Document Detail


Impact of collateral flow on tissue fate in acute ischaemic stroke.
MedLine Citation:
PMID:  18077482     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Collaterals may sustain penumbra prior to recanalisation yet the influence of baseline collateral flow on infarct growth following endovascular therapy remains unknown.
METHODS: Consecutive patients underwent serial diffusion and perfusion MRI before and after endovascular therapy for acute cerebral ischaemia. We assessed the relationship between MRI diffusion and perfusion lesion indices, angiographic collateral grade and infarct growth. Tmax perfusion lesion maps were generated and diffusion-perfusion mismatch regions were divided into Tmax >or=4 s (severe delay) and Tmax >or=2 but <4 s (mild delay).
RESULTS: Among 44 patients, collateral grade was poor in 7 (15.9%), intermediate in 20 (45.5%) and good in 17 (38.6%) patients. Although diffusion-perfusion mismatch volume was not different depending on the collateral grade, patients with good collaterals had larger areas of milder perfusion delay than those with poor collaterals (p = 0.005). Among 32 patients who underwent day 3-5 post-treatment MRIs, the degree of pretreatment collateral circulation (r = -0.476, p = 0.006) and volume of diffusion-perfusion mismatch (r = 0.371, p = 0.037) were correlated with infarct growth. Greatest infarct growth occurred in patients with both non-recanalisation and poor collaterals. Multiple regression analysis revealed that pretreatment collateral grade was independently associated with infarct growth.
CONCLUSION: Our data suggest that angiographic collateral grade and penumbral volume interactively shape tissue fate in patients undergoing endovascular recanalisation therapy. These angiographic and MRI parameters provide complementary information about residual blood flow that may help guide treatment decision making in acute cerebral ischaemia.
Authors:
O Y Bang; J L Saver; B H Buck; J R Alger; S Starkman; B Ovbiagele; D Kim; R Jahan; G R Duckwiler; S R Yoon; F Viñuela; D S Liebeskind;
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2007-12-12
Journal Detail:
Title:  Journal of neurology, neurosurgery, and psychiatry     Volume:  79     ISSN:  1468-330X     ISO Abbreviation:  J. Neurol. Neurosurg. Psychiatr.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-19     Completed Date:  2008-05-30     Revised Date:  2014-09-09    
Medline Journal Info:
Nlm Unique ID:  2985191R     Medline TA:  J Neurol Neurosurg Psychiatry     Country:  England    
Other Details:
Languages:  eng     Pagination:  625-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Blood Flow Velocity / drug effects
Cerebral Angiography*
Cerebral Cortex / blood supply*
Collateral Circulation / drug effects*,  physiology
Diffusion Magnetic Resonance Imaging*
Female
Follow-Up Studies
Humans
Infarction, Middle Cerebral Artery / diagnosis,  physiopathology,  therapy*
Magnetic Resonance Angiography*
Male
Middle Aged
Prospective Studies
Reperfusion Injury / diagnosis,  physiopathology
Thrombectomy*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
K23NS054084/NS/NINDS NIH HHS; P50 NS044378/NS/NINDS NIH HHS; P50 NS044378/NS/NINDS NIH HHS; P50 NS044378-069010/NS/NINDS NIH HHS
Investigator
Investigator/Affiliation:
Oh Young Bang / ; Jeffrey L Saver / ; Brian H Buck / ; Jeffry R Alger / ; Sidney Starkman / ; Bruce Ovbiagele / ; Doojin Kim / ; Latisha K Ali / ; Nerses Sanossian / ; Paul M Vespa / ; Reza Jahan / ; Noriko Salamon / ; Gary R Duckwiler / ; J Pablo Villablanca / ; Sa Rah Yoon / ; Fernando Viñuela / ; David S Liebeskind /
Comments/Corrections
Comment In:
J Neurol Neurosurg Psychiatry. 2008 Jun;79(6):615-6   [PMID:  18487551 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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