Peri-Therapeutic Quantitative Flow Analysis of Endovascular Revascularization for Ischemic Stroke Patients on Digital Subtraction Angiography

  • Shih-Neng Yang
  • Yu-Yi Lin
  • Tsung-Jung Ho
  • Shi-Yann Cheng
  • Yu-Rou Chiou
  • Chun-Han Liao
  • Geoffrey G. Zhang
  • Tzung-Chi Huang
Original Article
  • 43 Downloads

Abstract

Digital subtraction angiography (DSA) and optical flow method (OFM) were integrated to quantitate cerebral blood flow in patients with ischemic stroke and the results were utilized to predict the outcome of treatment. A total of 34 patients with ischemic stroke who received endovascular therapy were included in this study. The post-treatment blood flow velocity was significantly higher (P < .001) than the pre-treatment velocity. Anterior–posterior blood flow gain was correlated with National Institute of Health Stroke Scale (NIHSS) score improvement and 90-day mRS. Patients with a higher blood flow gain (> median value of 33.36%) were more likely to have a higher MBD NIHSS improve score (> 4) than those with a lower blood flow gain (< median value). Quantitative digital subtraction angiography provides hemodynamic information for patients treated with endovascular revascularization, and offers a reliable follow-up evaluation for the ischemic stroke treatment.

Keywords

Blood flow Digital subtraction angiography Ischemic stroke Optical flow method 

References

  1. 1.
    Saver, J. L., Jahan, R., Levy, E. I., Jovin, T. G., Baxter, B., Nogueira, R. G., et al. (2012). Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet, 380(9849), 1241–1249.CrossRefGoogle Scholar
  2. 2.
    Nogueira, R. G., Lutsep, H. L., Gupta, R., Jovin, T. G., Albers, G. W., Walker, G. A., et al. (2012). Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet, 380(9849), 1231–1240.CrossRefGoogle Scholar
  3. 3.
    Turk, A. S., Frei, D., Fiorella, D., Mocco, J., Baxter, B., Siddiqui, A., et al. (2014). ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J NeuroInterventional Surg, 6(4), 260–264.CrossRefGoogle Scholar
  4. 4.
    Khatri, P., Abruzzo, T., Yeatts, S. D., Nichols, C., Broderick, J. P., Tomsick, T. A., et al. (2009). Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology, 73(13), 1066–1072.CrossRefGoogle Scholar
  5. 5.
    Zaidat, O. O., Suarez, J. I., Sunshine, J. L., Tarr, R. W., Alexander, M. J., Smith, T. P., et al. (2005). Thrombolytic therapy of acute ischemic stroke: correlation of angiographic recanalization with clinical outcome. Am J Neuroradiol, 26(4), 880–884.Google Scholar
  6. 6.
    Rha, J. H., & Saver, J. L. (2007). The impact of recanalization on ischemic stroke outcome a meta-analysis. Stroke, 38(3), 967–973.CrossRefGoogle Scholar
  7. 7.
    Fargen, K. M., Meyers, P. M., Khatri, P., & Mocco, J. (2013). Improvements in recanalization with modern stroke therapy: a review of prospective ischemic stroke trials during the last two decades. J NeuroInterventional Surg, 5(6), 506–511.CrossRefGoogle Scholar
  8. 8.
    Costalat, V., Machi, P., Lobotesis, K., Maldonado, I., Vendrell, J. F., Riquelme, C., et al. (2011). Rescue, combined, and stand-alone thrombectomy in the management of large vessel occlusion stroke using the solitaire device: a prospective 50-patient single-center study timing, safety, and efficacy. Stroke, 42(7), 1929–1935.CrossRefGoogle Scholar
  9. 9.
    Zaidat, O. O., Yoo, A. J., Khatri, P., Tomsick, T. A., von Kummer, R., Saver, J. L., et al. (2013). Recommendations on angiographic revascularization grading standards for acute ischemic stroke a consensus statement. Stroke, 44(9), 2650–2663.CrossRefGoogle Scholar
  10. 10.
    Jones, H. R., Millikan, C. H., & Sandok, B. A. (1980). Temporal profile (clinical course) of acute vertebrobasilar system cerebral infarction. Stroke, 11(2), 173–177.CrossRefGoogle Scholar
  11. 11.
    Abilleira, S., Cardona, P., Ribó, M., Millán, M., Obach, V., Roquer, J., et al. (2014). Outcomes of a contemporary cohort of 536 consecutive patients with acute ischemic stroke treated with endovascular therapy. Stroke, 45(4), 1046–1052.CrossRefGoogle Scholar
  12. 12.
    Bonnefous, O., Pereira, V. M., Ouared, R., Brina, O., Aerts, H., Hermans, R., et al. (2012). Quantification of arterial flow using digital subtraction angiography. Med Phys, 39(10), 6264–6275.CrossRefGoogle Scholar
  13. 13.
    Shpilfoygel, S. D., Close, R. A., Valentino, D. J., & Duckwiler, G. R. (2000). X-ray videodensitometric methods for blood flow and velocity measurement: A critical review of literature. Med Phys, 27(9), 2008–2023.CrossRefGoogle Scholar
  14. 14.
    Scalzo, F., & Liebeskind, D. S. (2016). Perfusion angiography in acute ischemic stroke. Comput Math Methods Med. doi: 10.1155/2016/2478324.MathSciNetMATHGoogle Scholar
  15. 15.
    Huang, T. C., Wu, T. H., Lin, C. J., Mok, G. S., & Guo, W. Y. (2012). Peritherapeutic quantitative flow analysis of arteriovenous malformation on digital subtraction angiography. J Vasc Surg, 56(3), 812–815.CrossRefGoogle Scholar
  16. 16.
    Wu, T. H., Lin, C. J., Lin, Y. H., Guo, W. Y., & Huang, T. C. (2013). Quantitative analysis of digital subtraction angiography using optical flow method on occlusive cerebrovascular disease. Comput Methods Programs Biomed, 111(3), 693–700.CrossRefGoogle Scholar
  17. 17.
    Huang, T. C., Wu, T. H., Lin, Y. H., Guo, W. Y., Huang, W. C., & Lin, C. J. (2013). Quantitative flow measurement by digital subtraction angiography in cerebral carotid stenosis using optical flow method. J X-Ray Sci Technol, 21(2), 227–235.Google Scholar
  18. 18.
    Treger, I., Aidinof, L., Lutsky, L., & Kalichman, L. (2010). Mean flow velocity in the middle cerebral artery is associated with rehabilitation success in ischemic stroke patients. Arch Phys Med Rehabil, 91, 1737–1740.CrossRefGoogle Scholar
  19. 19.
    Treger, I., Streifler, J. Y., & Ring, H. (2005). The relationship between mean flow velocity and functional and neurologic parameters of ischemic stroke patients undergoing rehabilitation. Arch Phys Med Rehabil, 86, 427–430.CrossRefGoogle Scholar
  20. 20.
    Zanette, E. M., Roberti, C., Mancini, G., Pozzilli, C., Bragoni, M., & Toni, D. (1995). Spontaneous middle cerebral artery reperfusion in ischemic stroke. A follow-up study with transcranial Doppler. Stroke, 26(3), 430–433.CrossRefGoogle Scholar
  21. 21.
    Horn, B. K., & Schunck, B. G. (1981). Determining optical flow. Artif Intell, 17(1–3), 185–203.CrossRefGoogle Scholar
  22. 22.
    Huang, T. C., Lin, W. C., Wu, C. C., Zhang, G., & Lin, K. P. (2010). Experimental estimation of blood flow velocity through simulation of intravital microscopic imaging in micro-vessels by different image processing methods. Microvasc Res, 80(3), 477–483.CrossRefGoogle Scholar
  23. 23.
    Shih, T. C., Zhang, G., Wu, C. C., Hsiao, H. D., Wu, T. H., Lin, K. P., et al. (2011). Hemodynamic analysis of capillary in finger nail-fold using computational fluid dynamics and image estimation. Microvasc Res, 81(1), 68–72.CrossRefGoogle Scholar
  24. 24.
    Ho, Y. J., Chang, M. B., Lin, Y. H., Yao, C. H., & Huang, T. C. (2012). Quantitative portal vein velocity of liver cancer patients with transcatheter arterial chemoembolization on angiography. Sci World J, 2012, 830531.Google Scholar
  25. 25.
    Huang, T. C., Chang, C. K., Liao, C. H., & Ho, Y. J. (2013). Quantification of blood flow in internal cerebral artery by optical flow method on digital subtraction angiography in comparison with time-of-flight magnetic resonance angiography. PLoS ONE, 8(1), e54678.CrossRefGoogle Scholar
  26. 26.
    Goyal, M., Fargen, K. M., Turk, A. S., Mocco, J., Liebeskind, D. S., Frei, D., et al. (2014). 2C or not 2C: defining an improved revascularization grading scale and the need for standardization of angiography outcomes in stroke trials. J NeuroInterventional Surg, 6(2), 83–86.CrossRefGoogle Scholar
  27. 27.
    Kallmes, D. (2012). TICI: if you are not confused, then you are not paying attention. Am J Neuroradiol, 33(5), 975–976.CrossRefGoogle Scholar
  28. 28.
    Banks, J. L., & Marotta, C. A. (2007). Outcomes validity and reliability of the modified Rankin scale: Implications for stroke clinical trials a literature review and synthesis. Stroke, 38(3), 1091–1096.CrossRefGoogle Scholar
  29. 29.
    Demchuk, A. M., Burgin, W. S., Christou, I., Felberg, R. A., Barber, P. A., Hill, M. D., et al. (2001). Thrombolysis in brain ischemia (TIBI) transcranial Doppler flow grades predict clinical severity, early recovery, and mortality in patients treated with intravenous tissue plasminogen activator. Stroke, 32(1), 89–93.CrossRefGoogle Scholar

Copyright information

© Taiwanese Society of Biomedical Engineering 2017

Authors and Affiliations

  • Shih-Neng Yang
    • 1
    • 2
  • Yu-Yi Lin
    • 3
    • 4
  • Tsung-Jung Ho
    • 5
    • 6
    • 7
  • Shi-Yann Cheng
    • 8
    • 9
  • Yu-Rou Chiou
    • 2
  • Chun-Han Liao
    • 10
  • Geoffrey G. Zhang
    • 11
  • Tzung-Chi Huang
    • 1
    • 12
  1. 1.Department of Biomedical Imaging and Radiological ScienceChina Medical UniversityTaichungTaiwan
  2. 2.Department of Radiation OncologyChina Medical University HospitalTaichungTaiwan
  3. 3.Department of Nuclear MedicineChina Medical University Beigang HospitalYunlinTaiwan
  4. 4.Department of Nuclear Medicine, An Nan HospitalChina Medical UniversityTainanTaiwan
  5. 5.School of Chinese MedicineChina Medical UniversityTaichungTaiwan
  6. 6.Division of Chinese MedicineChina Medical University Beigang HospitalYunlinTaiwan
  7. 7.Division of Chinese Medicine, An Nan HospitalChina Medical UniversityTainanTaiwan
  8. 8.School of MedicineChina Medical UniversityTaichungTaiwan
  9. 9.Department of Obstetrics and GynecologyChin Medical University Beigang HospitalYunlinTaiwan
  10. 10.Department of RadiologyChina Medical University HospitalTaichungTaiwan
  11. 11.Department of Radiation OncologyMoffitt Cancer CenterTampaUSA
  12. 12.Department of Bioinformatics and Medical EngineeringAsia UniversityTaichungTaiwan

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