Cerebral blood volume index as a predictor of functional independence after basilar artery thrombectomy

Ursino, M., C. A. Lodi, S. Rossi, and N. Stocchetti.Intracranial pressure dynamics in patients with acute brain damage. J. Appl. Physiol. 82(4): 1270–1282, 1997.—The time pattern of intracranial pressure (ICP) during pressure-volume index (PVI) tests was analyzed in 20 patients with severe acute brain damage by means of a simple mathematical model. In most cases, a satisfactory fitting between model response and patient data was achieved by adjusting only four parameters: the cerebrospinal fluid (CSF) outflow resistance, the intracranial elastance coefficient, and the gain and time constant of cerebral autoregulation. The correlation between the parameter estimates was also analyzed to elucidate the main mechanisms responsible for ICP changes in each patient. Starting from information on the estimated parameter values and their correlation, the patients were classified into two main classes: those with weak autoregulation (8 of 20 patients) and those with strong autoregulation (12 of 20 patients). In the first group of patients, ICP mainly reflects CSF circulation and passive cerebral blood volume changes. In the second group, ICP exhibits paradoxical responses attributable to active changes in cerebral blood volume. Moreover, in two patients of the second group, the time constant of autoregulation is significantly increased (>40 s). The correlation between the parameter estimates was significantly different in the two groups of patients, suggesting the existence of different mechanisms responsible for ICP changes. Moreover, analysis of the correlation between the parameter estimates might give information on the directions of parameter changes that have a greater impact on ICP.

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Abstract P557: Hypoperfusion Intensity Ratio and Cerebral Blood Volume Index as Predictors of Outcome for Recanalized Middle Cerebral Artery Occlusions

Stroke ◽

10.1161/str.52.suppl_1.p557 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Jonathan M Parish ◽

Dale Strong ◽

Tanushree Prasad ◽

Jeremy B Rhoten ◽

Jonathan D Clemente ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Computerized Tomography ◽

Blood Volume ◽

Cerebral Artery ◽

Intensity Ratio ◽

Cerebral Blood Volume ◽

Favorable Outcome ◽

Volume Index ◽

Collateral Flow ◽

Mca Occlusion

Introduction: Preliminary data suggest the Hypoperfusion Intensity Ratio (HIR) and the Cerebral Blood Volume Index (CBVI) derived from Computerized Tomography Perfusion (CTP) imaging predict the rate of collateral flow, speed of infarct growth, and clinical outcome. We hypothesized that functional outcomes at hospital discharge would be significantly better for middle cerebral artery (MCA) occlusion patients achieving Thrombolysis in Cerebral Infarction (TICI) 2b or greater recanalization with presenting hospital CTPs consistent with “good” (HIR <0.5 and CBVI >0.7) versus “poor” (HIR ≥0.5 and CBVI ≤0.7) indices. Methods: We conducted a retrospective cohort study. A neuroradiologist confirmed the MCA occlusion based on the initial Computerized Tomography Angiogram (CTA). All TICI scores were confirmed by neurointerventionalists blinded to patient outcomes. We defined independent outcome as mRS ≤2, and favorable outcome as an mRS ≤3. We additionally stratified patients as initially presenting to thrombectomy versus non-thrombectomy centers. Results: We identified a total of 162 patients over a 3 ½ year period with an MCA occlusion achieving TICI 2b recanalization or greater, of whom 67 had good indices and 48 had poor indices. For patients with good compared to poor indices, there was a trend for achieving independent outcome (55% vs 37%, p=0.061) that reached significance for favorable outcome (69% vs 50%, p=0.043). Limiting the analysis to only patients presenting to non-thrombectomy centers (n=67), these findings were consistent, with a trend for achieving independent outcome for good versus poor collaterals (48% vs 30% p=0.173), which was again significant for a favorable outcome (66% vs 39%, p=0.036). Across all patients, HIR <0.5 (n=86) or CBVI >0.7 (n=95) were not independently associated with independent outcomes, but for patients presenting to non-thrombectomy centers, an HIR <0.5 alone (n=51) was significantly associated with favorable outcome. Conclusion: For MCA occlusion patients achieving TICI 2b recanalization, the combination of good HIR and CBVI is significantly associated with a favorable functional outcome. For patients presenting to non-thrombectomy centers, HIR alone may be sufficient to predict favorable outcome.

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Abstract T P371: Utility of Cerebral Oximetry with Cerebral Blood Volume Index (CBVI) in Detecting Pediatric Strokes

Stroke ◽

10.1161/str.46.suppl_1.tp371 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Thomas J Abramo ◽

Lori Jordan ◽

Zeah Harris ◽

Mark Meredith ◽

...

Keyword(s):

Blood Volume ◽

Cerebral Blood Volume ◽

Screening Tool ◽

Altered Mental Status ◽

Contralateral Side ◽

Cerebral Oximetry ◽

Volume Index ◽

Pediatric Stroke ◽

Cerebral Pathology ◽

Stroke Knowledge

Pediatric Strokes are increasing with recognition and imaging delays. Limited pediatric stroke knowledge, vague signs & symptoms and no reliable stroke detection tools is the cause. Improving recognition improves outcomes. Objective: To assess utility of Left & Right Cerebral rcSO2 and cerebral blood volume index (CBVI) in Pediatric Stroke Alert and Altered Mental Status (AMS) patients. Methods: Observational study of Stroke Alert & AMS patient’s Cerebral rcSO2 and CBVI. Stroke rcSO2 and CBVI values in stroke patients were compared to controls & AMS (no cerebral pathology) patients. Results: Controls (N=133), Stroke alert (N=25) & AMS stroke (N=52)'s rcSO2, CBVI means were consistent 0-60 minutes. Lower rcSO2 with or without CBVI readings correlated with stroke (Left rcSO2, CBVI (P<0.0001), Right rcSO2 (P=0.0038), CBVI (p=0.0006)). A 19.1% rcSO2 side difference had 100% PPV for stroke. Across 0-60 minutes, rcSO2, CBVI were consistent for stroke & type (Hemorrhagic or Ischemic) (P<0.0001). Left Stroke’s rcSO2, CBVI were lower than Right Strokes (P<0.0001). Hemorrhagic ipsilateral stroke and contralateral side had lower rcSO2, CBVI (P<0.001) then Ischemic. Conclusion: The rcSO2, CBVI difference between sidess objectively and consistently detected stroke, location, and stroke types (Hemorrhagic or Ischemic). A 19.1% rcSO2 differencehad had 100% PPV for detecting strokes demonstrating cerebral oximetry’s utility. Cerebral Oximetry with CBVI has shown its’ potential as an objective screening tool for identify pediatric strokes and types. Cerebral Oximetry with CBVI has potential for expediting stroke recognition and decreasing imaging time.

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Cerebral blood volume lesion extent predicts functional outcome in patients with vertebral and basilar artery occlusion

International Journal of Stroke ◽

10.1177/1747493017744465 ◽

2017 ◽

Vol 14 (5) ◽

pp. 540-547 ◽

Cited By ~ 4

Author(s):

Fana Alemseged ◽

Darshan G Shah ◽

Andrew Bivard ◽

Timothy J Kleinig ◽

Nawaf Yassi ◽

...

Keyword(s):

Blood Volume ◽

Basilar Artery ◽

Cerebral Blood Volume ◽

Ct Perfusion ◽

Mean Transit Time ◽

Intraclass Correlation ◽

Artery Occlusion ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Area Under Roc Curve

Background CT perfusion may improve diagnostic accuracy in posterior circulation stroke. The posterior circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS) on Computed Tomography Angiography source images (CTA-SI) predicts functional outcome in patients with basilar artery occlusion. Aims We assessed the prognostic value of pc-ASPECTS on CT perfusion in patients with vertebral and basilar artery occlusion (VBAO) in comparison with CTA-SI. Methods Whole-brain CT perfusion from consecutive stroke patients with VBAO at four stroke centers was retrospectively analyzed. pc-ASPECTS – a 10-point score assessing hypoattenuation on CTA-SI – was calculated from CT perfusion parameters as focally reduced cerebral blood flow or cerebral blood volume, focally increased time to peak of the deconvolved tissue residue function (Tmax) or mean transit time. Two investigators independently reviewed the images. Reliability was assessed with intraclass correlation coefficient. Good outcome was defined as modified Rankin scale ≤3 at three months. Results We included 60 patients with VBAO. After assessment of four CT perfusion maps simultaneously, area-under-ROC curve (AROC) was 0.83 (95%CI 0.72–0.93) for cerebral blood volume, 0.76 (95%CI 0.64–0.89) for cerebral blood flow, 0.77 (95%CI 0.64–0.89) for Tmax, 0.70 (95%CI 0.56–0.84) for mean transit time versus area-under-ROC curve 0.64 (95%CI 0.50–0.79) for CTA-SI. Cerebral blood volume had greater accuracy compared with CTA-SI for poor outcome (p = 0.04). In logistic regression analysis, cerebral blood volume pc-ASPECTS≤8 was independently associated with poor outcome (OR 9.3 95%CI 2.2–41; p = 0.003, adjusted for age and clinical severity). Inter-rater agreement was substantial for cerebral blood volume pc-ASPECTS (intraclass correlation coefficient 0.82 95%CI 0.71–0.90 versus 0.67 for CTA-SI 95%CI 0.43–0.81). Conclusions Cerebral blood volume pc-ASPECTS may identify VBAO patients at higher risk of disability.

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