Fluid-attenuated inversion recovery vascular hyperintensities in anterior circulation acute ischemic stroke: associations with cortical brain infarct volume and 90-day prognosis

2019 ◽  
Vol 40 (8) ◽  
pp. 1675-1682 ◽  
Author(s):  
Xiaoyu Dong ◽  
Jianfei Nao
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Inversion Recovery ◽  
Brain Infarct ◽  
Anterior Circulation ◽  
Fluid Attenuated Inversion Recovery

scholarly journals Thrombolysis Outcomes in Acute Ischemic Stroke by Fluid-Attenuated Inversion Recovery Hyperintense Arteries

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2240-2243
Author(s):  
Zien Zhou ◽  
Sohei Yoshimura ◽  
Candice Delcourt ◽  
Richard I. Lindley ◽  
Shoujiang You ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Inversion Recovery ◽  
Modified Rankin Scale ◽  
Resonance Imaging ◽  
Scale Scores ◽  
Fluid Attenuated Inversion Recovery

Background and Purpose: To determine factors associated with fluid-attenuated inversion recovery (FLAIR) hyperintense arteries (FLAIR-HAs) on magnetic resonance imaging and their prognostic significance in thrombolysis-treated patients with acute ischemic stroke from the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) trial alteplase-dose arm. Methods: Patients with acute ischemic stroke (N=293) with brain magnetic resonance imaging (FLAIR and diffusion-weighted imaging sequences) scanned <4.5 hours of symptom onset were assessed for location and extent (score) of FLAIR-HAs, infarct volume, large vessel occlusion (LVO), and other ischemic signs. Logistic regression models were used to determine predictors of FLAIR-HAs and the association of FLAIR-HAs with 90-day outcomes: favorable functional outcome (primary; modified Rankin Scale scores, 0–1), other modified Rankin Scale scores, and intracerebral hemorrhage. Results: Prior atrial fibrillation, LVO, large infarct volume, and anterior circulation infarction were independently associated with FLAIR-HAs. The rate of modified Rankin Scale scores 0 to 1 was numerically lower in patients with FLAIR-HAs versus without (69/152 [45.4%] versus 75/131 [57.3%]), as was the subset of LVO (37/93 [39.8%] versus 9/16 [56.3%]), but not in those without LVO (25/36 [69.4%] versus 60/106 [56.6%]). After adjustment for covariables, FLAIR-HAs were independently associated with increased primary outcome (adjusted odds ratio [95% CI]: overall 4.14 [1.63–10.50]; with LVO 4.92 [0.87–27.86]; no LVO 6.16 [1.57–24.14]) despite an increased risk of hemorrhagic infarct (4.77 [1.12–20.26]). Conclusions: FLAIR-HAs are more frequent in acute ischemic stroke with cardioembolic features and indicate potential for a favorable prognosis in thrombolysis-treated patients possibly mediated by LVO. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01422616.

Abstract 35: MR CLEAN Registry: A Post-trial Multicenter Registry of Intra-arterial Treatment for Acute Ischemic Stroke in the Netherlands

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ivo Jansen ◽  
Maxim Mulder ◽  
Robert-Jan Goldhoorn ◽  
Aad van der Lugt ◽  
Henk Marquering ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
The Netherlands ◽  
Acute Ischemic Stroke ◽  
Randomized Clinical Trials ◽  
Infarct Volume ◽  
Primary Study ◽  
Anterior Circulation ◽  
Serious Adverse Events ◽  
Post Trial ◽  
Mr Clean

Background & Purpose: Intra-arterial therapy (IAT) is being implemented worldwide as the main treatment option for acute ischemic stroke (AIS). We wondered whether effectiveness and safety results that have been reported in randomized clinical trials can be reproduced in everyday clinical practice. We will report results of the Dutch National post MR CLEAN IAT registry including work flow parameters, primary and secondary outcomes, as well as serious adverse events. Methods: The MR CLEAN Registry is a prospective registry of all patients undergoing IAT for AIS in the Netherlands, started after completion of the MR CLEAN trial in March 2014. Registration was required for reimbursement. A core set was defined, with inclusion criteria similar to those of the MR CLEAN trial, including a proven anterior circulation occlusion and treatment possible withing 6 hours from onset. The primary study outcome is the score on the modified Rankin Scale (mRS) at 90 days. The secondary clinical outcome is NIHSS after 24 to 48 hours. Secondary radiological outcomes include the mTICI score on DSA and final infarct volume and major bleeding on follow up NCCT. We used a propensity weighted and an unadjusted ordinal logistic regression model to compare outcomes in the MR CLEAN Registry core and total dataset with the treatment arm of MR CLEAN. Results: Between March 2014 and August 2016 the inclusion rate of the MR CLEAN Registry has been increasing steadily to an average of 79 (SD 22) per month for a cumulative inclusion of 1548 patients in July 2016 (Figure 1). Conclusions: The MR CLEAN registry data is now being analyzed. Results will be reported at the conference.

Negative fluid-attenuated inversion recovery imaging identifies acute ischemic stroke at 3 hours or less

2009 ◽  
Vol 65 (6) ◽  
pp. 724-732 ◽  
Author(s):  
Götz Thomalla ◽  
Philipp Rossbach ◽  
Michael Rosenkranz ◽  
Susanne Siemonsen ◽  
Anna Krützelmann ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Inversion Recovery ◽  
Inversion Recovery Imaging ◽  
Fluid Attenuated Inversion Recovery

scholarly journals Intravenous fibrinolysis plus endovascular thrombectomy versus direct endovascular thrombectomy for anterior circulation acute ischemic stroke: clinical and infarct volume results.

2019 ◽  
Author(s):  
Massimo Gamba ◽  
Nicola Gilberti ◽  
Enrico Premi ◽  
Angelo Costa ◽  
Michele Frigerio ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Safety Profile ◽  
Infarct Volume ◽  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracerebral Hemorrhage

Abstract Background and Purpose endovascular therapy (ET) is the standard of care for anterior circulation acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). The role of adjunctive intravenous thrombolysis (IVT) in these patients is still unclear. The present study aims to test whether IVT plus ET (CoT, combined therapy) provides additional benefits over direct ET for anterior circulation AIS by LVO. Methods we performed a single center retrospective observational study of patients with AIS caused by anterior circulation LVO, referred to our center between January 2014 and January 2017 and treated with ET. The patients were divided in 2 groups based on the treatment they received: CoT and, if IVT contraindicated, direct ET. We compared functional recovery (modified Rankin at 3-months follow-up), recanalization rate (thrombolysis in cerebral infarction [TICI] score) and time, early follow-up infarct volume (EFIV) (for recanalized patients only) as well as safety profile, defined as symptomatic intracerebral hemorrhage (sICH) and 3-month mortality, between groups. Results 145 subjects were included in the study, 70 in direct ET group and 75 in CoT group. Patients who received CoT presented more frequently a functional independence at 3-months follow-up compared to patients who received direct ET (mRS score 0-1: 48.5% vs 18.6%; P<0.001. mRS score 0-2: 67.1% vs 37.3%; P<0.001), higher first-pass success rate (62.7% vs 38.6%, P<0.05), higher recanalization rate (84.3% vs 65.3%; P=0.009) and, in recanalized subjects, smaller EFIV (16.4ml vs 62.3ml; P=0.003). The safety profile was similar for the 2 groups. In multivariable regression analysis, low baseline NIHSS score (P<0.05), vessel recanalization (P=0.05) and CoT (P=0.03) were indipendent predictors of 3-month favorable outcome. Conclusions CoT appears more effective than ET alone for anterior circulation AIS with LVO, with similar safety profile.

scholarly journals Brain Atrophy and the Risk of Futile Endovascular Reperfusion in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1514-1521 ◽  
Author(s):  
María I. Pedraza ◽  
Mercedes de Lera ◽  
Daniel Bos ◽  
Ana I. Calleja ◽  
Elisa Cortijo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Brain Atrophy ◽  
Regression Models ◽  
Infarct Volume ◽  
Cortical Atrophy ◽  
Anterior Circulation ◽  
Evans Index ◽  
The Impact

Background and Purpose— We aimed to evaluate the impact of brain atrophy on long-term clinical outcome in patients with acute ischemic stroke treated with endovascular therapy, and more specifically, to test whether there are interactions between the degree of atrophy and infarct volume, and between atrophy and age, in determining the risk of futile reperfusion. Methods— We studied consecutive patients with acute ischemic stroke with proximal anterior circulation intracranial arterial occlusions treated with endovascular therapy achieving successful arterial recanalization. Brain atrophy was evaluated on baseline computed tomography with the global cortical atrophy scale, and Evans index was calculated to assess subcortical atrophy. Infarct volume was assessed on control computed tomography at 24 hours using the formula for irregular volumes (A×B×C/2). Main outcome variable was futile recanalization, defined by functional dependence (modified Rankin Scale score >2) at 3 months. The predefined interactions of atrophy with age and infarct volume were studied in regression models. Results— From 361 consecutive patients with anterior circulation acute ischemic stroke treated with endovascular therapy, 295 met all inclusion criteria. Futile reperfusion was observed in 144 out of 295 (48.8%) patients. Cortical atrophy affecting parieto-occipital and temporal regions was associated with futile recanalization. Total global cortical atrophy score and Evans index were independently associated with futile recanalization in an adjusted logistic regression. Multivariable adjusted regression models disclosed significant interactions between global cortical atrophy score and infarct volume (odds ratio, 1.003 [95%CI, 1.002–1.004], P <0.001) and between global cortical atrophy score and age (odds ratio, 1.001 [95% CI, 1.001–1.002], P <0.001) in determining the risk of futile reperfusion. Conclusions— A higher degree of cortical and subcortical brain atrophy is associated with futile endovascular reperfusion in anterior circulation acute ischemic stroke. The impact of brain atrophy on insufficient clinical recovery after endovascular reperfusion appears to be independently amplified by age and by infarct volume.

Abstract WP40: “Good” Angiographic Collateral Circulation Correlates With Lower Dwi Infarct Volumes In Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Esteban Cheng-Ching ◽  
Dolora Wisco ◽  
Shumei Man ◽  
Ferdinand Hui ◽  
Gabor Toth ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Collateral Circulation ◽  
Infarct Volume ◽  
Artery Occlusion ◽  
Grading System ◽  
Large Artery ◽  
Anterior Circulation ◽  
Vessel Occlusion

Background and purpose Large artery occlusion leads to ischemic stroke which volume is influenced by time from symptom onset. This effect is modulated by several factors, including the presence and degree of collateral circulation. We analyze the correlation between a standard angiographic collateral grading system and DWI infarct volumes. Methods We reviewed a prospectively collected retrospective database of ischemic stroke patients admitted between august of 2006 and december of 2011. We included patients with anterior circulation acute ischemic stroke presenting within 8 hours from symptom onset with large vessel occlusion, who underwent pre-treatment MRI and endovascular therapy. DWI infarct volumes were measured by region of interest. ASITN collateral grading system was used and grouped into “good collaterals” for grades 3 and 4, and “poor collaterals” for grades 0, 1 and 2. JMP statistical software was utilized. Results 152 patients (71 (46.7%) male, mean age: 68±15 years;) were included in the initial analysis. We identified 49 patients who had angiographic collateral circulation grading. Seven patients had ASITN collateral grade 0 with mean infarct volume of 27.6 cc, 25 had collateral grade of 1 with mean infarct volume of 27.9 cc, 10 had collateral grade of 2 with mean infarct volume of 23.4 cc, 5 had collateral grade of 3 with mean infarct volume of 6.3 cc, and 2 had collateral grade of 4 with mean infarct volume of 14.6 cc. Forty two patients had “poor collaterals” with a mean infarct volume of 26.8 cc. Seven patients had “good collaterals” with mean infarct volume of 8.7 cc. When comparing the infarct volumes between these two groups, the difference was statistically significant (p=0.017). Conclusions In anterior circulation acute ischemic stroke, “good” angiographic collateral circulation defined as ASITN grading system of 3 or 4, correlates with lower infarct volumes on presentation.

Abstract W P17: Factors Associated With DWI Lesion Growth After Endovascular Therapy for Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Shumei Man ◽  
M. Shazam Hussain ◽  
Dolora Wisco ◽  
Esteban Cheng-ching ◽  
Toshiya Osanai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Cleveland Clinic ◽  
Antiplatelet Agents ◽  
Lesion Size ◽  
Anterior Circulation ◽  
Ischemic Lesion ◽  
Large Growth

Background: The factors impacting infarct evolution after intra-arterial(IA) intervention for acute ischemic stroke remain uncertain. We studied the infarct evolution on MRI DWI among acute stroke patients who underwent IA therapy. Methods: We reviewed the early ischemic stroke imaging database at Cleveland Clinic Cerebrovascular Center for those undergoing IA therapy in anterior circulation from 2009 to 2012. Patients with both pre-treatment and follow-up MRI were included. Infarct volume was measured on initial and follow-up DWI by region of interest demarcation. Patients were grouped into quartiles by infarct growth from initial to follow-up. Outcome were defined as modified Rankin Score 0-2 at 30 days. Results: Among the 76 patients, the median (range) infarct growth of four quartiles were 0.5 cc (-19.1-4.2), 13.8 cc (4.8-25.8), 38.8 cc (28.0-77.6), and 166.3 cc (78.0-314.5). Baseline characteristics of age, gender, race, diabetes, and hypertension were similar among groups except more smokers (p=0.017) and fewer patients on anticoagulation or antiplatelet agents in large-growth group (p=0.049). Compared to No-growth group (Quartile 1), large-growth group (Quartile 4) had more Hyperdense M1 MCA sign ( 26.3% vs 73.7%, p=0.004), larger initial ischemic lesion measured by CT ASPECT (p=0.002) and DWI volume (p=0.012), and absence of full collaterals on CTA ( 36.8% vs 0, p=0.004). There was a trend of lower recanalization rate in large-growth group (73.7% vs 47.4%, p=0.097). With the increment of infarct growth, there is a decrement in favorable outcomes (mRS 0-2) at 30 days: 42%, 37%, 26% and 10.5% (p=0.027). Conclusion: Infarct growth after IA therapy determines outcome. Initial ischemic lesion size, collaterals, and hyperdense vessel sign are associated with infarct growth.

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