Association of Computed Tomography Ischemic Lesion Location With Functional Outcome in Acute Large Vessel Occlusion Ischemic Stroke

Ernst, Marielle; Boers, Anna M. M.; Aigner, Annette; Berkhemer, Olvert A.; Yoo, Albert J.; Roos, Yvo B.W.E.M.; Dippel, Diederik W.J.; Lugt, Aad van der; Oostenbrugge, Robert J. van; Zwam, Wim H. van; Fiehler, Jens; Marquering, Henk A.; Majoie, Charles B. L. M.

doi:10.1161/strokeaha.117.017513

Cited by 47 publications

(43 citation statements)

References 36 publications

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“…Nevertheless, if located within strategic brain regions such as the motor cortex or cortico spinal tract, even small lesions might have a relevant effect on clinical outcome. Thus, it has been found that infarct location in addition to core infarct volumes is a significant factor determining the clinical outcome [17].…”

Section: Discussionmentioning

confidence: 99%

Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization

et al. 2020

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Background and aim To analyze the incidence of peripheral emboli after successful mechanical thrombectomy (MT) of intracranial large vessel occlusions (LVO). Methods We performed a prospective analysis of patients with intracranial LVO who underwent successful MT and received a 1.5 T MRI including diffusion-weighted imaging (DWI) in standard-and high-resolution as well as susceptibility-weighted imaging (SWI) on the day following the intervention. Reperfusion grade was assessed on post-thrombectomy digital subtraction angiography (DSA) using the expanded thrombolysis in cerebral infarction (eTICI) scale. Punctuate DWI lesions distal to the DWI core lesion were classified as peripheral emboli. DWI lesions outside the primary affected vascular territory were classified as emboli into new territories. Additionally, SWI and post-thrombectomy DSA were analyzed and correlated to findings on DWI. Results Twenty-eight patients undergoing successful MT met the inclusion criteria. In 26/28 patients (93%), a total of 324 embolic lesions were detected in DWI representing 2.1% of the cumulated ischemic core volume. 151 peripheral emboli were detected in standard-resolution DWI, 173 additional emboli were uncovered in high-resolution DWI. Eight out of nine patients with an eTICI 3 reperfusion had embolic lesions (29 DWI lesions). 9.6% (31/324) of peripheral emboli were observed in vascular territories not affected by the LVO. SWI lesions were observed in close proximity to 10.2% (33/324) of DWI lesions. Conclusions Peripheral emboli are frequent after MT even after complete reperfusion. These emboli occur rather in the vascular territory of the occluded vessel than in other territories. A large proportion of peripheral emboli is only detected by high-resolution DWI.

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Section: Discussionmentioning

confidence: 99%

Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization

et al. 2020

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“…Second, infarct location assessment was restricted to follow-up ASPECTS regions combined with lateralization. A more detailed analysis on the location of brain tissue injury may improve the strength of the relation between FIV and functional outcome, as this more closely resembles brain eloquence 25. Finally, we compared different populations to assess the optimal imaging modality and timing for FIV measurement.…”

Section: Discussionmentioning

confidence: 99%

Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials

Boers

Jansen

Beenen

et al. 2018

J NeuroIntervent Surg

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“…The goal of our study was to compare CoT versus ET in a real world single center cohort of AIS patients with LVO, exploring the safety profile of these two treatments and comparing their effect on radiological and functional outcomes [11,12].…”

Section: Introductionmentioning

confidence: 99%

Intravenous fibrinolysis plus endovascular thrombectomy versus direct endovascular thrombectomy for anterior circulation acute ischemic stroke: clinical and infarct volume results.

Gamba

Gilberti

Premi

et al. 2019

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Background and Purpose endovascular therapy (ET) is the standard of care for anterior circulation acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). The role of adjunctive intravenous thrombolysis (IVT) in these patients is still unclear. The present study aims to test whether IVT plus ET (CoT, combined therapy) provides additional benefits over direct ET for anterior circulation AIS by LVO. Methods we performed a single center retrospective observational study of patients with AIS caused by anterior circulation LVO, referred to our center between January 2014 and January 2017 and treated with ET. The patients were divided in 2 groups based on the treatment they received: CoT and, if IVT contraindicated, direct ET. We compared functional recovery (modified Rankin at 3-months follow-up), recanalization rate (thrombolysis in cerebral infarction [TICI] score) and time, early follow-up infarct volume (EFIV) (for recanalized patients only) as well as safety profile, defined as symptomatic intracerebral hemorrhage (sICH) and 3-month mortality, between groups. Results 145 subjects were included in the study, 70 in direct ET group and 75 in CoT group. Patients who received CoT presented more frequently a functional independence at 3-months follow-up compared to patients who received direct ET (mRS score 0-1: 48.5% vs 18.6%; P<0.001. mRS score 0-2: 67.1% vs 37.3%; P<0.001), higher first-pass success rate (62.7% vs 38.6%, P<0.05), higher recanalization rate (84.3% vs 65.3%; P=0.009) and, in recanalized subjects, smaller EFIV (16.4ml vs 62.3ml; P=0.003). The safety profile was similar for the 2 groups. In multivariable regression analysis, low baseline NIHSS score (P<0.05), vessel recanalization (P=0.05) and CoT (P=0.03) were indipendent predictors of 3-month favorable outcome. Conclusions CoT appears more effective than ET alone for anterior circulation AIS with LVO, with similar safety profile.

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Association of Computed Tomography Ischemic Lesion Location With Functional Outcome in Acute Large Vessel Occlusion Ischemic Stroke

Cited by 47 publications

References 36 publications

Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization

Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization

Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials

Intravenous fibrinolysis plus endovascular thrombectomy versus direct endovascular thrombectomy for anterior circulation acute ischemic stroke: clinical and infarct volume results.

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