OBJECTIVES: Recent studies indicate an interest in early infarct assessment, mainly using post-interventional perfusion imaging. This work evaluated two specific angiographic signs for infarct prediction in the basal ganglia immediately after successful mechanical intra-arterial thrombectomy. METHODS: In this retrospective study, 57 consecutive patients (mean ± SD age 67 ± 15 years) with acute occlusion of the proximal anterior circulation who underwent mechanical thrombectomy of the M1 segment of the middle cerebral artery were included. Two separate angiographic signs, early venous drainage and capillary blush, were identified and analysed regarding their statistical significance for infarct prediction within the basal ganglia. RESULTS: Four patients were excluded due to parenchymal haemorrhage. Forty-four of 53 patients developed infarction of the basal ganglia. Sensitivity/specificity were 93%/27%, respectively, for the capillary blush sign and 88%/63%, respectively, for the early venous drainage sign. Combining both signs increased the sensitivity and specificity to 88% and 81%, respectively, and increased the positive predictive value to 95%. CONCLUSIONS: Both angiographic signs seem to predict the irreversible damage of tissue in the basal ganglia reliably despite successful recanalization of the middle cerebral artery in patients with ischaemic stroke. KEY POINTS: • Evaluation of success in neurointerventional procedures is mainly based on recanalization rates. • Two separate angiographic signs can predict infarction immediately after proximal MCA recanalization. • Combining both signs increases their specificity.
OBJECTIVES: Recent studies indicate an interest in early infarct assessment, mainly using post-interventional perfusion imaging. This work evaluated two specific angiographic signs for infarct prediction in the basal ganglia immediately after successful mechanical intra-arterial thrombectomy. METHODS: In this retrospective study, 57 consecutive patients (mean ± SD age 67 ± 15 years) with acute occlusion of the proximal anterior circulation who underwent mechanical thrombectomy of the M1 segment of the middle cerebral artery were included. Two separate angiographic signs, early venous drainage and capillary blush, were identified and analysed regarding their statistical significance for infarct prediction within the basal ganglia. RESULTS: Four patients were excluded due to parenchymal haemorrhage. Forty-four of 53 patients developed infarction of the basal ganglia. Sensitivity/specificity were 93%/27%, respectively, for the capillary blush sign and 88%/63%, respectively, for the early venous drainage sign. Combining both signs increased the sensitivity and specificity to 88% and 81%, respectively, and increased the positive predictive value to 95%. CONCLUSIONS: Both angiographic signs seem to predict the irreversible damage of tissue in the basal ganglia reliably despite successful recanalization of the middle cerebral artery in patients with ischaemic stroke. KEY POINTS: • Evaluation of success in neurointerventional procedures is mainly based on recanalization rates. • Two separate angiographic signs can predict infarction immediately after proximal MCA recanalization. • Combining both signs increases their specificity.
Authors: N Lummel; G Schulte-Altedorneburg; C Bernau; T Pfefferkorn; M Patzig; H Janssen; C Opherk; H Brückmann; J Linn Journal: AJNR Am J Neuroradiol Date: 2013-08-01 Impact factor: 3.825
Authors: Randall T Higashida; Anthony J Furlan; Heidi Roberts; Thomas Tomsick; Buddy Connors; John Barr; William Dillon; Steven Warach; Joseph Broderick; Barbara Tilley; David Sacks Journal: Stroke Date: 2003-07-17 Impact factor: 7.914
Authors: Chelsea S Kidwell; Reza Jahan; Jeffrey Gornbein; Jeffry R Alger; Val Nenov; Zahra Ajani; Lei Feng; Brett C Meyer; Scott Olson; Lee H Schwamm; Albert J Yoo; Randolph S Marshall; Philip M Meyers; Dileep R Yavagal; Max Wintermark; Judy Guzy; Sidney Starkman; Jeffrey L Saver Journal: N Engl J Med Date: 2013-02-08 Impact factor: 91.245
Authors: Joseph P Broderick; Yuko Y Palesch; Andrew M Demchuk; Sharon D Yeatts; Pooja Khatri; Michael D Hill; Edward C Jauch; Tudor G Jovin; Bernard Yan; Frank L Silver; Rüdiger von Kummer; Carlos A Molina; Bart M Demaerschalk; Ronald Budzik; Wayne M Clark; Osama O Zaidat; Tim W Malisch; Mayank Goyal; Wouter J Schonewille; Mikael Mazighi; Stefan T Engelter; Craig Anderson; Judith Spilker; Janice Carrozzella; Karla J Ryckborst; L Scott Janis; Renée H Martin; Lydia D Foster; Thomas A Tomsick Journal: N Engl J Med Date: 2013-02-07 Impact factor: 91.245
Authors: Johannes Kaesmacher; Christian Maegerlein; Mirjam Kaesmacher; Claus Zimmer; Holger Poppert; Benjamin Friedrich; Tobias Boeckh-Behrens; Justus F Kleine Journal: J Am Heart Assoc Date: 2017-02-15 Impact factor: 5.501
Authors: Benjamin Friedrich; Donald Lobsien; Christian Maegerlein; Silke Wunderlich; Claus Zimmer; Johannes Kaesmacher; Justus Kleine Journal: Oncotarget Date: 2016-12-27