Effect of Collaterals on Clinical Presentation, Baseline Imaging, Complications, and Outcome in Acute Stroke

Fanou, E.; Knight, Jesse; Aviv, Richard I.; Hojjat, Seyed-Parsa; Symons, Sean; Zhang, L.; Wintermark, Max

doi:10.3174/ajnr.a4453

Cited by 86 publications

(66 citation statements)

References 36 publications

(55 reference statements)

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“…Our findings confirm the prognostic value of CBS for patients treated with IVT found in earlier studies [9][10][11][12] and further extends this finding to patients treated with IAT. Studies reporting the influence of thrombus length (measured on susceptibility weight imaging on magnetic resonance imaging) on recanalization rates after thrombectomy are conflicting.…”

Section: Discussionsupporting

confidence: 81%

“…Patients with a lower CBS have lower odds of reperfusion and larger final infarct volumes at follow-up in patients treated with IVT. [9][10][11][12] For patients treated with IAT, the association of CBS with treatment efficacy is still sparsely studied. A post hoc analysis of the IMS-III trial (Interventional Management of Stroke III) data showed that recanalization rates were consistent across occlusion locations in patients treated with IAT.…”

mentioning

confidence: 99%

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Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke

Treurniet¹,

Yoo²,

Berkhemer

et al. 2016

Stroke

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R ecanalization of the occluded vessel is the major focus of modern treatment for acute ischemic stroke. With the accumulating evidence of the additional benefit of intra-arterial treatment (IAT) in patients with anterior circulation acute ischemic stroke, a new era has started in stroke management. [1][2][3][4][5] However, even after IAT, up to 67% of patients with acute Background and Purpose-A high clot burden score (CBS) is associated with favorable outcome after intravenous treatment for acute ischemic stroke. The added benefit of intra-arterial treatment might be less in these patients. The aim of this exploratory post hoc analysis was to assess the relation of CBS with neurological improvement and endovascular treatment effect. Methods-For 499 of 500 patients in the MR CLEAN study (Multicenter Randomized Clinical Trial of EndovascularTreatment for Acute Ischemic Stroke in the Netherlands), the CBS was determined. Ordinal logistic regression models with and without main baseline prognostic variables were used to assess the association between CBS (continuous or dichotomized at CBS of 6) and a shift toward better outcome on the modified Rankin Scale. The model without main baseline prognostic variables only included treatment allocation and CBS. Models with and without a multiplicative interaction term of CBS and treatment were compared using the χ 2 test to assess treatment effect modification by CBS. Results-Higher CBS was associated with a shift toward better outcome on the modified Rankin Scale; adjusted common odds ratio per point CBS was 1.12 (95% confidence interval, 1.04-1.20]. Dichotomized CBS had an adjusted common odds ratio of 1.67 (95% confidence interval, 1.12-2.51). Both effect estimates were slightly attenuated by adding baseline prognostic variables. The addition of the interaction terms did not significantly improve the fit of the models. There was a small and insignificant increase of intra-arterial treatment efficacy in the high CBS group. Conclusions-A higher CBS is associated with improved outcome and may be used as a prognostic marker. We found no evidence that CBS modifies the effect of intra-arterial treatment. Clinical Trial Registration-URL: http://www.trialregister.nl. Unique identifier: NTR1804. URL: http://www.controlledtrials.com. Unique identifier: ISRCTN10888758.

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Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke

Treurniet¹,

Yoo²,

Berkhemer

et al. 2016

Stroke

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“…38 A clot burden score of 0 indicates a complete multisegmental vessel occlusion, with lower scores validated to independently predict lower recanalization rates with IV tPA, larger infarcts, poor outcome, and risk of hemorrhagic transformation. [38][39][40] Based on the data acquired from recent endovascular trials, the AHA/ASA has granted a grade I/A recommendation to endovascular candidates only with an occlusion located in the M1 or terminal ICA. The remaining large-vessel arterial locations are designated class IIb/C.…”

Section: Intracranial Laomentioning

confidence: 99%

“…Both the regional leptomeningeal collateral and collateral score have been shown to independently predict poor outcome (mRS score >2), infarct volume, and propensity for hemorrhagic transformation in the setting of an acute occlusion. 39,42 The aforementioned evaluations of collateral status use a single conventional CTA maximal intensity projection image (single phase). Multiphase CTA is a technique that can be used to increase temporal resolution of collateral blood flow and more accurately depict the process when compared with the opposite hemisphere.…”

Section: Collateral Assessmentmentioning

confidence: 99%

Acute Ischemic Stroke Therapy Overview

Catanese

Tarsia

Fisher

2017

Circulation Research

291

178

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A cute ischemic stroke (AIS) is a common disorder with almost 700 000 new or recurrent events per year in the United States. The risk of AIS varies by region, with the highest incidence occurring in the so-called stroke belt in the southern part of the country.1 The risk of AIS varies among African Americans, Latinos, and Caucasians, with the highest risk in African Americans. The risk of AIS increases with age, and the ageing of the US population portends an increase in AIS incidence and prevalence over the next several decades, despite increasingly effective efforts to treat stroke risk factors and the use of other preventive strategies.2 The incidence of AIS is also increasing in many other countries, largely related to potentially modifiable risk factors, especially in the developing world.3 The incidence of AIS is also greater among women beginning with an increased risk in the perimenopausal period and continuing into older age groups. Abstract: The treatment of acute ischemic stroke has undergone dramatic changes recently subsequent to the demonstrated efficacy of intra-arterial (IA) device-based therapy in multiple trials. The selection of patients for both intravenous and IA therapy is based on timely imaging with either computed tomography or magnetic resonance imaging, and if IA therapy is considered noninvasive, angiography with one of these modalities is necessary to document a large-vessel occlusion amenable for intervention. More advanced computed tomography and magnetic resonance imaging studies are available that can be used to identify a small ischemic core and ischemic penumbra, and this information will contribute increasingly in treatment decisions as the therapeutic time window is lengthened. Intravenous thrombolysis with tissue-type plasminogen activator remains the mainstay of acute stroke therapy within the initial 4.5 hours after stroke onset, despite the lack of Food and Drug Administration approval in the 3-to 4.5-hour time window. In patients with proximal, large-vessel occlusions, IA device-based treatment should be initiated in patients with small/moderate-sized ischemic cores who can be treated within 6 hours of stroke onset. The organization and implementation of regional stroke care systems will be needed to treat as many eligible patients as expeditiously as possible. Novel treatment paradigms can be envisioned combining neuroprotection with IA device treatment to potentially increase the number of patients who can be treated despite long transport times and to ameliorate the consequences of reperfusion injury. Acute stroke treatment has entered a golden age, and many additional advances can be anticipated. (Circ Res. 2017;120:541-558.

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“…Future studies investigating the sensitivity and specificity of each method/modality used to define ischemic core is essential. 16,19 Furthermore, studies investigating the relationship between the ischemic core volume and collaterals 20 should be pursued. The definitions of ischemic core will need to be revisited in populations of patients with ultra-fast reperfusion.…”

Section: Opportunities For Standardizationmentioning

confidence: 99%

Acute Stroke Imaging Research Roadmap III Imaging Selection and Outcomes in Acute Stroke Reperfusion Clinical Trials

Warach

Luby

Albers

et al. 2016

Stroke

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Background and Purpose The STroke Imaging Research (STIR) group, the Imaging Working Group of StrokeNet, the American Society of Neuroradiology and the Foundation of the American Society of Neuroradiology sponsored an imaging session and workshop during the Stroke Treatment Academy Industry Roundtable (STAIR) IX on October 5–6, 2015 in Washington, D.C. The purpose of this roadmap was to focus on the role of imaging in future research and clinical trials. Methods This forum brought together stroke neurologists, neuroradiologists, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (NINDS), industry representatives, and members of the U.S. Food and Drug Administration (FDA) to discuss stroke imaging research priorities in the light of an unprecedented series of positive acute stroke endovascular therapy clinical trials. Results The imaging session summarized and compared the imaging components of the recent positive endovascular trials, and proposed opportunities for pooled analyses. The imaging workshop developed consensus recommendations for optimal imaging methods for the acquisition and analysis of core, mismatch and collaterals across multiple modalities, and also a standardized approach for measuring the final infarct volume in prospective clinical trials. Conclusions Recent positive acute stroke endovascular clinical trials have demonstrated the added value of neurovascular imaging. The optimal imaging profile for endovascular treatment includes large vessel occlusion, smaller core, good collaterals and large penumbra. However, equivalent definitions for the imaging profile parameters across modalities are needed, and a standardization effort is warranted, potentially leveraging the pooled data resulting from the recent positive endovascular trials.

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Effect of Collaterals on Clinical Presentation, Baseline Imaging, Complications, and Outcome in Acute Stroke

Cited by 86 publications

References 36 publications

Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke

Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke

Acute Ischemic Stroke Therapy Overview

Acute Stroke Imaging Research Roadmap III Imaging Selection and Outcomes in Acute Stroke Reperfusion Clinical Trials

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