Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0–5 Treated by Thrombectomy

Panni, Pietro; Lapergue, Bertrand; Maïer, Benjamin; Finitsis, Stephanos; Clarençon, Frédéric; Richard, Sébastien; Marnat, Gaultier; Bourcier, Romain; Sibon, Igor; Dargazanli, Cyril; Blanc, Raphaël; Consoli, Arturo; Eugène, François; Vannier, Stéphane; Spelle, Laurent; Denier, Christian; Boulanger, Marion; Gauberti, Maxime; Saleme, Suzana; Macian, Francisco; Rosso, Charlotte; Naggara, Olivier; Turc, Guillaume; Ozkul-Wermester, Ozlem; Papagiannaki, Chrisanthi; Albucher, Jean‐François; Darcourt, Jean; Bras, Anthony Le; Evain, Sarah; Wolff, Valérie; Pop, Raoul; Timsit, Serge; Gentric, Jean‐Christophe; Bourdain, Frédéric; Veunac, Louis; Arquizan, Caroline; Gory, Benjamin

doi:10.1007/s00062-022-01156-z

Cited by 6 publications

(5 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent analysis by the ETIS investigators revealed that 19% of 211 patients presenting with DWI-ASPECTS 0–5 had DWI reversal after EVT, especially when there has been successful recanalization. 61 The impact of imaging modality used to measure ASPECTS on clinical outcomes is elegantly illustrated by the study by Kaesmacher et al , 41 in which EVT-treated 0–5 DWI-ASPECTS patients had better outcomes than EVT-treated 0–5 CT-ASPECTS patients. As we have included studies using either imaging modality or both, it should be acknowledged that this variation in ASPECTS assessment represents an additional methodological shortcoming of the current study.…”

Section: Discussionmentioning

confidence: 99%

“…A recent analysis by the ETIS investigators revealed that 19% of 211 patients presenting with DWI-ASPECTS 0-5 had DWI reversal after EVT, especially when there has been successful recanalization. 61 The impact of imaging modality used to measure ASPECTS on clinical outcomes is elegantly illustrated by the study by Kaesmacher et al, 41 in which EVT-treated 0-5 DWI-ASPECTS patients had better outcomes than EVT-treated 0-5…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Endovascular treatment for anterior circulation large-vessel occlusion ischemic stroke with low ASPECTS: a systematic review and meta-analysis

Safouris

Palaiodimou

Szikora

et al. 2022

Ther Adv Neurol Disord

View full text Add to dashboard Cite

Background: Endovascular treatment (EVT) for acute ischemic stroke (AIS) patients presenting with Alberta Stroke Program Early CT Score (ASPECTS) 0–5 has not yet proven safe and effective by clinical trials. Objectives: The aim of the study was to assess whether EVT in AIS patients presenting with low ASPECTS is beneficial. Design: Systematic review and meta-analysis of available studies in accordance with the PRISMA statement. Data sources and Methods: We have searched MEDLINE, the Cochrane Central Register of Controlled Trials, and reference lists of articles published until 28 May 2022 with the aim to calculate (1) modified Rankin scale (mRS) score 0–3 at 3 months, (2) mRS score 0–2 at 3 months, (3) symptomatic intracranial hemorrhage (sICH), and (3) mortality at 3 months. Results: Overall, 24 eligible studies were included in the meta-analysis, comprising a total of 2539 AIS patients with ASPECTS 0–5 treated with EVT. The pooled proportion of EVT-treated patients achieving mRS 0–3 at 3 months was calculated at 38.4%. The pooled proportion of EVT-treated patients achieving mRS 0–2 at 3 months was 25.7%. Regarding safety outcomes, sICH occurred in 12.8% of patients. The 3-month pooled mortality was 30%. In pairwise meta-analysis, patients treated with EVT had a higher likelihood of achieving mRS 0–3 at 3 months compared with patients treated with best medical therapy (BMT, OR: 2.41). sICH occurred more frequently in EVT-treated patients compared with the BMT-treated patients (OR: 2.30). Mortality at 3 months was not different between the two treatment groups (OR: 0.71). Conclusion: EVT may be beneficial for AIS patients with low baseline ASPECTS despite an increased risk for sICH. Further data from randomized-controlled clinical trials are needed to elucidate the role of EVT in this subgroup of AIS patients. Registration: The protocol has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO; Registration Number: CRD42022334417.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endovascular treatment for anterior circulation large-vessel occlusion ischemic stroke with low ASPECTS: a systematic review and meta-analysis

Safouris

Palaiodimou

Szikora

et al. 2022

Ther Adv Neurol Disord

View full text Add to dashboard Cite

show abstract

“…27 In a multivariable analysis, voxel-based DWI reversibility >50%, but not volumetric DWI reversibility, was associated with outcome at 90 days. Previous studies found DWI reversibility to be associated with short- 14,15,18,20,22,28 and long-term outcome. [19][20][21]25,28 Since stroke lesions in our population were small, reversible lesion volumes were also not very large, potentially precluding an unambiguous effect on 90-day outcome.…”

Section: Discussionmentioning

confidence: 93%

“…Previous studies found DWI reversibility to be associated with short- 14,15,18,20,22,28 and long-term outcome. [19][20][21]25,28 Since stroke lesions in our population were small, reversible lesion volumes were also not very large, potentially precluding an unambiguous effect on 90-day outcome. Any clinical association of DWI reversibility on outcome found in other studies might reflect a simultaneously higher incidence of penumbral salvage in patients with DWI reversibility, an analysis not included in our study.…”

Section: Discussionmentioning

confidence: 93%

Reversibility of Diffusion-Weighted Imaging Lesions in Patients With Ischemic Stroke in the WAKE-UP Trial

Scheldeman

Wouters

Bertels

et al. 2023

Stroke

View full text Add to dashboard Cite

BACKGROUND: Reversibility of the diffusion-weighted imaging (DWI) lesion means that not all of the DWI lesion represents permanently injured tissue. We investigated DWI reversibility and the association with thrombolysis, reperfusion and functional outcome in patients from the WAKE-UP trial (Efficacy and Safety of Magnetic Resonance Imaging–Based Thrombolysis in Wake-Up Stroke). METHODS: In this retrospective analysis of WAKE-UP, a randomized controlled trial (RCT) between September 2012 and June 2017 in Belgium, Denmark, France, Germany, Spain and United Kingdom, a convolutional neural network segmented the DWI lesions (b=1000 s/mm 2 ) at baseline and follow-up (24 hours). We calculated absolute and relative DWI reversibility in 2 ways: first, a volumetric (baseline volume−24-hour volume >0) and second, a voxel-based (part of baseline lesion not overlapping with 24-hour lesion) approach. We additionally defined relative voxel-based DWI-reversibility >50% to account for coregistration inaccuracies. We calculated the odds ratio for reversibility according to treatment arm. We analyzed the association of reversibility with excellent functional outcome (modified Rankin Scale score of 0–1), in a multivariable model. RESULTS: In 363 patients, the median DWI volume was 3 (1–10) mL at baseline and 6 (2–20) mL at follow-up. Volumetric DWI reversibility was present in 19% (69/363) with a median absolute reversible volume of 1 mL (0–2) or 28% (14–50) relatively. Voxel-based DWI reversibility was present in 358/363 (99%) with a median absolute volume of 1 mL (0–2), or 22% (9–38) relatively. In 18% of the patients (67/363), relative voxel-based DWI reversibility >50% was present. Volumetric DWI reversibility and relative voxel-based DWI reversibility >50% was more frequent in patients treated with alteplase versus placebo (OR, 1.86 [95% CI, 1.09–3.17] and OR, 2.03 [95% CI, 1.18–3.50], respectively). Relative voxel-based DWI reversibility >50% was associated with excellent functional outcome (OR, 2.30 [95% CI, 1.17–4.51]). CONCLUSIONS: Small absolute volumes of DWI reversibility were present in a large proportion of randomized patients in the WAKE-UP trial. Reversibility was more often present after thrombolysis.

show abstract

“…The mean volume of tissue reversal is reported to be small and it is more likely that clinical improvement is related to reperfusion of the collateral penumbra rather than to DWI reversal [ 46 ]. A recently published paper contradicted this claim to some extent as it reported that the partial reversal of DWI changes observed in a significant proportion of patients with DWI-ASPECTS ≤5 who were treated with mechanical thrombectomy was identified as a predictor of early neurological improvement and improvement of 3-month clinical outcomes in cases of successful recanalisation [ 60 ].…”

Section: Reversibility Of Cytotoxic Oedema In Acute Strokementioning

confidence: 99%

MRI of cerebral oedema in ischaemic stroke and its current use in routine clinical practice

Čivrný,

Tomáš,

Černá

2023

Neuroradiology

View full text Add to dashboard Cite

Currently, with the knowledge of the role of collateral circulation in the development of cerebral ischaemia, traditional therapeutic windows are being prolonged, with time not being the only criterion. Instead, a more personalised approach is applied to select additional patients who might benefit from active treatment. This review briefly describes the current knowledge of the pathophysiology of the development of early ischaemic changes, the capabilities of MRI to depict such changes, and the basics of the routinely used imaging techniques broadly available for the assessment of individual phases of cerebral ischaemia, and summarises the possible clinical use of routine MR imaging, including patient selection for active treatment and assessment of the outcome on the basis of imaging.

show abstract

Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0–5 Treated by Thrombectomy

Cited by 6 publications

References 36 publications

Endovascular treatment for anterior circulation large-vessel occlusion ischemic stroke with low ASPECTS: a systematic review and meta-analysis

Endovascular treatment for anterior circulation large-vessel occlusion ischemic stroke with low ASPECTS: a systematic review and meta-analysis

Reversibility of Diffusion-Weighted Imaging Lesions in Patients With Ischemic Stroke in the WAKE-UP Trial

MRI of cerebral oedema in ischaemic stroke and its current use in routine clinical practice

Contact Info

Product

Resources

About