospital, Suresnes, France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, University of Paris, FHU-NeuroVASC, Paris, INSERM-1148, France
| | - Benjamin Maier
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, University of Paris, FHU-NeuroVASC, Paris, INSERM-1148, France
| | | | | | - Guillaume Turc
- Department of Neurology, GHU Paris, Centre Hospitalier Sainte-Anne, Paris, France
| | - Bertrand Lapergue
- Department of Neurology, University of Versailles and Saint-Quentin-en-Yvelines, Foch Hospital, Suresnes, France
| | - Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nantes, Nantes, France
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