TY - JOUR
T1 - Follow-up infarct volume on fluid attenuated inversion recovery (FLAIR) imaging in distal medium vessel occlusions
T2 - the role of cerebral blood volume index
AU - Salim, Hamza
AU - Lakhani, Dhairya A.
AU - Balar, Aneri
AU - Musmar, Basel
AU - Adeeb, Nimer
AU - Hoseinyazdi, Meisam
AU - Luna, Licia
AU - Deng, Francis
AU - Hyson, Nathan Z.
AU - Mei, Janet
AU - Dmytriw, Adam A.
AU - Guenego, Adrien
AU - Faizy, Tobias D.
AU - Heit, Jeremy J.
AU - Albers, Gregory W.
AU - Urrutia, Victor C.
AU - Llinas, Raf
AU - Marsh, Elisabeth B.
AU - Hillis, Argye E.
AU - Nael, Kambiz
AU - Yedavalli, Vivek
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2024.
PY - 2024/6
Y1 - 2024/6
N2 - Background: Distal medium vessel occlusions (DMVOs) contribute substantially to the incidence of acute ischemic strokes (AIS) and pose distinct challenges in clinical management and prognosis. Neuroimaging techniques, such as Fluid Attenuation Inversion Recovery (FLAIR) imaging and cerebral blood volume (CBV) index derived from perfusion imaging, have significantly improved our ability to assess the impact of strokes and predict their outcomes. The primary objective of this study was to investigate relationship between follow-up infarct volume (FIV) as assessed by FLAIR imaging in patients with DMVOs. Methods: This prospectively collected, retrospective reviewed cohort study included patients from two comprehensive stroke centers within the Johns Hopkins Medical Enterprise, spanning August 2018–October 2022. The cohort consisted of adults with AIS attributable to DMVO. Detailed imaging analyses were conducted, encompassing non-contrast CT, CT angiography (CTA), CT perfusion (CTP), and FLAIR imaging. Univariable and multivariable linear regression models were employed to assess the association between different factors and FIV. Results: The study included 79 patients with DMVO stroke with a median age of 69 years (IQR, 62–77 years), and 57% (n = 45) were female. There was a negative correlation between the CBV index and FIV in a univariable linear regression analysis (Beta = – 16; 95% CI, – 23 to – 8.3; p < 0.001) and a multivariable linear regression model (Beta = – 9.1 per 0.1 change; 95% CI, – 15 to – 2.7; p = 0.006). Diabetes was independently associated with larger FIV (Beta = 46; 95% CI, 16 to 75; p = 0.003). Additionally, a higher baseline ASPECTS was associated with lower FIV (Beta = – 30; 95% CI, – 41 to – 20; p < 0.001). Conclusion: Our findings underscore the CBV index as an independent association with FIV in DMVOs, which highlights the critical role of collateral circulation in determining stroke outcomes in this patient population. In addition, our study confirms a negative association of ASPECTS with FLAIR FIV and identifies diabetes as independent factor associated with larger FIV. These insights pave the way for further large-scale, prospective studies to corroborate these findings, thereby refining the strategies for stroke prognostication and management.
AB - Background: Distal medium vessel occlusions (DMVOs) contribute substantially to the incidence of acute ischemic strokes (AIS) and pose distinct challenges in clinical management and prognosis. Neuroimaging techniques, such as Fluid Attenuation Inversion Recovery (FLAIR) imaging and cerebral blood volume (CBV) index derived from perfusion imaging, have significantly improved our ability to assess the impact of strokes and predict their outcomes. The primary objective of this study was to investigate relationship between follow-up infarct volume (FIV) as assessed by FLAIR imaging in patients with DMVOs. Methods: This prospectively collected, retrospective reviewed cohort study included patients from two comprehensive stroke centers within the Johns Hopkins Medical Enterprise, spanning August 2018–October 2022. The cohort consisted of adults with AIS attributable to DMVO. Detailed imaging analyses were conducted, encompassing non-contrast CT, CT angiography (CTA), CT perfusion (CTP), and FLAIR imaging. Univariable and multivariable linear regression models were employed to assess the association between different factors and FIV. Results: The study included 79 patients with DMVO stroke with a median age of 69 years (IQR, 62–77 years), and 57% (n = 45) were female. There was a negative correlation between the CBV index and FIV in a univariable linear regression analysis (Beta = – 16; 95% CI, – 23 to – 8.3; p < 0.001) and a multivariable linear regression model (Beta = – 9.1 per 0.1 change; 95% CI, – 15 to – 2.7; p = 0.006). Diabetes was independently associated with larger FIV (Beta = 46; 95% CI, 16 to 75; p = 0.003). Additionally, a higher baseline ASPECTS was associated with lower FIV (Beta = – 30; 95% CI, – 41 to – 20; p < 0.001). Conclusion: Our findings underscore the CBV index as an independent association with FIV in DMVOs, which highlights the critical role of collateral circulation in determining stroke outcomes in this patient population. In addition, our study confirms a negative association of ASPECTS with FLAIR FIV and identifies diabetes as independent factor associated with larger FIV. These insights pave the way for further large-scale, prospective studies to corroborate these findings, thereby refining the strategies for stroke prognostication and management.
KW - Acute ischemic stroke
KW - Cerebral blood volume
KW - Collaterals
KW - Distal vessel occlusion
KW - Infarct volume
KW - Medium vessel occlusion
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U2 - 10.1007/s00415-024-12279-3
DO - 10.1007/s00415-024-12279-3
M3 - Article
C2 - 38507075
AN - SCOPUS:85188185553
SN - 0340-5354
VL - 271
SP - 3389
EP - 3397
JO - Journal of neurology
JF - Journal of neurology
IS - 6
ER -