Absence of Collaterals is Associated with Larger Infarct Volume and Worse Outcome in Patients with Large Vessel Occlusion and Mild Symptoms

Kimmel, Eric R.; Kasab, Sami Al; Harvey, Jillian; Bathla, Girish; Ortega‐Gutiérrez, Santiago; Tóth, Gábor; Jaksich, Emily M.; Ali, Sheharyar; Roa, Jorge A; Hasan, David; Samaniego, Edgar A

doi:10.1016/j.jstrokecerebrovasdis.2019.03.032

Cited by 41 publications

(35 citation statements)

References 24 publications

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“…Japanese scholars have shown that the prognosis of AIS with LAO is gender-related: the prognosis of female patients after thrombolytic therapy is better 14 . Western studies have shown that such patients with low NIHSS and good collaterals achieve good long-term functional outcome 15 . In our results, high NIHSS was associated with multiple AC-LAO, and the patients with different AC-LAO subtypes showed different NIHSS, the average score of tandem ICA/MCA group is the highest and the bilateral ICA group is the lowest among eight subtypes.…”

Section: Discussionmentioning

confidence: 99%

Subtypes of anterior circulation large artery occlusions with acute brain ischemic stroke

Zhang

Tian

et al. 2020

Sci Rep

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Anterior circulation large artery occlusion (Ac-LAo) related acute ischemic stroke (AiS) is particularly common in clinics in China. We retrospectively analyzed 787 consecutively hospitalized AIS patients with AC-LAO in Hebei Province, China. AC-LAO was defined as a complete occlusion of at least one intracranial internal carotid artery (icA) or middle cerebral artery (McA) based on computed tomography or magnetic resonance angiography. Among eight subtypes of Ac-LAo, unilateral McA occlusion is the most common one (49.8%, n = 392), while bilateral ICA/unilateral MCA occlusion is the least (0.3%, n = 2). Compared with unilateral MCA and unilateral ICA occlusion, patients with tandem ICA/MCA and bilateral ICA/MCA occlusion had poor outcomes after suffering AIS. Age (OR 1.022; 95%CI, 1.007 to 1.036) was an independent risk factor for single artery progressed to multiple artery occlusion, while ApoA1 (OR 0.453; 95% CI, 0.235 to 0.953) was a protective factor. Patients with unilateral MCA occlusion were prone to artery-to-artery embolism infarction subtype, unilateral icA occlusion group were the most vulnerable to hypoperfusion/impaired emboli clearance subtype. Our results suggested various AC-LAO subtypes have different clinical characteristics and prognosis and were prone to different subtypes of infarction. Customized preventive measures based on AC-LAO subtypes may be more targeted preventions of stroke recurrences for AiS patients and could improve their prognoses.Anterior circulation large artery occlusion (AC-LAO) is the most common cause of ischemic strokes 1,2 , especially in Chinese population 3 . For the treatment of those patients, thrombolytic therapy has a time window, and endovascular intervention treatment requires advanced surgical equipment and intensive care. Due to the large differences in medical conditions and levels across China, endovascular intervention treatment is available only in major stroke centers in cities, which means it cannot be applied to all patients with acute infarction, especially in rural areas 4-6 . Previous study showed intravenous thrombolysis and endovascular intervention treatments may not be effective in most patients with high clot burden LAO, and the resulting emboli may cause a worse prognosis 7 . Thus, there is still no treatment much more effective for patients with LAO suffering acute ischemic stroke (AIS) currently. By reviewing the literature, we found that most studies focusing on single unilateral middle cerebral artery (MCA), unilateral internal carotid artery (ICA), or tandem ICA/MCA occlusion, showing that a thrombus in the more proximal intracranial vasculature were more likely to have a poor outcome [8][9][10] . However, in clinical work we found that there are some other types of AC-LAO, such as unilateral and/or bilateral MCA combining unilateral and/or bilateral ICA. Whether different infarction subtypes are related with different types of occlusions or whether the prognosis worsens with the degree of artery occlusion have not been studied in depth u...

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Section: Discussionmentioning

confidence: 99%

Subtypes of anterior circulation large artery occlusions with acute brain ischemic stroke

Zhang

Tian

et al. 2020

Sci Rep

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“…Collateral status correlates with stroke severity and reperfusion outcomes, due to their ability to restrict the growth of penumbral territory [44]. Although the underlying mechanisms of RIC are still not fully known, some recent preclinical studies have showed an enhancement of collateral circulation [45,46].…”

Section: Implications For Future Researchmentioning

confidence: 99%

Induced neuroprotection by remote ischemic perconditioning as a new paradigm in ischemic stroke at the acute phase, a systematic review

et al. 2020

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Background: Remote ischemic conditioning during cerebral ischemia (remote ischemic perconditioning, RIPerC) refers to the application of several cycles of brief ischemia and reperfusion (I/R) commonly to a limb, and it represents a new paradigm in neuroprotection with multiple mechanisms of action in ischemic stroke (IS) patients during acute phase. Some clinical trials just finished, and a few others are still ongoing; gather the current knowledge and pull it down to influence the present and future studies was the goal of this paper. Methods: A systematic review of published research papers and/or registered clinical trials since 2000 was performed. Results: Nineteen studies were identified and only four studies were completed. All of them have demonstrated that RIPerC is safe, feasible and well tolerated in IS patients. However, a high heterogeneity of clinical trial characteristics was observed: five (26.3%) randomized clinical trials (RCTs) included only thrombolytic-treated patients, three (15.8%) RCTs only thrombectomy-treated patients, and five (26.3%) RCTs required radiological confirmation of IS. Temporal inclusion criteria vary from 4 h to 48 h. Most of the clinical trials used 4 cycles of RIPerC in the upper non-affected limb. Interestingly, only three (16.7%) RCTs applied RIPerC during the transportation in the ambulance. Neuroimaging outputs were the main endpoints when endovascular therapy was applied; functional outcome is also the main endpoint in large-medium size studies. Conclusions: This review summarizes the completed and ongoing clinical trials on RIPerC in IS patients, where RIPerC has been used alone or in combination with recanalization therapies. Ongoing clinical trials will provide new information on the best RIPerC intervention strategy and potentially improve the functional outcome of IS patients; definition of new RIPerC strategies would ideally aim at enhancing tissue preservation, promoting neurological recovery, and stratify patients to improve treatment feasibility.

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“…This mechanosensitive Ca 2+ channel has been shown to induce significant collateral growth length and diameter in rats subjected to bilateral common carotid artery occlusion. Indeed, proper collateral vascular responses in stroke can significantly affect stroke outcome and mortality (Kimmel et al, 2019;Nannoni et al, 2019). However, current understanding of collateral vessel dynamics is not clear; interestingly, a recent study reported that collateral vessels have distinct endothelial and smooth muscle cell phenotypes (Zhang et al, 2019).…”

Section: Effects Of Stroke On Endothelial Cell Functionmentioning

confidence: 99%

Structural and Functional Remodeling of the Brain Vasculature Following Stroke

2020

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Absence of Collaterals is Associated with Larger Infarct Volume and Worse Outcome in Patients with Large Vessel Occlusion and Mild Symptoms

Cited by 41 publications

References 24 publications

Subtypes of anterior circulation large artery occlusions with acute brain ischemic stroke

Subtypes of anterior circulation large artery occlusions with acute brain ischemic stroke

Induced neuroprotection by remote ischemic perconditioning as a new paradigm in ischemic stroke at the acute phase, a systematic review

Structural and Functional Remodeling of the Brain Vasculature Following Stroke

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