Shadi Yaghi1,2, Brian Mac Grory1, Shyam Prabhakaran2, Sharon D Yeatts3, Shawna Cutting2, Mahesh Jayaraman2,4,5, Daniel Sacchetti2, Karen Furie2, Osama O Zaidat6, David S Liebeskind7, Pooja Khatri8,9. 1. Department of Neurology, New York Langone Medical Center, New York, NY. 2. Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, RI. 3. Department of Neurology, Northwestern University, Chicago, IL. 4. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC. 5. Department of Diagnostic Imaging, the Warren Alpert Medical School of Brown University, Providence, RI. 6. Department of Neurosurgery, the Warren Alpert Medical School of Brown University, Providence, RI. 7. Department of Neurology, Mercy St. Vincent Medical Center, Toledo, OH. 8. Neurovascular Imaging Research Core and UCLA Stroke Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA. 9. Department of Neurology, University of Cincinnati, Cincinnati, OH.
Abstract
BACKGROUND AND PURPOSE: Studies have shown an association between infarct patterns and recurrent stroke in patients with symptomatic intracranial stenosis (sICAS) but there are limited data on associations with perfusion imaging mismatch profile. We aim to determine the association between infarct pattern, optimal mismatch profile definition, and recurrent cerebrovascular events (RCVE) in patients with anterior circulation sICAS. METHODS: This is a retrospective study of consecutive patients with acutely sICAS admitted to a comprehensive stroke center over 18 month's period. Patients with sICAS underwent magnetic resonance perfusion (MRP) imaging within 24 hours from admission. Infarct patterns (internal BZ [IBZ], cortical BZ [CBZ], and core/perforator [C/P]) and RCVE within 90 days, were independently adjudicated by two reviewers. We compared mismatch profiles and recurrent event rates across infarct patterns. RESULTS: Twenty-five patients met inclusion criteria; 28% had IBZ infarcts and overall RCVE rate was 32.0%. When compared to patients without IBZ infarcts, those with IBZ infarcts were more likely to have a target mismatch profile using Tmax > 6 seconds (60% vs. 6.7%, P = .007) and RCVE (62.5% vs. 11.8%, P = .01). There were no associations between CBZ and C/P infarcts and target mismatch profiles and RCVE. CONCLUSION: IBZ infarcts may be a surrogate marker of distal perfusion status and RCVE risk. Larger multicenter, prospective, core-lab blindly adjudicated studies are needed to confirm our findings.
BACKGROUND AND PURPOSE: Studies have shown an association between infarct patterns and recurrent stroke in patients with symptomatic intracranial stenosis (sICAS) but there are limited data on associations with perfusion imaging mismatch profile. We aim to determine the association between infarct pattern, optimal mismatch profile definition, and recurrent cerebrovascular events (RCVE) in patients with anterior circulation sICAS. METHODS: This is a retrospective study of consecutive patients with acutely sICAS admitted to a comprehensive stroke center over 18 month's period. Patients with sICAS underwent magnetic resonance perfusion (MRP) imaging within 24 hours from admission. Infarct patterns (internal BZ [IBZ], cortical BZ [CBZ], and core/perforator [C/P]) and RCVE within 90 days, were independently adjudicated by two reviewers. We compared mismatch profiles and recurrent event rates across infarct patterns. RESULTS: Twenty-five patients met inclusion criteria; 28% had IBZinfarcts and overall RCVE rate was 32.0%. When compared to patients without IBZinfarcts, those with IBZinfarcts were more likely to have a target mismatch profile using Tmax > 6 seconds (60% vs. 6.7%, P = .007) and RCVE (62.5% vs. 11.8%, P = .01). There were no associations between CBZ and C/P infarcts and target mismatch profiles and RCVE. CONCLUSION:IBZinfarcts may be a surrogate marker of distal perfusion status and RCVE risk. Larger multicenter, prospective, core-lab blindly adjudicated studies are needed to confirm our findings.
Authors: Shadi Yaghi; Pooja Khatri; Adam de Havenon; Sharon Yeatts; Andrew D Chang; Shawna Cutting; Brian Mac Grory; Tina Burton; Mahesh V Jayaraman; Ryan A McTaggart; David Fiorella; Colin Derdeyn; Osama O Zaidat; Seena Dehkharghani; Sepideh Amin-Hanjani; Karen Furie; Shyam Prahbakaran; David Liebeskind Journal: J Neurointerv Surg Date: 2019-09-04 Impact factor: 5.836
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Authors: Adam de Havenon; Pooja Khatri; Shyam Prabhakaran; Sharon D Yeatts; Cecilia Peterson; Daniel Sacchetti; Matthew Alexander; Shawna Cutting; Brian Mac Grory; Karen Furie; David S Liebeskind; Shadi Yaghi Journal: J Neuroimaging Date: 2020-06-24 Impact factor: 2.486
Authors: Shadi Yaghi; Adam de Havenon; Tristan Honda; Jason D Hinman; Radoslav Raychev; Latisha K Sharma; Song Kim; Edward Feldmann; Jose G Romano; Shyam Prabhakaran; David S Liebeskind Journal: J Neuroimaging Date: 2021-02-10 Impact factor: 2.486
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Authors: Rajbeer S Sangha; Shyam Prabhakaran; Edward Feldmann; Tristan Honda; Azhar Nizam; George A Cotsonis; Iszet Campo-Bustillo; Jose G Romano; David S Liebeskind Journal: Front Neurol Date: 2021-01-21 Impact factor: 4.003
Authors: Ahmad A Ballout; Richard B Libman; Julia R Schneider; Karen Black; Panagiotis Sideras; Jason J Wang; Timothy G White; Amir R Dehdashti; Henry H Woo; Jeffrey M Katz Journal: J Am Heart Assoc Date: 2022-02-16 Impact factor: 6.106
Authors: Shadi Yaghi; George Cotsonis; Adam de Havenon; Shyam Prahbakaran; Jose G Romano; Ronald M Lazar; Randolph S Marshall; Edward Feldmann; David S Liebeskind Journal: J Stroke Cerebrovasc Dis Date: 2020-02-07 Impact factor: 2.136