Dataset Information

Time-dependent infarct volume affects the benefit of recanalization.

ABSTRACT: OBJECTIVES:The benefit threshold of infarct volume from recanalization remains unclear. We assumed that the threshold decreased over time, and then investigated the benefit curve of infarct volume during different time periods. METHODS:We reviewed prospectively collected clinical and imaging data from acute ischemic stroke patients with internal carotid artery and M1 occlusion who underwent angiography before and 24?h after reperfusion therapy. Ordinal analyses of modified Rankin Scale scores were performed and curves were fitted. RESULTS:Of the included 445 patients, the median age was 71?years and 157 (35.3%) were women. The mean time from onset to treatment (OTT) was 248?±?142?min. The median baseline infarct core volume was 49 (IQR 22-85) ml. Follow-up angiography revealed recanalization in 265 (59.6%) patients. The fitting curves showed that patients with an OTT ?3?h would benefit from recanalization no matter how large the infarct volume was, whereas patients with an OTT between 3 and 4.5?h and with an infarct volume???125?ml, and those with an OTT???4.5?h and with an infarct volume???80?ml did not benefit from recanalization. CONCLUSIONS:We established a time-dependent benefit threshold of infarct volume from recanalization, and thus suggested to estimate infarct core volume to select patients for reperfusion therapy in those with an OTT beyond 3?h.

SUBMITTER: Hu H

PROVIDER: S-EPMC6734046 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Time-dependent infarct volume affects the benefit of recanalization.

Hu Haitao H Yan Shenqiang S Zhou Ying Y Lou Min M

NeuroImage. Clinical 20190901

<h4>Objectives</h4>The benefit threshold of infarct volume from recanalization remains unclear. We assumed that the threshold decreased over time, and then investigated the benefit curve of infarct volume during different time periods.<h4>Methods</h4>We reviewed prospectively collected clinical and imaging data from acute ischemic stroke patients with internal carotid artery and M1 occlusion who underwent angiography before and 24 h after reperfusion therapy. Ordinal analyses of modified Rankin ...[more]

PMID: 31494401

Similar Datasets

Project description:Background and purposeIn acute middle cerebral artery (MCA) stroke, CT angiographic (CTA) source images (CTA-SI) identify tissue likely to infarct despite early recanalization. This pilot study evaluated the impact of recanalization status on clinical and radiologic predictors of patient outcomes.Materials and methodsOf 44 patients undergoing CT/CTA within 6 hours of developing symptoms of proximal MCA ischemia, 19 patients achieved complete proximal MCA (MCA M1) recanalization. Admission National Institutes of Health Stroke Scale (NIHSS) score, onset-to-imaging time, CTA-SI Alberta Stroke Program Early CT Score, MCA M1 occlusion, cerebrovascular collaterals score, and CTA-SI lesion volume were correlated with 3- to 6-month follow-up modified Rankin Scale (mRS). We developed 2 stepwise regression models: one for patients with complete MCA M1 recanalization and one for patients without complete recanalization.ResultsComplete and incomplete recanalization groups had similar median admission NIHSS scores (19 versus 19) and mean onset-to-imaging times (2.3 versus 1.9 hours) but different proportions of patients achieving mRS scores 0-2 (74% versus 40%; P = .04). The only independent predictors of clinical outcome in patients with complete recanalization were onset-to-imaging time and admission CTA-SI lesion volume (total model R(2) = 0.75; P = .01). The only independent predictors of outcome in patients with incomplete recanalization were admission CTA-SI lesion volume and NIHSS score (total model R(2) = 0.66; P = .007).ConclusionRegardless of recanalization status, admission CTA-SI lesion volume was associated with clinical outcome. Recanalization status did, however, affect which variables in addition to CTA-SI volume significantly impacted clinical outcome: time with complete recanalization and NIHSS with incomplete recanalization. This finding may support the development of a model predicting the potential clinical benefit expected with early successful recanalization.

Project description:Patients who have large cerebral infarctions may not be good candidates for endovascular treatment. Various methods for determining infarct volume have been used in clinical studies. We evaluated the effectiveness of several methods for measuring infarct volume, especially regarding futile outcomes despite endovascular treatment.Patients with acute ischemic stroke in unilateral anterior circulation territory who were treated with intra-arterial thrombectomy were included. For assessing infarct volume, the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) scoring system was applied to images obtained by noncontrast computed tomography (NCCT), postcontrast CT (PCCT), and diffusion-weighted imaging (DWI). DWI stroke volume was semiquantitatively measured with the manually outlined hyperintense lesion. Infarct core volume was calculated with a threshold apparent diffusion coefficient value of 600?×?10?mm/s. Intraclass correlation coefficients (ICC) were estimated to assess inter-reader reliability for ASPECTS scoring and DWI stroke volume. Receiver operating characteristic (ROC) curve analyses, and univariable and multivariable comparative analyses, were performed with each evaluation method to predict futile outcome (modified Rankin Scale score 5-6).The mean age of the included 79 patients was 65.1?±?15.7 years. Among them, 55 (69.6%) patients demonstrated successful reperfusion after intra-arterial thrombectomy, but 34 (43.0%) patients had futile outcomes. Inter-reader agreement was excellent for measurement of the DWI stroke volume (ICC, 0.973), DWI ASPECTS (0.940), and PCCT ASPECTS (0.859), but was moderate for NCCT ASPECTS (0.694). Regarding prediction of futile outcomes, area under ROC curve was 0.551 on NCCT ASPECTS and it was significantly smaller than that in PCCT ASPECTS (area under ROC 0.651, P?=?0.030), DWI ASPECTS (0.733, P?=?0.003), DWI stroke volume (0.702, P?=?0.022), and infarct core volume (0.702, P?=?0.021). Besides old age and high National Institutes of Health Stroke Scale score on admission, MRI parameters such as DWI ASPECTS and infarct core volume indicating large volumes were independently associated with futile outcomes in multivariable analyses.DWI ASPECTS can be a good parameter predicting futility, which is easily measured and has high prediction power.

Dataset Information

Time-dependent infarct volume affects the benefit of recanalization.

Publications

Time-dependent infarct volume affects the benefit of recanalization.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure