Quantitative collateral assessment evaluated by cerebral blood volume measured by CT perfusion in patients with acute ischemic stroke

Hirai, Sakyo; Tanaka, Yoji; Sato, Hirotaka; Kato, Koichi; Kim, Yongson; Yamamura, Toshihiro; Sumita, Kazutaka; Arai, Toshinari

doi:10.1016/j.jstrokecerebrovasdis.2021.105797

Cited by 12 publications

(8 citation statements)

References 27 publications

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“…Several recent studies have found that EVT procedural-related factors (e.g., first-pass effect versus multiple-pass effect) and post-procedural complications are strong predictors of unfavorable functional outcome (24,25). In addition, radiological markers are emerging, CT-based texture, blood-brain barrier disruption, brain atrophy, and leukoaraiosis, CT perfusion-based cerebral perfusion parameters, and diffusion-weighted imaging (DWI)-based large deep white-matter lesions have demonstrated to predict prognosis after EVT (26)(27)(28)(29)(30). Moreover, blood-based biomarkers are also found to be predictive for unfavorable early (END) and long-term functional outcomes of EVTtreated AIS patients, including interleukin-6, NLR, N-terminal probrain natriuretic peptide, albumin, matrix metalloprotease-9, enascin-c, thioredoxin, ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13, and occludin, etc.…”

Section: Discussionmentioning

confidence: 99%

Plasma Lipid Mediators Associate With Clinical Outcome After Successful Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

Hao

Feng

et al. 2022

Front. Immunol.

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BackgroundNeuroinflammatory response contributes to early neurological deterioration (END) and unfavorable long-term functional outcome in patients with acute ischemic stroke (AIS) who recanalized successfully by endovascular thrombectomy (EVT), but there are no reliable biomarkers for their accurate prediction. Here, we sought to determine the temporal plasma profiles of the bioactive lipid mediators lipoxin A4 (LXA4), resolvin D1 (RvD1), and leukotriene B4 (LTB4) for their associations with clinical outcome.MethodsWe quantified levels of LXA4, RvD1, and LTB4 in blood samples retrospectively and longitudinally collected from consecutive AIS patients who underwent complete angiographic recanalization by EVT at admission (pre-EVT) and 24 hrs post-EVT. The primary outcome was unfavorable long-term functional outcome, defined as a 90-day modified Rankin Scale score of 3-6. Secondary outcome was END, defined as an increase in National Institutes of Health Stroke Scale (NIHSS) score ≥4 points at 24 hrs post-EVT.ResultsEighty-one consecutive AIS patients and 20 healthy subjects were recruited for this study. Plasma levels of LXA4, RvD1, and LTB4 were significantly increased in post-EVT samples from AIS patients, as compared to those of healthy controls. END occurred in 17 (20.99%) patients, and 38 (46.91%) had unfavorable 90-day functional outcome. Multiple logistic regression analyses demonstrated that post-EVT levels of LXA4 (adjusted odd ratio [OR] 0.992, 95% confidence interval [CI] 0.987-0.998), ΔLXA4 (adjusted OR 0.995, 95% CI 0.991-0.999), LTB4 (adjusted OR 1.003, 95% CI 1.001-1.005), ΔLTB4 (adjusted OR 1.004, 95% CI 1.002-1.006), and post-EVT LXA4/LTB4 (adjusted OR 0.023, 95% CI 0.001-0.433) and RvD1/LTB4 (adjusted OR 0.196, 95% CI 0.057-0.682) ratios independently predicted END, and post-EVT LXA4 levels (adjusted OR 0.995, 95% CI 0.992-0.999), ΔLXA4 levels (adjusted OR 0.996, 95% CI 0.993-0.999), and post-EVT LXA4/LTB4 ratio (adjusted OR 0.285, 95% CI 0.096-0.845) independently predicted unfavorable 90-day functional outcome. These were validated using receiver operating characteristic curve analyses.ConclusionsPlasma lipid mediators measured 24 hrs post-EVT were independent predictors for early and long-term outcomes. Further studies are needed to determine their causal-effect relationship, and whether the imbalance between anti-inflammatory/pro-resolving and pro-inflammatory lipid mediators could be a potential adjunct therapeutic target.

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Section: Discussionmentioning

confidence: 99%

Plasma Lipid Mediators Associate With Clinical Outcome After Successful Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

Hao

Feng

et al. 2022

Front. Immunol.

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“…In AIS, regions of irreversibly infarcted tissue exhibit concordant reductions in CBF and CBV 48 . The CBV ratio, defined as the ratio of CBV values in affected MCA territories to the unaffected side, has been demonstrated to be an independent variable leading to a good functional outcome 49 . Furthermore, prior research has demonstrated an association between relative CBV and collateral status as well as infarct growth in stroke patients, thereby elucidating the importance of CBV as a critical variable in our model 50 .…”

Section: Discussionmentioning

confidence: 99%

Utilizing imaging parameters for functional outcome prediction in acute ischemic stroke: A machine learning study

Ozkara,

Karabacak,

Hoseinyazdi

et al. 2024

Journal of Neuroimaging

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Background and PurposeWe aimed to predict the functional outcome of acute ischemic stroke patients with anterior circulation large vessel occlusions (LVOs), irrespective of how they were treated or the severity of the stroke at admission, by only using imaging parameters in machine learning models.MethodsConsecutive adult patients with anterior circulation LVOs who were scanned with CT angiography (CTA) and CT perfusion were queried in this single‐center, retrospective study. The favorable outcome was defined as a modified Rankin score (mRS) of 0‐2 at 90 days. Predictor variables included only imaging parameters. CatBoost, XGBoost, and Random Forest were employed. Algorithms were evaluated using the area under the receiver operating characteristic curve (AUROC), the area under the precision‐recall curve (AUPRC), accuracy, Brier score, recall, and precision. SHapley Additive exPlanations were implemented.ResultsA total of 180 patients (102 female) were included, with a median age of 69.5. Ninety‐two patients had an mRS between 0 and 2. The best algorithm in terms of AUROC was XGBoost (0.91). Furthermore, the XGBoost model exhibited a precision of 0.72, a recall of 0.81, an AUPRC of 0.83, an accuracy of 0.78, and a Brier score of 0.17. Multiphase CTA collateral score was the most significant feature in predicting the outcome.ConclusionsUsing only imaging parameters, our model had an AUROC of 0.91 which was superior to most previous studies, indicating that imaging parameters may be as accurate as conventional predictors. The multiphase CTA collateral score was the most predictive variable, highlighting the importance of collaterals.

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“…However, the use of CBV as a perfusion parameter for estimating infarct core size in the consideration of recanalization therapy, is subject to debate. Hirai et al (2021) examined ratios of average CT perfusion CBV values in affected MCA territories to non-lesional contralateral sides in 60 AIS patients and compared those with CBV values obtained from follow-up MRI diffusion imaging [28]. They found that the CBV ratio was a strong predictor of good clinical outcome after successful recanalization, showing good functional outcome in patients with higher CBV values.…”

Section: Discussionmentioning

confidence: 99%

Can angiographic Flat Detector Computed Tomography blood volume measurement be used to predict final infarct size in acute ischemic stroke?

Zijden

Mondelaers

Loos

et al. 2023

European Journal of Radiology

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Quantitative collateral assessment evaluated by cerebral blood volume measured by CT perfusion in patients with acute ischemic stroke

Cited by 12 publications

References 27 publications

Plasma Lipid Mediators Associate With Clinical Outcome After Successful Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

Plasma Lipid Mediators Associate With Clinical Outcome After Successful Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

Utilizing imaging parameters for functional outcome prediction in acute ischemic stroke: A machine learning study

Can angiographic Flat Detector Computed Tomography blood volume measurement be used to predict final infarct size in acute ischemic stroke?

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