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

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

Abstract

Introduction: 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).

Methods: 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.

Results: 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%); p = 0.017]. In univariable analysis, a DWI-ASPECTS < 7 was associated with a brush sign. Following multivariable analysis, the brush-sign no longer affected DWI-ASPECTS < 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.

Conclusions and relevance: The brush-sign may be a marker of poor collateral status but did not independently predict a lower DWI-ASPECTS.

Clinical trial registration: ClinicalTrials.gov, identifier: NCT04620642.

Keywords: DWI-ASPECTS; MRI; brush-sign; collaterality; lesion volume; thrombectomy.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Rascle, Bani Sadr, Amaz, Mewton, Buisson, Hermier, Ong, Fontaine, Derex, Berthezène, Eker, Cho, Nighoghossian and Mechtouff.

Figures

Figure 1
Figure 1
Illustration of brush-sign. Axial gradient-recalled echo T2*-weighted imaging showing moderate (A) and obvious (B) brush-sign.
Figure 2
Figure 2
Brush sign severity according to collateral status (A) and diffusion-weighted imaging–Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) (B).

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