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Franx B, Dijkhuizen RM, Dippel DWJ. Acute Ischemic Stroke in the Clinic and the Laboratory: Targets for Translational Research. Neuroscience 2024:S0306-4522(24)00159-3. [PMID: 38670254 DOI: 10.1016/j.neuroscience.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/26/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
Ischemic stroke research has enabled significant advancements in diagnosis, treatment, and management of this debilitating disease, yet challenges remain standing in the way of better patient prognoses. In this narrative review, a fictional case illustrates challenges and uncertainties that medical professionals still face - penumbra identification, lack of neuroprotective agents, side-effects of tissue plasminogen activator, dearth of molecular biomarkers, incomplete microvascular reperfusion or no-reflow, post-recanalization hyperperfusion, blood pressure management and procedural anesthetic effects. The current state of the field is broadly reviewed per topic, with the aim to introduce a broad audience (scientist and clinician alike) to recent successes in translational stroke research and pending scientific queries that are tractable for preclinical assessment. Opportunities for co-operation between clinical and experimental stroke experts are highlighted to increase the size and frequency of strides the field makes to improve our understanding of this disease and ways of treating it.
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Affiliation(s)
- Bart Franx
- Translational Neuroimaging Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Rick M Dijkhuizen
- Translational Neuroimaging Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Diederik W J Dippel
- Stroke Center, Dept of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands.
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2
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Franx BAA, van Tilborg GAF, van der Toorn A, van Heijningen CL, Dippel DWJ, van der Schaaf IC, Dijkhuizen RM. Propofol anesthesia improves stroke outcomes over isoflurane anesthesia-a longitudinal multiparametric MRI study in a rodent model of transient middle cerebral artery occlusion. Front Neurol 2024; 15:1332791. [PMID: 38414549 PMCID: PMC10897009 DOI: 10.3389/fneur.2024.1332791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/24/2024] [Indexed: 02/29/2024] Open
Abstract
General anesthesia is routinely used in endovascular thrombectomy procedures, for which volatile gas and/or intravenous propofol are recommended. Emerging evidence suggests propofol may have superior effects on disability and/or mortality rates, but a mode-of-action underlying these class-specific effects remains unknown. Here, a moderate isoflurane or propofol dosage on experimental stroke outcomes was retrospectively compared using serial multiparametric MRI and behavioral testing. Adult male rats (N = 26) were subjected to 90-min filament-induced transient middle cerebral artery occlusion. Diffusion-, T2- and perfusion-weighted MRI was performed during occlusion, 0.5 h after recanalization, and four days into the subacute phase. Sequels of ischemic damage-blood-brain barrier integrity, cerebrovascular reactivity and sensorimotor functioning-were assessed after four days. While size and severity of ischemia was comparable between groups during occlusion, isoflurane anesthesia was associated with larger lesion sizes and worsened sensorimotor functioning at follow-up. MRI markers indicated that cytotoxic edema persisted locally in the isoflurane group early after recanalization, coinciding with burgeoning vasogenic edema. At follow-up, sequels of ischemia were further aggravated in the post-ischemic lesion, manifesting as increased blood-brain barrier leakage, cerebrovascular paralysis and cerebral hyperperfusion. These findings shed new light on how isoflurane, and possibly similar volatile agents, associate with persisting injurious processes after recanalization that contribute to suboptimal treatment outcome.
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Affiliation(s)
- Bart A. A. Franx
- Translational Neuroimaging Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Geralda A. F. van Tilborg
- Translational Neuroimaging Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Annette van der Toorn
- Translational Neuroimaging Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Caroline L. van Heijningen
- Translational Neuroimaging Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | | | | | - Rick M. Dijkhuizen
- Translational Neuroimaging Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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3
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Franx BAA, van Tilborg GAF, Taha A, Bobi J, van der Toorn A, Van Heijningen CL, van Beusekom HMM, Wu O, Dijkhuizen RM. Hyperperfusion profiles after recanalization differentially associate with outcomes in a rat ischemic stroke model. J Cereb Blood Flow Metab 2024; 44:209-223. [PMID: 37873758 PMCID: PMC10993873 DOI: 10.1177/0271678x231208993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 08/15/2023] [Accepted: 09/24/2023] [Indexed: 10/25/2023]
Abstract
Futile recanalization hampers prognoses of ischemic stroke after successful mechanical thrombectomy, hypothetically through post-recanalization perfusion deficits, onset-to-groin delays and sex effects. Clinically, acute multiparametric imaging studies remain challenging. We assessed possible relationships between these factors and disease outcome after experimental cerebral ischemia-reperfusion, using translational MRI, behavioral testing and multi-model inference analyses. Male and female rats (N = 60) were subjected to 45-/90-min filament-induced transient middle cerebral artery occlusion. Diffusion, T2- and perfusion-weighted MRI at occlusion, 0.5 h and four days after recanalization, enabled tracking of tissue fate, and relative regional cerebral blood flow (rrCBF) and -volume (rrCBV). Lesion areas were parcellated into core, salvageable tissue and delayed injury, verified by histology. Recanalization resulted in acute-to-subacute lesion volume reductions, most apparently in females (n = 19). Hyperacute normo-to-hyperperfusion in the post-ischemic lesion augmented towards day four, particularly in males (n = 23). Tissue suffering delayed injury contained higher ratios of hypoperfused voxels early after recanalization. Regressed against acute-to-subacute lesion volume change, increased rrCBF associated with lesion growth, but increased rrCBV with lesion reduction. Similar relationships were detected for behavioral outcome. Post-ischemic hyperperfusion may develop differentially in males and females, and can be beneficial or detrimental to disease outcome, depending on which perfusion parameter is used as explanatory variable.
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Affiliation(s)
- Bart AA Franx
- Biomedical MR Imaging and Spectroscopy group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Geralda AF van Tilborg
- Biomedical MR Imaging and Spectroscopy group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Aladdin Taha
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
| | - Joaquim Bobi
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
| | - Annette van der Toorn
- Biomedical MR Imaging and Spectroscopy group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Caroline L Van Heijningen
- Biomedical MR Imaging and Spectroscopy group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Heleen MM van Beusekom
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
| | - Ona Wu
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Rick M Dijkhuizen
- Biomedical MR Imaging and Spectroscopy group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - on behalf of the CONTRAST consortium
- Biomedical MR Imaging and Spectroscopy group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
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4
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van der Knaap N, Franx BAA, Majoie CBLM, van der Lugt A, Dijkhuizen RM. Implications of Post-recanalization Perfusion Deficit After Acute Ischemic Stroke: a Scoping Review of Clinical and Preclinical Imaging Studies. Transl Stroke Res 2024; 15:179-194. [PMID: 36653525 PMCID: PMC10796479 DOI: 10.1007/s12975-022-01120-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/20/2023]
Abstract
The goal of reperfusion therapy for acute ischemic stroke (AIS) is to restore cerebral blood flow through recanalization of the occluded vessel. Unfortunately, successful recanalization does not always result in favorable clinical outcome. Post-recanalization perfusion deficits (PRPDs), constituted by cerebral hypo- or hyperperfusion, may contribute to lagging patient recovery rates, but its clinical significance remains unclear. This scoping review provides an overview of clinical and preclinical findings on post-ischemic reperfusion, aiming to elucidate the pattern and consequences of PRPD from a translational perspective. The MEDLINE database was searched for quantitative clinical and preclinical studies of AIS reporting PRPD based on cerebral circulation parameters acquired by translational tomographic imaging methods. PRPD and stroke outcome were mapped on a charting table, creating an overview of PRPD after AIS. Twenty-two clinical and twenty-two preclinical studies were included. Post-recanalization hypoperfusion is rarely reported in clinical studies (4/22) but unequivocally associated with detrimental outcome. Post-recanalization hyperperfusion is more commonly reported (18/22 clinical studies) and may be associated with positive or negative outcome. PRPD has been replicated in animal studies, offering mechanistic insights into causes and consequences of PRPD and allowing delineation of possible courses of PRPD. Complex relationships exist between PRPD and stroke outcome. Diversity in methods and lack of standardized definitions in reperfusion studies complicate the characterization of reperfusion patterns. Recommendations are made to advance the understanding of PRPD mechanisms and to further disentangle the relation between PRPD and disease outcome.
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Affiliation(s)
- Noa van der Knaap
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Bart A A Franx
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rick M Dijkhuizen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
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Huang LJ, Jiao JF, He Q, Luo JW, Guo Y. Ultrafast power Doppler imaging for ischemic encephalopathy: A case report. World J Clin Cases 2023; 11:7640-7646. [DOI: 10.12998/wjcc.v11.i31.7640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/26/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Severely elevated intracranial pressure due to various reasons, such as decreased cerebral perfusion, can lead to devastating neurological outcomes, such as brain herniation. Decompression craniectomy is a life-saving procedure that is commonly performed for such a critical situation, but the changes in cerebral microvessels after brain herniation and decompression are unclear. Ultrafast power Doppler imaging (uPDI) is a new microvascular imaging technology that utilizes high frame rate plane/diverging wave transmission and advanced clutter filters. uPDI significantly improves Doppler sensitivity and can detect microvessels, which are usually invisible using traditional ultrasound Doppler imaging.
CASE SUMMARY In this report, uPDI was used for the first time to observe the brain blood flow of a hypoperfusion area in a 4-year-old girl who underwent decompression craniectomy due to refractory intracranial hypertension (ICP) after malignant brain tumor surgery. B-mode imaging was used to verify the increased densities of the cerebral cortex and basal ganglia that were observed by computed tomography.
CONCLUSION uPDI showed the local blood supplies and anatomical structures of the patient after decompressive craniectomy. uPDI is potentially a more intuitive and noninvasive method for evaluating the effects of severe ICP on cerebral microvessels.
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Affiliation(s)
- Li-Jie Huang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Jian-Feng Jiao
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Medicine, Tsinghua University, Beijing 102218, China
| | - Qiong He
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Jian-Wen Luo
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Yi Guo
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Medicine, Tsinghua University, Beijing 102218, China
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Rosso C, Belkacem S, Amor-Sahli M, Clarençon F, Leger A, Baronnet F, Dormont D, Alamowitch S, Lehericy S, Samson Y. Persistent perfusion abnormalities at day 1 correspond to different clinical trajectories after stroke. J Neurointerv Surg 2023; 15:e26-e32. [PMID: 35701108 DOI: 10.1136/neurintsurg-2022-018953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/01/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Perfusion abnormalities after thrombolysis are frequent within and surrounding ischemic lesions, but their relative frequency is not well known. OBJECTIVE To describe the different patterns of perfusion abnormalities observed at 24 hours and compare the characteristics of the patients according to their perfusion pattern. METHODS From our thrombolysis registry, we included 226 consecutive patients with an available arterial spin labeling (ASL) perfusion sequence at day 1. We performed a blinded assessment of the perfusion status (hypoperfusion-h, hyperperfusion-H, or normal-N) in the ischemic lesion and in the surrounding tissue. We compared the time course of clinical recovery, the rate of arterial recanalization, and hemorrhagic transformations in the different perfusion profiles. RESULTS We identified seven different perfusion profiles at day 1. Four of these (h/h, h/H, H/H, and H/N) represented the majority of the population (84.1%). The H/H profile was the most frequent (34.5%) and associated with 3-month good outcome (modified Rankin Scale (mRS): 63.5%). Patients with persistent hypoperfusion within and outside the lesion (h/h, 12.4%) exhibited worse outcomes after treatment (mRS score 0-2: 23.8%) than other patients, were less frequently recanalized (40.7%), and had more parenchymal hematoma (17.8%). The h/H profile had an intermediate clinical trajectory between the h/h profile and the hyperperfused profiles. CONCLUSION ASL hypoperfusion within the infarct and the surrounding tissue was associated with poor outcome. A more comprehensive view of the mechanisms in the hypoperfused surrounding tissue could help to design new therapeutic approaches during and after reperfusion therapies.
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Affiliation(s)
- Charlotte Rosso
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Samia Belkacem
- APHP-Neuroradiology Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Mélika Amor-Sahli
- APHP-Neuroradiology Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Frédéric Clarençon
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- APHP-Interventional Neuroradiology Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Anne Leger
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Flore Baronnet
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Didier Dormont
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- APHP-Neuroradiology Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sonia Alamowitch
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
- STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Stéphane Lehericy
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- APHP-Neuroradiology Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Yves Samson
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
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Luby M, Hsia AW, Lomahan CA, Davis R, Burton S, Kim Y, Craft V, Uche V, Cabatbat R, Adil MM, Thomas LC, De Vis JB, Afzal MM, McGavern D, Lynch JK, Leigh R, Latour LL. Post-ischemic hyperemia following endovascular therapy for acute stroke is associated with lesion growth. J Cereb Blood Flow Metab 2023; 43:856-868. [PMID: 36748316 PMCID: PMC10196753 DOI: 10.1177/0271678x231155222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 02/08/2023]
Abstract
A substantial proportion of acute stroke patients fail to recover following successful endovascular therapy (EVT) and injury to the brain and vasculature secondary to reperfusion may be a contributor. Acute stroke patients were included with: i) large vessel occlusion of the anterior circulation, ii) successful recanalization, and iii) evaluable MRI early after EVT. Presence of hyperemia on MRI perfusion was assessed by consensus using a modified ASPECTS. Three different approaches were used to quantify relative cerebral blood flow (rCBF). Sixty-seven patients with median age of 66 [59-76], 57% female, met inclusion criteria. Hyperemia was present in 35/67 (52%) patients early post-EVT, in 32/65 (49%) patients at 24 hours, and in 19/48 (40%) patients at 5 days. There were no differences in incomplete reperfusion, HT, PH-2, HARM, severe HARM or symptomatic ICH rates between those with and without early post-EVT hyperemia. A strong association (R2 = 0.81, p < 0.001) was found between early post-EVT hyperemia (p = 0.027) and DWI volume at 24 hours after adjusting for DWI volume at 2 hours (p < 0.001) and incomplete reperfusion at 24 hours (p = 0.001). Early hyperemia is a potential marker for cerebrovascular injury and may help select patients for adjunctive therapy to prevent edema, reperfusion injury, and lesion growth.
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Affiliation(s)
- Marie Luby
- NIH/NINDS, Stroke Branch, Bethesda,
MD, USA
| | - Amie W Hsia
- NIH/NINDS, Stroke Branch, Bethesda,
MD, USA
- MedStar Washington Hospital Center
Comprehensive Stroke Center, Washington, DC, USA
| | - Carolyn A Lomahan
- NIH/NINDS, Stroke Branch, Bethesda,
MD, USA
- Suburban Hospital, Johns Hopkins
Medicine, Bethesda, MD, USA
| | - Rachel Davis
- NIH/NINDS, Stroke Branch, Bethesda,
MD, USA
- Suburban Hospital, Johns Hopkins
Medicine, Bethesda, MD, USA
| | - Shannon Burton
- NIH/NINDS, Stroke Branch, Bethesda,
MD, USA
- MedStar Washington Hospital Center
Comprehensive Stroke Center, Washington, DC, USA
| | - Yongwoo Kim
- NIH/NINDS, Stroke Branch, Bethesda,
MD, USA
- MedStar Washington Hospital Center
Comprehensive Stroke Center, Washington, DC, USA
| | - Veronica Craft
- NIH/NINDS, Stroke Branch, Bethesda,
MD, USA
- MedStar Washington Hospital Center
Comprehensive Stroke Center, Washington, DC, USA
| | - Victoria Uche
- NIH/NINDS, Stroke Branch, Bethesda,
MD, USA
- MedStar Washington Hospital Center
Comprehensive Stroke Center, Washington, DC, USA
| | - Rainier Cabatbat
- NIH/NINDS, Stroke Branch, Bethesda,
MD, USA
- MedStar Washington Hospital Center
Comprehensive Stroke Center, Washington, DC, USA
| | - Malik M Adil
- NIH/NINDS, Stroke Branch, Bethesda,
MD, USA
- Suburban Hospital, Johns Hopkins
Medicine, Bethesda, MD, USA
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Leila C Thomas
- NIH/NINDS, Stroke Branch, Bethesda,
MD, USA
- Suburban Hospital, Johns Hopkins
Medicine, Bethesda, MD, USA
| | - Jill B De Vis
- NIH/NINDS, Stroke Branch, Bethesda,
MD, USA
- Department of Radiation Oncology,
Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Dorian McGavern
- NIH/NINDS Viral Immunology and
Intravital Imaging Section, Bethesda, MD, USA
| | | | - Richard Leigh
- NIH/NINDS, Stroke Branch, Bethesda,
MD, USA
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
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8
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Wang Y, Hou R, Liu Y. Plasma Homocysteine (Hcy) Concentration Functions as a Predictive Biomarker of SPECT-Evaluated Post-Ischemic Hyperperfusion in Acute Ischemic Stroke. Pharmgenomics Pers Med 2023; 16:481-489. [PMID: 37256202 PMCID: PMC10226540 DOI: 10.2147/pgpm.s400767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/24/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Homocysteine (Hcy) concentration has been reported to be associated with ischemic stroke. In this study, we aimed to investigate the potential of plasma Hcy in the prediction of post-ischemic hyperperfusion in AIS patients, which was diagnosed with the single-photon emission computed tomography (SPECT) method. Methods A total of 112 ischemic stroke patients were recruited in this study. According to whether the patients were subjected to post-ischemic hyperperfusion, all recruited subjects were divided into a post-ischemic hyperperfusion (+) group (N=48) and post-ischemic hyperperfusion (-) group (N=64). The basic demographical data, clinicopathological data and laboratory biochemical data were collected and compared. Level of homocysteine (Hcy) and cystatin-C (Cys-C) and their potential as predictive biomarker are also investigated. Results No significant differences were spotted between the post-ischemic hyperperfusion group (+) and post-ischemic hyperperfusion (-) group in respect to the basic demographical and clinicopathological data. And the serum Hcy levels were lower in the post-ischemic hyperperfusion (+) group. Moreover, ROC analysis indicated significant relationships between Hcy levels and the onset of post-ischemic hyperperfusion. Conclusion In conclusion, we validated that the plasma Hcy concentration can be used as a predictive biomarker of SPECT-evaluated post-ischemic hyperperfusion in patients suffering from acute ischemic stroke.
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Affiliation(s)
- Yingqiu Wang
- Department of Nuclear Medicine, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People’s Republic of China
| | - Renhua Hou
- Department of Nuclear Medicine, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People’s Republic of China
| | - Yan Liu
- Department of Nuclear Medicine, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People’s Republic of China
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9
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Meerwaldt AE, Straathof M, Oosterveld W, van Heijningen CL, van Leent MMT, Toner YC, Munitz J, Teunissen AJP, Daemen CC, van der Toorn A, van Vliet G, van Tilborg GAF, De Feyter HM, de Graaf RA, Hol EM, Mulder WJM, Dijkhuizen RM. In vivo imaging of cerebral glucose metabolism informs on subacute to chronic post-stroke tissue status - A pilot study combining PET and deuterium metabolic imaging. J Cereb Blood Flow Metab 2023; 43:778-790. [PMID: 36606595 PMCID: PMC10108187 DOI: 10.1177/0271678x221148970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/04/2022] [Accepted: 11/21/2022] [Indexed: 01/07/2023]
Abstract
Recanalization therapy after acute ischemic stroke enables restoration of cerebral perfusion. However, a significant subset of patients has poor outcome, which may be caused by disruption of cerebral energy metabolism. To assess changes in glucose metabolism subacutely and chronically after recanalization, we applied two complementary imaging techniques, fluorodeoxyglucose (FDG) positron emission tomography (PET) and deuterium (2H) metabolic imaging (DMI), after 60-minute transient middle cerebral artery occlusion (tMCAO) in C57BL/6 mice. Glucose uptake, measured with FDG PET, was reduced at 48 hours after tMCAO and returned to baseline value after 11 days. DMI revealed effective glucose supply as well as elevated lactate production and reduced glutamate/glutamine synthesis in the lesion area at 48 hours post-tMCAO, of which the extent was dependent on stroke severity. A further decrease in oxidative metabolism was evident after 11 days. Immunohistochemistry revealed significant glial activation in and around the lesion, which may play a role in the observed metabolic profiles. Our findings indicate that imaging (altered) active glucose metabolism in and around reperfused stroke lesions can provide substantial information on (secondary) pathophysiological changes in post-ischemic brain tissue.
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Affiliation(s)
- Anu E Meerwaldt
- Biomedical MR Imaging and
Spectroscopy Group, Center for Image Sciences, University Medical Center
Utrecht/Utrecht University, Utrecht, Netherlands
- BioMedical Engineering and Imaging
Institute, Icahn School of Medicine at Mount Sinai, New York, USA
- Diagnostic, Molecular and
Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
| | - Milou Straathof
- Biomedical MR Imaging and
Spectroscopy Group, Center for Image Sciences, University Medical Center
Utrecht/Utrecht University, Utrecht, Netherlands
| | - Wija Oosterveld
- Biomedical MR Imaging and
Spectroscopy Group, Center for Image Sciences, University Medical Center
Utrecht/Utrecht University, Utrecht, Netherlands
| | - Caroline L van Heijningen
- Biomedical MR Imaging and
Spectroscopy Group, Center for Image Sciences, University Medical Center
Utrecht/Utrecht University, Utrecht, Netherlands
| | - Mandy MT van Leent
- BioMedical Engineering and Imaging
Institute, Icahn School of Medicine at Mount Sinai, New York, USA
- Diagnostic, Molecular and
Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
| | - Yohana C Toner
- BioMedical Engineering and Imaging
Institute, Icahn School of Medicine at Mount Sinai, New York, USA
- Diagnostic, Molecular and
Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
- Department of Internal Medicine and
Radboud Center for Infectious Diseases, Radboud University Medical Center,
Nijmegen, Netherlands
| | - Jazz Munitz
- BioMedical Engineering and Imaging
Institute, Icahn School of Medicine at Mount Sinai, New York, USA
- Diagnostic, Molecular and
Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
| | - Abraham JP Teunissen
- BioMedical Engineering and Imaging
Institute, Icahn School of Medicine at Mount Sinai, New York, USA
- Diagnostic, Molecular and
Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
- Cardiovascular Research Institute,
Icahn School of Medicine at Mount Sinai, New York, USA
- Icahn Genomics Institute, Icahn
School of Medicine at Mount Sinai, New York, USA
| | - Charlotte C Daemen
- Department of Translational
Neuroscience, University Medical Center Utrecht Brain Center, Utrecht
University, Utrecht, The Netherlands
| | - Annette van der Toorn
- Biomedical MR Imaging and
Spectroscopy Group, Center for Image Sciences, University Medical Center
Utrecht/Utrecht University, Utrecht, Netherlands
| | - Gerard van Vliet
- Biomedical MR Imaging and
Spectroscopy Group, Center for Image Sciences, University Medical Center
Utrecht/Utrecht University, Utrecht, Netherlands
| | - Geralda AF van Tilborg
- Biomedical MR Imaging and
Spectroscopy Group, Center for Image Sciences, University Medical Center
Utrecht/Utrecht University, Utrecht, Netherlands
| | - Henk M De Feyter
- Department of Radiology and
Biomedical Imaging, Magnetic Resonance Research Center, Yale University School
of Medicine, New Haven, CT, USA
| | - Robin A de Graaf
- Department of Radiology and
Biomedical Imaging, Magnetic Resonance Research Center, Yale University School
of Medicine, New Haven, CT, USA
- Department of Biomedical
Engineering, Yale University School of Medicine, New Haven, CT, USA
| | - Elly M Hol
- Department of Translational
Neuroscience, University Medical Center Utrecht Brain Center, Utrecht
University, Utrecht, The Netherlands
| | - Willem JM Mulder
- BioMedical Engineering and Imaging
Institute, Icahn School of Medicine at Mount Sinai, New York, USA
- Diagnostic, Molecular and
Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
- Department of Internal Medicine and
Radboud Center for Infectious Diseases, Radboud University Medical Center,
Nijmegen, Netherlands
- Department of Chemical Biology,
Eindhoven University of Technology, Eindhoven, Netherlands
| | - Rick M Dijkhuizen
- Biomedical MR Imaging and
Spectroscopy Group, Center for Image Sciences, University Medical Center
Utrecht/Utrecht University, Utrecht, Netherlands
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10
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Robichon E, Maïer B, Mazighi M. Endovascular therapy for acute ischemic stroke: The importance of blood pressure control, sedation modality and anti-thrombotic management to improve functional outcomes. Rev Neurol (Paris) 2022; 178:175-184. [DOI: 10.1016/j.neurol.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/08/2021] [Accepted: 09/27/2021] [Indexed: 01/04/2023]
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11
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Valent A, Maïer B, Chabanne R, Degos V, Lapergue B, Lukaszewicz AC, Mazighi M, Gayat E. Anaesthesia and haemodynamic management of acute ischaemic stroke patients before, during and after endovascular therapy. Anaesth Crit Care Pain Med 2020; 39:859-870. [PMID: 33039657 DOI: 10.1016/j.accpm.2020.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/16/2020] [Accepted: 05/26/2020] [Indexed: 11/29/2022]
Abstract
Endovascular therapy (EVT) is now standard of care for eligible patients with acute ischaemic stroke caused by large vessel occlusion in the anterior circulation. EVT can be performed with general anaesthesia (GA) or with monitored anaesthesia care, involving local anaesthesia with or without conscious sedation (LA/CS). Controversies remain regarding the optimal choice of anaesthetic strategy and observational studies suggested poorer functional outcome and higher mortality in patients treated under GA, essentially because of its haemodynamic consequences and the delay to put patients under GA. However, these studies are limited by selection bias, the most severe patients being more likely to receive GA and recent randomised trials and meta-analysis showed that protocol-based GA compared with LA/CS is significantly associated with less disability at 3 months. Unlike for intravenous thrombolysis, few data exist to guide management of blood pressure (BP) before and during EVT, but arterial hypotension should be avoided as long as the occlusion persists. BP targets following EVT should probably be adapted to the degree of recanalisation and the extent of ischaemia. Lower BP levels may be warranted to prevent reperfusion injuries even if prospective haemodynamic management evaluations after EVT are lacking.
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Affiliation(s)
- Arnaud Valent
- Department of Anaesthesiology and Critical Care, Lariboisière Hospital, DMU Parabol, AP-HP Nord & University of Paris, Paris, France; UMR-S 942 MASCOT, Inserm, France
| | - Benjamin Maïer
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, 75019 Paris, France
| | - Russell Chabanne
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand Cedex, France
| | - Vincent Degos
- Department of Anaesthesia and Critical Care, Pitié Salpêtrière Hospital, AP-HP-SU, Paris, France, Groupe recherche clinique BIOSFAST, Sorbonne University, Paris, France
| | - Bertrand Lapergue
- Stroke Centre Neurology Division, Hôpital Foch, 92150, Suresnes, France
| | - Anne-Claire Lukaszewicz
- Service d'Anesthésie Réanimation, Hôpital Neurologique, Hospices Civils de Lyon, Bron, France; EA 7426 PI3 (Pathophysiology of Injury-induced Immunosuppression), Hospices Civils de Lyon/Université de Lyon/bioMérieux, Hôpital E. Herriot, Lyon cedex 03, France
| | - Mikael Mazighi
- Department of Neurology and Stroke Centre, Lariboisière Hospital, AP-HP, Paris University, Sorbonne Paris Cité, Paris, France; Département Hospitalo-Universistaire Neurovasc, Paris, France
| | - Etienne Gayat
- Department of Anaesthesiology and Critical Care, Lariboisière Hospital, DMU Parabol, AP-HP Nord & University of Paris, Paris, France; UMR-S 942 MASCOT, Inserm, France.
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12
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Ji Y, Lu D, Jiang Y, Wang X, Meng Y, Sun PZ. Development of fast multi-slice apparent T 1 mapping for improved arterial spin labeling MRI measurement of cerebral blood flow. Magn Reson Med 2020; 85:1571-1580. [PMID: 32970848 DOI: 10.1002/mrm.28510] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/12/2020] [Accepted: 08/18/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE To develop fast multi-slice apparent T1 (T1app ) mapping for accurate cerebral blood flow (CBF) quantification with arterial spin labeling (ASL) MRI. METHODS Fast multi-slice T1app was measured using a modified inversion recovery echo planar imaging (EPI) sequence with simultaneous application of ASL tagging radiofrequency (RF) and gradient pulses. The fast multi-slice T1app measurement was compared with the single-slice T1app imaging approach, repeated per slice. CBF was assessed in healthy adult Wistar rats (N = 5) and rats with acute stroke 24 hours after a transient middle cerebral artery occlusion (N = 5). RESULTS The fast multi-slice T1app measurement was in good agreement with that of a single-slice T1app imaging approach (Lin's concordance correlation coefficient = 0.92). CBF calculated using T1app reasonably accounted for the finite labeling RF duration, whereas the routine T1 -normalized ASL MRI underestimated the CBF, particularly at short labeling durations. In acute stroke rats, the labeling time and the CBF difference (ΔCBF) between the contralateral normal area and the ischemic lesion were significantly correlated when using T1 -normalized perfusion calculation (R = 0.844, P = .035). In comparison, T1app -normalized ΔCBF had little labeling time dependence based on the linear regression equation of ΔCBF = -0.0247*τ + 1.579 mL/g/min (R = -0.352, P = .494). CONCLUSIONS Our study found fast multi-slice T1app imaging improves the accuracy and reproducibility of CBF measurement.
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Affiliation(s)
- Yang Ji
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Dongshuang Lu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Yinghua Jiang
- Clinical Neuroscience Research Center, Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Xiaoying Wang
- Clinical Neuroscience Research Center, Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Yuguang Meng
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Phillip Zhe Sun
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA.,Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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13
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Premilovac D, Blackwood SJ, Ramsay CJ, Keske MA, Howells DW, Sutherland BA. Transcranial contrast-enhanced ultrasound in the rat brain reveals substantial hyperperfusion acutely post-stroke. J Cereb Blood Flow Metab 2020; 40:939-953. [PMID: 32063081 PMCID: PMC7181087 DOI: 10.1177/0271678x20905493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Direct and real-time assessment of cerebral hemodynamics is key to improving our understanding of cerebral blood flow regulation in health and disease states such as stroke. While a number of sophisticated imaging platforms enable assessment of cerebral perfusion, most are limited either spatially or temporally. Here, we applied transcranial contrast-enhanced ultrasound (CEU) to measure cerebral perfusion in real-time through the intact rat skull before, during and after ischemic stroke, induced by intraluminal filament middle cerebral artery occlusion (MCAO). We demonstrate expected decreases in cortical and striatal blood volume, flow velocity and perfusion during MCAO. After filament retraction, blood volume and perfusion increased two-fold above baseline, indicative of acute hyperperfusion. Adjacent brain regions to the ischemic area and the contralateral hemisphere had increased blood volume during MCAO. We assessed our data using wavelet analysis to demonstrate striking vasomotion changes in the ischemic and contralateral cortices during MCAO and reperfusion. In conclusion, we demonstrate the application of CEU for real-time assessment of cerebral hemodynamics and show that the ischemic regions exhibit striking hyperemia post-MCAO. Whether this post-stoke hyperperfusion is sustained long-term and contributes to stroke severity is not known.
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Affiliation(s)
- Dino Premilovac
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Sarah J Blackwood
- Åstrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden
| | - Ciaran J Ramsay
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Michelle A Keske
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - David W Howells
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Brad A Sutherland
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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14
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Erdener ŞE, Dalkara T. Small Vessels Are a Big Problem in Neurodegeneration and Neuroprotection. Front Neurol 2019; 10:889. [PMID: 31474933 PMCID: PMC6707104 DOI: 10.3389/fneur.2019.00889] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/01/2019] [Indexed: 12/11/2022] Open
Abstract
The cerebral microcirculation holds a critical position to match the high metabolic demand by neuronal activity. Functionally, microcirculation is virtually inseparable from other nervous system cells under both physiological and pathological conditions. For successful bench-to-bedside translation of neuroprotection research, the role of microcirculation in acute and chronic neurodegenerative disorders appears to be under-recognized, which may have contributed to clinical trial failures with some neuroprotectants. Increasing data over the last decade suggest that microcirculatory impairments such as endothelial or pericyte dysfunction, morphological irregularities in capillaries or frequent dynamic stalls in blood cell flux resulting in excessive heterogeneity in capillary transit may significantly compromise tissue oxygen availability. We now know that ischemia-induced persistent abnormalities in capillary flow negatively impact restoration of reperfusion after recanalization of occluded cerebral arteries. Similarly, microcirculatory impairments can accompany or even precede neural loss in animal models of several neurodegenerative disorders including Alzheimer's disease. Macrovessels are relatively easy to evaluate with radiological or experimental imaging methods but they cannot faithfully reflect the downstream microcirculatory disturbances, which may be quite heterogeneous across the tissue at microscopic scale and/or happen fast and transiently. The complexity and size of the elements of microcirculation, therefore, require utilization of cutting-edge imaging techniques with high spatiotemporal resolution as well as multidisciplinary team effort to disclose microvascular-neurodegenerative connection and to test treatment approaches to advance the field. Developments in two photon microscopy, ultrafast ultrasound, and optical coherence tomography provide valuable experimental tools to reveal those microscopic events with high resolution. Here, we review the up-to-date advances in understanding of the primary microcirculatory abnormalities that can result in neurodegenerative processes and the combined neurovascular protection approaches that can prevent acute as well as chronic neurodegeneration.
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Affiliation(s)
- Şefik Evren Erdener
- Institute of Neurological Sciences and Psychiatry, Hacettepe University, Ankara, Turkey
| | - Turgay Dalkara
- Institute of Neurological Sciences and Psychiatry, Hacettepe University, Ankara, Turkey.,Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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15
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Kaesmacher J, Kreiser K, Manning NW, Gersing AS, Wunderlich S, Zimmer C, Kleine JF, Wiestler B, Boeckh-Behrens T. Clinical outcome prediction after thrombectomy of proximal middle cerebral artery occlusions by the appearance of lenticulostriate arteries on magnetic resonance angiography: A retrospective analysis. J Cereb Blood Flow Metab 2018; 38:1911-1923. [PMID: 28737109 PMCID: PMC6259316 DOI: 10.1177/0271678x17719790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Post-ischemic vasodynamic changes in infarcted brain parenchyma are common and range from hypo- to hyperperfusion. In the present study, appearance of the lenticulostriate arteries (LSAs) on postinterventional 3T time-of-flight (TOF)-MRA suggestive for altered post-stroke vasodynamics following thrombectomy was investigated. Patients who underwent thrombectomy for a proximal MCA occlusion and for whom postinterventional 3T TOF-MRA (median at day 3) was available, were included in this retrospective analysis (n=98). LSA appearance was categorized into presence (LSA-sign+) or absence (LSA-sign-) of vasodilatation in the ischemic hemisphere. Functional outcome was determined using the modified Rankin scale (mRS). LSA-sign+ was observed in 64/98 patients. Hypertension (adjusted OR: 0.171, 95% CI: 0.046-0.645) and preinterventional IV rtPA (adjusted OR: 0.265, 95% CI: 0.088-0.798) were associated with absence of the LSA-sign+. In multivariate logistic regression, LSA-sign+ was associated with substantial neurologic improvement (adjusted OR: 10.18, 95% CI: 2.69-38.57) and good functional outcome (discharge-mRS ≤ 2, adjusted OR: 7.127, 95% CI: 1.913-26.551 and day 90 mRS ≤ 2, adjusted OR: 3.786, 95% CI: 1.026-13.973) after correcting for relevant confounders. For all clinical endpoints, model fit improved when including the LSA-sign term (p<0.05). Asymmetrical dilatation of LSAs following successful thrombectomy indicates favorable neurologic and mid-term functional outcomes. This may indicate preserved cerebral blood flow regulatory mechanisms.
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Affiliation(s)
- Johannes Kaesmacher
- 1 Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Kornelia Kreiser
- 1 Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Nathan W Manning
- 2 Florey Institute of Neuroscience and Mental Health, University of Melbourne, ViC, Australia
| | - Alexandra S Gersing
- 3 Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Silke Wunderlich
- 4 Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Claus Zimmer
- 1 Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Justus F Kleine
- 1 Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.,5 Department of Neuroradiology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Benedikt Wiestler
- 1 Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Tobias Boeckh-Behrens
- 1 Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
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16
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Valent A, Lukaszewicz AC, Labeyrie MA, Payen D. Increased middle cerebral artery Doppler velocities after stroke thrombectomy performed under general anaesthesia: A pilot monocentric retrospective study. Anaesth Crit Care Pain Med 2018; 38:287-288. [PMID: 30292486 DOI: 10.1016/j.accpm.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 07/02/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Arnaud Valent
- Department of anaesthesiology & critical care, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris (AP-HP), 2, rue Ambroise-Paré, 75010 Paris, France.
| | - Anne-Claire Lukaszewicz
- Department of anaesthesiology & critical care, hôpital neurologique HCL, 59, boulevard Pinel, 69003 Lyon, France
| | - Marc-Antoine Labeyrie
- Department of interventional neuroradiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris (AP-HP), 2, rue Ambroise-Paré, 75010 Paris, France
| | - Didier Payen
- Department of anaesthesiology & critical care, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris (AP-HP), 2, rue Ambroise-Paré, 75010 Paris, France
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17
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Havsteen I, Ovesen C, Willer L, Nybing JD, Ægidius K, Marstrand J, Meden P, Rosenbaum S, Folke MN, Christensen H, Christensen A. Small cortical grey matter lesions show no persistent infarction in transient ischaemic attack? A prospective cohort study. BMJ Open 2018; 8:e018160. [PMID: 29358426 PMCID: PMC5780721 DOI: 10.1136/bmjopen-2017-018160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To find determining factors for persistent infarction signs in patients with transient ischaemic attack (TIA), herein initial diffusion lesion size, visibility on apparent diffusion coefficient (ADC) or fluid-attenuated inversion recovery (FLAIR) and location. DESIGN Prospective cohort study of patients with clinical TIA receiving 3T-MRI within 72 hours of symptom onset and at 8-week follow-up. SETTING Clinical workflow in a single tertiary stroke centre between February 2012 and June 2014. PARTICIPANTS 199 candidate patients were recruited, 64 patients were excluded due to non-TIA discharge diagnosis or no 8-week MRI. 122 patients completed the study. PRIMARY OUTCOME MEASURES The primary outcome was visible persistent infarction defined as 8-week FLAIR hyperintensity or atrophy corresponding to the initial diffusion-weighted imaging (DWI) lesion. RESULTS 50 patients showed 84 initial DWI lesions. 29 (35%) DWI lesions did not result in infarction signs on 8-week FLAIR. 26 (90%, P<0.0001) reversing lesions were located in the cortical grey matter (cGM). cGM location (vs any other location) strongly predicted no 8-week infarction sign development (OR 0.02, 95% CI 0.001 to 0.17) or partial lesion area decrease (>30% of initial DWI-area, OR 14.10, 95% CI 3.61 to 54.72), adjusted for FLAIR-visibility, DWI-area, ADC-confirmation and time to scan (TTS) from symptom onset to baseline MRI. Acute FLAIR-visibility was a strong associated factor for persistent infarction signs (OR 33.06, 95% CI 2.94 to 1432.34). For cGM lesions area size was sole associated factor for persistent infarction signs with a 0.31 cm2 (area under the curve (AUC), 0.97) threshold. In eight (16%) DWI-positive patients, all lesions reversed fully. CONCLUSIONS 16% of DWI-positive patients and one-third of acute DWI lesions caused no persistent infarction signs, especially small cGM lesions were not followed by development of persistent infarction signs. Late MRI after TIA is likely to be less useful in the clinical setting, and it is dubious if the absence of old vascular lesions can be taken as evidence of no prior ischaemic attacks. TRIAL REGISTRATION NUMBER NCT01531946; Results.
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Affiliation(s)
- Inger Havsteen
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Christian Ovesen
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Lasse Willer
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Janus Damm Nybing
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Karen Ægidius
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Jacob Marstrand
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Per Meden
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Sverre Rosenbaum
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Marie Norsker Folke
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Anders Christensen
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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18
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Brunner C, Isabel C, Martin A, Dussaux C, Savoye A, Emmrich J, Montaldo G, Mas JL, Baron JC, Urban A. Mapping the dynamics of brain perfusion using functional ultrasound in a rat model of transient middle cerebral artery occlusion. J Cereb Blood Flow Metab 2017; 37:263-276. [PMID: 26721392 PMCID: PMC5363744 DOI: 10.1177/0271678x15622466] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 01/07/2023]
Abstract
Following middle cerebral artery occlusion, tissue outcome ranges from normal to infarcted depending on depth and duration of hypoperfusion as well as occurrence and efficiency of reperfusion. However, the precise time course of these changes in relation to tissue and behavioral outcome remains unsettled. To address these issues, a three-dimensional wide field-of-view and real-time quantitative functional imaging technique able to map perfusion in the rodent brain would be desirable. Here, we applied functional ultrasound imaging, a novel approach to map relative cerebral blood volume without contrast agent, in a rat model of brief proximal transient middle cerebral artery occlusion to assess perfusion in penetrating arterioles and venules acutely and over six days thanks to a thinned-skull preparation. Functional ultrasound imaging efficiently mapped the acute changes in relative cerebral blood volume during occlusion and following reperfusion with high spatial resolution (100 µm), notably documenting marked focal decreases during occlusion, and was able to chart the fine dynamics of tissue reperfusion (rate: one frame/5 s) in the individual rat. No behavioral and only mild post-mortem immunofluorescence changes were observed. Our study suggests functional ultrasound is a particularly well-adapted imaging technique to study cerebral perfusion in acute experimental stroke longitudinally from the hyper-acute up to the chronic stage in the same subject.
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Affiliation(s)
- Clément Brunner
- Stroke Research Group, Centre de Psychiatrie et Neuroscience, INSERM U894, Hôpital Sainte-Anne, Paris, France.,SANOFI Research and Development, Lead Generation to Candidate Realization, Chilly-Mazarin, France
| | - Clothilde Isabel
- Stroke Research Group, Centre de Psychiatrie et Neuroscience, INSERM U894, Hôpital Sainte-Anne, Paris, France
| | - Abraham Martin
- Molecular Imaging Unit, CIC biomaGUNE, San Sebastián, Spain
| | - Clara Dussaux
- Stroke Research Group, Centre de Psychiatrie et Neuroscience, INSERM U894, Hôpital Sainte-Anne, Paris, France
| | - Anne Savoye
- Stroke Research Group, Centre de Psychiatrie et Neuroscience, INSERM U894, Hôpital Sainte-Anne, Paris, France
| | | | - Gabriel Montaldo
- Stroke Research Group, Centre de Psychiatrie et Neuroscience, INSERM U894, Hôpital Sainte-Anne, Paris, France
| | - Jean-Louis Mas
- Stroke Research Group, Centre de Psychiatrie et Neuroscience, INSERM U894, Hôpital Sainte-Anne, Paris, France
| | - Jean-Claude Baron
- Stroke Research Group, Centre de Psychiatrie et Neuroscience, INSERM U894, Hôpital Sainte-Anne, Paris, France
| | - Alan Urban
- Stroke Research Group, Centre de Psychiatrie et Neuroscience, INSERM U894, Hôpital Sainte-Anne, Paris, France
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19
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Lake EM, Mester J, Thomason LAM, Adams C, Bazzigaluppi P, Koletar M, Janik R, Carlen P, McLaurin J, Stanisz GJ, Stefanovic B. Modulation of the peri-infarct neurogliovascular function by delayed COX-1 inhibition. J Magn Reson Imaging 2016; 46:505-517. [DOI: 10.1002/jmri.25541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/20/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Evelyn M.R. Lake
- Department of Radiology and Biomedical Imaging; Yale University; New Haven Connecticut USA
- Department of Medical Biophysics; University of Toronto; Ontario Canada
| | - James Mester
- Department of Medical Biophysics; University of Toronto; Ontario Canada
| | - Lynsie AM Thomason
- Physical Sciences, Sunnybrook Research Institute; Toronto Ontario Canada
| | - Conner Adams
- Department of Medical Biophysics; University of Toronto; Ontario Canada
| | - Paolo Bazzigaluppi
- Physical Sciences, Sunnybrook Research Institute; Toronto Ontario Canada
- Fundamental Neurobiology, Toronto Western Research Institute; Toronto Ontario Canada
| | - Margaret Koletar
- Physical Sciences, Sunnybrook Research Institute; Toronto Ontario Canada
| | - Rafal Janik
- Department of Medical Biophysics; University of Toronto; Ontario Canada
- Physical Sciences, Sunnybrook Research Institute; Toronto Ontario Canada
| | - Peter Carlen
- Fundamental Neurobiology, Toronto Western Research Institute; Toronto Ontario Canada
| | - JoAnne McLaurin
- Biological Science, Sunnybrook Research Institute; Toronto Ontario Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Ontario Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery; Ottawa Ontario Canada
| | - Greg J Stanisz
- Department of Medical Biophysics; University of Toronto; Ontario Canada
- Physical Sciences, Sunnybrook Research Institute; Toronto Ontario Canada
- Department of Neurosurgery and Pediatric Neurosurgery; Medical University; Lublin Poland
| | - Bojana Stefanovic
- Department of Medical Biophysics; University of Toronto; Ontario Canada
- Physical Sciences, Sunnybrook Research Institute; Toronto Ontario Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery; Ottawa Ontario Canada
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20
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Abstract
PURPOSE OF REVIEW This article provides an overview of the recent literature regarding the application of in-vivo brain imaging techniques to animal models of ischemic stroke. RECENT FINDINGS Major breakthroughs concerned the effects of sensory stimulation on neuronal function, local hemodynamics, and tissue outcome in the hyperacute phase of stroke; the novel application to stroke of hybrid scanners allowing simultaneous PET and magnetic resonance; the refinements of magnetic resonance-based oxygen imaging, allowing to map the ischemic penumbra in a completely noninvasive way; the implementation of new PET ligands to selectively map poststroke neuronal death and neuroinflammation; and the use of novel mesoscale imaging techniques to demonstrate the major role of interhemispheric connectivity in poststroke plasticity and functional recovery. SUMMARY The array of techniques to map in vivo the key pathophysiological brain processes involved in stroke is currently enlarging at an amazing pace. This is paralleled by ever-increasing sophistication in postprocessing tools. The combination of techniques allowing simultaneous access to several variables is particularly powerful as it affords unprecedented insights into the intimate processes underlying the tissue and neuronal changes that follow a stroke. These major leaps forward will hopefully lead to therapeutic breakthroughs aiming at improving functional outcome after stroke.
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21
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Abstract
Perfusion could provide useful information on the metabolic status and functional status of tissues and organs. This review summarizes the most commonly used perfusion measurement methods: Dynamic susceptibility contrast (DSC) and arterial spin labeling (ASL) and their applications in experimental stroke. Some new developments of cerebral blood flow (CBF) techniques in animal models are also discussed.
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Affiliation(s)
- Qiang Shen
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA; Department of Ophthalmology, University of Texas Health Science Center, San Antonio, Texas, USA; Department of Radiology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Timothy Q Duong
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA; Department of Ophthalmology, University of Texas Health Science Center, San Antonio, Texas, USA; Department of Radiology, University of Texas Health Science Center, San Antonio, Texas, USA; South Texas Veterans Health Care System, Department of Veterans Affairs, San Antonio, Texas, USA
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22
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Yeo LLL, Paliwal P, Low AF, Tay ELW, Gopinathan A, Nadarajah M, Ting E, Venketasubramanian N, Seet RCS, Ahmad A, Chan BPL, Teoh HL, Soon D, Rathakrishnan R, Sharma VK. How temporal evolution of intracranial collaterals in acute stroke affects clinical outcomes. Neurology 2016; 86:434-41. [PMID: 26740681 DOI: 10.1212/wnl.0000000000002331] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 10/09/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We compared intracranial collaterals on pretreatment and day 2 brain CT angiograms (CTA) to assess their evolution and relationship with functional outcomes in acute ischemic stroke (AIS) patients treated with IV tissue plasminogen activator (tPA). METHODS Consecutive AIS patients who underwent pretreatment and day 2 CTA and received IV tPA during 2010-2013 were included. Collaterals were evaluated by 2 independent neuroradiologists using 3 predefined criteria: the Miteff system, the Maas system, and 20-point collateral scale by the Alberta Stroke Program Early CT Score methodology. We stratified our cohort by baseline pre-tPA state of their collaterals and by recanalization status of the primary vessel for analysis. Good outcomes at 3 months were defined by a modified Rankin Scale score of 0-1. RESULTS This study included 209 patients. Delayed collateral recruitment by any grading system was not associated with good outcomes. All 3 scoring systems showed that collateral recruitment on the follow-up CTA from a baseline poor collateral state was significantly associated with poor outcome and increased bleeding risk. When the primary vessel remained persistently occluded, collateral recruitment was significantly associated with worse outcomes. Interestingly, collateral recruitment was significantly associated with increased mortality in 2 of the 3 grading systems. CONCLUSIONS Not all collateral recruitment is beneficial; delayed collateral recruitment may be different from early recruitment and can result in worse outcomes and higher mortality. Prethrombolysis collateral status and recanalization are determinants of how intracranial collateral evolution affects functional outcomes.
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Affiliation(s)
- Leonard L L Yeo
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore.
| | - Prakash Paliwal
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
| | - Adrian F Low
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
| | - Edgar L W Tay
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
| | - Anil Gopinathan
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
| | - Mahendran Nadarajah
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
| | - Eric Ting
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
| | - Narayanaswamy Venketasubramanian
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
| | - Raymond C S Seet
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
| | - Aftab Ahmad
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
| | - Bernard P L Chan
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
| | - Hock L Teoh
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
| | - Derek Soon
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
| | - Rahul Rathakrishnan
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
| | - Vijay K Sharma
- From the Division of Neurology, Department of Medicine (L.L.L.Y., P.P., R.C.S.S., A.A., B.P.L.C., H.L.T., D.S., R.R., V.K.S.), Cardiac Department (A.F.L., E.L.W.T.), and Department of Diagnostic Imaging (A.G., E.T.), National University Health System; Department of Neuroradiology (M.N.), National Neuroscience Institute; and Raffles Neuroscience Centre (N.V.), Raffles Medical Group, Singapore
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23
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Huang CH, Shih YYI, Siow TY, Hsu YH, Chen CCV, Lin TN, Jaw FS, Chang C. Temporal assessment of vascular reactivity and functionality using MRI during postischemic proangiogenenic vascular remodeling. Magn Reson Imaging 2015; 33:903-10. [PMID: 25944092 DOI: 10.1016/j.mri.2015.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 03/13/2015] [Accepted: 04/26/2015] [Indexed: 11/18/2022]
Abstract
Postischemic angiogenesis is an important recovery mechanism. Both arteries and veins are upregulated during angiogenesis, but eventually there are more angiogenic veins than arteries in terms of number and length. It is critical to understand how the veins are modulated after ischemia and then transitioned into angiogenic vessels during the proangiogenic stage to finally serve as a restorative strength to the injured area. Using a rat model of transient focal cerebral ischemia, the hypercapnic blood oxygen level-dependent (BOLD) response was used to evaluate vascular reactivity, while the hyperoxic BOLD and tissue oxygen level-dependent (TOLD) responses were used to evaluate the vascular functionality at 1, 3, and 7days after ischemia. Vessel-like venous signals appeared on R2* maps on days 3 and 7, but not on day 1. The large hypercapnic BOLD responses on days 3 and 7 indicated that these areas have high vascular reactivity. The temporal correlation between vascular reactivity and the immunoreactivity to desmin and VEGF further indicates that the integrity of vascular reactivity is associated with the pericyte coverage as regulated by the VEGF level. Vascular functionality remained low on days 1, 3, and 7, as reflected by the small hyperoxic BOLD and large hyperoxic TOLD responses, indicating the low oxygen consumption of the ischemic tissues. These functional changes in proangiogenic veins may be critical for angiogenesis.
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Affiliation(s)
- Chien-Hsiang Huang
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan
| | - Yen-Yu Ian Shih
- Experimental Neuroimaging Laboratory, Department of Neurology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Tiing-Yee Siow
- Department of Medical Imaging and Intervention, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Hua Hsu
- Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan
| | - Chiao-Chi V Chen
- Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan
| | - Teng-Nan Lin
- Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan
| | - Fu-Shan Jaw
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
| | - Chen Chang
- Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan.
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24
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3-Nitropropionic acid-induced ischemia tolerance in the rat brain is mediated by reduced metabolic activity and cerebral blood flow. J Cereb Blood Flow Metab 2014; 34:1522-30. [PMID: 24938399 PMCID: PMC4158668 DOI: 10.1038/jcbfm.2014.112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/28/2014] [Accepted: 05/29/2014] [Indexed: 12/26/2022]
Abstract
Tissue tolerance to ischemia can be achieved by noxious stimuli that are below a threshold to cause irreversible damage ('preconditioning'). Understanding the mechanisms underlying preconditioning may lead to the identification of novel therapeutic targets for diseases such as stroke. We here used the oxidative chain inhibitor 3-nitropropionic acid (NPA) to induce ischemia tolerance in a rat middle cerebral artery occlusion (MCAO) stroke model. Cerebral blood flow (CBF) and structural integrity were characterized by longitudinal magnetic resonance imaging (MRI) in combination with behavioral, histologic, and biochemical assessment of NPA-preconditioned animals and controls. Using this approach we show that the ischemia-tolerant state is characterized by a lower energy charge potential and lower CBF, indicating a reduced baseline metabolic demand, and therefore a cellular mechanism of neural protection. Blood vessel density and structural integrity were not altered by NPA treatment. When subjected to MCAO, preconditioned animals had a characteristic MRI signature consisting of enhanced CBF maintenance within the ischemic territory and intraischemic reversal of the initial cytotoxic edema, resulting in reduced infarct volumes. Thus, our data show that tissue protection through preconditioning occurs early during ischemia and indicate that a reduced cellular metabolism is associated with tissue tolerance to ischemia.
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