Relationships between brain perfusion and early recanalization after intravenous thrombolysis for acute stroke with large vessel occlusion

被引:25
作者
Seners, Pierre [1 ]
Turc, Guillaume [1 ]
Lion, Stephanie [2 ]
Cottier, Jean-Philippe [3 ]
Cho, Tae-Hee [4 ]
Arquizan, Caroline [5 ]
Bracard, Serge [6 ]
Ozsancak, Canan [7 ]
Legrand, Laurence [2 ]
Naggara, Olivier [2 ]
Debiais, Severine [8 ]
Berthezene, Yves [9 ]
Costalat, Vincent [10 ]
Richard, Sebastien [11 ]
Magni, Christophe [12 ]
Nighoghossian, Norbert [4 ]
Narata, Ana-Paula [3 ]
Dargazanli, Cyril [10 ]
Gory, Benjamin [6 ]
Mas, Jean-Louis [1 ]
Oppenheim, Catherine [2 ]
Baron, Jean-Claude [1 ]
机构
[1] Univ Paris 05, St Anne Hosp, AP HP, INSERM,UMR 1266, Paris, France
[2] Univ Paris 05, St Anne Hosp, INSERM, Radiol Dept,UMR 1266, Paris, France
[3] Univ Tours, Bretonneau Hosp, Dept Neuroradiol, Tours, France
[4] Univ Lyon 1, Hosp Civils Lyon, Dept Stroke Med, INSALyon,CNRS,CREATIS,INSERM,UMR 5220,U1044, Lyon, France
[5] CHRU Gui Chauliac, Dept Neurol, Montpellier, France
[6] Univ Hosp Nancy, Dept Diagnost & Intervent Neuroradiol, INSERM, U947, Nancy, France
[7] Orleans Hosp, Neurol Dept, Orleans, France
[8] Univ Tours, Bretonneau Hosp, Dept Neurol, Tours, France
[9] Hosp Civils Lyon, Neuroradiol Dept, Lyon, France
[10] CHRU Gui Chauliac, Dept Intervent Neuroradiol, Montpellier, France
[11] Univ Hosp Nancy, Neurol Dept, Nancy, France
[12] Orleans Hosp, Radiol Dept, Orleans, France
关键词
Cerebral perfusion; ischemic stroke; thrombolysis; thrombectomy; magnetic resonance imaging; ACUTE ISCHEMIC-STROKE; COLLATERAL CIRCULATION; COMPUTED-TOMOGRAPHY; MECHANICAL THROMBECTOMY; DEFUSE; REPERFUSION; FLOW; PREDICTORS; IMPACT; HYPOPERFUSION;
D O I
10.1177/0271678X19836288
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
In large vessel occlusion (LVO) stroke, it is unclear whether severity of ischemia is involved in early post-thrombolysis recanalization over and above thrombus site and length. Here we assessed the relationships between perfusion parameters and early recanalization following intravenous thrombolysis administration in LVO patients. From a multicenter registry, we identified 218 thrombolysed LVO patients referred for thrombectomy with both (i) pre-thrombolysis MRI, including diffusion-weighted imaging (DWI), T2*-imaging, MR-angiography and dynamic susceptibility-contrast perfusion-weighted imaging (PWI); and (ii) evaluation of recanalization on first angiographic run or non-invasive imaging <= 3 h from thrombolysis start. Infarct core volume on DWI, PWI-DWI mismatch volume and hypoperfusion intensity ratio (HIR; defined as Tmax >= 10 s volume/ Tmax >= 6 s volume, low HIR indicating milder hypoperfusion) were determined using a commercially available software. Early recanalization occurred in 34 (16%) patients, and multivariable analysis was associated with lower HIR (P = 0.006), shorter thrombus on T2*-imaging (P < 0.001) and more distal occlusion (P = 0.006). However, the relationship between HIR and early recanalization was robust only for thrombus length <14 mm. In summary, the present study disclosed an association between lower HIR and early post-thrombolysis recanalization. Early post-thrombolysis recanalization is therefore determined not only by thrombus site and length but also by severity of ischemia.
引用
收藏
页码:667 / 677
页数:11
相关论文
共 47 条
[1]   Occult Anterograde Flow Is an Under-Recognized but Crucial Predictor of Early Recanalization With Intravenous Tissue-Type Plasminogen Activator [J].
Ahn, Seong Hwan ;
d'Esterre, Christopher D. ;
Qazi, Emmad M. ;
Najm, Mohammed ;
Rubiera, Marta ;
Fainardi, Enrico ;
Hill, Michael D. ;
Goyal, Mayank ;
Demchuk, Andrew M. ;
Lee, Ting Y. ;
Menon, Bijoy K. .
STROKE, 2015, 46 (04) :968-975
[2]   Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging [J].
Albers, G. W. ;
Marks, M. P. ;
Kemp, S. ;
Christensen, S. ;
Tsai, J. P. ;
Ortega-Gutierrez, S. ;
McTaggart, R. A. ;
Torbey, M. T. ;
Kim-Tenser, M. ;
Leslie-Mazwi, T. ;
Sarraj, A. ;
Kasner, S. E. ;
Ansari, S. A. ;
Yeatts, S. D. ;
Hamilton, S. ;
Mlynash, M. ;
Heit, J. J. ;
Zaharchuk, G. ;
Kim, S. ;
Carrozzella, J. ;
Palesch, Y. Y. ;
Demchuk, A. M. ;
Bammer, R. ;
Lavori, P. W. ;
Broderick, J. P. ;
Lansberg, M. G. .
NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (08) :708-718
[3]   Late Window Paradox [J].
Albers, Gregory W. .
STROKE, 2018, 49 (03) :768-771
[4]  
[Anonymous], STROK EARL MAN AL PR
[5]   Impact of collateral flow on tissue fate in acute ischaemic stroke [J].
Bang, O. Y. ;
Saver, J. L. ;
Buck, B. H. ;
Alger, J. R. ;
Starkman, S. ;
Ovbiagele, B. ;
Kim, D. ;
Jahan, R. ;
Duckwiler, G. R. ;
Yoon, S. R. ;
Vinuela, F. ;
Liebeskind, D. S. .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2008, 79 (06) :625-629
[6]   Determinants of the distribution and severity of hypoperfusion in patients with ischemic stroke [J].
Bang, O. Y. ;
Saver, J. L. ;
Alger, J. R. ;
Starkman, S. ;
Ovbiagele, B. ;
Liebeskind, D. S. .
NEUROLOGY, 2008, 71 (22) :1804-1811
[7]   Multimodal MRI-Based Triage for Acute Stroke Therapy: Challenges and Progress [J].
Bang, Oh Young ;
Chung, Jong-Won ;
Son, Jeong Pyo ;
Ryu, Wi-Sun ;
Kim, Dong-Eog ;
Seo, Woo-Keun ;
Kim, Gyeong-Moon ;
Kim, Yoon-Chul .
FRONTIERS IN NEUROLOGY, 2018, 9
[8]   Collateral Circulation in Ischemic Stroke Assessment Tools and Therapeutic Strategies [J].
Bang, Oh Young ;
Goyal, Mayank ;
Liebeskind, David S. .
STROKE, 2015, 46 (11) :3302-3309
[9]   Effect of thrombus size on recanalization by bridging intravenous thrombolysis [J].
Behrens, L. ;
Moehlenbruch, M. ;
Stampfl, S. ;
Ringleb, P. A. ;
Hametner, C. ;
Kellert, L. ;
Pham, M. ;
Herweh, C. ;
Bendszus, M. ;
Rohde, S. .
EUROPEAN JOURNAL OF NEUROLOGY, 2014, 21 (11) :1406-1410
[10]   Direct Mechanical Intervention Versus Bridging Therapy in Stroke Patients Eligible for Intravenous Thrombolysis A Pooled Analysis of 2 Registries [J].
Bellwald, Sebastian ;
Weber, Ralph ;
Dobrocky, Tomas ;
Nordmeyer, Hannes ;
Jung, Simon ;
Hadisurya, Jeffrie ;
Mordasini, Pasquale ;
Mono, Marie-Luise ;
Stracke, Christian P. ;
Sarikaya, Hakan ;
Bernasconi, Corrado ;
Berger, Klaus ;
Arnold, Marcel ;
Chapot, Rene ;
Gralla, Jan ;
Fischer, Urs .
STROKE, 2017, 48 (12) :3282-3288