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 Collateral flow as causative of good outcomes in endovascular stroke therapy

2014 ◽  
Vol 8 (1) ◽  
pp. 2-7 ◽  
Author(s):  
Sunil A Sheth ◽  
Nerses Sanossian ◽  
Qing Hao ◽  
Sidney Starkman ◽  
Latisha K Ali ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Clinical Laboratory ◽  
Infarct Volume ◽  
Stroke Severity ◽  
Collateral Flow ◽  
Vessel Occlusion ◽  
Tertiary Referral Center ◽  
Acute Cerebral Ischemia ◽  
American Society ◽  
Time Of Presentation

BackgroundEndovascular reperfusion techniques are a promising intervention for acute ischemic stroke (AIS). Prior studies have identified markers of initial injury (arrival NIH stroke scale (NIHSS) or infarct volume) as predictive of outcome after these procedures. We sought to define the role of collateral flow at the time of presentation in determining the extent of initial ischemic injury and its influence on final outcome.MethodsDemographic, clinical, laboratory, and radiographic data were prospectively collected on a consecutive cohort of patients who received endovascular therapy for acute cerebral ischemia at a single tertiary referral center from September 2004 to August 2010.ResultsHigher collateral grade as assessed by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading scheme on angiography at the time of presentation was associated with improved reperfusion rates after endovascular intervention, decreased post-procedural hemorrhage, smaller infarcts on presentation and discharge, as well as improved neurological function on arrival to the hospital, discharge, and 90 days later. Patients matched by vessel occlusion, age, and time of onset demonstrated smaller strokes on presentation and better functional and radiographic outcome if found to have superior collateral flow. In multivariate analysis, lower collateral grade independently predicted higher NIHSS on arrival.ConclusionsImproved collateral flow in patients with AIS undergoing endovascular therapy was associated with improved radiographic and clinical outcomes. Independent of age, vessel occlusion and time, in patients with comparable ischemic burdens, changes in collateral grade alone led to significant differences in initial stroke severity as well as ultimate clinical outcome.

Abstract T P25: Poor Collaterals Necessitate Early Reperfusion: Relationship Between Time to Reperfusion, Collateral Flow, and Clinical Outcome

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Yang-Ha Hwang ◽  
Dong-Hun Kang ◽  
Yong-Won Kim ◽  
Yong-Sun Kim
Keyword(s):  
Clinical Outcome ◽  
Endovascular Therapy ◽  
Odds Ratio ◽  
Time Window ◽  
Favorable Outcome ◽  
Collateral Flow ◽  
Vessel Occlusion ◽  
Early Reperfusion ◽  
Complete Group ◽  
The Poor

Background: Clinical outcome following reperfusion can be affected by the adequacy of baseline collaterals during endovascular therapy. We examined the relationship between onset-to-reperfusion time (ORT), collateral grade, and clinical outcome with the hypothesis that there is a narrow therapeutic time window for good clinical outcomes in patients having poor collaterals. Methods: Among 300 patients who underwent endovascular therapy for acute large vessel occlusion in the anterior circulation, we identified 220 patients having a final TICI score of 2 or more. Patients’ collateral grades, using the ASITN/SIR scale on baseline angiography, were dichotomized into poor (0-1) versus partial/complete (2-4). Favorable functional outcome was defined as a 3-month mRS of 0-2. Results: Angiographic data on collaterals were available for 207/220 patients, with 76 in the poor collateral group and 131 in the partial/complete group. The TICI 2b-3 reperfusion rates were similar between the two groups [51/76 (67%) vs. 89/131 (68%), p=0.902], though functional outcomes were significantly different [35/76 (46%) vs. 81/131 (63%), p=0.027]. In the poor collateral group, the odds of favorable outcome significantly dropped for patients reperfused beyond 6-hour from onset [28/53 (54%) vs. 7/24 (29%); odds ratio 0.35 (95% CI 0.13-0.99); p=0.045], whereas the probability of favorable outcome in partial/complete group was not as influenced by reperfusion beyond the 6-hour time window [56/85 (66%) vs. 25/46 (54%); odds ratio 0.62 (95% CI 0.30-1.29); p=0.195]. In subgroup analysis of the poor collateral group, each 30-minute increase in ORT was associated with a decreased chance of favorable outcome despite reperfusion after adjustment for age, baseline NIHSS score, and baseline ASPECTS score [odds ratio 0.77 (95% CI 0.64-0.93); p=0.006]. Conclusions: Onset-to-reperfusion time in patients with poor collaterals is an another important factor affecting favorable outcome, and future trials would benefit from a non-invasive imaging technique to detect poor collaterals along with a strategy for early reperfusion.

scholarly journals Hyperintense posterior cerebral artery sign in patients with reversible cerebral vasoconstriction syndrome

2021 ◽  
Vol 12 ◽  
pp. 558
Author(s):  
Masaaki Imai ◽  
Masami Shimoda ◽  
Shinri Oda ◽  
Kaori Hoshikawa ◽  
Takahiro Osada ◽  
...  
Keyword(s):  
Acute Phase ◽  
Cerebral Arteries ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
White Matter Hyperintensity ◽  
Collateral Flow ◽  
Clinical Factor ◽  
Peripheral Vessel ◽  
Cerebral Vasoconstriction ◽  
Inversion Recovery Imaging ◽  
Fluid Attenuated Inversion Recovery

Background: This study investigated hyperintense vessel signs (HVS) on fluid-attenuated inversion recovery imaging in the P1–2 portions of posterior cerebral arteries (PCAs) as a “hyperintense PCA sign” and HVS of cortical arteries. We retrospectively examined whether these signs would be useful in diagnosing reversible cerebral vasoconstriction syndrome (RCVS) in the acute phase. Methods: Eighty patients with RCVS who underwent initial magnetic resonance imaging (MRI) within 7 days of onset were included in this study. HVS and related clinical factors were examined. Results: On initial MRI of RCVS patients, hyperintense PCA sign and HVS of cortical arteries were seen in 21 cases (26%) and 38 cases (48%), respectively. In patients showing hyperintense PCA sign, vasoconstriction of the A2–3 portion was a significant clinical factor. Conversely, vasoconstriction of the M1 and P1 portions and the presence of white matter hyperintensity on initial and chronic-stage MRI were significantly associated with the presence of HVS in cortical arteries. Conclusion: Because rich collateral flow exists around PCAs, the frequency of hyperintense PCA sign is not high. However, hyperintense PCA sign findings in patients with suspected RCVS offer credible evidence of extreme flow decreases due to vasoconstriction in peripheral PCAs and other arteries associated with the collateral circulation of PCAs. Conversely, HVS in cortical arteries tend to reflect slow antegrade circulation due to vasoconstriction of peripheral vessel and major trunks. Both signs appear useful for auxiliary diagnosis of acute-phase RCVS.

CTA collateral score predicts infarct volume and clinical outcome after endovascular therapy for acute ischemic stroke: a retrospective chart review

2015 ◽  
Vol 8 (6) ◽  
pp. 559-562 ◽  
Author(s):  
Lucas Elijovich ◽  
Nitin Goyal ◽  
Shraddha Mainali ◽  
Dan Hoit ◽  
Adam S Arthur ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Chart Review ◽  
Infarct Volume ◽  
Retrospective Chart Review ◽  
Favorable Outcome ◽  
Good Clinical Outcome

BackgroundAcute ischemic stroke (AIS) due to emergent large-vessel occlusion (ELVO) has a poor prognosis.ObjectiveTo examine the hypothesis that a better collateral score on pretreatment CT angiography (CTA) would correlate with a smaller final infarct volume and a more favorable clinical outcome after endovascular therapy (EVT).MethodsA retrospective chart review of the University of Tennessee AIS database from February 2011 to February 2013 was conducted. All patients with CTA-proven LVO treated with EVT were included. Recanalization after EVT was defined by Thrombolysis in Cerebral Infarction (TICI) score ≥2. Favorable outcome was assessed as a modified Rankin Score ≤3.ResultsFifty patients with ELVO were studied. The mean National Institutes of Health Stroke Scale score was 17 (2–27) and 38 of the patients (76%) received intravenous tissue plasminogen activator. The recanalization rate for EVT was 86.6%. Good clinical outcome was achieved in 32% of patients. Univariate predictors of good outcome included good collateral scores (CS) on presenting CTA (p=0.043) and successful recanalization (p=0.02). Multivariate analysis confirmed both good CS (p=0.024) and successful recanalization (p=0.009) as predictors of favorable outcome. Applying results of the multivariate analysis to our cohort we were able to determine the likelihood of good clinical outcome as well as predictors of smaller final infarct volume after successful recanalization.ConclusionsGood CS predict smaller infarct volumes and better clinical outcome in patients recanalized with EVT. These data support the use of this technique in selecting patients for EVT. Poor CS should be considered as an exclusion criterion for EVT as patients with poor CS have poor clinical outcomes despite recanalization.

Abstract W P137: Blood Viscosity Determinants and Clinical Outcome after Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kazutaka Nishimura ◽  
Masatoshi Koga ◽  
Kazuyuki Nagatsuka ◽  
Kazuo Minematsu ◽  
Kazunori Toyoda
Keyword(s):  
Shear Stress ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Blood Viscosity ◽  
National Institutes Of Health ◽  
Favorable Outcome ◽  
Stroke Severity ◽  
Yield Shear Stress ◽  
Important Regulator

Backgrounds and Purposes: Both hematocrit (Hct) and fibrinogen (Fbg) are major blood viscosity determinants. Blood viscosity is known to be an important regulator of cerebral blood flow. However, the relationships of Hct and Fbg with clinical outcome after ischemic stroke are controversial. We aimed to elucidate association of these viscosity determinants with clinical outcome. Methods: Consecutive patients with acute ischemic stroke admitted to our hospital within 7 days after the onset of symptoms between January 2011 and March 2013 were retrospectively studied from our single-center prospective stroke database. Plasma levels of Hct and Fbg were measured on admission. Yield shear stress (YSS) was calculated using the following equation: 13.5 (10 -12 ) (Fbg) 2 (Hct-6) 3 . Initial stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Favorable outcome was defined as the modified Rankin Scale (mRS) 0 or 1 at 3 months. Results: Of 1322 consecutive inpatients, 311 with premorbid mRS 2-5 and 139 with incomplete clinical data were excluded, and the remaining 872 were studied. Patients who had favorable outcome were younger (70±12 vs. 74±11, p<0.001), more commonly male (69.1 vs. 58.3 %, p=0.001), had lower NIHSS (median 2 vs. 9, p<0.001),had more hypertension (57.6 vs. 42.4 %, p=0.01) and less frequently had atrial fibrillation (21.4 vs. 37.5 %, p<0.001) than those without. Hct was 40.6±4.9 % in patients with favorable outcome and 39.2±5.4 % in those without (p<0.001). Fbg concentration was 332±74 mg/dl and 354±84 mg/dl (p<0.001), respectively, and YSS was 0.069±0.004 and 0.071±0.005 (p=0.44). Fbg (per 10 mg/dl, OR, 0.96; 95% CI, 0.94-0.98; p<0.001) and YSS (per 0.01, OR, 0.96; 95% CI, 0.92-0.99; p=0.002) remained independently significant to predict favorable outcome after adjustment for sex, age, comorbid disease and NIHSS, but Hct was not (per 1mg/dl; OR, 1.00; 95% CI, 0.97-1.04; p=0.69) Conclusions: Lower fibrinogen and lower yield shear stress, rather than hematocrit, were independently associated with favorable outcome in acute ischemic stroke.

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 Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes

2017 ◽  
Vol 10 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Ansaar T Rai ◽  
SoHyun Boo ◽  
Chelsea Buseman ◽  
Amelia K Adcock ◽  
Abdul R Tarabishy ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Endovascular Therapy ◽  
Hospital Costs ◽  
Stent Retriever ◽  
Large Vessel ◽  
Favorable Outcome ◽  
Total Hospital Cost ◽  
Stroke Severity ◽  
Significant Difference ◽  
The Mean

BackgroundLimited efficacy of IV recombinant tissue plasminogen activator (rt-PA) for large vessel occlusions (LVO) raises doubts about its utility prior to endovascular therapy.PurposeTo compare outcomes and hospital costs for anterior circulation LVOs (middle cerebral artery, internal carotid artery terminus (ICA-T)) treated with either primary endovascular therapy alone (EV-Only) or bridging therapy (IV+EV)).MethodsA single-center retrospective analysis was performed. Clinical and demographic data were collected prospectively and relevant cost data were obtained for each patient in the study.Results90 consecutive patients were divided into EV-Only (n=52) and IV+EV (n=38) groups. There was no difference in demographics, stroke severity, or clot distribution. The mean (SD) time to presentation was 5:19 (4:30) hours in the EV-Only group and 1:46 (0:52) hours in the IV+EV group (p<0.0001). Recanalization: EV-Only 35 (67%) versus IV+EV 31 (81.6%) (p=0.12). Favorable outcome: EV-Only 26 (50%) versus IV+EV 22 (58%) (p=0.45). For patients presenting within 4.5 hours (n=64): Recanalization: EV-Only 21/26 (81%) versus IV+EV 31/38 (81.6%) (p=0.93). Favorable outcome: EV-Only 14/26 (54%) versus IV+EV 22/38 (58%) (p=0.75). There was no significant difference in rates of hemorrhage, mortality, home discharge, or length of stay. A stent retriever was used in 67 cases (74.4%), with similar recanalization, outcomes, and number of passes in the EV-Only and IV+EV groups. The mean (SD) total hospital cost was $33 810 (13 505) for the EV-Only group and $40 743 (17 177) for the IV+EV group (p=0.02). The direct cost was $23 034 (8786) for the EV-Only group and $28 711 (11 406) for the IV+EV group (p=0.007). These significantly higher costs persisted for the subgroup presenting in <4.5 hours and the stent retriever subgroup. IV rt-PA administration independently predicted higher hospital costs.ConclusionsIV rt-PA did not improve recanalization, thrombectomy efficacy, functional outcomes, or length of stay. Combined therapy was associated with significantly higher total and direct hospital costs than endovascular therapy alone.

Collateral status reperfusion and outcomes after endovascular therapy: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) Registry

2021 ◽  
pp. neurintsurg-2021-017553
Author(s):  
Mohammad Anadani ◽  
Stephanos Finitsis ◽  
Frédéric Clarençon ◽  
Sébastien Richard ◽  
Gaultier Marnat ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Endovascular Therapy ◽  
Significant Interaction ◽  
Favorable Outcome ◽  
Poor Grade ◽  
Excellent Outcome ◽  
Grade 3 ◽  
American Society

BackgroundStudies have suggested that collateral status modifies the effect of successful reperfusion on functional outcome after endovascular therapy (EVT). We aimed to assess the association between collateral status and EVT outcomes and to investigate whether collateral status modified the effect of successful reperfusion on EVT outcomes.MethodsWe used data from the ongoing, prospective, multicenter Endovascular Treatment in Ischemic Stroke (ETIS) Registry. Collaterals were graded according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) guidelines. Patients were divided into two groups based on angiographic collateral status: poor (grade 0–2) versus good (grade 3–4) collaterals.ResultsAmong 2020 patients included in the study, 959 (47%) had good collaterals. Good collaterals were associated with favorable outcome (90-day modified Rankin Scale (mRS) 0–2) (OR 1.5, 95% CI 1.19 to 1.88). Probability of good outcome decreased with increased time from onset to reperfusion in both good and poor collateral groups. Successful reperfusion was associated with higher odds of favorable outcome in good collaterals (OR 6.01, 95% CI 3.27 to 11.04) and poor collaterals (OR 5.65, 95% CI 3.32 to 9.63) with no significant interaction. Similarly, successful reperfusion was associated with higher odds of excellent outcome (90-day mRS 0–1) and lower odds of mortality in both groups with no significant interaction. The benefit of successful reperfusion decreased with time from onset in both groups, but the curve was steeper in the poor collateral group.ConclusionsCollateral status predicted functional outcome after EVT. However, collateral status on the pretreatment angiogram did not decrease the clinical benefit of successful reperfusion.

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