scholarly journals ColorViz, a New and Rapid Tool for Assessing Collateral Circulation during Stroke

2020 ◽  
Vol 10 (11) ◽  
pp. 882
Author(s):  
Tommaso Verdolotti ◽  
Fabio Pilato ◽  
Simone Cottonaro ◽  
Edoardo Monelli ◽  
Carolina Giordano ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Gold Standard ◽  
Collateral Circulation ◽  
Arterial Occlusion ◽  
Point Scale ◽  
Conventional Angiography ◽  
Trained Observer ◽  
Reliable Technique ◽  
Processing Software ◽  
Rapid Tool

Prognosis of patients with acute ischemic stroke is strictly related to the patency and prominence of the collateral leptomeningeal pathways distal to the arterial occlusion. The gold standard for assessment of collateral circulation is conventional angiography, but it is invasive and used in selected cases. To date, the most reliable technique is multiphase CTA; currently, the available classifications of collateral circles are often complex, time-consuming, and require a trained observer. The purpose of our work is to establish the effectiveness of a new semi-automatic post-processing software (ColorViz FastStroke, GE Healthcare, Milwaukee, Wisconsin) in evaluation of collateral circulation compared to the six-point classifications of multiphase CTA already validated in literature. We selected 86 patients with anterior ischemic stroke symptoms who underwent multiphasic CTA in our emergency department. Two radiologists separately evaluated the collateral leptomeningeal vessels, analyzing respectively, the multiphase CTA (using the six-point scale and its trichotomized form) and ColorViz (using a three-point scale). Then the results were matched. We found a good correlation between the two different analyses; the main advantage of ColorViz is that, while maintaining fast diagnostic times, it allows a simpler and more immediate evaluation of collateral circulation, especially for less experienced radiologists.

Abstract 176: HERMES: Collaterals at Angiography Guide Clinical Outcomes

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David S Liebeskind ◽  
Tudor G Jovin ◽  
Charles B Majoie ◽  
Peter J Mitchell ◽  
Luis San Román ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Endovascular Therapy ◽  
Collateral Circulation ◽  
Arterial Occlusion ◽  
Strong Impact ◽  
Imaging Data ◽  
Conventional Angiography ◽  
Key Factor ◽  
Multivariable Regression ◽  
Symptomatic Intracranial Hemorrhage

Background: Collateral circulation is a key factor in the pathophysiology of ischemic stroke. We conducted detailed analyses of angiography acquired immediately prior to endovascular therapy in the HERMES collaboration of recent landmark thrombectomy trials to determine predictors of collateral status and assess impact on clinical outcomes. Methods: The HERMES Imaging Core, blind to all other clinical and imaging data, independently interpreted conventional angiography acquired immediately prior to endovascular therapy. Collaterals were graded with the ASITN scale, based on available data for the site of arterial occlusion defined on initial injections. The statistical core analyzed the association of collateral grade with demographics, baseline NIHSS, site of arterial occlusion and clinical outcomes of day 90 mRS. Results: Angiography of collaterals was available in 376/605 (62%), including ASITN grades 0 in 7 (2%), 1 in 40 (10%), 2 in 182 (48%), 3 in 129 (34%) and 4 in 18 (5%). Elevated blood glucose (p=0.011) and diabetes (p=0.048) were associated with worse collateral grades, but age and NIHSS were unrelated. Better collateral grade was strongly associated with the degree of subsequent TICI reperfusion (p<0.001). The limited numbers of symptomatic intracranial hemorrhage (14/376 or 3.7%) or parenchymal hematomas (18/376 or 4.8%) precluded analysis of association with collateral status. Collaterals had strong impact on mRS shift from baseline to 90 days (p<0.001). Multivariable regression revealed that better collateral status was a potent determinant (OR 1.37 per grade, p=0.028) of outcomes, equivalent to 4.5 points of NIHSS and 14 years of age in terms of impact on mRS outcomes. Conclusions: Collaterals at angiography were a potent determinant of clinical outcomes in recent landmark thrombectomy trials.

Abstract 56: Neuroimaging in Ischemic Stroke is Different Between Men and Women in the Defuse 3 Cohort

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adrienne N Dula ◽  
Michael Mlynash ◽  
Nathan D Zuck ◽  
Gregory W Albers ◽  
Steven J Warach ◽  
...  
Keyword(s):  
Sex Differences ◽  
Ischemic Stroke ◽  
Sex Difference ◽  
Intensity Ratio ◽  
Collateral Circulation ◽  
Imaging Modality ◽  
Volume Growth ◽  
Arterial Occlusion ◽  
Large Artery ◽  
Ischemic Core

Introduction: Clinical deficits from ischemic stroke are more severe in women but the pathophysiological basis of this sex difference is unknown. Sex differences in core and penumbral volumes were assessed in this sub-study of the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke (DEFUSE)-3 clinical trial. Methods: DEFUSE 3 randomized patients to thrombectomy or medical management who presented 6-16 hours from last known well with proximal middle cerebral artery or internal carotid artery occlusion and had target core and perfusion mismatch volumes on CT or MRI. Using univariate and adjusted regression models, the effect of sex was assessed on pre-randomization measures of core, perfusion, and mismatch volumes and hypoperfusion intensity ratio, and on core volume growth using 24-hour scans. Results: All patients were included in the analysis (n=182) with 90 men and 92 women. There was no sex difference in the site of baseline arterial occlusion. Adjusted by age, baseline NIHSS, baseline modified Rankin score, time to randomization, and imaging modality, women had smaller core, hypoperfusion, and penumbral volumes than men. Median (IQR) volumes for core were 8.0 mL (1.9-18.4) in women vs 12.6 mL (2.7-29.6) in men, for T max >6 seconds 89.0 mL (63.8-131.7) vs 133.9 mL (87.0-175.4), and for mismatch 82.1 (53.8-112.8) vs 108.2 (64.1-149.2). The hypoperfusion intensity ratio was lower in women, 0.31 (0.15-0.46) vs. 0.39 (0.26-0.57), p = 0.006, indicating better collateral circulation, which was consistent with the observed slower ischemic core growth than men within the medical group (p = 0.003). Conclusions: In the large vessel ischemic stroke cohort selected for DEFUSE 3, women had imaging evidence of better collateral circulation, smaller baseline core volumes, and slower ischemic core growth. These observations suggest sex differences in hemodynamic and temporal features of anterior circulation large artery occlusions.

Prestroke statin use enhances collateralization in acute ischemic stroke patients

2020 ◽  
Vol 38 (4) ◽  
pp. 311-321
Author(s):  
Jiaying Zhu ◽  
Mengmeng Ma ◽  
Jinghuan Fang ◽  
Jiajia Bao ◽  
Shuju Dong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Statin Therapy ◽  
Cerebral Artery ◽  
Functional Outcomes ◽  
Collateral Circulation ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Statin Use

Background: Statin therapy has been shown to be effective in the prevention of ischemic stroke. In addition, recent studies have suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcomes in the event of stroke. It was speculated that prestroke statin use may enhance collateral circulation and result in favorable functional outcomes. Objective: The aim of the study was to investigate the association of prestroke statin use with leptomeningeal collaterals and to determine the association of prestroke statin use with stroke severity and functional outcome in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 h in the neurology department of West China Hospital from May 2011 to April 2017. Computed tomographic angiography (CTA) imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; the National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission; the modified Rankin scale (mRS) was used to measure outcome at 90 days; and premorbid medications were recorded. Univariate and multivariate analyses were performed. Results: Overall, 239 patients met the inclusion criteria. Fifty-four patients used statins, and 185 did not use statins before stroke onset. Prestroke statin use was independently associated with good collateral circulation (rLMCS > 10) (odds ratio [OR], 4.786; 95% confidence interval [CI], 1.195–19.171; P = 0.027). Prestroke statin use was not independently associated with lower stroke severity (NIHSS score≤14) (OR, 1.955; 95% CI, 0.657–5.816; p = 0.228), but prestroke statin use was independently associated with favorable outcome (mRS score≤2) (OR, 3.868; 95% CI, 1.325–11.289; P = 0.013). Conclusions: Our findings suggest that prestroke statin use was associated with good leptomeningeal collaterals and clinical outcomes in acute ischemic stroke (AIS) patients presenting with occlusion of the middle cerebral artery. However, clinical studies should be conducted to verify this claim.

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 W P37: Accuracy Of CT Angiography In The Localization Of Carotid Occlusion Sites In Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Marcelo Rocha ◽  
William T Delfyett ◽  
Amin Aghaebrahim ◽  
Ashutosh Jadhav ◽  
Tudor Jovin
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Angiography ◽  
Target Lesion ◽  
Carotid Occlusion ◽  
Conventional Angiography ◽  
Vessel Occlusion ◽  
Cerebral Vessel ◽  
Ct Angiogram ◽  
Comprehensive Stroke Center

Background and Purpose: CT angiography yields rapid detection of a major cerebral vessel occlusion during the evaluation of patients with acute ischemic stroke leading to its widespread use in rapidly triaging for IA trial enrollment. In such trials, patients who have an extracranial carotid occlusion in tandem to the intracranial target lesion are typically excluded. However, ICA terminus occlusions may be misidentified as cervical carotid occlusions on CTA. The goal of this study is to determine the accuracy of CTA in identifying ICA terminus occlusions from tandem carotid occlusions (cervical and intracranial segments). Methods: Retrospective review of a prospectively maintained database containing patients treated at our comprehensive stroke center between 1996 and 2014 in whom catheter angiogram and CT angiogram were available on PACS. A Neuroradiologist, blinded to catheter angiographic results reviewed the CT angiography identifying the presence of intracranial stenoses and concomitant cervical carotid occlusions. Results: Of 196 patients presenting with intracranial carotid occlusions on catheter based angiogram, 101 patients were identified with good quality CT angiography and subsequent catheter angiograms. Mean ages for identified patients was 65 +/- 14, of which 52% women and 48% men. Forty-four percent of patients had an ASPECT score of 9-10. The overall rate of agreement between retrospective CTA and conventional angiography readings was 77%. Of 72 isolated intracranial occlusions on conventional angiography, CT angiography misidentified 23 cervical carotid occlusions. The sensitivity of CTA for detecting isolated carotid terminus occlusion was 68% in this cohort. Specific factors associated with CT and catheter based angiographic discrepancy are reviewed. Conclusions: The study raises systematic considerations for maximizing inclusion of patients with target arterial occlusions who are most likely to benefit from intra-arterial therapy in future clinical trials. Future steps will include determination of specificity, predictive value of CTA for localization of specific carotid occlusion sites. Clinical variables associated with lower CTA accuracy will also be examined.

Cerebral Collateral Circulation: A Review in the Context of Ischemic Stroke and Mechanical Thrombectomy

2019 ◽  
Vol 122 ◽  
pp. 33-42 ◽  
Author(s):  
Guilherme Santos Piedade ◽  
Clemens M. Schirmer ◽  
Oded Goren ◽  
Hua Zhang ◽  
Amir Aghajanian ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Collateral Circulation ◽  
Mechanical Thrombectomy

scholarly journals Predictors of the functional outcome after thrombolysis in an Egyptian patients’ sample

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
H. M. Eldeeb ◽  
D. H. Elsalamawy ◽  
A. M. Elabd ◽  
H. S. Abdelraheem
Keyword(s):  
Ischemic Stroke ◽  
Hospital Stay ◽  
Functional Outcome ◽  
Arterial Occlusion ◽  
University Hospital ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Predicting Factors ◽  
Egyptian Patients ◽  
Cerebrovascular Stroke

Abstract Background About 6.2 million individuals worldwide and approximately 200 Egyptians/100,000 citizens have cerebrovascular stroke annually, and only less than 1% of stroke patients received intravenous (IV) thrombolysis in 2014. Outcome of the ischemic stroke after IV thrombolysis varies, and there is lack of data about the predicting factors that contributes to the outcome of ischemic strokes after IV thrombolysis in Egypt. Objective The aim of this work is to study the predictors of the functional outcome of ischemic cerebrovascular stroke after IV thrombolysis in Egyptian patients. Patients and methods This is a prospective study that includes acute ischemic stroke patients who received IV thrombolysis at the Alexandria University Hospital during the year from February 2017 to February 2018, and they were evaluated initially by Rapid Arterial Occlusion Evaluation (RACE) scale and followed-up serially for 6 months after thrombolysis using the National Institutes of Health Stroke Scale (NIHSS) and modified ranking score (mRS). Results Forty-five patients are included; 56% had favorable functional outcome (mRS 0–2) after 6 months, 68% had ≥ 4 points improvement in NIHSS after 6 months, and 13% had hemorrhagic conversion with 18% mortality rate. High initial RACE scale and long hospital stay are associated with poor functional outcome 6 months after thrombolysis. Conclusion Stroke severity demonstrated by high initial RACE and the duration of hospital stay are the two most significant predictors with an impact on the functional outcome of ischemic cerebrovascular stroke after thrombolysis.

Blood pressure and collateral circulation in acute ischemic stroke

Herz ◽  
2018 ◽  
Vol 44 (5) ◽  
pp. 455-459 ◽  
Author(s):  
A. Wufuer ◽  
P. Mijiti ◽  
R. Abudusalamu ◽  
H. Dengfeng ◽  
C. Jian ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Collateral Circulation
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