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

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.

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

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.

scholarly journals Appropriateness of pediatric CT utilization in clinical practice

2019 ◽  
pp. 4-17
Author(s):  
Panruethai Trinavarat ◽  
Nisanard Pisuchpen ◽  
Sasitorn Petcharunpaisan ◽  
Darintr Sosothikul ◽  
Jitladda Deerojanawong ◽  
...  
Keyword(s):  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
Computed Tomographic Angiography ◽  
P Value ◽  
Anterior Circulation ◽  
Independent Predictive Factor ◽  
Middle Cerebral Artery Infarction ◽  
Clinical Criteria ◽  
Computed Tomographic ◽  
Tomographic Angiography

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.

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

2015 ◽  
Vol 6 (01) ◽  
pp. 059-064 ◽  
Author(s):  
Pornpatr A. Dharmasaroja ◽  
Arvemas Watcharakorn ◽  
Utairat Chaumrattanakul
Keyword(s):  
Computed Tomography ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Anterior Circulation ◽  
Severe Stroke ◽  
Middle Cerebral Artery Infarct ◽  
Multimodal Ct

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.

scholarly journals Prediction of Malignant Acute Middle Cerebral Artery Infarction via Computed Tomography Radiomics

2020 ◽  
Vol 14 ◽  
Author(s):  
Xuehua Wen ◽  
Yumei Li ◽  
Xiaodong He ◽  
Yuyun Xu ◽  
Zhenyu Shu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Middle Cerebral Artery Infarction

Association Between Preoperative Midline Shift Growing Rate and Outcomes of Decompressive Craniectomy in Patients with Malignant Middle Cerebral Artery Infarction

2020 ◽  
Vol 17 (2) ◽  
pp. 131-139
Author(s):  
Ruozhen Yuan ◽  
Simiao Wu ◽  
Yajun Cheng ◽  
Kaili Ye ◽  
Zilong Hao ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Decompressive Craniectomy ◽  
Mass Effect ◽  
Midline Shift ◽  
Middle Cerebral Artery Infarction ◽  
West China Hospital ◽  
Computed Tomography Scans ◽  
Adequate Decompression

Background: Whether preoperative midline shift and its growing rate are associated with outcomes of decompressive craniectomy in patients with malignant middle cerebral artery infarction is unknown. Methods: We retrospectively included patients: 1) who underwent decompressive craniectomy for malignant middle cerebral artery infarction in West China Hospital from August 2010 to December 2, 2018) who had at least two brain computed tomography scans before decompressive craniectomy. Midline shift was measured on the first and last preoperative computed tomography scans. Midline shift growing rate was calculated by dividing Δmidline shift value using Δ time. The primary outcome was inadequate decompression of the mass effect. Secondary outcomes were 3 month death and unfavorable outcomes. Results: Sixty-one patients (mean age 53.7 years, 57.4% (35/61) male) were included. Median time from onset to decompressive craniectomy was 51.8 h (interquartile range: 39.7-77.8). Rates of inadequate decompression, 3 month death, 3 month modified Rankin Scale 5-6 and 4-6 were 50.8% (31/61), 50.9% (29/57), 64.9% (37/57) and 84.2% (48/57), respectively. The inadequate decompression group had a higher midline shift growing rate than the adequate decompression group (median: 2.7 mm/8 h vs. 1.4 mm/8 h, P=0.041). No intergroup difference of 3 month outcomes was found in terms of preoperative midline shift growing rate. Conclusion: Higher preoperative midline shift growing rate was associated with inadequate decompression of decompressive craniectomy in patients with malignant middle cerebral artery infarction.

scholarly journals Attenuated Corticomedullary Contrast: An Early Cerebral Computed Tomography Sign Indicating Malignant Middle Cerebral Artery Infarction

Stroke ◽  
1999 ◽  
Vol 30 (5) ◽  
pp. 1076-1082 ◽  
Author(s):  
Hans-Peter Haring ◽  
Erika Dilitz ◽  
Anton Pallua ◽  
Gerald Hessenberger ◽  
Andreas Kampfl ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Middle Cerebral Artery Infarction ◽  
Cerebral Computed Tomography

scholarly journals Twin Middle Cerebral Artery with Aneurysm: A Variant of Early Bifurcation or a Discrete Entity

2017 ◽  
Vol 08 (S 01) ◽  
pp. S114-S116
Author(s):  
Sushant Sahoo ◽  
Sunil Singh ◽  
Anit Parihar
Keyword(s):  
Computed Tomography ◽  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Arterial Wall ◽  
Distinct Pattern ◽  
Branching Pattern ◽  
Digital Subtraction ◽  
Anterior Circulation ◽  
Computed Tomography Angiogram

ABSTRACTThe middle cerebral artery (MCA) usually bifurcates into a superior or frontal and inferior or temporal branch. However, it may have various branching pattern, and there may be additional arteries from the anterior circulation supplying its territory. The majority of them remain asymptomatic. Some cases may have aneurismal dilatation due to turbulent blood flow or the weak arterial wall. The surgical approach in these cases may be challenging due to complex anatomical pattern of MCA. In this report, we have described a distinct pattern of left MCA with an aneurysm which was not clear in computed tomography angiogram and further confirmed on digital subtraction angiography. The different anatomical patterns of MCA and their surgical implications have also been discussed.

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