Share：
Share this content in WeChat
X
[Chinese][PDF]126080
• Clinical Article •
Computational fluid dynamics analysis of hemorrhagic transformation after reperfusion therapy in acute ischemic stroke patients with middle cerebral artery occlusion
TANG Jie  CHEN Guozhong  MAO Cunnan  SU Wen  YIN Xindao 

Cite this article as: Tang J, Chen GZ, Mao CN, et al. Computational fluid dynamics analysis of hemorrhagic transformation after reperfusion therapy in acute ischemic stroke patients with middle cerebral artery occlusion . Chin J Magn Reson Imaging, 2020, 11(3): 161-165. DOI:10.12015/issn.1674-8034.2020.03.001.


[Abstract] Objective: To explore the relationship between hemodynamics of acute ischemic stroke (AIS) caused by middle cerebral artery occlusion and hemorrhagic transformation (HT) after reperfusion therapy based on computational fluid dynamics (CFD).Materials and Methods: A total of 38 AIS patients with middle cerebral artery occlusion confirmed by magnetic resonance angiography (MRA) were included. The data of MRA before treatment and general clinical data at admission were collected and analyzed retrospectively. Based on MRA-CFD models, hemodynamic parameters were obtained as follows: pressure, wall shear stress (WSS) and wall shear stress gradient (WSSG). Rpressure, RWSS, RWSSG is defined as the ratio of pressure, WSS, WSSG at the beginning of middle cerebral artery to the normal diameter of occlusion, respectively. All patients received standard treatment. According to whether there is bleeding on CT or MRI within 48 hours after treatment, the patients were divided into bleeding group and non-bleeding group. We compared the differences of clinical and hemodynamic parameters between the two groups and underwent correlation analysis.Results: Out of 38 patients, there were 17 patients in the bleeding group and 21 patients in the non-bleeding group. Compared with the non-bleeding group, the bleeding group had more hypertension patients (P=0.008), higher admission systolic blood pressure [(149.1±23.9) mm Hg VS (139.3±16.3) mm Hg, P=0.024] and diastolic blood pressure [(90.2±16.7) mm Hg VS (87.7±8.5) mm Hg, P=0.008], higher plasma homocysteine [(16.6±11.1) µmol/L VS (13.2±3.5) µmol/L, P=0.024]. RWSS and RWSSG in the bleeding group were higher than those in the non-bleeding group (P<0.05), while there was no statistical difference regarding to Rpressure (P>0.05). Correlation analysis showed that hypertension (r=-0.428, P=0.007) and RWSS (r=-0.341, P=0.036) had statistical difference with HT after reperfusion therapy.Conclusions: Hypertension, local intravascular RWSS were associated with HT after reperfusion therapy in patients with acute ischemic stroke due to middle cerebral artery occlusion, hypertension and local intravascular high RWSS before treatment were more likely to lead to HT after reperfusion treatment.
[Keywords] computational fluid dynamics；acute ischemic stroke；magnetic resonance imaging

TANG Jie Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

CHEN Guozhong Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

MAO Cunnan Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

SU Wen Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

YIN Xindao* Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

*Correspondence to: Yin XD, E-mail: y.163yy@163.com

Conflicts of interest   None.

ACKNOWLEDGMENTS  Jiangsu Provincial Special Program of Medical Science No. BE2017614
Received  2019-09-30
Accepted  2020-02-12
DOI: 10.12015/issn.1674-8034.2020.03.001
Cite this article as: Tang J, Chen GZ, Mao CN, et al. Computational fluid dynamics analysis of hemorrhagic transformation after reperfusion therapy in acute ischemic stroke patients with middle cerebral artery occlusion . Chin J Magn Reson Imaging, 2020, 11(3): 161-165. DOI:10.12015/issn.1674-8034.2020.03.001.

[1]
De Silva DA, Brekenfeld C, Ebinger M, et al. The benefits of intravenous thrombolysis related to the site of baseline arterial occlusion in the echoplanar imaging thrombolytic evaluation trial (EPITHET). Stroke, 2010, 41(2): 295-299.
[2]
Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med, 2015, 372(24): 2296-2306.
[3]
Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med, 2015, 372(11): 1019-1030.
[4]
Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med, 2015, 372(11): 1009-1018.
[5]
Bracard S, Ducrocq X, Mas JL, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol, 2016, 15(11): 1138-1147.
[6]
Hao Y, Yang D, Wang H, et al. Predictors for symptomatic intracranial hemorrhage after endovascular treatment of acute ischemic stroke. Stroke, 2017, 48(5): 1203-1209.
[7]
Cappellari M, Turcato G, Forlivesi S, et al. STARTING-SICH nomogram to predict symptomatic intracerebral hemorrhage after intravenous thrombolysis for stroke. Stroke, 2018, 49(2): 397-404.
[8]
Strbian D, Engelter S, Michel P, et al. Symptomatic intracranial hemorrhage after stroke thrombolysis: The SEDAN Score. Ann Neurol, 2012, 71(5): 634-641.
[9]
Amin-Hanjani S, Pandey DK, Rose-Finnell L, et al. Effect of hemodynamics on stroke risk in symptomatic atherosclerotic vertebrobasilar occlusive disease. JAMA Neurol, 2016, 73(2): 178-185.
[10]
Yassi N, Parsons MW, Christensen S, et al. Prediction of poststroke hemorrhagic transformation using computed tomography perfusion. Stroke, 2013, 44(11): 3039-3043.
[11]
Nael K, Knitter JR, Jahan R, et al. Multiparametric magnetic resonance imaging for prediction of parenchymal hemorrhage in acute ischemic stroke after reperfusion therapy. Stroke, 2017, 48(3): 664-670.
[12]
Leng X, Lan L, Ip HL, et al. Hemodynamics and stroke risk in intracranial atherosclerotic disease. Ann Neurol, 2019, 85(5): 752-764.
[13]
Neuberger U. Classification of bleeding events: comparison of ECASS III (European cooperative acute stroke study) and the new Heidelberg bleeding classification. Stroke, 2017, 48(7): 1983-1985.
[14]
Tikhonoff V, Zhang H, Richart T, et al. Blood pressure as a prognostic factor after acute stroke. Lancet Neurol, 2009, 8(10): 938-948.
[15]
Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet, 2016, 387 (10017): 435-443.
[16]
Anderson CS, Huang Y, Lindley RI, et al. Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial. Lancet, 2019, 393(10174): 877-888.
[17]
Samady H, Eshtehardi P, McDaniel MC, et al. Coronary artery wall shear stress is associated with progression and transformation of atherosclerotic plaque and arterial remodeling in patients with coronary artery disease. Circulation, 2011, 124(7): 779-788.
[18]
Hayakawa M. Reperfusion-Related Intracerebral Hemorrhage. Monographs Neural Sci, 2015, 37(119): 62-77.
[19]
Bang OY, Saver JL, Kim SJ, et al. Collateral flow averts hemorrhagic transformation after endovascular therapy for acute ischemic stroke. Stroke, 2011, 42(8): 2235-2239.
[20]
Mori F, Ishida F, Natori T, et al. Computational fluid dynamics analysis of lateral striate arteries in acute ischemic stroke using 7 T high-resolution magnetic resonance angiography. J Stroke Cerebrovasc Dis, 2019, 28(11): 104339.
[21]
Moghaddasi M, Mamarabadi M, Mirzadeh S, et al. Homocysteine, vitamin B12 and folate levels in Iranian patients with ischemic stroke. Neurol Res, 2010, 32(9): 953-956.
[22]
Jia SJ, Lai YQ, Zhao M, et al. Homocysteine-induced hypermethylation of DDAH2 promoter contributes to apoptosis of endothelial cells. Die Pharmazie, 2013, 68(4): 282-286.

PREV Progress in the application of ultrashort echo time magnetic resonance imaging in musculoskeletal system
NEXT Characteristics of function of left executive control network in heroin addicts during methadone maintenance treatment: a resting-state fMRI study
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn