MRSI Evaluation for Minor Stroke With Large Vessel Occlusion

Shanghai 6th People's Hospital75 enrolled

Overview

The goal of this observational study is to understand acute anterior circulation large artery occluded minor stroke (LVO-MIS) evolution using magnetic resonance spectroscopic imaging evaluation. The main questions it aims to answer are: 1. Neurometabolic predictors of early neurological deterioration and functional outcome; 2. Temporal and spatial dynamic changes of the neurometabolites from the acute stage (within 24 hours), through the subacute stage (5-7 days), to the chronic stage (90 days); 3. Temporal and spatial dynamic changes of the neurotransmitters GABA, glutamate, and glutamine from the acute stage to the chronic stage; 4. Brain regions exhibiting changes in whole-brain metabolic network connectivity.

Minor acute ischemic stroke (AIS) is a common medical condition accounting for more than 50% of AIS. Of the patients with minor AIS, 28.3% are unable to discharge home, and 28.5% cannot walk independently. Although most patients with large vessel occlusion (LVO) strokes and mild symptoms have good clinical outcomes, individuals with early neurological worsening tend to do poorly despite rescue thrombectomy. Therefore, it would be ideal to understand the factors associated with acute neurological deterioration ≥4 NIHSS points among this population to potentially triage higher risk individuals to upfront endovascular therapy. The main goal of this study was to investigate the spatial and temporal changes of neurometabolite concentrations in patients with acute mild ischemic stroke with large vessel occlusion (LVO-MIS) and to assess the extent to which the combination of all neurometabolite signals measured by 3D-MRSI could discriminate between early neurologic deterioration (END) and non-END patients. Patients who are older than 18 years of age diagnosed with acute mild ischemic stroke with large vessel occlusion (LVO-MIS) within 24 hours of onset will be enrolled into the study. MRSI will be performed in enrolled stroke patients from the acute stage (within 24 hours), through the subacute stage (5-7 days), to the chronic stage (90 days). Higher resolution 3D MRSI scans were performed using SPICE. The acquisition parameters were as follows: TR = 160 msec, TE = 1.6 msec, spatial resolution = 2.0 × 3.0 × 3.0 mm3, FOV = 240 × 240 × 120 mm3, scan time = 18:35 min.

Study Type

OBSERVATIONAL

Enrollment

Eligibility

Sex: ALLMin age: 18 YearsMax age: 100 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Adult (age ≥ 18 years) patients presenting with symptoms consistent with acute ischemic stroke due to occlusion of the intracranial internal carotid artery and/or M1 or M2 segment of the middle cerebral artery; 2. Patients with mild symptoms at admission (National Institutes of Health Stroke Scale (NIHSS)\<6); 3. Baseline multimodal-CT imaging, including NCCT, CTA and CTP, performed at the trial-site hospital; 4. Time from symptom onset or last known normal to enrollment is less than 24 hours; 5. Patient or legal representative willing to comply with protocol requirements and data collection procedures, understand and sign informed consent. Exclusion Criteria: 1. A pre-incident mRS ≥ 1 point before onset; 2. Previous clear history of cerebral infarction, cerebral hemorrhage, brain tumor and other diseases that affect cerebral metabolism; 3. Intolerance or non-cooperation with magnetic resonance examination; 4. Severe cardiac, hepatic, renal impairment or other systemic serious advanced diseases; 5. Pregnancy or lactation; 6. Life expectancy is less than 3 months; 7. Other conditions that, in the opinion of the investigator, are not suitable for participation in this study or may pose a significant risk to the patient (such as inability to understand and/or comply with study procedures and/or follow-up due to psychiatric disorders, cognitive or emotional disorders).

Outcomes

Primary Outcomes

Early neurological deterioration

It is defined as an increase of ≥4 points from baseline NIHSS at hospital arrival, and excluding non-ischemic causes such as hemorrhagic transformation and epilepsy.

Time frame: 24 hours

Secondary Outcomes

Neurological functional outcome

Modified Rankin Scale (mRS) score is used to measure the degree of disability in patients who have had a stroke, as follows 0: No symptoms at all 1. No significant disability despite symptoms; able to carry out all usual duties and activities 2. Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance 3. Moderate disability; requiring some help, but able to walk without assistance 4. Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance 5. Severe disability; bedridden, incontinent and requiring constant nursing care and attention 6. Dead

Time frame: 90 days

Composite Temporal and spatial dynamic changes of the neurometabolites

Signals of NAA, lactate, choline, creatine, and myo-inositol were evaluated using MRSI technology

Time frame: acute stage (within 24 hours), the subacute stage (5-7 days) and the chronic stage (90 days)

Composite Temporal and spatial dynamic changes of the neurotransmitters

Signal of GABA, glutamate, and glutamine determined by MRSI technology

Time frame: acute stage (within 24 hours), the subacute stage (5-7 days) and the chronic stage (90 days)

Changes in whole-brain metabolic network connectivity

Changes of metabolic connectivity mapping in whole brain between acute stage and chronic stage of stroke.

Time frame: acute stage (within 24 hours), the subacute stage (5-7 days) and the chronic stage (90 days)

MRSI Evaluation for Minor Stroke With Large Vessel Occlusion

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts