Predictors of Hemorrhage Following Intra-Arterial Thrombolysis for Acute Ischemic Stroke: The Role of Pial Collateral Formation

Christoforidis, Greg; Karakasis, Christopher; Mohammad, Yousef; Caragine, Louis P.; Yang, Ming; Slivka, A.

doi:10.3174/ajnr.a1276

Cited by 123 publications

(117 citation statements)

References 31 publications

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“…Besides lysis of the obstruction, thrombolytics also reverse stasis-induced thrombosis distal to the occlusion. However, access depends on the extent of the pial collateral circulation (Brozici et al, 2003;Liebeskind, 2005), yet patients with acute occlusion evidence wide variation in the extent of retrograde perfusion of the MCA tree (Bang et al, 2008;Christoforidis et al, 2009). Whether this is due to individual variation in the pial collateral circulation or thrombotic or other mechanisms is unclear because current imaging methods cannot resolve these small vessels in humans, and until now, no animal studies had been done.…”

Section: Discussionmentioning

confidence: 99%

“…Retrograde perfusion of the distal MCA in patients suffering acute obstruction of its trunk varies substantially (Bang et al, 2008;Christoforidis et al, 2009), presumably in part from differences in the extent of the preexisting pial collateral circulation. The contribution of genetic differences to such variation is unknown.…”

Section: Wide Genetic Variation In the Extent Of The Native Pial Collmentioning

confidence: 99%

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Wide Genetic Variation in the Native Pial Collateral Circulation is a Major Determinant of Variation in Severity of Stroke

Zhang

Prabhakar

Sealock

et al. 2010

J Cereb Blood Flow Metab

228

383

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Severity of stroke varies widely among individuals. Whether differences in the extent of the native (preexisting) pial collateral circulation exist and contribute to this variability is unknown. We addressed these questions and probed for potential genetic contributions using morphometric analysis of the collateral circulation in 15 inbred mouse strains recently shown to exhibit wide differences in infarct volume. Morphometrics were determined in the unligated left hemisphere (for native collaterals) and ligated right hemisphere (for remodeled collaterals) 6 days after permanent middle cerebral artery (MCA) occlusion. Variation among strains in native collateral number, diameter, MCA, anterior cerebral artery (ACA), and posterior cerebral artery (PCA) tree territories were, respectively: 56-fold, 3-fold, 42%, 56%, and 61%. Collateral length (P < 0.001) and the number of penetrating arterioles branching from them also varied (P < 0.05). Infarct volume correlated inversely with collateral number (P < 0.0001), diameter (P < 0.0001), and penetrating arteriole number (P < 0.05) and directly with MCA territory (P < 0.05). Relative collateral conductance and MCA territory, when factored together, strongly predicted infarct volume (P < 0.0001). Outward remodeling of collaterals in the ligated hemisphere varied B3-fold. These data show that the extent of the native pial collateral circulation and collateral remodeling after obstruction vary widely with genetic background, and suggest that this variability, due to natural polymorphisms, is a major contributor to variability in infarct volume.

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Section: Discussionmentioning

confidence: 99%

Section: Wide Genetic Variation In the Extent Of The Native Pial Collmentioning

confidence: 99%

Wide Genetic Variation in the Native Pial Collateral Circulation is a Major Determinant of Variation in Severity of Stroke

Zhang

Prabhakar

Sealock

et al. 2010

J Cereb Blood Flow Metab

228

383

View full text Add to dashboard Cite

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“…Kucinski et al 7 stated that good collateral circulation independently predicted good outcome in a series of patients treated with IV and IA thrombolysis. Some authors investigated pial collateral circulation through a new grading scale, finding an association between good pial collateral circulation and both good functional outcome and the reduction of haemorrhage at 24h CT scan [8][9][10] . The aim of this paper was to evaluate the role of recanalization, pial collateral circulation and their interaction on the functional outcome of patients treated Figure 2 Effect of interaction between reperfusion and collateral circulation on functional outcome.…”

Section: Methodsmentioning

confidence: 99%

Effect of the Interaction between Recanalization and Collateral Circulation on Functional Outcome in Acute Ischaemic Stroke

et al. 2014

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Identification of patients with acute ischaemic stroke who could most benefit from arterial recanalization after endovascular treatment remains an unsettled issue. Although several classifications of collateral circulation have been proposed, the clinical role of collaterals is still debated. We evaluated the effect of the collateral circulation in relation to recanalization as a predictor of clinical outcome. Data were prospectively collected from 103 patients consecutively treated for proximal middle cerebral or internal carotid artery occlusion. The collateral circulation was evaluated with a novel semiquantitative-qualitative score, the Careggi collateral score (CCS), in six grades. Both CCS and recanalization grades (TICI) were analysed in relation to clinical outcome. A statistical analysis was performed to evaluate the effect of interaction between recanalization and collateral circulation on clinical outcome. Out of the 103 patients, 37 (36.3%) had poor collaterals, and 65 (63.7%) had good collaterals. Patients with good collaterals had lower basal National Institute of Health Stroke Scale (NIHSS), more distal occlusion, smaller lesions at 24h CT scan and better functional outcome. After multivariate analysis, the interaction between recanalization and collateral grades was significantly stronger as a predictor of good outcome (OR 6.87, 95% CI 2.11–22.31) or death (OR 4.66, 95% CI 1.48–14.73) compared to the effect of the single variables. Collaterals showed an effect of interaction with the recanalization grade in determining a favourable clinical outcome. Assessment of the collateral circulation might help predict clinical results after recanalization in patients undergoing endovascular treatment for acute ischaemic stroke.

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“…In a study of 105 stroke patients, HT occurred more frequently in those with poor pial collaterals (25%, 8/32) compared with those with good pial collaterals (2.8%, 2/72) (P ¼ 0.0004). 179 In a study of 222 endovascular-treated stroke patients, symptomatic HT was more common in patients that recanalized and had poor collaterals (30.2%) compared with patients that recanalized and had good collaterals (14.3%). This highlights that reperfusion of infarcted brain tissue is a critical factor in HT, and poor collaterals likely increase the size and severity of cerebral infarction and thus promote HT.…”

Section: Clinical Factors Associated With Hemorrhagic Transformationmentioning

confidence: 99%

Hemorrhagic Transformation after Ischemic Stroke in Animals and Humans

Jickling

Liu

Stamova

et al. 2013

J Cereb Blood Flow Metab

461

369

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Hemorrhagic transformation (HT) is a common complication of ischemic stroke that is exacerbated by thrombolytic therapy. Methods to better prevent, predict, and treat HT are needed. In this review, we summarize studies of HT in both animals and humans. We propose that early HT (o18 to 24 hours after stroke onset) relates to leukocyte-derived matrix metalloproteinase-9 (MMP-9) and brain-derived MMP-2 that damage the neurovascular unit and promote blood-brain barrier (BBB) disruption. This contrasts to delayed HT (418 to 24 hours after stroke) that relates to ischemia activation of brain proteases (MMP-2, MMP-3, MMP-9, and endogenous tissue plasminogen activator), neuroinflammation, and factors that promote vascular remodeling (vascular endothelial growth factor and high-moblity-group-box-1). Processes that mediate BBB repair and reduce HT risk are discussed, including transforming growth factor beta signaling in monocytes, Src kinase signaling, MMP inhibitors, and inhibitors of reactive oxygen species. Finally, clinical features associated with HT in patients with stroke are reviewed, including approaches to predict HT by clinical factors, brain imaging, and blood biomarkers. Though remarkable advances in our understanding of HT have been made, additional efforts are needed to translate these discoveries to the clinic and reduce the impact of HT on patients with ischemic stroke.

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Predictors of Hemorrhage Following Intra-Arterial Thrombolysis for Acute Ischemic Stroke: The Role of Pial Collateral Formation

Cited by 123 publications

References 31 publications

Wide Genetic Variation in the Native Pial Collateral Circulation is a Major Determinant of Variation in Severity of Stroke

Wide Genetic Variation in the Native Pial Collateral Circulation is a Major Determinant of Variation in Severity of Stroke

Effect of the Interaction between Recanalization and Collateral Circulation on Functional Outcome in Acute Ischaemic Stroke

Hemorrhagic Transformation after Ischemic Stroke in Animals and Humans

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