Effect of Oxygen Extraction (Brush-Sign) on Baseline Core Infarct Depends on Collaterals (HIR)
Objectives: Baseline-core-infarct volume is a critical factor in patient selection and outcome in acute ischemic stroke (AIS) before mechanical thrombectomy (MT). We determined whether oxygen extraction efficiency and arterial collaterals, two different physiologic components of the cerebral ischemi...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-01-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2020.618765/full |
| _version_ | 1818950656113770496 |
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| author | Adrien Guenego Matthew Leipzig Robert Fahed Eric S. Sussman Tobias D. Faizy Blake W. Martin David G. Marcellus Max Wintermark Jean-Marc Olivot Gregory W. Albers Maarten G. Lansberg Jeremy J. Heit |
| author_facet | Adrien Guenego Matthew Leipzig Robert Fahed Eric S. Sussman Tobias D. Faizy Blake W. Martin David G. Marcellus Max Wintermark Jean-Marc Olivot Gregory W. Albers Maarten G. Lansberg Jeremy J. Heit |
| author_sort | Adrien Guenego |
| collection | DOAJ |
| description | Objectives: Baseline-core-infarct volume is a critical factor in patient selection and outcome in acute ischemic stroke (AIS) before mechanical thrombectomy (MT). We determined whether oxygen extraction efficiency and arterial collaterals, two different physiologic components of the cerebral ischemic cascade, interacted to modulate baseline-core-infarct volume in patients with AIS-LVO undergoing MT triage.Methods: Between January 2015 and March 2018, consecutive patients with an AIS and M1 occlusion considered for MT with a baseline MRI and perfusion-imaging were included. Variables such as baseline-core-infarct volume [mL], arterial collaterals (HIR: TMax > 10 s volume/TMax > 6 s), high oxygen extraction (HOE, presence of the brush-sign on T2*) were assessed. A linear-regression was used to test the interaction of HOE and HIR with baseline-core-infarct volume, after including potential confounding variables.Results: We included 103 patients. Median age was 70 (58–78), and 63% were female. Median baseline-core-infarct volume was 32 ml (IQR 8–74.5). Seventy six patients (74%) had HOE. In a multivariate analysis both favorable HIR collaterals (p = 0.02) and HOE (p = 0.038) were associated with lower baseline-core-infarct volume. However, HOE significantly interacted with HIR (p = 0.01) to predict baseline-core-infarct volume, favorable collaterals (low HIR) with HOE was associated with small baseline-core-infarct whereas patients with poor collaterals (high HIR) and HOE had large baseline-core-infarct.Conclusion: While HOE under effective collateral blood-flow has the lowest baseline-core-infarct volume of all patients, the protective effect of HOE reverses under poor collateral blood-flow and may be a maladaptive response to ischemic stroke as measured by core infarctions in AIS-LVO patients undergoing MT triage. |
| first_indexed | 2024-12-20T09:22:03Z |
| format | Article |
| id | doaj.art-52c1850378324f4caa54f4a3977466ee |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-20T09:22:03Z |
| publishDate | 2021-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-52c1850378324f4caa54f4a3977466ee2022-12-21T19:45:16ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-01-011110.3389/fneur.2020.618765618765Effect of Oxygen Extraction (Brush-Sign) on Baseline Core Infarct Depends on Collaterals (HIR)Adrien Guenego0Matthew Leipzig1Robert Fahed2Eric S. Sussman3Tobias D. Faizy4Blake W. Martin5David G. Marcellus6Max Wintermark7Jean-Marc Olivot8Gregory W. Albers9Maarten G. Lansberg10Jeremy J. Heit11Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United StatesInterventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United StatesDivision of Neurology, Department of Medicine, Ottawa Hospital, Ottawa, ON, CanadaInterventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United StatesInterventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United StatesInterventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United StatesInterventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United StatesInterventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United StatesToulouse Stroke Center, Toulouse, FranceStanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United StatesStanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United StatesInterventional and Diagnostic Neuroradiology, Stanford Medical Center, Palo Alto, CA, United StatesObjectives: Baseline-core-infarct volume is a critical factor in patient selection and outcome in acute ischemic stroke (AIS) before mechanical thrombectomy (MT). We determined whether oxygen extraction efficiency and arterial collaterals, two different physiologic components of the cerebral ischemic cascade, interacted to modulate baseline-core-infarct volume in patients with AIS-LVO undergoing MT triage.Methods: Between January 2015 and March 2018, consecutive patients with an AIS and M1 occlusion considered for MT with a baseline MRI and perfusion-imaging were included. Variables such as baseline-core-infarct volume [mL], arterial collaterals (HIR: TMax > 10 s volume/TMax > 6 s), high oxygen extraction (HOE, presence of the brush-sign on T2*) were assessed. A linear-regression was used to test the interaction of HOE and HIR with baseline-core-infarct volume, after including potential confounding variables.Results: We included 103 patients. Median age was 70 (58–78), and 63% were female. Median baseline-core-infarct volume was 32 ml (IQR 8–74.5). Seventy six patients (74%) had HOE. In a multivariate analysis both favorable HIR collaterals (p = 0.02) and HOE (p = 0.038) were associated with lower baseline-core-infarct volume. However, HOE significantly interacted with HIR (p = 0.01) to predict baseline-core-infarct volume, favorable collaterals (low HIR) with HOE was associated with small baseline-core-infarct whereas patients with poor collaterals (high HIR) and HOE had large baseline-core-infarct.Conclusion: While HOE under effective collateral blood-flow has the lowest baseline-core-infarct volume of all patients, the protective effect of HOE reverses under poor collateral blood-flow and may be a maladaptive response to ischemic stroke as measured by core infarctions in AIS-LVO patients undergoing MT triage.https://www.frontiersin.org/articles/10.3389/fneur.2020.618765/fullstrokeinterventionalMRI perfusion imagingMRI susceptibility weighted imagingthrombectomy |
| spellingShingle | Adrien Guenego Matthew Leipzig Robert Fahed Eric S. Sussman Tobias D. Faizy Blake W. Martin David G. Marcellus Max Wintermark Jean-Marc Olivot Gregory W. Albers Maarten G. Lansberg Jeremy J. Heit Effect of Oxygen Extraction (Brush-Sign) on Baseline Core Infarct Depends on Collaterals (HIR) Frontiers in Neurology stroke interventional MRI perfusion imaging MRI susceptibility weighted imaging thrombectomy |
| title | Effect of Oxygen Extraction (Brush-Sign) on Baseline Core Infarct Depends on Collaterals (HIR) |
| title_full | Effect of Oxygen Extraction (Brush-Sign) on Baseline Core Infarct Depends on Collaterals (HIR) |
| title_fullStr | Effect of Oxygen Extraction (Brush-Sign) on Baseline Core Infarct Depends on Collaterals (HIR) |
| title_full_unstemmed | Effect of Oxygen Extraction (Brush-Sign) on Baseline Core Infarct Depends on Collaterals (HIR) |
| title_short | Effect of Oxygen Extraction (Brush-Sign) on Baseline Core Infarct Depends on Collaterals (HIR) |
| title_sort | effect of oxygen extraction brush sign on baseline core infarct depends on collaterals hir |
| topic | stroke interventional MRI perfusion imaging MRI susceptibility weighted imaging thrombectomy |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2020.618765/full |
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