Determinants of the distribution and severity of hypoperfusion in patients with ischemic stroke

Bang, Oh Young; Saver, Jeffrey L.; Alger, Jeffry R.; Starkman, Sidney; Ovbiagele, Bruce; Liebeskind, David S

doi:10.1212/01.wnl.0000335929.06390.d3

Cited by 78 publications

(82 citation statements)

References 28 publications

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“…Bang et al 11 also found an association between smoking status and low HIR. Studies have suggested that long-term smoking-induced atherosclerosis leads to increased collateralization, 18 which may explain this observed phenomenon.…”

Section: Discussionmentioning

confidence: 89%

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Hyperintense Vessels on FLAIR: Hemodynamic Correlates and Response to Thrombolysis

Kufner¹,

Galinović

Ambrosi

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Hyperintense vessels on baseline FLAIR MR imaging of patients with ischemic stroke have been linked to leptomeningeal collateralization, yet the ability of these to maintain viable ischemic tissue remains unclear. We investigated whether hyperintense vessels on FLAIR are associated with the severity of hypoperfusion and response to thrombolysis in patients treated with intravenous tissue-plasminogen activator.

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Section: Discussionmentioning

confidence: 89%

“…Bang et al 11 used a hypoperfusion intensity ratio (HIR: time-to-maximum [Tmax] Ն 8 seconds/Tmax Ն 2 seconds) on baseline MR perfusion imaging as a surrogate marker of collateral status and found that excellent and intermediate collateral grades were highly associated with lower HIRs.…”

mentioning

confidence: 99%

Hyperintense Vessels on FLAIR: Hemodynamic Correlates and Response to Thrombolysis

Kufner¹,

Galinović

Ambrosi

et al. 2015

AJNR Am J Neuroradiol

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“…Similar HIRs were found to be related to angiographic and PWI-based collateral circulation grade in previous reports. [19][20][21] We compared the HIR in patients without early recanalization according to their acute reperfusion status.…”

Section: Image Analysismentioning

confidence: 99%

Reperfusion Within 6 Hours Outperforms Recanalization in Predicting Penumbra Salvage, Lesion Growth, Final Infarct, and Clinical Outcome

Cho

Nighoghossian

Mikkelsen

et al. 2015

Stroke

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Background and Purpose— The relative merits of reperfusion versus recanalization to predict tissue and clinical outcomes in anterior circulation stroke have been previously assessed using data acquired >12 hours postonset. To avoid late-occurring confounders such as non-nutritional reperfusion, futile recanalization and no-reflow phenomenon, we performed ultraearly assessment of reperfusion and recanalization. Methods— From a multicenter prospective database, 46 patients with acute magnetic resonance angiography–visible occlusion and in whom both reperfusion and recanalization were assessed on follow-up magnetic resonance imaging ≤6 hours of symptom onset were identified. Multiple linear regressions modeled salvaged penumbra, diffusion-weighted imaging lesion growth, and final infarct at 1 month using baseline clinical and imaging parameters and acute reperfusion or recanalization. Best predictors were determined with the Akaike information criterion. Univariate and multivariate logistic regressions identified the clinical and imaging predictors of clinical outcome. Results— Admission magnetic resonance imaging showed M1 occlusion in 15 (33%) patients; median penumbra volume was 13.4 mL. Acute reperfusion was observed in 27 (59%) patients; 42% of nonrecanalized patients demonstrated reperfusion. The dichotomized classification of reperfusion and recanalization was discordant ( P =0.0002). Reperfusion ≤6 hours was a significant ( P <0.05) predictor of increased penumbra salvage, reduced lesion growth, and final infarct size. Recanalization did not improve model accuracy. Reperfusion, but not recanalization, was significantly associated with good clinical outcome in logistic regressions. Conclusions— Reperfusion ≤6 hours was consistently superior to recanalization in predicting tissue and clinical outcome. Reperfusion without recanalization was frequent and probably related to retrograde reperfusion through leptomeningeal collaterals. Acute reperfusion was the strongest predictor of, and may therefore, represent a reliable surrogate for, clinical outcome.

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“…In the setting of AIS, an occluded artery causes focal cerebral ischemia, and a reduction in systemic blood pressure (cerebral perfusion pressure) may lead to reduction in collateral perfusion, 16 which could hasten the progression to complete infarction. 17 Typically, the most pronounced drop in blood pressure occurs immediately after induction.…”

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confidence: 99%

Anesthesia for endovascular treatment of acute ischemic stroke

et al. 2012

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The initial treatment of patients with acute ischemic stroke (AIS) focuses on rapid recanalization, which often includes the use of endovascular therapies. Endovascular treatment depends upon micronavigation of catheters and devices into the cerebral vasculature, which is easier and safer with a motionless patient. Unfortunately, many stroke patients are unable to communicate and sufficiently cooperate with the procedure. Thus, general anesthesia (GA) with endotracheal intubation provides an attractive means of keeping the patient comfortable and motionless during a procedure that could otherwise be lengthy and uncomfortable. However, several recent retrospective studies have shown an association between GA and poorer outcomes in comparison with conscious sedation for endovascular treatment of AIS, though prospective studies are lacking. The underlying reasons why GA might produce a worse outcome are unknown but may include hemodynamic instability and hypotension, delays in treatment, prolonged intubation with or without neuromuscular blockade, or even neurotoxicity of the anesthetic agent itself. Currently, the choice between GA and conscious sedation should be tailored to the individual patient, on the basis of neurologic deficits, airway and hemodynamic status, and treatment plan. The use of institutional treatment protocols may best support efficient and effective care for AIS patients undergoing endovascular therapy. Important components of such protocols would include parameters to choose anesthetic modality, timeliness of induction, blood pressure goals, minimization of neuromuscular blockade, and planned extubation at the end of the procedure. Neurology ® 2012;79 (Suppl 1):S167-S173

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Determinants of the distribution and severity of hypoperfusion in patients with ischemic stroke

Abstract: Background:In acute cerebral ischemia, two variables characterize the extent of hypoperfusion:

Cited by 78 publications

References 28 publications

Hyperintense Vessels on FLAIR: Hemodynamic Correlates and Response to Thrombolysis

Hyperintense Vessels on FLAIR: Hemodynamic Correlates and Response to Thrombolysis

Reperfusion Within 6 Hours Outperforms Recanalization in Predicting Penumbra Salvage, Lesion Growth, Final Infarct, and Clinical Outcome

Anesthesia for endovascular treatment of acute ischemic stroke

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