Abstract WP48: Relationship of Cerebral Blood Flow by Pseudo-continuous Arterial Spin Labeling and Stenosis in Middle Cerebral Artery Territory in Patients Evaluated for Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Eric Lai ◽  
Raja Rizal Azman Raja Aman ◽  
Hui Zhang ◽  
Pui-Wai Chiu ◽  
Queenie Chan ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Arterial Spin Labeling ◽  
Spin Labeling ◽  
Arterial Stenosis ◽  
Vascular Territory

Purpose: Correlation of arterial stenosis with cortical and subcortical cerebral blood flow (CBF) in the middle cerebral artery (MCA) territory. Methods: 126 patients with acute cerebrovascular symptoms from March to June 2015 underwent MRI and MR Angiography (MRA) in a University hospital using a 3.0 Tesla scanner. Sequences included T1W, T2W, FLAIR, DWI, MRA, Pseudocontinuous Arterial Spin Labeling (pcASL, post-labeling delay 1.525 s). 13 patients (corrupted pcASL data) were excluded, with 113 patients (mean age: 67.74±14.19) evaluated (61 acute ischemic stroke, 52 patients transient ischemic attack). Institutionally developed software was used to determine CBF. MCA stenosis was graded into 4 categories by a neuroradiologist: 0 (no stenosis), 1 (mild <50%), 2 (moderate 50-70%) and 3 (severe >70%). Mean and standard deviation of MCA categories (leptomeningeal and perforating) CBF and corresponding degree of MCA stenosis were measured. Spearman correlation coefficients between CBF of cortical and subcortical regions and degree of MCA stenoses were calculated using SPSS (version 23.0). Results: The table showed the descriptive statistics. There was significant correlation between CBF of cortical region of MCA vascular territory and degree of stenosis of MCA in both left (r s = -0.296, p =0.001) and right (r s = -0.306, p =0.001) side. In the contrary, there was no correlation between subcortical CBF of MCA vascular territory and degree of stenosis of MCA in both sides. Conclusion: pcASL is a feasible non-invasive method to measure CBF in clinical setting. In MCA territory, the cortical blood flow correlated (fairly) with large vessel stenosis but not subcortical flow. We conclude that cortical CBF correlated with large artery stenosis, though being attenuated by collateral blood supply. No such relationship in subcortical CBF might be due to differential grey and white matter CBF flow, variable MCA stenotic location, and perforators originating from other territories.

Changes in cerebral blood flow and oxygen metabolism during moderate hypothermia in patients with severe middle cerebral artery infarction

2000 ◽  
Vol 8 (5) ◽  
pp. 1-4 ◽  
Author(s):  
Emanuela Keller ◽  
Thorsten Steiner ◽  
Javier Fandino ◽  
Stefan Schwab ◽  
Werner Hacke
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Mild Hypothermia ◽  
Indicator Dilution ◽  
Dilution Method ◽  
Moderate Hypothermia ◽  
Double Indicator Dilution

Object Moderate hypothermia has been reported to be effective in the treatment of postischemic brain edema. The effect of hypothermia on cerebral hemodynamics is a matter of controversial discussion in literature. Clinical studies have yet to be performed in patients with ischemic stroke after induction of hypothermia. Methods Measurements during mild hypothermia (33–34°C) were made in six patients with severe ischemic stroke involving the middle cerebral artery territory. Hypothermia was induced as soon as possible and maintained for 48 to 72 hours. Cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) were estimated by a new double-indicator dilution method. Measurements of CBF were made during normothermia, immediately after induction of hypothermia, at the end of hypothermia, and after rewarming. A total of 19 measurements of CBF and jugular bulb O2 saturation were made. Immediately after induction of hypothermia, CBF decreased in all patients. During late hypothermia, CBF improved in patients who survived but remained diminished in the two patients who died. Reduced CMRO2 levels were observed during all phases of hypothermia in all but one case. Conclusions Preliminary oberservations indicate that moderate hypothermia seems to reduce CMRO2 Immediately after induction of hypothermia, CBF may decrease in all patients. During late hypothermia CBF seems to recover in patients with good outcome but remains diminished in patients who die. Serial bedside CBF measurements with the new double-indicator dilution technique may be useful to describe cerebral hemodynamic characteristics in patients with severe ischemic stroke during hypothermia.

scholarly journals Analysis of Thrombi Retrieved from Cerebral Arteries of Patients with Acute Ischemic Stroke.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 263-263
Author(s):  
Victor J. Marder ◽  
Dennis J. Chute ◽  
Sidney Starkman ◽  
Anna M. Abolian ◽  
Chelsea Kidwell ◽  
...  
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Cerebral Arteries ◽  
Clinical Consequence ◽  
Initiation Of Therapy ◽  
Stroke Center

Abstract To obtain insights into the pathogenesis of ischemic stroke, we analyzed thromboemboli and other occlusive material retrieved acutely from the cerebral arteries of patients. The experimental design was an observational study in 25 consecutive patients with acute ischemic stroke treated by endovascular mechanical thromboembolectomy. Patients with acute occlusion of a proximal cerebral artery, a disabling neurologic deficit, and either initiation of therapy within 8 hours of onset or initiation of therapy beyond 8 hours if imaging demonstrated substantial residual penumbral tissue at risk were treated at a tertiary Comprehensive Stroke Center (the UCLA Stroke Center). Thrombus was removed by an endovascular mechanical embolectomy device (Merci® Retriever System, Concentric Medical, Mountain View, CA) after placement by angiographic catheter into the occluded intracranial carotid artery, middle cerebral artery or vertebral-basilar artery under fluoroscopic guidance. Our results show that the large majority (20 of 25) of extracted thrombi have similar histologic architecture, a complex of layered, sometimes serpentine, lengths of fibrin:platelet deposits interspersed with linear streaks of nucleated cells. This histology was prevalent with both cardioembolic and atherosclerotic etiologies, indicating the same pathogenetic influences of blood flow and shear in thrombus formation. This histologic pattern among thrombi was present in both the internal carotid artery (ICA) and the middle cerebral artery (MCA). Clots composed uniformly of erythrocytes were uncommon (3 of 25) and were observed only with incomplete extractions, suggesting that sampling was of the proximal thrombus tail where post-occlusion thrombosis had occurred under conditions of stagnant flow. Calcifications or cholesterol were not present. Thrombus size, not histology, predicted the site of arterial occlusion, with no thrombus larger than 3 mm width causing stroke limited to the MCA and no thrombus larger than 5 mm width removed from the ICA. Fungus-containing thrombus was extracted from one patient who had mycotic valvular disease, and an unusual complication occurred in another case, namely, scraping of a small atheroma and attached intima from the MCA, albeit without clinical consequence. We conclude that thromboemboli that cause acute ischemic stroke are of similar, complex structure, regardless of macroscopic dimensions, and are similarly influenced by blood flow, whether the primary etiology is cardioembolic or atherosclerotic. Embolus size is the critical aspect that determines its ultimate destination, those of more than 5 mm width appearing to bypass the cerebral vessels entirely. The mixed fibrin:platelet pattern present in the preponderance of thromboemboli provides foundation for the success of both antiplatelet and anticoagulant treatment strategies in stroke prevention.

Arterial Spin Labeling MRI to Measure Cerebral Blood Flow in Untreated Ischemic Stroke

2018 ◽  
Vol 29 (2) ◽  
pp. 193-197 ◽  
Author(s):  
Girolamo Crisi ◽  
Silvano Filice ◽  
Umberto Scoditti
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
Arterial Spin Labeling ◽  
Spin Labeling

scholarly journals Cerebral blood flow and cognitive outcome after pediatric stroke in the middle cerebral artery

2021 ◽  
Author(s):  
Leonie Steiner ◽  
Andrea Federspiel ◽  
Jasmine Jaros ◽  
Nedelina Slavova ◽  
Roland Wiest ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cognitive Functions ◽  
Cognitive Outcome ◽  
Pediatric Stroke ◽  
Healthy Controls ◽  
Arterial Ischemic Stroke

Abstract Adaptive recovery of cerebral perfusion after pediatric arterial ischemic stroke (AIS) is sought to be crucial for sustainable rehabilitation of cognitive functions. We therefore examined cerebral blood flow in the chronic stage after stroke and its association with cognitive outcome in patients after pediatric arterial ischemic stroke (AIS). This cross-sectional study investigated cerebral blood flow and cognitive functions in 14 patients (age 13.5 ± 4.4 years) after pediatric AIS in the middle cerebral artery (time since AIS was at least 2 years prior to assessment) when compared with 36 healthy controls (aged 13.8 ± 4.3 years). Cognitive functions were assessed using neuropsychological tests and cerebral blood flow was measured with arterial spin labeled imaging in the area of the anterior, middle, and posterior cerebral artery (ACA, MCA, PCA). Patients had significantly lower IQ scores and poorer cognitive functions compared to healthy controls. Arterial spin labeled imaging revealed significantly lower cerebral blood flow in the ipsilesional MCA and PCA in patients compared to healthy controls. Further, we found significantly higher interhemispheric perfusion imbalance in the MCA in patients compared to controls. Higher interhemispheric perfusion imbalance in the MCA was significantly associated with lower working memory performance. Our findings revealed that even years after pediatric stroke in the MCA, reduced ipsilesional cerebral blood flow occurs in the MCA and PCA and interhemispheric imbalance is associated with cognitive performance. Thus, our data suggest that cerebral hypoperfusion might underlie some of the variability observed in long-term outcome after pediatric stroke.

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