Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship with Final Infarct Volume

Wijngaard, Ido R. van den; Holswilder, Ghislaine; Wermer, Marieke J.H.; Boiten, Jelis; Algra, Ale; Dippel, Diederik W.J.; Dankbaar, Jan Willem; Velthuis, Birgitta K.; Boers, Anna M. M.; Majoie, Charles B. L. M.; Walderveen, Marianne A.A. van

doi:10.3174/ajnr.a4746

Cited by 42 publications

(23 citation statements)

References 22 publications

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“…Relaxation of cerebral vessels during and after an ischemia/reperfusion leads to collateral cerebral blood flow, and thus characterizes an intrinsic strategy of the cerebral vasculature to protect neuroglial structures but also vasculature including endothelium against ischemic injury (Heiss et al, 2001), likewise reported for the heart (Koerselman et al, 2003; Meier et al, 2013). Indeed, cerebral collateral status and sufficiently enlarged calibers of collateral arteries have recently been identified as most relevant for final infarct volume, vasogenic edema formation (with subsequent midline shift), and hence patient outcome (Volny et al, 2016; van den Wijngaard et al, 2016; van der Hoeven et al, 2016). Therefore, patients at risk for stroke with unfortunate collateral status (thus portending poor outcome) could particularly profit from a lithium treatment at low concentrations via a generally improved endothelium-dependent vessel relaxation capacity.…”

Section: Discussionmentioning

confidence: 99%

Low-Dose Lithium Stabilizes Human Endothelial Barrier by Decreasing MLC Phosphorylation and Universally Augments Cholinergic Vasorelaxation Capacity in a Direct Manner

et al. 2016

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Lithium at serum concentrations up to 1 mmol/L has been used in patients suffering from bipolar disorder for decades and has recently been shown to reduce the risk for ischemic stroke in these patients. The risk for stroke and thromboembolism depend not only on cerebral but also on general endothelial function and health; the entire endothelium as an organ is therefore pathophysiologically relevant. Regardless, the knowledge about the direct impact of lithium on endothelial function remains poor. We conducted an experimental study using lithium as pharmacologic pretreatment for murine, porcine and human vascular endothelium. We predominantly investigated endothelial vasorelaxation capacities in addition to human basal and dynamic (thrombin-/PAR-1 receptor agonist-impaired) barrier functioning including myosin light chain (MLC) phosphorylation (MLC-P). Low-dose therapeutic lithium concentrations (0.4 mmol/L) significantly augment the cholinergic endothelium-dependent vasorelaxation capacities of cerebral and thoracic arteries, independently of central and autonomic nerve system influences. Similar concentrations of lithium (0.2–0.4 mmol/L) significantly stabilized the dynamic thrombin-induced and PAR-1 receptor agonist-induced permeability of human endothelium, while even the basal permeability appeared to be stabilized. The lithium-attenuated dynamic permeability was mediated by a reduced endothelial MLC-P known to be followed by a lessening of endothelial cell contraction and paracellular gap formation. The well-known lithium-associated inhibition of inositol monophosphatase/glycogen synthase kinase-3-β signaling-pathways involving intracellular calcium concentrations in neurons seems to similarly occur in endothelial cells, too, but with different down-stream effects such as MLC-P reduction. This is the first study discovering low-dose lithium as a drug directly stabilizing human endothelium and ubiquitously augmenting cholinergic endothelium-mediated vasorelaxation. Our findings have translational and potentially clinical impact on cardiovascular and cerebrovascular disease associated with inflammation explaining why lithium can reduce, e.g., the risk for stroke. However, further clinical studies are warranted.

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Section: Discussionmentioning

confidence: 99%

Low-Dose Lithium Stabilizes Human Endothelial Barrier by Decreasing MLC Phosphorylation and Universally Augments Cholinergic Vasorelaxation Capacity in a Direct Manner

et al. 2016

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“…A criticism of single-phase CTA in comparison with multiphase CTA is its inherent limitation of evaluating collaterals at a single point in time. Multiphase and dynamic CTA identify additional pial arterial filling on imaging beyond the peak arterial phase 20 21. We postulate, however, that collateral robustness is best evaluated during peak intracranial arterial enhancement and that further opacification of collaterals at more delayed phases (often at 8 and 16 s after peak enhancement) may not effectively assess the capacity of collaterals in sustaining an ischemic penumbra.…”

Section: Discussionmentioning

confidence: 92%

“…Multiphase and dynamic CTA have proved useful in evaluating collaterals, providing temporal information at separate data points 20 21. A criticism of single-phase CTA in comparison with multiphase CTA is its inherent limitation of evaluating collaterals at a single point in time.…”

Section: Discussionmentioning

confidence: 99%

Opercular Index Score: a CT angiography-based predictor of capillary robustness and neurological outcomes in the endovascular management of acute ischemic stroke

Copelan

Chehab

Brinjikji

et al. 2016

J NeuroIntervent Surg

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“…aus den Datensätzen der CTPerfusion (CTP) erhoben werden kann. Die Ergebnisse der dynamischen CTA haben eine höhere Korrelation zur resultieren den Infarktgröße und dem klinischen Verlauf [43,44]. In ESCAPE wurde die Mehrzahl der Patienten mit einer multiphasischen (m) CTA untersucht.…”

Section: Kollateralversorgungunclassified

Die Rolle der zerebralen Bildgebung für die Therapieentscheidung zur Thrombektomie

2017

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Zusammenfassung Sechs aktuelle randomisierte kontrollierte Studien haben einen signifikanten Behandlungseffekt der Thrombektomie auf den klinischen Verlauf bei Patienten mit akutem Schlaganfall aufgrund eines proximalen Gef??verschlusses im vorderen Stromgebiet gezeigt. Die positiven Ergebnisse dieser Studien m?ssen jetzt in die klinische Routine ?bertragen werden. Geeignete Patienten sollten dazu schnell und zuverl?ssig f?r eine Thrombektomie evaluiert werden. Alle Studien best?tigten die entscheidende Rolle einer pr?therapeutischen Bildgebung in der Auswahl der Patienten, die von einer endovaskul?ren Therapie profitieren k?nnen. Dabei wurden jedoch unterschiedliche bildgebungsbasierte Ans?tze mit Darstellung des behandelbaren Gef??verschlusses, des Infarktkerns, der arteriellen Kollateralversorgung oder der Penumbra gew?hlt. In dieser ?bersichtsarbeit werden anhand der aktuellen Studienlage die verschiedenen Untersuchungs- und Auswertetechniken der nichtinvasiven zerebralen Bildgebung und ihrer Rolle f?r die Therapieentscheidung zur Thrombektomie beim akuten Schlaganfall diskutiert.

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Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship with Final Infarct Volume

Abstract: BACKGROUND AND PURPOSE: Dynamic CTA is a promising technique for visualization of collateral filling in patients with acute ischemic stroke. Our aim was to describe collateral filling with dynamic CTA and assess the relationship with infarct volume at follow-up.

Cited by 42 publications

References 22 publications

Low-Dose Lithium Stabilizes Human Endothelial Barrier by Decreasing MLC Phosphorylation and Universally Augments Cholinergic Vasorelaxation Capacity in a Direct Manner

Low-Dose Lithium Stabilizes Human Endothelial Barrier by Decreasing MLC Phosphorylation and Universally Augments Cholinergic Vasorelaxation Capacity in a Direct Manner

Opercular Index Score: a CT angiography-based predictor of capillary robustness and neurological outcomes in the endovascular management of acute ischemic stroke

Die Rolle der zerebralen Bildgebung für die Therapieentscheidung zur Thrombektomie

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