Accelerated MR Evaluation of Patients with Suspected Large Arterial Vessel Occlusion: Diagnostic Performances of the FLAIR Vessel Hyperintensities

2020 ◽  
Vol 83 (4) ◽  
pp. 389-394
Author(s):  
Romain Bourcier ◽  
Romain Thiaudière ◽  
Laurence Legrand ◽  
Benjamin Daumas-Duport ◽  
Hubert Desal ◽  
...  
Keyword(s):  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Flair Sequence ◽  
Vascular Flow ◽  
Academic Center ◽  
Fluid Attenuated Inversion Recovery ◽  
Speed Up ◽  
Digital Subtracted Angiography

Background: Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) document slowed vascular flow at the level and after the occlusion site patients with acute ischemic stroke (AIS). We aimed to assess the accuracy of FVH for the confirmation and location of a large vessel occlusion (LVO). Methods: Three radiologists reviewed the FLAIR sequence of the admission MRI exam of patients with suspected AIS at a single academic center. Readers were provided with the main clinical deficit with National Institute of Health Stroke Severity score and were asked to identify and locate an LVO when appropriate. Kappa coefficients were calculated for agreement along with diagnosis performances of FVH to recognize and locate an LVO with digital subtracted angiography (DSA) as gold standard. Results: Among 125 patients screened with MRI for a suspected AIS, 96 (81%) were diagnosed with AIS and 47 (38%) patients had an anterior LVO of whom 25 (20%) had a DSA for mechanical thrombectomy. Kappa coefficients for intra- and inter-readers were good to excellent. Overall, the sensitivity and the specificity of the FVH to predict an anterior LVO was 0.98 (95% confidence interval [CI]: 0.94–1) and 0.86 (95% CI: 0.79–0.96), respectively, while PPV and NPV were 0.87 (95% CI: 0.85–0.95) and 0.98 (0.97–1), respectively. FVH also showed good to excellent accuracy for identifying M1 and M2 versus internal carotid artery occlusion site. Conclusion: We found that FVH demonstrated excellent diagnostic performances for the identification of LVO and its level with good to excellent reproducibility. This MRI radio marker of occlusion provides additional arguments and may speed-up the detection of potential candidates for MT.

scholarly journals Inhibition of Vascular Nitric Oxide after Rat Chronic Brain Hypoperfusion: Spatial Memory and Immunocytochemical Changes

2005 ◽  
Vol 25 (6) ◽  
pp. 663-672 ◽  
Author(s):  
Jack C. de la Torre ◽  
Gjumrakch Aliev
Keyword(s):  
Nitric Oxide ◽  
Spatial Memory ◽  
Memory Function ◽  
Critical Role ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Significant Loss ◽  
Electron Microscopic ◽  
Vessel Occlusion ◽  
Common Carotid Artery Occlusion

An aging rat model of chronic brain hypoperfusion (CBH) that mimics human mild cognitive impairment (MCI) was used to examine the role of nitric oxide synthase (NOS) isoforms on spatial memory function. Rats with CBH underwent bilateral common carotid artery occlusion (2-vessel occlusion (2-VO)) for either 26 or 8 weeks and were compared with nonoccluded sham controls (S-VO). The neuronal and endothelial (nNOS/eNOS) constitutive inhibitor nitro-L-arginine methyl ester (L-NAME) 20 mg/kg was administered after 26 weeks for 3 days to 2-VO and S-VO groups and spatial memory was assessed with a modified Morris watermaze test. Only 2-VO rats worsened their spatial memory ability after L-NAME. Electron microscopic immunocytochemical examination using an antibody against eNOS showed 2-VO rats had significant loss or absence of eNOS-containing positive gold particles in hippocampal endothelium and these changes were associated with endothelial cell compression, mitochondrial damage and heavy amyloid deposition in hippocampal capillaries and perivascular region. In the 8-week study, three groups of 2-VO rats were administered an acute dose of 7-NI, aminoguanidine or L-NIO, the relatively selective inhibitors of nNOS, inducible NOS and eNOS. Only rats administered the eNOS inhibitor L-NIO worsened markedly their watermaze performance ( P=0.009) when compared with S-VO nonoccluded controls. We conclude from these findings that vascular nitric oxide derived from eNOS may play a critical role in spatial memory function during CBH possibly by keeping cerebral perfusion optimal through its regulation of microvessel tone and cerebral blood flow and that disruption of this mechanism can result in spatial memory impairment. These findings may identify therapeutic targets for preventing MCI and treating Alzheimer's disease.

Abstract TP64: Negative-FLAIR Vascular Hyperintensities Serves as a Marker of Chronic Major Arterial Occlusion in Acute Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Junya Aoki ◽  
Kentaro Suzuki ◽  
Yuki Sakamoto ◽  
Arata Abe ◽  
Satoshi Suda ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
Multivariate Regression Analysis ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
National Institutes Of Health ◽  
Chronic Occlusion ◽  
Fluid Attenuated Inversion Recovery

Introduction: Because acute fluid-attenuated inversion recovery vascular hyperintensities (FVH) represent disordered blood flow, FVH has been considered as a marker of major arterial occlusions. Contrary, the role of absence of FVH (negative-FVH) is unknown. Hypothesis: We hypothesized that negative-FVH may indicate chronic occlusion. Thus, we investigated the clinical characteristics and neuroimaging findings in patients with negative-FVH and major arterial occlusion. Methods: Consecutive acute stroke patients within 24 hours of onset and major arterial occlusion on magnetic resonance angiography (MRA) were studied. All patients were examined using serial angiography to evaluate the presence of recanalization. Patients were classified into two groups (NF: group without FVH, F: group with FVH). Results: Seventy-two patients (49 [68%] males, 76 [66-83] years) were enrolled. Thirty-six (50%) patients were treated with acute recanalization therapy, including the intravenous thrombolysis or endovascular therapy. On admission, 10 patients were NF group and 62 were F group. Initial National Institutes of Health Stroke Scale (NIHSS) score was 4 (2-8) in NF group and 10 (4-21) in F group (p=0.012). The rate of internal carotid artery occlusion was similar between NF and F group (20% vs. 29%, p=0.716). Serial angiography studies revealed that recanalization was achieved in only 1 (10%) of the 10 patients with NF group and 49 (79%) of the 62 patients with F group during hospitalization (p<0.001). When all patients divided into 2 groups based on the presence or absence of recanalization, patients with recanalization were younger (p=0.023), had higher NIHSS (p=0.008), earlier admission (p=0.014), higher prevalence of atrial fibrillation (p=0.010), and frequently treated with acute recanalization therapy (p=0.040). When multivariate regression analysis was conducted, that Negative-FVH (odds ratio 0.061, 95% CI 0.06-0.620, p=0.018) was a negative independent factor associated with recanalization during hospitalization. Conclusions: Negative-FVH was independently associated with no recanalization during hospitalization. Negative-FLAIR may present not acute occlusion but chronic occlusion.

Abstract TMP1: Distal Hyperintense Vessels Score on Flair is a Marker of Collateral Flow Grade and Outcomes in Patients with Acute Ischemic Stroke After Endovascular Therapy

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Masatomo Miura ◽  
Makoto Nakajima ◽  
Takuya Kanamaru ◽  
Kazutaka Uchida ◽  
Manabu Shirakawa ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Therapy ◽  
Cerebral Angiography ◽  
Favorable Outcome ◽  
Stroke Severity ◽  
Collateral Flow ◽  
Flair Sequence ◽  
Inversion Recovery Imaging ◽  
Fluid Attenuated Inversion Recovery ◽  
American Society

Background: Distal hyperintense vessels (DHV) on fluid-attenuated inversion recovery imaging (FLAIR) is a noninvasive and useful imaging marker that reflects leptomeningeal collateral flow. We investigated relationship between DHV and collateral grade on cerebral angiography, and clinical outcome after endovascular therapy (EVT) in patients with AIS. Methods: We retrospectively analyzed the patients with AIS in two comprehensive stroke centers from October 2013 to February 2016. We selected the patients who underwent FLAIR sequence before EVT. DHV score (range 0-6) was evaluated based on the presence of DHV in each ASPECTS territory (M1-M6). Collateral grades on cerebral angiography were assessed with the American Society of Interventional and Therapeutic Neuroradiology Collateral Grading System (grade 0-4). Favorable clinical outcomes was defined as modified Rankin Scale [mRS] of 0-2 at 90 days. Results: A total of 60 patients (aged 71.2 ± 10.5 years; initial NIHSS score, 15 ± 8; median DWI-ASPECTS, 7) were included. DHV was detected in 42 patients (70%); median DHV score was 2 (IQR, 1-4). Higher DHV score was significantly related to better collateral flow grade ( p <0.001), and favorable outcome ( p <0.001). In multivariate analysis, DHV score predicted favorable outcome (OR 2.83 per 1 point; 95% CI 1.71-5.48; p <0.001), independent of stroke severity or successful reperfusion. Conclusions: DHV score on FLAIR is a marker of collateral flow status and can predict better clinical outcome in patients with AIS after EVT.

scholarly journals Acupuncture Rescues Cognitive Impairment and Upregulates Dopamine-β-Hydroxylase Expression in Chronic Cerebral Hypoperfusion Rats

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ling-Yong Xiao ◽  
Jing-Wen Yang ◽  
Xue-Rui Wang ◽  
Yang Ye ◽  
Na-Na Yang ◽  
...  
Keyword(s):  
Long Term Potentiation ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Chronic Cerebral Hypoperfusion ◽  
Cerebral Hypoperfusion ◽  
Vessel Occlusion ◽  
Memory Impairments ◽  
Beneficial Effects ◽  
Hippocampus Dependent Memory

Alteration of dopamine (DA) and noradrenaline (NA) contributes to cognitive function. Acupuncture has been shown to affect DA and NA in chronic cerebral hypoperfusion (CCH) rats. However, the effect of acupuncture on DA-β-hydroxylase (DBH), the biosynthetic enzyme of NA, remains unknown. In CCH rats we established chronic hypoperfusion by bilateral common carotid artery occlusion (two-vessel occlusion, 2VO) and treated them with acupuncture. Acupuncture displayed beneficial effects on hippocampus-dependent memory impairments, including nonspatial and spatial memory. That is also reflected in hippocampus long-term-potentiation (LTP). Moreover, DBH expression in the hippocampus and DBH activity in cerebrospinal fluid were upregulated after acupuncture treatment. In conclusion, these in vivo findings suggest that acupuncture exerts a therapeutic effect on hippocampus-dependent memory and hippocampus LTP in CCH rats, which may be partially related to the modulation of DBH in the hippocampus.

What constitutes the M1 segment of the middle cerebral artery?

2016 ◽  
Vol 8 (12) ◽  
pp. 1273-1277 ◽  
Author(s):  
Mayank Goyal ◽  
Bijoy K Menon ◽  
Timo Krings ◽  
Shivanand Patil ◽  
Emmad Qazi ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Intravenous Tissue Plasminogen Activator ◽  
Overwhelming Evidence ◽  
Segment Versus ◽  
Proximal Occlusion

Intravenous tissue plasminogen activator has limited efficacy in fibrinolysis of large proximal intracranial thrombi. Thus, recent endovascular acute stroke trials restricted their selection criteria to patients with proximal occlusions in the anterior circulation. Although the terminal internal carotid artery occlusion is relatively easy to identify, there is often a debate as to what constitutes a proximal (involving the M1 segment) versus a distal (involving the M2 segment and beyond) middle cerebral artery occlusion. In light of overwhelming evidence demonstrating superiority of endovascular treatment in patients with proximal occlusion, this distinction has significant practical implications in patient selection. Here we present a brief review of the proximal (M1) segment of the middle cerebral artery anatomy and provide practical methods to recognize and separate the M1 and M2 segments. In keeping with the belief that CT angiography (CTA) (preferably multiphase CTA) is the ideal screening test for patients with emergent large vessel occlusion, we have provided tips for expeditious and accurate vascular imaging interpretation.

scholarly journals Persistent or permanent atrial fibrillation is associated with severe cardioembolic stroke in patients with non-valvular atrial fibrillation

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Joji Hagii ◽  
Norifumi Metoki ◽  
Shin Saito ◽  
Hiroshi Shiroto ◽  
Satoko Sasaki ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Functional Outcome ◽  
Oral Anticoagulants ◽  
Japanese Patients ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Stroke Severity ◽  
Group 13 ◽  
Severe Stroke ◽  
The Difference

Abstract Background Little is known about the difference in the severity of cardioembolic (CE) stroke between patients with paroxysmal atrial fibrillation (PAF) and persistent/permanent AF (PerAF). We assessed stroke severity in patients with CE stroke divided by the type of AF. Methods Three hundred and fifty-eight consecutive patients with CE stroke within 48 h of onset and with a modified Rankin Scale (mRS) score ≤ 1 before onset were studied. We compared basic characteristics, stroke severity, and functional outcome between patients with PAF (n = 127) and PerAF (n = 231). Results Patients with PerAF were more likely to take oral anticoagulants (OACs) than those with PAF (37% vs. 13%, P <  0.0001), even though still underuse of OAC in both patients. Regarding stroke severity on admission, patients with PerAF exhibited a tendency toward a higher score on the National Institutes of Health Stroke Scale (NIHSS) compared with patients with PAF (12 [5–20] vs. 9 [4–18]; P = 0.12). Mortality and mRS score at discharge were higher in the PerAF than in the PAF group (13% vs. 4%; P = 0.005, and 3 [1–5] vs. 2 [1–4]; P = 0.01, respectively). Multivariate analyses confirmed that PerAF was a significant determinant of severe stroke (NIHSS score > 8) on admission (odds ratio [OR] to PAF = 1.80; 95% confidence interval [CI] 1.08–2.98; P = 0.02) and of an mRS score ≥ 3 at discharge (OR = 2.07; 95% CI 1.24–3.46; P = 0.006). Patients with PerAF had three times more internal carotid artery occlusion evaluated by magnetic resonance angiography, which indicated a more severe cerebral embolism compared with patients with PAF. Conclusions We found underuse of OAC in high risk AF patients with CE stroke. PerAF is significantly associated with severe stroke on admission and an unfavorable functional outcome at discharge in Japanese patients with CE stroke.

scholarly journals Increased Sestrin3 Contributes to Post-ischemic Seizures in the Diabetic Condition

2021 ◽  
Vol 14 ◽  
Author(s):  
Zhongshan Shi ◽  
Zhigang Lei ◽  
Fan Wu ◽  
Luoxing Xia ◽  
Yiwen Ruan ◽  
...  
Keyword(s):  
Granule Cells ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Diabetic Rats ◽  
Electrophysiological Recording ◽  
Diabetic Mice ◽  
Membrane Excitability ◽  
Vessel Occlusion ◽  
Bilateral Common Carotid Artery ◽  
Common Carotid Artery Occlusion

Seizures are among the most common neurological sequelae of stroke, and diabetes notably increases the incidence of post-ischemic seizures. Recent studies have indicated that Sestrin3 (SESN3) is a regulator of a proconvulsant gene network in human epileptic hippocampus. But the association of SESN3 and post-ischemic seizures in diabetes remains unclear. The present study aimed to reveal the involvement of SESN3 in seizures following transient cerebral ischemia in diabetes. Diabetes was induced in adult male mice and rats via intraperitoneal injection of streptozotocin (STZ). Forebrain ischemia (15 min) was induced by bilateral common carotid artery occlusion, the 2-vessel occlusion (2VO) in mice and 4-vessel occlusion (4VO) in rats. Our results showed that 59% of the diabetic wild-type mice developed seizures after ischemia while no seizures were observed in non-diabetic mice. Although no apparent cell death was detected in the hippocampus of seizure mice within 24 h after the ischemic insult, the expression of SESN3 was significantly increased in seizure diabetic mice after ischemia. The post-ischemic seizure incidence significantly decreased in SESN3 knockout mice. Furthermore, all diabetic rats suffered from post-ischemic seizures and non-diabetic rats have no seizures. Electrophysiological recording showed an increased excitatory synaptic transmission and intrinsic membrane excitability in dentate granule cells of the rat hippocampus, together with decreased IA currents and Kv4.2 expression levels. The above results suggest that SESN3 up-regulation may contribute to neuronal hyperexcitability and seizure generation in diabetic animals after ischemia. Further studies are needed to explore the molecular mechanism of SESN3 in seizure generation after ischemia in diabetic conditions.

scholarly journals Patients Receiving Extracranial to Intracranial Bypass for Atherosclerotic Vessel Occlusion Today Differ Significantly From the COSS Population

Stroke ◽  
2021 ◽  
Vol 52 (10) ◽  
Author(s):  
Lars Wessels ◽  
Nils Hecht ◽  
Peter Vajkoczy
Keyword(s):  
Cerebrovascular Disease ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Multivessel Disease ◽  
Vessel Occlusion ◽  
Ischemic Attack

Background and Purpose: Despite the findings reported in the COSS (Carotid Occlusion Surgery Study), patients with atherosclerotic cerebrovascular disease continue to be referred for superficial temporal artery to middle cerebral artery bypass surgery. Here, we determined how today’s patients differ from the population reported in COSS. Methods: We retrospectively analyzed all patients that were referred to our Department for superficial temporal artery to middle cerebral artery bypass surgery of atherosclerotic cerebrovascular disease following the publication of COSS. Results: Between 2012 and 2019, 179 patients were referred for 186 bypass surgeries. Ninety-one (51%) patients suffered atherosclerotic, unilateral internal carotid occlusion and 88 (49%) atherosclerotic multivessel disease. All patients had received intensive medical management. A single transitory ischemic attack or ischemic stroke within the last 120 days according to the inclusion criteria of COSS occurred in only 36 out of 179 (20%) patients, whereas 27 out of 179 (15%) suffered >1 transitory ischemic attack within 120 days, 109 out of 179 (61%) had recurrent minor ischemic stroke, and 7 out of 179 (4%) were hemodynamically unstable and required blood pressure maintenance. The distribution of symptoms did not differ between atherosclerotic unilateral internal carotid artery occlusion and atherosclerotic multivessel disease ( P =0.376) but hemodynamic impairment was significantly greater in atherosclerotic multivessel disease ( P <0.001 for atherosclerotic multivessel disease versus atherosclerotic unilateral internal carotid artery occlusion). The overall perioperative stroke rate was 4.3%. Conclusions: Patients referred for flow augmentation surgery today appear to suffer more severe symptoms and vessel occlusion patterns than patients reported in COSS. A new, carefully designed randomized controlled trial appears warranted, considering the still poor prognosis of severe atherosclerotic cerebrovascular disease.

Abstract 42: A Talin Mutant that Disrupts Talin-integrin Binding in Platelets Decelerates aIIbß3 Activation Without Pathological Bleeding

2013 ◽  
Vol 33 (suppl_1) ◽  
Author(s):  
Lucia Stefanini ◽  
Adam Snider ◽  
Raymond Piatt ◽  
Brian Petrich ◽  
Wolfgang Bergmeier
Keyword(s):  
Thrombus Formation ◽  
Kinetic Studies ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Proximal Region ◽  
Integrin Activation ◽  
Vessel Occlusion ◽  
Specific Expression ◽  
Shear Rates ◽  
Static Conditions

Tight regulation of integrin affinity is a critical component of hemostasis. The final step of integrin inside-out activation is talin binding to two distinct sites within the integrin β cytoplasmic tail, an NPLY sequence and a membrane-proximal region (MPR). Selective deletion of talin1 from platelets (Tln1fl/flPf4-Cre+) completely prevents integrin activation and thrombus formation, and results in profound defects in hemostasis. Interestingly, platelet-specific expression of a talin1 mutant (L325R) that lacks the ability to bind the MPR, but can still bind the NPLY sequence, phenocopies talin1-knockout platelets. In this study we sought to analyze the effects on thrombosis and hemostasis of a platelet-specific talin1 mutation (W359A) that dramatically impairs binding to the NPLY sequence and does not rescue the talin1 deficiency in transfected cells. Homozygous knock-in of talin(W359A) is embryonic lethal in mice. Thus, Tln1W359A/wt mice were crossed with Tln1fl/flPf4-Cre+ mice to generate Tln1W359A/flPf4-Cre+ (TlnWA) and Tln1wt/flPf4-Cre+ (Tlnwt) control mice. Expression of talin(W359A) in platelets partially rescued talin1 deficiency. Compared to Tlnwt controls, agonist-induced αIIbβ3 activation was reduced by ~50% and spreading on fibrinogen was only moderately impaired in TlnWA platelets. However, kinetic studies demonstrated decelerated αIIbβ3 activation in TlnWA platelets, which resulted in delayed aggregation under static conditions and reduced thrombus size at low shear rates. Interestingly, adhesion of TlnWA platelets to collagen at high shear rates was not significantly better than that of talin-deficient cells and TlnWA mice were completely protected from FeCl3-induced carotid artery occlusion. Lastly, in contrast to platelet-specific talin-knockout or TlnLR mice, TlnWA mice showed no detectable gastrointestinal bleeding and only modestly increased tail-bleeding times compared to littermate controls. In conclusion, we demonstrate that the talin(W359A) mutation decelerates, but does not abolish, talin-dependent integrin activation in platelets. Our studies further suggest that this delay in integrin activation is protective from pathological vessel occlusion while it does not affect hemostasis in mice.

Recanalization of Acute Common Carotid Artery Occlusion: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (5) ◽  
pp. 633-633 ◽  
Author(s):  
Thomas J Sorenson ◽  
Harry Cloft ◽  
Alejandro Rabinstein ◽  
Giuseppe Lanzino
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Vessel Occlusion ◽  
Major Vessel ◽  
Common Carotid Artery Occlusion ◽  
Treatment Risks ◽  
Major Stroke

Abstract While revascularization of the acutely or chronically occluded internal carotid artery has become commonplace with modern endovascular techniques, revascularization of an acutely occluded common carotid artery (CCA) is a controversial procedure with unique challenges. These challenges can be related to the lack of observable markers for identifying vessels during navigation or for identifying the exact location and extent of occlusion within the CCA, in addition to wide-ranging treatment risks. In this video, we illustrate the controversial revascularization of a 68-yr-old woman with an acute CCA occlusion who presented with fluctuating neurological symptoms. We believed treatment to be indicated by the lack of adequate collaterals on the intracranial CTA, and fluctuating symptoms in the absence of an intracranial major vessel occlusion, suggesting that the CCA occlusion was exerting important hemodynamic effects and at risk of causing a major stroke without revascularization, despite a low initial NIH stroke score. Though acute recanalization of patients with low NIH stroke score with stent-angioplasty is a controversial procedure, we believed it to be necessary in the case of our patient and believe it will likely be the focus of the next wave of large clinical trials dedicated to acute stroke.

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