Time to Endovascular Reperfusion and Outcome in Acute Ischemic Stroke

Ma, Gaoting; Yu, Zequan; Jia, Baixue; Xian, Ying; Ren, Zeguang; Mo, Dapeng; Ma, Ning; Gao, Feng; Tong, Xu; Shi, Xiaodong; Li, Ling; Pan, Yuesong; Miao, Zhongrong

doi:10.1007/s00062-022-01178-7

Cited by 10 publications

(10 citation statements)

References 23 publications

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“…These concepts have been proven by subanalyses of previous trials, which have shown a time-dependent benefit of acute reperfusion therapies even within the estab-lished time windows for treatment. [2][3][4][5] The widespread use of advanced neuroimaging has led to a better understanding of the dynamics of the progression of brain tissue from penumbra to infarct, to a better selection of patients for acute reperfusion therapies, and ultimately to the current ongoing expansion of the criteria to select patients for these treatments. The paradigm has accordingly been shifting from a timeoriented to a tissue-oriented approach.…”

Section: Introductionmentioning

confidence: 99%

Collateral Circulation in Ischemic Stroke: An Updated Review

Maguida

Shuaib

2023

J Stroke

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The collateral circulation plays a crucial role in maintaining perfusion to brain tissue in ischemic stroke, which prolongs the time window for effective therapies to be provided and ultimately avoids irreversible damage that may lead to worse clinical outcomes. The understanding of this complex vascular bypass system has advanced greatly in the past few years, yet effective treatments for its potentiation as a therapeutic target remain a challenge. The assessment of the collateral circulation is now part of the routine neuroimaging protocols for acute ischemic stroke, which provides a more complete pathophysiological picture in each patient that allows for a better selection for acute reperfusion therapies and a more accurate prognostication of outcomes, among other potential uses. In this review, we aim to provide a structured and updated approach to the collateral circulation while highlighting ongoing research areas with promising future clinical applications.

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Section: Introductionmentioning

confidence: 99%

Collateral Circulation in Ischemic Stroke: An Updated Review

Maguida

Shuaib

2023

J Stroke

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“…The time from symptom onset to imaging is still a major factor to guide treatment decision-making in ischemic stroke for both IVT and EVT. 24,25 On admission of an ischemic stroke patient in daily clinical practice, the time window is usually reported as a main variable besides clinical severity. In the past, strict time windows were used as obligatory criteria, for instance a required time frame of 3 hours or less to administer IVT, which was subsequently extended to 4.5 hours.…”

Section: Discussionmentioning

confidence: 99%

Investigating Neurologic Improvement After IV Thrombolysis

Broocks,

Meyer,

Bechstein

et al. 2023

Neurology

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Background and Objectives:Time from stroke onset is associated with clinical response to intravenous thrombolysis with alteplase (IVT) and is therefore used to select patients for treatment. Alternatively, neuroimaging may be used for treatment in the uncertain or extended time window. We hypothesized that the patient-specific imaging indicator of ischemic lesion progression (“tissue clock”) using CT-perfusion (CTP) or quantitative net water uptake (NWU) is a predictor of early neurological improvement (ENI) independent of time.Methods:Observational study of anterior circulation ischemic stroke patients with proximal vessel occlusion and known time from symptom onset triaged by multimodal-CT undergoing endovascular treatment. Quantitative NWU using an established threshold (11.5%) or CTP lesion-core mismatch (EXTEND criteria) were used to estimate ischemic lesion progression. The treatment effect of IVT depending on lesion progression defined by tissue clock versus time clock was assessed by inverse-probability weighting (IPW). Endpoints were binarized ENI and functional independence at day-90.Results:409 patients were included, of which 223 (54.5%) received IVT. The proportion of patients within an early time window (<4.5h), low NWU, and CTP-mismatch were 45.0%/86.5%/80.3%. In IPW, IVT was associated with higher rates of ENI (%-difference: 7.3%,p=0.02). For patients with CTP-mismatch or low NWU, IVT was associated with a 9.6%/7.2% higher rate of ENI, which was different than the effect of IVT in patients without CTP-mismatch or high NWU (-9.3%/-7.3%; p=0.004/p=0.03), while early treatment window did not modifiy the effect of IVT.Discussion:CT-based measures of the “tissue clock” might identify patients who benefit from IVT more accurately than conventional time windows. Considering the high number of patients with early “tissue clock” (low NWU/CTP-mismatch) within an extended time window, considerable benefit from IVT using imaging indicators of the “tissue clock” may be achieved.

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“…To define the volume of the ischemic core, the apparent diffusion coefficient (ADC) was multiplied by 620, and the volume of hypoperfusion was defined as cerebral blood flow (CBF) < 40% on ASL (22). The time to maximum (Tmax) > 6 s volume represents hypoperfusion, and a CBF < 30% of volume represents the ischemic core in CTP (23,24). Details of the hypoperfusion and ischemic core images are illustrated in Figure 2.…”

Section: Image Analysismentioning

confidence: 99%

Comparison of clinical outcomes in patients with acute ischemic stroke who underwent endovascular treatment using different perfusion modalities: a real-world multicenter study

Gao,

Jing,

Huang

et al. 2023

Front. Neurol.

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BackgroundAdvanced perfusion modalities are increasingly popular for various diseases. However, few studies have focused on contrasting perfusion patterns.ObjectiveThis study aimed to compare the time efficiency and clinical outcomes of patients with acute ischemic stroke (AIS) who underwent endovascular treatment (EVT) before one-stop arterial spin labeling (ASL) and computed tomography perfusion (CTP) protocols.MethodsThis study retrospectively included 326 patients with AIS who had accepted EVT within 24 h of onset from four comprehensive stroke centers between October 2017 and September 2022. After 1:1 matching of the propensity scores, 202 patients were separated into two groups: the ASL group (n = 101) and the CTP group (n = 101).ResultsFunctional independence at 90 days (modified Rankin Scale [mRS] 0–2; p = 0.574), onset-to-puncture time (p = 0.231), door-to-puncture time (p = 0.136), and door-to-perfusion time (p = 0.646) were not significantly different between the two groups. The proportion of EVT complications (31.7% in the ASL group vs. 14.9% in the CTP group, p = 0.005) and symptomatic intracranial hemorrhage (sICH) at 24 h (23.8% in the ASL group vs. 9.9% in the CTP group, p = 0.008) in the CTP group were lower than the ASL group. The ischemic core volume was a common predictor of favorable outcomes in both ASL (p < 0.001) and CTP (p < 0.001) groups.ConclusionThere were no significant differences in time efficiency and efficacy outcomes between the two groups of patients receiving one-stop ASL and CTP. The proportion of sICH at 24 h and EVT complications of patients in the CTP group was lower than the ASL group. The ischemic core volume was an independent predictor for favorable outcomes.

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Time to Endovascular Reperfusion and Outcome in Acute Ischemic Stroke

Cited by 10 publications

References 23 publications

Collateral Circulation in Ischemic Stroke: An Updated Review

Collateral Circulation in Ischemic Stroke: An Updated Review

Investigating Neurologic Improvement After IV Thrombolysis

Comparison of clinical outcomes in patients with acute ischemic stroke who underwent endovascular treatment using different perfusion modalities: a real-world multicenter study

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