Collaterals are a major determinant of the core but not the penumbra volume in acute ischemic stroke.
Purpose: Determinants of early loss of ischemic tissue (core) or its prolonged survival (penumbra) in acute ischemic stroke (AIS) are poorly understood. We aimed to identify radiological associations of core and penumbra volumes on CT perfusion (CTP) in a large cohort of AIS. Methods: In the ASTRAL...
| Publicado en: | Neuroradiology Vol. 61; no. 9; pp. 971 - 979 |
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| Autores principales: | , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Springer Nature
Sep2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=137992592&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 137992592 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00283940 NYZ jtl: Neuroradiology issn: 00283940 maglogo: N pubinfo: dt: Sep2019 vid: 61 iid: 9 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 137992592 137992592 137992592 10.1007/s00234-019-02224-x 137992592 ppf: 971 ppct: 8 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Collaterals are a major determinant of the core but not the penumbra volume in acute ischemic stroke. aug: au: Nannoni, Stefania Cereda, Carlo W. Sirimarco, Gaia Lambrou, Dimitris Strambo, Davide Eskandari, Ashraf Dunet, Vincent Wintermark, Max Michel, Patrik affil: Stroke Center, Neurology Service, Lausanne University Hospital, Rue du Bugnon, 46, 1011, Lausanne, Switzerland sug: subj: Stroke Radiography Cerebral Ischemia Radiography Tomography, X-Ray Computed Methods Perfusion Imaging Collateral Circulation Human Male Female Stroke Patients Thrombosis Regression Descriptive Statistics NIH Stroke Scale Scales Male Female ab: Purpose: Determinants of early loss of ischemic tissue (core) or its prolonged survival (penumbra) in acute ischemic stroke (AIS) are poorly understood. We aimed to identify radiological associations of core and penumbra volumes on CT perfusion (CTP) in a large cohort of AIS. Methods: In the ASTRAL registry (2003–2016), we identified consecutive AIS patients with proximal middle cerebral artery (MCA) occlusion. We calculated core and penumbra volumes using established thresholds and the mismatch ratio (MR). We graded collaterals into three categories on CT-angiography. We used clot burden score (CBS) to quantify the clot length. We related CTP volumes to radiological variables in multivariate regression analyses, adjusted for time from stroke onset to first imaging. Results: The median age of the 415 included patients was 69 years (IQR = 21) and 49% were female. Median admission NIHSS was 16 (11) and median delay to imaging 2.2 h (1.9). Lower core volumes were associated with higher ASPECTS (hazard ratio = 1.08), absence of hyperdense MCA sign (HR = 0.70), higher CBS (i.e., smaller clot, HR = 1.10), and better collaterals (HR = 1.95). Higher penumbra volumes were related to lower CBS (i.e., longer clot, HR = 1.08) and proximal intracranial occlusion (HR = 1.47), but not to collaterals. Higher MR was found in absence of hyperdense MCA sign (HR = 1.28), absence of distal intracranial occlusion (HR = 1.39), and with better collaterals (HR = 0.52). Conclusions: In AIS, better collaterals were associated with lower core volumes, but not with higher penumbra volumes. This suggests a major role of collaterals in early tissue loss and their limited significance as marker of salvageable tissue. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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