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Title: | Retinal vessel multifractals predict pial collateral status in patients with acute ischemic stroke | Authors: | Khan, Adnan DE BOEVER, Patrick Gerrits, Nele Akhtar, Naveed Saqqur, Maher Ponirakis, Georgios Gad, Hoda Petropoulos, Ioannis N. Shuaib, Ashfaq Faber, James E. Kamran, Saadat Malik, Rayaz A. |
Editors: | Popa-Wagner, Aurel | Issue Date: | 2022 | Publisher: | PUBLIC LIBRARY SCIENCE | Source: | PLoS One, 17 (5) (Art N° e0267837) | Abstract: | Objectives Pial collateral blood flow is a major determinant of the outcomes of acute ischemic stroke. This study was undertaken to determine whether retinal vessel metrics can predict the pial collateral status and stroke outcomes in patients. Methods Thirty-five patients with acute stroke secondary to middle cerebral artery (MCA) occlusion underwent grading of their pial collateral status from computed tomography angiography and retinal vessel analysis from retinal fundus images. Results The NIHSS (14.7 +/- 5.5 vs 10.1 +/- 5.8, p = 0.026) and mRS (2.9 +/- 1.6 vs 1.9 +/- 1.3, p = 0.048) scores were higher at admission in patients with poor compared to good pial collaterals. Retinal vessel multifractals: D-0 (1.673 +/- 0.028vs1.652 +/- 0.025, p= 0.028), D-1 (1.609 +/- 0.027vs1.590 +/- 0.025, p = 0.044) and f(a)max (1.674 +/- 0.027vs1.652 +/- 0.024, p = 0.019) were higher in patients with poor compared to good pial collaterals. Furthermore, support vector machine learning achieved a fair sensitivity (0.743) and specificity (0.707) for differentiating patients with poor from good pial collaterals. Age (p = 0.702), BMI (p = 0.422), total cholesterol (p = 0.842), triglycerides (p = 0.673), LDL (p = 0.952), HDL (p = 0.366), systolic blood pressure (p = 0.727), HbA(1)(c) (p = 0.261) and standard retinal metrics including CRAE (p = 0.084), CRVE (p = 0.946), AVR (p = 0.148), tortuosity index (p = 0.790), monofractal D-f (p = 0.576), lacunarity (p = 0.531), curve asymmetry (p = 0.679) and singularity length (p = 0.937) did not differ between patients with poor compared to good pial collaterals. Conclusions This is the first translational study to show increased retinal vessel multifractal dimensions in patients with acute ischemic stroke and poor pial collaterals. A retinal vessel classifier was developed to differentiate between patients with poor and good pial collaterals and may allow rapid non-invasive identification of patients with poor pial collaterals. | Notes: | Malik, RA (corresponding author), Weill Cornell Med Qatar, Doha, Qatar. ram2045@qatar-med.cornell.edu |
Keywords: | Cerebral Angiography;Collateral Circulation;Humans;Infarction, Middle Cerebral Artery;Retinal Vessels;Retrospective Studies;Brain Ischemia;Ischemic Stroke;Stroke | Document URI: | http://hdl.handle.net/1942/39128 | ISSN: | 1932-6203 | e-ISSN: | 1932-6203 | DOI: | 10.1371/journal.pone.0267837 | ISI #: | 000892294900073 | Rights: | 2022 Khan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2023 |
Appears in Collections: | Research publications |
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