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• Technical Article •
To investigate the impact of first pass reperfusion on functional outcome of acute stroke based on hypoperfusion intensity ratio
WU Han  GUO Qun  JIN Mingxu  PENG Mingyang  YIN Xindao  GAO Wei 

Cite this article as: Wu H, Guo Q, Jin MＸ, et al. To investigate the impact of first pass reperfusion on functional outcome of acute stroke based on hypoperfusion intensity ratio[J]. Chin J Magn Reson Imaging, 2021, 12(3): 34-38. DOI:10.12015/issn.1674-8034.2021.03.008.


[Abstract] Objects: To investigate the impact of first pass reperfusion (FPR) on functional outcome of acute stroke with different collateral circulation after endovascular thrombectomy (EVT). Materials andMethods A total of 180 acute stroke patients in our hospital were enrolled retrospectively. All patients underwent MR perfusion imaging and EVT therapy. Hypoperfusion intensity ratio (HIR) was used to evaluate collateral circulation. Good collateral circulation was defined as HIR＜0.4 and poor collateral circulation was defined as HIR≥0.4. FPR was defined as achieving modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3 after a single pass of the device. Statistical methods were performed to analyze the impact of FPR on the outcome in acute stroke with different collateral circulation after EVT therapy.Results For patients with HIR≥0.4 (n=72), compared with non-FPR group (n=30), the mortality rate at 3 months (11.90% vs. 33.33%) was lower and good functional outcome at 3 months (59.52% vs. 33.33%) was higher in FPR group (n=42). For patients with HIR＜0.4 (n=108), the mortality rate at 3 months and good functional outcome at 3 months had no significant differences between two group (P＞0.05). Logistic regression analysis showed that FPR was an independent predictor of good functional outcome in acute stroke patients with HIR≥0.4 (OR=2.281, 95% CI: 1.419—5.286; P=0.018). While FPR had no significant difference in predicting the good functional outcome in acute stroke patients with HIR＜0.4 (OR=1.693, 95% CI: 0.596－4.798; P=0.319).Conclusions The effect of FPR on functional outcome is highly dependent on collateral circulation. When the collateral circulation is poor (HIR≥0.4), the effect of FPR on functional outcome is more prominent.
[Keywords] stroke；magnetic resonance imaging；perfusion weighted imaging；endovascular thrombectomy therapy；functional outcome

WU Han   GUO Qun   JIN Mingxu   PENG Mingyang   YIN Xindao   GAO Wei*  

Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 21006, China

Gao W, E-mail: gao1974@yeah.net

Conflicts of interest   None.

ACKNOWLEDGMENTS  This article is supported by the Jiangsu Science and Technology Development Project No. BE2017614 This article is supported by the Medical and Health Research Project of Nanjing Health and Family Planning Commission No. YKK18101
Received  2020-10-16
Accepted  2021-01-21
DOI: 10.12015/issn.1674-8034.2021.03.008
Cite this article as: Wu H, Guo Q, Jin MＸ, et al. To investigate the impact of first pass reperfusion on functional outcome of acute stroke based on hypoperfusion intensity ratio[J]. Chin J Magn Reson Imaging, 2021, 12(3): 34-38. DOI:10.12015/issn.1674-8034.2021.03.008.

1
Desai SM, Starr M, Molyneaux BJ, et al. Acute ischemic stroke with vessel occlusion-prevalence and thrombectomy eligibility at a comprehensive stroke center. J Stroke Cerebrovasc Dis, 2019, 28(11): 104315. DOI: 10.1016/j.jstrokecerebrovasdis
2
Chinese Society of Neurology, Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018. Chin J Neurol, 2018, 51(9): 666-682. DOI: 10.3760/cma.j.issn.1006-7876.2018.09.004
3
Yoon W, Kim SK, Park MS, et al. Predictive factors for good outcome and mortality after stent-retriever thrombectomy in patients with acute anterior circulation stroke. J Stroke, 2017, 19(1): 97-103. DOI: 10.5853/jos.2016.00675
4
Zaidat OO, Castonguay AC, Linfante I, et al. First pass effect: a new measure for stroke thrombectomy devices. Stroke, 2018, 49(3): 660-666. DOI: 10.1161/STROKEAHA.117.020315
5
Guenego A, Marcellus DG, Martin BW, et al. Hypoperfusion intensity ratio is correlated with patient eligibility for thrombectomy. Stroke, 2019, 50(4): 917-922. DOI: 10.1161/STROKEAHA.118.024134
6
Li YX, Ma YH, Peng MY, et al. FLAIR vascular hyperintensity in acute stroke before and after endovascular therapy:associations with collateralization and functional outcome. J Clin Radiol, 2019, 38(11): 2021-2025. DOI: CNKI:SUN:LCFS.0.2019-11-004
7
Panni P, Gory B, Xie Y, et al. Acute stroke with large ischemic core treated by thrombectomy. Stroke, 2019, 50(5): 1164-1171. DOI: 10.1161/STROKEAHA.118.024295
8
Manno C, Disanto G, Bianco G, et al. Outcome of endovascular therapy in stroke with large vessel occlusion and mild symptoms. Neurology, 2019, 93(17): e1618-e1626. DOI: 10.1212/WNL.0000000000008362
9
Linfante I, Walker GR, Castonguay AC, et al. Predictors of mortality in acute ischemic stroke intervention: analysis of the north american solitaire acute stroke registry. Stroke, 2015, 46(8): 2305-2308. DOI: 10.1161/STROKEAHA.115.009530
10
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. DOI: 10.1056/NEJMoa1503780
11
Guenego A, Fahed R, Albers GW, et al. Hypoperfusion intensity ratio correlates with angiographic collaterals in acute ischaemic stroke with M1 occlusion. Eur J Neurol, 2020, 27(5): 864-870. DOI: 10.1111/ene.14181
12
Vagal A, Aviv R, Sucharew H, et al. Collateral clock is more important than time clock for tissue fate. Stroke, 2018, 49(9): 2102-2107. DOI: 10.1161/STROKEAHA.118.021484
13
Peschillo S, Diana F, Berge J, et al. A comparison of acute vascular damage caused by ADAPT versus a stent retriever device after thrombectomy in acute ischemic stroke: a histological and ultrastructural study in an animal model. J Neurointerv Surg, 2017, 9(8): 743-749. DOI: 10.1136/neurintsurg-2016-012533
14
Flottmann F, Leischner H, Broocks G, et al. Recanalization rate per retrieval attempt in mechanical thrombectomy for acute ischemic stroke. Stroke, 2018, 49(10): 2523-2525. DOI: 10.1161/STROKEAHA.118.022737
15
Chen GH, Qiu JB, Zheng SQ, et al. The value of collateral vessels on magnetic resonance angiography in the prognosis of stroke patients after mechanical thrombectomy associated with clinical outcomes. Chin J Magn Reson Imaging, 2020, 11(04): 270-274. DOI: 10.12015/issn.1674-8034.2020.04.006
16
Sheth SA, Sanossian N, Hao Q, et al. Collateral flow as causative of good outcomes in endovascular stroke therapy. J Neurointerv Surg, 2016, 8(1): 2-7. DOI: 10.1136/neurintsurg-2014-011438
17
Conrad J, Ertl M, Oltmanns MH, et al. Prediction contribution of the cranial collateral circulation to the clinical and radiological outcome of ischemic stroke. J Neurol, 2020267(7): 2013-2021. DOI: 10.1007/s00415-020-09798-0
18
Kim HJ, Lee SB, Choi JW, et al. Multiphase MR angiography collateral map: functional outcome after acute anterior circulation ischemic stroke. Radiology, 2020, 295(1): 192-201. DOI: 10.1148/radiol.2020191712
19
Kang DH, Kim BM, Heo JH, et al. Effects of first pass recanalization on outcomes of contact aspiration thrombectomy. J Neurointerv Surg, 2020, 12(5): 466-470. DOI: 10.1136/neurintsurg-2019-015221
20
Ducroux C, Piotin M, Gory B, et al. First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial. J Neurointerv Surg, 2020, 12(4): 386-391. DOI: 10.1136/neurintsurg-2019-015215
21
Chueh JY, Puri AS, Wakhloo AK, et al. Risk of distal embolization with stent retriever thrombectomy and ADAPT. J Neurointerv Surg, 2016, 8(2): 197-202. DOI: 10.1136/neurintsurg-2014-011491
22
Khatri P, Abruzzo T, Yeatts SD, et al. Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology, 2009, 73(13): 1066-1072. DOI: 10.1212/WNL.0b013e3181b9c847

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