Top

Neuroradiology

Published in:

01-04-2022 | Stroke | Interventional Neuroradiology

Artery diameter ratio after recanalization in endovascular therapy for acute ischemic stroke: a new predictor of clinical outcomes

Authors: Shuhan Huang, Chengchun Liu, Xiaoshu Li, Ya Wu, Chunrong Liang, Wei Li, Meng Zhang

Published in: Neuroradiology | Issue 4/2022

Abstract

Purpose

This study aimed to investigate the relationship between the artery diameter ratio (ADR) after recanalization and clinical outcomes.

Methods

Patients with middle cerebral artery occlusion confirmed by DSA from 1 January 2018, to 31 December 2019, were retrospectively analyzed. All patients confirmed TICI grade 2b or 3. The ADR was calculated as M2 segment diameter/M1 segment diameter. Multivariate regression analysis was used to describe clinical outcomes of two groups (ADR < 0.6 and ≥ 0.6). ROC curves were used to compare different models and find the best cutoff.

Results

A total of 143 patients were included in the study, including 77 males and 66 females, with an average age of 67.79 ± 12 years. The NIHSS at discharge was significantly higher in the ADR < 0.6 group than another group (mean, 16.37 vs. 6.19, P < 0.001). At 90 days, the cases of functional independence was significantly less in the ADR < 0.6 group (20.97% vs. 83.95%, OR 0.05, 95% CI 0.02–0.12, P < 0.001). The ADR < 0.6 group had a higher incidence of cerebral edema (P = 0.027) and sICH (P = 0.038). The ADR had the strongest power to distinguish mRS > 2 (AUC = 0.851) and DC (AUC = 0.805), and the best cutoff value are 0.6 (specificity 85.19%, sensitivity 75.81%) and 0.58 (specificity 65.96%, sensitivity 100%), respectively.

Conclusion

The low ADR is associated with poor outcomes. The decrease in ADR may be an indirect manifestation of the loss of cerebrovascular autoregulation.

Berkhemer OA, Fransen PS, Beumer D (eds) (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372(1): 11-20. https://doi.org/10.1056/nejmoa1411587

Goyal M, Demchuk AM, Menon BK (eds) (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372(11): 1019-30. https://doi.org/10.1056/nejmoa1414905

Saver JL, Goyal M, Bonafe A (eds) (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372(24): 2285–95. https://doi.org/10.1056/nejmoa1415061

Campbell BC, Mitchell PJ, Kleinig TJ (eds) (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372(11): 1009-18. https://doi.org/10.1056/nejmoa1414792

Jovin TG, Chamorro A, Cobo E (eds) (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372(24): 2296-306. https://doi.org/10.1056/nejmoa1403780

Nogueira RG, Jadhav AP, Haussen DC (eds) (2018) Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 378(1): 11–21. https://www.nejm.org/doi/https://doi.org/10.1056/NEJMoa1706442

Albers GW, Marks MP, Kemp S (eds) (2018) Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 378(8): 708–718. https://www.nejm.org/doi/https://doi.org/10.1056/NEJMoa1713973

Yoon W, Kim SK, Park MS, Baek BH, Lee YY (2017) Predictive factors for good outcome and mortality after stent-retriever thrombectomy in patients with acute anterior circulation stroke. J Stroke 19(1):97–103. https://doi.org/10.5853/jos.2016.00675CrossRefPubMedPubMedCentral

O'Connor KP, Hathidara MY, Danala G (eds) (2020) Predicting clinical outcome after mechanical thrombectomy: the GADIS (gender, age, diabetes mellitus history, infarct volume, and current smoker [corrected]) Score. World Neurosurg 134: e1130-e1142. https://doi.org/10.1016/j.wneu.2019.11.127

10.

Kaschka IN, Kloska SP, Struffert T (eds) (2016) Clinical and radiological outcome after mechanical thrombectomy in acute ischemic stroke: What matters. Neuroradiol J 29(2): 99-105. https://doi.org/10.1016/j.wneu.2019.11.127

11.

Panerai RB (1998) Assessment of cerebral pressure autoregulation in humans—a review of measurement methods. Physiol Meas 19(3):305–338. https://doi.org/10.1088/0967-3334/19/3/001CrossRefPubMed

12.

Boned S, Padroni M, Rubiera M (eds) (2017) Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept. J Neurointerv Surg 9(1): 66-69. https://doi.org/10.1136/neurintsurg-2016-012494

13.

Donahue J, Wintermark M (2015) Perfusion CT and acute stroke imaging: foundations, applications, and literature review. J Neuroradio 42(1):21–29. https://doi.org/10.1016/j.neurad.2014.11.003CrossRef

14.

Angermaier A, Khaw AV, Kirsch M, Kessler C, Langner S (2015) Influence of recanalization and time of cerebral ischemia on tissue outcome after endovascular stroke treatment on computed tomography perfusion. J Stroke Cerebrovasc Dis 24(10):2306–2312. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.06.025CrossRefPubMed

15.

Tong LS, Guo ZN, Ou YB (eds) (2018) Cerebral venous collaterals: a new fort for fighting ischemic stroke. Prog Neurobiol 163-164: 172-193. https://doi.org/10.1016/j.pneurobio.2017.11.001

16.

Munuera J, Blasco G, Hernández-Pérez M (eds) (2017) Venous imaging-based biomarkers in acute ischaemic stroke. J Neurol Neurosurg Psychiatry 88(1): 62-69. https://doi.org/10.1136/jnnp-2016-314814

17.

Tan IY, Demchuk AM, Hopyan J (eds) (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): 525-31. https://doi.org/10.3174/ajnr.a1408

18.

Tanriover N, Kawashima M, Rhoton AL Jr, Ulm AJ, Mericle RA (2003) Microsurgical anatomy of the early branches of the middle cerebral artery: morphometric analysis and classification with angiographic correlation. J Neurosurg 98(6):1277–1290. https://doi.org/10.3171/jns.2003.98.6.1277CrossRefPubMed

19.

Cilliers K, Page BJ (2017) Anatomy of the middle cerebral artery: cortical branches, branching pattern and anomalies. Turk Neurosurg 27(5):671–681. https://doi.org/10.5137/1019-5149.jtn.18127-16.1CrossRefPubMed

20.

Sadatomo T, Yuki K, Migita K, Imada Y, Kuwabara M, Kurisu K (2013) Differences between middle cerebral artery bifurcations with normal anatomy and those with aneurysms. Neurosurg Rev 36(3):437–445. https://doi.org/10.1007/s10143-013-0450-5CrossRefPubMed

21.

Jenkinson D (1999) ECASS-II: intravenous alteplase in acute ischaemic stroke. European Co-operative Acute Stroke Study-II. Lancet 353(9146):67–68. https://doi.org/10.1016/s0140-6736(05)74846-7CrossRefPubMed

22.

Lapi D, Colantuoni A (2015) Remodeling of Cerebral Microcirculation after Ischemia-Reperfusion. J Vasc Res 52(1):22–31. https://doi.org/10.1159/000381096CrossRefPubMed

23.

Gibbons GH, Dzau VJ (1994) The emerging concept of vascular remodeling. N Engl J Med 330(20):1431–1438. https://doi.org/10.1056/nejm199405193302008CrossRefPubMed

24.

Zhang ZG, Chopp M (2009) Neurorestorative therapies for stroke: underlying mechanisms and translation to the clinic. Lancet Neurol 8(5):491–500. https://doi.org/10.1016/s1474-4422(09)70061-4CrossRefPubMedPubMedCentral

25.

Durukan A, Tatlisumak T (2007) Acute ischemic stroke: overview of major experimental rodent models, pathophysiology, and therapy of focal cerebral ischemia. Pharmacol Biochem Behav 87(1):179–197. https://doi.org/10.1016/j.pbb.2007.04.015CrossRefPubMed

26.

Meyer JS, Denny-Brown D (1955) Studies of cerebral circulation in brain injury. II Cerebral concussion. Electroencephalogr Clin Neurophysiol 7(4):529–544. https://doi.org/10.1016/0013-4694(55)90078-xCrossRefPubMed

27.

Brown MM, Wade JP, Marshall J (1985) Fundamental importance of arterial oxygen content in the regulation of cerebral blood flow in man. Brain 108(Pt 1):81–93. https://doi.org/10.1093/brain/108.1.81CrossRefPubMed

28.

Jeong HG, Kim BJ, Kim H (eds) (2019) Blood pressure drop and penumbral tissue loss in nonrecanalized emergent large vessel occlusion. Stroke 50(10): 2677-2684. https://doi.org/10.1161/strokeaha.119.025426

29.

Meyer M, Juenemann M, Braun T (eds) (2020) Impaired cerebrovascular autoregulation in large vessel occlusive stroke after successful mechanical thrombectomy: a prospective cohort study. J Stroke Cerebrovasc Dis 29(3): 104596. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104596

30.

Regenhardt RW, Das AS, Lo EH, Caplan LR (2018) Advances in understanding the pathophysiology of lacunar stroke: a review. JAMA Neurol 75(10):1273–1281. https://doi.org/10.1001/jamaneurol.2018.1073CrossRefPubMedPubMedCentral

31.

Goyal N, Tsivgoulis G, Frei D (eds) (2019) Comparative safety and efficacy of modified TICI 2b and TICI 3 reperfusion in acute ischemic strokes treated with mechanical thrombectomy. Neurosurgery 84(3): 680-686. https://doi.org/10.1093/neuros/nyy097

32.

Ito H, Tomooka T, Sakai N (eds) (1992) Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation May;85(5):1699–705. https://doi.org/10.1161/01.cir.85.5.1699

33.

Ito H, Maruyama A, Iwakura K (eds) (1996) Clinical implications of the 'no reflow' phenomenon. A predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation Jan 15;93(2):223–8. https://doi.org/10.1161/01.cir.93.2.223

34.

Castro P, Azevedo E, Serrador J, Rocha I, Sorond F (2017) Hemorrhagic transformation and cerebral edema in acute ischemic stroke: Link to cerebral autoregulation. J Neurol Sci 372:256–261. https://doi.org/10.1016/j.jns.2016.11.065CrossRefPubMed

Title: Artery diameter ratio after recanalization in endovascular therapy for acute ischemic stroke: a new predictor of clinical outcomes
Authors: Shuhan Huang
Chengchun Liu
Xiaoshu Li
Ya Wu
Chunrong Liang
Wei Li
Meng Zhang
Publication date: 01-04-2022
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Angiography
Cerebral Edema
Published in: Neuroradiology / Issue 4/2022
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-021-02841-5

At a glance: The STEP trials

Springer Medicine

Artery diameter ratio after recanalization in endovascular therapy for acute ischemic stroke: a new predictor of clinical outcomes

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2022

Correction to: The role of shuntography in diagnosis of mechanic complications after implantation of ventriculoperitoneal shunts in patients with idiopathic normal pressure hydrocephalus: a retrospective clinical evaluation

A multicenter prospective registry of Borden type I dural arteriovenous fistula: results of a 3-year follow-up study

Different FreeSurfer versions might generate different statistical outcomes in case–control comparison studies

European Society of Neuroradiology (ESNR)

Application of artificial intelligence and radiomics in pituitary neuroendocrine and sellar tumors: a quantitative and qualitative synthesis

Value of ultra-high field MRI in patients with suspected focal epilepsy and negative 3 T MRI (EpiUltraStudy): protocol for a prospective, longitudinal therapeutic study