Significance of Development and Reversion of Collaterals on MRI in Early Neurologic Improvement and Long-Term Functional Outcome after Intravenous Thrombolysis for Ischemic Stroke

Ichijo, Masahiko; Iwasawa, Eri; Numasawa, Yoshiyuki; Miki, Kazunori; Ishibashi, Satoru; Tomita, Makoto; Tomimitsu, Hiroyuki; Kamata, Tomoyuki; Fujigasaki, Hiroto; Sato, Shuzo; Mizusawa, Hidehiro

doi:10.3174/ajnr.a4384

Cited by 25 publications

(30 citation statements)

References 31 publications

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“…Magnetic resonance imaging/MR angiography (MRI/MRA) of the brain has been utilized in defining collateral blood flow in the acute stroke setting . For an example, the Flair hyperintensity and MRA have been used to grade collateral status and its relation to outcome . The distal hyperintense vessels have a serpentine appearance and might be an indicator of slow retrograde CF .…”

Section: Introductionmentioning

confidence: 99%

“…20 For an example, the Flair hyperintensity and MRA have been used to grade collateral status and its relation to outcome. 21,22 The distal hyperintense vessels have a serpentine appearance and might be an indicator of slow retrograde CF. [23][24][25] However, MRI and MRA are not available in all centers, is time consuming, and provide still snap shot in time.…”

Section: Introductionmentioning

confidence: 99%

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Transcranial Doppler and Transcranial Color Duplex in Defining Collateral Cerebral Blood Flow

Saqqur

Khan

Derksen

et al. 2018

Journal of Neuroimaging

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In an acute stroke setting, transcranial Doppler (TCD) and transcranial color-coded duplex (TCCD) have an important diagnostic utility in the monitoring of an arterial occlusion and microemboli detection. In addition, TCD has proven to be a very useful tool in the detection and progression of cerebral vasospasm in patients with subarachnoid hemorrhage. TCD/TCCD may have an important role in defining collateral blood flow (CF) in stroke patients. It is a noninvasive technique and can be utilized repeatedly allowing for changes in the blood flow dynamics as treatment is delivered. In this review, we outlined the evolving role of TCD/TCCD in defining CF in patients with an acute ischemic stroke, predicting clinical outcome and monitoring the treatment's efficacy of the CF augmentation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transcranial Doppler and Transcranial Color Duplex in Defining Collateral Cerebral Blood Flow

Saqqur

Khan

Derksen

et al. 2018

Journal of Neuroimaging

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“…The biological mechanisms implied in the development of collateral circulation in the context of an ischemic insult seem to vary over time. In the acute and subacute stages two processes appear to promote collaterals: shear fluid stress precipitated by the pressure gradient caused by the acute thrombus and angiogenesis, as hypoxia triggers endothelial cells to sprout and form capillary networks [19]. In this last critical step, EPCs take a pivotal role through their paracrine (mainly through CAC subpopulation) and direct angiogenic properties (mostly oEPCs and CFU-ECs).…”

Section: Discussionmentioning

confidence: 99%

Endothelial Progenitor Cells influence acute and subacute stroke hemodynamics

Sargento-Freitas

Aday²,

Nunes³

et al. 2018

Journal of the Neurological Sciences

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“…A clinically relevant variable that captures the complex abnormalities that underlie ischemic stroke is also necessary to assess functioning outcome. Such a variable is expected to reflect the wide variation in a stroke patient baseline abnormality and provide clinical information regarding the state of a patient's recovery [3][4][5][6][7][8]. Treatment outcome with recombinant tissue plasminogen (rtPA) varies significantly across stroke patients with the same diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Prognostic models for ambulatory recovery functions in acute ischemic stroke patients with thrombolysis therapy

Scalise

Gainey

Bailes

et al. 2018

Preprint

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Background. The purpose of this study was to develop models to predict the recovery of ambulatory functions taking into account the capability of the motor system to functionally reorganize in response to thrombolysis therapy. Methods. We predicted ambulatory functions recovery using retrospective data from a stroke registry of acute ischemic stroke patients who received thrombolysis therapy. Multivariate regression was used to construct the models. Multicollinearity and significant interactions were examined using variance inflation factors, while a Cox & Snell classification were applied to check the fitness of each model. Results. The models correctly predicted clinical variables that were associated with an improvement or non-improvement in functional ambulatory outcome. Broca’s aphasia (OR = 2.270, P = 0.002, CI =1.34-3.83) was associated with improved functional outcome at discharge, while patients aged 80 years or older (OR = 0.942, P = <0.001, CI =0.92-0.96), patients with congestive heart failure (OR = 0.496, P = 0.040, CI = 0.25-0.97), higher NIHSS (OR=0.876, P = 0.001, CI = 0.80-0.95), taking antihypertensive medication (OR = 0.436, P = 0.023, CI = 0.21-0.89) were not associated with improved ambulatory functional outcome with thrombolysis. The discriminating ability for the model was 74.2% for the total population, 71.7% for the rtPA group, and 72.2% for the no-rtPA group indicating strong performance. Conclusion. Prognostic models that can predict improved functional ambulatory outcome in thrombolysis therapy can be beneficial in the care of stroke patients. Our models predicted improved functional recovery of Broca’s aphasia after thrombolysis therapy, suggesting a future potential to evaluate motor speech area after stroke.

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Significance of Development and Reversion of Collaterals on MRI in Early Neurologic Improvement and Long-Term Functional Outcome after Intravenous Thrombolysis for Ischemic Stroke

Abstract: Our results indicate that the development of leptomeningeal collaterals plays a crucial role in achieving early neurologic improvement, and reversion of collaterals predicts a favorable outcome via arterial recanalization after rtPA treatment for acute stroke.

Cited by 25 publications

References 31 publications

Transcranial Doppler and Transcranial Color Duplex in Defining Collateral Cerebral Blood Flow

Transcranial Doppler and Transcranial Color Duplex in Defining Collateral Cerebral Blood Flow

Endothelial Progenitor Cells influence acute and subacute stroke hemodynamics

Prognostic models for ambulatory recovery functions in acute ischemic stroke patients with thrombolysis therapy

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