Therapieentscheidung zur Thrombektomie: Rolle der zerebralen Bildgebung

Daniel Kaiser; Johannes C. Gerber; Volker Puetz

doi:10.1055/a-0578-3993

Neuroradiologie Scan, Table of Contents

Neuroradiologie Scan 2018; 08(03): 257-272
DOI: 10.1055/a-0578-3993

CME-Fortbildung

Therapieentscheidung zur Thrombektomie: Rolle der zerebralen Bildgebung

Role of neuroimaging in decision-making for endovascular thrombectomy

Daniel Kaiser

,

Johannes C. Gerber

,

Volker Puetz

Subject Editor: Wissenschaftlich verantwortlich gemäß Zertifizierungsbestimmungen für diesen Beitrag ist PD Dr. med. Volker Puetz, Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus, Dresden.

Abstract

Zusammenfassung

Der ischämische Schlaganfall ist eine potenziell reversible Erkrankung und bedarf einer schnellen Diagnostik und Therapie. Unbehandelt kann er innerhalb kürzester Zeit persistierende Behinderung oder Tod zur Folge haben. In dieser Übersichtsarbeit werden Techniken der nicht invasiven zerebralen Bildgebung erläutert und speziell ihre Rolle für die Therapieentscheidung zur Thrombektomie dargelegt.

Abstract

Six recent randomized controlled trials showed a significant benefit of endovascular therapy on patient outcome in acute ischemic stroke due to anterior cerebral artery occlusion. The positive results of these trials need to be implemented in clinical routine. Suitable patients should be evaluated for thrombectomy reliably and fast. All trials confirmed the role of pretherapeutic neuroimaging as crucial in selecting patients who can benefit from endovascular therapy. However, different approaches have been used, including imaging of the target vascular occlusion, infarct core, arterial collateral supply or the penumbra. In this review we discuss, in the context of the recent trials, the different methods of non-invasive neuroimaging and their role in decision-making for thrombectomy in acute ischemic stroke.

Schlüsselwörter

Schlaganfall - zerebrale Bildgebung - Thrombektomie

Keywords

stroke - neuroimaging - endovascular thrombectomy

Full Text

References

Literatur
1 Berkhemer OA, Fransen PSS, Beumer D. et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11-20
2 Goyal M, Demchuk AM, Menon BK. et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Eng J Med 2015; 372: 1019-1030
3 Campbell BCV, Mitchell PJ, Kleinig TJ. et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372: 1009-1018
4 Saver JL, Goyal M, Bonafe A. et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372: 2285-2295
5 Jovin TG, Chamorro A, Cobo E. et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372: 1-11
6 Bracard S, Ducrocq X, Mas JL. et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol 2016; 15: 1138-1147
7 Grotta JC, Hacke W. Stroke neurologist’s perspective on the new endovascular trials. Stroke 2015; 46: 1447-1452
8 Goyal M, Menon BK. Variability of results of recent acute endovascular trials: a statistical analysis. J Neurointerv Surg 2016; 8: 875-877
9 Broderick JP, Palesch YY, Demchuk AM. et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 2013; 368: 893-903
10 Kidwell CS, Jahan R, Gornbein J. et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 2013; 368: 914-923
11 Ciccone A, Valvassori L, Nichelatti M. et al. Endovascular treatment for acute ischemic stroke. N Engl J Med 2013; 368: 904-913
12 Warach SJ, Luby M, Albers GW. et al. Acute stroke imaging research roadmap III imaging selection and outcomes in acute stroke reperfusion clinical trials: consensus recommendations and further research priorities. Stroke 2016; 47: 1389-1398
13 Ringleb PA, Hamann GF, Röther J. et al. Akuttherapie des ischämischen Schlaganfalls – rekanalisierende Therapie: Ergänzung 2015. Akt Neurol 2016; 43: 82-91
14 Powers WJ, Rabinstein AA, Ackerson T. et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2018; 49: 46-110
15 Puetz V, Barlinn K, Bodechtel U. et al. Imaging-based selection for revascularization in acute ischemic stroke. Curr Opin Neurol 2016; 29: 20-29
16 Menon BK, Campbell BCV, Levi C. et al. Role of imaging in current acute ischemic stroke workflow for endovascular therapy. Stroke 2015; 46: 1453-1461
17 Saver JL. Time is brain – quantified. Stroke 2006; 37: 263-266
18 Menon BK, Sajobi TT, Zhang Y. et al. Analysis of workflow and time to treatment on thrombectomy outcome in the endovascular treatment for small core and proximal occlusion ischemic stroke (ESCAPE) randomized, controlled trial. Circulation 2016; 133: 2279-2286
19 Khatri P, Yeatts SD, Mazighi M. et al. Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trial. Lancet Neurol 2014; 13: 567-574
20 Goyal M, Fargen KM, Menon BK. Acute stroke, Bayes’ theorem and the art and science of emergency decision-making. J Neurointerv Surg 2013; 6: 2-6
21 Von Kummer R, Meyding-Lamade U, Forsting M. et al. Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk. AJNR 1994; 15: 9-18
22 Jovin TG, Yonas H, Gebel JM. et al. 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: 2426-2433
23 von Kummer R, Bourquain H, Bastianello S. et al. Early prediction of irreversible brain damage after ischemic stroke at CT. Radiology 2001; 219: 95-100
24 Puetz V, Dzialowski I, Hill MD. et al. The Alberta stroke program early ct score in clinical practice: What have we learned?. Int J Stroke 2009; 4: 354-364
25 Barber PA, Demchuk AM, Zhang J. et al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000; 355: 1670-1674
26 Hill MD, Rowley HA, Adler F. et al. Selection of acute ischemic stroke patients for intra-arterial thrombolysis with pro-urokinase by using ASPECTS. Stroke 2003; 34: 1925-1931
27 Hill MD, Demchuk AM, Goyal M. et al. Alberta stroke program early computed tomography score to select patients for endovascular treatment interventional management of stroke (IMS)-III trial. Stroke 2014; 45: 444-449
28 Yoo AJ, Zaidat OO, Chaudhry ZA. et al. Impact of pretreatment noncontrast CT Alberta stroke program early ct score on clinical outcome after intra arterial stroke therapy. Stroke 2014; 45: 746-751
29 Goyal M, Menon BK, Van Zwam WH. et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723-1731
30 Wolpert SM, Bruckmann H, Greenlee R. et al. Neuroradiologic evaluation of patients with acute stroke treated with recombinant tissue plasminogen activator. The rt-PA Acute Stroke Study Group. AJNR 1990; 14: 3-13
31 Barber PA, Demchuk AM, Hill MD. et al. The probability of middle cerebral artery MRA flow signal abnormality with quantified CT ischaemic change: targets for future therapeutic studies. J Neurol Neurosurg Psychiatry 2004; 75: 1426-1430
32 Mocco J, Zaidat OO, Von Kummer R. et al. Aspiration thrombectomy after intravenous alteplase versus intravenous alteplase alone. Stroke 2016; 47: 2331-2338
33 Bash S, Villablanca JP, Jahan R. et al. Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. AJNR 2005; 26: 1012-1021
34 Demchuk AM, Goyal M, Yeatts SD. et al. Recanalization and clinical outcome of occlusion sites at baseline CT angiography in the Interventional Management of Stroke III trial. Radiology 2014; 273: 202-210
35 Almekhlafi M, Menon B, Goyal M. Lessons learnt from recent endovascular stroke trials: finding a way to move forward. Exp Rev Cardiovasc Ther 2014; 12: 429-436
36 Appireddy RMR, Demchuk AM, Goyal M. et al. Endovascular therapy for ischemic stroke. J Clin Neurol 2015; 11: 1-8
37 Bhatia R, Bal SS, Shobha N. et al. CT angiographic source images predict outcome and final infarct volume better than noncontrast CT in proximal vascular occlusions. Stroke 2011; 42: 1575-1580
38 Coutts SB, Lev MH, Eliasziw M. et al. ASPECTS on CTA source images versus unenhanced CT: added value in predicting final infarct extent and clinical outcome. Stroke 2004; 35: 2472-2476
39 Pulli B, Schaefer PW, Hakimelahi R. et al. Acute ischemic stroke: infarct core estimation on CT angiography source images depends on CT angiography protocol. Radiology 2012; 262: 593-604
40 Liebeskind DS. Collateral circulation. Stroke 2003; 34: 2279-2284
41 Leng X, Fang H, Leung TWH. et al. Impact of collaterals on the efficacy and safety of endovascular treatment in acute ischaemic stroke: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2015; 87: 1-8
42 McVerry F, Liebeskind DS, Muir KW. Systematic review of methods for assessing leptomeningeal collateral flow. AJNR 2012; 33: 576-582
43 Berkhemer OA, Jansen IGH, Beumer D. et al. Collateral status on baseline computed tomographic angiography and intra-arterial treatment effect in patients with proximal anterior circulation stroke. Stroke 2016; 47: 768-776
44 Van Den Wijngaard IR, Holswilder G, Wermer MJH. et al. Assessment of collateral status by dynamic ct angiography in acute mca stroke: timing of acquisition and relationship with final infarct volume. AJNR 2016; 37: 1231-1236
45 Frölich AMJ, Wolff SL, Psychogios MN. et al. Time-resolved assessment of collateral flow using 4D CT angiography in large-vessel occlusion stroke. Eur Radiol 2014; 24: 390-396
46 Menon BK, D’esterre CD, Qazi EM. et al. Multiphase CT angiography: a new tool for the imaging triage of patients with acute ischemic stroke 1. Radiology 2015; 275: 510-520
47 Astrup J, Siesjö BK, Symon L. Thresholds in cerebral ischemia – the ischemic penumbra. Stroke 1981; 12: 723-725
48 Bivard A, Levi C, Spratt N. et al. Perfusion CT in acute stroke: a comprehensive analysis of infarct and penumbra. Radiology 2013; 267: 543-550
49 Campbell BCV, Yassi N, Ma H. et al. Imaging selection in ischemic stroke: feasibility of automated CT-perfusion analysis. Int J Stroke 2015; 10: 51-54
50 Dani KA, Thomas RGR, Chappell FM. et al. Systematic review of perfusion imaging with computed tomography and magnetic resonance in acute ischemic stroke: heterogeneity of acquisition and stroke imaging study. Stroke 2012; 43: 563-566
51 Heit JJ, Wintermark M. Perfusion computed tomography for the evaluation of acute ischemic stroke. Stroke 2016; 47: 1153-1158
52 Campbell BCV, Christensen S, Levi CR. et al. Cerebral blood flow is the optimal CT perfusion parameter for assessing infarct core. Stroke 2011; 42: 3435-3440
53 Austein F, Riedel C, Kerby T. et al. Comparison of perfusion CT software to predict the final infarct volume after thrombectomy. Stroke 2016; 47: 2311-2317
54 Olivot JM, Mlynash M, Thijs VN. et al. Optimal Tmax threshold for predicting penumbral tissue in acute stroke. Stroke 2009; 40: 469-475
55 Kamalian S, Kamalian S, Maas MB. et al. CT cerebral blood flow maps optimally correlate with admission diffusion-weighted imaging in acute stroke but thresholds vary by postprocessing platform. Stroke 2011; 42: 1923-1928
56 Campbell BCV, Christensen S, Levi CR. et al. Comparison of computed tomography perfusion and magnetic resonance imaging perfusion-diffusion mismatch in ischemic stroke. Stroke 2012; 43: 2648-2653
57 Borst J, Berkhemer OA, Roos YB. et al. Value of computed tomographic perfusion-based patient selection for intra-arterial acute ischemic stroke treatment. Stroke 2015; 46: 3375-3382
58 Muir KW, Buchan A, von Kummer R. et al. Imaging of acute stroke. Lancet Neurol 2006; 5: 755-768
59 Nael K, Khan R, Choudhary G. et al. Six-minute magnetic resonance imaging protocol for evaluation of acute ischemic stroke: pushing the boundaries. Stroke 2014; 45: 1985-1991
60 Wintermark M, Fiehler J, Kudo K. et al. International survey of acute stroke imaging capabilities. We need you!. Stroke 2013; 44: 2091
61 Lansberg MG, Straka M, Kemp S. et al. MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol 2012; 11: 860-867
62 Lansberg MG, Cereda CW, Mlynash M. et al. Response to endovascular reperfusion is not time-dependent in patients with salvageable tissue. Neurology 2015; 85: 708-714
63 Wouters A, Lemmens R, Christensen S. et al. Magnetic resonance imaging-based endovascular versus medical stroke treatment for symptom onset up to 12 h. Int J Stroke 2016; 11: 127-133
64 Gascou G, Lobotesis K, Machi P. et al. Stent retrievers in acute ischemic stroke: complications and failures during the perioperative period. AJNR 2014; 35: 734-740
65 Mokin M, Fargen KM, Primiani CT. et al. Vessel perforation during stent retriever thrombectomy for acute ischemic stroke: technical details and clinical outcomes. J Neurointerv Surg 2016;
66 Chen H, Liu N, Li Y. et al. Mismatch of low perfusion and high permeability predicts hemorrhagic transformation region in acute ischemic stroke patients treated with intra-arterial thrombolysis. Sci Rep 2016; 6: 27950
67 Coutinho JM, Liebeskind DS, Slater LA. et al. Mechanical thrombectomy for isolated M2 occlusions: a post hoc analysis of the STAR, SWIFT, and SWIFT PRIME studies. AJNR 2016; 37: 667-672
68 Singer OC, Berkefeld J, Nolte CH. et al. Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Akt Neurol 2015; 77: 415-424
69 van der Hoeven EJRJ, Schonewille WJ, Vos JA. et al. The Basilar Artery International Cooperation Study (BASICS): study protocol for a randomised controlled trial. Trials 2013; 14: 200
70 Nogueira RG, Jadhav AP, Haussen DC. et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 2018; 378: 708-718
71 Albers GW, Marks MP, Kemp S. et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med 2018; 378: 11-21