Baseline collateral status and infarct topography in post-ischaemic perilesional hyperperfusion: An arterial spin labelling study

Abstract

Focal hyperperfusion after acute ischaemic stroke could be of prognostic value depending upon its spatial localisation and temporal dynamics. Factors associated with late stage (12-24 h) perilesional hyperperfusion, identified using arterial spin labelling, are poorly defined. A prospective cohort of acute ischaemic stroke patients presenting within 4.5 h of symptom onset were assessed with multi-modal computed tomography acutely and magnetic resonance imaging at 24 AE 8 h. Multivariate logistic regression analysis and receiver operating characteristics curves were used. One hundred and nineteen hemispheric acute ischaemic stroke patients (mean age ¼ 71 AE 12 years) with 24 h arterial spin labelling imaging were included. Forty-two (35.3%) patients showed perilesional hyperperfusion on arterial spin labelling at 24 h. Several factors were independently associated with perilesional hyperperfusion: good collaterals (71% versus 29%, P < 0.0001; OR ¼ 5, 95% CI ¼ [1.6, 15.7], P ¼ 0.005), major reperfusion (81% versus 48%, P ¼ < 0.0001; OR ¼ 7.5, 95% CI ¼ [1.6, 35.1], P ¼ 0.01), penumbral salvage (76.2% versus 47%, P ¼ 0.002; OR ¼ 6.6, 95% CI ¼ [1.8, 24.5], P ¼ 0.004), infarction in striatocapsular (OR ¼ 9.5, 95% CI ¼ [2.6, 34], P ¼ 0.001) and in cortical superior division middle cerebral artery (OR ¼ 4.7, 95% CI ¼ [1.4, 15.7], P ¼ 0.012) territory. The area under the receiver operating characteristic curve was 0.91. Our results demonstrate good arterial collaterals, major reperfusion, penumbral salvage, and infarct topographies involving cortical superior middle cerebral artery and striatocapsular are associated with perilesional hyperperfusion.

Changes in structure and perfusion of grey matter tissues during recovery from Ischaemic subcortical stroke: a longitudinal MRI study

“…Stroke rehabilitation not only involves neuronal reorganization but also includes vascular remodelling through angiogenesis (Chopp et al ., ). Hyperperfusion in and around the stroke lesions has been described in recent studies (Yu et al ., ; Bhaskar et al ., ), but the evidence about perfusion change in remote GM tissues are rare. Similar to our finding of increased GMV, increased CBF was found in the regions related to cognition (hippocampus) and vision (LG).…”

“…In addition to structural plasticity, the homeostatic balance in the human brain can be regulated by neurovascular coupling which refers to a cascade of events triggered by an increase in neuronal activity resulting in an increasing of cerebral blood flow (CBF) (Girouard & Iadecola, ). The presence of post‐ischaemic hyperperfusion within or around the stroke lesions has been reported in recent human studies (Yu et al ., ; Bhaskar et al ., ). Our recent study demonstrated that post‐ischaemic hyperperfusion has an association with good outcome after stroke (Yu et al ., ).…”

Association of Cortical Vein Filling with Clot Location and Clinical Outcomes in Acute Ischaemic Stroke Patients

“…The advent of cutting-edge next generation 320-detector row 640-slice multi-detector CT (MDCT) scanners have facilitated the acquisition of whole-brain, sub-second, and volumetric acquisition of 4D-dCTA data13738. CTP/CTA is not an invasive procedure compared to digital subtraction angiography (DSA), and is routinely obtained during clinical care of stroke patients8323339, has proven to be of added clinical utility in the early evaluation of stroke, facilitating precise localization of site of occlusion40, and identification of hypoperfused territory at risk of infarction41. The CTP was acquired simultaneously with the CTA with the use of same contrast bolus42.…”

“…Volumes of the acute perfusion lesion (relative delay time (DT) ≥ 3 seconds) and acute infarct core (relative CBF ≤ 30%) were calculated using previously validated thresholds848. Penumbra volume was defined as the volume of the perfusion lesion (DT threshold ≥ 3 seconds) minus the volume of the infarct core (relative CBF threshold < 30% within the DT ≥ 3 sec lesion).…”

“…Therefore, delayed-LCVF, a more ‘direct’ and reproducible measure, may prove to be very helpful to assess collateral status. There is growing interest in the role of leptomeningeal collaterals in AIS12345678. The presence of baseline arterial collaterals is emerging as an important parameter in the evaluation and treatment of cerebral ischemia9, and is linked to infarct core volume10, and functional outcomes61112.…”