Cerebral blood flow quantification with multi-delay arterial spin labeling in ischemic stroke and the association with early neurological outcome

Luijten, Sven P.R.; Bos, Daniel; Doormaal, Pieter‐Jan van; Goyal, Mayank; Dijkhuizen, Rick M.; Dippel, Diederik W.J.; Roozenbeek, Bob; Lugt, Aad van der; Warnert, Esther

doi:10.1016/j.nicl.2023.103340

Cited by 6 publications

(18 citation statements)

References 43 publications

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“…Table 2 presents the relevant data for the eight articles (overall number of patients: 636) that fulfilled all our inclusion/exclusion criteria and reported post-MT hypoperfusion incidence separately for new-m/eTICI3 and m/eTICI2c recanalization (or whose authors provided this data following personal email contact), and were therefore included in the final analysis. 20,22 –26,30,32,33 Of these 8 articles, 5 reported retrospective analysis of prospectively collected data, 20,22,23,26,30,33 and 3 included patients from randomized controlled trials. 24,25,32 No study reported data regarding pre-thrombectomy thrombolysis or use of antithrombotics either prior to the stroke or during/following the endovascular procedure according to presence/absence of post-MT hypoperfusion.…”

Section: Resultsmentioning

confidence: 99%

“…23,26,28,31,43,44 Table 2 presents the relevant data for the eight articles (overall number of patients: 636) that fulfilled all our inclusion/exclusion criteria and reported post-MT hypoperfusion incidence separately for new-m/ eTICI3 and m/eTICI2c recanalization (or whose authors provided this data following personal email contact), and were therefore included in the final analysis. 20,[22][23][24][25][26]30,32,33 Of these 8 articles, 5 reported retrospective analysis of prospectively collected…”

Section: Resultsmentioning

confidence: 99%

“…20,22 –26,30,32,33 Of these 8 articles, 5 reported retrospective analysis of prospectively collected data, 20,22,23,26,30,33 and 3 included patients from randomized controlled trials. 24,25,32 No study reported data regarding pre-thrombectomy thrombolysis or use of antithrombotics either prior to the stroke or during/following the endovascular procedure according to presence/absence of post-MT hypoperfusion. Note that all studies save one 25 had as overall (explicit or implicit) assumption that the better the reperfusion after thrombectomy, the better the clinical outcome.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the remaining 5 studies, 4 did not report the functional impact of hypoperfusion, 22,23,25,30 while in the fifth the prevalence of hypoperfusion was zero in both mTICI2c and mTICI3 patients. 32 The remaining 7 studies that fulfilled the inclusion criteria but were not eligible for the final analysis 21,[27][28][29]31,43,44 did not use the new-mTICI or eTICI classification systems or did not report the findings separately for m/eTICI2c and new-m/eTICI3 (or their authors did not respond to our emails). For the sake of completeness, Supplemental Table 1 summarizes their methods and main findings.…”

Section: Studies Excluded (N=165)mentioning

confidence: 99%

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Incidence, severity and impact on functional outcome of persistent hypoperfusion despite large-vessel recanalization, a potential marker of impaired microvascular reperfusion: Systematic review of the clinical literature

Schiphorst,

Turc,

Hassen

et al. 2023

J Cereb Blood Flow Metab

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The reported incidence of persistent hypoperfusion despite complete recanalization as surrogate for impaired microvascular reperfusion (IMR) has varied widely among clinical studies, possibly due to differences in i) definition of complete recanalization, with only recent Thrombolysis in Cerebral Infarction (TICI) grading schemes allowing distinction between complete (TICI3) and partial recanalization with distal occlusions (TICI2c); ii) operational definition of IMR; and iii) consideration of potential alternative causes for hypoperfusion, notably carotid stenosis, re-occlusion and post-thrombectomy hemorrhage. We performed a systematic review to identify clinical studies that carried out brain perfusion imaging within 72 hrs post-thrombectomy for anterior circulation stroke and reported hypoperfusion rates separately for TICI3 and TICI2c grades. Authors were contacted if this data was missing. We identified eight eligible articles, altogether reporting 636 patients. The incidence of IMR after complete recanalization (i.e., TICI3) tended to decrease with the number of considered alternative causes of hypoperfusion: range 12.5–42.9%, 0–31.6% and 0–9.1% in articles that considered none, two or all three causes, respectively. No study reported the impact of IMR on functional outcome separately for TICI-3 patients. Based on this systematic review, IMR in true complete recanalization appears relatively rare, and reported incidence highly depends on definition used and consideration of confounding factors.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Studies Excluded (N=165)mentioning

confidence: 99%

See 2 more Smart Citations

Incidence, severity and impact on functional outcome of persistent hypoperfusion despite large-vessel recanalization, a potential marker of impaired microvascular reperfusion: Systematic review of the clinical literature

Schiphorst,

Turc,

Hassen

et al. 2023

J Cereb Blood Flow Metab

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“…44 Moreover, we recently contributed to a perfusion MRI study that showed that hyperperfusion is present in the lesion core of more than half of recanalized AIS patients after 24 h, whereas hypoperfusion was only detected in non-recanalized patients. 45 Still, IMR has been described in different animal models of brain ischemia. 7 Recently, neutrophils were caught in-vivo obstructing downstream microvasculature after reperfusion in mouse models of transient distal MCAO.…”

Section: Discussionmentioning

confidence: 99%

Hyperperfusion profiles after recanalization differentially associate with outcomes in a rat ischemic stroke model

Franx,

van Tilborg,

Taha

et al. 2023

J Cereb Blood Flow Metab

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Futile recanalization hampers prognoses of ischemic stroke after successful mechanical thrombectomy, hypothetically through post-recanalization perfusion deficits, onset-to-groin delays and sex effects. Clinically, acute multiparametric imaging studies remain challenging. We assessed possible relationships between these factors and disease outcome after experimental cerebral ischemia-reperfusion, using translational MRI, behavioral testing and multi-model inference analyses. Male and female rats (N = 60) were subjected to 45-/90-min filament-induced transient middle cerebral artery occlusion. Diffusion, T2- and perfusion-weighted MRI at occlusion, 0.5 h and four days after recanalization, enabled tracking of tissue fate, and relative regional cerebral blood flow (rrCBF) and -volume (rrCBV). Lesion areas were parcellated into core, salvageable tissue and delayed injury, verified by histology. Recanalization resulted in acute-to-subacute lesion volume reductions, most apparently in females (n = 19). Hyperacute normo-to-hyperperfusion in the post-ischemic lesion augmented towards day four, particularly in males (n = 23). Tissue suffering delayed injury contained higher ratios of hypoperfused voxels early after recanalization. Regressed against acute-to-subacute lesion volume change, increased rrCBF associated with lesion growth, but increased rrCBV with lesion reduction. Similar relationships were detected for behavioral outcome. Post-ischemic hyperperfusion may develop differentially in males and females, and can be beneficial or detrimental to disease outcome, depending on which perfusion parameter is used as explanatory variable.

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Intracerebral hemodynamic abnormalities in patients with Parkinson's disease: Comparison between multi-delay arterial spin labelling and conventional single-delay arterial spin labelling

Wang,

et al. 2024

Diagnostic and Interventional Imaging

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Cerebral blood flow quantification with multi-delay arterial spin labeling in ischemic stroke and the association with early neurological outcome

Cited by 6 publications

References 43 publications

Incidence, severity and impact on functional outcome of persistent hypoperfusion despite large-vessel recanalization, a potential marker of impaired microvascular reperfusion: Systematic review of the clinical literature

Incidence, severity and impact on functional outcome of persistent hypoperfusion despite large-vessel recanalization, a potential marker of impaired microvascular reperfusion: Systematic review of the clinical literature

Hyperperfusion profiles after recanalization differentially associate with outcomes in a rat ischemic stroke model

Intracerebral hemodynamic abnormalities in patients with Parkinson's disease: Comparison between multi-delay arterial spin labelling and conventional single-delay arterial spin labelling

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