Vol 55, No 5 (2021)
Research Paper
Published online: 2021-09-01

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Venous return in acute ischaemic stroke patients measured during computed tomography angiography of head and neck

Bartłomiej Łasocha1, Anna M. Grochowska2, Paweł Wrona3, Paweł J. Brzegowy2, Roman Pułyk3, Agnieszka Słowik3, Paweł R. Latacz3, Tadeusz J. Popiela2
Pubmed: 34477214
Neurol Neurochir Pol 2021;55(5):462-468.

Abstract

Introduction: The aim of this study was to analyse the general features and usefulness of the time elapsed between the start of contrast agent infusion and its appearance in the aortic arch in acute ischaemic stroke patients subjected to baseline computed tomographic angiography. This is, to the best of our knowledge, the first study of this parameter in a clinical context. We will refer to it hereafter as ‘needle-to-aorta delay’ (NAD). Material and methods: The following were recorded: the time it took iodinated contrast media to reach the aorta, the site of occlusion, and automatic perfusion assessments of infarct and salvageable tissue volumes. Demographic data such as age and sex, comorbidities, and clinical factors including heart rate, blood pressure, time elapsed from symptom onset, initial stroke severity, and course of disease, were also assessed. Results: We analysed 252 cases of stroke. NAD correlated with tissue at risk volume, and was greater for patients with hypertension and atrial fibrillation. The observed time was significantly shorter with less favourable core-to-penumbra ratios. No link was found between NAD and either the rate of infarct progression or the long-term clinical result. Conclusions: Although no clinical benefit was proven as a result of measuring the time it took contrast media to reach the aorta, our study implies that not only is the brain subject to circulation, but it may also affect its functioning.

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References

  1. Berkheimer OA, Fransen PSS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015; 1: 11–20.
  2. Jovin TG, Saver JL, Ribo M, et al. Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake up and late presenting strokes undergoing neurointervention with Trevo (DAWN) trial methods. Int J Stroke. 2017; 12(6): 641–652.
  3. Albers GW, Lansberg MG, Kemp S, et al. A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3). Int J Stroke. 2017; 12(8): 896–905.
  4. Thomalla G, Boutitie F, Fiebach JB, et al. WAKE-UP Investigators. Stroke with snknown time of symptom onset: baseline clinical and magnetic resonance imaging data of the first thousand patients in WAKE-UP (Efficacy and safety of MRI-based thrombolysis in wake-up stroke: A randomized, doubleblind, placebo-controlled trial). Stroke. 2017; 48(3): 770–773.
  5. Desai SM, Rocha M, Jovin TG, et al. High variability in neuronal loss. Stroke. 2019; 50(1): 34–37.
  6. Harjola VP, Mullens W, Banaszewski M, et al. Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail. 2017; 19(7): 821–836.
  7. Liu X, Czosnyka M, Donnelly J, et al. Assessment of cerebral autoregulation indices - a modelling perspective. Sci Rep. 2020; 10(1): 9600.
  8. Lichtwarck-Aschoff M, Beale R, Pfeiffer U. Central venous pressure, pulmonary artery occlusion pressure, intrathoracic blood volume, and right ventricular end-diastolic volume as indicators of cardiac preload. Journal of Critical Care. 1996; 11(4): 180–188.
  9. Campbell BCv, Parsons MW, Campbell BCV, et al. EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015; 372(11): 1009–1018.
  10. Saver JL. Time is brain--quantified. Stroke. 2006; 37(1): 263–266.
  11. Xiao M, Li Q, Feng H, et al. Neural vascular mechanism for the cerebral blood flow autoregulation after hemorrhagic stroke. Neural Plast. 2017; 2017: 5819514.
  12. Lo EH, Rosenberg GA. The neurovascular unit in health and disease: introduction. Stroke. 2009; 40(3 Suppl): S2–S3.
  13. von Kummer R, Dzialowski I. Imaging of cerebral ischemic edema and neuronal death. Neuroradiology. 2017; 59(6): 545–553.
  14. Agarwal S, Matys T, Marrapu ST, et al. Is CT-based perfusion and collateral imaging sensitive to time since stroke onset? Front Neurol. 2015; 6: 70.
  15. Wintermark M, Flanders AE, Velthuis B, et al. Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke. 2006; 37(4): 979–985.
  16. Vagal A, Menon BK, Foster LD, et al. Association between CT angiogram collaterals and CT perfusion in the interventional management of stroke III trial. Stroke. 2016; 47(2): 535–538.
  17. Fanou EM, Knight J, Aviv RI, et al. Effect of collaterals on clinical presentation, baseline imaging, complications, and outcome in acute stroke. AJNR Am J Neuroradiol. 2015; 36(12): 2285–2291.
  18. Compagne KCJ, van der Sluijs PM, van den Wijngaard IR, et al. MR CLEAN Registry Investigators. Endovascular treatment: The role of dominant caliber M2 segment occlusion in ischemic stroke. Stroke. 2019; 50(2): 419–427.
  19. Rocha M, Jovin TG. Fast versus slow progressors of infarct growth in large vessel occlusion stroke: clinical and research implications. Stroke. 2017; 48(9): 2621–2627.
  20. Chaturvedi A, Oppenheimer D, Rajiah P, et al. Contrast opacification on thoracic CT angiography: challenges and solutions. Insights into Imaging. 2016; 8(1): 127–140.
  21. Lakoma A, Tuite D, Sheehan J, et al. Measurement of pulmonary circulation parameters using time-resolved MR angiography in patients after Ross procedure. AJR Am J Roentgenol. 2010; 194(4): 912–919.
  22. Kathiria NN, Devcic Z, Chen JS, et al. Assessment of left ventricular enlargement at multidetector computed tomography. J Comput Assist Tomogr. 2015; 39(5): 794–796.
  23. Sohrabi S, Hope M, Saloner D, et al. Left atrial transverse diameter on computed tomography angiography can accurately diagnose left atrial enlargement in patients with atrial fibrillation. J Thorac Imaging. 2015; 30(3): 214–217.
  24. Heit JJ, Wintermark M. Perfusion computed tomography for the evaluation of acute ischemic stroke: strengths and pitfalls. Stroke. 2016; 47(4): 1153–1158.



Neurologia i Neurochirurgia Polska