Pathophysiology of acute middle cerebral artery infarct by multimodal computed tomography: A pilot study in Thai patients

ABSTRACTMultimodal computed tomography, including non-contrast computed tomography (CT), computed tomography perfusion (CTP) and computed tomography angiography (CTA), has been increasingly used. Aims: The purpose of this study was to study pathophysiology of acute middle cerebral artery infarct using multimodal CT and to evaluate the safety and feasibility of this method in our center. Materials and Methods: Patients who had moderate to severe stroke (NIHSS score > 10), suspected of anterior circulation infarct and presented within 4 hours after stroke onset were prospectively included. Multimodal CTs, using low-osmolar contrast agents, were performed in all patients. Results: Twenty-two patients were included. Mean NIHSS was 16. All patients received intravenous thrombolysis. Favorable outcome was found in nine patients (41%). CTP was unable to identify ischemic lesions in three patients with small subcortical infarct. Most patients (82%) with large middle cerebral artery infarct still had some salvageable brain (penumbra) which partly recovered in a follow-up imaging. Eleven patients (50%) had major artery occlusion. Two patients had creatinine rising within 72 hours. Conclusions: Multimodal CT does provide information about status of major artery and the volume of salvageable/infarct brain tissue and is safely and easily applicable in our center.

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Value of computed tomography angiographic collateral status in prediction of malignant middle cerebral artery infarction

The ASEAN Journal of Radiology ◽

10.46475/aseanjr.2020.01 ◽

2020 ◽

pp. 4-20

Author(s):

Sasitorn Petcharunpaisan ◽

Wannaporn Ngernbumrung ◽

Sukalaya Lerdlum

Keyword(s):

Computed Tomography ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Arterial Occlusion ◽

Intravenous Thrombolysis ◽

P Value ◽

Anterior Circulation ◽

Independent Predictive Factor ◽

Middle Cerebral Artery Infarction ◽

Clinical Criteria

Background: Cerebral collateral circulation is necessary to maintain cerebral blood flow and penumbra when arterial insufficiency occurred. Only a few studies about collateral status on development of malignant middle cerebral artery infarction (mMCAi) have been documented. Objective: To determine whether collateral status evaluated by single phase computed tomographic angiography (CTA) help prediction of mMCAi in patients with large arterial occlusion whom not received endovascular treatment. Material and Methods: We retrospectively reviewed patients with acute ischemic stroke in anterior circulation in our institute during January 2015 to December 2015. We analyzed clinical data, baseline National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS) on baseline nonenhanced computed tomography of the brain (NECT brain), and CTA collateral status. Malignant MCA infarction was defined according to clinical criteria. Results: Thirty-five patients were included. Mean age was 68.8±15.56 years. Mean baseline NIHSS and baseline ASPECTS were 17(±5) and 6(±3), respectively. All patients received intravenous thrombolysis. CTA collateral status and baseline NECT ASPECTS significantly correlated with development of mMCAi (P-value = 0.007 and 0.001). Only baseline NECT ASPECTS was an independent predictive factor for mMCAi (OR 0.63, 95%CI 0.46-0.86, P-value =0.004). Patients with baseline NECT ASPECTS ≤ 7 were more likely develop mMCAi (OR 14.29 95%CI 1.57-129.94, P-value 0.018). Conclusion: In acute stroke patients with proximal MCA or ICA occlusion received intravenous thrombolysis alone, baseline NECT ASPECTS and CTA collateral status were significantly correlate with development of mMCAi. However, only baseline ASPECTS ≤ 7 was an independent predictor for mMCAi.

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Outcomes of patients with large middle cerebral artery infarct treated with and without intravenous thrombolysis

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.172149 ◽

2016 ◽

Vol 7 (01) ◽

pp. 36-39

Author(s):

Pornpatr A. Dharmasaroja ◽

Sombat Muengtaweepongsa

Keyword(s):

Intracerebral Hemorrhage ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Demographic Data ◽

Intravenous Thrombolysis ◽

Recombinant Tissue Plasminogen Activator ◽

Severe Stroke ◽

Symptomatic Intracerebral Hemorrhage ◽

Significant Difference ◽

Middle Cerebral Artery Infarct

ABSTRACT Background: Many thrombolytic studies showed that severe stroke was associated with death and having symptomatic intracerebral hemorrhage and inversely related to a favorable outcome. Aims: The purpose of this study is to compare the outcomes of patients with acute large middle cerebral artery (MCA) infarction with and without intravenous recombinant-tissue-plasminogen activator (rtPA) treatment. Methods: Patients with acute, large MCA infarction (National Institute of Health Stroke Scale [NIHSS] >15) who were treated during 2011–2014 were studied. The demographic data and the outcomes were compared between patients with and without intravenous rtPA treatment. Results: Two hundred and forty patients were included. Mean NIHSS score was 20. One hundred and twenty patients were treated with intravenous rtPA treatment. The patients with rtPA treatment had higher rates of favorable outcomes (39% vs. 17%, P < 0.001) and lower mortality rate (16% vs. 51%, P < 0.001). There was no significant difference in the occurrence of symptomatic intracerebral hemorrhage (6% vs. 4%, P = 0.715). Conclusions: The study showed the benefit and safety of intravenous rtPA treatment in patients with acute large MCA infarct.

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Value of computed tomography angiographic collateral status in prediction of malignant middle cerebral artery infarction

The ASEAN Journal of Radiology ◽

10.46475/aseanjr.v21i1.51 ◽

2020 ◽

Vol 21 (1) ◽

pp. 04-20

Author(s):

Sasitorn Petcharunpaisan ◽

Wannaporn Ngernbumrung ◽

Sukalaya Lerdlum

Keyword(s):

Computed Tomography ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Arterial Occlusion ◽

Intravenous Thrombolysis ◽

P Value ◽

Anterior Circulation ◽

Independent Predictive Factor ◽

Middle Cerebral Artery Infarction ◽

Clinical Criteria

Background: Cerebral collateral circulation is necessary to maintain cerebral blood flow and penumbra when arterial insufficiency occurred. Only a few studies about collateral status on development of malignant middle cerebral artery infarction (mMCAi) have been documented. Objective: To determine whether collateral status evaluated by single phase computed tomographic angiography (CTA) help prediction of mMCAi in patients with large arterial occlusion whom not received endovascular treatment. Material and Methods: We retrospectively reviewed patients with acute ischemic stroke in anterior circulation in our institute during January 2015 to December 2015. We analyzed clinical data, baseline National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS) on baseline nonenhanced computed tomography of the brain (NECT brain), and CTA collateral status. Malignant MCA infarction was defined according to clinical criteria. Results: Thirty-five patients were included. Mean age was 68.8±15.56 years. Mean baseline NIHSS and baseline ASPECTS were 17(±5) and 6(±3), respectively. All patients received intravenous thrombolysis. CTA collateral status and baseline NECT ASPECTS significantly correlated with development of mMCAi (P-value = 0.007 and 0.001). Only baseline NECT ASPECTS was an independent predictive factor for mMCAi (OR 0.63, 95%CI 0.46-0.86, P-value =0.004). Patients with baseline NECT ASPECTS ? 7 were more likely develop mMCAi (OR 14.29 95%CI 1.57-129.94, P-value 0.018). Conclusion: In acute stroke patients with proximal MCA or ICA occlusion received intravenous thrombolysis alone, baseline NECT ASPECTS and CTA collateral status were significantly correlate with development of mMCAi. However, only baseline ASPECTS ? 7 was an independent predictor for mMCAi.

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Automated Detection of Intracranial Large Vessel Occlusions on Computed Tomography Angiography

Stroke ◽

10.1161/strokeaha.119.026259 ◽

2019 ◽

Vol 50 (10) ◽

pp. 2790-2798 ◽

Cited By ~ 9

Author(s):

Shalini A. Amukotuwa ◽

Matus Straka ◽

Heather Smith ◽

Ronil V. Chandra ◽

Seena Dehkharghani ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Middle Cerebral Artery Occlusion ◽

Negative Predictive Value ◽

Cerebral Artery ◽

Predictive Value ◽

Artery Occlusion ◽

Anterior Circulation ◽

Cerebral Artery Occlusion

Background and Purpose— Endovascular thrombectomy is highly effective in acute ischemic stroke patients with an anterior circulation large vessel occlusion (LVO), decreasing morbidity and mortality. Accurate and prompt identification of LVOs is imperative because these patients have large volumes of tissue that are at risk of infarction without timely reperfusion, and the treatment window is limited to 24 hours. We assessed the accuracy and speed of a commercially available fully automated LVO-detection tool in a cohort of patients presenting to a regional hospital with suspected stroke. Methods— Consecutive patients who underwent multimodal computed tomography with thin-slice computed tomography angiography between January 1, 2017 and December 31, 2018 for suspected acute ischemic stroke within 24 hours of onset were retrospectively identified. The multimodal computed tomographies were assessed by 2 neuroradiologists in consensus for the presence of an intracranial anterior circulation LVO or M2-segment middle cerebral artery occlusion (the reference standard). The patients’ computed tomography angiographies were then processed using an automated LVO-detection algorithm (RAPID CTA). Receiver-operating characteristic analysis was used to determine sensitivity, specificity, and negative predictive value of the algorithm for detection of (1) an LVO and (2) either an LVO or M2-segment middle cerebral artery occlusion. Results— CTAs from 477 patients were analyzed (271 men and 206 women; median age, 71; IQR, 60–80). Median processing time was 158 seconds (IQR, 150–167 seconds). Seventy-eight patients had an anterior circulation LVO, and 28 had an isolated M2-segment middle cerebral artery occlusion. The sensitivity, negative predictive value, and specificity were 0.94, 0.98, and 0.76, respectively for detection of an intracranial LVO and 0.92, 0.97, and 0.81, respectively for detection of either an intracranial LVO or M2-segment middle cerebral artery occlusion. Conclusions— The fully automated algorithm had very high sensitivity and negative predictive value for LVO detection with fast processing times, suggesting that it can be used in the emergent setting as a screening tool to alert radiologists and expedite formal diagnosis.

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