1
|
Gory B, Finitsis S, Olivot JM, Richard S, Marnat G, Sibon I, Viguier A, Cognard C, Mazighi M, Chamorro A, Lapergue B, Maïer B. Intravenous Thrombolysis before Complete Angiographic Reperfusion: Beyond Angiographic Assessment to Target Microvascular Obstruction? Ann Neurol 2024; 95:762-773. [PMID: 38148607 DOI: 10.1002/ana.26867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Recent data have suggested that ineffective tissue reperfusion despite successful angiographic reperfusion was partly responsible for unfavorable outcomes after endovascular therapy (EVT) and might be modulated by intravenous thrombolysis (IVT) use before EVT. To specifically decipher the effect played by IVT before EVT, we compared the clinical and safety outcomes of patients who experienced a complete reperfusion at the end of EVT according to IVT use before EVT. METHODS The Endovascular Treatment in Ischemic Stroke (ETIS) registry is an ongoing, prospective, observational study at 21 centers that perform EVT in France. Patients were included if they had an anterior large vessel occlusion of the intracranial internal carotid artery or middle cerebral artery (M1/M2 segments) and complete reperfusion (expanded Thrombolysis in Cerebral Infarction score = 3) with EVT within 6 hours, between January 2015 and December 2021. The cohort was divided into two groups according to IVT use before EVT, and propensity score matching (PSM) was used to balance the two groups. Primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included favorable outcome (mRS 0-2) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and 90-day mortality. Outcomes were estimated with multivariate logistic models adjusted for age, National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and time from symptom onset to puncture. RESULTS Among 5,429 patients included in the ETIS registry, 1,093 were included in the study, including 651 patients with complete recanalization treated with IVT before EVT. After PSM, 488 patients treated with IVT before EVT were compared to 337 patients without IVT. In the matched cohort analysis, the IVT+EVT group had a favorable shift in the overall mRS score distribution (adjusted odds ratio [aOR] = 1.41, 95% confidence interval [CI] = 1.04-1.91, p = 0.023) and higher rates of favorable outcome (61.1% vs 48.7%, aOR = 1.49, 95% CI = 1.02-2.20, p = 0.041) at 90 days compared with the EVT alone group. Rates of symptomatic intracerebral hemorrhage were comparable between both groups (6.0% vs 4.3%, aOR = 1.16, 95% CI = 0.53-2.54, p = 0.709). INTERPRETATION In clinical practice, even after complete angiographic reperfusion by EVT, prior IVT use improves clinical outcomes of patients without increasing bleeding risk. ANN NEUROL 2024;95:762-773.
Collapse
Affiliation(s)
- Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France
- INSERM U1254, IADI, Université de Lorraine, 54511, Vandoeuvre-les-Nancy, France
| | - Stephanos Finitsis
- Aristotle University of Thessaloniki, Ahepa Hospital, Thessaloniki, Greece
| | - Jean-Marc Olivot
- Department of Vascular Neurology, University Hospital of Toulouse, Toulouse, France
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, Université de Lorraine, CHRU-Nancy, Nancy, France
- CIC-P 1433, INSERM U1116, CHRU-Nancy, Nancy, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Igor Sibon
- Neurology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Alain Viguier
- Department of Vascular Neurology, University Hospital of Toulouse, Toulouse, France
| | | | - Mikael Mazighi
- Department of Interventional Neuroradiology, Hôpital Fondation A. de Rothschild, Paris, France
- Department of Neurology, Hôpital Lariboisière, Paris, France
- Université Paris-Cité, Paris, France
- Université Paris-Cité and Université Sorbonne Paris Nord, Paris, France
| | - Angel Chamorro
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Benjamin Maïer
- Department of Interventional Neuroradiology, Hôpital Fondation A. de Rothschild, Paris, France
- Université Paris-Cité, Paris, France
- Université Paris-Cité and Université Sorbonne Paris Nord, Paris, France
- Department of Neurology, Hôpital Saint-Joseph, Paris, France
| |
Collapse
|
2
|
Serrallach BL, Mujanovic A, Ntoulias N, Manhart M, Branca M, Brehm A, Psychogios MN, Kurmann CC, Piechowiak EI, Pilgram-Pastor S, Meinel T, Seiffge D, Mordasini P, Gralla J, Dobrocky T, Kaesmacher J. Flat-panel Detector Perfusion Imaging and Conventional Multidetector Perfusion Imaging in Patients with Acute Ischemic Stroke : A Comparative Study. Clin Neuroradiol 2024:10.1007/s00062-024-01401-7. [PMID: 38526586 DOI: 10.1007/s00062-024-01401-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/15/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Flat-panel detector computed tomography (FDCT) is increasingly used in (neuro)interventional angiography suites. This study aimed to compare FDCT perfusion (FDCTP) with conventional multidetector computed tomography perfusion (MDCTP) in patients with acute ischemic stroke. METHODS In this study, 19 patients with large vessel occlusion in the anterior circulation who had undergone mechanical thrombectomy, baseline MDCTP and pre-interventional FDCTP were included. Hypoperfused tissue volumes were manually segmented on time to maximum (Tmax) and time to peak (TTP) maps based on the maximum visible extent. Absolute and relative thresholds were applied to the maximum visible extent on Tmax and relative cerebral blood flow (rCBF) maps to delineate penumbra volumes and volumes with a high likelihood of irreversible infarcted tissue ("core"). Standard comparative metrics were used to evaluate the performance of FDCTP. RESULTS Strong correlations and robust agreement were found between manually segmented volumes on MDCTP and FDCTP Tmax maps (r = 0.85, 95% CI 0.65-0.94, p < 0.001; ICC = 0.85, 95% CI 0.69-0.94) and TTP maps (r = 0.91, 95% CI 0.78-0.97, p < 0.001; ICC = 0.90, 95% CI 0.78-0.96); however, direct quantitative comparisons using thresholding showed lower correlations and weaker agreement (MDCTP versus FDCTP Tmax 6 s: r = 0.35, 95% CI -0.13-0.69, p = 0.15; ICC = 0.32, 95% CI 0.07-0.75). Normalization techniques improved results for Tmax maps (r = 0.78, 95% CI 0.50-0.91, p < 0.001; ICC = 0.77, 95% CI 0.55-0.91). Bland-Altman analyses indicated a slight systematic underestimation of FDCTP Tmax maximum visible extent volumes and slight overestimation of FDCTP TTP maximum visible extent volumes compared to MDCTP. CONCLUSION FDCTP and MDCTP provide qualitatively comparable volumetric results on Tmax and TTP maps; however, direct quantitative measurements of infarct core and hypoperfused tissue volumes showed lower correlations and agreement.
Collapse
Affiliation(s)
- Bettina L Serrallach
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Adnan Mujanovic
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Nikolaos Ntoulias
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4/Spitalstrasse 21, 4031, Basel, Switzerland
| | - Michael Manhart
- Advanced Therapies, Siemens Healthcare GmbH, Siemensstrasse 1, 91301, Forchheim, Germany
| | - Mattia Branca
- CTU Bern, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Alex Brehm
- Advanced Therapies, Siemens Healthcare GmbH, Siemensstrasse 1, 91301, Forchheim, Germany
| | | | - Christoph C Kurmann
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Eike I Piechowiak
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Sara Pilgram-Pastor
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Thomas Meinel
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Pasquale Mordasini
- Department of Radiology, Netzwerk Radiologie, Kantosspital St Gallen, Rorschacher Straße 95, 9007, St. Gallen, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| |
Collapse
|
3
|
Galecio-Castillo M, Vivanco-Suarez J, Zevallos CB, Dajles A, Weng J, Farooqui M, Ribo M, Jovin TG, Ortega-Gutierrez S. Direct to angiosuite strategy versus standard workflow triage for endovascular therapy: systematic review and meta-analysis. J Neurointerv Surg 2023; 15:e17-e25. [PMID: 35710313 DOI: 10.1136/neurintsurg-2022-018895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/23/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Reducing stroke workflow times when performing endovascular thrombectomy is associated with improvement in clinical outcomes. We compared outcomes among large vessel occlusion (LVO) stroke patients following the direct to angiosuite (DTAS) strategy versus standard workflow (SW) when undergoing endovascular therapy. METHODS We conducted a systematic review and meta-analysis to compare rates of functional outcomes, reperfusion, symptomatic intracranial hemorrhage (sICH) and stroke workflow metrics. We included observational studies and clinical trials that compared the DTAS strategy versus SW, and at least one outcome of interest was assessed. Clinical, methodological and statistical heterogeneity were measured, and a random-effects model was used. RESULTS 12 studies were included in the systematic review and 8 in the meta-analysis (n=2890). The DTAS strategy was associated with significant higher odds of good functional outcome at 90 days (47.3% vs 34.9%; OR 1.58, 95% CI 1.16 to 2.14) and a significant average reduction of door-to-puncture (mean differences (MD) -35.09, 95% CI -49.76 to -20.41) and door-to-reperfusion times (MD -32.88, 95% CI -50.75 to -15.01). We found no differences in sICH (OR 0.80, 95% CI 0.53 to 1.20), mortality (OR 1.00, 95% CI 0.60 to 1.67) or successful reperfusion rates (OR 1.37, 95% CI 0.82 to 2.29). Moreover, the DTAS strategy was associated with greater odds of dramatic clinical improvement at 24 hours (OR 1.79, 95% CI 1.15 to 2.79). CONCLUSION Patients undergoing the DTAS strategy had a significant reduction in door-to-puncture and door-to-reperfusion times. This resulted in an increased rate of early neurological and 90-day functional recovery without compromising safety in LVO patients undergoing endovascular thrombectomy.
Collapse
Affiliation(s)
| | - Juan Vivanco-Suarez
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Cynthia B Zevallos
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Andres Dajles
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Julie Weng
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mudassir Farooqui
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Marc Ribo
- Stroke Unit. Neurology, Hospital Vall d'Hebron, Barcelona, Spain
- Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tudor G Jovin
- Neurology, Cooper University Hospital, Camden, New Jersey, USA
| | - Santiago Ortega-Gutierrez
- Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| |
Collapse
|
4
|
Cimflova P, Singh N, Kappelhof M, Ospel JM, Sehgal A, Kashani N, Almekhlafi MA, Demchuk AM, Berrouschot J, Dorn F, Kelly ME, Buck BH, Field TS, Dowlatshahi D, Tymianski M, Hill MD, Goyal M. Effect of incomplete reperfusion patterns on clinical outcome: insights from the ESCAPE-NA1 trial. J Neurointerv Surg 2023:jnis-2023-020553. [PMID: 37491383 DOI: 10.1136/jnis-2023-020553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Incomplete reperfusion (IR) after mechanical thrombectomy (MT) can be a consequence of residual occlusion, no-reflow phenomenon, or collateral counterpressure. Data on the impact of these phenomena on clinical outcome are limited. METHODS Patients from the ESCAPE-NA1 trial with IR (expanded Thrombolysis In Cerebral Infarction (eTICI) 2b) were compared with those with complete or near-complete reperfusion (eTICI 2c-3) on the final angiography run. Final runs were assessed for (a) an MT-accessible occlusion, or (b) a non-MT-accessible occlusion pattern. The primary clinical outcome was modified Rankin Scale (mRS) 0-2 at 90 days. Our imaging outcome was infarction in IR territory on follow-up imaging. Unadjusted and adjusted incidence rate ratios (aIRR) with 95% confidence intervals (95% CI) were obtained. RESULTS Of 1105 patients, 443 (40.1%) with IR and 506 (46.1%) with complete or near-complete reperfusion were included. An MT-accessible occlusion was identified in 147/443 patients (33.2%) and a non-MT-accessible occlusion in 296/443 (66.8%). As compared with patients with near-complete/complete reperfusion, patients with IR had significantly lower chances of achieving mRS 0-2 at 90 days (aIRR 0.82, 95% CI 0.74 to 0.91). Rates of mRS 0-2 were lower in the MT-accessible occlusion group as compared with the non-MT-accessible occlusion pattern group (aIRR 0.71, 95% CI 0.60 to 0.83, and aIRR 0.89, 95% CI 0.81 to 0.98, respectively). More patients with MT-accessible occlusion patterns developed infarcts in the non-reperfused territory as compared with patients with non-MT occlusion patterns (68.7% vs 46.3%). CONCLUSION IR was associated with worse clinical outcomes than near-complete/complete reperfusion. Two-thirds of our patients with IR had non-MT-accessible occlusion patterns which were associated with better clinical and imaging outcomes compared with those with MT-accessible occlusion patterns.
Collapse
Affiliation(s)
- Petra Cimflova
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Imaging and Faculty of Medicine, Masaryk University, St. Anne's University Hospital Brno, Brno, Czechia
| | - Nishita Singh
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Internal Medicine - Neurology division, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Johanna M Ospel
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Clinic of Radiology and Nuclear Medicine, Universitatsspital Basel, Basel, Switzerland
| | - Arshia Sehgal
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Nima Kashani
- University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Mohammed A Almekhlafi
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkis Brain Institute, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Andrew M Demchuk
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkis Brain Institute, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Joerg Berrouschot
- Klinik für Neurologie und Neurologische Intensivmedizin, Klinikum Altenburger Land GmbH, Altenburg, Germany
| | - Franziska Dorn
- Klinik für Neuroradiologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Michael E Kelly
- Department of Neurosurgery, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Brian H Buck
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Thalia S Field
- Division of Neurology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Dariush Dowlatshahi
- Division of Neurology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | | | - Michael D Hill
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkis Brain Institute, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkis Brain Institute, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| |
Collapse
|
5
|
Kurmann CC, Kaesmacher J, Cooke DL, Psychogios M, Weber J, Lopes DK, Albers GW, Mordasini P. Evaluation of time-resolved whole brain flat panel detector perfusion imaging using RAPID ANGIO in patients with acute stroke: comparison with CT perfusion imaging. J Neurointerv Surg 2023; 15:387-392. [PMID: 35396333 PMCID: PMC10086455 DOI: 10.1136/neurintsurg-2021-018464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/23/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND In contrast to conventional CT perfusion (CTP) imaging, flat panel detector CT perfusion (FD-CTP) imaging can be acquired directly in the angiosuite. OBJECTIVE To evaluate time-resolved whole brain FD-CTP imaging and assess clinically important qualitative and quantitative perfusion parameters in correlation with previously acquired conventional CTP using the new RAPID for ANGIO software. METHODS We included patients with internal carotid artery occlusions and M1 or M2 occlusions from six centers. All patients underwent mechanical thrombectomy (MT) with preinterventional conventional CTP and FD-CTP imaging. Quantitative performance was determined by comparing volumes of infarct core, penumbral tissue, and mismatch. Eligibility for MT according to the perfusion imaging criteria of DEFUSE 3 was determined for each case from both conventional CTP and FD-CTP imaging. RESULTS A total of 20 patients were included in the final analysis. Conventional relative cerebral blood flow (rCBF) <30% and FD-CTP rCBF <45% showed good correlation (R2=0.84). Comparisons of conventional CTP Tmax >6 s versus FD-CTP Tmax >6 s and CTP mismatch versus FD-CTP mismatch showed more variability (R2=0.57, and R2=0.33, respectively). Based on FD-CTP, 16/20 (80%) patients met the inclusion criteria for MT according to the DEFUSE 3 perfusion criteria, in contrast to 18/20 (90%) patients based on conventional CTP. The vessel occlusion could be correctly extrapolated from the hypoperfusion in 18/20 cases (90%). CONCLUSIONS In our multicenter study, time-resolved whole brain FD-CTP was technically feasible, and qualitative and quantitative perfusion results correlated with those obtained with conventional CTP.
Collapse
Affiliation(s)
- Christoph C Kurmann
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Marios Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Johannes Weber
- Clinic of Radiology and Nuclear Medicine, Diagnostic and Interventional Neuroradiology, Kantonsspital St Gallen, St. Gallen, Switzerland
| | - Demetrius K Lopes
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory W Albers
- Department of Neurology and Neurosurgery, Stanford University, Stanford, California, USA
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland
| |
Collapse
|
6
|
Maïer B, Finitsis S, Mazighi M, Lapergue B, Marnat G, Sibon I, Richard S, Viguier A, Cognard C, Gory B, Olivot JM. The Benefit of a Complete over a Successful Reperfusion Decreases with Time. Ann Neurol 2023; 93:934-941. [PMID: 36640043 DOI: 10.1002/ana.26599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/05/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Time from stroke onset to reperfusion (TSOR) is strongly associated with outcomes after endovascular treatment. A near-to-complete or complete reperfusion (modified Treatment in Cerebral Ischemia [mTICI] 2c-3) is associated with improved outcomes compared with a successful reperfusion (mTICI 2b). However, it is unknown whether this association remains stable as TSOR increases. Therefore, we sought to investigate the association between TSOR and outcomes according to the reperfusion status. METHODS We analyzed data from the Endovascular Treatment in Ischemic Stroke registry, a prospective, observational, multicentric study of acute ischemic stroke patients treated with endovascular treatment in 21 centers in France. We included patients with anterior occlusions (M1, internal carotid artery, tandem), with a known time of symptom onset. Outcomes were early neurological improvement at 24 hours and favorable outcome (modified Rankin Scale between 0 and 2) at 90 days. RESULTS Overall, 4,444 patients were analyzed. Compared with a mTICI 2b, a mTICI 2c-3 at 1 hour was associated with higher mean marginal probabilities of early neurological improvement (25.6%, 95% CI 11.7-39.5, p = 0.0003) and favorable outcome (15.2%, 95% CI 3.0-27.4, p = 0.0143), and progressively declined with TSOR. The benefit of a mTICI 2c-3 over a mTICI 2b was no longer significant regarding the rates of early neurological improvement and favorable outcome after a TSOR of 414 and 344 minutes, respectively. INTERPRETATION The prognostic value of a complete over a successful reperfusion progressively declined with time, and no difference regarding the rates of favorable outcome was observed between a complete and successful reperfusion beyond 5.7 hours. ANN NEUROL 2023.
Collapse
Affiliation(s)
- Benjamin Maïer
- Neurology Department, Hôpital Saint-Joseph, Paris, France.,Interventional Neuroradiology Department, Hôpital Fondation A. de Rothschild, Paris, France.,Université Paris-Cité, Paris, France.,Université Paris-Cité and Université Sorbonne Paris Nord, INSERM U1148, LVTS, Paris, France
| | - Stephanos Finitsis
- Aristotle University of Thessaloniki, Ahepa Hospital, Thessaoniki, Greece
| | - Mikael Mazighi
- Neurology Department, Hôpital Saint-Joseph, Paris, France.,Université Paris-Cité, Paris, France.,Université Paris-Cité and Université Sorbonne Paris Nord, INSERM U1148, LVTS, Paris, France.,Neurology Department, Hôpital Lariboisière, Paris, France
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Igor Sibon
- Neurology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Sebastien Richard
- Department of Neurology, Stroke Unit, Université de Lorraine, Nancy, France.,CIC-P 1433, INSERM U1116, CHRU-Nancy, Nancy, France
| | - Alain Viguier
- Vascular Neurology Department, University Hospital of Toulouse, Toulouse, France
| | | | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France.,Université de Lorraine, INSERM 1254, IADI, Nancy, France
| | - Jean-Marc Olivot
- Vascular Neurology Department, University Hospital of Toulouse, Toulouse, France
| | | |
Collapse
|
7
|
Kurmann CC, Kaesmacher J, Pilgram-Pastor S, Piechowiak EI, Scutelnic A, Heldner MR, Dobrocky T, Gralla J, Mordasini P. Correlation of Collateral Scores Derived from Whole-Brain Time-Resolved Flat Panel Detector Imaging in Acute Ischemic Stroke. AJNR Am J Neuroradiol 2022; 43:1627-1632. [PMID: 36202551 PMCID: PMC9731240 DOI: 10.3174/ajnr.a7657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/25/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Flat panel detector CT imaging allows simultaneous acquisition of multiphase flat panel CTA and flat panel CTP imaging directly in the angio suite. We compared collateral assessment derived from multiphase flat panel CTA and flat panel CTP with collateral assessment derived from DSA as the gold-standard. MATERIALS AND METHODS We performed a retrospective analysis of patients with occlusion of the first or second segment of the MCA who underwent pre-interventional flat panel detector CT. The hypoperfusion intensity ratio as a correlate of collateral status was calculated from flat panel CTP (time-to-maximum > 10 seconds volume/time-to-maximum > 6 seconds volume). Intraclass correlation coefficients were calculated for interrater reliability for the Calgary/Menon score for multiphase flat panel CTA and for the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) score for DSA collateral scores. Correlations of the hypoperfusion intensity ratio, multiphase flat panel CTA score, and the ASITN/SIR score were calculated using the Spearman correlation. RESULTS From November 2019 to February 2020, thirty patients were included. Moderate interrater reliability was achieved for the ASITN/SIR DSA score (0.68; 95% CI, 0.50-0.82) as well as for the Calgary/Menon multiphase flat panel CTA score (0.53; 95% CI, 0.29-0.72). We found a strong correlation between the ASITN/SIR DSA and Calgary/Menon multiphase flat panel CTA score (ρ = 0.54, P = .002) and between the hypoperfusion intensity ratio and the Calgary/Menon multiphase flat panel CTA score (ρ = -0.57, P < .001). The correlation was moderate between the hypoperfusion intensity ratio and the ASITN/SIR DSA score (ρ = -0.49, P = .006). The infarct core volume correlated strongly with the Calgary/Menon multiphase flat panel CTA score (ρ = -0.66, P < .001) and the hypoperfusion intensity ratio (ρ = 0.76, P < .001) and correlated moderately with the ASITN/SIR DSA score (ρ = -0.46, P = .01). CONCLUSIONS The Calgary/Menon multiphase flat panel CTA score and the hypoperfusion intensity ratio correlated with each other and with the ASITN/SIR DSA score as the gold-standard. In our cohort, the collateral scoring derived from flat panel detector CT was clinically reliable.
Collapse
Affiliation(s)
- C C Kurmann
- From the University Institute of Diagnostic and Interventional Neuroradiology (C.C.K., J.K., S.P.-P., E.I.P., T.D., J.G., P.M.)
- University Institute of Diagnostic and Interventional and Pediatric Radiology (C.C.K.)
| | - J Kaesmacher
- From the University Institute of Diagnostic and Interventional Neuroradiology (C.C.K., J.K., S.P.-P., E.I.P., T.D., J.G., P.M.)
| | - S Pilgram-Pastor
- From the University Institute of Diagnostic and Interventional Neuroradiology (C.C.K., J.K., S.P.-P., E.I.P., T.D., J.G., P.M.)
| | - E I Piechowiak
- From the University Institute of Diagnostic and Interventional Neuroradiology (C.C.K., J.K., S.P.-P., E.I.P., T.D., J.G., P.M.)
| | - A Scutelnic
- Department of Neurology (A.S., M.R.H.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - M R Heldner
- Department of Neurology (A.S., M.R.H.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - T Dobrocky
- From the University Institute of Diagnostic and Interventional Neuroradiology (C.C.K., J.K., S.P.-P., E.I.P., T.D., J.G., P.M.)
| | - J Gralla
- From the University Institute of Diagnostic and Interventional Neuroradiology (C.C.K., J.K., S.P.-P., E.I.P., T.D., J.G., P.M.)
| | - P Mordasini
- From the University Institute of Diagnostic and Interventional Neuroradiology (C.C.K., J.K., S.P.-P., E.I.P., T.D., J.G., P.M.)
| |
Collapse
|
8
|
Brehm A, Nguyen KAT, Blackham KA, Psychogios MN. Effective Dose Measurements of the Latest-Generation Angiographic System in Patients with Acute Stroke: A Comparison with the Newest Multidetector CT Generation. AJNR Am J Neuroradiol 2022; 43:1621-1626. [PMID: 36202555 PMCID: PMC9731251 DOI: 10.3174/ajnr.a7658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/06/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Patients with acute ischemic stroke are increasingly triaged with one-stop management approaches, resulting in baseline imaging with a flat detector CT scanner. This study aimed to estimate the effective dose to a patient of a novel cervical and intracranial flat detector CT angiography and a flat detector CT perfusion protocol and to compare it with the effective dose of analogous multidetector row CT protocols. MATERIALS AND METHODS We estimated the effective dose to the patient according to the International Commission on Radiological Protection 103 using an anthropomorphic phantom with metal oxide semiconductor field effect transistor dosimeters. Placement was according to the organ map provided by the phantom manufacturer. We used 100 measurement points within the phantom, and 18 metal oxide semiconductor field effect transistor dosimeters were placed on the surface of the phantom. All protocols followed the manufacturer's specifications, and patient positioning and collimation were performed as in routine clinical practice. Measurements were obtained on the latest-generation angiography and multidetector row CT systems with identical placement of the metal oxide semiconductor field effect transistor dosimeters. RESULTS The estimated effective doses of the investigated perfusion protocols were 4.52 mSv (flat detector CT perfusion without collimation), 2.88 mSv (flat detector CT perfusion with collimation), and 2.17 mSv (multidetector row CT perfusion). A novel protocol called portrait flat detector CT angiography that has a z-axis coverage area comparable with that of multidetector row CT angiography had an estimated effective dose of 0.91 mSv, while the dose from multidetector row CT was 1.35 mSv. CONCLUSIONS The estimated effective dose to the patient for flat detector CT perfusion and angiography on a modern biplane angiography system does not deviate substantially from that of analogous multidetector row CT protocols.
Collapse
Affiliation(s)
- A Brehm
- From the Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - K A T Nguyen
- From the Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - K A Blackham
- From the Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - M-N Psychogios
- From the Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
9
|
Ortega-Gutierrez S, Quispe-Orozco D, Schafer S, Farooqui M, Zevallos CB, Dandapat S, Mendez-Ruiz A, Aagaard-Kienitz B, Petersen N, Derdeyn CP. Angiography suite cone-beam CT perfusion for selection of thrombectomy patients: A pilot study. J Neuroimaging 2022; 32:493-501. [PMID: 35315169 PMCID: PMC9314685 DOI: 10.1111/jon.12988] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/07/2022] [Accepted: 02/26/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The availability of cone-beam CT perfusion (CBCTP) in angiography suites may improve large-vessel occlusion (LVO) triage and reduce reperfusion times for patients presenting during extended time window. We aim to evaluate the perfusion maps correlation and agreement between multidetector CT perfusion (MDCTP) and CBCTP when obtained sequentially in patients undergoing endovascular therapy. METHODS This is a prospective, pilot, single-arm interventional cohort study of consecutive patients with anterior circulation LVO. All patients underwent MDCTP and CBCTP prior to endovascular therapy, generating cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time-to-maximum/time to peak contrast concentration maps. We compared the two imaging modalities using three different methods: (1) six regions of interest (ROIs) placed in the anterior circulation territory; (2) ROIs placed in all 10 Alberta Stroke Program Early CT Score regions; and (3) ROI drawn around the entire ischemic area. ROI ratios (unaffected/affected area) were compared for all sequences in each method. We used the intraclass correlation coefficient to calculate the correlation between the studies. Bland-Altman plots were also created to measure the degree of agreement. Finally, a sensitivity analysis was done comparing both modalities in patients with low infarct growth rate. RESULTS Fourteen patients were included (median age 81 years [74-87], 50% males, median National Institutes of Health Stroke Scale 19 [14-22]). Median time between studies was 42 minutes (interquartile range 29-61). Independently of the method used, we found moderate to excellent correlation in CBF, CBV, and MTT between modalities. CBF correlation further improved in patients with low infarct growth. CONCLUSION These results demonstrate promising accuracy of CBCTP in evaluating ischemic tissue in patients presenting with LVO ischemic stroke.
Collapse
Affiliation(s)
- Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.,Department of Neurosurgery, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.,Department of Radiology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA
| | - Darko Quispe-Orozco
- Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA
| | | | - Mudassir Farooqui
- Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA
| | - Cynthia B Zevallos
- Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA
| | | | - Alan Mendez-Ruiz
- Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA
| | - Beverly Aagaard-Kienitz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nils Petersen
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Colin P Derdeyn
- Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.,Department of Neurosurgery, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.,Department of Radiology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA
| |
Collapse
|