scholarly journals Perfusion and plaque evaluation to predict recurrent stroke in symptomatic middle cerebral artery stenosis

2019 ◽  
Vol 4 (3) ◽  
pp. 129-134 ◽  
Author(s):  
Jinhao Lyu ◽  
Ning Ma ◽  
Chenglin Tian ◽  
Feng Xu ◽  
Hang Shao ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Recurrent Stroke ◽  
Multivariable Analysis ◽  
Volume Ratio ◽  
Plaque Burden ◽  
Atherosclerotic Stenosis ◽  
Imaging Characteristics ◽  
Significant Difference ◽  
Lumen Narrowing

Background and purposeWe investigated the baseline demographics of patients with severe unilateral atherosclerotic stenosis of the middle cerebral artery (MCA) using multimodal MRI and evaluated the haemodynamic impairments and plaque characteristics of patients who had a recurrent stroke.Materials and methodsWe retrospectively recruited consecutive patients with severe unilateral atherosclerotic MCA stenosis who underwent arterial spin labelling (ASL) with postlabelling delay (PLD) of 1.5 and 2.5 s, and vessel wall MRI. For each PLD, cerebral blood flow (CBF) maps were generated. Hypoperfusion volume ratio (HVR) from 2 PLD CBF was calculated. An HVR value ≥50% was considered as severe HVR. Plaque areas, plaque burden, plaque length and remodelling index were measured. Plaque enhancement at maximal lumen narrowing site were graded. Baseline clinical and imaging characteristics were compared between patients with (event+) and without (event−) 1 year ischaemic events.ResultsForty-three patients (47.23±12.15 years; 28 men) were enrolled in this study. Seven patients had an HVR ≥50%. During the 1-year follow-up, 7 patients had experienced a recurrent stroke. HVR were significantly higher in the event+ than event− (53.17%±29.82% vs 16.9%±15.57%, p=0.0002), whereas no significant difference was detected in plaque areas, plaque burden, remodelling index, plaque length and plaque enhancement grade. The multivariable analysis revealed that a severe HVR was significantly associated with a recurrent stroke (Odds ratio=12.93, 95% confidence interval 1.57 to 106.24, p=0.017) after adjusted by hypertension and smoking.ConclusionHVR obtained from two PLD ASL may be a useful imaging predictor of recurrent stroke.

Abstract WP136: Perfusion and Plaque Evaluation in Symptomatic Middle Cerebral Arterial Athrosclerotic Stenosis: Characterization With Multimodel MRI

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jinhao Lyu ◽  
Ning Ma ◽  
Xiaoxiao Ma ◽  
Lin Ma ◽  
Zhongrong Miao ◽  
...  
Keyword(s):  
Recurrent Events ◽  
Recurrent Stroke ◽  
Multivariable Analysis ◽  
Volume Ratio ◽  
Conventional Angiography ◽  
Post Contrast ◽  
Logistic Analysis ◽  
Lumen Narrowing ◽  
Intracranial Artery Stenosis

Objevtive: We investigated the baseline demographics of patients with severe unilateral middle cerebral artery(MCA) athrosclerotic stenosis using multimodel MRI and tired to find out the hemodynamic and plaque features of patients who had recurrent stroke. Methods: This retrospective study had recruited consecutive patients with severe unilateral MCA athrosclerotic stenosis at 2 centers. All patients were performed arterial spin labeling(ASL) with post labeling delay(PLD) of 1.5s and 2.5s, MR angiography and high-resolution MRI. Hypoerfusion volume ratio (HVR) was calculated as [hypoperfusion volume at 2.5s / hypoperfusion volume at 1.5s X 100%]. Plaques enhancement at maximal lumen narrowing were graded from 0(none enhancement) to 3(signal intensity as high as post-contrast pituitary). In patients who had conducted conventional angiography, Spearman correlation was analyzed between collateral grades and HVR. Baseline characteristics were compared between patients with 1 year follow up ischemic events(event+) and without(event-), then multivariable logistic analysis was performed. Results: Thirty-seven patients (47.1±11.8 years; 25 men) were included in this study. HVR was with a mean of 24.9±23.6% and ranged from 0% to 93%. In 17 patients (50.47±7.23 years; 12 men) who had underwent conventional angiography, HVR was significantly correlated with collateral grading (r=-0.40, p=0.0493). In 1 year follow up, 7 patients had recurrent events in the same territory. NIHSS, HVR was significantly higher in Event+ group(p<0.05) and no significantly difference was detected in plaque enhancement grade as well as age, risk factors, qualifying event and time from symptom onset to imaging. In multivariable analysis, HVR >50% was significantly associated with recurrent stroke(OR=13.714, 95% confidence interval: 1.061-177.320, p=0.045) after adjusted by NIHSS and plaque enhancement grade. Conclusion: Multimodel MRI may be a promising approach to explore the mechanism of ischemic stroke in patients with intracranial artery stenosis. HVR obtained from 2 PLD ASL is associated with collateral circulation and may be predictable for recurrent stroke.This work was supported by the National Natural Science Foundation of China (Grant number: 81471390).

scholarly journals Doppler Flow Velocity Indices (RI, PI, S/D & PSV) of Fetal Middle Cerebral Artery in Normal Pregnancies: Correlation with Gestational Age of 20 to 40 Weeks

2012 ◽  
Vol 2 (2) ◽  
pp. 77-80
Author(s):  
Md Abu Taher ◽  
Nuzhat Tasmin ◽  
AS Mohiuddin ◽  
Md Mohit Ul Alam ◽  
Md Mofazzal Sharif ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Cerebral Artery ◽  
Gestational Age ◽  
Resistance Index ◽  
Peak Systolic Velocity ◽  
Doppler Flow ◽  
Significant Difference ◽  
Before And After ◽  
Doppler Indices

This observational type of descriptive study was carried out in the Department of Radiology and Imaging, BIRDEM selecting 70 Bangladeshi pregnant babies with the aim to find out the normogram of foetal middle cerebral artery Doppler flow velocity indices and correlation between Doppler flow velocity indices [Resistance Index (RI), Pulsatility Index (PI), Systolic/Diastolic ratio (S/D) & Peak Systolic Velocity (PSV)] of foetal middle cerebral artery and gestational age in normal pregnancies of 20 to 40 weeks. It was observed that RI, PI and S/D were decreased with the advance of gestational age but PSV was increases with the advance of gestational age. Statistical analyses showed there were significant difference between mean PSV, RI and PI before and after 25 weeks of gestation. No significant difference was found between mean S/D before and after 25 weeks of gestation. It was observed from Correlation analysis between Doppler indices with independent gestational age that all the Doppler indices of foetal middle cerebra artery was positively correlated with the whole gestation period. The statistical analysis showed only PSV and RI were significantly correlated with the gestational age. Simple regression analysis between dependent Doppler index with independent gestational age before and after 25 weeks revealed that all the Doppler indices had positive relationship with the corresponding gestational age but relationship between PSV and PI (before 25 weeks) with their corresponding gestational ages were only statistically significant.DOI: http://dx.doi.org/10.3329/birdem.v2i2.12306 Birdem Med J 2012; 2(2) 77-80

Abstract WP1: Thrombectomy Outcomes in Acute Ischemic Stroke due to Middle Cerebral Artery M2 Occlusion with Stent-Retriever, Aspiration, MERCI: Multi-Center Experience

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kunakorn Atchaneeyasakul ◽  
Amer M Malik ◽  
Dileep R Yavagal ◽  
Mehdi Bouslama ◽  
Diogo C Haussen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Tertiary Care ◽  
Stent Retriever ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference

Introduction: Recent trials demonstrated that mechanical thrombectomy improve functional outcome in anterior circulation acute ischemic stroke (AIS) due to emergent large vessel occlusion (ELVO) of the middle cerebral artery (MCA) M1 segment. However, such data regarding AIS due to MCA M2 segment ELVO is limited. Analysis of the STAR, SWIFT, and SWIFT-PRIME trials found thrombectomy in MCA M2 occlusion to be feasible in achieving successful reperfusion. The most optimal technique and/or device used for such reperfusion is not clearly defined. We aim to compare the outcome for the contemporary techniques and devices used for thrombectomy of AIS patients due to MCA M2 ELVO. Methods: A retrospective review of AIS patients with MCA M2 ELVO receiving thrombectomy from three tertiary care academic medical centers was conducted. Thrombectomy technique and thrombectomy device utilized were recorded. Outcomes were successful angiographic reperfusion (TICI ≥2b), favorable modified Rankin Scale (mRS≤2) at discharge and at 90 days, and rate of symptomatic intracerebral hemorrhage (sICH). Results: From October 1999 through June 2016, 253 AIS patients underwent thrombectomy for MCA M2 ELVO. Thrombectomy methods utilized were Stent-retriever (n=118), Aspiration only [manual or Penumbra device] (n=83), and MERCI retriever (n=52). Table 1 shows rate of outcomes measured. There was no difference in baseline NIHSS or in stroke onset to groin puncture time. Stent-retriever group showed a significantly higher recanalization rate, lower sICH rate, and favorable 90-day mRS versus Aspiration group or MERCI group, respectively. No significant difference was seen in discharge mRS between the groups. Conclusions: Thrombectomy for AIS patients with MCA M2 ELVO with Stent-retriever appears to be feasible with a significantly higher rate of recanalization, lower sICH rate, and favorable 90-day mRS when compared to Aspiration and MERCI.

WM1-4 Decompressive craniectomy versus strokectomy for malignant middle cerebral artery (MCA) infarction

2019 ◽  
Vol 90 (3) ◽  
pp. e1.2-e1
Author(s):  
S Moughal ◽  
D Boeris ◽  
A Hainsworth ◽  
E Pereira ◽  
A Shtaya ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Decompressive Craniectomy ◽  
Modified Rankin Scale ◽  
Poor Outcome ◽  
Post Surgery ◽  
Significant Difference ◽  
Malignant Mca Infarction ◽  
Group Post

ObjectivesTo compare the outcomes of decompressive craniectomy (DC) with craniotomy and debulikng of stroke tissue (Strokectomy (SC)) for malignant MCA infarction at our centre.DesignRetrospective records review.SubjectsAll Patients with malignant MCA infraction that underwent DC and SC between Jan 2012 and Sep 2017.Methods20 patients had DC (11F/9M, mean age 44.7±1.8 y) and four patients had SC (1F/3M) 51.5±5.9 7 y). Outcomes were assessed by Modified Rankin Scale (mRS) scores before surgery and at latest follow up (3–6 months). mRS was dichotomised as good (0–3) and poor (4–6). Craniotomy size was measured by antero-posterior (AP) diameter and compared between the groups.Results18 patients (90%) of the DC group had mRS 4–6 before surgery versus 100% in the SC group. Post-surgery 15 patients (75%) of the DC group had poor outcome with 7 mortalities (35%) in comparison to one patient (25%) with poor outcome in the SC group and no mortalities. The average craniotomy size in DC was 120.1±4.1 mm versus 85.5±13.1 mm in the SC, p=0.003 students t test). Six patients of the DC group underwent cranioplasty where two developed post-operative seizures. There was no significant difference in age, sex and side of craniotomy (7 Left/13 Right in DC vs 2 Left/2 Right in SC).ConclusionsStrokectomy is comparable to decompressive craniectomy in outcomes without taking the extra risks and costs of cranioplasty. Further studies are required to promote this approach.

Sign in / Sign up

Export Citation Format

Share Document