A novel MRI approach for collateral flow imaging in ischemic stroke

Abstract Objective: Dedicated MRI sequences for evaluation of collaterals can be generated using MR perfusion (MRP) source data. We compared a novel collateral flow imaging technique with digital subtraction angiography (DSA) for determining collateral circulation in acute stroke and evaluated the ability of MR‐based collateral flow maps to predict outcomes after recanalization therapy. Methods: Consecutive patients who were candidates for endovascular treatment were enrolled. A collateral flow map derived from MRP source data was generated by manual or automatic post‐processing. Collateral grading based on the collateral flow map was performed and compared with grading based on DSA. Clinical and radiological outcomes were evaluated according to MR‐based collateral grading and early reperfusion (ER) status. Results: There was good correlation between MRI‐ and DSA‐based collateral grades (weighted κ‐coefficient=0.70). Collateral status and achievement of ER were the two main determinants of a favorable functional outcome and neurological improvement, as well as infarct growth. Regardless of achievement of ER, better collaterals were significantly associated with a lower modified Rankin score at day 90 (p
Source: Annals of Neurology - Category: Neurology Authors: Tags: Research Article Source Type: research

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Conclusions: Up to date, no data about PCIS and IVT are available from RTCs. Based on limited results from retrospective clinical studies and case series, IVT is safer for use in PCIS than in ACIS. Patients with brainstem ischemia, vertebral artery occlusion, and absence of basilar or posterior cerebral artery occlusion could be considered for treatment with IVT even in borderline cases. Time to IVT in PCIS seems to be a less crucial factor than in ACIS. IVT for PCIS may be beneficial even after 4.5 h from symptom onset. Introduction History of Intravenous Thrombolysis—The Most Relevant Studies Intravenous t...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusions: CG-FAST scale could be an effective and simple scale for accurate identification of LVOS among AIS patients. Introduction Large vessel occlusion stroke (LVOS) often leads to severe disability and mortality. Although endovascular therapy (EVT) has been proved to be effective for LVOS patients (1–9), especially in anterior circulation, its benefit is highly time-dependent (10, 11). As hospitals with around-the-clock endovascular capability are scarce in many parts of the world and patients admitted directly to a CSC would have better outcomes than those receiving drip and ship treatment (12, 13), thi...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusion: Postreperfusion BP management by decreasing BPV may have influence on improving clinical outcome in cases of poor collateral circulation among patients achieving successful recanalization after ERT. Introduction Endovascular recanalization therapy (ERT) has been adopted as standard stroke care in patients with acute ischemic stroke (1–6). Time to recanalization and degree of recanalization are the most important predictors of clinical outcomes after ERT (7). Before recanalization, an effort to reduce the time from symptom onset to reperfusion is critical for penumbral salvage. After recanalization, ...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Ahmed Mohamed Elhfnawy1*, Peter U. Heuschmann2, Mirko Pham3†, Jens Volkmann1† and Felix Fluri1,4 1Department of Neurology, University Hospital Würzburg, Würzburg, Germany 2Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany 3Institute of Diagnostic and Interventional Neuroradiology, University Hospital of Würzburg, Würzburg, Germany 4Department of Neurology, Kantonssptial St. Gallen, St. Gallen, Switzerland Background and Purpose: Internal carotid artery stenosis (ICAS)≥70% is a leading cause of ischemic cerebrovascular event...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
We report a rare case of MIE mimicking an acute ischemic stroke, and hypothesize the relationship between the findings of CTP and that of MRI based on the anatomical connection of the dentate nucleus and the cerebral hemisphere. PMID: 30078820 [PubMed - as supplied by publisher]
Source: Neurologia Medico-Chirurgica - Category: Neurosurgery Tags: Neurol Med Chir (Tokyo) Source Type: research
ConclusionsThe proportion of patients with acute stroke and large vessel occlusion presenting within 8 hours that would meet radiological criteria for endovascular stroke trials varies considerably (62–100%) in a cohort outside of clinical trials from an academic comprehensive stroke center. Thus, the radiological criteria used for candidate selection in daily practice will greatly influence the proportion of patients treated with endovascular therapy.
Source: Journal of Neuroradiology - Category: Radiology Source Type: research
Conclusions The proportion of patients with acute stroke and large vessel occlusion presenting within eight hours that would meet radiological criteria for endovascular stroke trials varies considerably (62-100%) in a cohort outside of clinical trials from an academic comprehensive stroke center. Thus, the radiological criteria used for candidate selection in daily practice will greatly influence the proportion of patients treated with endovascular therapy.
Source: Journal of Neuroradiology - Category: Radiology Source Type: research
Conclusions—Increased PS can predict HT of deep MCA territory after recanalization therapy for cerebral proximal large-vessel occlusion. Proximal MCA-M1 complete occlusion and distal internal carotid artery occlusion in conjunction with poor collaterals elevate deep MCA territory PS.
Source: Stroke - Category: Neurology Authors: Tags: Angiography, Computerized Tomography (CT), Blood-Brain Barrier, Ischemic Stroke Original Contributions Source Type: research
Publication date: Available online 24 August 2017 Source:European Journal of Radiology Author(s): Pedro Vilela, Howard A. Rowley Imaging plays a central role for patient selection for both intravenous and intra-arterial treatments. Computed tomography (CT)/CT angiography or magnetic resonance (MR)/MR angiography imaging are used to exclude stroke mimics and haemorrhage, to determine the cause and mechanism of stroke, to define the extension of brain infarct and to identify an arterial large-vessel occlusion. Multiparametric CT/MR imaging may be used to identify the extension of potential viable brain tissue (penumbra) and...
Source: European Journal of Radiology - Category: Radiology Source Type: research
Conclusion The incidence of complete cow is greater in women for all age groups and decreases with age in both genders. the most frequently absent vessel is pcom, either unilaterally or bilaterally. completion was significantly reduced in ischemic stroke and a subset of hemorrhagic stroke patients, suggesting that an incomplete cow is a risk factor for these indications. Disclosures O. Zaninovich: None. W. Ramey: None. C. Walter: None. T. Dumont: None.
Source: Journal of NeuroInterventional Surgery - Category: Neurosurgery Authors: Tags: Oral Poster Abstracts Source Type: research
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