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Open Access 01-12-2019 | Stroke | Critical Review

Current concepts in imaging and endovascular treatment of acute ischemic stroke: implications for the clinician

Authors: Thijs van der Zijden, Annelies Mondelaers, Laetitia Yperzeele, Maurits Voormolen, Paul M. Parizel

Published in: Insights into Imaging | Issue 1/2019

Abstract

During the last decade, the management of acute ischemic stroke has changed dramatically, from an expectant bedside “wait and see” attitude towards active treatment, thanks to the continuous improvement of new therapeutic options. In addition to the use of intravenous (IV) thrombolysis in emergent large vessel occlusion (ELVO), endovascular therapy (EVT) has proven to be very efficient in selected acute stroke patients. The indications for EVT have progressed from the era of thrombolysis to individual patient profiling. Recently, several indication parameters, e.g., “treatment time window” or “more distal vessel occlusion,” are under debate for adjustment. In this article, we review the imaging strategies in acute stroke and discuss several EVT indication dogmas, which are subject to change.

Benjamin EJ, Virani SS, Callaway CW et al (2018) Heart Disease and Stroke Statistics-2018 Update: a report from the American Heart Association. Circulation. 137(12):e67–e492. https://doi.org/10.1161/cir.0000000000000558

Malhotra K, Gornbein J, Saver JL (2017) Ischemic strokes due to large-vessel occlusions contribute disproportionately to stroke-related dependence and death: a review. Front Neurol 8:651. https://doi.org/10.3389/fneur.2017.00651 CrossRefPubMedPubMedCentral

Castano C, Dorado L, Guerrero C et al (2010) Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke. 41(8):1836–1840. https://doi.org/10.1161/strokeaha.110.584904 CrossRef

Broderick JP, Palesch YY, Demchuk AM et al (2013) Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368(10):893–903. https://doi.org/10.1056/NEJMoa1214300 CrossRef

Ciccone A, Valvassori L, Nichelatti M et al (2013) Endovascular treatment for acute ischemic stroke. N Engl J Med 368(10):904–913. https://doi.org/10.1056/NEJMoa1213701 CrossRef

Kidwell CS, Jahan R, Gornbein J et al (2013) A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 368(10):914–923. https://doi.org/10.1056/NEJMoa1212793 CrossRef

Berkhemer OA, Fransen PS, Beumer D et al (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 CrossRef

Campbell BC, Mitchell PJ, Kleinig TJ et al (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372(11):1009–1018. https://doi.org/10.1056/NEJMoa1414792 CrossRef

Goyal M, Demchuk AM, Menon BK et al (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372(11):1019–1030. https://doi.org/10.1056/NEJMoa1414905 CrossRef

10.

Turc G, Bhogal P, Fischer U et al (2019) European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischemic Stroke. J Neurointerv Surg. https://doi.org/10.1136/neurintsurg-2018-014569

11.

Powers WJ, Rabinstein AA, Ackerson T et al (2018) 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 49(3):e46–e110. https://doi.org/10.1161/str.0000000000000158

12.

Seker F, Pfaff J, Schonenberger S et al (2019) Clinical outcome after thrombectomy in patients with stroke with premorbid modified Rankin scale scores of 3 and 4: a cohort study with 136 patients. AJNR Am J Neuroradiol 40(2):283–286. https://doi.org/10.3174/ajnr.A5920 CrossRef

13.

Rowley HA (2001) The four Ps of acute stroke imaging: parenchyma, pipes, perfusion, and penumbra. AJNR Am J Neuroradiol 22(4):599–601PubMed

14.

Rahme R, Abruzzo TA, Ringer AJ (2011) Acute ischemic stroke in the setting of cervical carotid occlusion: a proposed management strategy. World Neurosurg 76(6 Suppl):S60–S65. https://doi.org/10.1016/j.wneu.2011.08.016 CrossRefPubMed

15.

Campbell BC, Christensen S, Levi CR et al (2011) Cerebral blood flow is the optimal CT perfusion parameter for assessing infarct core. Stroke. 42(12):3435–3440. https://doi.org/10.1161/strokeaha.111.618355 CrossRef

16.

Heit JJ, Wintermark M (2016) Perfusion computed tomography for the evaluation of acute ischemic stroke: strengths and pitfalls. Stroke. 47(4):1153–1158. https://doi.org/10.1161/strokeaha.116.011873 CrossRefPubMed

17.

Heiss WD, Zaro Weber O (2017) Validation of MRI determination of the penumbra by PET measurements in ischemic stroke. J Nucl Med 58(2):187–193. https://doi.org/10.2967/jnumed.116.185975 CrossRef

18.

Leng X, Fang H, Leung TW et al (2016) Impact of collateral status on successful revascularization in endovascular treatment: a systematic review and meta-analysis. Cerebrovasc Dis 41(1–2):27–34. https://doi.org/10.1159/000441803 CrossRef

19.

Liebeskind DS (2003) Collateral circulation. Stroke. 34(9):2279–2284. https://doi.org/10.1161/01.str.0000086465.41263.06 CrossRefPubMed

20.

Shuaib A, Butcher K, Mohammad AA, Saqqur M, Liebeskind DS (2011) Collateral blood vessels in acute ischaemic stroke: a potential therapeutic target. Lancet Neurol 10(10):909–921. https://doi.org/10.1016/s1474-4422(11)70195-8 CrossRefPubMed

21.

Menon BK, Smith EE, Coutts SB et al (2013) Leptomeningeal collaterals are associated with modifiable metabolic risk factors. Ann Neurol 74(2):241–248. https://doi.org/10.1002/ana.23906

22.

Lima FO, Furie KL, Silva GS et al (2010) The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long-term functional outcome in stroke patients with large vessel intracranial occlusion. Stroke. 41(10):2316–2322. https://doi.org/10.1161/strokeaha.110.592303 CrossRef

23.

Treurniet KM, Berkhemer OA, Immink RV et al (2018) A decrease in blood pressure is associated with unfavorable outcome in patients undergoing thrombectomy under general anesthesia. J Neurointerv Surg 10(2):107–111. https://doi.org/10.1136/neurintsurg-2017-012988 CrossRef

24.

Rocha M, Jovin TG (2017) Fast versus slow progressors of infarct growth in large vessel occlusion stroke: clinical and research implications. Stroke. 48(9):2621–2627. https://doi.org/10.1161/strokeaha.117.017673 CrossRefPubMed

25.

Martinon E, Lefevre PH, Thouant P, Osseby GV, Ricolfi F, Chavent A (2014) Collateral circulation in acute stroke: assessing methods and impact: a literature review. J Neuroradiol 41(2):97–107. https://doi.org/10.1016/j.neurad.2014.02.001 CrossRefPubMed

26.

Furlan A, Higashida R, Wechsler L et al (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in acute cerebral thromboembolism. JAMA. 282(21):2003–2011CrossRef

27.

Vagal AS, Khatri P, Broderick JP, Tomsick TA, Yeatts SD, Eckman MH (2014) Time to angiographic reperfusion in acute ischemic stroke: decision analysis. Stroke. 45(12):3625–3630. https://doi.org/10.1161/strokeaha.114.007188 CrossRefPubMed

28.

Goyal M, Menon BK, Coutts SB, Hill MD, Demchuk AM (2011) Effect of baseline CT scan appearance and time to recanalization on clinical outcomes in endovascular thrombectomy of acute ischemic strokes. Stroke. 42(1):93–97. https://doi.org/10.1161/strokeaha.110.594481 CrossRefPubMed

29.

Santos T, Carvalho A, Cunha AA et al (2018) NCCT and CTA-based imaging protocol for endovascular treatment selection in late presenting or wake-up strokes. J Neurointerv Surg. https://doi.org/10.1136/neurintsurg-2018-014051 CrossRef

30.

Nogueira RG, Jadhav AP, Haussen DC et al (2018) Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 378(1):11–21. https://doi.org/10.1056/NEJMoa1706442 CrossRef

31.

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

32.

Gory B, Haussen DC, Piotin M et al (2018) Impact of intravenous thrombolysis and emergent carotid stenting on reperfusion and clinical outcomes in acute stroke patients with tandem lesion treated with thrombectomy: a collaborative pooled analysis. Eur J Neurol. https://doi.org/10.1111/ene.13633 CrossRef

33.

Behme D, Molina CA, Selim MH, Ribo M (2017) Emergent carotid stenting after thrombectomy in patients with tandem lesions. Stroke. 48(4):1126–1128. https://doi.org/10.1161/strokeaha.117.016182 CrossRefPubMed

34.

Rangel-Castilla L, Rajah GB, Shakir HJ et al (2017) Management of acute ischemic stroke due to tandem occlusion: should endovascular recanalization of the extracranial or intracranial occlusive lesion be done first? Neurosurg Focus 42(4):E16. https://doi.org/10.3171/2017.1.focus16500 CrossRef

35.

Marnane M, Ni Chroinin D, Callaly E et al (2011) Stroke recurrence within the time window recommended for carotid endarterectomy. Neurology. 77(8):738–743. https://doi.org/10.1212/WNL.0b013e31822b00cf CrossRef

36.

Marnat G, Mourand I, Eker O et al (2016) Endovascular management of tandem occlusion stroke related to internal carotid artery dissection using a distal to proximal approach: insight from the RECOST study. AJNR Am J Neuroradiol 37(7):1281–1288. https://doi.org/10.3174/ajnr.A4752 CrossRef

37.

Zinkstok SM, Roos YB (2012) Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial. Lancet 380(9843):731–737. https://doi.org/10.1016/s0140-6736(12)60949-0 CrossRef

38.

Kirchoff-Torres KF, Bakradze E (2018) Cerebral hyperperfusion syndrome after carotid revascularization and acute ischemic stroke. Curr Pain Headache Rep 22(4):24. https://doi.org/10.1007/s11916-018-0678-4 CrossRefPubMed

39.

van Mook WN, Rennenberg RJ, Schurink GW et al (2005) Cerebral hyperperfusion syndrome. Lancet Neurol. 4(12):877–888. https://doi.org/10.1016/s1474-4422(05)70251-9 CrossRef

40.

Haussen DC, Bouslama M, Grossberg JA et al (2017) Too good to intervene? Thrombectomy for large vessel occlusion strokes with minimal symptoms: an intention-to-treat analysis. J Neurointerv Surg. 9(10):917–921. https://doi.org/10.1136/neurintsurg-2016-012633 CrossRef

41.

Heldner MR, Jung S, Zubler C et al (2015) Outcome of patients with occlusions of the internal carotid artery or the main stem of the middle cerebral artery with NIHSS score of less than 5: comparison between thrombolysed and non-thrombolysed patients. J Neurol Neurosurg Psychiatry 86(7):755–760. https://doi.org/10.1136/jnnp-2014-308401 CrossRef

42.

Sarraj A, Hassan A, Savitz SI et al (2018) Endovascular thrombectomy for mild strokes: how low should we go? Stroke. 49(10):2398–2405. https://doi.org/10.1161/strokeaha.118.022114 CrossRef

43.

Xu Y, Qian G, Wei L et al (2016) Predictive factors for the spontaneous recanalization of large and middle cerebral arteries after acute occlusion. J Stroke Cerebrovasc Dis 25(8):1896–1900. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.04.009 CrossRef

44.

Kaschner MG, Caspers J, Rubbert C et al (2018) Mechanical thrombectomy in MCA-mainstem occlusion in patients with low NIHSS scores. Interve Neuroradiol.1591019918760747. https://doi.org/10.1177/1591019918760747 CrossRef

45.

Bhogal P, Bücke P, Ganslandt O, Bäzner H, Henkes H, Pérez MA (2016) Mechanical thrombectomy in patients with M1 occlusion and NIHSS score ≤5: a single-centre experience. Stroke Vasc Neurol 1(4):165–171. https://doi.org/10.1136/svn-2016-000052 CrossRefPubMedPubMedCentral

46.

Maas MB, Lev MH, Ay H et al (2009) Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke. 40(9):3001–3005. https://doi.org/10.1161/STROKEAHA.109.552513 CrossRef

47.

Jovin TG, Chamorro A, Cobo E et al (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372(24):2296–2306. https://doi.org/10.1056/NEJMoa1503780 CrossRef

48.

Sims JR, Rordorf G, Smith EE et al (2005) Arterial occlusion revealed by CT angiography predicts NIH stroke score and acute outcomes after IV tPA treatment. AJNR Am J Neuroradiol 26(2):246–251

49.

Riedel CH, Zimmermann P, Jensen-Kondering U, Stingele R, Deuschl G, Jansen O (2011) The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length. Stroke. 42(6):1775–1777. https://doi.org/10.1161/strokeaha.110.609693 CrossRefPubMed

50.

Coutinho JM, Liebeskind DS, Slater LA et al (2016) Mechanical thrombectomy for isolated M2 occlusions: a post hoc analysis of the STAR, SWIFT, and SWIFT PRIME studies. AJNR Am J Neuroradiol 37(4):667–672. https://doi.org/10.3174/ajnr.A4591 CrossRef

51.

Bowen MT, Rebello LC, Bouslama M et al (2018) Clinical and imaging outcomes of endovascular therapy in patients with acute large vessel occlusion stroke and mild clinical symptoms. Interv Neurol 7(1–2):91–98. https://doi.org/10.1159/000481205 CrossRef

52.

Schonewille WJ, Wijman CA, Michel P et al (2009) Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol. 8(8):724–730. https://doi.org/10.1016/s1474-4422(09)70173-5 CrossRef

53.

van der Hoeven EJ, Schonewille WJ, Vos JA et al (2013) The Basilar Artery International Cooperation Study (BASICS): study protocol for a randomised controlled trial. Trials. 14:200. https://doi.org/10.1186/1745-6215-14-200 CrossRef

Title: Current concepts in imaging and endovascular treatment of acute ischemic stroke: implications for the clinician
Authors: Thijs van der Zijden
Annelies Mondelaers
Laetitia Yperzeele
Maurits Voormolen
Paul M. Parizel
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keyword: Stroke
Published in: Insights into Imaging / Issue 1/2019
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-019-0744-4

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Current concepts in imaging and endovascular treatment of acute ischemic stroke: implications for the clinician

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