Abstract TP53: Simple And Easy Way Using Time-Intensity Curve of Perfusion-Weighted Images to Find Penumbra In Stroke Patients Within 4.5 Hours Of Onset Due To The Carotid Artery Occlusion

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Takahisa Mori ◽  
Tomonori Iwata ◽  
Yuichi Miyazaki ◽  
Masahito Nakazaki ◽  
Yoichiro Takahashi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Hospital Death ◽  
Emergency Setting ◽  
Intensity Curve ◽  
Stroke Patients ◽  
Time Intensity Curve

[Purpose] It is not clear how to find penumbra from MR-PWI for reperfusion therapy (RT). The aim of our retrospective study was to investigate whether or not a simple way using time-intensity curve (TIC) of PWI can find penumbra in stroke patients admitted within 4.5 hours from sudden onset due to acute carotid artery occlusion. [Subjects and Methods] Included for analysis were stroke patients 1) who were admitted within 4.5 hours of onset between Jan 2006 and January 2011, 2) who presented NIHSS score of 6 or more on admission, and 3) who underwent emergency MR imaging , which suggested the affected carotid artery occlusion. We assessed, NIHSS on admission (NIH adm), DWI-ASPECT score, TIC types, successful recanalization (SR), NIHSS on the 7th day (NIH 7 th ), and in-hospital death. Early neurological improvement (ENI) was defined as NIH adm - NIH 7 th >0. TICs were generated on region of interests set at symmetrical positions of the bilateral MCA territories. According to the time to peak (TP) and the peak signal (PS) comparing the affected side (a) with the contralateral side (c), we classified TIC pattern into four types and defined type 1 as TPa>TPc and PSa<PSc/2, type2 as TPa>TPc and PSc/2≦PSa<PSc, type 3 as TPa >TPc and PSa≧PSc, and type 4 as TPa=TPc. Relationship between TIC types, in-hospital death and ENI were assessed. [Result] Eighty-seven patients were analyzed. There were 36, 39, 12 and 0 patients in TIC type 1, 2, 3 and 4, 39 patients (44.8%: 39/87) underwent RT and SR was achieved in 18 patients (46.2%), and 29 patients died. Among variables, TIC type 1 was the only determinant of in-hospital death (p<0.01) and SR coupled with TIC type 2 was the determinant of ENI (p<0.01). [Conclusion] TIC type 1 predetermines poor clinical outcome and type 2 means penumbra, where SR may early improve neurological symptoms. TIC is an easy way to find penumbra in an emergency setting.

Abstract WP65: Relationship Between Neurological Severity and CBF Grade of Mr Perfusion in Acute Stroke Patients With the Carotid Artery Occlusion

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Yuji Takahashi ◽  
Kazuhiro Yoshioka ◽  
Shigen Kasakura ◽  
Yuhei Tanno ◽  
Tomonori Iwata ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Contralateral Side ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Mr Perfusion ◽  
Stroke Patients ◽  
Statistical Significant Difference ◽  
Time To Peak ◽  
Significant Difference ◽  
Grade Groups

Introduction: It remains unclear how strongly perfusion findings are related to neurological severity (NS) and MR-DW images (DWI). Hypothesis: CBF grade based on MR perfusion (MRp) is related to NS or DWI and can identify candidates for endovascular therapy (ET). Methods: Included in our retrospective analysis were acute ischemic stroke patients 1) who were admitted to our stroke center within 24 hours of the onset between Jan 2004 and May 2015, 2) who presented NIHSS as NS of 0 or more, 3) who underwent MRA, displaying complete occlusion of the affected carotid artery. We evaluated patients’ baseline features, NIHSS, DWI-ASPECTS (ACT) at arrival and CBF grade, which was calculated by using bilateral time-intensity curves (TICs) of MR perfusion. According to the time to peak (TP) and the peak signal (PS) comparing the affected side (a) with the contralateral side (c), we regarded the affected-sided PSa divided by TPa as possible CBFa and the contralateral-sided PSc divided by TPc as possible CBFc. CBF grade 1 was defined as CBFa divided by CBFc (CBF%) less than 0.2, grade 2 as CBF% of 0.2 or more and CBF% less than 0.7 and grade 3 as CBF% of 0.7 or more. Results: During the study period, 176 patients matched our criteria for analysis. Median NIHSS was 18, and median ACT was 6. There were 30 patients with CBF grade1, 81 with grade2 and 65 with grade3. Median NIHSS in grade1, 2, and 3 patients was 23, 19, and 7 (p<0.0001), respectively, and there was a statistical significant difference between any grade groups (p<0.016). Median ACT in grade1, 2, and 3 was 1, 5, and 8 (p<0.0001), respectively, and there was a statistical significant difference between any grade groups (p<0.016). Among 32 patients with NIHSS of 7 or less and ACT of 8 or more, there were 28 (87.5%) in grade3. Among 10 patients with NIHSS of 23 or more and ACT of 1 or less, there were 9 (90%) in grade1. Among 40 patients with NIHSS of 8 or more and ACT of 8 or more, there was 22 (55%) in grade2 and 18 (45%) in grade3. Conclusion: CBF grade defined by MRp had strong relation to NIHSS and ACT. Patients with lower NIHSS score but higher ACT score were probable candidates for ET and many among them belonged to CBF grade2.

Abstract WP436: Reduced Blood Flow in the Pial Collaterals and Penetrating Arterioles During Chronic Hypoperfusion in Type 2 Diabetic Mice

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Yasuo Nishijima ◽  
Yosuke Akamatsu ◽  
Atsushi Kanoke ◽  
Shih Y Yang ◽  
Teiji Tominaga ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Circle Of Willis ◽  
Cerebral Hypoperfusion ◽  
Additional Risk Factor ◽  
Collateral Flow

Introduction: The degree of cortical hypoperfusion following carotid steno-occlusion depends on the dynamic compensation from the collateral circulation. The presence of collaterals is associated with a reduced risk of stroke and transient ischemic attack (TIA) in patients with steno-occlusive carotid artery disease. Although metabolic syndrome negatively impacts collateral status among patients with ischemic stroke, it is unclear whether type 2 diabetes (T2DM) specifically affects leptomeningeal collateral flow regulation and the adaptation of collateral vessels at the circle of Willis during hypoperfusion. Methods: Spatial and temporal changes of the leptomeningeal collateral flow and the flow dynamics of the penetrating arterioles in the distal MCA and ACA branches over two weeks following unilateral common carotid artery occlusion (CCAO) were determined by optical coherent tomography in db/+ and db/db mice, a mouse model for obesity and type 2 diabetes. The temporal adaptation of the circle of Willis (CW) following CCAO was assessed by measuring CW vessel diameters. Results: Following unilateral CCAO, db/db mice exhibited diminished leptomeningeal collateral flow compensation compared to db /+ mice, which coincided with a reduced dilation of distal ACA branches, leading to reduced flow not only in pial vessels, but also in penetrating arterioles bordering the distal MCA and ACA. However, no apparent cell death was detected in either strain of mice during the first week after CCAO. db/db mice also experienced a more severe early reduction in the vessel diameters of several ipsilateral main feeding arteries in the CW, in addition to a delayed post-CCAO adaptive response by one to two weeks compared to db/+ mice. Conclusions: T2DM is an additional risk factor for hemodynamic compromise during cerebral hypoperfusion, which may increase the severity and the risk of stroke or TIA.

Abstract 2632: The Relationship Between MRI/PWI-Time Intensity Curve And 3-month Clinical Outcome Of The Acute Ischemic Patients Who Underwent Endovascular Reperfusion Therapy For IC Or MCA Occlusion.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
MASAHITO NAKAZAKI ◽  
Takahisa Mori ◽  
Hiroyuki Tajiri ◽  
Tomonori Iwata ◽  
Yuichi Miayazaki
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Reperfusion Therapy ◽  
Intensity Curve ◽  
Stroke Patients ◽  
Time Intensity Curve ◽  
Favorable Clinical Outcome ◽  
The Relationship

The purpose of our study was to investigate the relationship between MRI/PWI-Time Intensity curve (TIC) and 3-month clinical outcome following endovascular reperfusion therapy in acute ischemic stroke patients with occlusion of the internal carotid artery (ICA) or the middle cerebral artery (MCA). We retrospectively analyzed the acute stroke patients 1) who were admitted to our institution from 2004 to 2010, 2) with serious neurological symptoms, 3) who had total occlusion of the ICA or MCA displayed by MRA with DWI -PWI mismatch and 5) who underwent emergency endovascular reperfusion therapy within 8 hours from stroke onset. We investigated patient's baseline characteristics, emergency MRI findings , successful recanalization defined as TICI 2B or 3,and 3-month modified Rankin scale(3M-mRS). We evaluated PWI findings using TIC types. Region of interests were set at symmetrical positions of the bilateral MCA territories and time-intensity-curves (TICs) were calculated. The types of TICs were classified into four patterns according to the timeto peak (TP) and the reduction value of the peak signal (PV). Comparing the affected side with the contralateral side, we defined type 1 as TPa>TPc and PVaTPc and PVc/2≤PVa<PVc, type 3 as TPa >TPc and PVa≥PVc, and type 4 as TPa=TPc. We analyzed the relationship between the PWI/TIC and mRS at 3 months (3M-mRS) statistically. We defined favorable clinical outcome as 3M-mRS of 0-2, and assessed pre-treatment predictors for favorable clinical outcome and death within 3months by using logistic regression analysis. Seventy one patients were analyzed. Their median age was 75 years, median admission NIHSS was 17, median DWI-ASPECT score was 7, sixty three patients had cadiogenic stroke, successful recanalization was achieved in 38 patients (54.0%), and median 3M-mRS was 3. Twenty three patients (32%) had 3M-mRS of 0-2 and 11 patients (37%) died within 3 months. PWI-TICs of type 1,2,3 and 4 were in 13, 37, 21 and 0 patients, respectively. Type of PWI-TIC was significantly correlated to 3M-mRS (r=-0.24,P=0.047). The higher PWI/TIC type were, the lower 3M-mRS were. Logistic regression analysis demonstrated that independent predictors of favorable clinical outcome (3M-mRS of 0-2) were DWI ASPECTS and age, whereas, independent predictors of death within 3months from onset were type 1 of PWI-TIC (OR,5.71;95%CI,1.28-25.4, P=0.022) and admission NIHSS. Conclusion; In ischemic stroke patients who underwent endovascular reperfusion therapy for the ICA or MCA occlusion within 8hours from onset, type of PWI-TIC was the significant predictor for death within 3months from onset.

scholarly journals Thrombectomy for acute ischemic stroke patients with isolated distal internal carotid artery occlusion: a retrospective observational study

2020 ◽  
Author(s):  
Jan W. Hoving ◽  
◽  
Manon Kappelhof ◽  
Mark Schembri ◽  
Bart J. Emmer ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Choroid Plexus ◽  
Internal Carotid ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Stroke Patients ◽  
Distal Internal Carotid Artery ◽  
Mr Clean

Abstract Purpose Acute stroke patients presenting with a distal internal carotid artery occlusion and patent carotid terminus, allowing for collateral flow via the circle of Willis, may have a more favorable natural history. Therefore, benefit of endovascular treatment (EVT) is less evident. We performed an exploratory analysis of EVT results compared to conservative treatment in patients with ‘carotid-I’ occlusions. Methods We report on EVT-treated and non-EVT-treated patients with carotid-I occlusions from the MR CLEAN Registry, MR CLEAN trial, and our comprehensive stroke center. CT-angiography was reviewed on primary collateral patency and choroid plexus enhancement. Perfusion deficits were assessed on CT-perfusion (CTP). Clot migration was assessed by comparing clot location on baseline CTA to its location on periprocedural digital subtraction angiography. Outcomes included 90-day functional independence (mRS 0–2), successful reperfusion and mortality. Results We included 51 patients. Forty-one patients received EVT, ten patients did not. Intravenous thrombolysis was administered in 32 (78%) EVT-treated patients and 6 (60%) non-EVT-treated patients. CTP, available for 17 patients, showed hypoperfusion on cerebral blood flow maps in 13 (76%) patients. Successful reperfusion after EVT occurred in 23 (56%), and clot migration in 8 patients (20%). Functional independence was achieved in 54% (21/39) of EVT-treated and in 10% (1/10) of non-EVT-treated patients. Mortality was 26% (10/39) and 30% (3/10), respectively. Anterior choroidal artery patency and choroid plexus enhancement were positively associated with functional independence. Conclusion In our population, data suggest improved outcomes after EVT in carotid-I occlusion patients and provide no arguments to withhold EVT in these patients.

scholarly journals Ekstrakranijinės-intrakranijinės jungties operacijos galimybės ir dažnis ištikus išeminiam insultui miego arterijos baseine

2003 ◽  
Vol 1 (2) ◽  
pp. 0-0
Author(s):  
Kęstutis Laurikėnas
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Stroke Patients ◽  
Hemispheric Stroke ◽  
Preoperative Selection

Kęstutis LaurikėnasVilniaus universiteto Neuroangiochirurgijos centras,Vilniaus greitosios pagalbos universitetinės ligoninėsKraujagyslių chirurgijos skyrius,Šiltnamių g. 29, LT-2043 VilniusEl paštas: [email protected] Įvadas / tikslas Šiuo metu pasaulinėje medicinos literatūroje raginama atlikti naujus ekstrakranijinės-intrakranijinės jungties operacijų veiksmingumo tyrimus, siekiant nurodyti aiškesnes šių operacijų indikacijas. Darbo tikslas buvo išsiaiškinti, kokiai daliai ligonių, sergančių išeminiais galvos smegenų sutrikimais, instrumentinių tyrimų būdu randama užakusi vidinė miego arterija arba susiaurėjusi a. cerebri media, ir kokiam šių ligonių skaičiui įmanoma atlikti ekstrakranijinės-intrakranijinės jungties operaciją. Ligoniai ir metodai 2000 metais VGPUL gydyta 418 ligonių, kuriems buvo išeminis kraujotakos sutrikimas miego arterijos baseine. Po detalaus klinikinio ir instrumentinio ištyrimo operuoti 95 ligoniai (23 % visų neembolinio tipo išeminių kraujotakos sutrikimų miego arterijos baseine). Rezultatai Hipoperfuzinio tipo išeminis insultas miego arterijos baseine ištiko 25 % ligonių iš visų 1677 smegenų kraujotakos nepakankamumu sergančių ligonių, gydytų stacionare. Iš 418 ligonių 385 (92 %) diagnozuotas išeminis insultas ir tik 33 ligoniams (8 %) – praeinantys kraujotakos sutrikimai miego arterijos baseine. Iš 418 ligonių chirurginis gydymas taikytas 95 (23 %) ligoniams. Tačiau patomorfologiniai miego arterijos ir jos šakų pokyčiai rasti net 183 (44 %) ligoniams iš 418, sergančių kraujotakos sutrikimais miego arterijos baseine. Ekstrakranijinės-intrakranijinės jungties operacija atlikta 12 ligonių (12,6 % visų miego arterijos rekonstrukcinių operacijų), iš jų 7 ligoniams miego arterija buvo užakusi kakle, 5 ligoniams diagnozuotas a. cerebri media užakimas arba kritinė stenozė, be to, 9 ligoniai sirgo išeminiu insultu ir 3 ligoniams buvo praeinantys kraujotakos sutrikimai (TIA). Išvados Dauguma ligonių, kuriems yra praeinantys išeminiai kraujotakos sutrikimai miego arterijos baseine, yra gydomi ambulatoriškai, reikiamai neištiriami arba iš viso liga nediagnozuojama. Todėl galima teigti, jog Lietuvoje miego arterijos patologija yra užleista. Prasminiai žodžiai: ekstrakranijinė-intrakranijinė jungtis, išeminis insultas, miego arterijos užakimas, chirurginis gydymas. Extracranial-intracranial bypass operations in cases of ishemic events of the brain Kęstutis Laurikėnas Background Surgical correction of insuffitient collateral circulation in cases of internal carotid artery occlusion first was postulated in 1951 by C. M. Fisher. The operative technique of M. G. Yasargil, using the superficial temporal artery as a bypass, is now the most successful surgical operation for cerebral revascularisation. The establishment of extra-intracranial arterial bypass surgery is based on the fact that nature itself in cases of stenosis or occlusion of internal carotid artery creates such a bypass, usually using the ophthalmic artery. But sometimes the patients could benefit from extra-intracranial bypass operation. Our retrospective study discovered a good number of neurologically successful extra-intracranial operations which have been performed in a large number of stroke patients. Results In the Vilnius Emergency Hospital we treated 418 patients with hemispheric stroke (with carotid or middle cerebral artery stenosis or occlusions). Neurologically deteriorated patients with large ischemic changes on CT were treated conservatively. After CT, TCD, Duplex and angiographic investigations we performed 83 carotid endarterectomies (20% of all patients) and only 12 extracranial-intracranial bypasses (3% of all patients) with good postoperative outcomes. Conclusions Good postoperative results were obtained only after a meticulous clinical preoperative selection of stroke patients. Extra-intracranial bypass was suitable in only about 3 per cent of nonembolic hemispheric stroke patients. Keywords: extracranial-intracranial bypass, carotid artery occlusion, stroke, surgical treatment

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