Your browser doesn't support javascript.
loading
Decreased Quantitative Cerebral Blood Volume Is Associated With Poor Outcomes in Large Core Patients.
Yedavalli, Vivek; Salim, Hamza Adel; Mei, Janet; Lakhani, Dhairya A; Balar, Aneri; Musmar, Basel; Adeeb, Nimer; Hoseinyazdi, Meisam; Luna, Licia; Deng, Francis; Hyson, Nathan Z; Dmytriw, Adam A; Guenego, Adrien; Faizy, Tobias D; Heit, Jeremy J; Albers, Gregory W; Lu, Hanzhang; Urrutia, Victor C; Nael, Kambiz; Marsh, Elisabeth B; Hillis, Argye E; Llinas, Raf.
Afiliación
  • Yedavalli V; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.).
  • Salim HA; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.).
  • Mei J; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.).
  • Lakhani DA; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.).
  • Balar A; Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston (D.A.L., A.A.D.).
  • Musmar B; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.).
  • Adeeb N; Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University (B.M., N.A.).
  • Hoseinyazdi M; Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University (B.M., N.A.).
  • Luna L; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.).
  • Deng F; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.).
  • Hyson NZ; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.).
  • Dmytriw AA; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.).
  • Guenego A; Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston (D.A.L., A.A.D.).
  • Faizy TD; Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.).
  • Heit JJ; Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.).
  • Albers GW; Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.).
  • Lu H; Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA (J.J.H., G.W.A.).
  • Urrutia VC; Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA (J.J.H., G.W.A.).
  • Nael K; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.).
  • Marsh EB; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.).
  • Hillis AE; David Geffen School of Medicine at UCLA, Los Angeles, CA (K.N.).
  • Llinas R; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.).
Stroke ; 55(10): 2409-2419, 2024 Oct.
Article en En | MEDLINE | ID: mdl-39185560
ABSTRACT

BACKGROUND:

Recent large core trials have highlighted the effectiveness of mechanical thrombectomy (MT) in acute ischemic stroke with large vessel occlusion. Variable perfusion-imaging thresholds and poor Alberta Stroke Program Early Computed Tomography Score reliability underline the need for more standardized, quantitative ischemia measures for MT patient selection. We aimed to identify the computed tomography perfusion parameter most strongly associated with poor outcomes in patients with acute ischemic stroke-large vessel occlusion with significant ischemic cores.

METHODS:

In this study from 2 comprehensive stroke centers from 2 comprehensive stroke centers within the Johns Hopkins Medical Enterprise (Johns Hopkins Hospita-East Baltimore and Bayview Medical Campus) from July 29, 2019 to January 29, 2023 in a continuously maintained database, we included patients with acute ischemic stroke-large vessel occlusion with ischemic core volumes defined as relative cerebral blood flow <30% and ≥50 mL on computed tomography perfusion or Alberta Stroke Program Early Computed Tomography Score <6. We used receiver operating characteristics to find the optimal cutoff for parameters like cerebral blood volume (CBV) <34%, 38%, 42%, and relative cerebral blood flow >20%, 30%, 34%, 38%, and time-to-maximum >4, 6, 8, and 10 seconds. The primary outcome was unfavorable outcomes (90-day modified Rankin Scale score 4-6). Multivariable models were adjusted for age, sex, diabetes, baseline National Institutes of Health Stroke Scale, intravenous thrombolysis, and MT.

RESULTS:

We identified 59 patients with large ischemic cores. A receiver operating characteristic curve analysis showed that CBV<42% ≥68 mL is associated with unfavorable outcomes (90-day modified Rankin Scale score 4-6) with an area under the curve of 0.90 (95% CI, 0.82-0.99) in the total and MT-only cohorts. Dichotomizing at this CBV threshold, patients in the ≥68 mL group exhibited significantly higher relative cerebral blood flow, time-to-maximum >8 and 10 seconds volumes, higher CBV volumes, higher HIR, and lower CBV index. The multivariable model incorporating CBV<42% ≥68 mL predicted poor outcomes robustly in both cohorts (area under the curve for MT-only subgroup was 0.87 [95% CI, 0.75-1.00]).

CONCLUSIONS:

CBV<42% ≥68 mL most effectively forecasts poor outcomes in patients with large-core stroke, confirming its value alongside other parameters like time-to-maximum in managing acute ischemic stroke-large vessel occlusion.
Asunto(s)
Palabras clave
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Volumen Sanguíneo Cerebral / Accidente Cerebrovascular Isquémico Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Stroke Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Volumen Sanguíneo Cerebral / Accidente Cerebrovascular Isquémico Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Stroke Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos