Abstract P557: Hypoperfusion Intensity Ratio and Cerebral Blood Volume Index as Predictors of Outcome for Recanalized Middle Cerebral Artery Occlusions

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jonathan M Parish ◽  
Dale Strong ◽  
Tanushree Prasad ◽  
Jeremy B Rhoten ◽  
Jonathan D Clemente ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Computerized Tomography ◽  
Blood Volume ◽  
Cerebral Artery ◽  
Intensity Ratio ◽  
Cerebral Blood Volume ◽  
Favorable Outcome ◽  
Volume Index ◽  
Collateral Flow ◽  
Mca Occlusion

Introduction: Preliminary data suggest the Hypoperfusion Intensity Ratio (HIR) and the Cerebral Blood Volume Index (CBVI) derived from Computerized Tomography Perfusion (CTP) imaging predict the rate of collateral flow, speed of infarct growth, and clinical outcome. We hypothesized that functional outcomes at hospital discharge would be significantly better for middle cerebral artery (MCA) occlusion patients achieving Thrombolysis in Cerebral Infarction (TICI) 2b or greater recanalization with presenting hospital CTPs consistent with “good” (HIR <0.5 and CBVI >0.7) versus “poor” (HIR ≥0.5 and CBVI ≤0.7) indices. Methods: We conducted a retrospective cohort study. A neuroradiologist confirmed the MCA occlusion based on the initial Computerized Tomography Angiogram (CTA). All TICI scores were confirmed by neurointerventionalists blinded to patient outcomes. We defined independent outcome as mRS ≤2, and favorable outcome as an mRS ≤3. We additionally stratified patients as initially presenting to thrombectomy versus non-thrombectomy centers. Results: We identified a total of 162 patients over a 3 ½ year period with an MCA occlusion achieving TICI 2b recanalization or greater, of whom 67 had good indices and 48 had poor indices. For patients with good compared to poor indices, there was a trend for achieving independent outcome (55% vs 37%, p=0.061) that reached significance for favorable outcome (69% vs 50%, p=0.043). Limiting the analysis to only patients presenting to non-thrombectomy centers (n=67), these findings were consistent, with a trend for achieving independent outcome for good versus poor collaterals (48% vs 30% p=0.173), which was again significant for a favorable outcome (66% vs 39%, p=0.036). Across all patients, HIR <0.5 (n=86) or CBVI >0.7 (n=95) were not independently associated with independent outcomes, but for patients presenting to non-thrombectomy centers, an HIR <0.5 alone (n=51) was significantly associated with favorable outcome. Conclusion: For MCA occlusion patients achieving TICI 2b recanalization, the combination of good HIR and CBVI is significantly associated with a favorable functional outcome. For patients presenting to non-thrombectomy centers, HIR alone may be sufficient to predict favorable outcome.

Abstract P361: Visualization of the Anterior Temporal Artery as a Predictor of Outcome in Middle Cerebral Artery Occlusion Patients Achieving Successful Recanalization After Interfacility Transfer

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jonathan M Parish ◽  
William R Stetler ◽  
Dale Strong ◽  
Tanushree Prasad ◽  
Jeremy B Rhoten ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Functional Outcome ◽  
Computerized Tomography ◽  
Patient Outcomes ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Mca Occlusion ◽  
Proximal Site

Introduction: Many non-thrombectomy centers lack Computerized Tomography Perfusion (CTP) capability. Anterior temporal artery (ATA) visualization on Computerized Tomography Angiography (CTA) has been previously associated with good outcomes in middle cerebral artery (MCA) occlusions, but not in the context of recanalization after interfacility transfer for thrombectomy. We hypothesized that independent functional outcome at 90 days would be greater for MCA occlusion patients initially presenting to non-thrombectomy centers with a visualized ATA on CTA who achieved TICI 2b or greater recanalization after transfer. Methods: We conducted a retrospective cohort study of patients transferred for mechanical thrombectomy. A neuroradiologist blinded to patient outcomes confirmed the MCA as the most proximal site of occlusion on CTA, and assessed for visualization of the ATA. TICI 2b or greater revascularization scores were confirmed by neurointerventionalists blinded to patient outcomes. Ninety-day mRS scores were obtained via telephone utilizing a structured questionnaire. Results: We identified a total of 107 MCA occlusion patients over a 3 ½ year period meeting our inclusion criteria. There were no significant differences in age, gender, race, comorbidities, median NIHSS, or time-to-revascularization variables between the ATA visualized (n=50) versus non-visualized (n=57) group, with the exception of significantly more wake-up strokes in the ATA visualized group (34.7% vs 16.1%, p=0.03). There was a non-significant trend for independent outcome (mRS ≤2) at 90 days for patients with ATA visualization compared to those for whom the ATA was not visualized on the CTA (63.8% vs 45.5%, p=0.06). Conclusion: For MCA occlusion patients initially presenting to non-thrombectomy centers achieving successful recanalization via mechanical thrombectomy, there is a strong trend for visualization of the anterior temporal artery on the CTA performed at the non-thrombectomy center as being a predictor of independent functional outcome. Especially for institutions without CTP capability, this association with ATA visualization should be further investigated as a predictor for good outcome after transfer for successful mechanical thrombectomy.

Abstract 3842: Angiographic Assessment Of Leptomeningeal Collateral Perfusion Parameters Following Experimental Transient Middle Cerebral Artery Occlusion

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Brian Theyel ◽  
Marc Benayoun ◽  
Cameron Rink ◽  
Chandan Sen ◽  
Gregory Christoforidis
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Blood Volume ◽  
Cerebral Artery ◽  
Cerebral Blood Volume ◽  
Infarct Volume ◽  
Artery Occlusion ◽  
Regions Of Interest ◽  
Custom Made ◽  
Cerebral Artery Occlusion

Objectives: This work aims to develop and validate an angiographically based quantitative assessment of leptomeningeal collateral perfusion (QLCP) in experimental reversible middle cerebral artery occlusion (MCAO). Methods: Pial collaterals were assessed during MCAO using an angiographically based transient MCAO model in eight mongrel dogs (20-30 kg). Angiographic images were analyzed using a custom-made MATLAB program which measured contrast density over time. Using bivariate linear fit analysis relative cerebral blood volume (rCBV), relative transit time (rTT) and relative cerebral blood flow (rCBF) derived from regions of interest (ROI) from the normal and abnormal hemispheres were extracted and compared to one hour post reperfusion MRI based infarct volume calculations and leptomeningeal collateral scoring using previously published methods. Results: QLCP was reproducibly assessed but variably predictive of infarct volume on one hour post reperfusion mean diffusivity maps using rCBV (p<0.0001; r2=0.937), rTT (p = 0.05, r2 = 0.494), and rCBF (p=0.0024, r2=0.807). Leptomeningeal collateral scoring variably correlated with rCBV (p<0.0001, r2 = 0.948), rTT (p=0.0285, r2= 0.578) and rCBF (p0.0021, r2= 0.817). Conclusion: QLCP was validated in an experimental MCAO model based on correlation with a leptomeningeal collateral scoring system. QLCP assessment of rCBV is a better predictor for infarct volume than rTT or rCBF in a transient MCAO model. It is noteworthy that an angiographically based assessment of rCBV, rTT and rCBF differs from CT and MRI based assessments. In particular , the time frame used and the relative density of the vasculature on the derived color maps differ ( figure 1). figure 1: QLCP derived cerebral blood volume map. The boxes indicate regions of interest for analysis.

scholarly journals Mapping the dynamics of brain perfusion using functional ultrasound in a rat model of transient middle cerebral artery occlusion

2016 ◽  
Vol 37 (1) ◽  
pp. 263-276 ◽  
Author(s):  
Clément Brunner ◽  
Clothilde Isabel ◽  
Abraham Martin ◽  
Clara Dussaux ◽  
Anne Savoye ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Blood Volume ◽  
Ultrasound Imaging ◽  
Cerebral Artery ◽  
Rat Model ◽  
Cerebral Blood Volume ◽  
Imaging Technique ◽  
Artery Occlusion ◽  
Cerebral Artery Occlusion

Following middle cerebral artery occlusion, tissue outcome ranges from normal to infarcted depending on depth and duration of hypoperfusion as well as occurrence and efficiency of reperfusion. However, the precise time course of these changes in relation to tissue and behavioral outcome remains unsettled. To address these issues, a three-dimensional wide field-of-view and real-time quantitative functional imaging technique able to map perfusion in the rodent brain would be desirable. Here, we applied functional ultrasound imaging, a novel approach to map relative cerebral blood volume without contrast agent, in a rat model of brief proximal transient middle cerebral artery occlusion to assess perfusion in penetrating arterioles and venules acutely and over six days thanks to a thinned-skull preparation. Functional ultrasound imaging efficiently mapped the acute changes in relative cerebral blood volume during occlusion and following reperfusion with high spatial resolution (100 µm), notably documenting marked focal decreases during occlusion, and was able to chart the fine dynamics of tissue reperfusion (rate: one frame/5 s) in the individual rat. No behavioral and only mild post-mortem immunofluorescence changes were observed. Our study suggests functional ultrasound is a particularly well-adapted imaging technique to study cerebral perfusion in acute experimental stroke longitudinally from the hyper-acute up to the chronic stage in the same subject.

Cerebral blood volume index as a predictor of functional independence after basilar artery thrombectomy

2021 ◽  
Author(s):  
Rahul R. Karamchandani ◽  
Dale Strong ◽  
Jeremy B. Rhoten ◽  
Tanushree Prasad ◽  
Jacob Selig ◽  
...  
Keyword(s):  
Blood Volume ◽  
Basilar Artery ◽  
Cerebral Blood Volume ◽  
Functional Independence ◽  
Volume Index

Acute Middle Cerebral Artery Occlusion: Experience with Volume Expansion Therapy

Neurosurgery ◽  
1986 ◽  
Vol 18 (4) ◽  
pp. 397-401 ◽  
Author(s):  
Bruce I. Tranmer ◽  
Cordell E. Gross ◽  
Ted S. Keller ◽  
Glenn W. Kindt
Keyword(s):  
Cardiac Output ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Volume Expansion ◽  
Artery Occlusion ◽  
Neurological Deficits ◽  
Life Styles ◽  
Arterial Blood ◽  
Mca Occlusion ◽  
The Mean

Abstract Five consecutive patients with acute neurological deficits after middle cerebral artery (MCA) occlusion were given emergency treatment with colloidal volume expansion. In each case, the diagnosis was confirmed promptly by computed tomography and cerebral angiography. Aggressive volume expansion therapy was started 2 to 18 hours (mean, 11 hr) after the onset of the neurological deficit. The mean colloidal volume used was 920 ml/day for an average of 4 days. During volume expansion, the mean cardiac output increased 57% from 4.6 + 0.6 to 7.2 + 1.9 litres/min (P &lt; 0.05). The mean hematocrit decreased 19% from 46 + 3% to 37 + 4% (P &lt; 0.01). The mean arterial blood pressure remained stable, and the pulmonary artery wedge pressure was maintained at &lt; 15 mm Hg. Three patients improved dramatically with volume expansion therapy and have returned to their previous life-styles. Two patients made partial recoveries and manage at home with nursing care. The three patients who improved dramatically were young (aged &lt;34) and, when compared to the older patients, they had greater increases in cardiac output (67% vs. 19%). No major complications or deaths were attributed to the volume expansion therapy. We propose that intravascular volume expansion and its concomitant augmentation of the cardiovascular dynamics may be effective in the treatment of acute neurological deficits after acute MCA occlusion.

scholarly journals Cerebral Energy Metabolism Measured in vivo by 31P-NMR in Middle Cerebral Artery Occlusion in the Cat—Relation to Severity of Stroke

1987 ◽  
Vol 7 (5) ◽  
pp. 557-562 ◽  
Author(s):  
S. Komatsumoto ◽  
S. Nioka ◽  
J. H. Greenberg ◽  
K. Yoshizaki ◽  
V. H. Subramanian ◽  
...  
Keyword(s):  
Energy Metabolism ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cerebral Metabolism ◽  
Recovery Period ◽  
Creatine Phosphate ◽  
Significant Shift ◽  
Mca Occlusion ◽  
Occlusion Model

The energy metabolism of the brain has been measured in a middle cerebral artery (MCA) occlusion model in the cat utilizing 31P-nuclear magnetic resonance (NMR). 31P-NMR spectra were serially obtained during 2 h of ischemia and a subsequent 4-h recovery period. The ratio of creatine phosphate (PCr) to inorganic phosphate (Pi) (PCr/Pi) showed a precipitous decrease in parallel with changes in electroencephalographic (EEG) amplitude in severe strokes during ischemia as well as during recirculation. Animals with mild strokes, as determined by EEG criteria, exhibited a much smaller decrease in PCr/Pi during ischemia. In the severe strokes, there was a splitting and significant shift of the Pi peak immediately after occlusion. In addition, the shifted Pi peak rapidly increased and remained elevated throughout the study. In the mild strokes, Pi also increased, but not as markedly. Intracellular pH determination by chemical shift of the Pi peak revealed a decrease from 7.1 to 6.2–6.3 during ischemia and the subsequent recovery period in the animals with severe strokes, whereas the pH in the animals with mild strokes did not show a significant change. A gradual decrease in adenosine triphosphate (ATP) to 57–79% of the control was exhibited in severely stroked animals during both the ischemia and the recovery period, whereas there was no change in ATP in the mild stroked animals. These results suggest that the dynamic process of pathophysiological changes in an MCA occlusion model in the cat leads to significant differences in cerebral metabolism between animals with mild and severe strokes.

scholarly journals ARL 17477, a Potent and Selective Neuronal NOS Inhibitor Decreases Infarct Volume after Transient Middle Cerebral Artery Occlusion in Rats

1996 ◽  
Vol 16 (4) ◽  
pp. 599-604 ◽  
Author(s):  
Zheng G. Zhang ◽  
David Reif ◽  
James Macdonald ◽  
Wen Xue Tang ◽  
Dietgard K. Kamp ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cell Damage ◽  
Infarct Volume ◽  
Artery Occlusion ◽  
Arterial Blood ◽  
Mca Occlusion ◽  
Nos Inhibitor ◽  
Oxide Synthase ◽  
Cerebral Artery Occlusion

We tested the effects of administration of a selective neuronal nitric oxide synthase (nNOS) inhibitor, ARL 17477, on ischemic cell damage and regional cerebral blood flow (rCBF), in rats subjected to transient (2 h) middle cerebral artery (MCA) occlusion and 166 h of reperfusion (n = 48) and in rats without MCA occlusion (n = 25), respectively. Animals were administered ARL 17477 (i.v.): 10 mg/kg; 3 mg/kg; 1 mg/kg; N-nitro-L-arginine (L-NA) 10 mg/kg L-NA 1 mg/kg; and Vehicle. Administration of ARL 17477 1 mg/kg, 3 mg/kg and 10 mg/kg reduced ischemic infarct volume by 53 (p < 0.05), 23, and 6.5%, respectively. L-NA 1 mg/kg and 10 mg/kg increased infarct volume by 2 and 15%, respectively (p > 0.05). Administration of ARL 17477 (10 mg/kg) significantly (p < 0.05) decreased rCBF by 27 ± 5.3 and 24 ± 14.08% and cortical NOS activity by 86 ± 14.9 and 91 ± 8.9% at 10 min or 3 h, respectively, and did not alter mean arterial blood pressure (MABP). L-NA (10 mg/kg) significantly reduced rCBF by 23 ± 9.8% and NOS activity by 81 ± 7% and significantly (p < 0.05) increased MABP. Treatment with 3 mg/kg and 1 mg/kg ARL 17477 reduced rCBF by only 2.4 ± 4.5 and 0%, respectively, even when NOS activity was reduced by 63 ± 13.4 and 45 ± 15.7% at 3 h, respectively, (p < 0.05). The data demonstrate that ARL 17477 inhibits nNOS in the rat brain and causes a dose-dependent reduction in infarct volume after transient MCA occlusion.

Studies of collateral perfusion to canine middle cerebral artery territory

1990 ◽  
Vol 259 (2) ◽  
pp. H560-H566 ◽  
Author(s):  
C. M. Loftus ◽  
G. M. Greene ◽  
K. N. Detwiler ◽  
G. L. Baumbach ◽  
D. D. Heistad
Keyword(s):  
At Risk ◽  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Autologous Blood ◽  
Base Line ◽  
Collateral Flow ◽  
Area At Risk ◽  
Risk Area ◽  
Anatomical Basis

Previous studies of intracranial collateral circulation have not distinguished between true "collateral" blood flow (flow to a region that occurs only when a primary artery is occluded) and "overlap" flow (flow to a region that is present under both normal and demand conditions). These experiments had three purposes: 1) to identify tissues that were truly collateral dependent, 2) to determine potential for true collateral flow in the absence of overlap flow, and 3) to determine whether an anatomical basis for overlap flow could be demonstrated. Branches (700-900 microns) of the dog middle cerebral artery (MCA) were perfused with autologous blood. The perfused region, which was the area at risk, was identified by intravenous injection of neutral red dye. Microspheres were used to measure regional cerebral blood flow (rCBF). Overlap flow was determined by perfusion of the artery with microsphere-free blood. True collateral flow (total rCBF minus overlap flow) was determined by analysis of rCBF to the risk area after cessation of vessel perfusion. Most of the risk area had substantial levels of overlap flow (about one-third of base line). In the center of the area at risk, the true collateral-dependent area was identified [mean overlap flow 4 +/- 1 (mean +/- SE) ml.min-1.100 g-1], which had high levels of perfusion from collateral vessels (102 +/- 14) within 30 s of vascular occlusion. Microfil injection into two adjacent MCA branches showed discrete borders between vascular territories, with no overlapping vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

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