MRI Mismatch–Based Intravenous Thrombolysis for Isolated Cerebellar Infarction

Köhrmann, Martin; Sauer, Roland; Huttner, Hagen B.; Engelhorn, Tobias; Doerfler, Arnd; Schellinger, Peter D.

doi:10.1161/strokeaha.108.532838

Cited by 18 publications

(6 citation statements)

References 10 publications

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“…Trials have demonstrated that EVT in anterior circulation ischemic stroke patients with target mismatch profile was related to good outcome 7 . Previous case reports or case series also put forward the possible benefit of reperfusion therapy in isolated cerebellar infarction with mismatch profiles, 25 but data from randomized trials or register studies are lacking for BAO. Our data revealed that, in patients with other types of BAO, the procedure of EVT was related to better outcome than IVT alone in those with target mismatch, but not in those without.…”

Section: Discussionmentioning

confidence: 99%

Effect of Imaging Markers on Reperfusion Therapy in Basilar Artery Occlusion

Yan

Zhou

Zhao

et al. 2022

Annals of Neurology

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Objective: We aimed to investigate the effectiveness of endovascular therapy (EVT) versus intravenous thrombolysis (IVT) in patients with basilar artery occlusion (BAO), based on the information of advanced imaging. Methods: We analyzed data of stroke patients with radiologically confirmed BAO within 24 hours. BAO subjects were categorized into "top-of-the-basilar" syndrome (TOBS) and other types. An initial infarct size of <70ml and a ratio of ischemic tissue to infarct volume of ≥1.8 was defined as "target mismatch." The primary outcome was a good outcome, defined as a modified Rankin Scale score of 0 to 3 at 3 months. Propensity score adjustment and inverse probability of treatment weighting (IPTW) propensity score methods were used. Results: Among 474 BAO patients, 93 (19.6%) were treated with IVT prior to EVT, 91 (19.2%) were treated with IVT alone, 95 (20.0%) were treated with EVT alone, and 195 (41.1%) were treated with antithrombotic therapy. In IPTW analyses, we found no benefit of EVT over IVT for good outcome in either TOBS patients (odds ratio = 1.08, 95% confidence interval [CI] = 0.88-1.31) or those with other types (odds ratio = 1.13, 95% CI = 0.94-1.36). However, in patients with other types, if there existed a target mismatch, EVT was independently related to good outcome (odds ratio = 1.46, 95% CI = 1.17-1.81). Interpretation: The "target mismatch profile" seems to be a possible candidate selection standard of EVT for those with other types of BAO. Future studies should separate TOBS from other types of BAO, and try to use advanced imaging.

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Section: Discussionmentioning

confidence: 99%

Effect of Imaging Markers on Reperfusion Therapy in Basilar Artery Occlusion

Yan

Zhou

Zhao

et al. 2022

Annals of Neurology

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“…Unlike the abundance of publications dealing with large intracranial vessel occlusion and consecutive hypoperfusion as well as MRI-guided thrombolysis in acute ischemic stroke in the anterior circulation [11,12,13,14,15,16,17], reports on the penumbra and its nowadays widely used MRI surrogate, the DWI-PWI mismatch in posterior circulation stroke are rare [18,19]. Only recently did Kim et al [20] report a series of patients with medullary infarction, demonstrating not only feasibility of PWI but also its impact on the prediction of clinical outcomes in this subtype of brainstem infarction.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Susceptibility Contrast Perfusion MRI Identifies Persistent Vessel Pathology in Acute Pontine Stroke

Förster¹,

Ottomeyer²,

Wolf³

et al. 2010

Cerebrovasc Dis

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Background: In large territorial stroke of the anterior and the posterior circulation, the extent of affected tissue can be characterized by the demonstration of vessel occlusion on MR angiography (MRA), while the extent of hypoperfusion can be shown on dynamic susceptibility contrast perfusion-weighted MRI (PWI). The ability of MRA and conventional MRI sequences to demonstrate branches of the basilar artery (BA) is very limited. This study analyzes the value of the combined use of diffusion-weighted MRI (DWI), MRA and PWI in acute pontine stroke. Methods: A series of 24 consecutive patients with acute pontine stroke received an extensive MRI stroke workup including DWI, PWI and MRA. Results: In 11/24 patients visual analysis of PWI demonstrated persisting hypoperfusion, and in 1/24 patients indication of hyperperfusion was found. Vessel abnormalities were seen in 19/24 patients (15/24 hypoplastic vertebral artery, 9/24 stenosis or occlusion of the BA, 1/20 ectatic BA). Persistent pontine hypoperfusion was more frequently associated with BA pathology (9/11 vs. 1/13, p = 0.001), large-vessel disease (8/11 vs. 1/13; p = 0.001) and a more pronounced clinical deficit (NIHSS score on day 1: 7 vs. 3, p = 0.01). Conclusions: In pontine ischemia areas of hypoperfusion can be identified due to the strong contrast induced by ischemia on PWI and can be easily related to DWI lesion size. This is of use particularly as small vessels are frequently missed by MRA and occlusion of the BA can be better characterized with the help of PWI.

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“…Any patient whose blood pressure is greater than 220/120 mmHg should be treated with antihypertensive drugs, while, in the occasional patient with hemodynamically fluctuating symptoms, therapy to augment cerebral blood flow might be considered (Adams et al 2007). Patients with cerebellar infarction can be treated with intravenous thrombolysis according to the NINDS criteria Köhrmann et al 2009). However, randomized trials specific for cerebellar stroke are scarce, and most trials have generally excluded patients with cerebellar infarction.…”

Section: Treatmentmentioning

confidence: 99%