You are here

  • Home
  • Online First
  • Susceptibility vessel sign on MRI predicts better clinical outcome in patients with anterior circulation acute stroke treated with stent retriever as first-line strategy

Article Text

Article menu

other Versions

Download PDFPDF
Ischemic Stroke
Original research
Susceptibility vessel sign on MRI predicts better clinical outcome in patients with anterior circulation acute stroke treated with stent retriever as first-line strategy
  1. Romain Bourcier1,
  2. Wagih Ben Hassen2,
  3. Sébastien Soize3,4,
  4. Pascal Roux5,
  5. Julien Labreuche6,
  6. Maeva Kyheng6,
  7. Marie Tisserand7,
  8. Charlotte Rosso8,
  9. Raphael Blanc5,
  10. Michel Piotin5,
  11. Imad Derraz9,
  12. Gregoire Boulouis2,
  13. Catherine Oppenheim2,
  14. Hubert Desal1,
  15. Serge Bracard10,
  16. Bertrand Lapergue7,
  17. Olivier Naggara2,11
  18. on behalf of the ASTER and the THRACE investigators
    1. 1 Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
    2. 2 Department of Neuroradiology, Université Paris<Descartes. INSERM U894, Sainte Anne Hospital, Paris, France
    3. 3 Department of Diagnostic and Interventional Neuroradiology, University Hospital of Reims, Reims, France
    4. 4 INSERM UMR<S 1237 Physiopathology and Imaging of Neurological Disorders, Université Caen Normandie, Caen, France
    5. 5 Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
    6. 6 Department of Biostatistics, University Lille, CHU Lille, EA 2694-Santé Publique: Epidémiologie et Qualité des Soins, Lille, France
    7. 7 Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
    8. 8 Urgences cérébro-vasculaires, Sorbonne Université, UPMC Univ Paris 06, Hôpital Pitié<Salpêtrière, Paris, France
    9. 9 Department of Diagnostic and Interventional Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
    10. 10 Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
    11. 11 Pediatric Radiology Department, Necker Enfants Mala des, Paris, France
    1. Correspondence to Dr Romain Bourcier, Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes 44800 S-H, France; romain.bourcier2{at}gmail.com

    Abstract

    Background Susceptibility vessel sign (SVS) can be a useful MRI biomarker of an occlusion but its relationship with clinical outcomes of acute ischemic stroke (AIS) is yet to be fully elucidated.

    Objective To investigate SVS in relation to the clinical outcomes after mechanical thrombectomy using a stent retriever (SR) as first-line approach in patients with AIS.

    Material and methods We included patients with a first-line SR approach for anterior AIS from the the Contact Aspiration vs Stent Retriever for Successful Revascularization (ASTER) and THRombectomie des Artères CErebrales (THRACE) trials when both baseline imaging of SVS and 90-day modified Rankin Scale (mRS) scores were available. Patients were assigned to two groups based on the presence of an SVS (independent core laboratory), and the overall distributions of the mRS score at 90 days (shift analysis) and clinical independence (mRS score ≤2) were compared.

    Results 217 patients were included and SVS was diagnosed in 76.0% of cases (n=165, 95% CI 70.4% to 81.7%). After adjustment for potential confounders, SVS+ was significantly associated with 90-day mRS improvement (adjusted common OR=2.75; 95% CI 1.44 to 5.26) and favorable outcome (adjusted common OR=2.76; 95% CI 1.18 to 6.45).

    Conclusion Based on results for patients of the ASTER and THRACE trials receiving first-line SR treatment, SVS was associated with lower disability at 3 months. Large prospective studies using MRI-based thrombus evaluation are warranted.

    • mri
    • stroke
    • thrombectomy

    https://doi.org/10.1136/neurintsurg-2018-014217

    Statistics from Altmetric.com

      Request Permissions

      If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

      View Full Text

      Footnotes

      • BL and ON contributed equally.

      • Contributors RB conceived the idea for the study and wrote the manuscript. ON, BL, and WBH wrote the manuscript. SS, PR, MT, CR, RB, MP, ID, GB, CO, HD and SB collected data and made a critical review of the manuscript. JL and MK performed the statistical analysis.

      • Funding The ASTER trial research was sponsored by Fondation Ophtalmologique Adolphe de Rothschild. An unrestricted research grant was provided by Penumbra, Alameda, California. The THRACE trial was funded by the French Ministry for Health as part of its 2009 STIC programme for the support of costly innovations (grant number 2009 A00753-54).

      • Competing interests None declared.

      • Patient consent Obtained.

      • Ethics approval The ASTER protocol was registered with ClinicalTrials.gov (Identifier NCT02523261) and the consent form was approved by the Comité de Protection des Personnes Ile de France VI (ID 2015- A00830 -49). The THRACE trial aimed to compare intravenous thrombectomy (IVT) alone with IVT plus mechanical thrombectomy using SR to determine their effect on clinical independence at 3 months in patients with acute ischemic stroke. Patients were included within respectively 4 and 6 hours of symptom onset in the THRACE and ASTER trial. The THRACE protocol was approved by the Comité de Protection des Personnes III Nord Est Ethics Committee and the research boards of the participating centers. All patients or their legal representatives provided written informed consent.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data sharing statement Data are available upon request from the corresponding author.

      • Collaborators The THRACE trial investigators are Alain Bonafé (Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier, France), Xavier Leclerc (Department of Radiology, University Hospital of Lille, Lille, France), Nelly Agrinier (Department of Clinical Epidemiology INSERM CIC-EC 1433, University of Lorraine and University Hospital of Nancy, Nancy, France), Serge Bakchine (Department of Neurology, University Hospital of Reims, Reims, France), Flore Baronnet (Stroke Unit, Pitié-Salpétrière Hospital Group and Paris 6 Université Pierre et Marie Curie, Paris, France), Marine Beaumont (Department of INSERM CIC-IT, University of Lorraine and University Hospital of Nancy, Nancy, France), Yannick Bejot (Department of Neurology, University Hospital of Dijon, Dijon, France), Jerome Berge (Department of Interventional and Diagnostic Neuroradiology, University Hospital of Bordeaux, Bordeaux, France), Marc Bintner (Department of Neuroradiology Sud-Reunion Hospital Group, Saint Pierre, France), Romain Bourcier (Department of Interventional and Diagnostic Neuroradiology, University Hospital of Nantes, Nantes, France), Tae Hee Cho (Department of Neurology, University Hospital of Lyon, Lyon, France), Frédéric Clarençon (Department of Interventional Neuroradiology Pitié-Salpétrère Hospital Group and Paris 6 Universityé Pierre et Marie Curie, Paris, France), Julien Cogez (Department of Neurology, University Hospital of Caen, Caen, France), Charlotte Cordonnier (Department of Neurology, University Hospital of Lille, Lille, France), Christian Denier (Department of Neurology, University Hospital of Bicètre, Le Kremlin-Bicètre, France), Anne Laure Derelle (Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France), Olivier Detante (Department of Neurology, University Hospital of Grenoble, Grenoble, France), Anthony Faivre (Department of Neurology, Hopital d’Instruction des Armées, Sainte Anne, Toulon, France), Anne Ferrier, (Department of Neurology, University Hospital Gabriel-Montpied, Clermont-Ferrand, France), Laetitia Gimenez (Department of Neurology, University Hospital of Limoges, Limoges, France), Sophie Godard (Department of Neurology, University Hospital of Angers, Angers, France), Benoit Guillon (Department of Neurology, University Hospital of Nantes, Nantes, France), Emmanuel Houdart (Department of Neuroradiology, University Hospital Lariboisière, Paris, France), Bertrand Lapergue (Department of Neurology, Foch Hospital, Suresnes, France), Mariano Musacchio (Department of Neuroradiology, Pasteur Hospital, Colmar, France), Olivier Naggara (Department of Neuroradiology, Sainte-Anne Hospital and Paris-Descartes University, INSERM U894, Paris, France), Jean Philippe Neau (Department of Neurology, University Hospital of Poitiers, Poitiers, France), Michael Obadia (Department of Neurology, Rothschild Ophthalmological Foundation, Paris, France), Anne Pasco-Papon (Department of Radiology, University Hospital of Angers, Angers, France), Michel Piotin (Department of Interventional Neuroradiology [MP] Rothschild Ophthalmological Foundation, Paris, France), Laurent Pierot (Department of Neuroradiology, University Hospital of Reims, Reims, France), Helene Raoult (Department of Neuroradiology, University Hospital of Rennes, Rennes, France), Sébastien Richard (Department of Neurology University Hospital of Nancy, Nancy, France), Frederic Ricolfi (Department of Neuroradiology, University Hospital of Dijon, Dijon, France), Thomas Ronziere (Department of Neurology, University Hospital of Rennes, Rennes, France), Guillaume Saliou (Department of Neuroradiology, University Hospital of Bicètre, Le Kremlin-Bicètre, France), Igor Sibon (Department of Neurology, University Hospital of Bordeaux, Bordeaux, France), Sebastien Soize (Department of Neuroradiology, University Hospital of Reims, Reims, France), Jacques Sedat (Department of Radiology, University Hospital of Nice, Nice, France), Christian Stapf (Department of Neurology, University Hospital Lariboisière, Paris, France), Laurent Suissa (Department of Neurology, University Hospital of Nice, Nice, France), Marie Tisserand (Department of Neuroradiology, Sainte-Anne Hospital and Paris- Descartes University, INSERM U894, Paris, France), Francis Turjman (Department of Interventional Neuroradiology, University Hospital of Lyon, Lyon, France), and Stephane Velasco (Departments of Radiology, University Hospital of Poitiers, Poitiers, France). The ASTER trial Investigators are: Piotin Michel, Blance Raphael, Redjem Hocine, Mazighi Mickael, Fahed Robert, Desilles Jean Philippe, Lapergue Bertrand, Rodesch Georges, Consoli Arturo, Di Maria Federico, Turjman Francis, Gory Benjamin, Labeyrie Paul Emile, Riva Roberto, Mounayer Charbel, Saleme Suzana, Costalat Vincent, Bonafé Alain, Eker Omer, Gascou Grégory, Dargazanli Cyril, Bracard Serge, Tonnelet Romain, Derelle Anne Laure, Anxionnat René, Desal Hubert, Bourcier Romain, Daumas-Duport Benjamin, Berge Jérome, Barreau Xavier, Margnat Grégoire, Labreuche Julien.