Impact of relative cerebral blood volume reduction on early neurological improvement in extensive ischemic stroke.
biomarker
computed tomography
stroke
thrombectomy
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
received:
08
06
2022
accepted:
29
06
2022
pubmed:
10
7
2022
medline:
12
10
2022
entrez:
9
7
2022
Statut:
ppublish
Résumé
The benefit of endovascular treatment (EVT) for patients with low Alberta Stroke Program early computed tomography score (ASPECTS) is still ambiguous and is currently being investigated in randomized trials. Computed tomography (CT) perfusion, used to estimate infarct extent and progression, might predict early neurological improvement (ENI) after EVT. We hypothesized that the degree of relative cerebral blood volume (rCBV) reduction is directly associated with ENI in low ASPECTS patients undergoing EVT. Ischemic stroke patients with ASPECTS ≤ 5 who received multimodal CT and underwent thrombectomy were analyzed. rCBV reduction was defined as the ratio of cerebral blood volume (CBV), measured in the ischemic lesion to contralateral CBV. Complete reperfusion was defined as an expanded Thrombolysis in Cerebral Infarction score 2c-3. The clinical endpoint was ENI at 24 h, defined continuously (National Institutes of Health Stroke Scale [NIHSS] score change from baseline to 24 h) and binarized (NIHSS score at 24 h ≤ 8). A total of 102 patients were included. Lower rCBV reduction and complete EVT were independently associated with ENI (-11.4 NIHSS points, p = 0.04; -7.3 points, p < 0.0001, respectively). The effect of complete EVT on ENI was directly linked to the degree of rCBV reduction: the probability for binary ENI was +34.6% (p = 0.004) in patients with low rCBV reduction versus +8.2% (p = 0.28) in patients with high rCBV reduction). In patients with ischemic stroke with low ASPECTS, ENI was directly linked to the degree of rCBV reduction, a potential indicator of ischemia depth in extensive baseline infarction. Lower rCBV reduction was associated with higher probability of ENI after complete reperfusion, suggesting less pronounced lesion progression despite its large extent and hence, a higher susceptibility to EVT.
Sections du résumé
BACKGROUND AND PURPOSE
The benefit of endovascular treatment (EVT) for patients with low Alberta Stroke Program early computed tomography score (ASPECTS) is still ambiguous and is currently being investigated in randomized trials. Computed tomography (CT) perfusion, used to estimate infarct extent and progression, might predict early neurological improvement (ENI) after EVT. We hypothesized that the degree of relative cerebral blood volume (rCBV) reduction is directly associated with ENI in low ASPECTS patients undergoing EVT.
METHODS
Ischemic stroke patients with ASPECTS ≤ 5 who received multimodal CT and underwent thrombectomy were analyzed. rCBV reduction was defined as the ratio of cerebral blood volume (CBV), measured in the ischemic lesion to contralateral CBV. Complete reperfusion was defined as an expanded Thrombolysis in Cerebral Infarction score 2c-3. The clinical endpoint was ENI at 24 h, defined continuously (National Institutes of Health Stroke Scale [NIHSS] score change from baseline to 24 h) and binarized (NIHSS score at 24 h ≤ 8).
RESULTS
A total of 102 patients were included. Lower rCBV reduction and complete EVT were independently associated with ENI (-11.4 NIHSS points, p = 0.04; -7.3 points, p < 0.0001, respectively). The effect of complete EVT on ENI was directly linked to the degree of rCBV reduction: the probability for binary ENI was +34.6% (p = 0.004) in patients with low rCBV reduction versus +8.2% (p = 0.28) in patients with high rCBV reduction).
CONCLUSION
In patients with ischemic stroke with low ASPECTS, ENI was directly linked to the degree of rCBV reduction, a potential indicator of ischemia depth in extensive baseline infarction. Lower rCBV reduction was associated with higher probability of ENI after complete reperfusion, suggesting less pronounced lesion progression despite its large extent and hence, a higher susceptibility to EVT.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3264-3272Informations de copyright
© 2022 European Academy of Neurology.
Références
Meyer L, Stracke CP, Jungi N, et al. Thrombectomy for primary distal posterior cerebral artery occlusion stroke: the TOPMOST study. JAMA Neurol. 2021;78:434-444.
Broocks G, Kemmling A, Tessarek S, et al. Quantitative lesion water uptake as stroke imaging biomarker: a tool for treatment selection in the extended time window? Stroke. 2022;53:201-209.
Meyer L, Bechstein M, Bester M, et al. Thrombectomy in extensive stroke may not be beneficial and is associated with increased risk for hemorrhage. Stroke. 2021;52:3109-3117.
Meyer L, Broocks G, Bechstein M, et al. Early clinical surrogates for outcome prediction after stroke thrombectomy in daily clinical practice. J Neurol Neurosurg Psychiatry. 2020;91:1055-1059.
Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. 'Malignant' middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol. 1996;53:309-315.
Broocks G, Flottmann F, Scheibel A, et al. Quantitative lesion water uptake in acute stroke computed tomography is a predictor of malignant infarction. Stroke. 2018;49:1906-1912.
Goyal M, Ospel JM, Menon B, et al. Challenging the ischemic Core concept in acute ischemic stroke imaging. Stroke. 2020;51:3147-3155.
Boned S, Padroni M, Rubiera M, et al. Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept. J Neurointerv Surg. 2017;9:66-69.
Fiorelli M, Bastianello S, von Kummer R, 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;30:2280-2284.
Souza LC, Yoo AJ, Chaudhry ZA, et al. Malignant CTA collateral profile is highly specific for large admission DWI infarct core and poor outcome in acute stroke. Am J Neuroradiol. 2012;33:1331-1336.
Liebeskind DS, Bracard S, Guillemin F, et al. eTICI reperfusion: defining success in endovascular stroke therapy. J Neurointerv Surg. 2018;11:433-438.
Bendszus M, Fiehler J, Thomalla G. New interventional stroke trials. Clin Neuroradiol. 2019;29:1.
Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378:708-718.
Sarraj A, Campbell B, Ribo M, et al. SELECTion criteria for large core trials: dogma or data? J Neurointerv Surg. 2021;13:500-504.
Sarraj A, Pizzo E, Lobotesis K, et al. Endovascular thrombectomy in patients with large core ischemic stroke: a cost-effectiveness analysis from the SELECT study. J Neurointerv Surg. 2020;13:875-882.
Roman LS, Menon BK, Blasco J, et al. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol. 2018;17:895-904.
Broocks G, Flottmann F, Schonfeld M, et al. Incomplete or failed thrombectomy in acute stroke patients with Alberta stroke program early computed tomography score 0-5 - how harmful is trying? Eur J Neurol. 2020;27:2031-2035.
Yoshimura S, Sakai N, Yamagami H, et al. Endovascular therapy for acute stroke with a large ischemic region. N Engl J Med. 2022;386(14):1303-1313.
Broocks G, McDonough R, Meyer L, et al. Reversible ischemic lesion hypodensity in acute stroke CT following endovascular reperfusion. Neurology. 2021;97:e1075-e1084.
Inoue M, Mlynash M, Christensen S, et al. Early diffusion-weighted imaging reversal after endovascular reperfusion is typically transient in patients imaged 3 to 6 hours after onset. Stroke. 2014;45:1024-1028.
Martins N, Aires A, Mendez B, et al. Ghost infarct Core and admission computed tomography perfusion: redefining the role of neuroimaging in acute ischemic stroke. Interv Neurol. 2018;7:513-521.
Broocks G, Minnerup J, McDonough R, Flottmann F, Kemmling A. Letter by Broocks et al regarding article, "challenging the ischemic Core concept in acute ischemic stroke imaging". Stroke. 2021;52:e76-e77.
Jadhav AP, Hacke W, Dippel DWJ, et al. Select wisely: the ethical challenge of defining large core with perfusion in the early time window. J Neurointerv Surg. 2021;13(6):497-499.
Schaefer PW, Mui K, Kamalian S, Nogueira RG, Gonzalez RG, Lev MH. Avoiding "pseudo-reversibility" of CT-CBV infarct core lesions in acute stroke patients after thrombolytic therapy: the need for algorithmically "delay-corrected" CT perfusion map postprocessing software. Stroke. 2009;40:2875-2878.
Bivard A, Kleinig T, Miteff F, et al. Ischemic core thresholds change with time to reperfusion: a case control study. Ann Neurol. 2017;82:995-1003.
Huang S, Kim JK, Atochin DN, et al. Cerebral blood volume affects blood-brain barrier integrity in an acute transient stroke model. J Cereb Blood Flow Metab. 2013;33:898-905.
Broocks G, Kniep H, Schramm P, et al. Patients with low Alberta stroke program early CT score (ASPECTS) but good collaterals benefit from endovascular recanalization. J Neurointerv Surg. 2020;12:747-752.
Campbell BCV, Majoie C, Albers GW, 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.
Broocks G, Flottmann F, Ernst M, et al. Computed tomography-based imaging of voxel-wise lesion water uptake in ischemic brain: relationship between density and direct Volumetry. Invest Radiol. 2018;53:207-213.
van Horn N, Kniep H, Broocks G, et al. ASPECTS interobserver agreement of 100 investigators from the TENSION study. Clin Neuroradiol. 2021;31:1093-1100.
Bivard A, McElduff P, Spratt N, Levi C, Parsons M. Defining the extent of irreversible brain ischemia using perfusion computed tomography. Cerebrovasc Dis. 2011;31:238-245.