Abstract W P43: Extent of “Blooming Effect” Predicts Middle Cerebral Artery Recanalization After Intravenous Thrombolysis

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Shenqiang Yan ◽  
Min Lou
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Phase Contrast ◽  
Intravenous Thrombolysis ◽  
Imaging Data ◽  
Blooming Effect ◽  
Contrast Enhanced ◽  
The Relationship ◽  
Delayed Phase ◽  
Iron Forms

Background and Purpose: Hemosiderin was shown to have a stronger T2 shortening effect than deoxyhemoglobin. Therefore, the extent of “blooming effect” of susceptibility vessel sign (SVS) might represent composition of different iron forms. We aimed to investigate the relationship between extent of overestimation of thrombus burden and middle cerebral artery (MCA) recanalization. Methods: We retrospectively examined clinical and imaging data from consecutive acute ischemic stroke patients with MCA occlusion who underwent MRI before and 24 hours after IV thrombolysis in our hospital. A delayed phase contrast enhanced T1-WI was used to measure the true size of thrombus. We then examined the association of MCA recanalization and extent of overestimation of thrombus burden. Results: We observed the presence of MCA SVS in 44 patients on initial gradient-recalled echo (GRE) scans and MCA recanalization in 21 (47.7%) patients 24 hours after treatment. The extent of overestimation of thrombus width on GRE was an acceptable predictor for MCA recanalization (odds ratio 1.584 per 10%; 95% CI: 1.090 to 2.310; p=0.016), with a receiver-operator characteristic of 0.884 (95% CI: 0.780 to 0.988; p < 0.001). The optimal cut-off point for predicting recanalization was identified at 1.7814, and this yielded a sensitivity of 87.0% and a specificity of 85.7%. Conclusions: Overestimation of thrombus burden on GRE might reflect the content of hemosiderin. A larger overestimation might indicate aged thrombus, which were resistant to thrombolysis.

Stroke etiologic subtype may influence the rate of hyperdense middle cerebral artery sign disappearance after intravenous thrombolysis

2016 ◽  
Vol 43 (1) ◽  
pp. 86-90 ◽  
Author(s):  
Stefano Forlivesi ◽  
Paolo Bovi ◽  
Giampaolo Tomelleri ◽  
Nicola Micheletti ◽  
Monica Carletti ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intravenous Thrombolysis ◽  
Hyperdense Middle Cerebral Artery

scholarly journals Diffusion- and Susceptibility Weighted Imaging Mismatch Correlates With Collateral Circulation and Prognosis After Middle Cerebral Artery M1-Segment Occlusion

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhihua Xu ◽  
Zhenhua Tong ◽  
Yang Duan ◽  
Dengxiang Xing ◽  
Hongyan Song ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Collateral Circulation ◽  
Cerebral Arteries ◽  
Binary Logistic Regression ◽  
National Institutes Of Health ◽  
Susceptibility Weighted Imaging ◽  
Imaging Data ◽  
Fluid Attenuated Inversion Recovery ◽  
Patient Prognosis

Objective: To explore the relation between diffusion-weighted and susceptibility weighted imaging (DWI-SWI) mismatch and collateral circulation or prognosis in patients with occluded M1 segments of middle cerebral artery (MCA).Methods: We enrolled 59 patients with MCA M1-segment occlusion for a retrospective review of baseline clinical and imaging data. As markers of circulatory collaterals, prominent laterality of posterior (PLPCA) and anterior (PLACA) cerebral arteries on magnetic resonance angiography (MRA) studies and a hyperintense vessel sign (HVS) on T2 fluid-attenuated inversion recovery (FLAIR) images were collectively scored. The extent of acute cerebral infarction was then quantified on DWI, using the Alberta Stroke Program Early CT Score (DWI-ASPECTS). Hypointensity vessel sign prominence (PVS) was also evaluated by SWI and similarly scored (SWI-ASPECT) to calculate DWI-SWI mismatch [(DWI-ASPECTS) – (SWI-ASPECTS)], ranging from −10 to 10 points.Results: DWI-SWI mismatch showed significant associations with PLPCA, PLACA, HVS prominence, and collective collateral scores (all, p &lt; 0.05). National Institutes of Health Stroke Scale (NIHSS), DWI-SWI mismatch, and DWI-ASPECTS also differed significantly according to patient prognosis (good vs. poor) after MCA M1-segment occlusion (p &lt; 0.05). In binary logistic regression analyses, NIHSS and DWI-SWI mismatch emerged as independent prognostic factors (p &lt; 0.05).Conclusions: Collateral circulation may be an important aspect of DWI-SWI mismatch, which in this study correlated with prognostic outcomes of MCA M1-segment occlusion.

Hypoperfusion in lenticulostriate arteries territory related to unexplained early neurological deterioration after intravenous thrombolysis

2019 ◽  
Vol 14 (3) ◽  
pp. 306-309 ◽  
Author(s):  
Ying Zhou ◽  
Wansi Zhong ◽  
Anli Wang ◽  
Wanyun Huang ◽  
Shenqiang Yan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Terminal Branch ◽  
Stroke Patients ◽  
Lenticulostriate Arteries ◽  
Early Neurological Deterioration

Background Early neurological deterioration occurs in approximately 10% acute ischemic stroke patients after thrombolysis. Over half of the early neurological deterioration occurred without known causes and is called unexplained early neurological deterioration. Aims We aimed to explore the development of early neurological deterioration at 24 h after thrombolysis, and whether it could be predicted by the presence of baseline hypoperfusion in lenticulostriate arteries territory in acute ischemic stroke patients. Methods We retrospectively reviewed our prospectively collected database of acute ischemic stroke patients in the unilateral middle cerebral artery territory who had baseline perfusion image and received thrombolysis. Unexplained early neurological deterioration was defined as ≥ 2 points increase of National Institutes of Health Stroke Scale (NIHSS) from baseline to 24 h, without known causes. Hypoperfusion lesions in different territories were identified on perfusion maps. Results A total of 306 patients were included in analysis. Patients with pure lenticulostriate arteries hypoperfusion (defined as the presence of hypoperfusion in lenticulostriate artery territory, but not in middle cerebral artery terminal branch territory) were more likely to have unexplained early neurological deterioration than others (27.6% vs. 6.1%; OR, 5.974; p = 0.001), after adjusting for age, baseline NIHSS and onset to treatment time. Conclusions Patients presenting hypoperfusion in pure lenticulostriate arteries territory were easier to experience unexplained early neurological deterioration.

Morphology of Susceptibility Vessel Sign Predicts Middle Cerebral Artery Recanalization After Intravenous Thrombolysis

Stroke ◽  
2014 ◽  
Vol 45 (9) ◽  
pp. 2795-2797 ◽  
Author(s):  
Shenqiang Yan ◽  
Haitao Hu ◽  
Zhenghao Shi ◽  
Xuting Zhang ◽  
Sheng Zhang ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intravenous Thrombolysis

scholarly journals Urgent Middle Cerebral Artery Embolectomy of Calcified Embolus After Intravenous Thrombolysis: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (2) ◽  
pp. E54-E55 ◽  
Author(s):  
Jiri Fiedler ◽  
Svatopluk Ostry ◽  
Martin Bombic ◽  
Ludek Sterba ◽  
Petr Kostal
Keyword(s):  
Informed Consent ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Ct Perfusion ◽  
Intravenous Thrombolysis ◽  
Complete Recovery ◽  
Clinical Findings ◽  
Left Middle Cerebral Artery ◽  
Initial Flow ◽  
Ct Perfusion Imaging

Abstract This video shows an urgent microsurgical embolectomy of the inferior division of the left middle cerebral artery in a patient treated by intravenous thrombolysis (IVT). Patient was eligible for endovascular mechanical thrombectomy1; however, the interventional radiologist was not comfortable performing the procedure given prior unsuccessful attempts to remove a calcified cerebral embolus.2 A 75-yr-old female presented with an acute ischemic stroke with isolated aphasia (NIHSS 9). Using the drip-and-ship concept, IVT (0.9 mg/kg rt-PA) was administered in a regional hospital. Fifty-five minutes after a complete recovery following IVT, multiple transient ischemic attacks of aphasia were observed. While the patient was a candidate for mechanical thrombectomy based on CT perfusion imaging, given the unsuccessful reports in the literature and the interventional radiologist's experience, the decision was made to offer microsurgical embolectomy of the calcified cerebral embolus.3 Informed consent for the procedure was obtained directly from the patient. Calcified, crumbly embolus was removed from a 5 mm longitudinal arteriotomy. The arteriotomy was sutured with interrupted 10-0 suture. Initial flow after the embolectomy was 6.5 mL/min. Upon inspection, a distal kink was found in the M2 and after repositioning, flow improved to 35 mL/min. Postoperative CT angiography documented complete recanalization. The clinical findings completely resolved (NIHSS 0) within 12 hr and remained unchanged at 3 mo and 1 yr. Informed consent was obtained from the patient for use of media for educational and publication purposes.

scholarly journals Diluted Contrast-enhanced Cone-beam CT during Acute-phase Recanalization Therapy for Occlusion of the Middle Cerebral Artery

2019 ◽  
Vol 13 (2) ◽  
pp. 91-94
Author(s):  
Mitsuhiro Iwasaki ◽  
Makoto Saito ◽  
Akihiro Nemoto ◽  
Takanori Suzuki ◽  
Chiyoe Hikita ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Acute Phase ◽  
Cerebral Artery ◽  
Cone Beam Ct ◽  
Cone Beam ◽  
Contrast Enhanced
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