Predicting Penumbra Salvage and Infarct Growth in Acute Ischemic Stroke: A Multifactor Survival Game

Gaia, Silvia; Strambo, Davide; Nannoni, Stefania; Labreuche, Julien; Cereda, Carlo; Dunet, Vincent; Puccinelli, Francesco; Saliou, Guillaume; Meuli, Reto; Eskandari, Ashraf; Wintermark, Max; Michel, Patrik

doi:10.3390/jcm12144561

Cited by 3 publications

(1 citation statement)

References 91 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study contributes by investigating various stroke-related factors to identify additional predictors of LVO in the anterior circulation. Our findings reveal independent associations of NIHSS, current smoking status, intracranial atherosclerotic disease, extracranial atherosclerotic carotid stenosis, and type 2 diabetes mellitus with anterior circulation LVO [ 19 - 22 ]. Notably, our developed model demonstrates higher accuracy in predicting LVO compared to using NIHSS alone [ 23 ].…”

Section: Discussionmentioning

confidence: 85%

Factors Contributing to Rapid Early Infarct Expansion in Acute Ischemic Stroke Patients With Large Vessel Occlusion

Abidi,

Arif,

Ahmed

et al. 2024

Cureus

View full text Add to dashboard Cite

BackgroundAcute ischemic stroke, particularly in cases involving large vessel occlusion (LVO), poses a significant challenge due to the potential for rapid infarct expansion in the early phase. Such expansion, if not managed promptly, can lead to severe neurological deficits and poor clinical outcomes. Understanding the contributing factors that accelerate early infarct expansion is crucial for optimizing treatment strategies and improving patient prognosis. The main aim of the study is to determine the factors contributing to rapid early infarct expansion in acute ischemic stroke patients with LVO. MethodologyThe retrospective study was conducted at Liaquat National Hospital in Karachi from August 2023 to December 2023. Data were collected from 685 patients with anterior circulation LVO-related acute stroke with witnessed stroke onset and baseline perfusion imaging. Extracted clinical data included age, gender, medical history (hypertension, diabetes, etc.), and baseline National Institutes of Health Stroke Scale (NIHSS) scores. ResultsThe mean age of the included patients was 67.4 years, with a relatively balanced gender distribution, i.e., 48.5% male (n = 332) and 51.5% female (n = 353). The mean baseline NIHSS score was 14.2, reflecting initial neurological severity. Imaging parameters revealed that 294 (42.6%) patients exhibited infarct expansion, with an average penumbra size of 23.5 mL. Hypoperfusion intensity ratio (HIR) quartiles demonstrated a notable association with progression rates, escalating from 27 (4%) patients in the first quartile to approximately 527 (77%) patients in the fourth quartile, highlighting a significant correlation between HIR and infarct expansion (p < 0.001). ConclusionsHIR emerged as a pivotal factor strongly associated with rapid infarct expansion, underscoring its significance in predicting the trajectory of ischemic injury.

show abstract

Section: Discussionmentioning

confidence: 85%

Factors Contributing to Rapid Early Infarct Expansion in Acute Ischemic Stroke Patients With Large Vessel Occlusion

Abidi,

Arif,

Ahmed

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

Endovascular Stroke Thrombectomy for Patients With Large Ischemic Core

Chen,

Lee,

Michel

et al. 2024

JAMA Neurol

View full text Add to dashboard Cite

ImportanceRecently, 6 randomized clinical trials—RESCUE-Japan-LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism—Japan Large Ischemic Core Trial), ANGEL-ASPECT (Trial of Endovascular Therapy for Acute Ischemic Stroke With Large Infarct), SELECT2 (Trial of Endovascular Thrombectomy for Large Ischemic Strokes), TESLA (Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke), TENSION (Endovascular Thrombectomy for Acute Ischemic Stroke With Established Large Infarct), and LASTE (Large Stroke Therapy Evaluation)—have concluded their investigations on the efficacy and safety of endovascular thrombectomy (EVT) for the treatment of patients with ischemic stroke, anterior-circulation large vessel occlusions, and large areas of ischemic changes defined as an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 5 or less. Overall, the results appeared to be positive, with 5 of the 6 trials meeting their primary efficacy end point, and 1 trial that was a near miss. However, questions remain regarding how these trial results should be interpreted and incorporated into routine clinical practice.ObservationsIn this narrative review and analysis of published trials, important nuances of the available clinical data were identified, and important areas of lingering uncertainty were highlighted, including the efficacy and safety of EVT for patients with a low ASPECTS score in late treatment windows and those with large core volumes. Also emphasized was the possibly important role of advanced neuroimaging modalities such as perfusion and magnetic resonance imaging when making EVT treatment decisions for select patients with low ASPECTS scores.Conclusions and RelevanceRecent trial data provide strong evidence that EVT is safe and effective for patients with anterior, large vessel–occlusion stroke and low ASPECTS scores who present within 6 hours from stroke onset. However, patient outcomes often remain poor despite EVT treatment. The efficacy and safety of EVT for patients with low ASPECTS scores who present beyond 6 hours of stroke onset remain uncertain, and the current trial data seem too scarce to justify forgoing advanced stroke imaging during this extended time window. Furthermore, the efficacy and safety of EVT for patients with large core volumes (100 mL or greater) or M2 occlusions (ie, occlusions of the second segment of the middle cerebral artery) remain uncertain. Future research to better identify patients likely to meaningfully respond to EVT is needed to further optimize the stroke triage process and health care resource utilization.

show abstract

Pretreatment CT perfusion collateral parameters correlate with penumbra salvage in middle cerebral artery occlusion

Lakhani,

Balar,

Koneru

et al. 2023

Journal of Neuroimaging

Self Cite

View full text Add to dashboard Cite

Background and PurposeAcute ischemic stroke due to large vessel occlusion (AIS‐LVO) is a major cause of functional dependence. Collateral status (CS) is an important determinant of functional outcomes. Pretreatment CT perfusion (CTP) parameters serve as reliable surrogates of CS. Penumbra Salvage Index (PSI) is another parameter predictive of functional outcomes in AIS‐LVO. The aim of this study is to assess the relationship of pretreatment CTP parameters with PSI.MethodsIn this prospectively collected, retrospectively reviewed multicenter analysis, inclusion criteria were as follows: (1) CT angiography confirmed middle cerebral artery (MCA) M1‐segment and proximal M2‐segment occlusion from 9/1/2017 to 9/22/2022; (2) diagnostic CTP; and (3) available diagnostic Magnetic resonance Imaging (MRI) diffusion‐weighted images. Pearson correlation analysis was performed to assess the association between cerebral blood volume (CBV) index and hypoperfusion intensity ratio (HIR) with PSI. p value ≤.05 was considered statistically significant.ResultsIn total, 131 patients (n = 86, M1 and n = 45, proximal M2 occlusion) met our inclusion criteria. CBV index showed a modest positive correlation with PSI (r = 0.34, p<.001) in patients with proximal MCA occlusion. Similar trends were noted in subgroup analysis of patients with M1 occlusion, and proximal M2 occlusion. Whereas, HIR did not have a strong trend or correlation with PSI.ConclusionCBV index correlates with PSI, whereas HIR does not. Future studies are needed to expand our understanding of the adjunct role of CBV index with other similar pretreatment CTP‐based markers in clinical evaluation and decision‐making in patients with MCA occlusion.

show abstract

Predicting Penumbra Salvage and Infarct Growth in Acute Ischemic Stroke: A Multifactor Survival Game

Cited by 3 publications

References 91 publications

Factors Contributing to Rapid Early Infarct Expansion in Acute Ischemic Stroke Patients With Large Vessel Occlusion

Factors Contributing to Rapid Early Infarct Expansion in Acute Ischemic Stroke Patients With Large Vessel Occlusion

Endovascular Stroke Thrombectomy for Patients With Large Ischemic Core

Pretreatment CT perfusion collateral parameters correlate with penumbra salvage in middle cerebral artery occlusion

Contact Info

Product

Resources

About