Patient Selection and Clinical Efficacy of Urgent Superficial Temporal Artery-Middle Cerebral Artery Bypass in Acute Ischemic Stroke Using Advanced Magnetic Resonance Imaging Techniques

Abstract BACKGROUND: Selected patients with acute ischemic stroke might benefit from superficial temporal artery-middle cerebral artery (STA-MCA) bypass, but the indications for urgent STA-MCA bypass are unknown. OBJECTIVE: To report our experiences of urgent STA-MCA bypass in patients requiring urgent reperfusion who were ineligible for other reperfusion therapies, using advanced magnetic resonance imaging (MRI) techniques. METHODS: The inclusion criteria for urgent STA-MCA bypass were as follows: acute infarct volume <70 mL with a ratio of perfusion/diffusion lesion volume ≥1.2, and a regional cerebral blood volume ratio >0.85. From January 2013 to October 2015, 21 urgent STA-MCA bypass surgeries were performed. The control group included 19 patients who did not undergo bypass surgery mainly due to refusal of surgery or the decision of the neurologist. Clinical and radiological data were compared between the surgery and control group. RESULTS: The median age of the control group (70 years, interquartile range [IQR] 58-76) was higher than that of the surgery group (62 years, IQR 49-66), but the median preoperative diffusion and perfusion lesion volumes of the surgery group (13.8 mL, IQR 7.5-26.0 and 120.9 mL, IQR 84.9-176.0, respectively) were higher than those of the control group (5.6 mL, IQR 2.1-9.1 and 69.7 mL, IQR 23.9-125.3, respectively). Sixteen (76.2%) patients in the surgery group and 2 (10.5%) patients in the control group had favorable outcomes (P < .001). Logistic regression analysis identified bypass surgery as the strongest predictive factor. CONCLUSION: STA-MCA bypass can be used as a therapeutic tool for acute ischemic stroke. Advanced MRI techniques are helpful for selecting patients and for decision making.

Download Full-text

Patients With Acute Ischemic Stroke Who Receive Brain Magnetic Resonance Imaging Demonstrate Favorable In‐Hospital Outcomes

Journal of the American Heart Association ◽

10.1161/jaha.120.016987 ◽

2020 ◽

Vol 9 (20) ◽

Author(s):

Hwan Lee ◽

Yifeng Yang ◽

Baoqiong Liu ◽

Simon A. Castro ◽

Tiantian Shi

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Hospital Stay ◽

Acute Ischemic Stroke ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Control Group ◽

Inpatient Mortality ◽

Resonance Imaging

Background Use of inpatient brain magnetic resonance imaging (MRI) in patients with acute ischemic stroke is highly institution dependent and has been associated with increased length and cost of hospital stay. We examined whether inpatient brain MRI in patients with acute ischemic stroke is associated with improved clinical outcomes to justify its resource requirements. Methods and Results The National Inpatient Sample database was queried retrospectively to find 94 003 patients who were admitted for acute ischemic stroke and then received inpatient brain MRI between 2012 and 2014. Multivariable regression analysis was performed with respect to a control group to assess for differences in the rates of inpatient mortality and complications, as well as the length and cost of hospital stay based on brain MRI use. Inpatient brain MRI was independently associated with lower rates of inpatient mortality (1.67% versus 3.09%; adjusted odds ratio [OR], 0.60; 95% CI, 0.53–0.68; P <0.001), gastrostomy (2.28% versus 2.89%; adjusted OR, 0.82; 95% CI, 0.73–0.93; P <0.001), and mechanical ventilation (1.97% versus 2.82%; adjusted OR, 0.68; 95% CI, 0.60–0.77; P <0.001). Brain MRI was independently associated with ≈0.32 days (8%) and $1131 (11%) increase in the total length ( P <0.001) and cost ( P <0.001) of hospital stay, respectively. Conclusions Inpatient brain MRI in patients with acute ischemic stroke is associated with substantial decrease in the rates of inpatient mortality and complications, at the expense of marginally increased length and cost of hospitalization.

Download Full-text

Diagnosis of Acute Ischemic Stroke Based on Time-To-Peak and Diffusion-Weighted Magnetic Resonance Imaging.

Neurologia medico-chirurgica ◽

10.2176/nmc.42.281 ◽

2002 ◽

Vol 42 (7) ◽

pp. 281-288

Author(s):

Keisuke MARUYAMA ◽

Tsuneyoshi EGUCHI ◽

Shigeo SORA ◽

Masafumi IZUMI ◽

Hirofumi HIYAMA ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Acute Ischemic Stroke ◽

Resonance Imaging ◽

Time To Peak ◽

Diffusion Weighted ◽

Weighted Magnetic Resonance Imaging ◽

And Diffusion

Download Full-text

Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Stroke ◽

10.1161/strokeaha.116.016227 ◽

2017 ◽

Vol 48 (5) ◽

pp. 1241-1247 ◽

Cited By ~ 13

Author(s):

Karl Georg Haeusler ◽

Christian Wollboldt ◽

Laura zu Bentheim ◽

Juliane Herm ◽

Sebastian Jäger ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cardiovascular Magnetic Resonance ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Acute Ischemic Stroke ◽

Cardiovascular Magnetic Resonance Imaging ◽

Diagnostic Value ◽

Resonance Imaging

Download Full-text

Abstract TP400: The Differences of Vessel Wall Features Between the Anterior and Posterior Brain Arteries Detected by High Resolution Magnetic Resonance Imaging in Patients With Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp400 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Xiangyan Chen ◽

Lu Zheng ◽

Jia LI ◽

Wenjie Yang

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

High Resolution ◽

Acute Ischemic Stroke ◽

Vessel Wall ◽

Posterior Circulation ◽

Intraplaque Hemorrhage ◽

Resonance Imaging ◽

Anterior Circulation

Backgrounds: The purpose of this study was to investigate vessel wall features visualization by high resolution magnetic resonance imaging (HRMRI) in a series of ischemic stroke patients and to identify differences between lesions in the anterior and posterior circulation. Methods: We consecutively recruited Chinese patients with acute ischemic stroke or transient ischemic attack from 2016 to 2018. All patients were scanned at 3T magnetic resonance imaging. We evaluated pre-and post-contrast cross-sectional views of M1 and M2 segments of middle cerebral arteries (MCAs), basilar arteries (BA) and V4 segments of vertebral arteries (VAs). Results: A total of 74 patients (males 52.3%; median age 62 years old) were included in this study, among which, 234 lesions were identified on HRMRI, including 117 MCA lesions, 26 BA lesions, and 91 VA lesions. The sensitivity and specificity of MRA for diagnosing stenosis in anterior circulation were 89.3% (95% CI, 81.8%- 94.2%) and 50.0 (95% CI, 9.2%- 90.8%). The sensitivity and specificity of MRA for diagnosing stenosis in posterior circulation were 73.2% (95% CI, 63.9%- 80.9%) and 40.0 (95% CI, 7.3%- 83.0%). VA had a significantly higher contrast enhancement index (43.71± 7.74, p <0.016) than MCA (23.32± 2.46) or BA (22.69± 5.31) . Anterior circulation plaques had higher degree of stenosis (anterior versus posterior: 68.5% vs. 62.9%, p =0.036), more eccentric distribution (anterior versus posterior: 70.1% versus 53.8%, p =0.015) and higher rate of intraplaque hemorrhage (anterior versus posterior: 17.1% versus 7.7%, p =0.046). The plaques in posterior circulation had a thicker lesion wall (posterior versus anterior 16.58± 8.25 mm 2 vs. 9.10± 4.07 mm 2 , p <0.001) and higher enhancement index (posterior versus anterior 39.04± 8.50 vs. 23.32± 2.46, p <0.001) than the plaques in anterior circulation. Conclusions: The lesions in posterior circulations could be obscure on MRA. The area stenosis, intraplaque hemorrhage and enhancement index differed between circulations.

Download Full-text

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

Stroke ◽

10.1161/strokeaha.119.028550 ◽

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.

Download Full-text