Collateral status contributes to differences between observed and predicted 24-h infarct volumes in DEFUSE 3

Rao, Vaishnavi; Mlynash, Michael; Christensen, Søren; Yennu, Amarnath; Kemp, Stephanie; Zaharchuk, Greg; Heit, Jeremy J; Marks, Michael P.; Lansberg, Maarten G.; Albers, Gregory W.

doi:10.1177/0271678x20918816

Cited by 57 publications

(65 citation statements)

References 20 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the same manner, it appears that a low HIR may also have a favorable effect on infarct development and its progression. In a previous study, a high HIR was significantly associated with greater infarct growth [ 7 , 15 , 16 , 17 ]. Our study showed that the HIR alone was an independent factor for a favorable outcome in the multivariable model without considering the ASPECTS.…”

Section: Discussionmentioning

confidence: 99%

Low Hypoperfusion Intensity Ratio Is Associated with a Favorable Outcome Even in Large Ischemic Core and Delayed Recanalization Time

Baek

Lee

Choi

et al. 2021

JCM

View full text Add to dashboard Cite

In ischemic brain tissue, hypoperfusion severity can be assessed using the hypoperfusion intensity ratio (HIR). We evaluated the link between HIR and clinical outcomes after successful recanalization by endovascular treatment. We retrospectively reviewed 162 consecutive patients who underwent endovascular treatment for intracranial large vessel occlusion. The HIR was calculated using an automated software program, with initial computed tomography perfusion images. The HIR was compared between patients with and without favorable outcomes. To observe the modifying effect of the HIR on the well-known major outcome determinants, regression analyses were performed in the low and high HIR groups. The median HIR value was significantly lower in patients with a favorable outcome, with an optimal cut-off point of 0.54. The HIR was an independent factor for a favorable outcome in a specific multivariable model and was significantly correlated with the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). In contrast to the high HIR group, the low HIR group showed that ASPECTS and onset-to-recanalization time were not independently associated with a favorable outcome. Finally, the low HIR group had a more favorable outcome even in cases with an unfavorable ASPECTS and onset-to-recanalization time. The HIR could be useful in predicting outcomes after successful recanalization.

show abstract

Section: Discussionmentioning

confidence: 99%

Low Hypoperfusion Intensity Ratio Is Associated with a Favorable Outcome Even in Large Ischemic Core and Delayed Recanalization Time

Baek

Lee

Choi

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…In fact, our finding of no reliable prediction of lesion size by preischemic PcomA scores suggests that not the preischemic anatomical size of the PcomA but the postischemic flow after collateral recruitment is what determines ischemic lesion size. Collateral status has recently been shown to be a key predictor of lesion size evolution in the first 24 h in humans (Rao et al, 2020). It can thus be hypothesized that postischemic PcomA flow as measured in this study is only a correlate of a general level of collateral recruitment in the individual animal determining the size of the ischemic lesion.…”

Section: Discussionmentioning

confidence: 76%

A Semiquantitative Non-invasive Measurement of PcomA Patency in C57BL/6 Mice Explains Variance in Ischemic Brain Damage in Filament MCAo

et al. 2020

View full text Add to dashboard Cite

Numerous studies on experimental ischemic stroke use the filament middle cerebral artery occlusion (fMCAo) model in C57BL/6 mice, but lesion sizes in this strain are highly variable. A known contributor is variation in the posterior communicating artery (PcomA) patency. We therefore aimed to provide a semiquantitative non-invasive in vivo method to routinely assess PcomA patency. We included 43 male C57BL/6 mice from four independent studies using a transient 45 min fMCAo model. Edema-corrected lesion sizes were measured by magnetic resonance (MR) imaging 24 h after reperfusion. Timeof-flight MR angiography was performed 7 days before and 24 h after fMCAo. Scores of PcomA size measured 24 h after, but not scores measured 7 days before fMCAo were negatively correlated with lesion size. Variability in PcomA patency explained 30% of the variance in our cohort (p < 0.0001, coefficient of determination r 2 = 0.3). In a simulation using parameters typical for experimental stroke research, the power to detect a true effect of d = 1 between two groups increased by 15% when an according covariate was included in the statistical model. We have demonstrated that in vivo measurement of PcomA size is feasible and can lead to increased accuracy in assessing the effect of treatments.

show abstract

“…12 It is well established that collateral status is key to the infarct progression and clinical outcomes of patients with large vessel occlusions. 26,27 However, recent studies using dynamic 4-dimentional angiography derived from perfusion CT acquisitions have visualized collateral flow in SSIs, with compensatory blood supply to the ischemic area from adjacent perforator arteries. 20,28 Moreover, CSVD has now been recognized to reflect whole-brain endothelial dysfunction, which is strongly correlated with loss of brain reactivity, and is reflected by a more globally compromised CBF.…”

Section: Discussionmentioning

confidence: 99%

Hemispheric cerebral blood flow predicts outcome in acute small subcortical infarcts

Hong

Ling

et al. 2021

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

The association between baseline perfusion measures and clinical outcomes in patients with acute small subcortical infarcts (SSIs) has not been studied in detail. Post-processed acute perfusion CT and follow-up diffusion-weighted imaging of 71 patients with SSIs were accurately co-registered. Relative perfusion values were calculated from the perfusion values of the infarct lesion divided by those of the mirrored contralateral area. The association between perfusion measures with clinical outcomes and the interaction with intravenous thrombolysis were studied. Additionally, the perfusion measures for patients having perfusion CT before and after thrombolysis were compared. Higher contralateral hemispheric cerebral blood flow (CBF) was the only independent predictor of an excellent clinical outcome (modified Rankin Scale of 0-1) at 3 months (OR = 1.3, 95% CI 1.1–1.4, P = 0.001) amongst all the perfusion parameters, and had a significant interaction with thrombolysis (P = 0.04). Patients who had perfusion CT after thrombolysis demonstrated a better perfusion profile (relative CBF ≥1) than those who had perfusion CT before thrombolysis (After:45.5%, Before:21.1%, P = 0.03). This study implies that for patients with SSIs, hemispheric CBF is a predictor of clinical outcome and has an influence on the effect of intravenous thrombolysis.

show abstract

Collateral status contributes to differences between observed and predicted 24-h infarct volumes in DEFUSE 3

Cited by 57 publications

References 20 publications

Low Hypoperfusion Intensity Ratio Is Associated with a Favorable Outcome Even in Large Ischemic Core and Delayed Recanalization Time

Low Hypoperfusion Intensity Ratio Is Associated with a Favorable Outcome Even in Large Ischemic Core and Delayed Recanalization Time

A Semiquantitative Non-invasive Measurement of PcomA Patency in C57BL/6 Mice Explains Variance in Ischemic Brain Damage in Filament MCAo

Hemispheric cerebral blood flow predicts outcome in acute small subcortical infarcts

Contact Info

Product

Resources

About