Validity of Acute Stroke Lesion Volume Estimation by Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomographic Score Depends on Lesion Location in 496 Patients With Middle Cerebral Artery Stroke

P75 Background and Purpose: Previous studies demonstrated that secondary ischemic lesions documented by diffusion-weighted imaging might be smaller than, larger than or similar to initial lesions that occur during ischemia. The purpose of this study was to investigate if the size of secondary lesions can be predicted. Methods: Twelve rats underwent 30 minutes of transient middle cerebral artery occlusion with the intraluminal suture method. Diffusion- and perfusion-weighted images were performed just before reperfusion, 90 minutes and 24 hours after reperfusion. The ischemic lesion size was calculated by tracing visual abnormalities on the apparent diffusion coefficient (ADC) maps. Cerebral blood flow index (CBF i ) ratio was calculated by dividing the ipsilateral CBF i by the contralateral CBF i . Based on difference between initial and secondary lesion volume, rats were assigned to reperfusion-benefit group (n=6) where secondary lesions were smaller than initial lesions (less than 85% of initial lesions) and reperfusion-nonbenefit group (n=6) where secondary lesions were similar to or larger than initial lesions (more than 85% of initial lesions). Results: At 90 minutes after reperfusion, the initial ischemic lesions almost disappeared in both groups. At 24 hours, secondary lesions were 54±11% (mean±SD) of the initial lesions in the reperfusion-benefit group and 100±14% of the initial lesions in the reperfusion-nonbenefit group (p<0.001). There was no difference in ADC values (47±2×10 -5 mm 2 /s vs 46±5×10 -5 mm 2 /s, p=0.7) and CBF i ratio (0.62±0.06 vs 0.67±0.04, p=0.2) between the two groups before reperfusion. However, the initial lesion volume was significantly smaller in the reperfusion-benefit group than in the reperfusion-nonbenefit group (125±54 mm 3 vs 195±36 mm 3 , p=0.037). Conclusions: Changes of ADC values and CBF before reperfusion are unable to predict if initial ischemic lesions will eventually shrink or not after reperfusion. Smaller size of initial lesions may suggest that secondary lesions will be smaller than initial lesions.

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Ischemic Lesion Volume Correlation with Functional Outcome after PNF Application in Middle Cerebral Artery Stroke Survivors

Indian Journal of Physiotherapy and Occupational Therapy - An International Journal ◽

10.5958/0973-5674.2015.00053.2 ◽

2015 ◽

Vol 9 (2) ◽

pp. 52

Author(s):

Poonam Chaturvedi ◽

Vimal Tyagi

Keyword(s):

Middle Cerebral Artery ◽

Functional Outcome ◽

Cerebral Artery ◽

Stroke Survivors ◽

Lesion Volume ◽

Ischemic Lesion ◽

Middle Cerebral Artery Stroke

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What ASPECTS Value Best Predicts the 100-mL Threshold on Diffusion Weighted Imaging? Study of 150 Patients with Middle Cerebral Artery Stroke

Journal of Neuroimaging ◽

10.1111/j.1552-6569.2010.00487.x ◽

2010 ◽

Vol 21 (3) ◽

pp. 229-231 ◽

Cited By ~ 19

Author(s):

Ke Lin ◽

Stephanie A. Lee ◽

Walter E. Zink

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Diffusion Weighted Imaging ◽

Imaging Study ◽

Diffusion Weighted ◽

Middle Cerebral Artery Stroke

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Relationship between Ischemic Lesion Volume and Functional Status in the 2nd Week after Middle Cerebral Artery Stroke

Neurorehabilitation and Neural Repair ◽

10.1177/154596830501900207 ◽

2005 ◽

Vol 19 (2) ◽

pp. 133-138 ◽

Cited By ~ 26

Author(s):

S. K. Schiemanck ◽

M. W.M. Post ◽

Th. D. Witkamp ◽

L. J. Kappelle ◽

A. J.H. Prevo

Keyword(s):

Middle Cerebral Artery ◽

Functional Status ◽

Cerebral Artery ◽

Right Hemisphere ◽

Small Lesion ◽

Lesion Volume ◽

Modified Rankin Scale ◽

Ischemic Lesion ◽

Middle Cerebral Artery Stroke ◽

The Relationship

Objective. To examine the relationship between the volume of the middle cerebral artery stroke lesion and functional status in the subacute phase of stroke. Methods. Infarctvolumes of 94 patients with a 1st middle cerebral artery stroke assessed on conventional MRI scans obtained in the 2nd week poststroke were related to a clinical measure of stroke severity (National Institutes of Health Stroke Scale [NIHSS]) and to functional status: motor impairment (Motricity Index [MI]) and limitation in activities (Barthel Index [BI] and modified Rankin Scale). Separate correlations were computed for patients with large (>30 ml) and small (30 ml) lesions, and to investigate the influence of lesion location on the relationship between volume and functional status, correlations were computed for patients with left and right hemisphere lesions and for patients with cortical and subcortical lesions. Results. Lesion volume correlated strongly with NIHSS scores (R = 0.61) and moderately with the patient’s functional status (MI [R between -0.42 and - 0.49], BI [R = -0.43], and Modified Rankin Scale [R = 0.45]). Right hemisphere lesions and cortical lesions had a stronger correlation with functional status. In patients with small lesion volumes (0-30 ml), no relationship between lesion volumes and functional status was seen at all. Conclusions. Lesion volume is moderately to strongly related to the functional status in the 2nd week poststroke.

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Lesion volume, lesion location, and outcome after middle cerebral artery territory stroke

Archives of Disease in Childhood ◽

10.1136/adc.81.4.295 ◽

1999 ◽

Vol 81 (4) ◽

pp. 295-300 ◽

Cited By ~ 55

Author(s):

V Ganesan ◽

V Ng ◽

W K Chong ◽

F J Kirkham ◽

A Connelly

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Lesion Volume ◽

Middle Cerebral Artery Territory ◽

Lesion Location

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Abstract 179: Significant Efficacy of Adenosine A3 Receptor Agonist AST-004 in Rat and Non-human Primate Models of Transient Middle Cerebral Artery Occlusion

Stroke ◽

10.1161/str.51.suppl_1.179 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Theodore Liston ◽

JingMei Ren ◽

Russell B Poe ◽

Ikuo Hayashi ◽

Hiroyuki Takamatsu ◽

...

Keyword(s):

Steady State ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Neurological Deficit ◽

Intravenous Infusion ◽

Lesion Volume ◽

Adenosine A3 Receptor ◽

Stroke Lesion ◽

Dose Levels ◽

Human Primate

Acute Ischemic Stroke (AIS) is the second-leading cause of global mortality with an estimated 6.7 million victims dying each year. Our research has focused on a non-neuronal cell type, the astrocyte, and has demonstrated that GPCR receptor-mediated maintenance of astrocyte function enhances critical homeostatic mechanisms in the brain including protection against AIS-associated edema, glutamate excitotoxicity and oxidative stress. AST-004 is a small-molecule agonist of the GPCR Adenosine A3 receptor (ADORA3), demonstrating excellent pharmacokinetics and blood-brain barrier permeability in preclinical species. The efficacy and dose-response of AST-004 was assessed in rat and non-human primate stroke models of transient occlusion of the middle cerebral artery (tMCAO). In rats, a 1.5-hour tMCAO was conducted with a 24-hour steady-state intravenous infusion of vehicle or AST-004 initiated at time of reperfusion (vehicle or three AST-004 dose levels, n=12/group); neurological deficit and stroke lesion volume (TTC staining/image analysis) were assessed 24 hours post-reperfusion. Compared to vehicle, AST-004 reduced brain lesion volume by 50% (p=0.04) and improved neurological function by 36% (p=0.03). In non-human primates (cynomolgus macaque), a 4-hour tMCAO was conducted with a 22-hour steady-state intravenous infusion initiated 2 hours prior to reperfusion (vehicle or three AST-004 dose levels, n=4/group). Stroke lesion, perfusion deficits and penumbral endpoints were assessed by FLAIR, T2, MRA, DWI and ASL at multiple timepoints out to 5 days post-occlusion. Neurological deficit was assessed at 5-days post-occlusion. AST-004 treatment resulted in statistically significant improvements in outcome relative to vehicle, up to a 44% decrease in lesion volume (p=0.02) and a 72% decrease in percentage of lesion growth (p=0.0006) over the 5-day study period. AST-004 treatment during occlusion also reduced the slope of lesion evolution prior to reperfusion by 72% (p=0.05) relative to vehicle. Together, these studies indicate the potential of a non-neuronal approach to reducing stroke lesion damage via the ADORA3 receptor. AST-004 is a first-in-class candidate that warrants further evaluation in human clinical stroke trials.

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Middle cerebral artery stroke due to paradoxical embolism in a patient with COVID-19 pneumonia

Revista Española de Cardiología (English Edition) ◽

10.1016/j.rec.2020.12.011 ◽

2021 ◽

Author(s):

Laura Pons-Pellicé ◽

Elena Camio-Visauta ◽

Ivette Chocron-Da Prat ◽

José Fernando Rodríguez-Palomares ◽

Ferran Rosés Noguer ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Paradoxical Embolism ◽

Middle Cerebral Artery Stroke

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The anesthetic approach for endovascular recanalization therapy depends on the lesion site in acute ischemic stroke

Neuroradiology ◽

10.1007/s00234-021-02762-3 ◽

2021 ◽

Author(s):

Kilian Fröhlich ◽

Gabriela Siedler ◽

Svenja Stoll ◽

Kosmas Macha ◽

Thomas M. Kinfe ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Cerebral Artery ◽

Posterior Circulation ◽

Neurological Deficits ◽

Stroke Severity ◽

Lesion Volume ◽

Middle Cerebral Artery Territory ◽

Cerebral Lesion

Abstract Purpose Endovascular therapy (EVT) of large-vessel occlusion in acute ischemic stroke (AIS) may be performed in general anesthesia (GA) or conscious sedation (CS). We intended to determine the contribution of ischemic cerebral lesion sites on the physician’s decision between GA and CS using voxel-based lesion symptom mapping (VLSM). Methods In a prospective local database, we sought patients with documented AIS and EVT. Age, stroke severity, lesion volume, vigilance, and aphasia scores were compared between EVT patients with GA and CS. The ischemic lesions were analyzed on CT or MRI scans and transformed into stereotaxic space. We determined the lesion overlap and assessed whether GA or CS is associated with specific cerebral lesion sites using the voxel-wise Liebermeister test. Results One hundred seventy-nine patients with AIS and EVT were included in the analysis. The VLSM analysis yielded associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas. Stroke severity and lesion volume were significantly higher in the GA group. The prevalence of aphasia and aphasia severity was significantly higher and parameters of vigilance lower in the GA group. Conclusions The VLSM analysis showed associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas including the thalamus that are known to cause neurologic deficits, such as aphasia or compromised vigilance, in AIS-patients with EVT. Our data suggest that higher disability, clinical impairment due to neurological deficits like aphasia, or reduced alertness of affected patients may influence the physician’s decision on using GA in EVT.

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