Topographic distribution of cerebral infarct probability in patients with acute ischemic stroke: mapping of intra-arterial treatment effect.

Boers, A M M; Berkhemer, O A; Slump, C H; van Zwam, W H; Roos, Y B W E M; van der Lugt, A; van Oostenbrugge, R J; Yoo, A J; Dippel, D W J; Marquering, H A; Majoie, C B L M; Mattle, Heinrich (2017). Topographic distribution of cerebral infarct probability in patients with acute ischemic stroke: mapping of intra-arterial treatment effect. Journal of neurointerventional surgery, 9(5), pp. 431-436. BMJ Publishing Group 10.1136/neurintsurg-2016-012387

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BACKGROUND Since proof emerged that IA treatment (IAT) is beneficial for patients with acute ischemic stroke, it has become the standard method of care. Despite these positive results, recovery to functional independence is established in only about one-third of treated patients. The effect of IAT is commonly assessed by functional outcome, whereas its effect on brain tissue salvage is considered a secondary outcome measure (at most). Because patient and treatment selection needs to be improved, understanding the treatment effect on brain tissue salvage is of utmost importance. OBJECTIVE To introduce infarct probability maps to estimate the location and extent of tissue damage based on patient baseline characteristics and treatment type. METHODS Cerebral infarct probability maps were created by combining automatically segmented infarct distributions using follow-up CT images of 281 patients from the MR CLEAN trial. Comparison of infarct probability maps allows visualization and quantification of probable treatment effects. Treatment impact was calculated for 10 Alberta Stroke Program Early CT Score (ASPECTS) and 27 anatomical regions. RESULTS The insular cortex had the highest infarct probability in both control and IAT populations (47.2% and 42.6%, respectively). Comparison showed significant lower infarct probability in 4 ASPECTS and 17 anatomical regions in favor of IAT. Most salvaged tissue was found within the ASPECTS M2 region, which was 8.5% less likely to infarct. CONCLUSIONS Probability maps intuitively visualize the topographic distribution of infarct probability due to treatment, which makes it a promising tool for estimating the effect of treatment.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DCR Unit Sahli Building > Forschungsgruppe Neurologie
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Mattle, Heinrich

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1759-8486

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Stefanie Hetzenecker

Date Deposited:

30 Mar 2017 12:32

Last Modified:

16 Apr 2017 01:36

Publisher DOI:

10.1136/neurintsurg-2016-012387

PubMed ID:

27112775

Uncontrolled Keywords:

Brain; CT; Stroke; Technology; Thrombectomy

BORIS DOI:

10.7892/boris.93265

URI:

https://boris.unibe.ch/id/eprint/93265

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