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Major Artery Ischemic Stroke

Imaging and Management

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Clinical Neuroradiology

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Abstract

Among all ischemic strokes, those caused by major cerebral artery occlusion have the worst prognosis but can be successfully treated if diagnosed on time. This chapter describes the impact of Clinical Neuroradiology on ischemic stroke diagnosis, treatment, and patients’ clinical outcomes by applying imaging and interventional methods provided by modern Radiology Techniques. Computed tomography (CT) and magnetic resonance imaging (MRI) allow early identification of major artery stenosis and occlusion with brain ischemia and can assess its causes and subsequent edema and infarction thus enabling personalized effective treatment and secondary prophylaxis. Endovascular treatment in the hands of well-trained neuroradiologists can restore cerebral blood flow and allow the patients’ complete recovery from severe neurological deficits.

This publication is endorsed by: European Society of Neuroradiology (www.esnr.org).

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Abbreviations

ACA:

Anterior cerebral artery

ADC:

Apparent diffusion coefficient

ASL:

Arterial spin labeling

ASPECTS:

Alberta Stroke Program Early CT Score

ATP:

Adenosine triphosphate

BA:

Basilar artery

BBB:

Blood-brain barrier

CBF:

Cerebral blood flow

CBV:

Cerebral blood volume

CMRO2:

Cerebral metabolism rate of oxygen

CNS:

Central nervous system

CT:

Computed tomography

CTA:

CT angiography

CTP:

CT perfusion imaging

DCI:

Delayed cerebral ischemia

DSA:

Digital subtraction angiography

DWI:

Diffusion-weighted imaging

EDS:

Ehlers-Danlos syndrome

EEG:

Electroencephalogram

EP:

Evoked potentials

EVT:

Endovascular therapy

FLAIR:

Fluid attenuated inversion recovery

FWD:

Fibromuscular dysplasia

ICA:

Internal carotid artery

IPH:

Intraplaque hemorrhage

MCA:

Middle cerebral artery

MFS:

Marfan syndrome

MIP:

Maximum intensity projection

mmHg:

Millimeter mercury

MRA:

MR angiography

MRI:

Magnetic resonance imaging

MRP:

MR perfusion imaging

MTT:

Mean transit time

NCT:

Non-enhanced CT

OEF:

Oxygen extraction fraction

PCA:

Posterior cerebral artery

PET:

Positron emission tomography

rtPA:

Recombinant tissue plasminogen activator

SAH:

Subarachnoid hemorrhage

SNR:

Signal-to-noise ratio

SWI:

Susceptibility-weighted MRI

TOF:

Time-of-flight

TTP:

Time-to-peak

VA:

Vertebral artery

References

  • Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, McTaggart RA, Torbey MT, Kim-Tenser M, Leslie-Mazwi T, Sarraj A, Kasner SE, Ansari SA, Yeatts SD, Hamilton S, Mlynash M, Heit JJ, Zaharchuk G, Kim S, Carrozzella J, Palesch YY, Demchuk AM, Bammer R, Lavori PW, Broderick JP, Lansberg MG, DEFUSE 3 Investigators. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708–18. Epub 2018 Jan 24.

    Article  PubMed  Google Scholar 

  • Al-Shahi Salman R, Counsell CE, White PM. Conservative management vs intervention for unruptured brain arteriovenous malformations – reply. JAMA. 2014;312(10):1058–9.

    Article  PubMed  Google Scholar 

  • Barber P, Demchuk A, Zhang J, Buchan A. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet. 2000;355:1670–4.

    Article  CAS  PubMed  Google Scholar 

  • Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Majoie CB, Dippel DW; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20. Epub 2014 Dec 17. Erratum in: N Engl J Med. 2015 Jan 22;372(4):394.

    Article  PubMed  Google Scholar 

  • Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, Brott T, Cohen G, Davis S, Donnan G, Grotta J, Howard G, Kaste M, Koga M, von Kummer R, Lansberg M, Lindley RI, Murray G, Olivot JM, Parsons M, Tilley B, Toni D, Toyoda K, Wahlgren N, Wardlaw J, Whiteley W, del Zoppo GJ, Baigent C, Sandercock P, Hacke W, Stroke Thrombolysis Trialists’ Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384(9958):1929–35.

    Article  CAS  Google Scholar 

  • Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Davalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millan M, Davis SM, Roy D, Thornton J, Roman LS, Ribo M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG, HERMES Collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–31.

    Google Scholar 

  • Gupta A, Baradaran H, Schweitzer AD, Kamel H, Pandya A, Delgado D, Dunning A, Mushlin AI, Sanelli PC. Carotid plaque MRI and stroke risk: a systematic review and meta-analysis. Stroke. 2013;44(11):3071–7. Epub 2013 Aug 29. Review.

    Article  PubMed  Google Scholar 

  • Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, Flores-Suarez LF, Gross WL, Guillevin L, Hagen EC, Hoffman GS, Jayne DR, Kallenberg CG, Lamprecht P, Langford CA, Luqmani RA, Mahr AD, Matteson EL, Merkel PA, Ozen S, Pusey CD, Rasmussen N, Rees AJ, Scott DG, Specks U, Stone JH, Takahashi K, Watts RA. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1–11.

    Article  Google Scholar 

  • Jovin T, Yonas H, Gebel J, Kanal E, Chang Y, Grahovac S, Goldstein S, Wechsler L. The cortical ischemic core and not the consistently present penumbra is a determinant of clinical outcome in acute middle cerebral artery occlusion. Stroke. 2003;34:2426–35.

    Article  PubMed  Google Scholar 

  • Kim ST, Brinjikji W, Kallmes DF. Prevalence of intracranial aneurysms in patients with connective tissue diseases: a retrospective study. AJNR Am J Neuroradiol. 2016;37(8):1422–6.

    Article  CAS  PubMed  Google Scholar 

  • Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot JM, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG, Trial Investigators DAWN. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11–21.

    Article  PubMed  Google Scholar 

  • Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Damaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwie TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL, on behalf of the American Heart Association Stroke Council. 2018 Guidelines for the early management of patients with acute ischemic stroke. Stroke. 2018;49:e46–99.

    Article  PubMed  Google Scholar 

  • Riedel CH, Zoubie J, Ulmer S, Gierthmuehlen J, Jansen O. Thin-slice reconstructions of nonenhanced CT images allow for detection of thrombus in acute stroke. Stroke. 2012;43(9):2319–23.

    Article  PubMed  Google Scholar 

  • Saam T, Hetterich H, Hoffmann V, Yuan C, Dichgans M, Poppert H, Koeppel T, Hoffmann U, Reiser MF, Bamberg F. Meta-analysis and systematic review of the predictive value of carotid plaque hemorrhage on cerebrovascular events by magnetic resonance imaging. J Am Coll Cardiol. 2013;62(12):1081–91. Epub 2013 Jul 10. Review.

    Article  PubMed  Google Scholar 

  • Saba L, Yuan C, Hatsukami TS, Balu N, Qiao Y, DeMarco JK, Saam T, Moody AR, Li D, Matouk CC, Johnson MH, Jäger HR, Mossa-Basha M, Kooi ME, Fan Z, Saloner D, Wintermark M, Mikulis DJ, Wasserman BA, Vessel Wall Imaging Study Group of the American Society of Neuroradiology. Carotid artery wall imaging: perspective and guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol. 2018;39(2):E9–31. Epub 2018 Jan 11.

    Article  CAS  PubMed  Google Scholar 

  • Simard J, Tarasov K, Gerzanich V. Non-selective cation channels, transient receptor potential channels and ischemic stroke. Biochim Biophys Acta. 2007;1772:947–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • von Kummer R, Dzialowski I. Imaging of cerebral ischemic edema and neuronal death. Neuroradiology. 2017;59(6):545–53.

    Article  PubMed  Google Scholar 

  • Wityk RJ, Zanferrari C, Oppenheimer S. Neurovascular complications of marfan syndrome: a retrospective, hospital-based study. Stroke. 2002;33(3):680–4.

    Article  PubMed  Google Scholar 

  • Younger DS. Vasculitis of the nervous system. Curr Opin Neurol. 2004;17(3):317–36.

    Article  PubMed  Google Scholar 

  • Zilocchi M, Macedo TA, Oderich GS, Vrtiska TJ, Biondetti PR, Stanson AW. Vascular Ehlers-Danlos syndrome: imaging findings. AJR Am J Roentgenol. 2007;189(3):712–9.

    Article  PubMed  Google Scholar 

  • Zülch K-J. The cerebral infarct. Heidelberg: Springer; 1985.

    Book  Google Scholar 

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Author information

Authors and Affiliations

  1. Institute and Policlinic of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany

    Rüdiger von Kummer

  2. Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Aad van der Lugt

Authors
  1. Rüdiger von Kummer
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  2. Aad van der Lugt
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Corresponding author

Correspondence to Rüdiger von Kummer .

Editor information

Editors and Affiliations

  1. Department of Radiology and Nuclear Medicine, VU University Medical Centre (VUmc), Amsterdam, The Netherlands

    Frederik Barkhof

  2. The National Hospital for Neurology and Neurosurgery and University College Hospital (UCH), UCL Institute of Neurology, London, UK

    Hans Rolf Jäger

  3. Section of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, University Hospital Vienna, Vienna, Austria

    Majda M. Thurnher

  4. Department of Radiology and Nuclear Medicine Vall d’Hebron University Hospital Professor of Radiology and Neuroimmunology, Autonomous University of Barcelona Vall d’Hebron Research Institute (VHIR), Barcelona, Spain

    Àlex Rovira

Section Editor information

  1. Institut und Poliklinik für Neuroradiologie, Universitätsklinikum Carl Gustav Carus, Dresden, Dresden, Saxonia, Germany

    Rüdiger von Kummer

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von Kummer, R., van der Lugt, A. (2019). Major Artery Ischemic Stroke. In: Barkhof, F., Jäger, H., Thurnher, M., Rovira, À. (eds) Clinical Neuroradiology. Springer, Cham. https://doi.org/10.1007/978-3-319-68536-6_21

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  • DOI: https://doi.org/10.1007/978-3-319-68536-6_21

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-68535-9

  • Online ISBN: 978-3-319-68536-6

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