Ipsilateral Sinus Hypoplasia and Poor Leptomeningeal Collaterals as Midline Shift Predictors

Volný, Ondřej; Cimflová, Petra; Mikulík, Robert

doi:10.1016/j.jstrokecerebrovasdis.2016.04.004

Cited by 8 publications

(4 citation statements)

References 24 publications

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“…There is a well-established association between cerebral edema and poor outcome or death, particularly in severe stroke with malignant progression . Proximal arterial occlusion, a higher baseline National Institutes of Health Stroke Scale, higher baseline glucose, poor collaterals, and lower ASPECTS are associated with malignant brain edema . The observation that decompressive hemicraniectomy, if performed early enough, can improve outcome in a subset of patients supports the conclusion that edema formation has a more direct relation with poor outcome.…”

Section: Discussionmentioning

confidence: 75%

Association of Reperfusion With Brain Edema in Patients With Acute Ischemic Stroke

et al. 2018

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It is uncertain whether therapeutic reperfusion with endovascular treatment yields more or less brain edema. OBJECTIVE To elucidate the association between reperfusion and brain edema. The secondary objectives were to evaluate whether brain edema could partially be responsible for worse outcomes in patients with later reperfusion or lower Alberta Stroke Program Early Computed Tomography Score. DESIGN, SETTING, AND PARTICIPANTS This was a post hoc analysis of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), which was a prospective, randomized, multicenter clinical trial of endovascular treatment compared with conventional care of patients with acute anterior circulation ischemic stroke. Of 502 patients enrolled from December 2010 to June 2014, 2 patients declined to participate. Additionally, exclusion criteria were absence of follow-up imaging or presence of parenchymal hematoma, resulting in 462 patients included in this study. Brain edema was assessed retrospectively, from December 10, 2016, to July 24, 2017, by measuring midline shift (MLS) in all available follow-up scans. Observers were blinded to clinical data. MAIN OUTCOMES AND MEASURES Midline shift was assessed as present or absent and as a continuous variable. Reperfusion status was assessed by the modified thrombolysis in cerebral infarction score in the endovascular treatment arm. The modified arterial occlusive lesion score was used to evaluate the recanalization status in both arms. The modified Rankin scale score at 90 days was used for functional outcome. RESULTS Of 462 patients, the mean (SD) age was 65 (11) years, and 41.8% (n = 193) were women. Successful reperfusion and recanalization were associated with a reduced likelihood of having MLS (adjusted common odds ratio, 0.25; 95% CI, 0.12-0.53; P < .001 and adjusted common odds ratio, 0.34; 95% CI, 0.21-0.55; P < .001, respectively). Midline shift was partially responsible for worse modified Rankin scale scores in patients without reperfusion or recanalization (MLS changed the logistic regression coefficients by 30.3% and 12.6%, respectively). In patients with delayed reperfusion or lower Alberta Stroke Program Early Computed Tomography Score, MLS mediated part of the worse modified Rankin scale scores, corresponding to a change in the regression coefficient of 33.3% and 64.2%, respectively. CONCLUSIONS AND RELEVANCE Successful reperfusion was associated with reduced MLS. This study identifies an additional benefit of reperfusion in relation to edema, as well as rescuing ischemic brain tissue at risk for infarction.

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Section: Discussionmentioning

confidence: 75%

Association of Reperfusion With Brain Edema in Patients With Acute Ischemic Stroke

et al. 2018

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“…Relaxation of cerebral vessels during and after an ischemia/reperfusion leads to collateral cerebral blood flow, and thus characterizes an intrinsic strategy of the cerebral vasculature to protect neuroglial structures but also vasculature including endothelium against ischemic injury (Heiss et al, 2001), likewise reported for the heart (Koerselman et al, 2003; Meier et al, 2013). Indeed, cerebral collateral status and sufficiently enlarged calibers of collateral arteries have recently been identified as most relevant for final infarct volume, vasogenic edema formation (with subsequent midline shift), and hence patient outcome (Volny et al, 2016; van den Wijngaard et al, 2016; van der Hoeven et al, 2016). Therefore, patients at risk for stroke with unfortunate collateral status (thus portending poor outcome) could particularly profit from a lithium treatment at low concentrations via a generally improved endothelium-dependent vessel relaxation capacity.…”

Section: Discussionmentioning

confidence: 99%

Low-Dose Lithium Stabilizes Human Endothelial Barrier by Decreasing MLC Phosphorylation and Universally Augments Cholinergic Vasorelaxation Capacity in a Direct Manner

et al. 2016

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Lithium at serum concentrations up to 1 mmol/L has been used in patients suffering from bipolar disorder for decades and has recently been shown to reduce the risk for ischemic stroke in these patients. The risk for stroke and thromboembolism depend not only on cerebral but also on general endothelial function and health; the entire endothelium as an organ is therefore pathophysiologically relevant. Regardless, the knowledge about the direct impact of lithium on endothelial function remains poor. We conducted an experimental study using lithium as pharmacologic pretreatment for murine, porcine and human vascular endothelium. We predominantly investigated endothelial vasorelaxation capacities in addition to human basal and dynamic (thrombin-/PAR-1 receptor agonist-impaired) barrier functioning including myosin light chain (MLC) phosphorylation (MLC-P). Low-dose therapeutic lithium concentrations (0.4 mmol/L) significantly augment the cholinergic endothelium-dependent vasorelaxation capacities of cerebral and thoracic arteries, independently of central and autonomic nerve system influences. Similar concentrations of lithium (0.2–0.4 mmol/L) significantly stabilized the dynamic thrombin-induced and PAR-1 receptor agonist-induced permeability of human endothelium, while even the basal permeability appeared to be stabilized. The lithium-attenuated dynamic permeability was mediated by a reduced endothelial MLC-P known to be followed by a lessening of endothelial cell contraction and paracellular gap formation. The well-known lithium-associated inhibition of inositol monophosphatase/glycogen synthase kinase-3-β signaling-pathways involving intracellular calcium concentrations in neurons seems to similarly occur in endothelial cells, too, but with different down-stream effects such as MLC-P reduction. This is the first study discovering low-dose lithium as a drug directly stabilizing human endothelium and ubiquitously augmenting cholinergic endothelium-mediated vasorelaxation. Our findings have translational and potentially clinical impact on cardiovascular and cerebrovascular disease associated with inflammation explaining why lithium can reduce, e.g., the risk for stroke. However, further clinical studies are warranted.

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“…However, we infer that stroke itself may influence TS symmetry because the rate of symmetric TS was actually changed in patients with stroke. In a healthy population, 50–60% of patients had right dominant TS and 10–20% had left dominant TS, leaving the occurrence rate of symmetric TS as low as 30% ( 20 , 21 ), whereas in other two stroke studies, 57% of patients had symmetric TS and 21–30% had “hypoplasia” or “occlusion” of ipsilateral TS ( 22 , 23 ). Similarly, in our study, 52.2% of patients presented symmetric TS and 22% presented FDITS, indicating that TS morphology may be modulated by ischemic stroke and might be a stroke-related imaging feature.…”

Section: Discussionmentioning

confidence: 91%

Filling Defect of Ipsilateral Transverse Sinus in Acute Large Artery Occlusion

Chen

Zhang²,

Yan³

et al. 2022

Front. Neurol.

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Background and PurposeCerebral venous systems play a key role in regulating stroke outcomes. We aimed to elucidate the effect of the transverse sinus (TS) filling patterns on edema expansion and neurological outcomes in patients with acute large artery occlusion (LAO).Materials and MethodsWe recruited consecutive patients with acute M1 middle cerebral artery and/or internal carotid artery occlusion who underwent pretreatment computed tomographic perfusion (CTP). On the reconstructed 4-dimensional computed tomographic angiography derived from CTP, the filling defect of the ipsilateral transverse sinus (FDITS) was defined as the length of contrast filling defect occupying at least half of the ipsilateral TS. An unfavorable outcome was defined as having a modified Rankin Scale (mRS) score of 3–6 at 3 months.ResultsA total of 318 patients were enrolled in the final analysis and 70 (22.0%) patients had baseline FDITS. The presence of FDITS was associated with the baseline NIHSS (odds ratio [OR] 1.119; 95% CI, 1.051–1.192; p < 0.001) and poor arterial collaterals (OR 3.665; 95% CI 1.730–7.766; p = 0.001). In addition, FDITS was associated with 24-h brain edema expansion (OR 7.188; 95% CI, 3.095–16.696; p < 0.001) and 3-month unfavorable outcome (OR 8.143; 95% CI 2.547–26.041; p < 0.001) independent of arterial collateral status. In the subgroup analysis of patients with FDITS who received reperfusion therapy, no significant difference was found in the rate of edema expansion and unfavorable outcome between non-reperfusion and reperfusion subgroups (both p > 0.05).ConclusionFilling defect of the ipsilateral transverse sinus was associated with edema expansion and an unfavorable outcome irrespective of the baseline arterial collateral status in patients with acute LAO, indicating that FDITS may be an important stroke-related prognostic imaging marker.

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Ipsilateral Sinus Hypoplasia and Poor Leptomeningeal Collaterals as Midline Shift Predictors

Cited by 8 publications

References 24 publications

Association of Reperfusion With Brain Edema in Patients With Acute Ischemic Stroke

Association of Reperfusion With Brain Edema in Patients With Acute Ischemic Stroke

Low-Dose Lithium Stabilizes Human Endothelial Barrier by Decreasing MLC Phosphorylation and Universally Augments Cholinergic Vasorelaxation Capacity in a Direct Manner

Filling Defect of Ipsilateral Transverse Sinus in Acute Large Artery Occlusion

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