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Neuroradiology

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01-04-2014 | Interventional Neuroradiology

Stability of ischemic core volume during the initial hours of acute large vessel ischemic stroke in a subgroup of mechanically revascularized patients

Authors: Stephanos Finitsis, Andrea Kemmling, Stephanie Havemeister, Götz Thomalla, Jens Fiehler, Caspar Brekenfeld

Published in: Neuroradiology | Issue 4/2014

Abstract

Introduction

This study aimed to relate growth of the infarct core with time to recanalization in patients receiving mechanical recanalization in whom the time of recanalization is known.

Methods

We analyzed data from patients with anterior circulation acute ischemic stroke who underwent mechanical recanalization. Demographic and angiographic characteristics, initial apparent diffusion coefficient (ADC) infarct volume, time-to-peak defect volume, revascularization grade, 24–48 h nonenhanced computed tomography (CT) infarct volume, symptom onset to recanalization time, diffusion-weighted imaging to recanalization time, and discharge National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores were compared between minimal and substantial infarct growth groups. Substantial infarct growth was defined as an increase of infarct volume >10 cm³ assessed by subtracting initial ADC infarct core volume from infarct volume at 24–48 h CT.

Results

Of 25 patients, 9 had minimal infarct growth (median 0 cm³, interquartile range (IQR) −3 to 5 cm³) and 16 had substantial infarct growth (median 103 cm³, IQR 48–132 cm³). Patients with minimal infarct growth had a median time from symptom onset to recanalization of 329 min (IQR 314–412 min) and a median time from imaging to recanalization of 231 min (IQR 198–309 min). On univariate analysis, minimal infarct growth was related to male gender (p = 0.04), smaller initial ADC volume (p = 0.04), higher recanalization grade (p < 0.001), and lower discharge NIHSS (p = 0.04) and mRS grades (p = 0.04).

Conclusion

There was no or minimal infarct core growth in at least one third of patients despite an exceptionally long median time from magnetic resonance imaging to recanalization of almost 4 h.

Rha JH, Saver JL (2007) The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke; A J Cereb Circ 38(3):967–973. doi:10.1161/01.STR.0000258112.14918.24 CrossRef

Kidwell CS, Alger JR, Saver JL (2003) Beyond mismatch: evolving paradigms in imaging the ischemic penumbra with multimodal magnetic resonance imaging. Stroke; A J Cereb Circ 34(11):2729–2735. doi:10.1161/01.STR.0000097608.38779.CC CrossRef

Hillis AE, Gold L, Kannan V, Cloutman L, Kleinman JT, Newhart M, Heidler-Gary J, Davis C, Aldrich E, Llinas R, Gottesman RF (2008) Site of the ischemic penumbra as a predictor of potential for recovery of functions. Neurology 71(3):184–189. doi:10.1212/01.wnl.0000317091.17339.98 PubMedCrossRef

Toth G, Albers GW (2009) Use of MRI to estimate the therapeutic window in acute stroke: is perfusion-weighted imaging/diffusion-weighted imaging mismatch an EPITHET for salvageable ischemic brain tissue? Stroke; A J Cereb Circ 40(1):333–335. doi:10.1161/STROKEAHA.108.525683 CrossRef

Grigoryan M, Tung CE, Albers GW (2011) Role of diffusion and perfusion MRI in selecting patients for reperfusion therapies. Neuroimaging Clin N Am 21(2):247–257. doi:10.1016/j.nic.2011.01.002, ix-xPubMedCrossRef

Copen WA, Rezai Gharai L, Barak ER, Schwamm LH, Wu O, Kamalian S, Gonzalez RG, Schaefer PW (2009) Existence of the diffusion-perfusion mismatch within 24 hours after onset of acute stroke: dependence on proximal arterial occlusion. Radiology 250(3):878–886. doi:10.1148/radiol.2503080811 PubMedCrossRef

Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, Albers GW, Kaste M, Marler JR, Hamilton SA, Tilley BC, Davis SM, Donnan GA, Hacke W, Allen K, Mau J, Meier D, del Zoppo G, De Silva DA, Butcher KS, Parsons MW, Barber PA, Levi C, Bladin C, Byrnes G (2010) Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 375(9727):1695–1703. doi:10.1016/S0140-6736(10)60491-6 PubMedCrossRef

Gonzalez RG, Hakimelahi R, Schaefer PW, Roccatagliata L, Sorensen AG, Singhal AB (2010) Stability of large diffusion/perfusion mismatch in anterior circulation strokes for 4 or more hours. BMC Neurol 10:13. doi:10.1186/1471-2377-10-13 PubMedCentralPubMedCrossRef

Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boysen G, Bluhmki E, Hoxter G, Mahagne MH et al (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA: J Am Med Ass 274(13):1017–1025CrossRef

10.

Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 352(9136):1245–1251PubMedCrossRef

11.

Christensen S, Mouridsen K, Wu O, Hjort N, Karstoft H, Thomalla G, Rother J, Fiehler J, Kucinski T, Ostergaard L (2009) Comparison of 10 perfusion MRI parameters in 97 sub-6-hour stroke patients using voxel-based receiver operating characteristics analysis. Stroke; J Cereb Circ 40(6):2055–2061. doi:10.1161/STROKEAHA.108.546069 CrossRef

12.

Christoforidis GA, Mohammad Y, Kehagias D, Avutu B, Slivka AP (2005) Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke. AJNR Am J Neuroradiol 26(7):1789–1797PubMed

13.

Tomsick T, Broderick J, Carrozella J, Khatri P, Hill M, Palesch Y, Khoury J (2008) Revascularization results in the Interventional Management of Stroke II trial. AJNR Am J Neuroradiol 29(3):582–587. doi:10.3174/ajnr.A0843 PubMedCentralPubMedCrossRef

14.

Almekhlafi MA, Menon BK, Freiheit EA, Demchuk AM, Goyal M (2013) A meta-analysis of observational intra-arterial stroke therapy studies using the Merci device, Penumbra system, and retrievable stents. AJNR Am J Neuroradiol 34(1):140–145. doi:10.3174/ajnr.A3276 PubMedCrossRef

15.

Jayaraman MV, Grossberg JA, Meisel KM, Shaikhouni A, Silver B (2012) The clinical and radiographic importance of distinguishing partial from near-complete reperfusion following intra-arterial stroke therapy. AJNR Am J Neuroradiol. doi:10.3174/ajnr.A3278

16.

Saver JL (2006) Time is brain—quantified. Stroke; J Cereb Circ 37(1):263–266. doi:10.1161/01.STR.0000196957.55928.ab CrossRef

17.

Fiehler J, Kucinski T, Knudsen K, Rosenkranz M, Thomalla G, Weiller C, Rother J, Zeumer H (2004) Are there time-dependent differences in diffusion and perfusion within the first 6 hours after stroke onset? Stroke; A J Cereb Circ 35(9):2099–2104. doi:10.1161/01.STR.0000138450.15078.b5 CrossRef

18.

Liebeskind DS (2005) Collaterals in acute stroke: beyond the clot. Neuroimaging Clin N Am 15(3):553–573. doi:10.1016/j.nic.2005.08.012, xPubMedCrossRef

19.

Liebeskind DS (2003) Collateral circulation. Stroke; J Cereb Circ 34(9):2279–2284. doi:10.1161/01.STR.0000086465.41263.06 CrossRef

20.

Kucinski T, Koch C, Eckert B, Becker V, Kromer H, Heesen C, Grzyska U, Freitag HJ, Rother J, Zeumer H (2003) Collateral circulation is an independent radiological predictor of outcome after thrombolysis in acute ischaemic stroke. Neuroradiology 45(1):11–18. doi:10.1007/s00234-002-0881-0 PubMed

21.

Tan IY, Demchuk AM, Hopyan J, Zhang L, Gladstone D, Wong K, Martin M, Symons SP, Fox AJ, Aviv RI (2009) CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 30(3):525–531. doi:10.3174/ajnr.A1408 PubMedCrossRef

22.

Bang OY, Saver JL, Buck BH, Alger JR, Starkman S, Ovbiagele B, Kim D, Jahan R, Duckwiler GR, Yoon SR, Vinuela F, Liebeskind DS (2008) Impact of collateral flow on tissue fate in acute ischaemic stroke. J Neurol, Neurosurg, Psychiatry 79(6):625–629. doi:10.1136/jnnp.2007.132100 CrossRef

23.

Ringelstein EB, Biniek R, Weiller C, Ammeling B, Nolte PN, Thron A (1992) Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalization. Neurology 42(2):289–298PubMedCrossRef

24.

Takada T, Yasaka M, Minematsu K, Naritomi H, Yamaguchi T (2004) Predictors of clinical outcome in patients receiving local intra-arterial thrombolysis without subsequent symptomatic intracranial hemorrhage against acute middle cerebral artery occlusion. AJNR Am J Neuroradiol 25(10):1796–1801PubMed

25.

Fiehler J, Foth M, Kucinski T, Knab R, von Bezold M, Weiller C, Zeumer H, Rother J (2002) Severe ADC decreases do not predict irreversible tissue damage in humans. Stroke; J Cereb Circ 33(1):79–86CrossRef

26.

Ma L, Gao PY, Hu QM, Lin Y, Jing LN, Xue J, Wang XC, Chen ZJ, Wang YL, Liao XL, Liu ML, Chen WJ (2010) Prediction of infarct core and salvageable ischemic tissue volumes by analyzing apparent diffusion coefficient without intravenous contrast material. Acad Radiol 17(12):1506–1517. doi:10.1016/j.acra.2010.07.010 PubMedCrossRef

27.

Knight RA, Dereski MO, Helpern JA, Ordidge RJ, Chopp M (1994) Magnetic resonance imaging assessment of evolving focal cerebral ischemia. Comparison with histopathology in rats. Stroke;J Cereb Circ 25(6):1252–1261, discussion 1261–1252CrossRef

28.

Yoo AJ, Chaudhry ZA, Nogueira RG, Lev MH, Schaefer PW, Schwamm LH, Hirsch JA, Gonzalez RG (2012) Infarct volume is a pivotal biomarker after intra-arterial stroke therapy. Stroke; J Cereb Circ 43(5):1323–1330. doi:10.1161/STROKEAHA.111.639401 CrossRef

29.

Lansberg MG, Lee J, Christensen S, Straka M, De Silva DA, Mlynash M, Campbell BC, Bammer R, Olivot JM, Desmond P, Davis SM, Donnan GA, Albers GW (2011) RAPID automated patient selection for reperfusion therapy: a pooled analysis of the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) and the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) study. Stroke; J Cereb Circ 42(6):1608–1614. doi:10.1161/STROKEAHA.110.609008 CrossRef

30.

Mokin M, Kass-Hout T, Kass-Hout O, Dumont TM, Kan P, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI (2012) Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion: a systematic review of clinical outcomes. Stroke; a J Cereb Circ 43(9):2362–2368. doi:10.1161/STROKEAHA.112.655621 CrossRef

31.

Machi P, Costalat V, Lobotesis K, Maldonado IL, Vendrell JF, Riquelme C, Bonafe A (2012) Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients. J Neurointerventional Surg 4(1):62–66. doi:10.1136/jnis.2010.004051 CrossRef

Title: Stability of ischemic core volume during the initial hours of acute large vessel ischemic stroke in a subgroup of mechanically revascularized patients
Authors: Stephanos Finitsis
Andrea Kemmling
Stephanie Havemeister
Götz Thomalla
Jens Fiehler
Caspar Brekenfeld
Publication date: 01-04-2014
Publisher: Springer Berlin Heidelberg
Published in: Neuroradiology / Issue 4/2014
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-014-1329-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Stability of ischemic core volume during the initial hours of acute large vessel ischemic stroke in a subgroup of mechanically revascularized patients

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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