scholarly journals Impact of endovascular recanalization on quantitative lesion water uptake in ischemic anterior circulation strokes

2019 ◽  
Vol 40 (2) ◽  
pp. 437-445 ◽  
Author(s):  
Gabriel Broocks ◽  
Fabian Flottmann ◽  
Uta Hanning ◽  
Gerhard Schön ◽  
Peter Sporns ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Brain Edema ◽  
Water Uptake ◽  
Imaging Biomarker ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Ischemic Brain ◽  
Multicenter Observational Study ◽  
Endovascular Recanalization ◽  
Ischemic Brain Edema

Studies evaluating the effect of reperfusion on ischemic edema in acute stroke described conflicting results. Net water uptake (NWU) per brain volume is a new quantitative imaging biomarker of space-occupying ischemic edema, which can be measured in computed tomography (CT). We sought to investigate the effects of vessel recanalization on the formation of ischemic brain edema using quantitative NWU. In this multicenter observational study, acute ischemic stroke patients with a large vessel occlusion (LVO) in the anterior circulation were consecutively screened. Patients with vessel recanalization (thrombolysis in cerebral infarction (TICI) 2 b or 3) versus persistent vessel occlusion (no thrombectomy, TICI 0-1) were compared. Lesion-NWU was quantified in multimodal admission CT and follow-up CT (FCT), and ΔNWU was calculated as difference. Of 194 included patients, 150 had successful endovascular recanalization and 44 persistent LVO. In FCT after treatment, the mean (standard deviation) ΔNWU was 15.8% (5.7) in patients with persistent LVO and 9.8% (5.8) with vessel recanalization ( p < 0.001). In multivariate regression analysis, vessel recanalization was independently associated with a lowered ΔNWU by 6.3% compared to LVO (95% confidence interval: 3.7–9.0, p < 0.001). Successful vessel recanalization was associated with a significantly reduced formation of ischemic brain edema. Quantitative NWU may be used to compare the treatment effects in acute stroke.

scholarly journals Value of Dual-Energy Dual-Layer CT After Mechanical Recanalization for the Quantification of Ischemic Brain Edema

2021 ◽  
Vol 12 ◽  
Author(s):  
Paul Steffen ◽  
Friederike Austein ◽  
Thomas Lindner ◽  
Lukas Meyer ◽  
Matthias Bechstein ◽  
...  
Keyword(s):  
Brain Edema ◽  
Strong Predictor ◽  
Ct Images ◽  
Artery Occlusion ◽  
Dual Energy ◽  
Imaging Biomarker ◽  
Ischemic Brain ◽  
Ischemic Brain Edema ◽  
Conventional Ct

Background and Purpose: Ischemic brain edema can be measured in computed tomography (CT) using quantitative net water uptake (NWU), a recently established imaging biomarker. NWU determined in follow-up CT after mechanical thrombectomy (MT) has shown to be a strong predictor of functional outcome. However, disruption of the blood–brain barrier after MT may also lead to contrast staining, increasing the density on CT scans, and hence, directly impairing measurements of NWU. The purpose of this study was to determine whether dual-energy dual-layer CT (DDCT) after MT can improve the quantification of NWU by measuring NWU in conventional polychromatic CT images (CP-I) and virtual non-contrast images (VNC-I). We hypothesized that VNC-based NWU (vNWU) differs from NWU in conventional CT (cNWU).Methods: Ten patients with middle cerebral artery occlusion who received a DDCT follow-up scan after MT were included. NWU was quantified in conventional and VNC images as previously published and was compared using paired sample t-tests.Results: The mean cNWU was 3.3% (95%CI: 0–0.41%), and vNWU was 11% (95%CI: 1.3–23.4), which was not statistically different (p = 0.09). Two patients showed significant differences between cNWU and vNWU (Δ = 24% and Δ = 36%), while the agreement of cNWU/vNWU in 8/10 patients was high (difference 2.3%, p = 0.23).Conclusion: NWU may be quantified precisely on conventional CT images, as the underestimation of ischemic edema due to contrast staining was low. However, a proportion of patients after MT might show significant contrast leakage resulting in edema underestimation. Further research is needed to validate these findings and investigate clinical implications.

Patients with low Alberta Stroke Program Early CT Score (ASPECTS) but good collaterals benefit from endovascular recanalization

2019 ◽  
Vol 12 (8) ◽  
pp. 747-752 ◽  
Author(s):  
Gabriel Broocks ◽  
Helge Kniep ◽  
Peter Schramm ◽  
Uta Hanning ◽  
Fabian Flottmann ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Water Uptake ◽  
Selection Criterion ◽  
Multivariable Logistic Regression Analysis ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Edema Formation ◽  
Endovascular Recanalization ◽  
Point Increase

BackgroundBenefit of thrombectomy in patients with a low initial Alberta Stroke Program Early CT Score (ASPECTS) is still uncertain. We hypothesized that, despite low ASPECTS, patients may benefit from endovascular recanalization if good collaterals are present.MethodsIschemic stroke patients with large vessel occlusion in the anterior circulation and an ASPECTS of ≤5 were analyzed. Collateral status (CS) was assessed using a 5-point-scoring system in CT angiography with poor CS defined as CS=0–1. Clinical outcome was determined using the modified Rankin Scale (mRS) score after 90 days. Edema formation was measured in admission and follow-up CT by net water uptake.Results27/100 (27%) patients exhibited a CS of 2–4. 50 patients underwent successful vessel recanalization and 50 patients had a persistent vessel occlusion. In multivariable logistic regression analysis, collateral status (OR 3.0; p=0.003) and vessel recanalization (OR 12.2; p=0.009) significantly increased the likelihood of a good outcome (mRS 0–3). A 1-point increase in CS was associated with 1.9% (95% CI 0.2% to 3.7%) lowered lesion water uptake in follow-up CT .ConclusionEndovascular recanalization in patients with ASPECTS of ≤5 but good collaterals was linked to improved clinical outcome and attenuated edema formation. Collateral status may serve as selection criterion for thrombectomy in low ASPECTS patients.

Reversible Ischemic Lesion Hypodensity in Acute Stroke CT Following Endovascular Reperfusion

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012484
Author(s):  
Gabriel Broocks ◽  
Rosalie McDonough ◽  
Lukas Meyer ◽  
Matthias Bechstein ◽  
Helge Kniep Dipl.Ing ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Water Uptake ◽  
Vasogenic Edema ◽  
Brain Infarction ◽  
Future Research ◽  
Anterior Circulation ◽  
Ischemic Lesion ◽  
Ischemic Brain Edema ◽  
The Difference

Background and ObjectivesIn acute stroke, early ischemic lesion hypodensity in computed tomography (CT) is considered the imaging hallmark of brain infarction, representing a state of irreversible tissue damage with a continual increase of net water uptake. This dogma is however challenged by rare cases of apparently reversed early lesion hypodensity following complete reperfusion. The purpose of this study was to investigate the occurrence of reversible ischemic edema after endovascular treatment.Methods184 acute ischemic anterior circulation stroke patients were included after consecutive screening. Ischemic brain edema was determined using quantitative lesion net water uptake (NWU) in admission-CT and follow-up CT based on CT-densitometry and ΔNWU was calculated as the difference. The association of edema progression to imaging and clinical parameters was investigated. Clinical outcome was assessed using modified Ranking Scale (mRS) scores at day 90.Results27/184 patients (14.7%) showed edema arrest and 3 patients (1.6%) exhibited significant edema reversibility. Higher degree of recanalization (odds ratio (OR): 2.96, 95%CI: 1.46-6.01, p<0.01) and shorter time from imaging to recanalization (OR/hour: 0.32, 95%CI: 0.18-0.54, p<0.0001) were significantly associated with edema arrest or reversibility. Clinical outcome was significantly better in patients without edema progression (median mRS 2 versus mRS 5, p=0.004).DiscussionAlbeit rare, lesion hypodensity considered to be representative of early infarct in acute stroke CT may be reversible following complete recanalization. Arrest of edema progression of acute brain infarct lesions may occur after successful rapid vessel recanalization, resulting in improved functional outcome. Future research is needed to investigate conditions where early revascularization may halt or even reverse vasogenic edema of ischemic tissue.

scholarly journals In-Hospital Intravenous Thrombolysis Offers No Benefit in Mechanical Thrombectomy in Optimized Tertiary Stroke Center Setting

2020 ◽  
Author(s):  
Juha-Pekka Pienimäki ◽  
Jyrki Ollikainen ◽  
Niko Sillanpää ◽  
Sara Protto
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
Clinical Laboratory ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Ordinal Logistic Regression Analysis ◽  
Stroke Center

Abstract Purpose Mechanical thrombectomy (MT) is the first-line treatment in acute stroke patients presenting with large vessel occlusion (LVO). The efficacy of intravenous thrombolysis (IVT) prior to MT is being contested. The objective of this study was to evaluate the efficacy of MT without IVT in patients with no contraindications to IVT presenting directly to a tertiary stroke center with acute anterior circulation LVO. Materials and Methods We collected the data of 106 acute stroke patients who underwent MT in a single high-volume stroke center. Patients with anterior circulation LVO eligible for IVT and directly admitted to our institution who subsequently underwent MT were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of intravenous thrombolysis on 3-month clinical outcome (mRS) was analyzed with univariate tests and binary and ordinal logistic regression analysis. Results Fifty-eight out of the 106 patients received IVT + MT. These patients had 2.6-fold higher odds of poorer clinical outcome in mRS shift analysis (p = 0.01) compared to MT-only patients who had excellent 3-month clinical outcome (mRS 0–1) three times more often (p = 0.009). There were no significant differences between the groups in process times, mTICI, or number of hemorrhagic complications. A trend of less distal embolization and higher number of device passes was observed among the MT-only patients. Conclusions MT without prior IVT was associated with an improved overall three-month clinical outcome in acute anterior circulation LVO patients.

Impact of Mediterranean Diet prior to Stroke on the Prognosis of Patients Undergoing Endovascular Treatment

2021 ◽  
pp. 1-7
Author(s):  
Carmen García-Cabo ◽  
Maria Castañón-Apilánez ◽  
Lorena Benavente-Fernández ◽  
Jose Maria Jimenez ◽  
Juan Arenillas ◽  
...  
Keyword(s):  
Olive Oil ◽  
Mediterranean Diet ◽  
Daily Consumption ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Stroke Outcomes ◽  
Multicenter Observational Study ◽  
Adherence Score ◽  
Cholesterol Levels ◽  
Item Scale

Introduction: Mediterranean diet (MeDiet) has been associated with lower risk of stroke. Additionally, animal models suggested that some components of MeDiet are associated with better outcomes after ischemic stroke (IS). We aimed to evaluate the association between global adherence to the MeDiet and the consumption of particular components of the MeDiet with stroke outcomes. Material and Methods: Multicenter observational study of consecutive IS patients treated with endovascular therapy. Inclusion criteria were large anterior circulation vessel occlusion and pre-stroke modified Rankin scale (mRS) <2. Adherence to MeDiet prior to stroke was evaluated using MEDAS 14-item scale. We evaluated the total score and also individual components of the scale. Clinical, radiological, and prognostic variables were collected. Good functional prognosis was considered as mRS ≤2 and complete recanalization as thrombolysis in cerebral infarction 3. Results: From January 1 to October 30, 2018, 239 patients were included (mean age 71 years, 48% women, median baseline NIHSS 16). Median MEDAS scale was 8 points (7–10). Patients with a higher adherence to MeDiet had significantly lower total and LDL-cholesterol levels. Total adherence score was not associated with stroke outcomes. In multivariate analyses, consumption of olive oil as the principal source of fat was independently associated with good functional outcome at 3 months, OR 3.2 (1.1–10.1) and daily consumption of wine was independently associated with complete recanalization, OR 2.0 (1.1–3.8). Conclusions: Our study suggests that some components of MeDiet, such as olive oil and wine consumption, are related to better prognosis after stroke. More studies are needed to confirm these findings.

scholarly journals Proton NMR relaxation times in ischemic brain edema.

Stroke ◽  
1986 ◽  
Vol 17 (6) ◽  
pp. 1149-1152 ◽  
Author(s):  
Y Horikawa ◽  
S Naruse ◽  
C Tanaka ◽  
K Hirakawa ◽  
H Nishikawa
Keyword(s):  
Brain Edema ◽  
Relaxation Times ◽  
Proton Nmr ◽  
Nmr Relaxation ◽  
Ischemic Brain ◽  
Ischemic Brain Edema ◽  
Nmr Relaxation Times

scholarly journals Experimental brain infarcts in cats. II. Ischemic brain edema.

Stroke ◽  
1980 ◽  
Vol 11 (6) ◽  
pp. 593-601 ◽  
Author(s):  
F J Schuier ◽  
K A Hossmann
Keyword(s):  
Brain Edema ◽  
Ischemic Brain ◽  
Brain Infarcts ◽  
Ischemic Brain Edema

scholarly journals Transport of sodium from blood to brain in ischemic brain edema.

Stroke ◽  
1987 ◽  
Vol 18 (1) ◽  
pp. 150-157 ◽  
Author(s):  
W D Lo ◽  
A L Betz ◽  
G P Schielke ◽  
J T Hoff
Keyword(s):  
Brain Edema ◽  
Ischemic Brain ◽  
Ischemic Brain Edema

The function of aquaporin4 in ischemic brain edema

2014 ◽  
Vol 127 ◽  
pp. 5-9 ◽  
Author(s):  
Wen-Wen Wang ◽  
Cheng-long Xie ◽  
Li-Li Zhou ◽  
Guo-Sheng Wang
Keyword(s):  
Brain Edema ◽  
Ischemic Brain ◽  
Ischemic Brain Edema

Abstract 1122‐000022: Delays in Care for Patients with Acute Stroke During Hospitalization for Other Reasons

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Nicholas Vigilante ◽  
Parth Patel ◽  
Prasanth Romiyo ◽  
Lauren Thau ◽  
Mark Heslin ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Acute Care ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Single Center ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Symptom Recognition ◽  
Risk Patients ◽  
Recognition Imaging

Introduction : In‐hospital stroke (IHS) is defined as stroke that occurs during hospitalization for non‐stroke conditions. We aimed to understand the timing of symptom recognition for patients who experienced IHS and its impact on the care they receive. Methods : A prospective, single center registry of adult patients (9/20/19‐2/28/21) was queried for acute anterior circulation IHS. Indications for hospitalization, delays from last known well (LKW) to symptom recognition, imaging, and treatment were explored. Results : Of 928 consecutively evaluated adults with acute stroke, 85 (9%) developed an anterior circulation IHS, 39 (46%) of whom were female, with a median age of 67 years (IQR 60–76) and median NIHSS of 15 (IQR 4–22). Sixty‐eight (80%) had a >1 hour delay from last known well to symptom recognition. Two patients (2%) received IV thrombolysis, although another 38 (45%) would have been eligible if not for a delay in symptom recognition. An ICA, M1, or M2 occlusion was observed in 18 patients (21%), 7 of whom were treated at a median of 174 minutes after LKW (IQR 65–219). Compared to the 11 patients who did not undergo thrombectomy with large vessel occlusion, those who underwent thrombectomy had non‐significantly shorter delays from LKW until neuroimaging (median 85 [IQR 65‐162] vs. 216 [IQR 133‐507], p = 0.12). Conclusions : While uncommon, patients with IHS experience delays in symptom recognition and treatment, which lead to exclusion from acute care treatment such as thrombolysis and thrombectomy. Earlier detection with more frequent nursing assessments or advanced neuromonitoring devices in at‐risk patients may reduce delays in care.

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