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The volume of steal phenomenon is associated with neurological deterioration in patients with large-vessel occlusion minor stroke not eligible for thrombectomy
Introduction: A significant number of patients who present with mild symptoms following large-vessel occlusion acute ischemic stroke (LVO-AIS) are currently considered ineligible for EVT. However, they frequently experience neurological deterioration during hospitalization. This study aimed to inves...
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| Published in: | European stroke journal 2024-12, Vol.9 (4), p.927-935 |
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| container_title | European stroke journal |
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| creator | Bellomo, Jacopo Sebök, Martina van Niftrik, Christiaan HB Stumpo, Vittorio Schubert, Tilman Madjidyar, Jawid Thurner, Patrick Globas, Christoph Wegener, Susanne Luft, Andreas R Kulcsár, Zsolt Regli, Luca Fierstra, Jorn |
| description | Introduction:
A significant number of patients who present with mild symptoms following large-vessel occlusion acute ischemic stroke (LVO-AIS) are currently considered ineligible for EVT. However, they frequently experience neurological deterioration during hospitalization. This study aimed to investigate the association between neurological deterioration and hemodynamic impairment by assessing steal phenomenon derived from blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) in this specific patient cohort.
Patients and methods:
From the database of our single-center BOLD-CVR observational cohort study (June 2015–October 2023) we retrospectively identified acute ischemic stroke patients with admission NIHSS |
| doi_str_mv | 10.1177/23969873241251718 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11569536</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_23969873241251718</sage_id><sourcerecordid>3054841392</sourcerecordid><originalsourceid>FETCH-LOGICAL-c391t-e5d75408d6ad681ea29563e47bc93daa45cf56c0052351a243c12c3b2d4475733</originalsourceid><addsrcrecordid>eNp9kctu1TAQhiMEolXpA7BBXrJJG9-dFUIVl0qV2JS15TiTxMWxD7ZzUJ-GV8VHpxyBkFiMPBp_8489f9O8xt0VxlJeE9qLXklKGCYcS6yeNeeHWtsrhZ-fcknPmsucH7quwz0WVOGXzRlVkhGqxHnz834BtI9-WwHFCeUCxqPdAiGuNQJyGZmco3WmwIh-uLKgAFuKPs7OVnSEAsnFZIo70AHtagah5CPrTZqh3UPO4FG01m_5wK0uxFSHpfgNUIgFgXezGzygqdbLkuI6gC1xfXzVvJiMz3D5dF40Xz9-uL_53N59-XR78_6utbTHpQU-Ss46NQozCoXBkJ4LCkwOtqejMYzbiQvbdZxQjg1h1GJi6UBGxiSXlF407466u21YYbT1C8l4vUtuNelRR-P03zfBLXqOe40xFz2noiq8fVJI8fsGuejVZQvemwBxy5p2nCmGaU8qio-oTTHnBNNpDu70wVz9j7m1582fDzx1_LayAldHIJsZ9EPcUqgL-4_iL_ShsZE</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3054841392</pqid></control><display><type>article</type><title>The volume of steal phenomenon is associated with neurological deterioration in patients with large-vessel occlusion minor stroke not eligible for thrombectomy</title><source>Sage Journals Online</source><source>PubMed Central</source><creator>Bellomo, Jacopo ; Sebök, Martina ; van Niftrik, Christiaan HB ; Stumpo, Vittorio ; Schubert, Tilman ; Madjidyar, Jawid ; Thurner, Patrick ; Globas, Christoph ; Wegener, Susanne ; Luft, Andreas R ; Kulcsár, Zsolt ; Regli, Luca ; Fierstra, Jorn</creator><creatorcontrib>Bellomo, Jacopo ; Sebök, Martina ; van Niftrik, Christiaan HB ; Stumpo, Vittorio ; Schubert, Tilman ; Madjidyar, Jawid ; Thurner, Patrick ; Globas, Christoph ; Wegener, Susanne ; Luft, Andreas R ; Kulcsár, Zsolt ; Regli, Luca ; Fierstra, Jorn</creatorcontrib><description>Introduction:
A significant number of patients who present with mild symptoms following large-vessel occlusion acute ischemic stroke (LVO-AIS) are currently considered ineligible for EVT. However, they frequently experience neurological deterioration during hospitalization. This study aimed to investigate the association between neurological deterioration and hemodynamic impairment by assessing steal phenomenon derived from blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) in this specific patient cohort.
Patients and methods:
From the database of our single-center BOLD-CVR observational cohort study (June 2015–October 2023) we retrospectively identified acute ischemic stroke patients with admission NIHSS < 6, a newly detected large vessel occlusion of the anterior circulation and ineligible for EVT. Neurological deterioration during hospitalization as well as outcome at hospital discharge were rated with NIHSS score. We analyzed the association between these two outcomes and BOLD-CVR-derived steal phenomenon volume through regression analysis. Additionally, we investigated the discriminatory accuracy of steal phenomenon volume for predicting neurological deterioration.
Results:
Forty patients were included in the final analysis. Neurological deterioration occurred in 35% of patients. In the regression analysis, a strong association between steal phenomenon volume and neurological deterioration (OR 4.80, 95% CI 1.32–31.04, p = 0.04) as well as poorer NIHSS score at hospital discharge (OR 3.73, 95% CI 1.52–10.78, p = 0.007) was found. The discriminatory accuracy of steal phenomenon for neurological deterioration prediction had an AUC of 0.791 (95% CI 0.653–0.930).
Discussion:
Based on our results we may distinguish two groups of patients with minor stroke currently ineligible for EVT, however, showing hemodynamic impairment and exhibiting neurological deterioration during hospitalization: (1) patients exhibiting steal phenomenon on BOLD-CVR imaging as well as hemodynamic impairment on resting perfusion imaging; (2) patients exhibiting steal phenomenon on BOLD-CVR imaging, however, no relevant hemodynamic impairment on resting perfusion imaging.
Conclusion:
The presence of BOLD-CVR derived steal phenomenon may aid to further study hemodynamic impairment in patients with minor LVO-AIS not eligible for EVT.
Graphical abstract</description><identifier>ISSN: 2396-9873</identifier><identifier>ISSN: 2396-9881</identifier><identifier>EISSN: 2396-9881</identifier><identifier>DOI: 10.1177/23969873241251718</identifier><identifier>PMID: 38742386</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Aged ; Aged, 80 and over ; Cerebrovascular Circulation - physiology ; Female ; Humans ; Ischemic Stroke - diagnostic imaging ; Ischemic Stroke - physiopathology ; Ischemic Stroke - therapy ; Male ; Middle Aged ; Original ; Retrospective Studies ; Thrombectomy - methods</subject><ispartof>European stroke journal, 2024-12, Vol.9 (4), p.927-935</ispartof><rights>European Stroke Organisation 2024</rights><rights>European Stroke Organisation 2024 2024 European Stroke Organisation</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c391t-e5d75408d6ad681ea29563e47bc93daa45cf56c0052351a243c12c3b2d4475733</cites><orcidid>0009-0005-8945-4838 ; 0000-0003-4369-7023</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569536/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569536/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793,79364</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38742386$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bellomo, Jacopo</creatorcontrib><creatorcontrib>Sebök, Martina</creatorcontrib><creatorcontrib>van Niftrik, Christiaan HB</creatorcontrib><creatorcontrib>Stumpo, Vittorio</creatorcontrib><creatorcontrib>Schubert, Tilman</creatorcontrib><creatorcontrib>Madjidyar, Jawid</creatorcontrib><creatorcontrib>Thurner, Patrick</creatorcontrib><creatorcontrib>Globas, Christoph</creatorcontrib><creatorcontrib>Wegener, Susanne</creatorcontrib><creatorcontrib>Luft, Andreas R</creatorcontrib><creatorcontrib>Kulcsár, Zsolt</creatorcontrib><creatorcontrib>Regli, Luca</creatorcontrib><creatorcontrib>Fierstra, Jorn</creatorcontrib><title>The volume of steal phenomenon is associated with neurological deterioration in patients with large-vessel occlusion minor stroke not eligible for thrombectomy</title><title>European stroke journal</title><addtitle>Eur Stroke J</addtitle><description>Introduction:
A significant number of patients who present with mild symptoms following large-vessel occlusion acute ischemic stroke (LVO-AIS) are currently considered ineligible for EVT. However, they frequently experience neurological deterioration during hospitalization. This study aimed to investigate the association between neurological deterioration and hemodynamic impairment by assessing steal phenomenon derived from blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) in this specific patient cohort.
Patients and methods:
From the database of our single-center BOLD-CVR observational cohort study (June 2015–October 2023) we retrospectively identified acute ischemic stroke patients with admission NIHSS < 6, a newly detected large vessel occlusion of the anterior circulation and ineligible for EVT. Neurological deterioration during hospitalization as well as outcome at hospital discharge were rated with NIHSS score. We analyzed the association between these two outcomes and BOLD-CVR-derived steal phenomenon volume through regression analysis. Additionally, we investigated the discriminatory accuracy of steal phenomenon volume for predicting neurological deterioration.
Results:
Forty patients were included in the final analysis. Neurological deterioration occurred in 35% of patients. In the regression analysis, a strong association between steal phenomenon volume and neurological deterioration (OR 4.80, 95% CI 1.32–31.04, p = 0.04) as well as poorer NIHSS score at hospital discharge (OR 3.73, 95% CI 1.52–10.78, p = 0.007) was found. The discriminatory accuracy of steal phenomenon for neurological deterioration prediction had an AUC of 0.791 (95% CI 0.653–0.930).
Discussion:
Based on our results we may distinguish two groups of patients with minor stroke currently ineligible for EVT, however, showing hemodynamic impairment and exhibiting neurological deterioration during hospitalization: (1) patients exhibiting steal phenomenon on BOLD-CVR imaging as well as hemodynamic impairment on resting perfusion imaging; (2) patients exhibiting steal phenomenon on BOLD-CVR imaging, however, no relevant hemodynamic impairment on resting perfusion imaging.
Conclusion:
The presence of BOLD-CVR derived steal phenomenon may aid to further study hemodynamic impairment in patients with minor LVO-AIS not eligible for EVT.
Graphical abstract</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cerebrovascular Circulation - physiology</subject><subject>Female</subject><subject>Humans</subject><subject>Ischemic Stroke - diagnostic imaging</subject><subject>Ischemic Stroke - physiopathology</subject><subject>Ischemic Stroke - therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Retrospective Studies</subject><subject>Thrombectomy - methods</subject><issn>2396-9873</issn><issn>2396-9881</issn><issn>2396-9881</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><recordid>eNp9kctu1TAQhiMEolXpA7BBXrJJG9-dFUIVl0qV2JS15TiTxMWxD7ZzUJ-GV8VHpxyBkFiMPBp_8489f9O8xt0VxlJeE9qLXklKGCYcS6yeNeeHWtsrhZ-fcknPmsucH7quwz0WVOGXzRlVkhGqxHnz834BtI9-WwHFCeUCxqPdAiGuNQJyGZmco3WmwIh-uLKgAFuKPs7OVnSEAsnFZIo70AHtagah5CPrTZqh3UPO4FG01m_5wK0uxFSHpfgNUIgFgXezGzygqdbLkuI6gC1xfXzVvJiMz3D5dF40Xz9-uL_53N59-XR78_6utbTHpQU-Ss46NQozCoXBkJ4LCkwOtqejMYzbiQvbdZxQjg1h1GJi6UBGxiSXlF407466u21YYbT1C8l4vUtuNelRR-P03zfBLXqOe40xFz2noiq8fVJI8fsGuejVZQvemwBxy5p2nCmGaU8qio-oTTHnBNNpDu70wVz9j7m1582fDzx1_LayAldHIJsZ9EPcUqgL-4_iL_ShsZE</recordid><startdate>20241201</startdate><enddate>20241201</enddate><creator>Bellomo, Jacopo</creator><creator>Sebök, Martina</creator><creator>van Niftrik, Christiaan HB</creator><creator>Stumpo, Vittorio</creator><creator>Schubert, Tilman</creator><creator>Madjidyar, Jawid</creator><creator>Thurner, Patrick</creator><creator>Globas, Christoph</creator><creator>Wegener, Susanne</creator><creator>Luft, Andreas R</creator><creator>Kulcsár, Zsolt</creator><creator>Regli, Luca</creator><creator>Fierstra, Jorn</creator><general>SAGE Publications</general><scope>AFRWT</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0009-0005-8945-4838</orcidid><orcidid>https://orcid.org/0000-0003-4369-7023</orcidid></search><sort><creationdate>20241201</creationdate><title>The volume of steal phenomenon is associated with neurological deterioration in patients with large-vessel occlusion minor stroke not eligible for thrombectomy</title><author>Bellomo, Jacopo ; Sebök, Martina ; van Niftrik, Christiaan HB ; Stumpo, Vittorio ; Schubert, Tilman ; Madjidyar, Jawid ; Thurner, Patrick ; Globas, Christoph ; Wegener, Susanne ; Luft, Andreas R ; Kulcsár, Zsolt ; Regli, Luca ; Fierstra, Jorn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c391t-e5d75408d6ad681ea29563e47bc93daa45cf56c0052351a243c12c3b2d4475733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cerebrovascular Circulation - physiology</topic><topic>Female</topic><topic>Humans</topic><topic>Ischemic Stroke - diagnostic imaging</topic><topic>Ischemic Stroke - physiopathology</topic><topic>Ischemic Stroke - therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Retrospective Studies</topic><topic>Thrombectomy - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bellomo, Jacopo</creatorcontrib><creatorcontrib>Sebök, Martina</creatorcontrib><creatorcontrib>van Niftrik, Christiaan HB</creatorcontrib><creatorcontrib>Stumpo, Vittorio</creatorcontrib><creatorcontrib>Schubert, Tilman</creatorcontrib><creatorcontrib>Madjidyar, Jawid</creatorcontrib><creatorcontrib>Thurner, Patrick</creatorcontrib><creatorcontrib>Globas, Christoph</creatorcontrib><creatorcontrib>Wegener, Susanne</creatorcontrib><creatorcontrib>Luft, Andreas R</creatorcontrib><creatorcontrib>Kulcsár, Zsolt</creatorcontrib><creatorcontrib>Regli, Luca</creatorcontrib><creatorcontrib>Fierstra, Jorn</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European stroke journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bellomo, Jacopo</au><au>Sebök, Martina</au><au>van Niftrik, Christiaan HB</au><au>Stumpo, Vittorio</au><au>Schubert, Tilman</au><au>Madjidyar, Jawid</au><au>Thurner, Patrick</au><au>Globas, Christoph</au><au>Wegener, Susanne</au><au>Luft, Andreas R</au><au>Kulcsár, Zsolt</au><au>Regli, Luca</au><au>Fierstra, Jorn</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The volume of steal phenomenon is associated with neurological deterioration in patients with large-vessel occlusion minor stroke not eligible for thrombectomy</atitle><jtitle>European stroke journal</jtitle><addtitle>Eur Stroke J</addtitle><date>2024-12-01</date><risdate>2024</risdate><volume>9</volume><issue>4</issue><spage>927</spage><epage>935</epage><pages>927-935</pages><issn>2396-9873</issn><issn>2396-9881</issn><eissn>2396-9881</eissn><abstract>Introduction:
A significant number of patients who present with mild symptoms following large-vessel occlusion acute ischemic stroke (LVO-AIS) are currently considered ineligible for EVT. However, they frequently experience neurological deterioration during hospitalization. This study aimed to investigate the association between neurological deterioration and hemodynamic impairment by assessing steal phenomenon derived from blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) in this specific patient cohort.
Patients and methods:
From the database of our single-center BOLD-CVR observational cohort study (June 2015–October 2023) we retrospectively identified acute ischemic stroke patients with admission NIHSS < 6, a newly detected large vessel occlusion of the anterior circulation and ineligible for EVT. Neurological deterioration during hospitalization as well as outcome at hospital discharge were rated with NIHSS score. We analyzed the association between these two outcomes and BOLD-CVR-derived steal phenomenon volume through regression analysis. Additionally, we investigated the discriminatory accuracy of steal phenomenon volume for predicting neurological deterioration.
Results:
Forty patients were included in the final analysis. Neurological deterioration occurred in 35% of patients. In the regression analysis, a strong association between steal phenomenon volume and neurological deterioration (OR 4.80, 95% CI 1.32–31.04, p = 0.04) as well as poorer NIHSS score at hospital discharge (OR 3.73, 95% CI 1.52–10.78, p = 0.007) was found. The discriminatory accuracy of steal phenomenon for neurological deterioration prediction had an AUC of 0.791 (95% CI 0.653–0.930).
Discussion:
Based on our results we may distinguish two groups of patients with minor stroke currently ineligible for EVT, however, showing hemodynamic impairment and exhibiting neurological deterioration during hospitalization: (1) patients exhibiting steal phenomenon on BOLD-CVR imaging as well as hemodynamic impairment on resting perfusion imaging; (2) patients exhibiting steal phenomenon on BOLD-CVR imaging, however, no relevant hemodynamic impairment on resting perfusion imaging.
Conclusion:
The presence of BOLD-CVR derived steal phenomenon may aid to further study hemodynamic impairment in patients with minor LVO-AIS not eligible for EVT.
Graphical abstract</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>38742386</pmid><doi>10.1177/23969873241251718</doi><tpages>9</tpages><orcidid>https://orcid.org/0009-0005-8945-4838</orcidid><orcidid>https://orcid.org/0000-0003-4369-7023</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2396-9873 |
| ispartof | European stroke journal, 2024-12, Vol.9 (4), p.927-935 |
| issn | 2396-9873 2396-9881 2396-9881 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11569536 |
| source | Sage Journals Online; PubMed Central |
| subjects | Aged Aged, 80 and over Cerebrovascular Circulation - physiology Female Humans Ischemic Stroke - diagnostic imaging Ischemic Stroke - physiopathology Ischemic Stroke - therapy Male Middle Aged Original Retrospective Studies Thrombectomy - methods |
| title | The volume of steal phenomenon is associated with neurological deterioration in patients with large-vessel occlusion minor stroke not eligible for thrombectomy |
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