Quantification of pial collateral pressure in acute large vessel occlusion stroke: basic concept with patient outcomes

Tahir, Rizwan; Affan, Muhammad; Marin, Horia; Haider, Sameah; Alsrouji, Owais; Ahmad, Ayesha; Chebl, Alex; Katramados, Angelos; Harn, Meredith Van; Kole, Max

doi:10.1007/s00234-021-02641-x

Cited by 3 publications

(4 citation statements)

References 31 publications

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“…The pressure drop over the thrombus has been measured in vivo [ 49 , 50 ]. The observed pressure drop was found to be 56.7 ± 18.0 mmHg for patients with a modified Rankin scale (mRS) of 0–2 and 63.1 ± 19.1 mmHg for patients with a mRS of 3–6 [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Modelling collateral flow and thrombus permeability during acute ischaemic stroke

Padmos

Terreros

Józsa

et al. 2022

J. R. Soc. Interface.

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The presence of collaterals and high thrombus permeability are associated with good functional outcomes after an acute ischaemic stroke. We aim to understand the combined effect of the collaterals and thrombus permeability on cerebral blood flow during an acute ischaemic stroke. A cerebral blood flow model including the leptomeningeal collateral circulation is used to simulate cerebral blood flow during an acute ischaemic stroke. The collateral circulation is varied to capture the collateral scores: absent, poor, moderate and good. Measurements of the transit time, void fraction and thrombus length in acute ischaemic stroke patients are used to estimate thrombus permeability. Estimated thrombus permeability ranges between 10 −7 and 10 −4 mm 2 . Measured flow rates through the thrombus are small and the effect of a permeable thrombus on brain perfusion during stroke is small compared with the effect of collaterals. Our simulations suggest that the collaterals are a dominant factor in the resulting infarct volume after a stroke.

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Section: Discussionmentioning

confidence: 99%

Modelling collateral flow and thrombus permeability during acute ischaemic stroke

Padmos

Terreros

Józsa

et al. 2022

J. R. Soc. Interface.

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“…It would also be expected that in MeVOs, a lower NIHSS to be mediated by better collaterals which would favor a smaller thrombus burden and increased post-thrombus pressure, thereby facilitating passes. 24 Theoretically, a complete secondary reperfusion with multiple passes in the same time window should lead to similar outcomes as first-pass reperfusion. However, FPE remained a significant factor for favorable outcomes in a previously matched cohort analysis.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study

Radu,

Costalat,

Fahed

et al. 2023

European Stroke Journal

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Introduction: First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. Patients and Methods: We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0–2 at 3 months. Results: Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10–2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93–0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59–3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25–0.72) and 0.55 (95% CI, 0.39–0.77), respectively. Conclusion: Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.

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“…In contrast, in aspiration thrombectomy, the clot is not crossed and thus the pressure gradient remains. The magnitude of the pressure gradient across the clot has been measured in only a few studies ( 48 , 49 ).…”

Section: Characteristics Of Current In-vitro Modelsmentioning

confidence: 99%

A Review of the Advancements in the in-vitro Modelling of Acute Ischemic Stroke and Its Treatment

Johnson

Dwivedi

Mirza

et al. 2022

Front. Med. Technol.

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In-vitro neurovascular models of large vessel occlusions (LVOs) causing acute ischemic stroke (AIS) are used extensively for pre-clinical testing of new treatment devices. They enable physicians and engineers to examine device performance and the response of the occlusion to further advance design solutions for current unmet clinical needs. These models also enable physicians to train on basic skills, to try out new devices and new procedural approaches, and for the stroke team to practice workflows together in the comfort of a controlled environment in a non-clinical setting. Removal of the occlusive clot in its entirety is the primary goal of the endovascular treatment of LVOs via mechanical thrombectomy (MT) and the medical treatment via thrombolysis. In MT, recanalization after just one pass is associated with better clinical outcomes than procedures that take multiple passes to achieve the same level of recanalization, commonly known as first pass effect (FPE). To achieve this, physicians and engineers are continually investigating new devices and treatment approaches. To distinguish between treatment devices in the pre-clinical setting, test models must also be optimized and expanded become more nuanced and to represent challenging patient cohorts that could be improved through new technology or better techniques. The aim of this paper is to provide a perspective review of the recent advancements in the in-vitro modeling of stroke and to outline how these models need to advance further in future. This review provides an overview of the various in-vitro models used for the modeling of AIS and compares the advantages and limitations of each. In-vitro models remain an extremely useful tool in the evaluation and design of treatment devices, and great strides have been made to improve replication of physiological conditions. However, further advancement is still required to represent the expanding indications for thrombectomy and thrombolysis, and the generation of new thrombectomy devices, to ensure that smaller treatment effects are captured.

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Quantification of pial collateral pressure in acute large vessel occlusion stroke: basic concept with patient outcomes

Cited by 3 publications

References 31 publications

Modelling collateral flow and thrombus permeability during acute ischaemic stroke

Modelling collateral flow and thrombus permeability during acute ischaemic stroke

First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study

A Review of the Advancements in the in-vitro Modelling of Acute Ischemic Stroke and Its Treatment

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