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Impact of Slow Blood Filling via Collaterals on Infarct Growth: Comparison of Mismatch and Collateral Status
BACKGROUND AND PURPOSE: Perfusion-diffusion mismatch has been evaluated to determine whether the presence of a target mismatch helps to identify patients who respond favorably to recanalization therapies. We compared the impact on infarct growth of collateral status and the presence of a penumbra, u...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Korean Stroke Society
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5307934/ https://www.ncbi.nlm.nih.gov/pubmed/28030891 http://dx.doi.org/10.5853/jos.2016.00955 |
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author | Son, Jeong Pyo Lee, Mi Ji Kim, Suk Jae Chung, Jong-Won Cha, Jihoon Kim, Gyeong-Moon Chung, Chin-Sang Lee, Kwang Ho Bang, Oh Young |
author_facet | Son, Jeong Pyo Lee, Mi Ji Kim, Suk Jae Chung, Jong-Won Cha, Jihoon Kim, Gyeong-Moon Chung, Chin-Sang Lee, Kwang Ho Bang, Oh Young |
author_sort | Son, Jeong Pyo |
collection | PubMed |
description | BACKGROUND AND PURPOSE: Perfusion-diffusion mismatch has been evaluated to determine whether the presence of a target mismatch helps to identify patients who respond favorably to recanalization therapies. We compared the impact on infarct growth of collateral status and the presence of a penumbra, using magnetic resonance perfusion (MRP) techniques. METHODS: Consecutive patients who were candidates for recanalization therapy and underwent serial diffusion-weighted imaging (DWI) and MRP were enrolled. A collateral flow map derived from MRP source data was generated by automatic post-processing. The impact of a target mismatch (Tmax>6 s/apparent diffusion coefficient (ADC) volume≥1.8, ADC volume<70 mL; and Tmax>10 s for ADC volume<100 mL) on infarct growth was compared with MR-based collateral grading on day 7 DWI, using multivariate linear regression analysis. RESULTS: Among 73 patients, 55 (75%) showed a target mismatch, whereas collaterals were poor in 14 (19.2%), intermediate in 36 (49.3%), and good in 23 (31.5%) patients. After adjusting for initial severity of stroke, early recanalization (P<0.001) and the MR-based collateral grading (P=0.001), but not the presence of a target mismatch, were independently associated with infarct growth. Even in patients with a target mismatch and successful recanalization, the degree of infarct growth depended on the collateral status. Perfusion status at later Tmax time points (beyond the arterial phase) was more closely correlated with collateral status. CONCLUSIONS: Patients with good collaterals show a favorable outcome in terms of infarct growth, regardless of the presence of a target mismatch pattern. The presence of slow blood filling predicts collateral status and infarct growth. |
format | Online Article Text |
id | pubmed-5307934 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Korean Stroke Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-53079342017-02-14 Impact of Slow Blood Filling via Collaterals on Infarct Growth: Comparison of Mismatch and Collateral Status Son, Jeong Pyo Lee, Mi Ji Kim, Suk Jae Chung, Jong-Won Cha, Jihoon Kim, Gyeong-Moon Chung, Chin-Sang Lee, Kwang Ho Bang, Oh Young J Stroke Original Article BACKGROUND AND PURPOSE: Perfusion-diffusion mismatch has been evaluated to determine whether the presence of a target mismatch helps to identify patients who respond favorably to recanalization therapies. We compared the impact on infarct growth of collateral status and the presence of a penumbra, using magnetic resonance perfusion (MRP) techniques. METHODS: Consecutive patients who were candidates for recanalization therapy and underwent serial diffusion-weighted imaging (DWI) and MRP were enrolled. A collateral flow map derived from MRP source data was generated by automatic post-processing. The impact of a target mismatch (Tmax>6 s/apparent diffusion coefficient (ADC) volume≥1.8, ADC volume<70 mL; and Tmax>10 s for ADC volume<100 mL) on infarct growth was compared with MR-based collateral grading on day 7 DWI, using multivariate linear regression analysis. RESULTS: Among 73 patients, 55 (75%) showed a target mismatch, whereas collaterals were poor in 14 (19.2%), intermediate in 36 (49.3%), and good in 23 (31.5%) patients. After adjusting for initial severity of stroke, early recanalization (P<0.001) and the MR-based collateral grading (P=0.001), but not the presence of a target mismatch, were independently associated with infarct growth. Even in patients with a target mismatch and successful recanalization, the degree of infarct growth depended on the collateral status. Perfusion status at later Tmax time points (beyond the arterial phase) was more closely correlated with collateral status. CONCLUSIONS: Patients with good collaterals show a favorable outcome in terms of infarct growth, regardless of the presence of a target mismatch pattern. The presence of slow blood filling predicts collateral status and infarct growth. Korean Stroke Society 2017-01 2016-12-12 /pmc/articles/PMC5307934/ /pubmed/28030891 http://dx.doi.org/10.5853/jos.2016.00955 Text en Copyright © 2017 Korean Stroke Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Son, Jeong Pyo Lee, Mi Ji Kim, Suk Jae Chung, Jong-Won Cha, Jihoon Kim, Gyeong-Moon Chung, Chin-Sang Lee, Kwang Ho Bang, Oh Young Impact of Slow Blood Filling via Collaterals on Infarct Growth: Comparison of Mismatch and Collateral Status |
title | Impact of Slow Blood Filling via Collaterals on Infarct Growth: Comparison of Mismatch and Collateral Status |
title_full | Impact of Slow Blood Filling via Collaterals on Infarct Growth: Comparison of Mismatch and Collateral Status |
title_fullStr | Impact of Slow Blood Filling via Collaterals on Infarct Growth: Comparison of Mismatch and Collateral Status |
title_full_unstemmed | Impact of Slow Blood Filling via Collaterals on Infarct Growth: Comparison of Mismatch and Collateral Status |
title_short | Impact of Slow Blood Filling via Collaterals on Infarct Growth: Comparison of Mismatch and Collateral Status |
title_sort | impact of slow blood filling via collaterals on infarct growth: comparison of mismatch and collateral status |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5307934/ https://www.ncbi.nlm.nih.gov/pubmed/28030891 http://dx.doi.org/10.5853/jos.2016.00955 |
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