Pretreatment CTP Collateral Parameters Predict Good Outcomes in Successfully Recanalized Middle Cerebral Artery Distal Medium Vessel Occlusions.
Acute ischemic stroke
CT perfusion
Collateral imaging
Medium vessel occlusion
Stroke imaging instead
Journal
Clinical neuroradiology
ISSN: 1869-1447
Titre abrégé: Clin Neuroradiol
Pays: Germany
ID NLM: 101526693
Informations de publication
Date de publication:
28 Dec 2023
28 Dec 2023
Historique:
received:
05
09
2023
accepted:
23
11
2023
medline:
29
12
2023
pubmed:
29
12
2023
entrez:
28
12
2023
Statut:
aheadofprint
Résumé
Distal medium vessel occlusions (DMVOs) account for a large percentage of vessel occlusions resulting in acute ischemic stroke (AIS) with disabling symptoms. We aim to assess whether pretreatment quantitative CTP collateral status (CS) parameters can serve as imaging biomarkers for good clinical outcomes prediction in successfully recanalized middle cerebral artery (MCA) DMVOs. We performed a retrospective analysis of consecutive patients with AIS secondary to primary MCA-DMVOs who were successfully recanalized by mechanical thrombectomy (MT) defined as modified thrombolysis in cerebral infarction (mTICI) 2b, 2c, or 3. We evaluated the association between the CBV index and HIR independently with good clinical outcomes (modified Rankin score 0-2) using Spearman rank correlation, logistic regression, and ROC analyses. From 22 August 2018 to 18 October 2022 8/22/2018 to 10/18/2022, 60 consecutive patients met our inclusion criteria (mean age 71.2 ± 13.9 years old [mean ± SD], 35 female). The CBV index (r = -0.693, p < 0.001) and HIR (0.687, p < 0.001) strongly correlated with 90-day mRS. A CBV index ≥ 0.7 (odds ratio, OR, 2.27, range 6.94-21.23 [OR] 2.27 [6.94-21.23], p = 0.001)) and lower likelihood of prior stroke (0.13 [0.33-0.86]), p = 0.024)) were independently associated with good outcomes. The ROC analysis demonstrated good performance of the CBV index in predicting good 90-day mRS (AUC 0.73, p = 0.003) with a threshold of 0.7 for optimal sensitivity (71% [52.0-85.8%]) and specificity (76% [54.9-90.6%]). The HIR also demonstrated adequate performance in predicting good 90-day mRS (AUC 0.77, p = 0.001) with a threshold of 0.3 for optimal sensitivity (64.5% [45.4-80.8%]) and specificity (76.0% [54.9-90.6%]). A CBV index ≥ 0.7 may be independently associated with good clinical outcomes in our cohort of AIS caused by MCA-DMVOs that were successfully treated with MT. Furthermore, a HIR < 0.3 is also associated with good clinical outcomes. This is the first study of which we are aware to identify a CBV index threshold for MCA-DMVOs.
Sections du résumé
BACKGROUND/PURPOSE
OBJECTIVE
Distal medium vessel occlusions (DMVOs) account for a large percentage of vessel occlusions resulting in acute ischemic stroke (AIS) with disabling symptoms. We aim to assess whether pretreatment quantitative CTP collateral status (CS) parameters can serve as imaging biomarkers for good clinical outcomes prediction in successfully recanalized middle cerebral artery (MCA) DMVOs.
METHODS
METHODS
We performed a retrospective analysis of consecutive patients with AIS secondary to primary MCA-DMVOs who were successfully recanalized by mechanical thrombectomy (MT) defined as modified thrombolysis in cerebral infarction (mTICI) 2b, 2c, or 3. We evaluated the association between the CBV index and HIR independently with good clinical outcomes (modified Rankin score 0-2) using Spearman rank correlation, logistic regression, and ROC analyses.
RESULTS
RESULTS
From 22 August 2018 to 18 October 2022 8/22/2018 to 10/18/2022, 60 consecutive patients met our inclusion criteria (mean age 71.2 ± 13.9 years old [mean ± SD], 35 female). The CBV index (r = -0.693, p < 0.001) and HIR (0.687, p < 0.001) strongly correlated with 90-day mRS. A CBV index ≥ 0.7 (odds ratio, OR, 2.27, range 6.94-21.23 [OR] 2.27 [6.94-21.23], p = 0.001)) and lower likelihood of prior stroke (0.13 [0.33-0.86]), p = 0.024)) were independently associated with good outcomes. The ROC analysis demonstrated good performance of the CBV index in predicting good 90-day mRS (AUC 0.73, p = 0.003) with a threshold of 0.7 for optimal sensitivity (71% [52.0-85.8%]) and specificity (76% [54.9-90.6%]). The HIR also demonstrated adequate performance in predicting good 90-day mRS (AUC 0.77, p = 0.001) with a threshold of 0.3 for optimal sensitivity (64.5% [45.4-80.8%]) and specificity (76.0% [54.9-90.6%]).
CONCLUSION
CONCLUSIONS
A CBV index ≥ 0.7 may be independently associated with good clinical outcomes in our cohort of AIS caused by MCA-DMVOs that were successfully treated with MT. Furthermore, a HIR < 0.3 is also associated with good clinical outcomes. This is the first study of which we are aware to identify a CBV index threshold for MCA-DMVOs.
Identifiants
pubmed: 38155255
doi: 10.1007/s00062-023-01371-2
pii: 10.1007/s00062-023-01371-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
Références
Saver JL, et al. Thrombectomy for distal, medium vessel occlusions: a consensus statement on present knowledge and promising directions. Stroke. 2020;51:2872–84.
doi: 10.1161/STROKEAHA.120.028956
pubmed: 32757757
Guenego A, et al. Thrombectomy for distal medium vessel occlusion with a new generation of Stentretriever (Tigertriever 13). Interv Neuroradiol. 2021;15910199211039926.
Kauw F, et al. Collateral status in Ischemic stroke: a comparison of computed tomography angiography, computed tomography perfusion, and digital subtraction Angiography. J Comput Assist Tomogr. 2020;44:984–92.
doi: 10.1097/RCT.0000000000001090
pubmed: 33196604
pmcid: 7668337
Wolff L, et al. Inter-rater reliability for assessing intracranial collaterals in patients with acute ischemic stroke: comparing 29 raters and an artificial intelligence-based software. Neuroradiology. 2022;64:2277–84.
doi: 10.1007/s00234-022-02984-z
pubmed: 35608629
pmcid: 9643213
Arenillas JF, et al. Relative cerebral blood volume is associated with collateral status and infarct growth in stroke patients in SWIFT PRIME. J Cereb Blood Flow Metab. 2018;38:1839–47.
doi: 10.1177/0271678X17740293
pubmed: 29135347
Guenego A, et al. Hypoperfusion intensity ratio correlates with angiographic collaterals in acute ischaemic stroke with M1 occlusion. Eur J Neurol. 2020;27:864–70.
doi: 10.1111/ene.14181
pubmed: 32068938
Olivot JM, et al. Hypoperfusion intensity ratio predicts infarct progression and functional outcome in the DEFUSE 2 Cohort. Stroke. 2014;45:1018–23.
doi: 10.1161/STROKEAHA.113.003857
pubmed: 24595591
pmcid: 4047639
Guenego A, et al. Hypoperfusion intensity ratio is correlated with patient eligibility for thrombectomy. Stroke. 2019;50:917–22.
doi: 10.1161/STROKEAHA.118.024134
pubmed: 30841821
Rao VL, et al. Collateral status contributes to differences between observed and predicted 24‑h infarct volumes in DEFUSE 3. J Cereb Blood Flow Metab. 2020;40:1966–74.
doi: 10.1177/0271678X20918816
pubmed: 32423329
pmcid: 7786839
Guenego A, et al. Hypoperfusion intensity ratio predicts infarct growth after successful thrombectomy for distal medium vessel occlusion. Clin Neuroradiol. 2022;32:849–56.
doi: 10.1007/s00062-022-01141-6
pubmed: 35166857
Simera I, Moher D, Hoey J, Schulz KF, Altman DG. A catalogue of reporting guidelines for health research. Eur J Clin Invest. 2010;40:35–53.
doi: 10.1111/j.1365-2362.2009.02234.x
pubmed: 20055895
Menon BK, et al. Efficacy of endovascular thrombectomy in patients with M2 segment middle cerebral artery occlusions: meta-analysis of data from the HERMES Collaboration. J Neurointerv Surg. 2019;11:1065–9.
doi: 10.1136/neurintsurg-2018-014678
pubmed: 30975736
Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, et al. 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. 1998;352:1245–1251.
doi: 10.1016/S0140-6736(98)08020-9
pubmed: 9788453
Liu L, et al. Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017. Stroke Vasc Neurol. 2018;3:117–30.
doi: 10.1136/svn-2017-000135
pubmed: 30294467
pmcid: 6169613
Saber H, et al. Endovascular therapy vs medical management for patients with acute stroke with medium vessel occlusion in the anterior circulation. JAMA Netw Open. 2022;5:e2238154.
doi: 10.1001/jamanetworkopen.2022.38154
pubmed: 36279137
pmcid: 9593229
Farouki Y, et al. First-pass effect predicts clinical outcome and infarct growth after thrombectomy for distal medium vessel occlusions. Neurosurgery. 2022;91:913–9.
doi: 10.1227/neu.0000000000002129
pubmed: 36250706
MacLellan A, et al. Perfusion imaging collateral scores predict infarct growth in non-Reperfused DEFUSE 3 patients. J Stroke Cerebrovasc Dis. 2022;31:106208.
doi: 10.1016/j.jstrokecerebrovasdis.2021.106208
pubmed: 34823091
Lu W‑Z, Lin H‑A, Hou S‑K, Bai C‑H, Lin S‑F. Diagnostic test accuracy of pretreatment collateral score in predicting stroke outcomes after intra-arterial endovascular thrombectomy: a meta-analysis in DSA and CTA. Eur Radiol. 2022;32:6097–107.
doi: 10.1007/s00330-022-08706-6
pubmed: 35322281
van den Wijngaard IR, et al. Impact of collateral status evaluated by dynamic computed tomographic angiography on clinical outcome in patients with Ischemic stroke. Stroke. 2015;46:3398–404.
doi: 10.1161/STROKEAHA.115.010354
pubmed: 26542691
Lyndon D, et al. Hypoperfusion intensity ratio correlates with CTA collateral status in large-vessel occlusion acute ischemic stroke. AJNR Am J Neuroradiol. 2021;42:1380–6.
doi: 10.3174/ajnr.A7181
pubmed: 34140276
pmcid: 8367626
Winkelmeier L, et al. Hypoperfusion intensity ratio is correlated with the risk of parenchymal hematoma after endovascular stroke treatment. Stroke. 2023;54:135–43.
doi: 10.1161/STROKEAHA.122.040540
pubmed: 36416127
Ospel JM, et al. Prevalence and outcomes of medium vessel occlusions with discrepant infarct patterns. Stroke. 2020;51:2817–24.
doi: 10.1161/STROKEAHA.120.030041
pubmed: 32757752
Flach C, Muruet W, Wolfe CDA, Bhalla A, Douiri A. Risk and secondary prevention of stroke recurrence: a population-base cohort study. Stroke. 2020;51:2435–44.
doi: 10.1161/STROKEAHA.120.028992
pubmed: 32646337
pmcid: 7382537
Burn J, et al. Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire community stroke project. Stroke. 1994;25:333–7.
doi: 10.1161/01.STR.25.2.333
pubmed: 8303740
Kolmos M, Christoffersen L, Kruuse C. Recurrent Ischemic stroke—A systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2021;30:105935.
doi: 10.1016/j.jstrokecerebrovasdis.2021.105935
pubmed: 34153594
Kargiotis O, et al. Computed tomography perfusion imaging in acute ischemic stroke: accurate interpretation matters. Stroke. 2023;54:e104–8.
doi: 10.1161/STROKEAHA.122.041117
pubmed: 36756889
Faizy TD, et al. Distinct intra-arterial clot localization affects tissue-level collaterals and venous outflow profiles. Eur J Neurol. 2021;28:4109–16.
doi: 10.1111/ene.15079
pubmed: 34424584