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Arteriovenous shunts and capillary blush as an early sign of basal ganglia infarction after successful mechanical intra-arterial thrombectomy in ischaemic stroke

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Abstract

Objectives

Recent studies indicate an interest in early infarct assessment, mainly using post-interventional perfusion imaging. This work evaluated two specific angiographic signs for infarct prediction in the basal ganglia immediately after successful mechanical intra-arterial thrombectomy.

Methods

In this retrospective study, 57 consecutive patients (mean ± SD age 67 ± 15 years) with acute occlusion of the proximal anterior circulation who underwent mechanical thrombectomy of the M1 segment of the middle cerebral artery were included. Two separate angiographic signs, early venous drainage and capillary blush, were identified and analysed regarding their statistical significance for infarct prediction within the basal ganglia.

Results

Four patients were excluded due to parenchymal haemorrhage. Forty-four of 53 patients developed infarction of the basal ganglia. Sensitivity/specificity were 93 %/27 %, respectively, for the capillary blush sign and 88 %/63 %, respectively, for the early venous drainage sign. Combining both signs increased the sensitivity and specificity to 88 % and 81 %, respectively, and increased the positive predictive value to 95 %.

Conclusions

Both angiographic signs seem to predict the irreversible damage of tissue in the basal ganglia reliably despite successful recanalization of the middle cerebral artery in patients with ischaemic stroke.

Key Points

• Evaluation of success in neurointerventional procedures is mainly based on recanalization rates.

• Two separate angiographic signs can predict infarction immediately after proximal MCA recanalization.

• Combining both signs increases their specificity.

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Abbreviations

ACA:

Anterior cerebral artery

AcomA:

Anterior communicating Artery

ASPECTS:

Alberta stroke program early CT score

ECASS III:

European Cooperative Acute Stroke Study III

IA:

Intra-arterial

ICA:

Internal carotid artery

NPV:

Negative predictive value

PCHD:

Post-interventional cerebral hyperdensity

PH2:

Parenchymal haemorrhage with significant space-occupying effect

PcomA:

Posterior communicating artery

PPV:

Positive predictive value

TICI:

Thrombolysis in cerebral infarction

TIMI:

Thrombolysis in myocardial infarction

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Acknowledgments

The scientific guarantor of this publication is Prof. Dr. Karl-Titus Hoffmann. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, observational, performed at one institution.

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    Authors and Affiliations

    1. Department of Neuroradiology, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany

      D. Fritzsch, M. Reiss-Zimmermann, D. Lobsien, U. Quäschling & K. T. Hoffmann

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    1. D. Fritzsch
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    2. M. Reiss-Zimmermann
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    3. D. Lobsien
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    4. U. Quäschling
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    5. K. T. Hoffmann
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    Correspondence to M. Reiss-Zimmermann.

    Additional information

    D. Fritzsch and M. Reiss-Zimmermann contributed equally to this work.

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    Supplemental Fig. 1

    Illustration of capillary blush and early venous drainage in a patient in a.p. (upper row) and d.s. projection (bottom row) with a temporal resolution of all three images in 1 s. In the early arterial phase after injection of contrast agent in the ICA, the capillary blush of the basal ganglia is already detectable (black arrowheads). Immediately after, the early venous drainage towards the internal cerebral veins and straight sinus can be seen (white arrow heads), while the periphery of the MCA territory is still in the arterial phase. Both signs can also be detected in the lateral view (bottom row). (GIF 210 kb)

    High resolution image (TIFF 12103 kb)

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    Fritzsch, D., Reiss-Zimmermann, M., Lobsien, D. et al. Arteriovenous shunts and capillary blush as an early sign of basal ganglia infarction after successful mechanical intra-arterial thrombectomy in ischaemic stroke. Eur Radiol 25, 3060–3065 (2015). https://doi.org/10.1007/s00330-015-3704-5

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