1
|
Zhang X, Han N, Zhang Y, Yuan W, Kan S, Zhang G, Ma H, Ge H, Du C, Gao Y, Li S, Yan X, Shi W, Tian Y, Chang M. Predicting 3-month Functional Outcome After Endovascular Thrombectomy in Patients with Anterior Circulation Occlusion with an Arterial Transit Artifact Grading System. Clin Neuroradiol 2024; 34:241-249. [PMID: 38051349 DOI: 10.1007/s00062-023-01362-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/26/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE The objective of this study was to evaluate the relationship between arterial transit artifact (ATA), arterial spin labeling (ASL) perfusion imaging, and the outcome of patients with acute ischemic stroke (AIS) due to occlusion of large vessels in anterior circulation after endovascular thrombectomy (EVT). METHODS Patients with anterior circulation occlusion treated with EVT between October 2017 and December 2021 were enrolled in this retrospective study, and ATA was quantified by a 4-point scale. A favorable outcome was defined by modified Rankin Scale (mRS) scores of 0-2 at 3 months. To identify independent predictors of favorable outcome, age, sex, risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) score, site of occlusion, cause of stroke, and early reperfusion were evaluated with univariate and multivariate analyses. Predictive accuracy was evaluated by calculating the area under the receiver operating characteristic (ROC) curve (AUC) for the model. RESULTS In this study 187 patients (age, 65.0 ± 12.5 years; men, 55%) were evaluated. Younger age (odds ratio, OR, 0.95; 95% confidence interval, CI, 0.92-0.98, p = 0.002), lower baseline NIHSS score (OR, 0.88; 95% CI, 0.82-0.94, p < 0.001), and lower ATA score (OR, 1.14; 95% CI, 1.06-1.22, p < 0.001) were independently associated with favorable outcomes in multivariate analysis. The ATA score has moderate to good accuracy in predicting favorable outcomes (AUC, 0.753). CONCLUSION A high ATA score as a potential predictor, can help identify patients who may benefit from EVT.
Collapse
Affiliation(s)
- Xiaobo Zhang
- The College of Life Sciences, Northwest University, Xi'an, China
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Nannan Han
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Yu Zhang
- The College of Life Sciences, Northwest University, Xi'an, China
| | - Wenting Yuan
- The College of Life Sciences, Northwest University, Xi'an, China
| | - Shangguang Kan
- The College of Life Sciences, Northwest University, Xi'an, China
| | - Gejuan Zhang
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Haojun Ma
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Hanming Ge
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Chengxue Du
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Yanjun Gao
- Department of Radiology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Shilin Li
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Xudong Yan
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Wenzhen Shi
- Medical Research Center, Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Ye Tian
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China.
- Medical Research Center, Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China.
| | - Mingze Chang
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China.
| |
Collapse
|
2
|
Sachithanandan S, Ramachandran H, Jayadevan ER, Kannath SK, Sreedharan SE, Sylaja PN. CT angiographic patterns predict carotid pseudo-occlusion in acute ischemic stroke. Ann Indian Acad Neurol 2024; 27:72-76. [PMID: 38495242 PMCID: PMC10941882 DOI: 10.4103/aian.aian_750_23] [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: 08/20/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 03/19/2024] Open
Abstract
Background Identifying carotid pseudo-occlusion (PO) from true occlusion (TO) has implications in determining the candidacy and feasibility of successful endovascular thrombectomy (EVT) in acute ischemic stroke (AIS). Purpose We reviewed the computed tomography angiographic (CTA) patterns differentiating a PO from a TO and analyzed the rate of successful recanalization after EVT. Materials and Methods Patients with AIS and proximal internal carotid artery (ICA) occlusion who underwent EVT from 2014 to 2021 were identified. The patterns of carotid occlusion in CTA were classified into beak, dome, and flat patterns and correlated with microcatheter digital subtraction angiography (DSA) as PO and TO. The rates of successful recanalization in PO and TO were analyzed. Results Of the 24 patients, 16 (66%) had ICA PO and eight (33%) had TO in DSA. A beak pattern of the proximal ICA on CTA was significantly higher among the PO group patients (87.5% vs. 25%, P = 0.005), and a flat pattern was significantly higher among the TO group patients (50% vs. 12%, P = 0.005). A gradual contrast decline of the proximal ICA on CTA images was seen only in PO group patients (85.7% vs. 0%, P = 0.05). There was no significant difference in the rate of successful recanalization between PO and TO group patients (81.25% vs. 62.5%, P = 0.362). Conclusion Beak pattern and gradual contrast decline at the proximal ICA occlusion site in CTA are suggestive of carotid PO. Identification of PO in CTA can help in planning intervention strategies and prognostication.
Collapse
Affiliation(s)
- Sayooja Sachithanandan
- Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Harikrishnan Ramachandran
- Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - ER Jayadevan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Santhosh K. Kannath
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sapna E. Sreedharan
- Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - PN Sylaja
- Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| |
Collapse
|
3
|
Pathuri SC, Johnson WC, Webb MR, Fielder TC, Al-Saiegh F, Morton RP, Rodriguez P, Birnbaum L, Mascitelli JR. Development of the Circle of Willis Score (COWS) to help guide decision making during acute tandem occlusion treatment: Preliminary analysis. Clin Neurol Neurosurg 2024; 236:108116. [PMID: 38244414 DOI: 10.1016/j.clineuro.2024.108116] [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: 11/19/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Acute tandem occlusions (TOs) are challenging to treat. Although acute carotid stenting of the proximal lesion is well tolerated, there are certain situations when the practitioner may be wary of acute stenting (bleeding concerns). OBJECTIVE The purpose of this study was to retrospectively study patients with tandem occlusions who had re-occlusion of the extracranial ICA and develop a Circle of Willis Score (COWS) to help predict which patients could forego acute stenting. METHODS This is a retrospective review of TO patients with a persistent proximal occlusion following intervention (either expected or unexpected). Pre intervention CTA and intraoperative DSA were reviewed, and each patient was assigned a score 2 (complete COW), 1a (patent A1-Acomm-A1), 1p (patent Pcomm), or 0 (incomplete COW). Findings from the DSA took precedence over the CTA. Two cohorts were created, the complete COW cohort (COWS 2) versus the incomplete COW cohort (COWS 1a,1p, or 0). Angiographic outcomes were assessed using the mTICI score (2b-3) and clinical outcomes were assessed using discharge mRS (good outcome mRS 0-3). RESULTS Of 68 TO cases, 12 had persistent proximal occlusions. There were 5/12 (42 %) patients in the complete COW cohort, and 7/12 (58 %) in the incomplete COW cohort (5/12 with scores of 1a/1p and 2/12 with a score of 0). In the complete COW cohort, there were 2 ICA-ICA and 3 ICA-MCA occlusions. In the incomplete COW cohort, there was one ICA-ICA occlusion and 6 ICA-MCA occlusions. LKW-puncture was shorter in the complete COW cohort (208 min vs. 464 min, p = 0.16). Successful reperfusion was higher in the complete COW cohort (100 % vs. 71 %). There was a trend toward better clinical outcomes in the complete COW cohort (80 % vs 29 %, p = 0.079). CONCLUSION The COWS is a simple score that may help predict a successful clinical outcome without proximal revascularization when concerned about performing an acute carotid stent during TO treatment. Evaluation in larger TO cohort is warranted.
Collapse
Affiliation(s)
- Sarath C Pathuri
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - William C Johnson
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - Matthew R Webb
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - Tristan C Fielder
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - Fadi Al-Saiegh
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - Ryan P Morton
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA; Department of Neurosurgery, Brooke Army Medical Center, San Antonio, TX, USA.
| | - Pavel Rodriguez
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - Lee Birnbaum
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - Justin R Mascitelli
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| |
Collapse
|
4
|
Zhou C, Cao YZ, Liu S, Jia ZY, Zhao LB, Shi HB, Zhao Y. Endovascular recanalization for symptomatic chronic internal carotid artery occlusion: proposal of a modified angiographic classification and clinical outcomes. Clin Neurol Neurosurg 2023; 233:107935. [PMID: 37573678 DOI: 10.1016/j.clineuro.2023.107935] [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: 06/11/2023] [Revised: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE To stratify angiographic images of chronic internal carotid artery occlusion (CICAO) into a newly modified angiographic classification, and identify suitable candidates for endovascular recanalization. METHODS This study included 51 consecutive patients with symptomatic CICAO who underwent endovascular recanalization at our institution. Patients' clinical information, angiographic findings, procedural results, and outcomes were recorded. We attempted to stratify all angiographic images into categories based on morphological occlusive patterns and distal internal carotid artery (ICA) lumen reconstitution on digital subtraction angiography (DSA). RESULTS Four types (I-IV) of CICAO were identified based on angiographic characteristics. We defined type I as having a tapered (IA) or blunt stump (IB) and distal ICA lumen reconstitution with collateral filling; type II as having no stump but with distal ICA lumen reconstitution; type III as having a tapered (IIIA) or blunt stump (IIIB) but no distal ICA lumen reconstitution; type IV as having no stump and no distal ICA lumen reconstitution. The rate of successful recanalization was 90.3 % for type I, 60.0 % for type II, 50.0 % for type III, 0 % for type IV, respectively (P = 0.002). The overall intraoperative complication rate was 11.8 %, and none of them led to severe neurological damage or death. The follow-up modified Rankin Scale (mRS) scores were significantly decreased in successfully revascularized patients, whilst there were no significant changes in the other failed patients. CONCLUSION For symptomatic CICAO, our newly modified angiographic classification may be comprehensive and useful in selecting suitable patients for recanalization and grading the difficulty of the procedures.
Collapse
Affiliation(s)
- Chun Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Yue-Zhou Cao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Zhen-Yu Jia
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Lin-Bo Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China.
| |
Collapse
|
5
|
Dolotova DD, Blagosklonova ER, Muslimov RS, Ramazanov GR, Zagryazkina TA, Stepanov VN, Gavrilov AV. Inter-Rater Reliability of Collateral Status Assessment Based on CT Angiography: A Retrospective Study of Middle Cerebral Artery Ischaemic Stroke. J Clin Med 2023; 12:5470. [PMID: 37685536 PMCID: PMC10487547 DOI: 10.3390/jcm12175470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 09/10/2023] Open
Abstract
The importance of assessing the collateral status (CS) in patients with ischaemic stroke (IS) has repeatedly been emphasised in clinical guidelines. Various publications offer qualitative or semiquantitative scales with gradations corresponding to the different extents of the collaterals, visualised mostly on the basis of CTA images. However, information on their inter-rater reliability is limited. Therefore, the aim of this study is to investigate the inter-rater reliability of the scales for collateral assessment. CTA images of 158 patients in the acute period of IS were used in the study. The assessment of CS was performed by two experts using three methodologies: the modified Tan scale, the Miteff scale, and the Rosenthal scale. Cohen's kappa, weighted kappa and Krippendorff's alpha were used as reliability measures. For the modified Tan scale and the Miteff and Rosenthal scales, the weighted kappa values were 0.72, 0.49 and 0.59, respectively. Although the best measure of consistency was found for the modified Tan scale, no statistically significant differences were revealed among the scales. The impact of the CS on the degree of neurological deficit at discharge was shown for the modified Tan and Rosenthal scales. In conclusion, the analysis showed a moderate inter-rater reliability of the three scales, but was not able to distinguish the best one among them.
Collapse
Affiliation(s)
- Daria D. Dolotova
- Department of Bioinformatics, Department of Pediatric Surgery, Pirogov Russian National Research Medical University, Russian Ministry of Health, 117997 Moscow, Russia
- Research Department, Gammamed-Soft, Ltd., 127473 Moscow, Russia
| | | | - Rustam Sh. Muslimov
- Department of Radiology, Scientific Department of Emergency Neurology and Rehabilitation Treatment, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Health Department, 129090 Moscow, Russia
| | - Ganipa R. Ramazanov
- Department of Radiology, Scientific Department of Emergency Neurology and Rehabilitation Treatment, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Health Department, 129090 Moscow, Russia
| | | | - Valentin N. Stepanov
- Department of Radiology, Scientific Department of Emergency Neurology and Rehabilitation Treatment, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Health Department, 129090 Moscow, Russia
| | - Andrey V. Gavrilov
- Research Department, Gammamed-Soft, Ltd., 127473 Moscow, Russia
- Scobeltsyn Nuclear Physics Research Institute, Lomonosov Moscow State University, 119991 Moscow, Russia
| |
Collapse
|
6
|
Sadeh-Gonik U, Budylev A, Krivitzky D, Molad J, Halevi H, Jonas-Kimchi T, Yashar H, Ben Assayag E, Seyman E. Circle of Willis integrity in acute middle cerebral artery occlusion: does the posterior communicating artery matter? J Neurointerv Surg 2023:jnis-2023-020326. [PMID: 37527929 DOI: 10.1136/jnis-2023-020326] [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: 03/17/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Collateral circulation is an important determinant of outcome in people with acute ischemic stroke due to large vessel occlusion (LVO). OBJECTIVE To explore the impact of the circle of Willis (CW) anatomical characteristics ipsilateral to the occlusion site, particularly the posterior communicating artery (PComA) and the A1-portion of the anterior cerebral artery (A1-ACA), on stroke outcomes in a cohort of patients with LVO and middle cerebral artery (MCA) occlusion, undergoing endovascular thrombectomy (EVT). METHODS This is a retrospective cohort study performed in a comprehensive tertiary stroke center. The study population consisted of consecutive patients with LVO with proximal MCA occlusion (M1) between June 2016 and April 2021, undergoing EVT. Demographic, clinical, and imaging information was extracted from patient files. Patency and diameters of ipsilateral A1-ACA and PComA were manually measured on admission CT angiography images in the core laboratory. RESULTS One hundred and five patients with LVO comprised the study cohort, mean age 72.3 years, 43.8% were male, mean National Institutes of Health Stroke Scale score at admission 15.2. The cohort was grouped according to CW vessel characteristics. On univariate analysis, a well-developed PComA was associated with lower rates of hemorrhagic transformation (1.8% vs 14.3%, P=0.01) and a trend towards lower mortality rates (8.9% vs 20.4%, P=0.08).On multivariable regression analysis a well-developed PComA emerged as an independent predictor for survival (aOR=0.09, 95% CI 0.01 to 0.4 for survival at discharge, P=0.009, aOR=0.22, 95% CI 0.05 to 0.8 for survival at 90 days, P=0.02). CONCLUSIONS In a cohort of patients with LVO due to M1 occlusion undergoing EVT, a well-developed PComA was associated with significantly lower hemorrhagic transformation rates, a trend towards better functional outcomes, and independently predicted survival. Larger studies are needed to understand the differential effect of CW collateral conduits on stroke outcome and evaluate the practicality of incorporating such factors in the clinical decision-making process prior to EVT.
Collapse
Affiliation(s)
- Udi Sadeh-Gonik
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anatoly Budylev
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David Krivitzky
- Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jeremy Molad
- Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hen Halevi
- Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience Tel Aviv University, Tel-Aviv, Israel
- The Faculty of Medicine,Tel Aviv University, Tel-Aviv, Israel
| | - Tali Jonas-Kimchi
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hila Yashar
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einor Ben Assayag
- Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience Tel Aviv University, Tel-Aviv, Israel
- The Faculty of Medicine,Tel Aviv University, Tel-Aviv, Israel
| | - Estelle Seyman
- Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Faculty of Medicine,Tel Aviv University, Tel-Aviv, Israel
| |
Collapse
|
7
|
Cao R, Lu Y, Qi P, Wang Y, Hu H, Jiang Y, Chen M, Chen J. Collateral Circulation and BNP in Predicting Outcome of Acute Ischemic Stroke Patients with Atherosclerotic versus Cardioembolic Cerebral Large-Vessel Occlusion Who Underwent Endovascular Treatment. Brain Sci 2023; 13:brainsci13040539. [PMID: 37190504 DOI: 10.3390/brainsci13040539] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 05/17/2023] Open
Abstract
PURPOSE The aim of this study was to verify the value of collateral circulation and B-type natriuretic peptide (BNP) in predicting clinical outcomes of patients with acute ischemic stroke (AIS) and their biomarker value for stroke subtypes before endovascular treatment (EVT). PATIENTS AND METHODS In this retrospective study, 182 patients who underwent EVT for unilateral anterior circulation large-vessel occlusion between March 2016 and January 2022 were analyzed. The modified collateral circulation scoring system on four-dimensional computed tomography angiography (4D CTA-CS) was used to assess collateral status, and stroke subtypes were determined according to the TOAST classification criteria. Patients were divided into good (mRS ≤ 2) and poor outcome (mRS > 2) groups based on their modified Rankin Scale (mRS) score at 3 months. RESULTS 4D CTA-CS was an independent predictor of the clinical outcome for all AIS patients (odds ratio = 0.253; 95% CI, 0.147-0.437; p < 0.001), CE stroke patients (odds ratio = 0.513; 95% CI, 0.280-0.939; p = 0.030), and LAA stroke patients (odds ratio = 0.148; 95% CI, 0.049-0.447; p = 0.001). The BNP was a biomarker for clinical outcome prediction in CE (odds ratio = 1.004; 95% CI, 1.001-1.008; p = 0.005) but not in LAA patients. Combined with BNP, 4D CTA-CS improved predictive values for clinical outcomes (p < 0.05). CONCLUSION Collateral status and BNP could be used as independent predictors of clinical outcomes in AIS patients and could determine stroke subtypes (CE stroke or LAA stroke). In addition, the model of 4D CTA-CS combined with BNP was the most effective in predicting clinical outcomes compared with collateral status or BNP alone.
Collapse
Affiliation(s)
- Ruoyao Cao
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
- Graduate School of Peking Union Medical College, Beijing 100730, China
| | - Yao Lu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yanyan Wang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Hailong Hu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yun Jiang
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
- Graduate School of Peking Union Medical College, Beijing 100730, China
| | - Juan Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| |
Collapse
|
8
|
Zhou C, Cao YZ, Jia ZY, Zhao LB, Lu SS, Shi HB, Liu S. Endovascular Recanalization of Symptomatic Chronic ICA Occlusion: Procedural Outcomes and Radiologic Predictors. AJNR Am J Neuroradiol 2023; 44:303-310. [PMID: 36822826 PMCID: PMC10187816 DOI: 10.3174/ajnr.a7804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND AND PURPOSE Endovascular recanalization has been attempted in patients with symptomatic chronic ICA occlusion, however, the heterogeneity of recanalization outcomes and the perioperative complications present challenges for the clinical application. Our aim was to evaluate the safety and efficacy of endovascular recanalization for symptomatic chronic ICA occlusion and identify potential predictors for successful recanalization. MATERIALS AND METHODS This study included 47 consecutive patients with symptomatic chronic ICA occlusion who underwent endovascular recanalization at our institution. Patients' clinical information, radiologic characteristics, procedural results, and outcomes were recorded. Factors related to technical success were analyzed by univariate and multivariate analyses. RESULTS The technical success rate was 74.5% (35/47); 12.8% of patients (6/47) experienced intraoperative complications, but none had permanent neurologic deficits. Three months after recanalization, 21 of the 29 recanalized patients (72.4%) and 3 of the 10 failed patients (30.0%) demonstrated improved mRS scores. Restenosis or re-occlusion occurred in 12.9% of patients (4/31) with successful recanalization. Multivariate analysis showed that tapered or blunt stump (P = .016), distal ICA occlusion segment (below the cavernous segment versus at or above the ophthalmic segment, P = .003; at the cavernous or clinoid segment versus at or above the ophthalmic segment, P = .027), and radiologic occlusion to recanalization of ≤3 months (P = .044) were significantly associated with successful recanalization. Patients were assigned points according to the coefficients of the prediction model, and the technical success rates were 0%, 46.2%, 90.5%, and 100% in patients with 1, 2, 3, and 4 points, respectively. CONCLUSIONS Endovascular recanalization is a safe and effective treatment for symptomatic chronic ICA occlusion in selected patients. A residual stump, low levels of the distal ICA occlusion segment, and a short radiologic occlusion time were identified as positive predictors of technical success.
Collapse
Affiliation(s)
- C Zhou
- From the Departments of Interventional Radiology (C.Z., Y.-Z.C., Z.-Y.J., L.-B.Z., H.-B.S., S.L.)
| | - Y-Z Cao
- From the Departments of Interventional Radiology (C.Z., Y.-Z.C., Z.-Y.J., L.-B.Z., H.-B.S., S.L.)
| | - Z-Y Jia
- From the Departments of Interventional Radiology (C.Z., Y.-Z.C., Z.-Y.J., L.-B.Z., H.-B.S., S.L.)
| | - L-B Zhao
- From the Departments of Interventional Radiology (C.Z., Y.-Z.C., Z.-Y.J., L.-B.Z., H.-B.S., S.L.)
| | - S-S Lu
- Radiology (S.-S.L.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - H-B Shi
- From the Departments of Interventional Radiology (C.Z., Y.-Z.C., Z.-Y.J., L.-B.Z., H.-B.S., S.L.)
| | - S Liu
- From the Departments of Interventional Radiology (C.Z., Y.-Z.C., Z.-Y.J., L.-B.Z., H.-B.S., S.L.)
| |
Collapse
|
9
|
Shen X, Zhang X, Liu M, Dong N, Liao J, Zhou G, Cao Z, Yu L, Xu Y, Jiang Y, Wan Y, Fang Q. NT-proBNP Levels and Collateral Circulation Status in Patients with Acute Ischemic Stroke. DISEASE MARKERS 2023; 2023:5318012. [PMID: 37091896 PMCID: PMC10121344 DOI: 10.1155/2023/5318012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 04/25/2023]
Abstract
Methods In this study, 326 hospitalized patients with acute anterior circulation ischemic stroke (AACIS) were included. A comparison of the clinical characteristics of those with and without AF was conducted. The Spearman rank correlation was used for the correlation analysis of plasma NT-proBNP level, regional leptomeningeal collateral (rLMC) score, and computed tomography perfusion (CTP) status in the AF and non-AF groups. An analysis of multivariate linear regression was used to determine how plasma NT-proBNP level, rLMC score, and CTP status influenced the score on the NIHSS. Results There was a greater plasma NT-proBNP level in the AF group compared with the non-AF group, an increased CTP volume (including CTP ischemic volume, CTP infarct core volume, and CTP ischemic penumbra volume (P = 0.002)), higher NIHSS score on admission, and lower rLMC score (P < 0.001 for the remaining parameters). A negative correlation exists between plasma NT-proBNP level and rLMC score (r = -0.156, P = 0.022), but a positive correlation exists between plasma NT-proBNP level and both CTP ischemic volume and CTP infarct core volume (r = 0.148, P = 0.003) in the AF group, but not in the non-AF group. Multivariate linear regression analysis demonstrated that NT-proBNP, CTP ischemic penumbra volume, and rLMC score were associated with NIHSS score, and NT-proBNP was positively associated with NIHSS scores (95% confidence interval (CI), 0.000-0.002; P = 0.004) in the AF group, whatever in the unadjusted model or adjusted models, but not in the nonlarge artery atherosclerosis (LAA) group. Conclusion In AACIS patients with AF, NT-proBNP level negatively correlated with collateral status, positively with CTP ischemic volume, and positively with NIHSS score.
Collapse
Affiliation(s)
- Xiaozhu Shen
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Xianxian Zhang
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Neurology, Yancheng Third People's Hospital, Yancheng, China
| | - Mengqian Liu
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Nan Dong
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Neurology, Suzhou Industrial Park Xinghai Hospital, Suzhou, China
| | - Juan Liao
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Guoqing Zhou
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhiyong Cao
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Liqiang Yu
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiwen Xu
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Yi Jiang
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Yue Wan
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Fang
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
10
|
Xiao C, Chen X, Lu L, Ye Z, Chen X, Dong M, Qin C. Hemodynamic Changes in Patients with Chronic Internal Carotid Artery Occlusion After Recanalization. Neuropsychiatr Dis Treat 2023; 19:1103-1115. [PMID: 37162808 PMCID: PMC10164545 DOI: 10.2147/ndt.s400496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/14/2023] [Indexed: 05/11/2023] Open
Abstract
Objective This study aimed to investigate the feasibility and clinical efficacy of endovascular recanalization in patients with chronic internal carotid artery occlusion (CICAO) and explore the application value of computed tomography perfusion (CTP) in endovascular recanalization. Methods This non-randomized controlled study included 41 patients with CICAO. All patients received active medical treatment. In this study, patients with successful endovascular recanalization and those who refused endovascular recanalization were included in the recanalization and medication groups, respectively. Before and 90 days after treatment, cognitive function was evaluated using the Montreal Cognitive Function Assessment, and neurological function was evaluated using the National Institutes of Health Stroke Scale and modified Rankin scale. For patients with successful endovascular recanalization, brain CTP imaging was performed to evaluate hemodynamic changes in patients with CICAO before and three days after treatment. Results Overall, 41 symptomatic patients with CICAO were included, and 20 patients received endovascular recanalization therapy, with a success rate of 60% (12/20). The perioperative complication rate was 15% (3/20); there were no events such as hyperperfusion, distal embolism, vascular rupture, or cerebral hemorrhage, and no stroke-related or death-related events. Patients were divided into a medication group (n=21) and recanalization group (n=12). After 90 days of follow-up, patients in the recanalization group showed greater improvement in overall cognitive and neurological function. In addition, successful endovascular recanalization significantly improved cerebral blood perfusion on the occluded side of patients with CICAO. Conclusion Successful recanalization can effectively improve the overall cognitive and neurological functions of patients in the short term. CTP can be used to quantitatively evaluate not only the cerebral hemodynamic changes after internal carotid artery occlusion but also the improvement of cerebral blood perfusion after successful endovascular recanalization, which provides a reliable method for postoperative follow-up.
Collapse
Affiliation(s)
- Chao Xiao
- Department of Neurology, Liuzhou People’s Hospital Affiliated to Guangxi Medical University, Liuzhou, People’s Republic of China
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Xiuen Chen
- Department of Neurology, Liuzhou People’s Hospital Affiliated to Guangxi Medical University, Liuzhou, People’s Republic of China
| | - Lizhi Lu
- Department of Neurology, Forsea Life Insurance Nanning Hospital, Nanning, People’s Republic of China
| | - Ziming Ye
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Xiangren Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Meiyu Dong
- The First Clinical Medical College of Guangxi Medical University, Nanning, People’s Republic of China
| | - Chao Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
- Correspondence: Chao Qin, Department of Neurology, First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, 530021, People’s Republic of China, Email
| |
Collapse
|
11
|
Shen X, Liao J, Jiang Y, Xu Y, Liu M, Zhang X, Dong N, Yu L, Chen Q, Fang Q. Elevated NT-proBNP levels are associated with CTP ischemic volume and 90-day functional outcomes in acute ischemic stroke: a retrospective cohort study. BMC Cardiovasc Disord 2022; 22:431. [PMID: 36180827 PMCID: PMC9524121 DOI: 10.1186/s12872-022-02861-w] [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: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate the impact of N-terminal pro-B-type natriuretic peptide (NT-proBNP) on CTP infarct core volume and poor 90-day functional outcomes in acute ischemic stroke (AIS). Methods A total of 403 hospitalized patients with AIS in the Stroke Center of the First Hospital Affiliated to Soochow University were enrolled from March 2018 to January 2021. The association between NT-proBNP and clinical outcomes in acute ischemic patients was assessed by logistic regression and adjusted for confounding factors. Also, subgroup analyses were conducted based on treatment decisions. Results NT-proBNP was positively correlated with CTP ischemic volume (p < 0.001), infarct core volume (p < 0.001), and ischemic penumbra volume (p < 0.001). Univariate analysis showed that the influence of NT-proBNP and functional outcomes were statistically significant in model 1 (p = 0.002). This phenomenon was persistent after adjusted for age, sex, and body mass index in model 2 (p = 0.011), adjusted for SBP, current smoking, family history of stroke, hypertension, and diabetes mellitus in model 3 (p < 0.001), and adjusted for TnI, D-dimer, PLT, Cr, TC, TG, HDL-C, treatment decisions, and NIHSS score in model 4 (p = 0.027). A high NT-proBNP was associated with a high 90-days mRS score among the total population, IV rt-PA, and standardized treatment groups, but not in IV rt-PA + EVT, EVT, and EVT/IV rt-PA + EVT groups. Conclusion Elevated NT-proBNP levels reveal large CTP infarct core volume and poor 90-day functional outcome in AIS. NT-pro BNP is an independent risk factor for functional outcomes.
Collapse
Affiliation(s)
- Xiaozhu Shen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.,Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Juan Liao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Yi Jiang
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Yiwen Xu
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Mengqian Liu
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Xianxian Zhang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China. .,Department of Neurology, Yancheng Third People's Hospital, Yancheng, China.
| | - Nan Dong
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.,Department of Neurology, Suzhou Industrial Park Xinghai Hospital, Suzhou, China
| | - Liqiang Yu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Qingmei Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
| |
Collapse
|
12
|
Intracranial Flow Volume Estimation in Patients with Internal Carotid Artery Occlusion. Diagnostics (Basel) 2022; 12:diagnostics12030766. [PMID: 35328320 PMCID: PMC8947284 DOI: 10.3390/diagnostics12030766] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 12/02/2022] Open
Abstract
(1) Background: Carotid artery occlusion (CAO) in population studies has a reported prevalence of about 6 per 100,000 people; however, the data may be underestimated. CAO carries a significant risk of stroke. Up to 15% of large artery infractions may be secondary to the CAO, and in 27−38% of patients, ischaemic stroke is a first presentation of the disease. The presence of sufficient and well-developed collateral circulation has a protective influence, being a good prognostic factor in patients with carotid artery disease, both chronic and acute. Understanding the mechanisms and role of collateral circulation may be very important in the risk stratification of such patients. (2) Materials and Methods: This study included 46 patients (mean age: 70.5 ± 6 years old; 15 female, mean age 68.5 ± 3.8 years old and 31 male, mean age 71.5 ± 6.7 years old) with unilateral or bilateral ICA occlusion. In all patients, a Doppler ultrasound (DUS) examination, measuring blood flow volume in the internal carotid artery (ICA), external carotid artery (ECA), and vertebral artery (VA), was performed. The cerebral blood flow (CBF) was compared to the previously reported CBF values in the healthy population >65 years old. (3) Results: In comparison with CBF values in the healthy population, three subgroups with CBF changes were identified among patients with ICA occlusion: patients with significant volumetric flow compensation (CBF higher than average + standard deviation for healthy population of the same age), patients with flow similar to the healthy population (average ± standard deviation), and patients without compensation (CBF lower than the average-standard deviation for healthy population). The percentage of patients with significant volumetric flow compensation tend to rise with increasing age, while a simultaneous decline was observed in the group without compensation. The percentage of patients with flow similar to the healthy population remained relatively unchanged. ICA played the most important role in volumetric flow compensation in patients with CAO; however, the relative increase in flow in the ICA was smaller than that in the ECA and VA. Compensatory increased flow was observed in about 50% of all patent extracranial arteries and was more frequently observed in ipsilateral vessels than in contralateral ones, in both the ECA and the VA. In patients with CAO, there was no decrease in CBF, ICA, ECA, and VA flow volume with increasing age. (4) Conclusions: Volumetric flow compensation may play an important predictive role in patients with CAO.
Collapse
|
13
|
Wang Z, Yu Q. Retinal vascular morphology and blood flow characteristics of patients with various degrees of intracranial internal carotid artery stenosis. J Fr Ophtalmol 2022; 45:398-404. [DOI: 10.1016/j.jfo.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/09/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
|
14
|
Ostrý S, Nevšímal M, Reiser M, Voldřich R, Krtička O, Kubále J, Nevšímalová M, Fiedler J. Intraoperative neurophysiological monitoring during urgent surgical extracranial internal carotid artery recanalization. Clin Neurophysiol 2022; 138:221-230. [DOI: 10.1016/j.clinph.2022.01.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/23/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022]
|
15
|
Shen L, Gan Q, Yang Y, Reis C, Zhang Z, Xu S, Zhang T, Sun C. Mitophagy in Cerebral Ischemia and Ischemia/Reperfusion Injury. Front Aging Neurosci 2021; 13:687246. [PMID: 34168551 PMCID: PMC8217453 DOI: 10.3389/fnagi.2021.687246] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/10/2021] [Indexed: 02/03/2023] Open
Abstract
Ischemic stroke is a severe cerebrovascular disease with high mortality and morbidity. In recent years, reperfusion treatments based on thrombolytic and thrombectomy are major managements for ischemic stroke patients, and the recanalization time window has been extended to over 24 h. However, with the extension of the time window, the risk of ischemia/reperfusion (I/R) injury following reperfusion therapy becomes a big challenge for patient outcomes. I/R injury leads to neuronal death due to the imbalance in metabolic supply and demand, which is usually related to mitochondrial dysfunction. Mitophagy is a type of selective autophagy referring to the process of specific autophagic elimination of damaged or dysfunctional mitochondria to prevent the generation of excessive reactive oxygen species (ROS) and the subsequent cell death. Recent advances have implicated the protective role of mitophagy in cerebral ischemia is mainly associated with its neuroprotective effects in I/R injury. This review discusses the involvement of mitochondria dynamics and mitophagy in the pathophysiology of ischemic stroke and I/R injury in particular, focusing on the therapeutic potential of mitophagy regulation and the possibility of using mitophagy-related interventions as an adjunctive approach for neuroprotective time window extension after ischemic stroke.
Collapse
Affiliation(s)
- Luoan Shen
- Zhejiang University-University of Edinburgh Institute, School of Medicine, Zhejiang University, Haining, China
| | - Qinyi Gan
- Zhejiang University-University of Edinburgh Institute, School of Medicine, Zhejiang University, Haining, China
| | - Youcheng Yang
- Zhejiang University-University of Edinburgh Institute, School of Medicine, Zhejiang University, Haining, China
| | - Cesar Reis
- VA Loma Linda Healthcare System, Loma Linda University, Loma Linda, CA, United States
| | - Zheng Zhang
- Zhejiang University-University of Edinburgh Institute, School of Medicine, Zhejiang University, Haining, China
| | - Shanshan Xu
- Institute for Advanced Study, Shenzhen University, Shenzhen, China
| | - Tongyu Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chengmei Sun
- Zhejiang University-University of Edinburgh Institute, School of Medicine, Zhejiang University, Haining, China.,Institute for Advanced Study, Shenzhen University, Shenzhen, China
| |
Collapse
|
16
|
Cui C, Hong Y, Bao J, He L. The diagnostic reliability and validity of noninvasive imaging modalities to assess leptomeningeal collateral flow for ischemic stroke patients: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25543. [PMID: 33950927 PMCID: PMC8104240 DOI: 10.1097/md.0000000000025543] [Citation(s) in RCA: 3] [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] [Received: 12/04/2019] [Accepted: 03/23/2021] [Indexed: 02/05/2023] Open
Abstract
Leptomeningeal collateral flow (LMF) is associated with infarct area and clinical outcome for ischemic stroke patients. Although LMF can be detected by multiple imaging methods, but their diagnostic performance is uncertain.The aim of this study was to evaluate the diagnostic validity or reliability of noninvasive image methods in assessing LMF.Databases included PubMed, Web of Science, Embase, and Cochrane Library.Original observational cohort studies.Ischemic stroke patients.Different noninvasive image methods to assess LMF.Newcastle-Ottawa Scale to evaluate the quality of the studies; forest plot to show pooled results; I2 and Egger test to evaluate the heterogeneity and publication bias.Thirty of the 126 selected studies were eligible. For CT angiography, the interobserver agreement ranged from 0.494 to 0.93 and weighted kappa was 0.888; for patients receiving thrombolysis or endovascular treatment, 0.68 to 0.91; 0.494 to 0.89 for the 2-point system, 0.60 to 0.93 for the 3-point system, 0.68 to 0.87 for the system of >4 points; area under the curve (AUC) was 0.78. For perfusion computed tomography (CTP), the interobserver agreement ranged from 0.724 to 0.872; for patients receiving thrombolysis or endovascular treatment, 0.74 to 0.872; 0.724 for the 2-point system, 0.783 to 0.953 for the 3-point system; the intraobserver agreement was 0.884; AUC was 0.826. For MRI-fluid attenuated inversion recovery (FLAIR), the interobserver agreement ranged from 0.58 to 0.86; for patients receiving thrombolysis or endovascular treatment, 0.75 to 0.86; 0.86 for the two-point system, 0.77 to 0.87 for the system of more than 5 points; AUC was 0.82.No pooled data of CTP and FLAIR. The difference cohort study had difference bias. The unpublished data were not included.CT angiography is a good tool for assessing LMF. CTP shows a good validity and reliability, but its diagnostic value needs more evidence. FLAIR is a good modality to assess LMF. These image methods had better validity and reliability to evaluate LMF of patients receiving thrombolysis or endovascular treatment than all ischemic stroke patients.
Collapse
|
17
|
Surgical therapy for chronic internal carotid artery occlusion: a systematic review and meta-analysis. Updates Surg 2021; 73:2065-2078. [PMID: 33864610 DOI: 10.1007/s13304-021-01055-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Chronic internal carotid artery occlusion (CICAO) significantly increases the risk of recurrent stroke. Given unfavorable outcomes, revascularization procedures are not generally recommended for CICAO. In the last several years, loads of studies reported successful surgical revascularization for CICAO with promising success rate and favorable short-term outcomes. Meanwhile, due to the lack of high-quality evidence, the safety and efficacy of revascularization procedures remain debatable. This systematic review aims to scrutinize current evidence for the applicability of revascularization for CICAO. We also investigated potential predictors of postoperative prognosis. We searched clinical studies on surgical treatment of CICAO on the Medline, Cochrane library, and Embase databases, published from Jan 1990 to Jan 2021. Surgical operation was restricted to bypass surgery, endarterectomy, endovascular therapy, and hybrid surgery. Controlled clinical studies were included for clinical outcomes. Large-sample single-arm studies were supplemented to assess complications and success rate. Co-primary endpoints were technical success rate and neurological function; secondary endpoints were recurrent stroke/cerebrovascular events, complications, and deaths within follow-up. This systematic review has been registered in PROSPERO (CRD42020181250). One RCT and 5 cohort studies with a total of 465 patients were included in this review. Seven single-arm studies were supplemented for assessing success rate and complications. Bypass surgery presented the highest graft patency of 96% and a low incidence of complications, but no benefits on neurological function, recurrent stroke, or deaths. Endovascular therapy (carotid stenting) was characterized by a relatively lower technical success rate, significant neurological function recovery, and nonsignificant reduction of cerebrovascular events and deaths. Hybrid surgery was considered as a potential treatment for CICAO because of a high technical success rate and significant neurological improvement. Endarterectomy is only suitable for short-segment occlusion. Prospective clinical trials should focus on carotid stenting and hybrid surgery for their significant capacity of improving neurologic function and potential capacity of reducing deaths and cerebrovascular events.
Collapse
|
18
|
Joud H, Noureldine MHA, Peto I, Kumar JI, Bajric J, Agazzi S. Subarachnoid Hemorrhage and Internal Carotid Artery Dissection and Occlusion Following Self-Enucleation. Asian J Neurosurg 2021; 15:1050-1054. [PMID: 33708688 PMCID: PMC7869289 DOI: 10.4103/ajns.ajns_183_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/14/2020] [Accepted: 08/10/2020] [Indexed: 11/04/2022] Open
Abstract
Self-enucleation is an uncommon type of major self-injury, which may lead to severe neurological deficits and life-threatening complications, such as subarachnoid hemorrhage (SAH) and internal carotid artery (ICA) dissection and occlusion. Our patient is a 53-year-old man with a history of bipolar disorder and schizophrenia who presented with SAH, intraventricular hemorrhage, ICA dissection and occlusion, and right cerebral infarct following self-enucleation. Despite a Glasgow Coma Score of 6 on initial presentation, he improved with conservative management. He achieved a near-complete neurological recovery, with residual left lower extremity weakness and mild confusion. Self-enucleation is a major neurologic, ophthalmologic, and psychiatric emergency with a potential for serious neurological complications and contralateral visual loss. Yet, conservative management may lead to dramatic recovery.
Collapse
Affiliation(s)
- Hadi Joud
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Mohammad Hassan A Noureldine
- Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Johns Hopkins University School of Medicine, Saint Petersburg, Florida, USA
| | - Ivo Peto
- Department of Neurosurgery and Brain Repair, Tampa General Hospital, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Jay I Kumar
- Department of Neurosurgery and Brain Repair, Tampa General Hospital, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Jasmina Bajric
- Department of Ophthalmology, Tampa General Hospital, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Siviero Agazzi
- Department of Neurosurgery and Brain Repair, Tampa General Hospital, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| |
Collapse
|
19
|
Viticchi G, Falsetti L, Buratti L, Acciarri MC, Emiliani A, Bartolini M, Silvestrini M. Carotid occlusion: Impact of cerebral hemodynamic impairment on cognitive performances. Int J Geriatr Psychiatry 2021; 36:197-206. [PMID: 32857468 DOI: 10.1002/gps.5414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/11/2020] [Accepted: 08/14/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether the presence of carotid artery occlusion (CO) may be associated with different cognitive performances in relation to the side of the occlusion and its hemodynamic consequences. METHODS During a 12-month period, 61 asymptomatic patients, 32 with right and 29 with left CO, were enrolled. Each patient underwent an assessment of cerebrovascular reactivity (CVR) to hypercapnia with transcranial Doppler (TCD) ultrasonography using the breath-holding index (BHI). Neuropsychological assessment evaluating performances of the hemisphere ipsilateral to CO were administered at entry (T0 ) and then repeated after 2 years (T1 ). RESULTS Scores obtained at colored progressive matrices (CPM) and Rey Complex Figure Copy Test were significantly lower at T0 in patients with reduced BHI values ipsilateral to CO. Multivariate models showed that reduced BHI values were also associated to a significant decrease from T0 to T1 in scores obtained for CPM and Categorical Verbal Fluency tests, respectively, in patients with right (P = 0.002) or left CO (P = 0.004). CONCLUSIONS These findings suggest that hemodynamic alterations could be involved in the reduction in cognitive function regulated by the hemisphere ipsilateral to CO. The assessment of CVR with TCD ultrasonography may be a reliable approach for the individuation of asymptomatic patients with CO at increased risk of cognitive deterioration.
Collapse
Affiliation(s)
| | - Lorenzo Falsetti
- Internal and Subintensive Medicine, Ospedali Riuniti, Ancona, Italy
| | - Laura Buratti
- Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Maria C Acciarri
- Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Andrea Emiliani
- Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Marco Bartolini
- Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | | |
Collapse
|
20
|
Lall A, Yavagal DR, Bornak A. Chronic total occlusion and spontaneous recanalization of the internal carotid artery: Natural history and management strategy. Vascular 2020; 29:733-741. [PMID: 33297876 DOI: 10.1177/1708538120978043] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Spontaneous recanalization of a chronic total occlusion of the extra-cranial internal carotid artery is an under-reported clinical entity. This paper reviews the different etiologies of internal carotid artery occlusion, its natural course, as well as the significance and our recommendations for the management of spontaneous internal carotid artery recanalization. METHODS A review of literature on etiology, diagnosis, and treatment of internal carotid artery occlusion and recanalization was conducted. PubMed database was searched using the terms "internal carotid occlusion" and "recanalization". Articles were reviewed and studies involving the management of internal carotid artery occlusion and spontaneous recanalization were included. We subsequently developed a management algorithm for chronic total occlusion of the internal carotid artery and spontaneous recanalization of such lesions based on the available evidence. RESULTS Common etiologies of chronic total occlusion of the internal carotid artery include carotid atherosclerotic disease, cardioembolic, and carotid dissection. Progression of an asymptomatic to symptomatic occlusion is estimated at 2-8% annually. Well-compensated patients can be asymptomatic. In others, clinical symptoms range from ipsilateral or global hypoperfusion to embolic stroke in some cases of spontaneous recanalization. Spontaneous recanalization occurs in 2.3-10.3% of patients but rarely results in a cerebrovascular event. CONCLUSIONS Progression of an asymptomatic chronic total occlusion of the internal carotid artery to symptomatic is infrequent. The management algorithm of chronic total occlusion of the internal carotid artery and spontaneous recanalization of the internal carotid artery must be tailored to the patient based on symptoms, etiology of the lesion, imaging findings, surgical risk, and reliability for follow-up.
Collapse
Affiliation(s)
- Alex Lall
- Vascular & Endovascular Surgery, University of Miami, Miami, FL, USA
| | | | - Arash Bornak
- Vascular & Endovascular Surgery, University of Miami, Miami, FL, USA
| |
Collapse
|
21
|
Uwano I, Kameda H, Harada T, Kobayashi M, Yanagihara W, Setta K, Ogasawara K, Yoshioka K, Yamashita F, Mori F, Matsuda T, Sasaki M. Detection of impaired cerebrovascular reactivity in patients with chronic cerebral ischemia using whole-brain 7T MRA. J Stroke Cerebrovasc Dis 2020; 29:105081. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 11/28/2022] Open
|
22
|
Abd-Allah F, Rizk H, Farrag MA, Shaaban MH, Nasreldein A. Assessment of Intracranial Collateral Circulation Using Novel TCCS Grading System in Patients With Symptomatic Carotid Occlusion. Front Neurol 2020; 11:666. [PMID: 32793099 PMCID: PMC7393180 DOI: 10.3389/fneur.2020.00666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/03/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Foad Abd-Allah
- Neurology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
- *Correspondence: Foad Abd-Allah
| | - Haytham Rizk
- Neurology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mohammad Ahmed Farrag
- Neurology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | | | - Ahmed Nasreldein
- Neurology Department, Assiut University Hospitals, Assiut University, Assiut, Egypt
| |
Collapse
|
23
|
Kang K, Yang B, Gong X, Chen X, Gu W, Ma G, Miao Z, Zhao X, Ma N. Cerebral Hemodynamic Changes After Endovascular Recanalization of Symptomatic Chronic Intracranial Artery Occlusion. Front Neurol 2020; 11:318. [PMID: 32431659 PMCID: PMC7214835 DOI: 10.3389/fneur.2020.00318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/31/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: We performed this study to evaluate the hemodynamic changes over time after successful endovascular recanalization in patients with symptomatic chronic intracranial artery occlusion (CIAO). Materials and Methods: We included 20 patients with symptomatic CIAO in a high-volume stroke center from June 2014 to June 2019. All subjects were evaluated with CT perfusion (CTP) studies before and after the recanalization. The relative cerebral blood flows (rCBFs) in perforating artery territory (PAT) and cortical artery territory (CAT) of occluded arteries were compared before and after the recanalization. The patients were categorized into subgroups based on the time interval from revascularization to post-procedural CTP, occlusion sites, and restenosis status. The proportion of rCBF change (rCBFc%) was compared in variable subgroups. Results: The rCBF increased significantly from 0.52 to 0.71 in PAT (P < 0.001) and from 0.59 to 0.85 in CAT (P < 0.001) after recanalization, and there were also statistical differences in variable subgroups except for those with restenosis. The median and interquartile range (IQR) of rCBFc% were 35.2 and 18.6–56.6%. For patients with short-term follow-up (55.2%), the rCBFc% was relatively higher than that in patients with mid-term (35.4%) and long-term follow-up (32.7%), although without statistical difference (P = 0.273). For patients with restenosis, the rCBFc% was significantly lower than that in patients without restenosis (18.5 vs. 37.3%, P = 0.008). Conclusions: In patients with symptomatic CIAO, the CBF may increase and be relatively stable over time after successful recanalization except for restenosis.
Collapse
Affiliation(s)
- Kaijiang Kang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Bo Yang
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Jiangong Hospital, Beijing, China
| | - Xiping Gong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xing Chen
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Weibin Gu
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guofeng Ma
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Ning Ma
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
24
|
Cao R, Jiang Y, Lu J, Wu G, Zhang L, Chen J. Evaluation of Intracranial Vascular Status in Patients with Acute Ischemic Stroke by Time Maximum Intensity Projection CT Angiography: A Preliminary Study. Acad Radiol 2020; 27:696-703. [PMID: 31324580 DOI: 10.1016/j.acra.2019.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 02/05/2023]
Abstract
RATIONALE AND OBJECTIVES To describe the application of time maximum intensity projection CTA (t-MIP CTA) in acute ischemic stroke and compare t-MIP CTA and single-phase CTA (sCTA) in assessing collateral circulation and predicting prognosis. MATERIALS AND METHODS Twenty-nine acute ischemic stroke patients who underwent one-stop CT angiography (CTA)-CT perfusion scan were reviewed retrospectively. sCTA and t-MIP CTA were developed by CT perfusion scanning data. Image quality and collateral circulation were compared between the sCTA and t-MIP CTA groups. CT attenuation values, image noise, signal to noise , contrast to noise, and subjective image quality were obtained and compared between these two groups. The correlations of clinical prognosis and infarct volume with collateral status on t-MIP CTA and sCTA were analyzed, separately. Receiver operating characteristic curve was used to reveal the sensitivity and specificity of t-MIP CTA and sCTA in predicting outcome. RESULTS All images exhibited good quality for diagnosis. In objective evaluation, the noise level of t-MIP CTA was significantly lower than that of sCTA (p < 0.001). Vascular attenuation (signal to noise and contrast to noise) of t-MIP were higher than those of sCTA (all, p < 0.001). The collateral status on t-MIP CTA and sCTA were both negatively correlated with modified Rankin Scale scores (t-MIP CTA, r = -0.709, p < 0.001; sCTA, r = -0.551, p = 0.024) and the final infarction volume (t-MIP CTA, r = -0.716, p = 0.001; sCTA, r = -0.629, p = 0.003). t-MIP CTA was better for predicting prognosis (AUC, 0.956; sensitivity, 0.917; specificity, 0.941; p < 0.001) than sCTA (AUC, 0.824; sensitivity, 0.500; specificity, 0.941; p = 0.003). CONCLUSION In comparison with sCTA, t-MIP images showed higher image quality of intracranial vascularity and MIP could reveal vascular occlusion and evaluate collateral circulation more accurately. It was speculated that t-MIP could predict the prognosis more precisely.
Collapse
Affiliation(s)
- Ruoyao Cao
- Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, China; Department of Radiology, Beijing Hospital, National Center of Gerontology, No.1, DaHua Road, Dong Dan, Beijing 100730, China
| | - Yun Jiang
- Department of Neurology, Beijing Hospital, National Center of Gerontology, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, China
| | - Guogeng Wu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, No.1, DaHua Road, Dong Dan, Beijing 100730, China
| | - Lei Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, No.1, DaHua Road, Dong Dan, Beijing 100730, China
| | - Juan Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, No.1, DaHua Road, Dong Dan, Beijing 100730, China.
| |
Collapse
|
25
|
贾 子, 李 选, 郑 梅, 栾 景, 王 昌, 韩 金. [Hybrid treatment for symptomatic long-segment chronic internal carotid artery occlusion without stump]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52:177-180. [PMID: 32071483 PMCID: PMC7439078 DOI: 10.19723/j.issn.1671-167x.2020.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To summarize the preliminary experience of hybrid operation for the treatment of symptomatic long-segment chronic internal carotid artery occlusion (CICAO) without stump. METHODS Clinical data of 12 patients of symptomatic long-segment CICAO without stump undergoing hybrid operation treatment from July 2015 to December 2017 were retrospectively analyzed. The safety and efficacy of hybrid operation for the treatment of symptomatic long-segment CICAO without stump were preliminarily assessed. CICAO was defined as occlusion time being more than 4 weeks. The primary outcome was defined as any stroke (including ischemic or hemorrhagic) or deaths from any cause after hybrid operation within 30 days. The secondary outcome was defined as successful revascularization and occurrence of >50% in-stent restenosis during the follow-up period. RESULTS In this group, the symptomatic long-segment CICAO of 11 patients were successfully recanalized. Technical success rate was 91.7% (11/12). The main complication rate was 8.3% (1/12). This patient encountered iatrogenic internal carotid artery cavernous sinus fistula caused by micro-guide wire in the midway of the hybrid operation, the proximal segment of this internal carotid artery was ligated and the iatrogenic internal carotid artery cavernous sinus fistula disappeared in the following digital subtraction angiography image. No patient encountered hemorrhagic stroke and ischemic stroke. No death complications occurred. In this group 10 patients of them were followed up. The follow-up period ranged from 10 to 32 months [mean, (19±9) months]. During the follow-up period, 1 patients developed in-stent restenosis and improved after reoperation of percutaneous transluminal angioplasty by the right size balloon without stenting treatment. CONCLUSION Hybrid operation for the treatment of highly screened patients with symptomatic long-segment CICAO without stump is safe and effective, could reduce the incidence of complications and improve procedural success rate.
Collapse
Affiliation(s)
- 子昌 贾
- 北京大学第三医院 介入血管外科, 北京 100191Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - 选 李
- 北京大学第三医院 介入血管外科, 北京 100191Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - 梅 郑
- 北京大学第三医院 神经内科,北京 100191Department of Neurology, Peking University Third Hospital, Beijing 100191, China
| | - 景源 栾
- 北京大学第三医院 介入血管外科, 北京 100191Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - 昌明 王
- 北京大学第三医院 介入血管外科, 北京 100191Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - 金涛 韩
- 北京大学第三医院 介入血管外科, 北京 100191Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| |
Collapse
|
26
|
Cao R, Ye G, Wang R, Xu L, Jiang Y, Wang G, Wang D, Chen J. Collateral Vessels on 4D CTA as a Predictor of Hemorrhage Transformation After Endovascular Treatments in Patients With Acute Ischemic Stroke: A Single-Center Study. Front Neurol 2020; 11:60. [PMID: 32117022 PMCID: PMC7019033 DOI: 10.3389/fneur.2020.00060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/15/2020] [Indexed: 12/03/2022] Open
Abstract
Objective: Although the benefits of good collateral circulation on infarct volume and outcomes have been confirmed in previous studies, few studies have investigated the relationship between hemorrhagic transformation (HT) and collateral circulation in acute ischemic stroke (AIS). This study aimed to assess whether collateral circulation is an essential factor of HT after endovascular treatments (EVTs). Methods: In total, 71 consecutive AIS patients who underwent EVTs between July 2015 and February 2019 were retrospectively studied. The correlations among HT, collateral vessels on 4D CT angiography (4D CTA), and other predictive factors for HT [e.g., National Institutes of Health Stroke Scale (NIHSS) score, age, sex, serum glucose, and atrial fibrillation history] were evaluated by logistic regression analysis. Results: The rate of hemorrhagic transformation was 42.3% (30/71) in AIS patients. Multivariate logistic regression showed that a good collateral status (OR 0.76, 95% CI 0.73–0.80) was associated with a lower risk of HT. History of atrial fibrillation (OR 2.35, 95% CI 1.96–2.82), baseline NIHSS scores (OR 2.00, 95% CI 1.72–2.32), and higher serum glucose levels (OR 1.70, 95% CI 1.57–1.85) were all independent risk factors of HT. Conclusions: Patients with poor collateral circulation are at a higher risk of HT after receiving endovascular therapy. Thus, variations in collateral circulation based on 4D CTA may be an important factor for personalized clinical treatments. In addition, high blood glucose, atrial fibrillation and the baseline NIHSS score are all important independent predictors of HT.
Collapse
Affiliation(s)
- Ruoyao Cao
- Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Gengfan Ye
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Rui Wang
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Xu
- Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yun Jiang
- Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Guoxuan Wang
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Juan Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
27
|
Zhao H, Wang B, Xu G, Dong Y, Dong Q, Cao W. Collateral grade of the Willis' circle predicts outcomes of acute intracranial internal carotid artery occlusion before thrombectomy. Brain Behav 2019; 9:e01452. [PMID: 31696661 PMCID: PMC6908856 DOI: 10.1002/brb3.1452] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/21/2019] [Accepted: 09/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Endovascular mechanical thrombectomy (EVMT) shows significant promise in improving acute ischemic stroke (AIS) with proximal artery occlusion, but outcomes have been variable. We explored the patients treated by thrombectomy to investigate the association between a favorable clinical outcome of EVMT in intracranial internal carotid artery occlusion (iICAO) and a set of predictors. METHODS A total of 38 iICAO patients treated by EVMTs were analyzed. Primary collateral grades (PCG) at baseline based on the integrity of Willis' circle were categorized into three degrees. The favorable outcomes, measured by modified Rankin scale (mRS), were defined as ≤2 at 90 days. The reperfusion was one of the most important confounders, defined as modified thrombolysis in cerebral infarction (mTICI) ≥ 2b. The other risk factors included demographic characteristics, vascular risk factors, stroke severity, procedural EVMT, and PCG at baseline was adjusted to reveal the association with favorable outcomes. RESULTS Of 38 iICAO patients, 65.8% (25 in 38) achieved reperfusion. However, only 31.6% (12/38) achieved favorable outcomes at 90 days. With a PCG3, 61.5% of them achieved favorable outcomes, while only 37.5% of those with PCG2 and PCG1 achieved favorable outcomes (p = .003). In multivariable logistic regression, PCG was revealed as a predictor for favorable outcomes (OR 5.278, p = .019) after adjusting the reperfusion and other factors. CONCLUSIONS The PCG based on the integrity of Willis' circle might be an underlying predictor of the prognosis of AIS in patients with iICAO after EVMT. The function of intact anterior communicating artery (AcoA) and ipsilateral posterior communicating artery (PcoA) in favoring prognosis of the iICAO patients might need to be validation in future study.
Collapse
Affiliation(s)
- Hongchen Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Baolin Wang
- The Third Peoples' Hospital of Qingdao, Qingdao, China
| | | | - Yi Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjie Cao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
28
|
Xu B, Li C, Guo Y, Xu K, Yang Y, Yu J. Current understanding of chronic total occlusion of the internal carotid artery. Biomed Rep 2017; 8:117-125. [PMID: 29435269 PMCID: PMC5776422 DOI: 10.3892/br.2017.1033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 01/08/2023] Open
Abstract
At present, there is limited understanding of chronic total occlusion (CTO) of the internal carotid artery (ICA). Therefore, the present report collected related cases from PubMed and reviewed the literature. Cerebral vessels may form collateral circulation immediately or gradually following CTO of the ICA. The natural history of CTO of the ICA includes a variety of outcomes, all of which are biased toward a non-benign progressive process and are characterized by insufficient cerebral perfusion, embolus detachment and cognitive dysfunction. The majority of cases of CTO of the ICA require treatment. In early studies, the results of external-ICA bypass were unsatisfactory, while recanalization is now considered the only viable option. The current treatment indications mainly depend on the degree of injury to the cerebrovascular reserve and the extent to which the oxygen extraction fraction is increased. The length, height and duration of ICA occlusion are also relevant, though more frequently, the condition depends on multiple factors. Endovascular interventional recanalization, carotid endarterectomy (CEA) and hybrid surgery may be conducted in a select group of patients. As novel materials are developed, the success rate of simple recanalization may gradually increase; however, hybrid surgery may be more representative of the current trend, as advanced CEA can remove carotid atherosclerosis plaques, thus reducing the technological demands of the subsequent interventional recanalization. There are many complications that may result from recanalization following CTO of the ICA, including hyperperfusion and technical errors; therefore, the operation must be conducted carefully. If the recanalization is successful, it typically results in a stable improvement of patient condition in the long term. However, despite these conclusions, more studies are required in the future to further improve current understanding of CTO of the ICA.
Collapse
Affiliation(s)
- Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Chao Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| |
Collapse
|