scholarly journals Value of susceptibility weighted imaging (SWI) in assessment of intra-arterial thrombus in patients with acute ischemic stroke

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ehab Ali Abdelgawad ◽  
Mohammed F. Amin ◽  
Ahmed Abdellatif ◽  
Mohamed Aboulfotoh Mourad ◽  
Manal F. Abusamra
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Standard Treatment ◽  
Arterial Occlusion ◽  
Internal Capsule ◽  
The Other ◽  
Susceptibility Weighted Imaging ◽  
Lentiform Nucleus ◽  
Other Hand ◽  
Arterial Thrombus

Abstract Background Ischemic stroke is a major cause of death and disability. Thrombolytic therapy is a standard treatment stroke nowadays for ischemic strokes up to 4.5 h from start of symptoms. Although arterial occlusion can be detected by digital subtraction angiography (DSA), magnetic resonance angiography (MRA), and computed tomography angiography (CTA), the question about thrombus composition and formation times still might not be replied. The use of susceptibility weighted imaging (SWI) for detecting thrombus in acute ischemic stroke is getting to be a strongly investigated field. SWI can show the thrombus as a hypointense susceptibility vessel sign (SVS) in the affected area. Results Ninety-seven of our patients showed thrombus in MRA study. M1 segment was the most affected MCA segment representing about 57.6%. SWI detected intra-arterial thrombus in 122 patients compared to 97 patients detected by MRA (P = 0.0002). All patients had positive susceptibility sign. 88.8% of patients with positive thrombus in SWI had solitary thrombus, and 11.2% has multiple thrombi; on the other hand, MRA fails to detect any distant thrombi. 81% of patients with abnormally prominent vessel sign (APVS) showed parenchymal changes in these areas. On the other hand, deep structures, namely caudate nucleus, internal capsule and lentiform nucleus, are the least affected areas. All patients with abnormally prominent vessel sign showed arterial occlusion, and only 9 patients with no APVS showed arterial occlusion (P = 0.0001). Conclusion SWI plays an important role in the detection of peripheral thrombi in patients with acute ischemic stroke. Both SWI and MRA might complement each other for visual detection of occluded vessel. We recommend implementation of SWI into routine acute stroke MRI protocols.

scholarly journals Comparison of Susceptibility Weighted Imaging and Time of Flight MR Angiography in the Detection of Intra-Arterial Thrombus in Acute Ischemic Stroke Patients

2020 ◽  
Author(s):  
Ahmet Mesrur Halefoglu
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Of Flight ◽  
Arterial Occlusion ◽  
Susceptibility Weighted Imaging ◽  
Stroke Patients ◽  
Thrombotic Occlusion ◽  
Tof Mra ◽  
Arterial Thrombus ◽  
Major Vessel

Susceptibility weighted imaging (SWI) and time of flight (TOF) magnetic resonance angiography (MRA) techniques can be used in the detection of major vessel occlusion. Our aim was to compare diagnostic accuracies of SWI and TOF MRA in the detection of arterial thrombotic occlusion in acute ischemic stroke patients. In this prospective study, we included 63 consecutive patients presenting with acute ischemic stroke symptoms in whom diagnoses were based on clinical findings and diffusion-weighted imaging (DWI) studies performed within 24 hours of the onset of symptoms. The susceptibility vessel sign (SVS) and TOF MRA findings of the patients were statistically evaluated in terms of detecting acute thrombotic arterial occlusion. In 50 out of 63 patients, SVS on SWI in major intracranial artery territories and a corresponding occlusion or severe stenosis of vessels on TOF MRA were detected with a concordance. In 5 patients, although the SVS was available, TOF MRA did not reveal any occlusion or stenosis in the corresponding artery territory. On the contrary, 3 patients showed stenosis or occlusion on TOF MRA in whom SVS was negative. Finally, in the remaining 5 patients with acute infarct, neither SVS on SWI nor occlusion or stenosis on TOF MRA were displayed. SVS on SWI yielded slightly higher sensitivity than TOF MRA in detecting intra-arterial thrombus in acute ischemic stroke patients. Although SWI and TOF MRA have similar diagnostic accuracies in the diagnosis of acute thrombotic occlusion in stroke patients, SWI has been found slightly superior to TOF MRA.

Abstract W MP24: Modified Tibi (Thrombolysis in Brain Ischemia) Grading System for Assessment of Abnormal Residual Flow at Site of Intracranial Occlusion in Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Aftab Ahmad ◽  
Vijay K Sharma ◽  
Ghazala Basir ◽  
Khurshid Khan ◽  
Andrei V Alexandrov ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Brain Ischemia ◽  
High Probability ◽  
Arterial Occlusion ◽  
P Value ◽  
Grading System ◽  
Mean Flow ◽  
Diastolic Flow

Background and purpose: The intracranial blood flow at the site of arterial occlusion in acute ischemic stroke can be measured with Transracial Doppler (TCD) using the Thrombolysis in Brain Ischemia (TIBI) grading system. The TIBI ranges from 0 to 5, where 0 no flow and 5 normal flow. Our study’s aim is to modify the TIBI grading system in order to make it simple to implement in an acute stroke setting. METHODS: We classified Modified TIBI grading as: Grade 0- no flow, Grade 1- Bad flow: there is systolic flow but no diastolic flow or systolic flow with delayed acceleration and diastolic flow, Grade 2-Good flow: normal upstroke systolic flow and diastolic flow with decreased mean flow velocity compared to contralateral vessel by 30 %. We used the clotbust database to evaluate the modified TIBI scoring system. Poor long-term outcome was defined as modified rankin scale (MRS) score > 2. RESULTS: Total of 369 patients with acute ischemic stroke and intracranial arterial occlusion received IV r TPA. Median age was 71 years (IQ range: 58.7-79), Sex: women: 170(46.1%). Median NIHSS was 16 (IQ range: 12.7-2), 17/98 (17.3%) patients with modified TIBI 0, 73/205(35.6%) with modified TIBI 1 and 31/66( 47%) with modified TIBI 2 had achieved complete recanalization ( p value=0001). The multiple logistic regression model revealed Baseline higher NIHSS, systolic BP, glucose and modified TIBI grade 0 were independent negative predictor of complete recanalization. Patients with modified TIBI 3 had high probability of complete recanalization compared to TIBI 0(OR 3.14, CI 95%: 1.4-6.8, P=0.004).Poor outcome at 3 months (MRS>2) was found in 46/75(61.3%) patients with modified TIBI 0, 94/170(55.3%) with modified TIBI 1 and 19/38(33.3%) with modified TIBI 2(P value <0.004). On logistic model age, baseline NIHSS, glucose and TIBI 0 were independent negative predictors of good outcome.Although statistically insignificant but patients with modified TIBI 3 had a trend towards high probability of good functional outcome (OR: 1.73, CI 95%:0.73-4.12, p=0.20). CONCLUSION: Modified TIBI grading system is simplified version of TIBI grading and is easy to understand and apply clinically. It also predicts reliably the recanalization and functional outcome.

Abstract 74: Early Arterial Recanalization After Intra-venous Tissue-Plasminogen-Activator Treatment in the Interventional Management of Stroke-3 Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Ruediger Von Kummer ◽  
Andrew M Demchuk ◽  
Lydia D Foster ◽  
Bernard Yan ◽  
Wouter J Schonewille ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Arterial Occlusion ◽  
Posterior Circulation ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Tissue Plasminogen ◽  
Arterial Recanalization

Background: Data on arterial recanalization after IV t-PA treatment are rare. IMS-3 allows the study of variables affecting arterial recanalization after IV t-PA in acute ischemic stroke patients with CTA-proved major artery occlusions. Methods: Of 656 acute ischemic stroke patients in IMS-3, 306 were examined with baseline CTA and randomized either to IV t-PA (N=95) or to IV t-PA followed by digital subtraction angiography (DSA) and endovascular therapy (EVT) (N=211). Comparison of baseline CTA to DSA within 5 hours of stroke onset assessed early arterial recanalization after IV t-PA. A central core lab categorized DSA vessel occlusion as “no, partial, or complete”. We studied the association between arterial occlusion sites on baseline CTA with early recanalization for the endovascular group and analyzed its impact on clinical outcome at 90 days. Results: In the EVT group, 22 patients (10.4%) had no CTA intracranial occlusions, but 1 extracranial occlusion; 42 patients (19.9%) had occlusions of intracranial internal carotid artery (ic-ICA); 10 patients (4.7%) had tandem occlusions of the cervical ICA and middle cerebral artery (MCA); 95 patients (45.0%) had MCA-trunk (M1) occlusions, 33 patients (15.6%) had M2 occlusions, 3 patients (1.4%) had M3/4 occlusions, and 6 patients (2.8%) occlusions within posterior circulation. Partial or complete recanalization occurred in 28.6% of patients before DSA and was marginally associated with occlusion site (p=0.0525) (8 patients (19.0%) with ic-ICA occlusion, 0 patients with tandem ICA/MCA occlusions, 34 patients (35.8%) with M1 occlusions, 11 patients (33.3%) with M2 occlusions, 0 patients with M3/4 occlusions, and 1 patient (16.7%) with occlusion within posterior circulation). Three CTA negative patients had intracranial occlusions on DSA. Thirty-two patients (59.3%) with early recanalization achieved mRS of 0-2 at 90 days compared to 51 patients (38.4%) without early recanalization (p=0.0099). There was no relationship between early recanalization and time to IV t-PA or mean t-PA dose. Conclusion: Before EVT, IV rt-PA may facilitate arterial recanalization and better clinical outcome in about one third of patients.

Abstract TMP26: Existence of Neutrophil Extracellular Traps in Arterial Thrombi from Patients with Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Wei Li ◽  
Huan Wang ◽  
Wuwei Feng ◽  
Meng Zhang
Keyword(s):  
Electron Microscopy ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
White Blood Cells ◽  
Neutrophil Extracellular Traps ◽  
Immunofluorescence Staining ◽  
Large Artery ◽  
Extracellular Traps ◽  
Arterial Thrombus ◽  
Hematoxylin Eosin

Introduction: Neutrophil extracellular traps (NETs) are composed mainly of strands of filamentous DNA and nuclear proteins, such as chromatin or isoforms of histone and secretable neutrophil granular proteins. Recent studies have shown that NETs existed in the venous thrombi and might function as a scaffold and had implication for thrombolytic treatments. Hypothesis: NETs also exists in cerebral arterial thrombus collected from patients with acute ischemic stroke(AIS). Methods: Ten arterial thrombi were collected from 10 AIS patients (33-78 years old, 4 females) who were treated by endovascular therapy (eight of them accepted alteplase thrombolysis firstly)within 8 hours after symptoms onset. Hematoxylin-eosin (HE) staining, immunofluorescence staining (including anti-histone H3 and Hoechst 33342 which label DNA) and electron microscopy were performed to identify the existence of fibrin and/or NETs in thrombus. Results: There were 4 thrombi from middle cerebral artery, 3 from internal carotid artery and 3 from basilar artery. Cardioembolism were considered as etiology for 5 patients and large artery atherosclerosis was the etiology for another 5 patients. HE staining showed that large amounts of fibrin and white blood cells in all ten cerebral arterial thrombi. NETs structures were also identified in 10/10 cerebral arterial thrombi by immunofluorescence staining. Furthermore, the existence of neutrophil-released DNA network together with fibrin was confirmed using electron microscopy in all 10 thrombi. Conclusion: Our results directly demonstrated that NETs do exist in the arterial thrombi from patients with AIS. they may serve as another structural component in addition to fibrin in both cardiogenic and artery atherosclerotic thrombi. NETs can be a new potential target for the recanalization treatment. Keyword: Neutrophil extracellular traps (NETs); arterial thrombus; Acute ischemic stroke

Abstract TMP89: Collaterals and Reperfusion Mediate Blood Pressure Changes in Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David S Liebeskind ◽  
Graham W Woolf ◽  
Nerses Sanossian ◽  
Jason D Hinman ◽  
Radoslav Raychev ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Arterial Occlusion ◽  
Patient Specific ◽  
Pressure Data ◽  
Blood Pressure Data ◽  
Pressure Changes ◽  
Continuous Blood Pressure

Background: The pathophysiology and optimal management of blood pressure changes in acute ischemic stroke remain unknown. Blood pressure guidelines do not consider patient-specific or serial data on dynamic blood pressure readings. We investigated continuous blood pressure data during endovascular therapy for acute stroke to discern changes associated with collaterals, recanalization and reperfusion. Methods: Continuous monitoring blood pressure data was collected in consecutive cases of endovascular therapy for acute ischemic stroke due to ICA or proximal MCA occlusion. Angiography details were independently analyzed to document site of arterial occlusion, baseline collateral grade, time of device deployments, time of recanalization, time of final reperfusion, final AOL recanalization and final TICI reperfusion. Statistical analyses correlated instantaneous and serial blood pressure changes with these angiographic parameters. Results: 80 patients (median age 73 years; 33 women) were studied. Arterial lesions included 37 ICA and 41 proximal M1 MCA occlusions. Collateral grade prior to intervention included 2 ASITN grade 4, 26 grade 3, 23 grade 2, 6 grade 1 and 0 grade 0. oTICI2C reperfusion scores after thrombectomy included 2 TICI 3 (100%), 22 TICI 2C (90-99%), 25 TICI o2B (67-89%), 9 TICI m2B (50-66%), 19 TICI 2A (<50%) and 3 TICI 0/1. More robust collateral grade was associated with greater reperfusion scores (r=0.32, p=0.028). The change in blood pressure (ΔBP) from earliest BP to time of recanalization was mean 59% of ΔBP during the entire procedure. Better collaterals were associated with lower BP prior to recanalization (r=-0.377, p=0.012). Lower BP prior to recanalization was linked with greater TICI reperfusion (r=-0.242, p=0.050). Higher TICI reperfusion scores were also associated with a greater drop or ΔBP at the time of recanalization (r=0.269, p=0.031). AOL recanalization was not related to ΔBP. Conclusions: Collaterals and reperfusion, but not recanalization, mediate blood pressure changes in acute ischemic stroke. Prospective, precision medicine stroke studies should leverage patient-specific, real-time data on continuous blood pressure with imaging correlates to define BP goals of future in-hospital management.

Abstract TP75: Normal Appearing White Matter Integrity and Motor Impairment Severity in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Carson Ingo ◽  
Chen Lin ◽  
James Higgins ◽  
Yurany Arevalo ◽  
Shyam Prabhakaran
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Motor Function ◽  
Motor Impairment ◽  
Internal Capsule ◽  
Posterior Limb ◽  
Normal Appearing White Matter ◽  
Stroke Group ◽  
Microstructural Integrity

Introduction: The effect of white matter hyperintensities (WMH) as measured by fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging on functional impairment and recovery after ischemic stroke has been investigated thoroughly. However, there has been growing interest to investigate normal-appearing white matter (NAWM) microstructural integrity following ischemic stroke onset with techniques such as diffusion tensor imaging (DTI). Methods: 52 patients with acute ischemic stroke and 36 without stroke were evaluated with a DTI and FLAIR imaging protocol and clinically assessed for severity of motor impairment using the Motricity Index within 72 hours of suspected symptom onset. Results: There were widespread decreases in fractional anisotropy (FA) and increases in mean diffusivity (MD) and radial diffusivity (RD) for the acute stroke group compared to the non-stroke group. As shown in the abstract figure with the blue voxels, there was a significant positive association between FA and motor function and a significant negative association between MD/RD and motor function. The NAWM regions of interest that were most sensitive to the Motricity Index were the anterior/posterior limb of the internal capsule in the infarcted hemisphere and the splenium of the corpus callosum, external capsule, posterior limb/retrolenticular part of the internal capsule, superior longitudinal fasciculus, and cingulum (hippocampus) of the intra-/contralateral hemisphere. Conclusion: The microstructural integrity of NAWM is a significant parameter to identify neural differences not only between those individuals with and without acute ischemic stroke, but also correlated with severity of acute motor impairment.

scholarly journals Susceptibility-weighted Imaging in Thrombolytic Therapy of Acute Ischemic Stroke

2017 ◽  
Vol 130 (20) ◽  
pp. 2489-2497 ◽  
Author(s):  
Lin Li ◽  
Ming-Su Liu ◽  
Guang-Qin Li ◽  
Yang Zheng ◽  
Tong-Li Guo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Susceptibility Weighted Imaging

scholarly journals Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients With Acute Ischemic Stroke

JAMA ◽  
2019 ◽  
Vol 322 (4) ◽  
pp. 326 ◽  
Author(s):  
Karen C. Johnston ◽  
Askiel Bruno ◽  
Qi Pauls ◽  
Christiana E. Hall ◽  
Kevin M. Barrett ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Standard Treatment

scholarly journals Turning a stroke into a TIA: curative thrombolysis with combined intravenous and intra-arterial tPA

CJEM ◽  
2006 ◽  
Vol 8 (01) ◽  
pp. 54-57 ◽  
Author(s):  
David J. Gladstone ◽  
Richard I. Aviv ◽  
Babak Jahromi ◽  
Sandra E. Black ◽  
Devra Baryshnik ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Standard Treatment ◽  
Treatment Approach ◽  
Novel Treatment ◽  
Intravenous Tissue Plasminogen Activator ◽  
Investigational Treatment ◽  
Tissue Plasminogen ◽  
Proximal Middle Cerebral Artery ◽  
Emergency Revascularization

ABSTRACT Intravenous tissue plasminogen activator (tPA) is standard treatment for eligible patients with acute ischemic stroke, but may be less effective for very severe strokes caused by proximal intracranial artery occlusions. We report the case of a woman with a devastating stroke who recovered completely following emergency revascularization of an occluded proximal middle cerebral artery using a novel treatment approach that combines both intravenous (IV) and intra-arterial (IA) tPA. This case illustrates the potential value of the combined IV–IA thrombolytic approach, which is an emerging investigational treatment strategy for selected patients with severe acute ischemic stroke.

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