Perfusion Imaging Collateral Scores Predict Infarct Growth in Non-Reperfused DEFUSE 3 Patients

MacLellan, Adam; Mlynash, Michael; Kemp, Stephanie; Ortega‐Gutiérrez, Santiago; Heit, Jeremy J; Marks, Michael P.; Lansberg, Maarten G.; Albers, Gregory W.

doi:10.1016/j.jstrokecerebrovasdis.2021.106208

Cited by 23 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Following full-text review, two publications were noted to have substantial similarities in cohorts, methods, and image analysis techniques [ 20 , 21 ], two studies pooled data from ASTER and THRACE [ 22 , 23 ], and two studies pooled data from DEFUSE3 [ 24 , 25 ]. Only one from each pair of overlapping studies was included [ 20 , 23 , 24 ].…”

Section: Resultsmentioning

confidence: 99%

MRI for collateral assessment pre-thrombectomy and association with outcome: a systematic review and meta-analysis

Abousrafa

Mair

2023

Neuroradiology

View full text Add to dashboard Cite

Purpose Various neuroimaging methods exist to assess the collateral circulation in stroke patients but much of the evidence is based on computed tomography. Our aim was to review the evidence for using magnetic resonance imaging for collateral status evaluation pre-thrombectomy and assess the impact of these methods on functional independence. Methods We systematically reviewed EMBASE and MEDLINE for studies that evaluated baseline collaterals using MRI pre-thrombectomy and conducted a meta-analysis to express the relationship between good collaterals (defined variably as the presence [good] vs absence [poor] or quality [ordinal scores binarized as good-moderate vs poor] of collaterals) and functional independence (modified Rankin score mRS≤2) at 90 days. Outcome data were presented as relative risk (RR, 95% confidence interval, 95%CI). We assessed for study heterogeneity, publication bias, and conducted subgroup analyses of different MRI methods and affected arterial territories. Results From 497 studies identified, we included 24 (1957 patients) for the qualitative synthesis, and 6 (479 patients) for the metanalysis. Good pre-thrombectomy collaterals were significantly associated with favorable outcome at 90 days (RR=1.91, 95%CI=1.36–2.68], p= 0.0002) with no difference between MRI methods and affected arterial territory subgroups. There was no evidence of statistical heterogeneity (I2=25%) among studies but there was evidence of publication bias. Conclusion In stroke patients treated with thrombectomy, good pre-treatment collaterals assessed using MRI are associated with double the rate of functional independence. However, we found evidence that relevant MR methods are heterogenous and under-reported. Greater standardization and clinical validation of MRI for collateral evaluation pre-thrombectomy are required.

show abstract

Section: Resultsmentioning

confidence: 99%

MRI for collateral assessment pre-thrombectomy and association with outcome: a systematic review and meta-analysis

Abousrafa

Mair

2023

Neuroradiology

View full text Add to dashboard Cite

show abstract

“…CT Alberta Stroke Program Early CT Score (ASPECTS) was calculated by a fellowship‐trained, board‐certified neuroradiologist. Automated postprocessing software with either RAPID (iSchemaView, Inc.) or Viz.ai was used to record core infarct size (cerebral blood flow [CBF] <30%), delayed perfusion (time‐to‐maximum of the residue function greater than 6 seconds [ T m > 6s]), mismatch volume (delayed perfusion minus core), mismatch ratio (delayed perfusion divided by core), hypoperfusion intensity ratio (HIR; defined as T m > 10 divided by T m > 6), and cerebral blood volume (CBV) index (average CBV in T m > 6 region divided by average CBV in tissue with normal perfusion), with the latter two being markers of collateral circulation 18–21 …”

Section: Methodsmentioning

confidence: 99%

The Charlotte Large artery occlusion Endovascular therapy Outcome Score predicts independent outcome after thrombectomy

Karamchandani,

Satyanarayana,

Yang

et al. 2023

Journal of Neuroimaging

View full text Add to dashboard Cite

Background and PurposePredicting functional outcomes after endovascular thrombectomy (EVT) is of interest to patients and families as they navigate hospital and post‐acute care decision‐making. We evaluated the prognostic ability of several scales to predict good neurological function after EVT.MethodsWe retrospectively analyzed records from a health system's code stroke registry, including consecutive successful thrombectomy patients from August 2020 to February 2023 presenting with an anterior circulation large vessel occlusion who were evaluated with pre‐EVT CT perfusion. Primary and secondary outcomes were 90‐day modified Rankin Scale (mRS) scores 0‐2 and 0‐1, respectively. Logistic regression was performed to evaluate the ability of each scale to predict the outcomes. Scales were compared by calculating the area under the curve (AUC).ResultsA total of 465 patients (mean age 68.1 [±14.9] years, median National Institutes of Health Stroke Scale [NIHSS] 16 [11‐21]) met inclusion criteria. In the logistic regression, the Charlotte Large artery occlusion Endovascular therapy Outcome Score (CLEOS), Totaled Health Risks in Vascular Events, Houston Intra‐Arterial Therapy‐2, Pittsburgh Response to Endovascular therapy, and Stroke Prognostication using Age and NIHSS were significant in predicting the primary and secondary outcomes. CLEOS was superior to all other scales in predicting 90‐day mRS 0‐2 (AUC .75, 95% confidence interval [CI] .70‐.80) and mRS 0‐1 (AUC .74, 95% CI .69‐.78). Twenty of 22 patients (90.9%) with CLEOS <315 had 90‐day mRS 0‐2.ConclusionsCLEOS predicts independent and excellent neurological function after anterior circulation EVT.

show abstract

“…4,5 Several studies have reported that leptomeningeal collateral flow, either assessed on CT angiography or on perfusion imaging using the hypoperfusion intensity ratio (HIR), is the main factor associated with fast IG. [6][7][8][9][10][11][12][13][14][15] The HIR reflects the percentage of the perfusion lesion that has severely delayed contrast arrival times and correlates with the quality of the collateral circulation determined by angiography. 8,16 The relationship between IG and collateral status-or HIR-has been reported with IG rate calculated either from symptom onset to baseline imaging ("early" IG), [8][9][10]13,15 during interhospital transfer for thrombectomy (i.e., from a baseline imaging in a primary stroke center to a control imaging on arrival in the comprehensive center) 6,7 or from symptom onset to final infarct volume.…”

Section: Introductionmentioning

confidence: 99%

“…8,16 The relationship between IG and collateral status-or HIR-has been reported with IG rate calculated either from symptom onset to baseline imaging ("early" IG), [8][9][10]13,15 during interhospital transfer for thrombectomy (i.e., from a baseline imaging in a primary stroke center to a control imaging on arrival in the comprehensive center) 6,7 or from symptom onset to final infarct volume. 8,11,12,17 However, most previous studies were limited by infarct volumes quantified on noncontrast CT or CT perfusion-which is less precise than MRI-small to moderate sample sizes, and inclusion limited to patients receiving thrombectomy, which may have biased the association observed because large core patients are less frequently treated with thrombectomy. Moreover, most studies enrolled patients with unwitnessed symptom onset, a situation where early IG rate (EIGR) calculation is imprecise.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Fast Early Infarct Growth in Patients With Acute Ischemic Stroke With a Large Vessel Occlusion

Seners,

Yuen,

Olivot

et al. 2023

Neurology

Self Cite

View full text Add to dashboard Cite

Background and objectives:The optimal methods for predicting early infarct growth rate (EIGR) in acute ischemic stroke with a large vessel occlusion (LVO) have not been established. We aimed to study the factors associated with EIGR, with a focus on the collateral circulation as assessed by the Hypoperfusion Intensity Ratio (HIR) on perfusion imaging, and determine whether the associations found are consistent across imaging modalities.Methods:Retrospective multicenter international study including anterior circulation LVO-related acute stroke patients with witnessed stroke onset and baseline perfusion imaging (MRI or CT) performed within 24hrs from symptom onset. To avoid selection bias, patients were selected from (1) the prospective registries of four comprehensive stroke centers with systematic use of perfusion imaging and including both thrombectomy-treated and untreated patients, and (2) one prospective thrombectomy study where perfusion imaging was acquired per protocol but treatment decisions were made blinded to the results. EIGR was defined as infarct volume on baseline imaging divided by onset-to-imaging time, and fast progressors as EIGR ≥10mL/hr. The HIR, defined as the proportion of Tmax>6s with Tmax>10s volume, was measured on perfusion imaging using RAPID software. The factors independently associated with fast progression were studied using multivariable logistic regression models, with separate analyses for CT- and MRI-assessed patients.Results:Overall, 1127 patients were included (CT, n=471; MRI, n=656). Median age was 74 years (IQR, 62-83), 52% were male, median NIHSS was 16 (IQR, 9-21), median HIR was 0.42 (IQR, 0.26-0.58) and 415 (37%) were fast progressors. The HIR was the primary factor associated with fast progression, with very similar results across imaging modalities: the proportion of fast progressors was 4% in the first HIR quartile (i.e.excellent collaterals), ∼15% in the second, ∼50% in the third, and ∼77% in the fourth (P<0.001 for each imaging modality). Fast progression was independently associated with poor 3-month functional outcome in both the CT and MRI cohorts (P<0.001 andP=0.030, respectively).Discussion:The HIR is the primary factor associated with fast infarct progression, regardless of imaging modality. These results have implication for neuroprotection trial design, as well as informing triage decisions at primary stroke centers.

show abstract

Perfusion Imaging Collateral Scores Predict Infarct Growth in Non-Reperfused DEFUSE 3 Patients

Cited by 23 publications

References 23 publications

MRI for collateral assessment pre-thrombectomy and association with outcome: a systematic review and meta-analysis

MRI for collateral assessment pre-thrombectomy and association with outcome: a systematic review and meta-analysis

The Charlotte Large artery occlusion Endovascular therapy Outcome Score predicts independent outcome after thrombectomy

Factors Associated With Fast Early Infarct Growth in Patients With Acute Ischemic Stroke With a Large Vessel Occlusion

Contact Info

Product

Resources

About