Role of Recanalization in Acute Stroke Outcome: Rationale for a CT Angiogram-Based "Benefit of Recanalization" Model
In acute middle cerebral artery (MCA) stroke, CT angiographic (CTA) source images (CTA-SI) identify tissue likely to infarct despite early recanalization. This pilot study evaluated the impact of recanalization status on clinical and radiologic predictors of patient outcomes. Of 44 patients undergoi...
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| Veröffentlicht in: | American journal of neuroradiology : AJNR 2008-09, Vol.29 (8), p.1471-1475 |
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| creator | Rosenthal, E.S Schwamm, L.H Roccatagliata, L Coutts, S.B Demchuk, A.M Schaefer, P.W Gonzalez, R.G Hill, M.D Halpern, E.F Lev, M.H |
| description | In acute middle cerebral artery (MCA) stroke, CT angiographic (CTA) source images (CTA-SI) identify tissue likely to infarct despite early recanalization. This pilot study evaluated the impact of recanalization status on clinical and radiologic predictors of patient outcomes.
Of 44 patients undergoing CT/CTA within 6 hours of developing symptoms of proximal MCA ischemia, 19 patients achieved complete proximal MCA (MCA M1) recanalization. Admission National Institutes of Health Stroke Scale (NIHSS) score, onset-to-imaging time, CTA-SI Alberta Stroke Program Early CT Score, MCA M1 occlusion, cerebrovascular collaterals score, and CTA-SI lesion volume were correlated with 3- to 6-month follow-up modified Rankin Scale (mRS). We developed 2 stepwise regression models: one for patients with complete MCA M1 recanalization and one for patients without complete recanalization.
Complete and incomplete recanalization groups had similar median admission NIHSS scores (19 versus 19) and mean onset-to-imaging times (2.3 versus 1.9 hours) but different proportions of patients achieving mRS scores 0-2 (74% versus 40%; P = .04). The only independent predictors of clinical outcome in patients with complete recanalization were onset-to-imaging time and admission CTA-SI lesion volume (total model R(2) = 0.75; P = .01). The only independent predictors of outcome in patients with incomplete recanalization were admission CTA-SI lesion volume and NIHSS score (total model R(2) = 0.66; P = .007).
Regardless of recanalization status, admission CTA-SI lesion volume was associated with clinical outcome. Recanalization status did, however, affect which variables in addition to CTA-SI volume significantly impacted clinical outcome: time with complete recanalization and NIHSS with incomplete recanalization. This finding may support the development of a model predicting the potential clinical benefit expected with early successful recanalization. |
| doi_str_mv | 10.3174/ajnr.A1153 |
| format | Article |
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Of 44 patients undergoing CT/CTA within 6 hours of developing symptoms of proximal MCA ischemia, 19 patients achieved complete proximal MCA (MCA M1) recanalization. Admission National Institutes of Health Stroke Scale (NIHSS) score, onset-to-imaging time, CTA-SI Alberta Stroke Program Early CT Score, MCA M1 occlusion, cerebrovascular collaterals score, and CTA-SI lesion volume were correlated with 3- to 6-month follow-up modified Rankin Scale (mRS). We developed 2 stepwise regression models: one for patients with complete MCA M1 recanalization and one for patients without complete recanalization.
Complete and incomplete recanalization groups had similar median admission NIHSS scores (19 versus 19) and mean onset-to-imaging times (2.3 versus 1.9 hours) but different proportions of patients achieving mRS scores 0-2 (74% versus 40%; P = .04). The only independent predictors of clinical outcome in patients with complete recanalization were onset-to-imaging time and admission CTA-SI lesion volume (total model R(2) = 0.75; P = .01). The only independent predictors of outcome in patients with incomplete recanalization were admission CTA-SI lesion volume and NIHSS score (total model R(2) = 0.66; P = .007).
Regardless of recanalization status, admission CTA-SI lesion volume was associated with clinical outcome. Recanalization status did, however, affect which variables in addition to CTA-SI volume significantly impacted clinical outcome: time with complete recanalization and NIHSS with incomplete recanalization. This finding may support the development of a model predicting the potential clinical benefit expected with early successful recanalization.</description><identifier>ISSN: 0195-6108</identifier><identifier>EISSN: 1936-959X</identifier><identifier>DOI: 10.3174/ajnr.A1153</identifier><identifier>PMID: 18599577</identifier><identifier>CODEN: AAJNDL</identifier><language>eng</language><publisher>Oak Brook, IL: Am Soc Neuroradiology</publisher><subject>Aged ; Biological and medical sciences ; Brain ; Cerebral Angiography - methods ; Female ; Fundamental and applied biological sciences. Psychology ; Humans ; Infarction, Middle Cerebral Artery - diagnostic imaging ; Infarction, Middle Cerebral Artery - therapy ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Nervous system ; Pilot Projects ; Prognosis ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Radiographic Image Interpretation, Computer-Assisted - methods ; Reproducibility of Results ; Sensitivity and Specificity ; Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors ; Thrombolytic Therapy - methods ; Tomography, X-Ray Computed - methods ; Treatment Outcome ; Vertebrates: nervous system and sense organs</subject><ispartof>American journal of neuroradiology : AJNR, 2008-09, Vol.29 (8), p.1471-1475</ispartof><rights>2008 INIST-CNRS</rights><rights>Copyright © American Society of Neuroradiology 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119059/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119059/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20675796$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18599577$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rosenthal, E.S</creatorcontrib><creatorcontrib>Schwamm, L.H</creatorcontrib><creatorcontrib>Roccatagliata, L</creatorcontrib><creatorcontrib>Coutts, S.B</creatorcontrib><creatorcontrib>Demchuk, A.M</creatorcontrib><creatorcontrib>Schaefer, P.W</creatorcontrib><creatorcontrib>Gonzalez, R.G</creatorcontrib><creatorcontrib>Hill, M.D</creatorcontrib><creatorcontrib>Halpern, E.F</creatorcontrib><creatorcontrib>Lev, M.H</creatorcontrib><title>Role of Recanalization in Acute Stroke Outcome: Rationale for a CT Angiogram-Based "Benefit of Recanalization" Model</title><title>American journal of neuroradiology : AJNR</title><addtitle>AJNR Am J Neuroradiol</addtitle><description>In acute middle cerebral artery (MCA) stroke, CT angiographic (CTA) source images (CTA-SI) identify tissue likely to infarct despite early recanalization. This pilot study evaluated the impact of recanalization status on clinical and radiologic predictors of patient outcomes.
Of 44 patients undergoing CT/CTA within 6 hours of developing symptoms of proximal MCA ischemia, 19 patients achieved complete proximal MCA (MCA M1) recanalization. Admission National Institutes of Health Stroke Scale (NIHSS) score, onset-to-imaging time, CTA-SI Alberta Stroke Program Early CT Score, MCA M1 occlusion, cerebrovascular collaterals score, and CTA-SI lesion volume were correlated with 3- to 6-month follow-up modified Rankin Scale (mRS). We developed 2 stepwise regression models: one for patients with complete MCA M1 recanalization and one for patients without complete recanalization.
Complete and incomplete recanalization groups had similar median admission NIHSS scores (19 versus 19) and mean onset-to-imaging times (2.3 versus 1.9 hours) but different proportions of patients achieving mRS scores 0-2 (74% versus 40%; P = .04). The only independent predictors of clinical outcome in patients with complete recanalization were onset-to-imaging time and admission CTA-SI lesion volume (total model R(2) = 0.75; P = .01). The only independent predictors of outcome in patients with incomplete recanalization were admission CTA-SI lesion volume and NIHSS score (total model R(2) = 0.66; P = .007).
Regardless of recanalization status, admission CTA-SI lesion volume was associated with clinical outcome. Recanalization status did, however, affect which variables in addition to CTA-SI volume significantly impacted clinical outcome: time with complete recanalization and NIHSS with incomplete recanalization. This finding may support the development of a model predicting the potential clinical benefit expected with early successful recanalization.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Brain</subject><subject>Cerebral Angiography - methods</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Humans</subject><subject>Infarction, Middle Cerebral Artery - diagnostic imaging</subject><subject>Infarction, Middle Cerebral Artery - therapy</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system</subject><subject>Pilot Projects</subject><subject>Prognosis</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Radiographic Image Interpretation, Computer-Assisted - methods</subject><subject>Reproducibility of Results</subject><subject>Sensitivity and Specificity</subject><subject>Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors</subject><subject>Thrombolytic Therapy - methods</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Treatment Outcome</subject><subject>Vertebrates: nervous system and sense organs</subject><issn>0195-6108</issn><issn>1936-959X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNplkFFrFDEUhYNY7Fp98QdIKOjb1GQySSY-FLaL2kKlsFbwLdyZubObmklqMuOiv96hrrXi03043_0OHEJecHYiuK7ewE1IJ0vOpXhEFtwIVRhpvjwmC8aNLBRn9SF5mvMNY0waXT4hh7yWxkitF2RcR4809nSNLQTw7ieMLgbqAl2204j005jiV6RX09jGAd_S9V0O81MfEwW6uqbLsHFxk2AoziBjR4_PMGDvxv-1x_Rj7NA_Iwc9-IzP9_eIfH7_7np1XlxefbhYLS-LrSjlWHSIRrOq0QxaxTTrABF4BX2FHRO8arCXWLesEVorWSvJq6o2uu5Y2QBqJY7I6W_v7dQM2LUYxgTe3iY3QPphIzj7bxLc1m7id1tzbuatZsHrvSDFbxPm0Q4ut-g9BIxTtspIIeo78OXDpvuKP0PPwKs9ALkF3ycIrcv3XMmUltqov41bt9nuXEKbB_B-1nK72-1KY2vLK83FL3femyc</recordid><startdate>20080901</startdate><enddate>20080901</enddate><creator>Rosenthal, E.S</creator><creator>Schwamm, L.H</creator><creator>Roccatagliata, L</creator><creator>Coutts, S.B</creator><creator>Demchuk, A.M</creator><creator>Schaefer, P.W</creator><creator>Gonzalez, R.G</creator><creator>Hill, M.D</creator><creator>Halpern, E.F</creator><creator>Lev, M.H</creator><general>Am Soc Neuroradiology</general><general>American Society of Neuroradiology</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20080901</creationdate><title>Role of Recanalization in Acute Stroke Outcome: Rationale for a CT Angiogram-Based "Benefit of Recanalization" Model</title><author>Rosenthal, E.S ; Schwamm, L.H ; Roccatagliata, L ; Coutts, S.B ; Demchuk, A.M ; Schaefer, P.W ; Gonzalez, R.G ; Hill, M.D ; Halpern, E.F ; Lev, M.H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-h325t-dee9704b70ac6070daeea14af4ed0314bef5e8c0b377658651448978d02bae763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Brain</topic><topic>Cerebral Angiography - methods</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Humans</topic><topic>Infarction, Middle Cerebral Artery - diagnostic imaging</topic><topic>Infarction, Middle Cerebral Artery - therapy</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous system</topic><topic>Pilot Projects</topic><topic>Prognosis</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Radiographic Image Interpretation, Computer-Assisted - methods</topic><topic>Reproducibility of Results</topic><topic>Sensitivity and Specificity</topic><topic>Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors</topic><topic>Thrombolytic Therapy - methods</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Treatment Outcome</topic><topic>Vertebrates: nervous system and sense organs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rosenthal, E.S</creatorcontrib><creatorcontrib>Schwamm, L.H</creatorcontrib><creatorcontrib>Roccatagliata, L</creatorcontrib><creatorcontrib>Coutts, S.B</creatorcontrib><creatorcontrib>Demchuk, A.M</creatorcontrib><creatorcontrib>Schaefer, P.W</creatorcontrib><creatorcontrib>Gonzalez, R.G</creatorcontrib><creatorcontrib>Hill, M.D</creatorcontrib><creatorcontrib>Halpern, E.F</creatorcontrib><creatorcontrib>Lev, M.H</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of neuroradiology : AJNR</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rosenthal, E.S</au><au>Schwamm, L.H</au><au>Roccatagliata, L</au><au>Coutts, S.B</au><au>Demchuk, A.M</au><au>Schaefer, P.W</au><au>Gonzalez, R.G</au><au>Hill, M.D</au><au>Halpern, E.F</au><au>Lev, M.H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of Recanalization in Acute Stroke Outcome: Rationale for a CT Angiogram-Based "Benefit of Recanalization" Model</atitle><jtitle>American journal of neuroradiology : AJNR</jtitle><addtitle>AJNR Am J Neuroradiol</addtitle><date>2008-09-01</date><risdate>2008</risdate><volume>29</volume><issue>8</issue><spage>1471</spage><epage>1475</epage><pages>1471-1475</pages><issn>0195-6108</issn><eissn>1936-959X</eissn><coden>AAJNDL</coden><abstract>In acute middle cerebral artery (MCA) stroke, CT angiographic (CTA) source images (CTA-SI) identify tissue likely to infarct despite early recanalization. This pilot study evaluated the impact of recanalization status on clinical and radiologic predictors of patient outcomes.
Of 44 patients undergoing CT/CTA within 6 hours of developing symptoms of proximal MCA ischemia, 19 patients achieved complete proximal MCA (MCA M1) recanalization. Admission National Institutes of Health Stroke Scale (NIHSS) score, onset-to-imaging time, CTA-SI Alberta Stroke Program Early CT Score, MCA M1 occlusion, cerebrovascular collaterals score, and CTA-SI lesion volume were correlated with 3- to 6-month follow-up modified Rankin Scale (mRS). We developed 2 stepwise regression models: one for patients with complete MCA M1 recanalization and one for patients without complete recanalization.
Complete and incomplete recanalization groups had similar median admission NIHSS scores (19 versus 19) and mean onset-to-imaging times (2.3 versus 1.9 hours) but different proportions of patients achieving mRS scores 0-2 (74% versus 40%; P = .04). The only independent predictors of clinical outcome in patients with complete recanalization were onset-to-imaging time and admission CTA-SI lesion volume (total model R(2) = 0.75; P = .01). The only independent predictors of outcome in patients with incomplete recanalization were admission CTA-SI lesion volume and NIHSS score (total model R(2) = 0.66; P = .007).
Regardless of recanalization status, admission CTA-SI lesion volume was associated with clinical outcome. Recanalization status did, however, affect which variables in addition to CTA-SI volume significantly impacted clinical outcome: time with complete recanalization and NIHSS with incomplete recanalization. This finding may support the development of a model predicting the potential clinical benefit expected with early successful recanalization.</abstract><cop>Oak Brook, IL</cop><pub>Am Soc Neuroradiology</pub><pmid>18599577</pmid><doi>10.3174/ajnr.A1153</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Biological and medical sciences Brain Cerebral Angiography - methods Female Fundamental and applied biological sciences. Psychology Humans Infarction, Middle Cerebral Artery - diagnostic imaging Infarction, Middle Cerebral Artery - therapy Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Nervous system Pilot Projects Prognosis Radiodiagnosis. Nmr imagery. Nmr spectrometry Radiographic Image Interpretation, Computer-Assisted - methods Reproducibility of Results Sensitivity and Specificity Somesthesis and somesthetic pathways (proprioception, exteroception, nociception) interoception electrolocation. Sensory receptors Thrombolytic Therapy - methods Tomography, X-Ray Computed - methods Treatment Outcome Vertebrates: nervous system and sense organs |
| title | Role of Recanalization in Acute Stroke Outcome: Rationale for a CT Angiogram-Based "Benefit of Recanalization" Model |
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