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Brush Sign on pre-treatment imaging is associated with good functional outcome in stroke patients treated with mechanical thrombectomy: A prospective monocentric study 治疗前成像上的刷状标志与接受机械血栓切除术治疗的脑卒中患者的良好功能预后有关:前瞻性单中心研究
IF 3.5 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-16 DOI: 10.1016/j.neurad.2024.02.004
Vi Tuan Hua , Sami Benhammida , Thi Phuong Nguyen , Grégoire Boulouis , Alexandre Doucet , Nathalie Caucheteux , Sébastien Soize , Solène Moulin

Background

The Brush Sign (BrS) is a radiological biomarker (MRI) showing signal decrease of subependymal and deep medullary veins on paramagnetic-sensitive magnetic resonance sequences. Previous studies have shown controversial results regarding the prognostic value of BrS. We aimed to assess whether BrS on T2*-weighted sequences could predict functional prognosis in patients treated with mechanical thrombectomy (MT).

Methods

We included all consecutive patients with large artery occlusion related stroke in anterior circulation treated with MT between February 2020 and August 2022 at Reims University Hospital. Multivariable logistic regression models were used to investigate factors associated with BrS and its impact on outcomes.

Results

Of the 327 included patients, 124 (37,9%) had a BrS on baseline MRI. Mean age was 72 ± 16 years and 184 (56,2 %) were female. In univariate analysis, BrS was associated with a younger age (67 vs 74; p<0.001), a higher NIHSS score (16(10–20) vs 13(8–19); p = 0.047) history of diabetes (15.3% vs 26.1 %; p = 0.022) and a shorter onset to MRI time (145.5 (111.3–188.5) vs 162 (126–220) p = 0.008). In multivariate analyses, patients with a BrS were younger (OR:0.970 (0.951 – 0.989)), tend to have a higher NIHSS score at baseline (OR:1.046 (1.000 – 1.094) and were less likely to have diabetes (OR: 0.433; 0.214–0.879). The presence of BrS was independently associated with functional independence (OR: 2.234(1.158–4,505) at 3 months but not with mortality nor with symptomatic intracerebral hemorrhage.

Conclusion

BrS on pre-treatment imaging could be considered as a biomarker of physiological adaptation to cerebral ischemia, allowing prolonged viability of brain tissue and might participate in the therapeutic decision.

背景:刷状征象(BrS)是一种放射生物标志物(磁共振成像),在顺磁感应磁共振序列上显示髓内脐下和髓质深静脉信号减弱。以往的研究显示,关于 BrS 的预后价值存在争议。我们的目的是评估 T2* 加权序列上的 BrS 是否能预测接受机械血栓切除术(MT)治疗的患者的功能性预后:我们纳入了 2020 年 2 月至 2022 年 8 月期间兰斯大学医院所有接受 MT 治疗的前循环大动脉闭塞相关脑卒中连续患者。采用多变量逻辑回归模型研究与 BrS 相关的因素及其对预后的影响:在纳入的 327 名患者中,124 人(37.9%)在基线磁共振成像中发现有 BrS。平均年龄为 72 ± 16 岁,184 人(56.2%)为女性。在单变量分析中,BrS 与年龄较小有关(67 岁对 74 岁;p 结论:治疗前成像中的BrS可被视为脑缺血生理适应的生物标志物,可延长脑组织的存活时间,并可参与治疗决策。
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引用次数: 0
Outcomes of antiplatelet therapy before endovascular treatment of acute large vessel occlusion: Data from the ANGEL-ACT registry 急性大血管闭塞血管内治疗前抗血小板治疗的效果:来自 ANGEL-ACT 注册中心的数据。
IF 3.5 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-10 DOI: 10.1016/j.neurad.2024.02.001
Dapeng Sun , Shuo Li , Raynald , Xiaochuan Huo , Baixue Jia , Xu Tong , Anxin Wang , Ning Ma , Feng Gao , Dapeng Mo , Thanh N Nguyen , Zhongrong Miao , ANGEL-ACT study group

Objectives

To investigate whether single or dual antiplatelet therapy (SAPT or DAPT) within 24 hours before endovascular treatment (EVT) could improve the clinical outcomes of patients with large vessel occlusion (LVO).

Methods

Patients from the ANGEL-ACT registry were divided into antiplatelet therapy (APT) and non-APT groups. The APT group was divided into SAPT and DAPT groups. Outcome measurement included 90-day modified Rankin Scale (mRS) distribution, change in the NIHSS at 7 days or discharge, number of passes, modified first pass effect (mFPE), symptomatic intracranial hemorrhage (SICH), and mortality within 90 days. To compare the outcomes, we performed multivariable analyses by adjusting for the propensity score calculated by the logistic regression model.

Results

Of 1611 patients, 1349 were in the non-APT group, while 262 (16.3 %) were in the APT group (122 [46.6 %] received SAPT, 140 [53.4 %] received DAPT). APT, SAPT or DAPT were not associated with a shift to better outcomes (non-APT vs. APT, 3[0–5] vs. 3[0–5], common odds ratio [OR], 1.04, 95 %confidence interval [CI]:0.82–1.34, P = 0.734). DAPT was associated with mFPE (OR,2.05, 95 %CI:1.39–3.01, P<0.001), more NIHSS reduction at 7 days or discharge (β, -2.13, 95 %CI: -4.02–-0.24, P = 0.028), lower number of passes (β, -0.40, 95 %CI: -0.68–-0.12, P=0.006), and shorter procedure duration (β, -12.4, 95 %CI: -23.74–-1.05, P = 0.032) without increasing odds of successful recanalization, PH within 24 hours and mortality with 90 days .

Conclusions

APT before MT for AIS due to LVO does not affect clinical outcome in 90 days despite a tendency to reduce MT procedure time and number of passes. APT before MT in LVO does not increase SICH or mortality rates.

目的研究在血管内治疗(EVT)前24小时内进行单一或双重抗血小板治疗(SAPT或DAPT)能否改善大血管闭塞(LVO)患者的临床预后:方法:将ANGEL-ACT登记处的患者分为抗血小板治疗(APT)组和非APT组。APT 组又分为 SAPT 组和 DAPT 组。结果测量包括 90 天改良 Rankin 量表(mRS)分布、7 天或出院时 NIHSS 的变化、通过次数、首次通过再通畅(FPR)、成功再通畅、症状性颅内出血(SICH)和 90 天内死亡率。为了比较结果,我们根据逻辑回归模型计算出的倾向得分进行了多变量分析:在 1611 名患者中,1349 人属于非 APT 组,262 人(16.3%)属于 APT 组(122 人[46.6%]接受 SAPT,140 人[53.4%]接受 DAPT)。APT、SAPT 或 DAPT 与转好结果无关(非 APT vs. APT,3[0-5] vs. 3[0-5],普通比值比 [OR],1.04,95% 置信区间 [CI]:0.82-1.34,P= 0.734)。DAPT 与 FPR 相关(OR,2.05, 95%CI:1.39-3.01, PConclusions:尽管 MT 有缩短手术时间和减少通过次数的趋势,但在 MT 前进行 APT 并不会影响 LVO 引起的 AIS 在 90 天内的临床预后。在 LVO MT 前进行 APT 不会增加 SICH 或死亡率。
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引用次数: 0
Growing importance of brain morphometry analysis in the clinical routine: The hidden impact of MR sequence parameters 脑形态分析在临床常规工作中的重要性与日俱增:磁共振序列参数的隐性影响
IF 3.5 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.04.003
Michael Rebsamen , Milena Capiglioni , Robert Hoepner , Anke Salmen , Roland Wiest , Piotr Radojewski , Christian Rummel

Volumetric assessment based on structural MRI is increasingly recognized as an auxiliary tool to visual reading, also in examinations acquired in the clinical routine. However, MRI acquisition parameters can significantly influence these measures, which must be considered when interpreting the results on an individual patient level.

This Technical Note shall demonstrate the problem. Using data from a dedicated experiment, we show the influence of two crucial sequence parameters on the GM/WM contrast and their impact on the measured volumes. A simulated contrast derived from acquisition parameters TI/TR may serve as surrogate and is highly correlated (r=0.96) with the measured contrast.

在临床常规检查中,基于结构性核磁共振成像的容积评估越来越多地被认为是肉眼判读的辅助工具。然而,核磁共振成像采集参数会对这些测量结果产生重大影响,在解释个体患者的结果时必须考虑到这一点。我们利用专门实验的数据,展示了两个关键序列参数对 GM/WM 对比度的影响及其对测量体积的影响。根据采集参数 TI/TR 得出的模拟对比度可作为替代对比度,与测量对比度高度相关(r=0.96)。
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引用次数: 0
Computed diffusion-weighted imaging in patients with transient neurovascular symptoms with and without ischemic infarction 伴有或不伴有缺血性梗死的一过性神经血管症状患者的计算机弥散加权成像
IF 3.5 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.02.007
A. Förster , Ana Ramos , H. Wenz , C. Groden , A. Alonso

Purpose

Detection of ischemic lesions in patients with transient neurovascular symptoms is relevant for the estimation of the risk of a subsequent stroke and etiological classification. To improve detection rates, different technical approaches have been used, such as diffusion-weighted imaging (DWI) with high b-values or higher magnetic field strength. Here, we sought to investigate the value of computed DWI (cDWI) with high b-values in these patients.

Methods

From an MRI report database we identified patients with transient neurovascular symptoms who underwent repeated MRI including DWI. cDWI was calculated with a monoexponential model with high b-values (2000, 3000, and 4000 s/mm2) and compared to the routinely used standard DWI with regard to presence of ischemic lesions and lesion detectability.

Result

Overall 33 patients with transient neurovascular symptoms (71 [IQR 57–83.5] years; 21 [63.6%] male) were included. On DWI, acute ischemic lesions were observed in 22 (78.6%). Acute ischemic lesions were observed in 17 (51.5%) patients on initial DWI, and in 26 (78.8%) patients on follow-up DWI. Lesion detectability was rated significantly better on cDWI at 2000s/mm2 compared to standard DWI. In 2 (9.1%) patients, cDWI at 2000s/mm2 revealed an acute ischemic lesion proven on follow-up standard DWI which was not detected with certainty on the initial standard DWI.

Conclusion

cDWI might be a valuable addition to routinely acquired standard DWI in patients with transient neurovascular symptoms since its use might result in improved ischemic lesion detection. A b-value of 2000s/mm2 seems most promising for clinical practice.

目的检测一过性神经血管症状患者的缺血性病变与估计后续中风风险和病因分类有关。为了提高检测率,人们采用了不同的技术方法,如高 b 值或更高磁场强度的弥散加权成像(DWI)。方法从磁共振成像报告数据库中,我们确定了重复接受磁共振成像(包括 DWI)的一过性神经血管症状患者。结果共纳入 33 名有短暂神经血管症状的患者(71 [IQR 57-83.5] 岁;21 [63.6%] 名男性)。在 DWI 上,22 例患者(78.6%)观察到急性缺血性病变。在初始 DWI 中观察到急性缺血性病变的患者有 17 人(51.5%),在随访 DWI 中观察到急性缺血性病变的患者有 26 人(78.8%)。与标准 DWI 相比,2000s/mm2 的 cDWI 病变可探测性明显更好。有 2 例(9.1%)患者在复查标准 DWI 时发现了急性缺血性病变,而在最初的标准 DWI 中并未确定检测到该病变。b 值为 2000s/mm2 似乎最适合临床实践。
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引用次数: 0
Acknowledging our 2023 reviewers 感谢我们的 2023 年审查员
IF 3.5 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/S0150-9861(24)00085-3
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引用次数: 0
Retrograde placement of flow diversion for the treatment of giant internal carotid artery aneurysm 逆行置放分流治疗颈内巨动脉瘤。
IF 3.5 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.11.001
Haoyu Zhu , Shikai Liang , Yupeng Zhang , Chuhan Jiang

The use of flow diverters has been well-validated for the treatment of giant internal carotid artery aneurysms. However, in certain complex cases, the navigation of stent microcatheters across the neck may pose a relative challenge.1, 2, 3 In this technical video (video 1), we present the case of a patient in their 50s experiencing discomfort in the left eye. Angiography identified a giant aneurysm in the ophthalmic segment of the left internal carotid artery. Before seeking care at our institution, the patient had two interventional procedures, both unsuccessful due to difficulties in navigating the microcatheter past the aneurysm neck.4, 5 In our management, after multiple unsuccessful anterograde attempts, we employed a retrograde strategy via the vertebral-basilar-posterior communicating artery route. This approach facilitated the successful deployment of the flow diverter and led to effective aneurysm embolization, underscoring the value of retrograde techniques for challenging cases.

血流分流器的应用已被证实可用于治疗巨大的颈内动脉瘤。然而,在某些复杂的情况下,支架微导管穿过颈部的导航可能会带来相对的挑战。1-3在这段技术视频(视频1)中,我们介绍了一位50多岁的患者左眼不适的病例。血管造影发现在左颈内动脉眼段有一个巨大的动脉瘤。在本院就诊前,患者进行了两次介入手术,均因微导管难以通过动脉瘤颈部而失败。4-5在我们的治疗中,在多次逆行尝试失败后,我们采用了椎-基底-后交通动脉路线的逆行策略。这种方法促进了分流器的成功部署,并导致了有效的动脉瘤栓塞,强调了逆行技术在具有挑战性的病例中的价值。
{"title":"Retrograde placement of flow diversion for the treatment of giant internal carotid artery aneurysm","authors":"Haoyu Zhu ,&nbsp;Shikai Liang ,&nbsp;Yupeng Zhang ,&nbsp;Chuhan Jiang","doi":"10.1016/j.neurad.2023.11.001","DOIUrl":"10.1016/j.neurad.2023.11.001","url":null,"abstract":"<div><p><span><span>The use of flow diverters has been well-validated for the treatment of giant </span>internal carotid artery aneurysms. However, in certain complex cases, the navigation of stent microcatheters across the neck may pose a relative challenge.</span><span>1</span>, <span>2</span>, <span>3</span> In this technical video (<span>video 1</span><span>), we present the case of a patient in their 50s experiencing discomfort in the left eye. Angiography<span> identified a giant aneurysm in the ophthalmic<span> segment of the left internal carotid artery. Before seeking care at our institution, the patient had two interventional procedures, both unsuccessful due to difficulties in navigating the microcatheter past the aneurysm neck.</span></span></span><span>4</span>, <span>5</span><span> In our management, after multiple unsuccessful anterograde attempts, we employed a retrograde strategy via the vertebral-basilar-posterior communicating artery route. This approach facilitated the successful deployment of the flow diverter and led to effective aneurysm embolization, underscoring the value of retrograde techniques for challenging cases.</span></p></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"51 1","pages":"Page 89"},"PeriodicalIF":3.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Percutaneous transluminal angioplasty and stenting of post-irradiated stenosis of subclavian artery: A matched case-control study 锁骨下动脉放射后狭窄的经皮腔内血管成形术和支架植入术:匹配病例对照研究
IF 3.5 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.06.004
Chun-Chao Huang , Hsin-Fan Chiang , Cheng‑Chih Hsieh , Hui-Chen Lin , Chia-Hung Wu , Te-Ming Lin , Jung-Hsuan Chen , Chao-Bao Luo , Feng-Chi Chang

Background

Although radiotherapy is common for head/neck and chest cancers (HNCC), it can result in post-irradiation stenosis of the subclavian artery (PISSA). The efficacy of percutaneous transluminal angioplasty and stenting (PTAS) to treat severe PISSA is not well-clarified.

Aims

To compare the technical safety and outcomes of PTAS between patients with severe PISSA (RT group) and radiation-naïve counterparts (non-RT group).

Methods

During 2000 and 2021, we retrospectively enrolled patients with severe symptomatic stenosis (>60%) of the subclavian artery who underwent PTAS. The rate of new recent vertebrobasilar ischaemic lesions (NRVBIL), diagnosed on diffusion-weight imaging (DWI) within 24 h of postprocedural brain MRI; symptom relief; and long-term stent patency were compared between the two groups.

Results

Technical success was achieved in all 61 patients in the two groups. Compared with the non-RT group (44 cases, 44 lesions), the RT group (17 cases, 18 lesions) had longer stenoses (22.1 vs 11.1 mm, P = 0.003), more ulcerative plaques (38.9% vs 9.1%, P = 0.010), and more medial- or distal-segment stenoses (44.4% vs 9.1%, P<0.001). The technical safety and outcome between the non-RT group and the RT group were NRVBIL on DWI of periprocedural brain MRI 30.0% vs 23.1%, P = 0.727; symptom recurrence rate (mean follow-up 67.1 ± 50.0 months) 2.3% vs 11.8%, P = 0.185; and significant in-stent restenosis rate (>50%) 2.3% vs 11.1%, P = 0.200.

Conclusion

The technical safety and outcome of PTAS for PISSA were not inferior to those of radiation-naïve counterparts. PTAS for PISSA is an effective treatment for medically refractory ischaemic symptoms of HNCC patients with PISSA.

背景虽然放疗是头颈部和胸部癌症(HNCC)的常见治疗方法,但放疗可能导致锁骨下动脉放疗后狭窄(PISSA)。目的 比较重度 PISSA 患者(RT 组)和放射治疗无效患者(非 RT 组)PTAS 的技术安全性和疗效。方法 2000 年至 2021 年期间,我们回顾性地纳入了接受 PTAS 的锁骨下动脉重度无症状狭窄(60%)患者。比较了两组患者术后 24 小时内脑核磁共振弥散加权成像(DWI)诊断的新近椎基底动脉缺血性病变(NRVBIL)发生率、症状缓解率和支架长期通畅率。与非 RT 组(44 例,44 个病灶)相比,RT 组(17 例,18 个病灶)的血管狭窄时间更长(22.1 mm vs 11.1 mm,P = 0.003),溃疡性斑块更多(38.9% vs 9.1%,P = 0.010),内侧或远端血管狭窄更多(44.4% vs 9.1%,P<0.001)。非 RT 组与 RT 组的技术安全性和结果分别为:围手术期脑 MRI DWI 上的 NRVBIL 为 30.0% vs 23.1%,P = 0.727;症状复发率(平均随访 67.1 ± 50.0 个月)为 2.结论PISSA的PTAS的技术安全性和结果并不逊色于未接受放射治疗的同行。PISSA的PTAS是治疗HNCC患者PISSA药物难治性缺血症状的有效方法。
{"title":"Percutaneous transluminal angioplasty and stenting of post-irradiated stenosis of subclavian artery: A matched case-control study","authors":"Chun-Chao Huang ,&nbsp;Hsin-Fan Chiang ,&nbsp;Cheng‑Chih Hsieh ,&nbsp;Hui-Chen Lin ,&nbsp;Chia-Hung Wu ,&nbsp;Te-Ming Lin ,&nbsp;Jung-Hsuan Chen ,&nbsp;Chao-Bao Luo ,&nbsp;Feng-Chi Chang","doi":"10.1016/j.neurad.2023.06.004","DOIUrl":"10.1016/j.neurad.2023.06.004","url":null,"abstract":"<div><h3>Background</h3><p>Although radiotherapy is common for head/neck and chest cancers (HNCC), it can result in post-irradiation stenosis of the subclavian artery (PISSA). The efficacy of percutaneous transluminal angioplasty and stenting (PTAS) to treat severe PISSA is not well-clarified.</p></div><div><h3>Aims</h3><p>To compare the technical safety and outcomes of PTAS between patients with severe PISSA (RT group) and radiation-naïve counterparts (non-RT group).</p></div><div><h3>Methods</h3><p>During 2000 and 2021, we retrospectively enrolled patients with severe symptomatic stenosis (&gt;60%) of the subclavian artery who underwent PTAS. The rate of new recent vertebrobasilar ischaemic lesions (NRVBIL), diagnosed on diffusion-weight imaging (DWI) within 24 h of postprocedural brain MRI; symptom relief; and long-term stent patency were compared between the two groups.</p></div><div><h3>Results</h3><p>Technical success was achieved in all 61 patients in the two groups. Compared with the non-RT group (44 cases, 44 lesions), the RT group (17 cases, 18 lesions) had longer stenoses (22.1 vs 11.1 mm, <em>P</em> = 0.003), more ulcerative plaques (38.9% vs 9.1%, <em>P</em> = 0.010), and more medial- or distal-segment stenoses (44.4% vs 9.1%, <em>P</em>&lt;0.001). The technical safety and outcome between the non-RT group and the RT group were NRVBIL on DWI of periprocedural brain MRI 30.0% vs 23.1%, <em>P</em> = 0.727; symptom recurrence rate (mean follow-up 67.1 ± 50.0 months) 2.3% vs 11.8%, <em>P</em> = 0.185; and significant in-stent restenosis rate (&gt;50%) 2.3% vs 11.1%, <em>P</em> = 0.200.</p></div><div><h3>Conclusion</h3><p>The technical safety and outcome of PTAS for PISSA were not inferior to those of radiation-naïve counterparts. PTAS for PISSA is an effective treatment for medically refractory ischaemic symptoms of HNCC patients with PISSA.</p></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"51 1","pages":"Pages 66-73"},"PeriodicalIF":3.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10095421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Thrombectomy alone vs thrombectomy with over 2/3-dose intravenous thrombolysis pretreatment in the DIRECT-MT trial DIRECT-MT试验中单纯血栓切除术与血栓切除术加2/3剂量以上静脉溶栓预处理的比较
IF 3.5 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.04.004
Wenjin Yang , Hongjian Zhang , Lei Zhang , Zifu Li , Pengfei Xing , Hongjian Shen , Yongxin Zhang , Xiaoxi Zhang , Xiaofei Ye , Qinghai Huang , Yi Xu , Yongwei Zhang , Jianmin Liu , Conghui Li , Pengfei Yang , DIRECT-MT Investigators

Background

The DIRECT-MT trial showed that endovascular thrombectomy (EVT) alone was noninferior to EVT preceded by intravenous alteplase. However, the infusion of intravenous alteplase was uncompleted before the initiation of EVT in most cases of this trial. Therefore, the additional benefit and risk of over 2/3-dose intravenous alteplase pretreatment remain to be assessed.

Methods

We assessed patients with acute anterior circulation ischemic stroke who received EVT alone or with over 2/3-dose intravenous alteplase pretreatment from the DIRECT-MT trial. Patients were assigned to the thrombectomy-alone group and the alteplase pretreatment group. The primary outcome was the distribution of modified Rankin Scale (mRS) at 90 days. The interaction of treatment allocation and collateral capacity was assessed.

Results

A total of 393 patients (thrombectomy alone: 315; alteplase pretreatment: 78) were identified. The thrombectomy alone was comparable with alteplase pretreatment prior to the thrombectomy on the distribution of mRS at 90 days without significant effect modification by collateral capacity (adjusted common odds ratio (acOR), 1.12; 95% CI, 0.72–1.74; adjusted P for interaction = 0.83). Successful reperfusion before thrombectomy and the number of passes in the thrombectomy alone group differed significantly from the alteplase pretreatment group (2.6% vs. 11.5%; corrected P = 0.02 and 2 vs. 1; corrected P = 0.003). There was no interaction between treatment allocation and collateral capacity on all outcomes.

Conclusions

EVT alone and EVT preceded by over 2/3-dose intravenous alteplase might have equal efficacy and safety for patients with acute anterior circulation large vessel occlusion, except for successful perfusion before thrombectomy and the number of passes.

背景DIRECT-MT试验显示,单纯血管内血栓切除术(EVT)的效果并不优于先进行静脉注射阿替普酶的EVT。然而,在该试验的大多数病例中,静脉阿替普酶输注在开始 EVT 之前尚未完成。方法我们评估了 DIRECT-MT 试验中单纯接受 EVT 或接受超过 2/3 剂量静脉阿替普酶预处理的急性前循环缺血性卒中患者。患者被分配到单纯血栓切除术组和阿替普酶预处理组。主要结果是90天时改良Rankin量表(mRS)的分布情况。结果 共确定了 393 名患者(单纯血栓切除术:315 人;阿替普酶预处理:78 人)。单纯血栓切除术与阿替普酶预处理在 90 天后的 mRS 分布方面具有可比性,但并不因侧支容量的不同而产生显著的影响(调整后的共同几率比(acOR),1.12;95% CI,0.72-1.74;调整后的交互作用 P = 0.83)。单纯血栓切除术组与阿替普酶预处理组在血栓切除术前再灌注成功率和通过次数上有显著差异(2.6% 对 11.5%;校正后 P = 0.02;2 对 1;校正后 P = 0.003)。结论对于急性前循环大血管闭塞患者,除血栓切除术前成功灌注和通过次数外,单纯EVT和EVT前超过2/3剂量静脉注射阿替普酶可能具有相同的疗效和安全性。
{"title":"Thrombectomy alone vs thrombectomy with over 2/3-dose intravenous thrombolysis pretreatment in the DIRECT-MT trial","authors":"Wenjin Yang ,&nbsp;Hongjian Zhang ,&nbsp;Lei Zhang ,&nbsp;Zifu Li ,&nbsp;Pengfei Xing ,&nbsp;Hongjian Shen ,&nbsp;Yongxin Zhang ,&nbsp;Xiaoxi Zhang ,&nbsp;Xiaofei Ye ,&nbsp;Qinghai Huang ,&nbsp;Yi Xu ,&nbsp;Yongwei Zhang ,&nbsp;Jianmin Liu ,&nbsp;Conghui Li ,&nbsp;Pengfei Yang ,&nbsp;DIRECT-MT Investigators","doi":"10.1016/j.neurad.2023.04.004","DOIUrl":"10.1016/j.neurad.2023.04.004","url":null,"abstract":"<div><h3>Background</h3><p>The DIRECT-MT trial showed that endovascular thrombectomy<span> (EVT) alone was noninferior to EVT preceded by intravenous alteplase. However, the infusion of intravenous alteplase was uncompleted before the initiation of EVT in most cases of this trial. Therefore, the additional benefit and risk of over 2/3-dose intravenous alteplase pretreatment remain to be assessed.</span></p></div><div><h3>Methods</h3><p>We assessed patients with acute anterior circulation ischemic stroke<span> who received EVT alone or with over 2/3-dose intravenous alteplase pretreatment from the DIRECT-MT trial. Patients were assigned to the thrombectomy-alone group and the alteplase pretreatment group. The primary outcome was the distribution of modified Rankin Scale<span> (mRS) at 90 days. The interaction of treatment allocation and collateral capacity was assessed.</span></span></p></div><div><h3>Results</h3><p><span>A total of 393 patients (thrombectomy alone: 315; alteplase pretreatment: 78) were identified. The thrombectomy alone was comparable with alteplase pretreatment prior to the thrombectomy on the distribution of mRS at 90 days without significant effect modification by collateral capacity (adjusted common odds ratio (acOR), 1.12; 95% CI, 0.72–1.74; adjusted P for interaction = 0.83). Successful reperfusion before thrombectomy and the number of passes in the thrombectomy alone group differed significantly from the alteplase pretreatment group (2.6% vs. 11.5%; corrected </span><em>P</em> = 0.02 and 2 vs. 1; corrected <em>P</em> = 0.003). There was no interaction between treatment allocation and collateral capacity on all outcomes.</p></div><div><h3>Conclusions</h3><p>EVT alone and EVT preceded by over 2/3-dose intravenous alteplase might have equal efficacy and safety for patients with acute anterior circulation large vessel occlusion, except for successful perfusion before thrombectomy and the number of passes.</p></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"51 1","pages":"Pages 52-58"},"PeriodicalIF":3.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9484099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
MRI features and disability in multiple sclerosis: A systematic review and meta-analysis 多发性硬化症的 MRI 特征与残疾:系统回顾和荟萃分析。
IF 3.5 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.11.007
Fardin Nabizadeh , Rasa Zafari , Mobin Mohamadi , Tahereh Maleki , Mohammad Sadegh Fallahi , Nazanin Rafiei

Background

In this systematic review and meta-analysis, we aimed to investigate the correlation between disability in patients with Multiple sclerosis (MS) measured by the Expanded Disability Status Scale (EDSS) and brain Magnetic Resonance Imaging (MRI) features to provide reliable results on which characteristics in the MRI can predict disability and prognosis of the disease.

Methods

A systematic literature search was performed using three databases including PubMed, Scopus, and Web of Science. The selected peer-reviewed studies must report a correlation between EDSS scores and MRI features. The correlation coefficients of included studies were converted to the Fisher's z scale, and the results were pooled.

Results

Overall, 105 studies A total of 16,613 patients with MS entered our study. We found no significant correlation between total brain volume and EDSS assessment (95 % CI: -0.37 to 0.08; z-score: -0.15). We examined the potential correlation between the volume of T1 and T2 lesions and the level of disability. A positive significant correlation was found (95 % CI: 0.19 to 0.43; z-score: 0.31), (95 % CI: 0.17 to 0.33; z-score: 0.25). We observed a significant correlation between white matter volume and EDSS score in patients with MS (95 % CI: -0.37 to -0.03; z-score: -0.21). Moreover, there was a significant negative correlation between gray matter volume and disability (95 % CI: -0.025 to -0.07; z-score: -0.16).

Conclusion

In conclusion, this systematic review and meta-analysis revealed that disability in patients with MS is linked to extensive changes in different brain regions, encompassing gray and white matter, as well as T1 and T2 weighted MRI lesions.

背景:在这篇系统性综述和荟萃分析中,我们旨在研究多发性硬化症(MS)患者通过扩展残疾状况量表(EDSS)测量的残疾程度与脑部磁共振成像(MRI)特征之间的相关性,从而为磁共振成像中哪些特征可以预测残疾程度和疾病预后提供可靠的结果:使用 PubMed、Scopus 和 Web of Science 等三个数据库进行了系统的文献检索。所选的同行评审研究必须报告 EDSS 评分与 MRI 特征之间的相关性。将纳入研究的相关系数转换成费雪z标度,并对结果进行汇总:共有 105 项研究,16613 名多发性硬化症患者参与了研究。我们发现大脑总体积与 EDSS 评估之间无明显相关性(95 % CI:-0.37 至 0.08;z 值:-0.15)。我们研究了 T1 和 T2 病变体积与残疾程度之间的潜在相关性。结果发现两者之间存在正相关(95 % CI:0.19 至 0.43;z-评分:0.31)和负相关(95 % CI:0.17 至 0.33;z-评分:0.25)。我们观察到多发性硬化症患者的白质体积与 EDSS 评分之间存在明显的相关性(95 % CI:-0.37 至 -0.03;z 评分:-0.21)。此外,灰质体积与残疾之间存在明显的负相关(95 % CI:-0.025 至 -0.07;z 评分:-0.16):总之,该系统综述和荟萃分析表明,多发性硬化症患者的残疾与不同脑区的广泛变化有关,包括灰质和白质,以及T1和T2加权磁共振成像病变。
{"title":"MRI features and disability in multiple sclerosis: A systematic review and meta-analysis","authors":"Fardin Nabizadeh ,&nbsp;Rasa Zafari ,&nbsp;Mobin Mohamadi ,&nbsp;Tahereh Maleki ,&nbsp;Mohammad Sadegh Fallahi ,&nbsp;Nazanin Rafiei","doi":"10.1016/j.neurad.2023.11.007","DOIUrl":"10.1016/j.neurad.2023.11.007","url":null,"abstract":"<div><h3>Background</h3><p>In this systematic review<span> and meta-analysis, we aimed to investigate the correlation between disability in patients<span><span> with Multiple sclerosis (MS) measured by the </span>Expanded Disability Status Scale (EDSS) and brain Magnetic Resonance Imaging (MRI) features to provide reliable results on which characteristics in the MRI can predict disability and prognosis of the disease.</span></span></p></div><div><h3>Methods</h3><p>A systematic literature search was performed using three databases including PubMed, Scopus, and Web of Science. The selected peer-reviewed studies must report a correlation between EDSS scores and MRI features. The correlation coefficients of included studies were converted to the Fisher's z scale, and the results were pooled.</p></div><div><h3>Results</h3><p>Overall, 105 studies A total of 16,613 patients with MS entered our study. We found no significant correlation between total brain volume and EDSS assessment (95 % CI: -0.37 to 0.08; z-score: -0.15). We examined the potential correlation between the volume of T1 and T2 lesions and the level of disability. A positive significant correlation was found (95 % CI: 0.19 to 0.43; z-score: 0.31), (95 % CI: 0.17 to 0.33; z-score: 0.25). We observed a significant correlation between white matter volume and EDSS score in patients with MS (95 % CI: -0.37 to -0.03; z-score: -0.21). Moreover, there was a significant negative correlation between gray matter volume and disability (95 % CI: -0.025 to -0.07; z-score: -0.16).</p></div><div><h3>Conclusion</h3><p>In conclusion, this systematic review and meta-analysis revealed that disability in patients with MS is linked to extensive changes in different brain regions, encompassing gray and white matter, as well as T1 and T2 weighted MRI lesions.</p></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"51 1","pages":"Pages 24-37"},"PeriodicalIF":3.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Day 1 carotid patency on outcome in dissection-related tandem occlusions treated with mechanical thrombectomy 采用机械血栓切除术治疗夹层相关串联闭塞症时,第 1 天颈动脉通畅对疗效的影响
IF 3.5 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2024.01.076
Guillaume Perrin , Elisabeth Molinier , Benjamin Gory , Maeva Kyheng , Julien Labreuche , Marco Pasi , Kevin Janot , Romain Bourcier , Igor Sibon , Arturo Consoli , Jean-Philippe Desilles , Jean-Marc Olivot , Chrysanthi Papagiannaki , Sebastien Soize , Jean-Christophe Gentric , Cyril Dargazanli , Jildaz Caroff , Raoul Pop , Olivier Naggara , Solene Moulin , Gaultier Marnat

Background

The clinical benefit of mechanical thrombectomy(MT) for stroke patients with tandem occlusion is similar to that of isolated intracranial occlusions. However, the management of cervical internal carotid artery(ICA) occlusion during the MT, particularly in the setting of carotid dissection, remains controversial. We aimed to investigate the clinical impact of cervical ICA patency at day 1 on 3-month functional outcome.

Methods

We collected data from the Endovascular Treatment in Ischemic Stroke, a prospective national registry in 30 French centers performing MT between January 2015 and January 2022. Inclusion criteria were consecutive tandem occlusions related to cervical ICA dissection treated with MT. Tandem occlusions of other etiology, isolated cervical ICA occlusions without intracranial thrombus and patients without day-1 ICA imaging were excluded. Primary endpoint was the 3-month functional outcome. Secondary endpoints included intracranial hemorrhage(ICH), excellent outcome, mortality and early neurological improvement. A sensitivity analysis was performed in patients with intracranial favorable recanalization after MT.

Results

During the study period, 137 patients were included of which 89(65%) presented ICA patency at day 1. The odds of favorable outcome did not significantly differ between patients with patent and occluded ICA at day 1(68.7 vs 59.1%;aOR=1.30;95%CI 0.56-3.00,p=0.54). Excellent outcome, early neurological improvement, mortality and ICH were also comparable between groups. Sensitivity analysis showed similar results.

Conclusion

ICA patency at day 1 in patients with tandem occlusions related to dissection did not seem to influence functional outcome. Endovascular recanalization of the cervical ICA including stenting might not be systematically required in this setting.

背景:机械取栓术(MT)对串联闭塞的卒中患者的临床获益与孤立的颅内闭塞相似。然而,在机械取栓术中如何处理颈内动脉(ICA)闭塞,尤其是在颈动脉夹层的情况下,仍存在争议。我们旨在研究颈部颈内动脉(ICA)第1天的通畅对3个月功能预后的临床影响:我们从缺血性中风的血管内治疗中收集了数据,这是一项前瞻性的国家登记,在 2015 年 1 月至 2022 年 1 月期间,法国有 30 个中心开展了 MT 治疗。纳入标准为接受 MT 治疗的颈部 ICA 夹层相关的连续串联闭塞。其他病因引起的串联闭塞、无颅内血栓的孤立性颈部ICA闭塞以及未进行ICA第一天成像的患者不在纳入之列。主要终点是 3 个月的功能预后。次要终点包括颅内出血(ICH)、优良预后、死亡率和早期神经功能改善。对MT术后颅内再通有利的患者进行了敏感性分析:在研究期间,共纳入了 137 名患者,其中 89 人(65%)在第 1 天时出现了 ICA 通畅。第 1 天 ICA 通畅和闭塞患者的良好预后几率无明显差异(68.7 vs 59.1%;aOR=1.30;95%CI 0.56-3.00,p=0.54)。两组患者的优良预后、早期神经功能改善、死亡率和 ICH 也相当。敏感性分析显示了相似的结果:结论:对于因夹层导致串联闭塞的患者,第1天的ICA通畅率似乎并不影响功能预后。在这种情况下,可能不需要系统性地进行包括支架在内的颈部 ICA 血管内再通路治疗。
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Journal of Neuroradiology
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