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Cerebral arterial calcification is an imaging prognostic marker for revascularization treatment of acute middle cerebral arterial occlusion.

Lee SJ, Hong JM, Lee M, Huh K, Choi JW, Lee JS - J Stroke (2015)

Bottom Line: Initial National Institutes of Health Stroke Scale (NIHSS) scores did not differ (HCB 13.3±2.7 vs.However, the HCB group had significantly higher NIHSS scores at discharge (16.0±12.3 vs. 7.9±8.3), and more frequent grave outcome at 3 months (57.1% vs. 22.0%) than the LCB group.HCB was proven as an independent predictor for grave outcome at 3 months when several confounding factors were adjusted (odds ratio 4.135, 95% confidence interval, 1.045-16.359, P=0.043).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.

ABSTRACT

Background and purpose: To study the significance of intracranial artery calcification as a prognostic marker for acute ischemic stroke patients undergoing revascularization treatment after middle cerebral artery (MCA) trunk occlusion.

Methods: Patients with acute MCA trunk occlusion, who underwent intravenous and/or intra-arterial revascularization treatment, were enrolled. Intracranial artery calcification scores were calculated by counting calcified intracranial arteries among major seven arteries on computed tomographic angiography. Patients were divided into high (HCB; score ≥3) or low calcification burden (LCB; score <3) groups. Demographic, imaging, and outcome data were compared, and whether HCB is a prognostic factor was evaluated. Grave prognosis was defined as modified Rankin Scale 5-6 for this study.

Results: Of 80 enrolled patients, the HCB group comprised 15 patients, who were older, and more commonly had diabetes than patients in the LCB group. Initial National Institutes of Health Stroke Scale (NIHSS) scores did not differ (HCB 13.3±2.7 vs. LCB 14.6±3.8) between groups. The final good reperfusion after revascularization treatment (thrombolysis in cerebral infarction score 2b-3, HCB 66.7% vs. LCB 69.2%) was similarly achieved in both groups. However, the HCB group had significantly higher NIHSS scores at discharge (16.0±12.3 vs. 7.9±8.3), and more frequent grave outcome at 3 months (57.1% vs. 22.0%) than the LCB group. HCB was proven as an independent predictor for grave outcome at 3 months when several confounding factors were adjusted (odds ratio 4.135, 95% confidence interval, 1.045-16.359, P=0.043).

Conclusions: Intracranial HCB was associated with grave prognosis in patients who have undergone revascularization for acute MCA trunk occlusion.

No MeSH data available.


Related in: MedlinePlus

Representative patient categorization based on the number of intracranial arterial calcifications. One calcification is shown in the terminal segment of the right internal carotid artery. This case was assigned to the low calcification burden group. Five calcifications are shown in the right middle cerebral artery, the right and left terminal internal carotid, and the distal vertebral arteries. This case was assigned to the high calcification burden group.
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Figure 1: Representative patient categorization based on the number of intracranial arterial calcifications. One calcification is shown in the terminal segment of the right internal carotid artery. This case was assigned to the low calcification burden group. Five calcifications are shown in the right middle cerebral artery, the right and left terminal internal carotid, and the distal vertebral arteries. This case was assigned to the high calcification burden group.

Mentions: Patient demographics, vascular risk factors, stroke etiology and laboratory results, and critical pathway data were retrieved from our Acute Ischemic Stroke and Thrombolysis databases. We further evaluated the first NECT scan and CT angiography obtained for each patient using the Alberta Stroke Program Early CT (ASPECTS) and IAC scores, respectively. The ASPECTS was determined from the initial NECT; scores ≥8 were considered high and those <8 were considered low.24 IAC scores were determined from CT angiography MIP images using a previously described method in which the number of intracranial calcified arteries was counted.1 Calcification was defined as the presence of hyperdense foci along the artery with a peak intensity >130 Hounsfield units (HU) with adjustments of window setting to differentiate contrast.1,25 This semi-quantitative scoring system was applied to 7 intracranial arteries: the right and left internal carotid starting from the cavernous segment to the communicating segment, the right and left middle cerebral, the right and left vertebral, and the basilar arteries. The IAC score was the number of arteries showing calcification, and therefore ranged from 0 (no calcification) to 7 (calcification in all 7 intracranial arteries examined). Patients were assigned to 1 of 2 groups depending on their IAC score. Patients with low IAC scores (<3) were assigned to the low calcification burden (LCB) group, whereas patients with high IAC scores (≥3) were assigned to the high calcification burden (HCB) group (Figure 1). From our preliminary receiver operating characteristic curve analysis, dichotomizing 0-2 and 3-7 had the largest area under the receiver operating characteristic curve among various combinations for grave outcome. On this ground, patients with low IAC scores (<3) were assigned to the low calcification burden (LCB) group, whereas patients with high IAC scores (≥3) were assigned to the high calcification burden (HCB) group (Figure 1). Before IA treatment began, leptomeningeal collaterals from the ipsilateral anterior cerebral artery were evaluated and graded with transfemoral cerebral angiography, as previously reported.26 This collateral grade was not evaluated when the MCA was fully or partially recanalized. Following either IV or IA treatment, final reperfusion status was evaluated using the thrombolysis in cerebral infarction (TICI) system.26 A TICI score of 2b-3 (reperfusion in ≥67%) was considered to indicate a good reperfusion, whereas lower TICI scores indicated a poor reperfusion.27 Post-treatment intracerebral hemorrhages were evaluated according to criteria defined by the European Cooperative Acute Stroke Study.28 The final infarct volume was determined using the total volume of diffusion restriction lesions observed on MRIs obtained between 1 and 7 days following revascularization treatment. When MRI was unavailable, the final infarct volume was determined from the total hypodensity observed on CTs obtained during the same time period. The infarct volume was calculated using a previously described semi-quantitative method.29 Calcification scoring and other imaging analyses were performed with consensus by raters who were blinded to the clinical information (S. J. Lee, J. W. Choi, J. S. Lee).


Cerebral arterial calcification is an imaging prognostic marker for revascularization treatment of acute middle cerebral arterial occlusion.

Lee SJ, Hong JM, Lee M, Huh K, Choi JW, Lee JS - J Stroke (2015)

Representative patient categorization based on the number of intracranial arterial calcifications. One calcification is shown in the terminal segment of the right internal carotid artery. This case was assigned to the low calcification burden group. Five calcifications are shown in the right middle cerebral artery, the right and left terminal internal carotid, and the distal vertebral arteries. This case was assigned to the high calcification burden group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325637&req=5

Figure 1: Representative patient categorization based on the number of intracranial arterial calcifications. One calcification is shown in the terminal segment of the right internal carotid artery. This case was assigned to the low calcification burden group. Five calcifications are shown in the right middle cerebral artery, the right and left terminal internal carotid, and the distal vertebral arteries. This case was assigned to the high calcification burden group.
Mentions: Patient demographics, vascular risk factors, stroke etiology and laboratory results, and critical pathway data were retrieved from our Acute Ischemic Stroke and Thrombolysis databases. We further evaluated the first NECT scan and CT angiography obtained for each patient using the Alberta Stroke Program Early CT (ASPECTS) and IAC scores, respectively. The ASPECTS was determined from the initial NECT; scores ≥8 were considered high and those <8 were considered low.24 IAC scores were determined from CT angiography MIP images using a previously described method in which the number of intracranial calcified arteries was counted.1 Calcification was defined as the presence of hyperdense foci along the artery with a peak intensity >130 Hounsfield units (HU) with adjustments of window setting to differentiate contrast.1,25 This semi-quantitative scoring system was applied to 7 intracranial arteries: the right and left internal carotid starting from the cavernous segment to the communicating segment, the right and left middle cerebral, the right and left vertebral, and the basilar arteries. The IAC score was the number of arteries showing calcification, and therefore ranged from 0 (no calcification) to 7 (calcification in all 7 intracranial arteries examined). Patients were assigned to 1 of 2 groups depending on their IAC score. Patients with low IAC scores (<3) were assigned to the low calcification burden (LCB) group, whereas patients with high IAC scores (≥3) were assigned to the high calcification burden (HCB) group (Figure 1). From our preliminary receiver operating characteristic curve analysis, dichotomizing 0-2 and 3-7 had the largest area under the receiver operating characteristic curve among various combinations for grave outcome. On this ground, patients with low IAC scores (<3) were assigned to the low calcification burden (LCB) group, whereas patients with high IAC scores (≥3) were assigned to the high calcification burden (HCB) group (Figure 1). Before IA treatment began, leptomeningeal collaterals from the ipsilateral anterior cerebral artery were evaluated and graded with transfemoral cerebral angiography, as previously reported.26 This collateral grade was not evaluated when the MCA was fully or partially recanalized. Following either IV or IA treatment, final reperfusion status was evaluated using the thrombolysis in cerebral infarction (TICI) system.26 A TICI score of 2b-3 (reperfusion in ≥67%) was considered to indicate a good reperfusion, whereas lower TICI scores indicated a poor reperfusion.27 Post-treatment intracerebral hemorrhages were evaluated according to criteria defined by the European Cooperative Acute Stroke Study.28 The final infarct volume was determined using the total volume of diffusion restriction lesions observed on MRIs obtained between 1 and 7 days following revascularization treatment. When MRI was unavailable, the final infarct volume was determined from the total hypodensity observed on CTs obtained during the same time period. The infarct volume was calculated using a previously described semi-quantitative method.29 Calcification scoring and other imaging analyses were performed with consensus by raters who were blinded to the clinical information (S. J. Lee, J. W. Choi, J. S. Lee).

Bottom Line: Initial National Institutes of Health Stroke Scale (NIHSS) scores did not differ (HCB 13.3±2.7 vs.However, the HCB group had significantly higher NIHSS scores at discharge (16.0±12.3 vs. 7.9±8.3), and more frequent grave outcome at 3 months (57.1% vs. 22.0%) than the LCB group.HCB was proven as an independent predictor for grave outcome at 3 months when several confounding factors were adjusted (odds ratio 4.135, 95% confidence interval, 1.045-16.359, P=0.043).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.

ABSTRACT

Background and purpose: To study the significance of intracranial artery calcification as a prognostic marker for acute ischemic stroke patients undergoing revascularization treatment after middle cerebral artery (MCA) trunk occlusion.

Methods: Patients with acute MCA trunk occlusion, who underwent intravenous and/or intra-arterial revascularization treatment, were enrolled. Intracranial artery calcification scores were calculated by counting calcified intracranial arteries among major seven arteries on computed tomographic angiography. Patients were divided into high (HCB; score ≥3) or low calcification burden (LCB; score <3) groups. Demographic, imaging, and outcome data were compared, and whether HCB is a prognostic factor was evaluated. Grave prognosis was defined as modified Rankin Scale 5-6 for this study.

Results: Of 80 enrolled patients, the HCB group comprised 15 patients, who were older, and more commonly had diabetes than patients in the LCB group. Initial National Institutes of Health Stroke Scale (NIHSS) scores did not differ (HCB 13.3±2.7 vs. LCB 14.6±3.8) between groups. The final good reperfusion after revascularization treatment (thrombolysis in cerebral infarction score 2b-3, HCB 66.7% vs. LCB 69.2%) was similarly achieved in both groups. However, the HCB group had significantly higher NIHSS scores at discharge (16.0±12.3 vs. 7.9±8.3), and more frequent grave outcome at 3 months (57.1% vs. 22.0%) than the LCB group. HCB was proven as an independent predictor for grave outcome at 3 months when several confounding factors were adjusted (odds ratio 4.135, 95% confidence interval, 1.045-16.359, P=0.043).

Conclusions: Intracranial HCB was associated with grave prognosis in patients who have undergone revascularization for acute MCA trunk occlusion.

No MeSH data available.


Related in: MedlinePlus