Abstract TP11: CTA Collateral Status and Final Infarct Distribution Following Thrombectomy in Stroke Patients With Large Vessel Occlusion

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Khalid Al-Dasuqi ◽  
Seyedmehdi Payabvash ◽  
Anthony Abou Karam ◽  
Sumita Strander ◽  
Sreeja Kodali ◽  
...  
Keyword(s):  
White Matter ◽  
Interaction Analysis ◽  
Infarct Volume ◽  
Large Vessel ◽  
Border Zone ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Deep White Matter ◽  
Major Predictor

Aim: The angiographic collateral status is a major predictor of final infarct volume in patients with large vessel occlusion (LVO). In this study, we assessed the effects of collateral status on final infarct lesion distribution after thrombectomy. Methods: Acute ischemic stroke patients with occluded terminal ICA and/or MCA M1 segment who underwent thrombectomy and had a follow up MRI within a week were included. The angiographic collateral status was evaluated on pre-thrombectomy CTA and graded according to Miteff et al. (Brain 2009;132(8):2231-8). The final infarct lesion was segmented on DWI; and using voxel-wise general linear model, we determined the correlation of final infarct volume with post-thrombectomy TICI (thrombolysis in cerebral infarction) score, and collateral status - as a covariate. Results: Among 106 patients with terminal ICA and/or MCA M1 occlusion in analysis, final infarct volume had a significant correlation with TICI reperfusion score (rho=0.384, p<0.001), CTA collaterals (rho=0.221, p=0.023), and TICIxCollaterals interaction term (rho=0.446, p<0.001). Voxel-wise analysis (Figure) showed that better reperfusion after thrombectomy (i.e. higher TICI) was associated with preservation of MCA territory cortex and deep white matter (green). The voxel-wise interaction analysis of TICI and CTA collateral status showed that poor collateral status is associated with infarction of the MCA-PCA border zone (red). Alternatively, good collaterals may preserve the peripheral edges of the MCA territory and MCA-ACA border zone (blue). Conclusion: A successful thrombectomy in LVO stroke patients can preserve the cortical and deep white matter of MCA territory - including eloquent speech and motor regions - while CTA collateral status mainly determines the fate of the MCA-PCA border zone. On the other hand, lentiform nuclei tend to infarct despite successful reperfusion and good CTA collateral status.

Abstract 3130: A 101 cm 3 Diffusion-Weighted Imaging (DWI) Cerebral Infarct Volume is the Maximum Volume Compatible with Good 30- Day Functional Outcome

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Esteban Cheng-Ching ◽  
Junya Aoki ◽  
Yohei Tateishi ◽  
Dolora Wisco ◽  
Gabor Toth ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Functional Outcome ◽  
Diffusion Weighted Imaging ◽  
Infarct Volume ◽  
Cerebral Infarct ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Stroke Treatment

Background: Several predictors of clinical outcome have been identified in acute ischemic stroke patients, including age, National Institutes of Health Stroke Scale scores (NIHSS), and large vessel occlusion. Predicted infarct volumes are thought to generally correlate with clinical outcome, however, to date, mostly small studies have failed to demonstrate a convincing relationship between Diffusion-weighted imaging (DWI) volumes and clinical outcome, and this correlation is controversial. Hypothesis: We hypothesized that final DWI infarction volumes would correlate with 30-day modified Rankin Score (mRS). We also sought to describe the maximum cerebral infarct volume compatible with a favorable 30 day (mRS of 0-2) outcome. Methods: We retrospectively reviewed a prospectively collected database of acute stroke patients with large vessel occlusion who were potential intra-arterial therapy candidate, which recently incorporated systematically collected imaging data at our large academic medical center. Additional inclusion criteria were MRI on admission as per our hyperacute stroke treatment protocol, and available 30-day mRS (n=91). Final DWI volume was obtained from the last MRI the patient had during their stroke treatment admission. Differences between final DWI volume and 30-day mRS were analyzed using the Kruskal-Wallis test. Results: See Table 1 for DWI volumes by individual mRS. There was a strong overall positive relationship between final DWI volume and 30-day mRS [Kruskall Wallis p= .0047]. No patient with an mRS of 0 had a DWI volume >12.1 cm 3 . No patients with an mRS of ≤1 had an DWI volume over 85 cm 3 , and no patient with a mRS of ≤2 had a DWI volume over 101 cm 3 . Conclusions: Cerebral infarct volumes strongly correlate with 30-day functional outcome, but there is great individual variability. The maximum infarct volume compatible with survival and mild or less disability at 30 days was 101 cm 3 . In this study, the maximum cerebral infarct volume compatible with zero clinical symptoms or disability at 30 days was 12.1 cm 3 .

Leukoaraiosis and collateral blood flow in stroke patients with anterior circulation large vessel occlusion

2020 ◽  
Vol 12 (10) ◽  
pp. 942-945 ◽  
Author(s):  
Ian Mark ◽  
Seyed Mohammad Seyedsaadat ◽  
John C Benson ◽  
David F Kallmes ◽  
Alejandro A Rabinstein ◽  
...  
Keyword(s):  
Blood Flow ◽  
White Matter ◽  
Large Vessel ◽  
Periventricular White Matter ◽  
Collateral Flow ◽  
Collateral Blood Flow ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion

BackgroundLeukoaraiosis and collateral blood flow are processes that involve small vessels, the former related to flow within the deep perforating arterioles and the latter involving the small, cortical pial-pial connections, both of which are independently used to predict cerebrovascular events and treatment outcomes. The aim of this study was to investigate their relationship to each other.MethodsWe retrospectively reviewed patients who underwent mechanical thrombectomy for stroke with pre-procedural CT imaging within 24 hours of the onset of symptoms. Leukoaraiosis was graded by the total Fazekas score on non-contrast CT, periventricular white matter (PVWM) and deep white matter (DWM) scores, both ranging from 0 to 3. Collateral cerebral blood flow was measured by the American Society of Interventional and Therapeutic Radiology/Society of Interventional Radiology (ASITN/SIR) collateral scale.Results178 patients were included with a mean age of 67.6±14.8 years. We found an inverse relationship between total Fazekas score and collateral flow (p<0.0001). Among patients with good collaterals, 75.1% had total Fazekas scores of 0–2, compared with 36.6% of patients with moderate collaterals and 32.7% of patients with poor collaterals with total Fazekas scores of 0–2. Mean Fazekas scores were 1.6±1.5, 3.1±1.5 and 3.4±1.6 for good, moderate and poor collaterals, respectively (p<0.0001). On multivariate analysis, total Fazekas score was the only variable independently associated with collateral status (p<0.0001).ConclusionsIncreasing severity of leukoaraiosis is associated with poor collateral grade among ischemic stroke patients with anterior circulation large vessel occlusion. These findings suggest that leukoaraiosis may be a marker for global cerebrovascular dysfunction.

Abstract TP154: Infarct Volume and Prolonged Intubation are Critical Determinants of Inpatient Rehabilitation Cost in Anterior Circulation Large Vessel Occlusion Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Christopher Streib ◽  
Srikant Rangaraju ◽  
Ashutosh Jadhav ◽  
Tudor Jovin
Keyword(s):  
Infarct Volume ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Inpatient Rehabilitation ◽  
Large Vessel ◽  
P Value ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion

Introduction: Anterior circulation large vessel occlusion (ACLVO) stroke is one of the most devastating stroke subtypes. Significant recent advances, including endovascular thrombectomy, have markedly improved ACLVO stroke outcomes. The economic burden of ACLVO stroke treatment is now an important consideration. Our study investigates the critical determinants of acute inpatient rehabilitation (AIR) cost in ACLVO stroke. Methods: We utilized comprehensive patient-level cost-tracking software to calculate AIR costs for ACLVO stroke patients at our institution between July 2012-October 2014. Cost was calculated from the hospital perspective. Patient demographics, clinical course, neurologic exam, and imaging findings were analyzed. Variables with p-value <0.20 in univariate analysis were included in multivariable analysis to determine significant predictors of AIR cost (p<0.05). Results: 65 patients were included in our analysis (median age 61 [IQR 54-73], median AIR admit NIHSS 12 [6-16]). Univariate analysis results are shown (Figure). In our multivariable analysis the only statistically significant predictors of AIR cost were the patient’s final infarct volume (p<0.001) and intubation >48 hours during the hospitalization (p=0.044). AIR costs increased by $66.46 for every 1 cubic centimeter increase in infarct volume. Conclusion: Infarct volume and intubation >48 hours were significant predictors of AIR cost in ACLVO stroke patients at our institution. ACLVO stroke interventions that limit infarct volume may decrease AIR costs, in addition to avoidance of intubation and aggressive pursuit of extubation when feasible.

scholarly journals Factors associated with prominent vessel sign on susceptibility-weighted imaging in acute ischemic stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hai-fei Jiang ◽  
Yi-qun Zhang ◽  
Jiang-xia Pang ◽  
Pei-ning Shao ◽  
Han-cheng Qiu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Large Vessel ◽  
Susceptibility Weighted Imaging ◽  
Regression Analyses ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Factors Associated ◽  
Univariate Analyses

AbstractThe prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) is not displayed in all cases of acute ischemia. We aimed to investigate the factors associated with the presence of PVS in stroke patients. Consecutive ischemic stroke patients admitted within 24 h from symptom onset underwent emergency multimodal MRI at admission. Associated factors for the presence of PVS were analyzed using univariate analyses and multivariable logistic regression analyses. A total of 218 patients were enrolled. The occurrence rate of PVS was 55.5%. Univariate analyses showed significant differences between PVS-positive group and PVS-negative group in age, history of coronary heart disease, baseline NIHSS scores, total cholesterol, hemoglobin, anterior circulation infarct, large vessel occlusion, and cardioembolism. Multivariable logistic regression analyses revealed that the independent factors associated with PVS were anterior circulation infarct (odds ratio [OR] 13.7; 95% confidence interval [CI] 3.5–53.3), large vessel occlusion (OR 123.3; 95% CI 33.7–451.5), and cardioembolism (OR 5.6; 95% CI 2.1–15.3). Anterior circulation infarct, large vessel occlusion, and cardioembolism are independently associated with the presence of PVS on SWI.

Penumbra Consumption Rates Based on Time-to-Maximum Delay and Reperfusion Status: A Post Hoc Analysis of the DEFUSE 3 Trial

Stroke ◽  
2021 ◽  
Author(s):  
Shadi Yaghi ◽  
Eytan Raz ◽  
Seena Dehkharghani ◽  
Howard Riina ◽  
Ryan McTaggart ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Infarct Volume ◽  
Interquartile Range ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Post Hoc Analysis ◽  
Consumption Rates ◽  
Post Hoc

Background and Purpose: In patients with acute large vessel occlusion, the natural history of penumbral tissue based on perfusion time-to-maximum (T max ) delay is not well established in relation to late-window endovascular thrombectomy. In this study, we sought to evaluate penumbra consumption rates for T max delays in patients with large vessel occlusion evaluated between 6 and 16 hours from last known normal. Methods: This is a post hoc analysis of the DEFUSE 3 trial (The Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke), which included patients with an acute ischemic stroke due to anterior circulation occlusion within 6 to 16 hours of last known normal. The primary outcome is percentage penumbra consumption, defined as (24-hour magnetic resonance imaging infarct volume–baseline core infarct volume)/(T max 6 or 10 s volume–baseline core volume). We stratified the cohort into 4 categories based on treatment modality and Thrombolysis in Cerebral Infarction (TICI score; untreated, TICI 0-2a, TICI 2b, and TICI3) and calculated penumbral consumption rates in each category. Results: We included 141 patients, among whom 68 were untreated. In the untreated versus TICI 3 patients, a median (interquartile range) of 53.7% (21.2%–87.7%) versus 5.3% (1.1%–14.6%) of penumbral tissue was consumed based on T max >6 s ( P <0.001). In the same comparison for T max >10 s, we saw a difference of 165.4% (interquartile range, 56.1%–479.8%) versus 25.7% (interquartile range, 3.2%–72.1%; P <0.001). Significant differences were not demonstrated between untreated and TICI 0-2a patients for penumbral consumption based on T max >6 s ( P =0.52) or T max >10 s ( P =0.92). Conclusions: Among extended window endovascular thrombectomy patients, T max >10-s mismatch volume may comprise large volumes of salvageable tissue, whereas nearly half the T max >6-s mismatch volume may remain viable in untreated patients at 24 hours.

Abstract 31: Penumbra Consumption Rates Based on T Max Delay and Reperfusion Status: A Post-Hoc Analysis of the Defuse-3 Trial

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Eytan Raz ◽  
Seena Dehkharghani ◽  
Howard Riina ◽  
Ryan McTaggart ◽  
...  
Keyword(s):  
Infarct Volume ◽  
Secondary Analysis ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Consumption Rates ◽  
Definition Of ◽  
Post Hoc ◽  
New Generation

Introduction: In patients with acute large vessel occlusion, the definition of penumbral tissue based on T max delay perfusion imaging is not well established in relation to late-window endovascular thrombectomy (EVT). In this study, we sought to evaluate penumbra consumption rates for T max delays in patients treated between 6 and 16 hours from last known normal. Methods: This is a secondary analysis of the DEFUSE-3 trial, which included patients with an acute ischemic stroke due to anterior circulation occlusion within 6-16 hours of last known normal. The primary outcome is percentage penumbra consumption defined as (24 hour infarct volume-core infarct volume)/(Tmax volume-baseline core volume). We stratified the cohort into 4 categories (untreated, TICI 0-2a, TICI 2b, and TICI3) and calculated penumbral consumption rates. Results: We included 143 patients, of which 66 were untreated, 16 had TICI 0-2a, 46 had TICI 2b, and 15 had TICI 3. In untreated patients, a median (IQR) of 48% (21% - 85%) of penumbral tissue was consumed based on Tmax6 as opposed to 160.6% (51% - 455.2%) of penumbral tissue based on Tmax10. On the contrary, in patients achieving TICI 3 reperfusion, a median (IQR) of 5.3% (1.1% - 14.6%) of penumbral tissue was consumed based on Tmax6 and 25.7% (3.2% - 72.1%) of penumbral tissue based on Tmax10. Conclusion: Contrary to prior studies, we show that at least 75% of penumbral tissue with Tmax > 10 sec delay can be salvaged with successful reperfusion and new generation devices. In untreated patients, since infarct expansion can occur beyond 24 hours, future studies with delayed brain imaging are needed to determine the optimal T max delay threshold that defines penumbral tissue in patients with proximal anterior circulation large vessel occlusion.

scholarly journals Mechanical Thrombectomy for Minor Stroke Patients (NIHSS <6) With Large Vessel Occlusion

2018 ◽  
Vol 24 (2) ◽  
pp. 67-70
Author(s):  
Çetin Kürşad Akpınar ◽  
Erdem Gürkaş ◽  
Emrah Aytaç ◽  
Murat Çalık
Keyword(s):  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Minor Stroke ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion

Abstract TP74: Aspects Scoring Applied to CTA Source Images is Predictive of Final Infarct Volume and Good Functional Outcome

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joseph F Carrera ◽  
Joseph H Donahue ◽  
Prem P Batchala ◽  
Andrew M Southerland ◽  
Bradford B Worrall
Keyword(s):  
Linear Regression ◽  
Functional Outcome ◽  
Infarct Volume ◽  
Univariate Analysis ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Good Outcome ◽  
The Impact

Introduction: CTP and MRI are increasingly used to assess endovascular thrombectomy (EVT) candidacy in large vessel occlusion stroke. Unfortunately, availability of these advanced neuroimaging techniques is not widespread and this can lead to over-triage to EVT-capable centers. Hypothesis: ASPECTS scoring applied to computed tomography angiography source images (CTA-SI) will be predictive of final infarct volume (FIV) and functional outcome. Methods: We reviewed data from consecutive patients undergoing EVT at our institution for anterior circulation occlusion between 01/14 - 01/19. We recorded demographics, comorbidities, NIHSS, treatment time parameters, and outcomes as defined by mRS (0-2 = good outcome). Cerebrovascular images were assessed by outcome-blinded raters and collateral score, TICI score, FIV, and both CT and CTA-SI ASPECTS scores were noted. Patients were grouped by ASPECTS score into low (0-4), intermediate (5-7), and high (8-10) for some analyses. FIV was predicted using a linear regression with NIHSS, good reperfusion (TICI 2b/3), collateral score, CT to groin puncture, CT and CTA-SI ASPECTS as independent variables. After excluding those with baseline mRS≥2, a binary logistic regression was performed including covariates of age, NIHSS, good reperfusion, and diabetes (factors significant at p<0.05 on univariate analysis) to assess the impact of CTA-SI ASPECTS group on outcome. Results: Analysis included 137 patients for FIV and 102 for outcome analysis (35 excluded for baseline mRS≥ 2). Linear regression found CTA-SI ASPECTS (Beta -10.8, p=0.002), collateral score (Beta -42.9, p=0.001) and good reperfusion (Beta 72.605, p=0.000) were independent predictors of FIV. Relative to the low CTA-SI ASPECTS group, the high CTA-SI ASPECTS group was more likely to have good outcome (OR 3.75 [95% CI 1.05-13.3]; p=0.41). CT ASPECTS was not predictive of FIV or good outcome. Outcomes: In those undergoing EVT for anterior circulation occlusion, CTA-SI ASPECTS is predictive of both FIV and functional outcome, while CT ASPECTS predicts neither. CTA-SI ASPECTS holds promise as a lower-cost, more widely available option for triage of patients with large vessel occlusion. Further study is needed comparing CTA-SI ASPECTS to CTP parameters.

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