Assessment of Irreversible Tissue Injury in Extensive Ischemic Stroke-Potential of Quantitative Cerebral Perfusion.
Brain edema
Infarction
Stroke
Thrombolysis
Journal
Translational stroke research
ISSN: 1868-601X
Titre abrégé: Transl Stroke Res
Pays: United States
ID NLM: 101517297
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
received:
11
02
2022
accepted:
23
06
2022
revised:
07
06
2022
medline:
29
6
2023
pubmed:
2
7
2022
entrez:
1
7
2022
Statut:
ppublish
Résumé
Computed tomography perfusion (CTP) is used as a tool to select ischemic stroke patients for endovascular treatment (EVT) and is currently investigated in the setting of extensive stroke with low Alberta Stroke Program Early CT scores (ASPECTS). The purpose of this study was to perform a comprehensive quantitative analysis of cerebral blood flow within the ischemic lesion compared to threshold-derived core lesion volumes. We hypothesized that the degree of cerebral blood volume (CBV) reduction within the ischemic lesion is predictive of irreversible tissue injury and functional outcome in patients with low ASPECTS. Ischemic stroke patients with an ASPECTS ≤ 5 who received multimodal CT on admission and underwent thrombectomy were analyzed. The ischemic lesion on CTP was identified, and CTP-derived parameters were measured as absolute means within the lesion and relative to the physiological perfusion measured in a contralateral region of interest. The degree of irreversible tissue injury was assessed using quantitative net water uptake (NWU). Functional endpoint was good outcome defined as modified Rankin Scale (mRS) scores 0-3 at day 90. One hundred eleven patients were included. The median core lesion volume was 71 ml (IQR: 25-107), and the median quantitative NWU was 9.5% (IQR: 6-13). Relative CBV (rCBV) reduction and ASPECTS at baseline were independently associated with NWU in multivariable linear regression analysis (ß: 12.4, 95%CI: 6.0-18.9, p < 0.0001) and (ß: - 0.78, 95% CI: - 1.53 to - 0.02; p = 0.045), respectively. Furthermore, rCBV was significantly associated with good outcome in patients with core volumes > 50 ml (OR: 0.16, 95% CI: 0.05-0.49, p = 0.001). Our study shows that rCBV reduction serves as an early surrogate for increase of NWU as a marker of irreversible tissue injury and lesion progression. Thus, the analysis of rCBV reduction within ischemic lesions may add another dimension to acute stroke triage in addition to core volumes or ASPECTS as indicators of the infarct extent and viability.
Identifiants
pubmed: 35778671
doi: 10.1007/s12975-022-01058-9
pii: 10.1007/s12975-022-01058-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
562-571Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Bendszus M, Fiehler J, Thomalla G. New interventional stroke trials. Clin Neuroradiol. 2019;29:1.
doi: 10.1007/s00062-019-00763-7
pubmed: 30762071
Flottmann F, Broocks G, Faizy TD, Ernst M, Forkert ND, Grosser M, et al. Ct-perfusion stroke imaging: a threshold free probabilistic approach to predict infarct volume compared to traditional ischemic thresholds. Sci Rep. 2017;7:6679.
doi: 10.1038/s41598-017-06882-w
pubmed: 28751692
pmcid: 5532266
Goyal M, Ospel JM, Menon B, Almekhlafi M, Jayaraman M, Fiehler J, et al. Challenging the ischemic core concept in acute ischemic stroke imaging. Stroke. 2020;51:3147–55.
doi: 10.1161/STROKEAHA.120.030620
pubmed: 32933417
Broocks G, Flottmann F, Ernst M, Faizy TD, Minnerup J, Siemonsen S, et al. Computed tomography-based imaging of voxel-wise lesion water uptake in ischemic brain: relationship between density and direct volumetry. Invest Radiol. 2018;53:207–13.
doi: 10.1097/RLI.0000000000000430
pubmed: 29200013
Broocks G, McDonough R, Meyer L, Bechstein M, Kniep H, Schon G, et al. Reversible ischemic lesion hypodensity in acute stroke ct following endovascular reperfusion. Neurology. 2021;97:e1075–84.
doi: 10.1212/WNL.0000000000012484
pubmed: 34261783
Fiorelli M, Bastianello S, von Kummer R, del Zoppo GJ, Larrue V, Lesaffre E, et al. Hemorrhagic transformation within 36 hours of a cerebral infarct: relationships with early clinical deterioration and 3-month outcome in the european cooperative acute stroke study i (ecass i) cohort. Stroke. 1999;30:2280–4.
doi: 10.1161/01.STR.30.11.2280
pubmed: 10548658
Meyer L, Bechstein M, Bester M, Hanning U, Brekenfeld C, Flottmann F, et al. Thrombectomy in extensive stroke may not be beneficial and is associated with increased risk for hemorrhage. Stroke. 2021;52:3109–17.
doi: 10.1161/STROKEAHA.120.033101
pubmed: 34470489
Campbell BC, Christensen S, Levi CR, Desmond PM, Donnan GA, Davis SM, et al. Cerebral blood flow is the optimal ct perfusion parameter for assessing infarct core. Stroke. 2011;42:3435–40.
doi: 10.1161/STROKEAHA.111.618355
pubmed: 21980202
Lee TY, Murphy BD, Aviv RI, Fox AJ, Black SE, Sahlas DJ, et al. Cerebral blood flow threshold of ischemic penumbra and infarct core in acute ischemic stroke: a systematic review. Stroke. 2006;37:2201; author reply 2203
Minnerup J, Broocks G, Kalkoffen J, Langner S, Knauth M, Psychogios MN, et al. Computed tomography-based quantification of lesion water uptake identifies patients within 4.5 hours of stroke onset: a multicenter observational study. Ann Neurol. 2016;80:924–34.
doi: 10.1002/ana.24818
pubmed: 28001316
Broocks G, Flottmann F, Scheibel A, Aigner A, Faizy TD, Hanning U, et al. Quantitative lesion water uptake in acute stroke computed tomography is a predictor of malignant infarction. Stroke. 2018;49:1906–12.
doi: 10.1161/STROKEAHA.118.020507
pubmed: 29976584
Souza LC, Yoo AJ, Chaudhry ZA, Payabvash S, Kemmling A, Schaefer PW, et al. Malignant cta collateral profile is highly specific for large admission dwi infarct core and poor outcome in acute stroke. AJNR Am J Neuroradiol. 2012;33:1331–6.
doi: 10.3174/ajnr.A2985
pubmed: 22383238
pmcid: 3888794
Kim JT, Liebeskind DS, Jahan R, Menon BK, Goyal M, Nogueira RG, et al. Impact of hyperglycemia according to the collateral status on outcomes in mechanical thrombectomy. Stroke. 2018;49:2706–14.
doi: 10.1161/STROKEAHA.118.022167
pubmed: 30355207
Broocks G, Kniep H, Schramm P, Hanning U, Flottmann F, Faizy T, et al. Patients with low alberta stroke program early ct score (aspects) but good collaterals benefit from endovascular recanalization. J Neurointerv Surg. 2020;12:747–52.
doi: 10.1136/neurintsurg-2019-015308
Sarraj A, Hassan AE, Abraham M, Ribo M, Blackburn S, Chen M, et al. Express: a randomized controlled trial to optimize patientas selection for endovascular treatment in acute ischemic stroke (select2): Study protocol. Int J Stroke. 2021:17474930211035032
Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378:708–18.
doi: 10.1056/NEJMoa1713973
pubmed: 29364767
pmcid: 6590673
Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11–21.
doi: 10.1056/NEJMoa1706442
pubmed: 29129157
Ma H, Campbell BCV, Parsons MW, Churilov L, Levi CR, Hsu C, et al. Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. N Engl J Med. 2019;380:1795–803.
doi: 10.1056/NEJMoa1813046
pubmed: 31067369
Campbell BCV, Majoie C, Albers GW, Menon BK, Yassi N, Sharma G, et al. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurol. 2019;18:46–55.
doi: 10.1016/S1474-4422(18)30314-4
pubmed: 30413385
Rocha M, Jovin TG. Fast versus slow progressors of infarct growth in large vessel occlusion stroke: Clinical and research implications. Stroke. 2017;48:2621–7.
doi: 10.1161/STROKEAHA.117.017673
pubmed: 28794271
Wintermark M, Flanders AE, Velthuis B, Meuli R, van Leeuwen M, Goldsher D, et al. Perfusion-ct assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke. 2006;37:979–85.
doi: 10.1161/01.STR.0000209238.61459.39
pubmed: 16514093
Albers GW, Goyal M, Jahan R, Bonafe A, Diener HC, Levy EI, et al. Ischemic core and hypoperfusion volumes predict infarct size in swift prime. Ann Neurol. 2016;79:76–89.
doi: 10.1002/ana.24543
pubmed: 26476022
Boned S, Padroni M, Rubiera M, Tomasello A, Coscojuela P, Romero N, et al. Admission ct perfusion may overestimate initial infarct core: the ghost infarct core concept. J Neurointerv Surg. 2017;9:66–9.
doi: 10.1136/neurintsurg-2016-012494
pubmed: 27566491
McDonough R, Elsayed S, Meyer L, Ewers T, Bechstein M, Kniep H, et al. Low baseline ischemic water uptake is directly related to overestimation of ct perfusion-derived ischemic core volume. Preprint at Scientific Reports. 2022
Knash M, Tsang A, Hameed B, Saini M, Jeerakathil T, Beaulieu C, et al. Low cerebral blood volume is predictive of diffusion restriction only in hyperacute stroke. Stroke. 2010;41:2795–800.
doi: 10.1161/STROKEAHA.110.590554
pubmed: 21051672
Nawabi J, Flottmann F, Kemmling A, Kniep H, Leischner H, Sporns P, et al. Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization - when “tissue clock” and “time clock” are desynchronized. Int J Stroke. 2021;16:863–72.
doi: 10.1177/1747493019884522
pubmed: 31657283
Tan BY, Wan-Yee K, Paliwal P, Gopinathan A, Nadarajah M, Ting E, et al. Good intracranial collaterals trump poor aspects (alberta stroke program early ct score) for intravenous thrombolysis in anterior circulation acute ischemic stroke. Stroke. 2016;47:2292–8.
doi: 10.1161/STROKEAHA.116.013879
pubmed: 27491731
Broocks G, Kemmling A, Meyer L, Nawabi J, Schon G, Fiehler J, et al. Computed tomography angiography collateral profile is directly linked to early edema progression rate in acute ischemic stroke. Stroke. 2019;50:3424–30.
doi: 10.1161/STROKEAHA.119.027062
pubmed: 31665994
Almallouhi E, Al Kasab S, Hubbard Z, Bass EC, Porto G, Alawieh A, et al. Outcomes of mechanical thrombectomy for patients with stroke presenting with low alberta stroke program early computed tomography score in the early and extended window. JAMA Netw Open. 2021;4:e2137708.
doi: 10.1001/jamanetworkopen.2021.37708
pubmed: 34878550
pmcid: 8655598
Broocks G, McDonough R, Meyer L, Bechstein M, Dipl Ing HK, Schon G, et al. Reversible ischemic lesion hypodensity in acute stroke ct following endovascular reperfusion. Neurology. 2021
Nawabi J, Kniep H, Schon G, Flottmann F, Leischner H, Kabiri R, et al. Hemorrhage after endovascular recanalization in acute stroke: lesion extent, collaterals and degree of ischemic water uptake mediate tissue vulnerability. Front Neurol. 2019;10:569.
doi: 10.3389/fneur.2019.00569
pubmed: 31214107
pmcid: 6558047
Nowinski WL, Gupta V, Qian G, He J, Poh LE, Ambrosius W, et al. Automatic detection, localization, and volume estimation of ischemic infarcts in noncontrast computed tomographic scans: method and preliminary results. Invest Radiol. 2013;48:661–70.
doi: 10.1097/RLI.0b013e31828d8403
pubmed: 23666092