AUTHOR=Rascle Lucie , Bani Sadr Alexandre , Amaz Camille , Mewton Nathan , Buisson Marielle , Hermier Marc , Ong Elodie , Fontaine Julia , Derex Laurent , Berthezène Yves , Eker Omer Faruk , Cho Tae-Hee , Nighoghossian Norbert , Mechtouff Laura 

TITLE=Does the Brush-Sign Reflect Collateral Status and DWI-ASPECTS in Large Vessel Occlusion?

JOURNAL=Frontiers in Neurology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.828256

DOI=10.3389/fneur.2022.828256

ISSN=1664-2295

ABSTRACT=<sec><title>Introduction</title><p>The relevance of the brush-sign remained poorly documented in large vessel occlusion (LVO). We aimed to assess the relationship between the brush-sign and collateral status and its potential impact on baseline diffusion-weighted imaging–Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) in acute ischemic stroke (AIS) patients eligible to mechanical thrombectomy (MT).</p></sec><sec><title>Methods</title><p>Consecutive patients admitted in the Lyon Stroke Center with anterior circulation AIS due to intracranial internal carotid artery (ICA) and/or M1 or M2 segment of the middle cerebral artery (MCA) occlusion eligible for MT were included. The brush-sign was assessed on T2-gradient-echo MRI. Collateral status was assessed on digital subtraction angiography according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) score.</p></sec><sec><title>Results</title><p>In this study, 504 patients were included, among which 171 (33.9%) patients had a brush-sign. Patients with a brush-sign more frequently had a poor collateral status [72 (42.1%) vs. 103 (30.9%); <italic>p</italic> = 0.017]. In univariable analysis, a DWI-ASPECTS &lt; 7 was associated with a brush sign. Following multivariable analysis, the brush-sign no longer affected DWI-ASPECTS &lt; 7 while the latter remained associated with younger age [odds ratio (OR) 0.97, 95% CI.96–0.99], male sex (OR 1.79, 95% CI 1.08–2.99), a higher National Institutes of Health Stroke Scale (NIHSS) score (OR 1.16, 95% CI 1.1–1.21), a poor collateral status (OR 9.35, 95% CI 5.59-16.02), MCA segment (OR 2.54, 95% CI 1.25–5.38), and intracranial ICA (OR 3.01, 95% CI 1.16–8) occlusion.</p></sec><sec><title>Conclusions and Relevance</title><p>The brush-sign may be a marker of poor collateral status but did not independently predict a lower DWI-ASPECTS.</p></sec><sec><title>Clinical Trial Registration</title><p><ext-link ext-link-type="uri" xlink:href="https://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, identifier: NCT04620642.</p></sec>