51
|
Yoshimura S, Uchida K, Sakai N, Imamura H, Yamagami H, Tanaka K, Ezura M, Nonaka T, Matsumoto Y, Shibata M, Ohta H, Morimoto M, Fukawa N, Hatano T, Enomoto Y, Takeuchi M, Ota T, Shimizu F, Kimura N, Kamiya Y, Shimamura N, Morimoto T. Safety of Early Administration of Apixaban on Clinical Outcomes in Patients with Acute Large Vessel Occlusion. Transl Stroke Res 2020; 12:266-274. [PMID: 32766953 PMCID: PMC7925454 DOI: 10.1007/s12975-020-00839-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 01/01/2023]
Abstract
Early administration of direct oral anticoagulants in patients with acute large vessel occlusion (LVO) and nonvalvular atrial fibrillation (NVAF) is a concern, as endovascular therapy (EVT) became highly utilized. We conducted a historical and prospective multicenter registry at 38 centers in Japan from July 2016 to February 2018. Patients aged ≥ 20 years with NVAF and acute LVO or stenosis who received apixaban within 14 days from onset were included. We compared patients who received apixaban < 48 h (Early group) and ≥ 48 h (Late group) after onset in terms of the primary outcome (a composite of ischemic events, major bleeding events, and all-cause deaths). The secondary outcomes were each component of the primary outcome. Among the 686 patients, the median time from onset to administration was 2.5 days (range, 0–14; Early 263, Late 423). The Alberta Stroke Program Early CT Score (ASPECTS) and diffusion-weighted imaging (DWI)-ASPECTS) were significantly higher in the Early group than in the Late group. Recombinant tissue plasminogen activator (rt-PA) and EVT were more utilized in the Early group (rt-PA 46% vs. 35%, p = 0.003; EVT 62% vs. 46%, p < 0.0001). The cumulative incidence of primary outcome was similar between groups (ischemic events: Early 1.9% vs. Late 0.5% at 30 days; 3.5% vs. 0.7% at 90 days, major bleeding 3.4% vs. 2.9% at 30 days; 5.0% vs. 3.4% at 90 days). Early administration of apixaban (< 48 h), after onset of acute LVO in patients with NVAF, was generally safe compared with those who received it Late (≥ 48 h). http://www.clinicaltrials.gov. Unique identifier: NCT02818868 (June 30, 2016)
Collapse
Affiliation(s)
- Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
- Department of Clinical Epidemiology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Yamagami
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kanta Tanaka
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masayuki Ezura
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Tadashi Nonaka
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Japan
| | - Yasushi Matsumoto
- Department of Neuroendovascular Therapy, Kohnan Hospital, Miyagi, Japan
| | | | - Hajime Ohta
- Department of Neurosurgery, Division of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masafumi Morimoto
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Yokohama, Japan
| | - Norihito Fukawa
- Department of Neurosurgery, Faculty of Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Taketo Hatano
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yukiko Enomoto
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | | | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | | | - Naoto Kimura
- Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Yuki Kamiya
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Norito Shimamura
- Department of Neurosurgery, Hirosaki University Hospital, Hirosaki, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
| |
Collapse
|
52
|
Wan C, Wu G, Jin X, Liao S, Zhang F, Hu M, Meng M, Guo Y, You J. Predictive value on diffusion weighted imaging scores for basilar artery occlusion after endovascular treatment. Interv Neuroradiol 2020; 27:81-87. [PMID: 32640857 DOI: 10.1177/1591019920940514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To assess the predictive value of three scoring systems based on diffusion weighted imaging in basilar artery occlusion patients after endovascular treatment. METHODS We analyzed clinical and radiological data of patients with basilar artery occlusion from January 2010 to June 2019, with modified Rankin Scale of 0-2 and 3-6 defined as favorable outcome and unfavorable outcome at three months. Diffusion weighted imaging posterior circulation ASPECTS Score (DWI pc-ASPECT Score), Renard diffusion weighted imaging Score, and diffusion weighted imaging Brainstem Score were used to evaluate the early ischemic changes. RESULTS There were a total of 88 basilar artery occlusion patients enrolled in the study after endovascular treatment, with 33 of them getting a favorable outcome. According to the analysis, the time from onset to puncture within 12 h (odds ratio: 4.34; 95% confidence interval: 1.55-12.16; P = 0.01), presence of collateral flow via PCoA (odds ratio: 0.31; 95%CI: 0.12-0.79; P = 0.01) or between PICA and SCA (odds ratio: 0.18; 95%CI: 0.07-0.47; P = 0.00), equal or less than 15 points on baseline NIHSS (area under the curve 0.79, 95% CI 0.69-0.89; sensitivity = 69.1%, specificity = 81.8%; P = 0.00), and equal or less than 1.5 points on diffusion weighted imaging Renard score (area under the curve 0.63, 95% CI 0.51-0.75; sensitivity = 83.6%, specificity = 39.4%; P = 0.046) were independently associated with favorable outcome. CONCLUSIONS Renard diffusion weighted imaging score may be an independent predictor of functional outcome in basilar artery occlusion patients after endovascular treatment.
Collapse
Affiliation(s)
- Can Wan
- Second Clinical Medical School, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Guangliang Wu
- Department of Neurology, The Second Affiliated Hospital, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xing Jin
- Second Clinical Medical School, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Shaojun Liao
- Second Clinical Medical School, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Foming Zhang
- Department of Neurology, The Second Affiliated Hospital, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Mingzhe Hu
- Second Clinical Medical School, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Miaomiao Meng
- Second Clinical Medical School, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yixin Guo
- Second Clinical Medical School, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jinsong You
- Department of Neurology, The Second Affiliated Hospital, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| |
Collapse
|
53
|
Dhand S, O'Connor P, Hughes C, Lin SP. Acute Ischemic Stroke: Acute Management and Selection for Endovascular Therapy. Semin Intervent Radiol 2020; 37:109-118. [PMID: 32419723 PMCID: PMC7224969 DOI: 10.1055/s-0040-1709152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Stroke is a medical emergency and expeditious treatment is critical to reducing permanent disability or death. Acute management of patients suffering from acute ischemic stroke (AIS) requires early recognition of symptoms, rapid assessment and stabilization (hyperacute workup), and appropriate selection of patients for reperfusion with intravenous alteplase and/or mechanical thrombectomy. Established stroke protocols which involve both prehospital emergency medical services and in-hospital multidisciplinary stroke teams have been shown to be crucial to reducing the long term, devastating effects of stroke.
Collapse
Affiliation(s)
- Sabeen Dhand
- Department of Radiology, Lambert Radiology Medical Group at PIH Health, Whittier, California
| | - Paul O'Connor
- Department of Radiology, Lambert Radiology Medical Group at PIH Health, Whittier, California
| | - Charles Hughes
- Department of Neuroscience, University of California Los Angeles, Los Angeles, California
| | - Shao-Pow Lin
- Department of Radiology, Lambert Radiology Medical Group at PIH Health, Whittier, California
| |
Collapse
|
54
|
Yoon W, Baek BH, Lee YY, Kim SK, Kim JT, Park MS. Association of pretreatment pontine infarction with extremely poor outcome after endovascular thrombectomy in acute basilar artery occlusion. J Neurointerv Surg 2020; 13:136-140. [PMID: 32447299 DOI: 10.1136/neurintsurg-2020-015930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/20/2020] [Accepted: 04/26/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The association between pretreatment brain stem infarction and thrombectomy outcomes remains to be elucidated in patients with acute basilar artery occlusion (BAO). We aimed to assess the association between pretreatment pontine infarction and extremely poor outcome in patients who underwent endovascular thrombectomy due to acute BAO. METHODS We retrospectively reviewed data from a stroke database to identify patients with acute BAO who underwent thrombectomy between January 2011 and August 2019. Patient characteristics, pretreatment diffusion-weighted imaging (DWI) data, and outcomes were evaluated. The largest infarct core was expressed as the percentage of infarct core area in each brain stem region on the DWI slice displaying the largest lesion. Extremely poor outcome was defined as a 90-day modified Rankin Scale score of 5 or 6. RESULTS A total of 113 patients were included, 37 of whom had extremely poor outcome. Among the 15 patients with extensive pontine infarction (largest pontine infarct core of ≥70%), 93.3% had extremely poor outcome. Multivariate logistic regression analysis revealed that the following variables were independent predictors of extremely poor outcome: extensive pontine infarction (adjusted OR 22.494; 95% CI 2.335 to 216.689; p=0.007), posterior circulation ASPECTS on DWI (adjusted OR per 1-point decrease 1.744; 95% CI 1.197 to 2.541; p=0.004), age (adjusted OR per 1-year increase 1.067; 95% CI 1.009 to 1.128; p=0.023), and baseline NIHSS (adjusted OR per 1-point increase 1.105; 95% CI 1.004 to 1.216; p=0.040). CONCLUSION Our results showed that a large pontine infarct core of ≥70% on pretreatment DWI was strongly associated with extremely poor outcome among patients treated with endovascular thrombectomy for acute BAO.
Collapse
Affiliation(s)
- Woong Yoon
- Radiology, Chonnam National University Hospital, Gwangju, Korea (the Republic of)
| | - Byung Hyun Baek
- Radiology, Chonnam National University Hospital, Gwangju, Korea (the Republic of)
| | - Yun Young Lee
- Radiology, Chonnam National University Hospital, Gwangju, Korea (the Republic of)
| | - Seul Kee Kim
- Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Korea (the Republic of)
| | - Joon-Tae Kim
- Neurology, Chonnam National University Hospital, Gwangju, Korea (the Republic of)
| | - Man Seok Park
- Neurology, Chonnam National University Hospital, Gwangju, Korea (the Republic of)
| |
Collapse
|
55
|
Alawieh AM, Eid M, Anadani M, Sattur M, Maier IL, Feng W, Goyal N, Starke RM, Rai A, Fargen KM, Psychogios MN, De Leacy R, Grossberg JA, Keyrouz SG, Dumont TM, Kan P, Lena J, Liman J, Arthur AS, Elijovich L, Mccarthy DJ, Saini V, Wolfe SQ, Mocco J, Fifi JT, Nascimento FA, Giles JA, Allen M, Crosa R, Fox WC, Gory B, Spiotta AM. Thrombectomy Technique Predicts Outcome in Posterior Circulation Stroke—Insights from the STAR Collaboration. Neurosurgery 2020; 87:982-991. [DOI: 10.1093/neuros/nyaa179] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Randomized controlled trials evaluating mechanical thrombectomy (MT) for acute ischemic stroke predominantly studied anterior circulation patients. Both procedural and clinical predictors of outcome in posterior circulation patients have not been evaluated in large cohort studies.
OBJECTIVE
To investigate technical and clinical predictors of functional independence after posterior circulation MT while comparing different frontline thrombectomy techniques.
METHODS
In a retrospective multicenter international study of 3045 patients undergoing MT for stroke between 06/2014 and 12/2018, 345 patients had posterior circulation strokes. MT was performed using aspiration, stent retriever, or combined approach. Functional outcomes were assessed using the 90-d modified Rankin score dichotomized into good (0-2) and poor outcomes (3-6).
RESULTS
We included 2700 patients with anterior circulation and 345 patients with posterior circulation strokes. Posterior patients (age: 60 ± 14, 46% females) presented with mainly basilar occlusion (80%) and were treated using contact aspiration or ADAPT (39%), stent retriever (31%) or combined approach (19%). Compared to anterior strokes, posterior strokes had delayed treatment (500 vs 340 min, P < .001), higher national institute of health stroke scale (NIHSS) (17.1 vs 15.7, P < .01) and lower rates of good outcomes (31% vs 43%, P < .01). In posterior MT, diabetes (OR = 0.28, 95%CI: 0.12-0.65), admission NIHSS (OR = 0.9, 95%CI: 0.86-0.94), and use of stent retriever (OR = 0.26, 95%CI: 0.11-0.62) or combined approach (OR = 0.35, 95%CI: 0.12-1.01) vs ADAPT were associated with lower odds of good outcome. Stent retriever use was associated with lower odds of good outcomes compared to ADAPT even when including patients with only basilar occlusion or with successful recanalization only.
CONCLUSION
Despite similar safety profiles, use of ADAPT is associated with higher rates of functional independence after posterior circulation thrombectomy compared to stent retriever or combined approach in large “real-world” retrospective study.
Collapse
Affiliation(s)
- Ali M Alawieh
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Maya Eid
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Mohammad Anadani
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Mithun Sattur
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Ilko L Maier
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Wuwei Feng
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee
| | - Robert M Starke
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Ansaar Rai
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
| | - Reade De Leacy
- Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - Jonathan A Grossberg
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Salah G Keyrouz
- Department of Neurology, Washington University in Saint Louis, St. Louis, Missouri
| | - Travis M Dumont
- Department of Surgery, Division of Neurosurgery, Banner University of Arizona Medical Center, Tucson, Arizona
| | - Peter Kan
- Department of Neurology, Baylor College of medicine, Houston, Texas
| | - Jonathan Lena
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jan Liman
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Adam S Arthur
- Department of Neurology, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee
| | - Lucas Elijovich
- Department of Neurology, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee
| | - David J Mccarthy
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Vasu Saini
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - Johanna T Fifi
- Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | | | - James A Giles
- Department of Neurology, Washington University in Saint Louis, St. Louis, Missouri
| | - Michelle Allen
- Department of Neurology, Washington University in Saint Louis, St. Louis, Missouri
| | - Roberto Crosa
- Centro Endovascular Neurológico, Médica Uruguaya, Montevideo, Uruguay
| | - W Christopher Fox
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
56
|
Deguchi I, Osada T, Kimura H, Hayashi T, Takahashi S, Takao M. Clinical outcomes of mechanical thrombectomy following intravenous administration of recombinant tissue-type plasminogen activator for basilar artery occlusion. Clin Neurol Neurosurg 2020; 194:105796. [PMID: 32247170 DOI: 10.1016/j.clineuro.2020.105796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 01/19/2020] [Accepted: 03/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Mechanical thrombectomy (MT) following intravenous administration of recombinant tissue-type plasminogen activator (IV-rt-PA) is considered an effective treatment for the occlusion of the internal carotid artery or the M1 segment of the middle cerebral artery. However, its efficacy in treating basilar artery (BA) occlusion is still unclear. In order to evaluate the efficacy of MT in treating BA occlusion, we aimed to analyzed the clinical outcomes of those patients who had undergone MT following IV-rt-PA administration. PATIENTS AND METHODS We retrospectively analyzed the clinical outcomes of 11 patients with BA occlusion who had undergone MT following IV-rt-PA administration between January 1, 2015, and March 31, 2019. RESULTS The patients consisted of 8 men and 3 women. The mean (±standard deviation) age was 73 ± 9.4 years. Stroke subtypes were found to be atherothrombosis in 2 patients, cardiogenic embolism in 6, arterial dissection in 1, and an unknown cause in 2. The median pretreatment scores were 9 on the Glasgow Coma Scale (GCS) and 25 on the National Institutes of Health Stroke Scale. The time elapsed from onset of the stroke to reperfusion was 281 min. Successful reperfusion, characterized by a modified Thrombolysis in Cerebral Infarction grade ≥ 2b, was achieved in all patients. The 3-month outcomes were good [modified Rankin Scale (mRS) 0-2] in 5 patients and poor (mRS 3-6) in 6 patients. The pretreatment median GCS scores were significantly higher in patients with a good outcome compared to that in those with a poor outcome with scores of 11 and 7.5, respectively (P = 0.044). The receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off score on the GCS was 9.5 [area under the curve (AUC), 0.867; sensitivity, 0.8; specificity, 1.0]. Complications occurred in 1 patient with arterial dissection who had developed a subarachnoid hemorrhage and later died. CONCLUSION The results of the present study suggests that the pretreatment GCS score might affect the clinical outcomes in patients with BA occlusion who underwent MT following IV-rt-PA therapy.
Collapse
Affiliation(s)
- Ichiro Deguchi
- Department of Neurology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, Japan.
| | - Takashi Osada
- Department of Neurology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, Japan.
| | - Hiroaki Kimura
- Department of Neurology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, Japan.
| | - Takeshi Hayashi
- Department of Neurology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, Japan.
| | - Shinichi Takahashi
- Department of Neurology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, Japan.
| | - Masaki Takao
- Department of Neurology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, Japan.
| |
Collapse
|
57
|
Lee SJ, Hong JM, Choi JW, Park JH, Park B, Kang DH, Kim YW, Kim YS, Hong JH, Yoo J, Kim CH, Sohn SI, Hwang YH, Lee JS. Predicting Endovascular Treatment Outcomes in Acute Vertebrobasilar Artery Occlusion: A Model to Aid Patient Selection from the ASIAN KR Registry. Radiology 2020; 294:628-637. [PMID: 31990269 DOI: 10.1148/radiol.2020191227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The decision to perform endovascular treatment (EVT) for stroke related to vertebrobasilar occlusion (VBO) remains controversial. Purpose To identify preprocedural predictors of good outcomes and to develop a model to aid patient selection for VBO. Materials and Methods For this retrospective study using a Korean multicenter registry, a predictive model for good outcomes (modified Rankin scale score, 0-2) was generated based on a derivation sample of patients with VBO (January 2011-February 2016). Preprocedural parameters, including onset-to-puncture time, infarct volume, occlusion type as a surrogate marker of intracranial atherosclerotic stenosis-related occlusion or embolic occlusion (truncal-type occlusion vs branching site occlusion), and collateral status, were analyzed. Continuous variables were dichotomized based on receiver operating characteristic analysis. Multiple logistic regression analysis was performed to generate a predictive model. The model was internally validated with the bootstrap method and was externally validated with a single-center sample (April 2016-December 2018). Results A predictive model was generated from 71 patients (mean age, 67 years ± 11 [standard deviation]; 41 [58%] men) and was externally validated in 32 patients (mean age, 72 years ± 13; 19 [59%] men). The composite of initial DW imaging volume of less than 10 mL (odds ratio [OR], 19.3; 95% confidence interval [CI]: 3.0, 126.4; P = .002), onset-to-puncture time of less than 8 hours (OR, 8.7; 95% CI: 1.8, 42.0; P = .007), and branching-site occlusion (OR, 6.1; 95% CI: 1.5, 26.0; P = .01) could be used to predict good outcomes, with a median area under the receiver operating characteristic curve of 0.86 (interquartile range [IQR], 0.77-0.95; bootstrap optimism-corrected C statistic, 0.837) in the derivation sample and 0.78 (IQR, 0.62-0.95) in the validation sample. Results failed to show an association between collateral status and outcome (P = .67). Conclusion When selecting patients with vertebrobasilar occlusion for endovascular treatment, the combination of onset-to-puncture time of less than 8 hours, initial infarct volume of less than 10 mL, and presence of branching-site occlusions is indicative of a good outcome. © RSNA, 2020 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Seong-Joon Lee
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Ji Man Hong
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jin Wook Choi
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Ji Hyun Park
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Bumhee Park
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Dong-Hun Kang
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yong-Won Kim
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yong-Sun Kim
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jeong-Ho Hong
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Joonsang Yoo
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Chang-Hyun Kim
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sung-Il Sohn
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yang-Ha Hwang
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jin Soo Lee
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| |
Collapse
|
58
|
Buonomo O, Caragliano AA, Tessitore A, Pitrone A, Vinci SL. A Multidisciplinary Approach in the Management of a Paediatric Posterior Fossa Ischaemic Stroke: A Case Report. Cureus 2019; 11:e6418. [PMID: 31988819 PMCID: PMC6970101 DOI: 10.7759/cureus.6418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/19/2019] [Indexed: 01/01/2023] Open
Abstract
Posterior circulation acute ischaemic stroke in childhood is a rare but life-threatening disease. We describe a paediatric case of a 17-year-old Indian boy who was admitted to our centre for headache, nausea, vomiting, asthenia, and fever for two days. Computed tomography angiography (CTA), magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) were performed, showing a thrombotic occlusion of the basilar artery due to focal dissection into the proximal third of the left vertebral artery. In a multidisciplinary fashion, we decided to perform a direct aspiration first pass technique (ADAPT), which led to the complete recanalization of either the left vertebral artery or the basilar artery. Twenty-four hours later, despite the anti-edemigenic medical therapy, a preventive occipital craniectomy was performed because of the presence of cerebral oedema to avoid the possible worsening of the patient and compression on the brainstem. Our experience emphasizes the importance of a multidisciplinary and preventive approach in the management of a paediatric posterior fossa ischaemic stroke.
Collapse
Affiliation(s)
- Orazio Buonomo
- Neuroradiology Unit, Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, ITA
| | - Antonio Armando Caragliano
- Neuroradiology Unit, Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, ITA
| | - Agostino Tessitore
- Neuroradiology Unit, Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, ITA
| | - Antonio Pitrone
- Neuroradiology Unit, Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, ITA
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, ITA
| |
Collapse
|
59
|
Buchman SL, Merkler AE. Basilar Artery Occlusion: Diagnosis and Acute Treatment. Curr Treat Options Neurol 2019; 21:45. [DOI: 10.1007/s11940-019-0591-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
60
|
Ravindren J, Aguilar Pérez M, Hellstern V, Bhogal P, Bäzner H, Henkes H. Predictors of Outcome After Endovascular Thrombectomy in Acute Basilar Artery Occlusion and the 6hr Time Window to Recanalization. Front Neurol 2019; 10:923. [PMID: 31608001 PMCID: PMC6773802 DOI: 10.3389/fneur.2019.00923] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/09/2019] [Indexed: 12/20/2022] Open
Abstract
Background and Purpose: Decision algorithms for large vessel occlusions in the anterior circulation remain unconfirmed for acute basilar artery occlusion (aBAO). The aim of this study was to investigate procedural parameters, patient characteristics, functional outcome, and survival in dependency of the time window to recanalization from symptom onset. Furthermore predictors of outcome were identified. Materials and Methods: Retrospectively 231 patients with aBAO treated with endovascular treatment (EVT) between November 2008 and February 2019 were identified in a prospectively maintained single center stroke database. Baseline characteristics such as age, cardiovascular risk factors, NIHSS at admission, pre-interventional PC-ASPECTS, periprocedural parameters such as time to recanalization, duration of treatment, extent of reperfusion, collateral status, and occlusion patterns, as well as post-interventional 24 h NIHSS and post-interventional ICH were evaluated. Target variables were mRS at 90 days and mortality over 90 days. Results: Good outcome (mRS 0–2) was attained in 29.5% (n = 68) of patients, overall mortality was 36.8% (n = 85). In mulitivariate analyses patients with time to reperfusion beyond 6 h had a more than half fold decreased chance of good outcome [OR 0.47 95% CI (0.23–0.95) p < 0.05]. The odds for good outcome were reduced by almost 2/3 if post-interventional imaging revealed intracerebral hemorrhage [OR 0.28 95% CI (0.08–0.98)]. Unfavorable outcome was noted in 100% (n = 14) of patients with symptomatic ICH. Risk for death was reduced by more than 80% if collaterals were present [0.16 95% CI (0.03–0.87)] and if recanalization was successful (TICI 2b-3) [OR 0.19 95% CI (0.05–0.78)]. The odds for survival were 5-fold higher in patients with no post-interventional hemorrhages present [OR 5.35 95% CI (2.2–1.58)]. Conclusion: This study might contribute to explaining the ambiguous findings regarding the validity of the 6 h time window in aBAO, suggesting that collateral status impacts the odds of survival in the time window to recanalization beyond 6 h. In our study recanalization within 6 h from symptom onset was associated with good outcome. Successful recanalization (TICI 2b-3a) was necessary for good outcome and survival, post-interventional ICH was highly associated with unfavorable outcome. This might ease the decision making for EVT.
Collapse
Affiliation(s)
- Johannes Ravindren
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany.,Neurological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - Marta Aguilar Pérez
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - Victoria Hellstern
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - Pervinder Bhogal
- Department of Neuroradiology, St Bartholomew's Hospital, London, United Kingdom
| | - Hansjörg Bäzner
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany.,Medical Faculty, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
61
|
Francalanza I, Ciacciarelli A, Caragliano AA, Casella C, Cotroneo M, Dell'Aera C, Fazio MC, Grillo F, Pitrone A, Vinci SL, Trimarchi G, Musolino RF, La Spina P. Acute Stroke Treatment in Patients with Basilar Artery Occlusion: A Single-Center Observational Study. Cerebrovasc Dis Extra 2019; 9:90-97. [PMID: 31466054 PMCID: PMC6787421 DOI: 10.1159/000502084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/10/2019] [Indexed: 01/06/2023] Open
Abstract
Background Acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) represents 1–4′ of all ischemic strokes. BAO results in strokes associated with a high risk of a poor functional outcome and, in 86–95′ of the untreated cases, it results in death because of the vital cerebral structures involved. Diagnosis can be delayed because of the variability in presenting symptoms, and acute treatment is often attempted even beyond 6 h from symptoms onset because of the high risk of a fatal prognosis. Objective In this observational study, we retrospectively analyzed patients with AIS due to BAO referred to the stroke center of the University Hospital of Messina. We aimed to assess prognostic factors and to evaluate the association between clinical outcome and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and collateral status. Method BAO was confirmed by cerebral computed tomography (CT) angiography or cerebral angiography. All patients underwent CT scan and magnetic resonance imaging (MRI). We assessed the pc-ASPECTS on diffusion-weighted imaging (DWI) MR images and the Posterior Circulation Collateral Score (PC-CS) for every patient. Functional outcome was assessed at 3 months using the modified Rankin Scale (mRS). Results The study population consisted of 27 patients; 16 males and 11 females. The mean age was 66 (±14) years. We observed a favorable outcome (mRS 0–3) in 40.7′ of cases, 25.9′ reached mRS 0–2, and 29.6′ had a poor clinical outcome (mRS 4–5). Patient survival was 70.4′, whereas 8 patients died (29.6′). In 7 patients, pc-ASPECTS was ≥7. According to the PC-CS, 33.3′ had moderate collaterals and 63.0′ had good collateral status prior to receiving the treatment. Favorable outcome was significantly associated with age, NIHSS score at admission, pc-ASPECTS, hypercholesterolemia, and female sex but not with the other risk factors. Conclusions In our study, we found that younger age, low NIHSS score at admission, and high pc-ASPECTS, but not onset to treatment time, are associated with a favorable clinical outcome. Transferred patients did not have a significantly poorer outcome. These findings confirm that acute stroke treatment improves clinical outcome in BAO patients, in spite of a delayed diagnosis and an extended therapeutic window, considering lesion volume and localization in DWI MRI.
Collapse
Affiliation(s)
- Isabella Francalanza
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Ciacciarelli
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Armando Caragliano
- Neuroradiology Unit, Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Carmela Casella
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Masina Cotroneo
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Cristina Dell'Aera
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Carolina Fazio
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Grillo
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Pitrone
- Neuroradiology Unit, Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy
| | | | - Rosa Fortunata Musolino
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolino La Spina
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy,
| |
Collapse
|
62
|
Posterior circulation ischemic stroke-a review part II: imaging and acute treatment. Neurol Sci 2019; 40:2007-2015. [PMID: 31127426 DOI: 10.1007/s10072-019-03936-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/09/2019] [Indexed: 01/01/2023]
Abstract
Posterior circulation strokes affect the vertebrobasilar arterial system, account for about 20-25% of all ischemic strokes, and are a significant cause of patient disability and mortality. Diagnosis can be challenging; clinical presentation and common pitfalls facing posterior circulation stroke have been discussed elsewhere. In the first part of the review, we focus on the imaging, discussing the information that can be gathered through a correct selection and interpretation of different possible studies helping to achieve an early diagnosis and to select the best medical treatment. In the second part of the review, we will discuss the best therapeutic treatments available at the moment for posterior circulation ischemia.
Collapse
|
63
|
Kayan Y, Meyers PM, Prestigiacomo CJ, Kan P, Fraser JF. Current endovascular strategies for posterior circulation large vessel occlusion stroke: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee. J Neurointerv Surg 2019; 11:1055-1062. [DOI: 10.1136/neurintsurg-2019-014873] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/17/2019] [Accepted: 04/22/2019] [Indexed: 01/30/2023]
Abstract
BackgroundThe aim of this publication is to provide a detailed update on the diagnosis, treatment, and endovascular techniques for posterior circulation emergent large vessel occlusion (pc-ELVO).MethodsWe performed a review of the literature to specifically evaluate this disease and its treatments.ResultsData were analyzed, and recommendations were reported based on the strength of the published evidence and expert consensus.ConclusionWhile many questions about pc-ELVO remain to be studied, there is evidence to support particular practices in its evaluation and treatment.
Collapse
|
64
|
Shigeta K, Ota T, Amano T, Ueda M, Matsumaru Y, Shiokawa Y, Hirano T. Widening Time Disparities between Two Paradigms: Tama-REgistry of Acute Endovascular Thrombectomy. J Stroke Cerebrovasc Dis 2019; 28:1267-1273. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/04/2019] [Accepted: 01/19/2019] [Indexed: 11/26/2022] Open
|
65
|
Küpper C, Heinrich J, Müller K, Feil K, Kellert L. [Acute stroke]. MMW Fortschr Med 2019; 161:22-31. [PMID: 30912060 DOI: 10.1007/s15006-019-0008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Clemens Küpper
- Klinik und Poliklinik für Neurologie, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, D-81377, München, Deutschland
| | | | | | - Katharina Feil
- Ludwig-Maximilians-Universität München, München, Deutschland
| | - Lars Kellert
- Klinik und Poliklinik für Neurologie, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, D-81377, München, Deutschland.
- Ludwig-Maximilians-Universität München, München, Deutschland.
- Neurologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
| |
Collapse
|
66
|
Valor de la escala ASPECTS de circulación posterior y del índice puente-mesencéfalo en imágenes de TC sin contraste y angiografía por TC en pacientes con oclusiones de la arteria basilar recanalizados tras trombectomía mecánica. RADIOLOGIA 2019; 61:143-152. [DOI: 10.1016/j.rx.2018.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/12/2018] [Accepted: 06/10/2018] [Indexed: 11/23/2022]
|
67
|
Werner M, López-Rueda A, Zarco F, Blasco J, San Román L, Amaro S, Carrero E, Valero R, Oleaga L, Macho J, Bargalló N. Value of Posterior circulation ASPECTS and Pons-Midbrain Index on non-contrast CT and CT Angiography Source Images in patients with basilar artery occlusion recanalized after mechanical thrombectomy. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
68
|
Pallesen LP, Barlinn K, Puetz V. Role of Decompressive Craniectomy in Ischemic Stroke. Front Neurol 2019; 9:1119. [PMID: 30687210 PMCID: PMC6333741 DOI: 10.3389/fneur.2018.01119] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022] Open
Abstract
Ischemic stroke is one of the leading causes for death and disability worldwide. In patients with large space-occupying infarction, the subsequent edema complicated by transtentorial herniation poses a lethal threat. Especially in patients with malignant middle cerebral artery infarction, brain swelling secondary to the vessel occlusion is associated with high mortality. By decompressive craniectomy, a significant proportion of the skull is surgically removed, allowing the ischemic tissue to shift through the surgical defect rather than to the unaffected regions of the brain, thus avoiding secondary damage due to increased intracranial pressure. Several studies have shown that decompressive craniectomy reduces the mortality rate in patients with malignant cerebral artery infarction. However, this is done for the cost of a higher proportion of patients who survive with severe disability. In this review, we will describe the clinical and radiological features of malignant middle cerebral artery infarction and the role of decompressive craniectomy and additional therapies in this condition. We will also discuss large cerebellar stroke and the possibilities of suboccipital craniectomy.
Collapse
Affiliation(s)
- Lars-Peder Pallesen
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
69
|
Early Diffusion-Weighted Imaging Brain Stem Score for Acute Basilar Artery Occlusion Treated with Mechanical Thrombectomy. J Stroke Cerebrovasc Dis 2018; 27:2822-2828. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/20/2018] [Accepted: 06/14/2018] [Indexed: 11/24/2022] Open
|
70
|
Outcome and predictive factors in post-stroke seizures: A retrospective case-control study. Seizure 2018; 62:11-16. [PMID: 30245457 DOI: 10.1016/j.seizure.2018.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate clinical, radiographic, and electrophysiological features in the development and prognosis of ischemic post-stroke seizures (PSS). METHOD A retrospective study of 1119 patient records was performed between January 2006 and December 2016. After selection, 42 patients with seizures due to ischemic stroke were matched to a control group of 60 patients where seizures were absent. Stroke size and severity were analyzed using ASPECTS and NIHSS, respectively. Hemorrhagic transformation graded by ECASS III classification. Outcomes were assessed using the modified Rankin Scale. Fisher's exact test assessed categorical variables, and Mann-Whitney tested continuous variables. RESULTS Forty-two patients experienced PSS (22 females; median age 72.5 years) and were matched with 60 control subjects that had ischemic stroke without seizures. Focal seizures were present in 42.9% (18/42), and focal to bilateral convulsions in 57.1% (24/42). Stroke localization and severity did not differ (p = 0.6 and 0.21, respectively). Stroke size in anterior circulation was larger in PSS patients (median ASPECTS 6 vs 8 [p = 0.01]). Posterior circulation stroke size was similar in both groups. The presence of hemorrhage was the primary risk factor for PSS (61.9%) compared to controls (36.7%), p = 0.01. The presence of laminar necrosis (LN) (47.6% vs 21.6%, p = 0.005) and hemosiderin deposition (38.1% vs 18.3%, p = 0.02) were most predictive. PSS patients demonstrated worse outcomes than the controls (median mRS 3 vs 2, [p=<0.001]) with a median follow up of 14.8 and 20.7 months, respectively. CONCLUSIONS The size of anterior infarction, presence of blood products within the infarct bed, and especially LN predicted PSS.
Collapse
|
71
|
Yoshimura S, Sakai N, Uchida K, Yamagami H, Ezura M, Okada Y, Kitagawa K, Kimura K, Sasaki M, Tanahashi N, Toyoda K, Furui E, Matsumaru Y, Minematsu K, Morimoto T. Endovascular Therapy in Ischemic Stroke With Acute Large-Vessel Occlusion: Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism Japan Registry 2. J Am Heart Assoc 2018; 7:JAHA.118.008796. [PMID: 29695384 PMCID: PMC6015290 DOI: 10.1161/jaha.118.008796] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Endovascular therapy has been shown to be effective in patients with acute cerebral large-vessel occlusion, but real-world efficacies are unknown. METHODS AND RESULTS We conducted a prospective registry at 46 centers between October 2014 and January 2017. Eligible patients were those who were aged 20 years or older, with acute cerebral large-vessel occlusion, and who were hospitalized within 24 hours of the onset. We enrolled both consecutive patients who were treated with or without endovascular therapy. Endovascular therapy included thrombectomy, balloon angioplasty, stenting, local fibrinolysis, and piercing. The primary outcome was a favorable outcome as defined by a modified Rankin Scale of 0 to 2 at 90 days after onset. Secondary outcomes were modified Rankin Scale of 0 to 1 and mortality. Safety outcomes were intracerebral hemorrhage or a recurrence of ischemic stroke. We constructed the 2242 (1121 each) propensity score-matched patients cohort based on a propensity score for endovascular therapy and estimated the adjusted odds ratio, followed by sensitivity analyses on original 2399 (1278 in endovascular therapy versus 1121 in no endovascular therapy) patients. In the propensity score-matched cohort, favorable outcomes were observed in 35.3% and 30.7% of patients in the endovascular therapy and no endovascular therapy groups, respectively (P=0.02). The adjusted odds ratio for the favorable outcome was 1.44 (95% confidence interval, 1.10-1.86, P=0.007). The efficacy of endovascular therapy in achieving favorable outcomes did not differ between our subgroups and in the sensitivity analyses. CONCLUSIONS Endovascular therapy decreased disabilities at 90 days in real-world patients with acute cerebral large-vessel occlusion. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02419794.
Collapse
Affiliation(s)
- Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroshi Yamagami
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masayuki Ezura
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Yasushi Okada
- Cerebrovascular Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Makoto Sasaki
- Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan
| | - Norio Tanahashi
- Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Eisuke Furui
- Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Tsukuba University, Tsukuba, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| |
Collapse
|
72
|
Lin SF, Chen CI, Hu HH, Bai CH. Predicting functional outcomes of posterior circulation acute ischemic stroke in first 36 h of stroke onset. J Neurol 2018; 265:926-932. [PMID: 29455362 PMCID: PMC5878189 DOI: 10.1007/s00415-018-8746-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 11/27/2022]
Abstract
Posterior circulation acute ischemic stroke constitutes one-fourth of all ischemic strokes and can be efficiently quantified using the posterior circulation Alberta stroke program early computed tomography score (PC-ASPECTS) through diffusion-weighted imaging. We investigated whether the PC-ASPECTS and National Institutes of Health Stroke Scale (NIHSS) facilitate functional outcome prediction among Chinese patients with posterior circulation acute ischemic stroke. Participants were selected from our prospective stroke registry from January 1, 2015, to December 31, 2016. The baseline NIHSS score was assessed on the first day of admission, and brain magnetic resonance imaging was performed within 36 h after stroke onset. Simple and multiple logistic regressions were conducted to determine stroke risk factors and the PC-ASPECTS. Receiver operating characteristics (ROC) curve analysis was performed to compare the NIHSS and PC-ASPECTS. Of 549 patients from our prospective stroke admission registry database, 125 (22.8%) had a diagnosis of posterior circulation acute ischemic stroke. The optimal cutoff for the PC-ASPECTS in predicting outcomes was 7. The odds ratios of the PC-ASPECTS (≤ 7 vs > 7) in predicting outcomes were 6.33 (p = 0.0002) and 8.49 (p = 0.0060) in the univariate and multivariate models, respectively, and 7.52 (p = 0.0041) in the aging group. On ROC curve analysis, the PC-ASPECTS demonstrated more reliability than the baseline NIHSS for predicting functional outcomes of minor posterior circulation stroke. In conclusion, both the PC-ASPECTS and NIHSS help clinicians predict functional outcomes. PC-ASPECTS > 7 is a helpful discriminator for achieving favorable functional outcome prediction in posterior circulation acute ischemic stroke.
Collapse
Affiliation(s)
- Sheng-Feng Lin
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chin-I Chen
- Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Han-Hwa Hu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Research Center of Cerebrovascular Disease Treatment, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Neurology, Taipei Medical University-Shaung Ho Hospital, Taipei, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan. .,Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, 110, Taiwan.
| |
Collapse
|
73
|
Mechanical Thrombectomy in Basilar Artery Occlusion. Clin Neuroradiol 2017; 29:153-160. [DOI: 10.1007/s00062-017-0651-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
|
74
|
Smith AG, Rowland Hill C. Imaging assessment of acute ischaemic stroke: a review of radiological methods. Br J Radiol 2017; 91:20170573. [PMID: 29144166 DOI: 10.1259/bjr.20170573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Acute ischaemic stroke is the second largest cause of death worldwide and a cause of major physical and psychological morbidity. Current evidence based treatment includes intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), both requiring careful patient selection and to be administered as quickly as possible within a limited time window from symptom onset. Imaging plays a crucial role identifying patients who may benefit from MT or IVT whilst excluding those that may be harmed. For IVT, imaging must as a minimum exclude haemorrhage, stroke mimics and provide an estimate of non-viable brain. For MT, imaging must in addition detect and characterize intra-arterial thrombus and assess the intra and extracranial arterial architecture. More advanced imaging techniques may be used to assess more accurately the volume of non-viable and potentially salvageable brain tissue. It is highly likely that further research will identify patients who would benefit from treatment beyond currently accepted time windows for IVT (4.5 h) and MT (6 h) and patients with an unknown time of symptom onset. Current evidence indicates that best outcomes are achieved when treatment is instituted as soon as possible after symptom onset. A rapid, efficient imaging pathway including interpretation is fundamental to achieving the best outcomes. This review summarizes current techniques for imaging assessment of acute stroke, highlighting strengths and limitations of each. The optimum pathway is a balance between diagnostic information, local resources, specialization and the time taken to acquire, process and interpret the data. As new evidence emerges, it is likely that the minimum required imaging data will change.
Collapse
|
75
|
Gao J, Parsons MW, Kawano H, Levi CR, Evans TJ, Lin L, Bivard A. Visibility of CT Early Ischemic Change Is Significantly Associated with Time from Stroke Onset to Baseline Scan beyond the First 3 Hours of Stroke Onset. J Stroke 2017; 19:340-346. [PMID: 29037011 PMCID: PMC5647641 DOI: 10.5853/jos.2016.01424] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 06/08/2017] [Accepted: 08/13/2017] [Indexed: 11/11/2022] Open
Abstract
Background and Purpose Non-contrast brain computed tomography (NCCT) remains the most common imaging modality employed to select patients for thrombolytic therapy in acute ischemic stroke. The current study used the Alberta Stroke Program Early CT Score (ASPECTS) to identify early ischemic changes on brain NCCT imaging with the aim to investigate whether a relationship exists between time from symptoms onset to NCCT with the presence of early ischaemic change quantified by ASPECTS. Methods We studied 1,329 ischemic stroke patients who had NCCT within 8 hours of stroke onset. Patients were assessed to see if they had any ASPECTS lesion and if the rate of patients with a lesion increased with time using logistic regression. Results 30% patients had an ASPECTS <10 within the first 3 hours from symptom onset. Within the first 3 hours, the odds for a CT change (ASPECTS <10) per minute of time was 1.00 with 95% confidence interval (CI) (0.99 to 1.00) (P=0.266). After 3 hours, there was a significant increase in odds of ASPECTS <10 with increasing time. The odds of being ASPECTS positive increased 1% (odds ratio=1.01) per 1 minute of time with 95% CI (1.00 to 1.01) (P=0.002). Conclusions We have identified that prior to first 3 hours of stroke there was no effect of time on odds of CT ischemic change; after the first 3 hours of stroke the odds increased with increasing time to CT scan. The occurrence of early ischemic change may be a marker of time from stroke onset rather than severity.
Collapse
Affiliation(s)
- Jian Gao
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Mark W Parsons
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Hiroyuki Kawano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitake, Tokyo, Japan
| | - Christopher R Levi
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Tiffany-Jane Evans
- Centre for Bioinformatics, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Longting Lin
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Andrew Bivard
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
76
|
Lee WJ, Jung KH, Ryu YJ, Kim JM, Lee ST, Chu K, Kim M, Lee SK, Roh JK. Utility of digital subtraction angiography-based collateral evaluation in medically treated acute symptomatic basilar artery stenosis. Eur J Neurol 2017; 24:1148-1155. [PMID: 28707434 DOI: 10.1111/ene.13351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 06/01/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Although a stroke from atherosclerosis in the basilar artery (BA) often presents with mild initial stroke severity, it has heterogeneous clinical courses. We investigated the efficacy of digital subtraction angiography (DSA)-based collateral perfusion evaluation in association with long-term outcomes of medically treated symptomatic basilar artery stenosis. METHODS From a registry database of all consecutive patients with stroke, we included 98 medically treated patients (due to mild initial stroke severity) [National Institute of Health Stroke Scale (NIHSS) scores ≤ 4; symptomatic basilar artery stenosis, 70-99%] with available initial diagnostic DSA. Basilar collateral scoring was performed via the DSA, using a modified version of the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology grading system in both the superior cerebellar artery and anterior/posterior-inferior cerebellar artery territories (score 0-8). The outcomes were designated as the 90-day modified Rankin Scale (mRS90) score (poor, 3-6). Student's t-test, chi-square test and logistic regression analyses were used to identify factors associated with a poor outcome. RESULTS The median initial NIHSS score was 2 [interquartile range (IQR), 0-3], median posterior circulation Alberta Stroke Program Early CT Score was 8 (IQR, 7-10), median collateral score was 7 (IQR, 7-8) and 20 (20.4%) had poor mRS90 scores. In multivariate analysis, poorer collateral scores (P = 0.003), higher NIHSS scores (P = 0.005) and lower posterior circulation Alberta Stroke Program Early CT Score (P = 0.017) were independently associated with a poor mRS90 score. CONCLUSIONS The DSA-based collateral scoring of the BA large branches might predict long-term outcome in medically treated symptomatic basilar artery stenosis with mild initial severity. Evaluation of BA collateral perfusion status might be useful to determine appropriate treatment strategies.
Collapse
Affiliation(s)
- W-J Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - K-H Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Y J Ryu
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - J-M Kim
- Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea
| | - S-T Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - K Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - M Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - S K Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - J-K Roh
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea
| |
Collapse
|
77
|
Garg R, Biller J. Neuroimaging Predictors of Clinical Outcome in Acute Basilar Artery Occlusion. Front Neurol 2017; 8:293. [PMID: 28674517 PMCID: PMC5474464 DOI: 10.3389/fneur.2017.00293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/06/2017] [Indexed: 11/13/2022] Open
Abstract
Certain early neuroimaging findings are independent predictors of clinical outcome in acute basilar artery occlusion. These imaging findings may serve as important baseline imaging characteristics as well as subgroups in future randomized controlled trials. The purpose of this review is to review and compare early neuroimaging findings seen on non-invasive cranial imaging that predict clinical outcome in acute basilar artery occlusion.
Collapse
Affiliation(s)
- Ravi Garg
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - José Biller
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| |
Collapse
|
78
|
Lee YY, Yoon W, Kim SK, Baek BH, Kim GS, Kim JT, Park MS. Acute Basilar Artery Occlusion: Differences in Characteristics and Outcomes after Endovascular Therapy between Patients with and without Underlying Severe Atherosclerotic Stenosis. AJNR Am J Neuroradiol 2017; 38:1600-1604. [PMID: 28546252 DOI: 10.3174/ajnr.a5233] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/24/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Prediction of underlying intracranial atherosclerotic stenosis before endovascular therapy might be helpful for appropriate therapeutic planning in patients with acute ischemic stroke. This study aimed to compare the characteristics and treatment outcomes in patients with acute basilar artery occlusion relative to the existence or nonexistence of underlying intracranial atherosclerotic stenosis. MATERIALS AND METHODS Sixty-two patients with acute basilar artery occlusion underwent multimodal endovascular therapy. All patients underwent stent-retriever thrombectomy as a first-line endovascular therapy. Patients with underlying intracranial atherosclerotic stenosis underwent additional intracranial angioplasty and stent placement. The clinical and imaging characteristics and treatment outcomes were retrospectively analyzed and compared between patients with and without intracranial atherosclerotic stenosis. RESULTS Underlying intracranial atherosclerotic stenosis was identified at the occlusion site in 15 patients (24.1%). Occlusion in the proximal segment of the basilar artery was more common in patients with intracranial atherosclerotic stenosis (60% versus 6.4%, P < .001), whereas occlusion in the distal segment was more common in those without it (91.5% versus 26.7%, P < .001). Bilateral thalamic infarction on a pretreatment DWI was less common in patients with intracranial atherosclerotic stenosis (0% versus 27.7%, P = .027) compared with those without it. There were no significant differences in the rates of successful revascularization, favorable outcome, symptomatic hemorrhage, and mortality between the 2 groups. CONCLUSIONS Underlying intracranial atherosclerotic stenosis was not uncommon in patients with acute basilar artery occlusion. The occlusion segment of the basilar artery and the presence or absence of bilateral thalamic infarction on a pretreatment DWI might be helpful for predicting underlying intracranial atherosclerotic stenosis in patients with acute basilar artery occlusion. Patients with and without underlying intracranial atherosclerotic stenosis who underwent endovascular therapy had similar outcomes.
Collapse
Affiliation(s)
- Y Y Lee
- From the Departments of Radiology (Y.Y.L., W.Y., S.K.K., B.H.B., G.S.K.)
| | - W Yoon
- From the Departments of Radiology (Y.Y.L., W.Y., S.K.K., B.H.B., G.S.K.)
| | - S K Kim
- From the Departments of Radiology (Y.Y.L., W.Y., S.K.K., B.H.B., G.S.K.)
| | - B H Baek
- From the Departments of Radiology (Y.Y.L., W.Y., S.K.K., B.H.B., G.S.K.)
| | - G S Kim
- From the Departments of Radiology (Y.Y.L., W.Y., S.K.K., B.H.B., G.S.K.)
| | - J T Kim
- Neurology (J.T.K., M.S.P.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - M S Park
- Neurology (J.T.K., M.S.P.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| |
Collapse
|
79
|
Fahed R, Di Maria F, Rosso C, Sourour N, Degos V, Deltour S, Baronnet-Chauvet F, Léger A, Crozier S, Gabrieli J, Samson Y, Chiras J, Clarençon F. A leap forward in the endovascular management of acute basilar artery occlusion since the appearance of stent retrievers: a single-center comparative study. J Neurosurg 2017; 126:1578-1584. [DOI: 10.3171/2016.2.jns151983] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVEContrary to acute ischemic stroke involving the anterior circulation, no randomized trial has yet demonstrated the safety and effectiveness of endovascular management in acute basilar artery occlusion (BAO). Recently developed thrombectomy devices, such as stentrievers and aspiration systems, have helped in improving the endovascular management of acute ischemic stroke. The authors sought to assess the impact of these devices in the endovascular treatment of acute BAO.METHODSA retrospective analysis of 34 consecutive patients treated in Pitié-Salpêtrière Hospital for acute BAO was carried out. All patients had undergone an endovascular procedure. In addition to the global results in terms of safety and effectiveness (recanalization rate and 3-month clinical outcome based on the modified Rankin Scale [mRS]), the authors aimed to determine if the patients treated with the most recently developed devices (i.e., the Solitaire stentriever or the ADAPT catheter) had better angiographic and clinical outcomes than those treated with older endovascular strategies.RESULTSThe overall successful recanalization rate (thrombolysis in cerebral infarction score 2b–3) was 50% (17 of 34 patients). A good clinical outcome (mRS score 0–2 at 3-month follow-up) was achieved in 11 (32.3%) of 34 patients. The mortality rate at 3-month follow-up was 29.4% (10 of 34 patients). Patients treated with the Solitaire stentriever and the ADAPT catheter had a higher recanalization rate (12 [92.3%] of 13 patients vs 5 [23.8%] of 21 patients, p = 0.0002) and a shorter mean (± SD) procedure duration (88 ± 31 minutes vs 126 ± 58 minutes, p = 0.04) than patients treated with older devices.CONCLUSIONSThe latest devices have improved the effectiveness of mechanical thrombectomy in acute BAO. Their use in further studies may help demonstrate a benefit in the endovascular management of acute BAO.
Collapse
Affiliation(s)
| | | | - Charlotte Rosso
- 2Vascular Neurology, and
- 3Paris VI University, Pierre et Marie Curie; and
- 4Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, INSERM, Paris, France
| | | | - Vincent Degos
- 3Paris VI University, Pierre et Marie Curie; and
- 5Anesthesiology, Pitié-Salpêtrière Hospital
| | | | | | | | | | - Joseph Gabrieli
- Departments of 1Interventional Neuroradiology,
- 3Paris VI University, Pierre et Marie Curie; and
| | - Yves Samson
- 2Vascular Neurology, and
- 3Paris VI University, Pierre et Marie Curie; and
- 4Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, INSERM, Paris, France
| | - Jacques Chiras
- Departments of 1Interventional Neuroradiology,
- 3Paris VI University, Pierre et Marie Curie; and
| | - Frédéric Clarençon
- Departments of 1Interventional Neuroradiology,
- 3Paris VI University, Pierre et Marie Curie; and
| |
Collapse
|
80
|
van der Hoeven EJRJ, McVerry F, Vos JA, Algra A, Puetz V, Kappelle LJ, Schonewille WJ. Collateral flow predicts outcome after basilar artery occlusion: The posterior circulation collateral score. Int J Stroke 2016; 11:768-75. [DOI: 10.1177/1747493016641951] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/14/2016] [Indexed: 11/16/2022]
Abstract
Background and Aim Our aim was to assess the prognostic value of a semiquantitative computed tomography angiography-based grading system, for the prediction of outcome in patients with acute basilar artery occlusion, based on the presence of potential collateral pathways on computed tomography angiography: the posterior circulation collateral score (PC-CS). Methods One hundred forty-nine patients with acute basilar artery occlusion from the Basilar Artery International Cooperation Study were included. We related poor outcome at one month, defined as a modified Rankin scale score of 4 or 5, or death to collateral flow with Poisson regression. We used a 10 points grading system to quantify the potential for collateral flow in the posterior communicating arteries and the cerebellar arteries. Additionally, the relation between the presence and size of posterior communicating arteries and outcome was analyzed. Results Thirty-six patients had poor (PC-CS: 0–3), 59 patients intermediate (PC-CS: 4–5), and 54 patients good (PC-CS: 6–10) collaterals. Multivariable analyses showed a statistically significant lower risk of poor outcome in patients with a good PC-CS than in patients with a poor PC-CS (risk ratio (RR): 0.74, 95% confidence interval (CI): 0.58–0.96), but not for patients with an intermediate PC-CS compared with patients with a poor PC-CS (RR: 0.95, 95% CI: 0.78–1.15). Multivariable analyses showed a statistically significant lower risk of poor outcome for the presence of at least one posterior communicating artery and for larger caliber of posterior communicating arteries (RR: 0.79, 95% CI: 0.66–0.95 and 0.76, 95% CI: 0.61–0.96, respectively). Conclusions The PC-CS predicted poor outcome at one month. In a separate analysis, both the absence and smaller caliber of posterior communicating arteries predicted poor outcome.
Collapse
Affiliation(s)
| | - Ferghal McVerry
- Department of Neurology, Altnagelvin Area Hospital, Derry, Northern Ireland
| | - Jan Albert Vos
- Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Ale Algra
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Patient Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Volker Puetz
- Department of Neurology, Dresden University Stroke Center, University Clinics Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | |
Collapse
|
81
|
Lee WJ, Jung KH, Ryu YJ, Lee KJ, Lee ST, Chu K, Lee SK, Roh JK. Acute Symptomatic Basilar Artery Stenosis: MR Imaging Predictors of Early Neurologic Deterioration and Long-term Outcomes. Radiology 2016; 280:193-201. [DOI: 10.1148/radiol.2016151827] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
82
|
Abstract
BACKGROUND few studies have addressed the association between the characteristics of ischemic lesions detected by diffusion-weighted imaging (dWi) and the clinical outcome in patients with hyperacute posterior circulation ischemic stroke. this study demonstrates a relationship between the findings assessed by dWi and the outcome in patients with hyperacute posterior circulation ischemic stroke. METHODS We reviewed data from 118 patients who had posterior circulation ischemic stroke within six hours from the onset of their symptoms. the clinical outcome included early neurological deterioration (end) and a favorable outcome at three months after the onset of symptoms. using dWi, the lesion volume and the number and location of injured anatomical regions were analyzed to evaluate whether the results correlated with the clinical outcome measures. RESULTS the number of injured anatomical regions assessed by dWi was associated with the initial and delayed neurological status. Both the total volume and the number of injured anatomical regions associated with end and a favorable outcome. analysis of the location of the injured regions determined that only a pontine lesion independently associated with end. interestingly, four out of five patients who underwent decompressive craniectomy exhibited a large infarction volume but minor symptoms. CONCLUSIONS in patients with hyperacute posterior circulation ischemic strokes, the lesions assessed by dWi were associated with the clinical outcome, regardless of the initial neurological status. dWi is an effective initial imaging tool for assessing the extent of lesions and clinical outcomes in patients with hyperacute posterior circulation ischemic stroke.
Collapse
|
83
|
Tsivgoulis G, Safouris A, Krogias C, Arthur AS, Alexandrov AV. Endovascular reperfusion therapies for acute ischemic stroke: dissecting the evidence. Expert Rev Neurother 2016; 16:527-34. [DOI: 10.1586/14737175.2016.1168297] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
84
|
Yoon W, Kim SK, Heo TW, Baek BH, Lee YY, Kang HK. Predictors of Good Outcome After Stent-Retriever Thrombectomy in Acute Basilar Artery Occlusion. Stroke 2015; 46:2972-5. [DOI: 10.1161/strokeaha.115.010840] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/04/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Woong Yoon
- From the Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
| | - Seul Kee Kim
- From the Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
| | - Tae Wook Heo
- From the Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
| | - Byung Hyun Baek
- From the Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
| | - Yun Young Lee
- From the Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
| | - Heoung Keun Kang
- From the Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
| |
Collapse
|
85
|
Son S, Kim YW, Oh MK, Kim SK, Park KJ, Choi NC, Kwon OY, Lim BH, Choi HC, Choi DS. Initial factors affecting the clinical outcome after successful recanalization via MR-based mechanical thrombectomy in patients with acute ischemic stroke due to basilar artery occlusion. J Neurointerv Surg 2015; 8:889-93. [DOI: 10.1136/neurintsurg-2015-011912] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/31/2015] [Indexed: 11/04/2022]
Abstract
Background and purposeTo determine the initial factors, including patient characteristics, stroke etiology and severity, time factors, and imaging findings, that could affect the clinical outcome of patients with acute ischemic stroke (AIS) caused by basilar artery occlusion (BAO) where successful recanalization was achieved via mechanical thrombectomy.MethodsBetween March 2011 and December 2014, 35 patients with AIS caused by BAO received MRI/MR angiography-based mechanical thrombectomies, and recanalization was achieved with a Thrombolysis In Cerebral Infarction score of >2b. The patients were divided into a good outcome group (n=19), defined as those with a modified Rankin Scale (mRS) score of 0–2 at 3 months after stroke onset, and a poor outcome group (n=16), defined as a mRS score of 3–6. The differences between the groups were analyzed.ResultsInitial National Institutes of Health Stroke Scale (NIHSS) score (good vs poor: 17.9±8.9 vs 27.6±8.5, p=0.003), posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) based on initial diffusion-weighted images (DWI) (good vs poor: 7.8±1.6 vs 5.4±1.8, p=0.001), pc-ASPECTS based on contrast staining on the post-thrombectomy control CT (good vs poor: 9.2±1.5 vs 6.3±2.2, p<0.001), and presence of contrast staining in the brainstem on that CT (good vs poor: 15.8% vs 81.6%, p<0.001) were significantly different between the groups.ConclusionsPatients with AIS caused by BAO with a lower initial NIHSS score, fewer lesions on initial DWI, and less contrast staining on the post-thrombectomy control CT have higher probabilities of a good clinical outcome after successful recanalization via a mechanical thrombectomy.
Collapse
|
86
|
Yeung JT, Matouk CC, Bulsara KR, Sheth KN. Endovascular revascularization for basilar artery occlusion. INTERVENTIONAL NEUROLOGY 2015; 3:31-40. [PMID: 25999990 DOI: 10.1159/000368968] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Basilar artery occlusion is one of the most devastating neurological conditions known to man. Though rare, patients with clinical syndromes localized to this anatomical region are often referred to acute stroke and endovascular units. Recent studies evaluating the efficacy of endovascular approaches to stroke have focused on anterior circulation syndromes. In this review, we examine the approaches to stroke syndromes due to basilar artery thrombosis. We share the relevant data for intravenous and intra-arterial tissue plasminogen activator as well as mechanical approaches to restoring perfusion in this critical area of the brain.
Collapse
Affiliation(s)
- Jacky T Yeung
- Department of Neurosurgery, Yale School of Medicine, New Haven, Conn., USA
| | - Charles C Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, Conn., USA
| | - Ketan R Bulsara
- Department of Neurosurgery, Yale School of Medicine, New Haven, Conn., USA
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, Conn., USA
| |
Collapse
|
87
|
External validation of the MRI-DRAGON score: early prediction of stroke outcome after intravenous thrombolysis. PLoS One 2014; 9:e99164. [PMID: 24896827 PMCID: PMC4045936 DOI: 10.1371/journal.pone.0099164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/12/2014] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose The aim of our study was to validate in an independent cohort the MRI-DRAGON score, an adaptation of the (CT-) DRAGON score to predict 3-month outcome in acute ischemic stroke patients undergoing MRI before intravenous thrombolysis (IV-tPA). Methods We reviewed consecutive (2009–2013) anterior circulation stroke patients treated within 4.5 hours by IV-tPA in the Lille stroke unit (France), where MRI is the first-line pretherapeutic work-up. We assessed the discrimination and calibration of the MRI-DRAGON score to predict poor 3-month outcome, defined as modified Rankin Score >2, using c-statistic and the Hosmer-Lemeshow test, respectively. Results We included 230 patients (mean ±SD age 70.4±16.0 years, median [IQR] baseline NIHSS 8 [5]–[14]; poor outcome in 78(34%) patients). The c-statistic was 0.81 (95%CI 0.75–0.87), and the Hosmer-Lemeshow test was not significant (p = 0.54). Conclusions The MRI-DRAGON score showed good prognostic performance in the external validation cohort. It could therefore be used to inform the patient's relatives about long-term prognosis and help to identify poor responders to IV-tPA alone, who may be candidates for additional therapeutic strategies, if they are otherwise eligible for such procedures based on the institutional criteria.
Collapse
|
88
|
Gawlitza M, Quäschling U, Hobohm C, Otto J, Voigt P, Hoffmann KT, Lobsien D. Hyperintense basilar artery on FLAIR MR imaging: diagnostic accuracy and clinical impact in patients with acute brain stem stroke. AJNR Am J Neuroradiol 2014; 35:1520-6. [PMID: 24812014 DOI: 10.3174/ajnr.a3961] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE FLAIR-hyperintense vessels are known to be a sign of sluggish collateral blood flow in hemispheric vessel occlusion. Additionally, they seem to have a prognostic implication. The aim of the current study was to evaluate the hyperintense configuration of the basilar artery (FLAIR-hyperintense basilar artery) as a marker of basilar artery occlusion and as a predictor of patient outcome. MATERIALS AND METHODS We retrospectively identified 20 patients with basilar artery occlusion who initially underwent MR imaging with subsequent DSA. The diagnostic accuracy of the FLAIR-hyperintense basilar artery sign was tested by 4 independent readers in a case-control design, and the relation among FLAIR-hyperintense basilar artery and DWI posterior circulation-ASPECTS, patient outcome, and patient survival was evaluated. To grade the extent of the FLAIR-hyperintense basilar artery sign, we generated a score by counting the number of sections from the basilar tip to the foramen magnum in which a hyperintense signal in the vessel lumen was present multiplied by the section thickness. RESULTS The FLAIR-hyperintense basilar artery sign showed moderate sensitivity (65%-95%) but very good specificity (95%-100%) and accuracy (85%-93%) for the detection of basilar artery occlusion. Substantial or excellent inter-reader agreement was observed (Cohen κ, 0.64-0.85). The FLAIR-hyperintense basilar artery inversely correlated with the posterior circulation-ASPECTS (r = -0.67, P = .01). Higher FLAIR-hyperintense basilar artery scores were associated with patient death (28.3 ± 13.7 versus 13.4 ± 11.1, P < .05). CONCLUSIONS The FLAIR-hyperintense basilar artery sign proved to be a valuable marker of vessel occlusion and may substantially support the diagnosis of basilar artery occlusion. The established FLAIR-hyperintense basilar artery score may be helpful for the prediction of individual patient survival.
Collapse
Affiliation(s)
- M Gawlitza
- From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.)Diagnostic and Interventional Radiology (M.G., J.O., P.V.)
| | - U Quäschling
- From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.)
| | - C Hobohm
- Neurology (C.H.), University Hospital Leipzig, Leipzig, Germany
| | - J Otto
- Diagnostic and Interventional Radiology (M.G., J.O., P.V.)
| | - P Voigt
- Diagnostic and Interventional Radiology (M.G., J.O., P.V.)
| | - K-T Hoffmann
- From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.)
| | - D Lobsien
- From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.)
| |
Collapse
|
89
|
Nouh A, Remke J, Ruland S. Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management. Front Neurol 2014; 5:30. [PMID: 24778625 PMCID: PMC3985033 DOI: 10.3389/fneur.2014.00030] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 03/04/2014] [Indexed: 12/12/2022] Open
Abstract
Posterior circulation strokes represent approximately 20% of all ischemic strokes (1, 2). In contrast to the anterior circulation, several differences in presenting symptoms, clinical evaluation, diagnostic testing, and management strategy exist presenting a challenge to the treating physician. This review will discuss the anatomical, etiological, and clinical classification of PC strokes, identify diagnostic pitfalls, and overview current therapeutic regimens.
Collapse
Affiliation(s)
- Amre Nouh
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Jessica Remke
- Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Sean Ruland
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| |
Collapse
|
90
|
|
91
|
Mourand I, Machi P, Nogué E, Arquizan C, Costalat V, Picot MC, Bonafé A, Milhaud D. Diffusion-weighted imaging score of the brain stem: A predictor of outcome in acute basilar artery occlusion treated with the Solitaire FR device. AJNR Am J Neuroradiol 2014; 35:1117-23. [PMID: 24524920 DOI: 10.3174/ajnr.a3870] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The prognosis for ischemic stroke due to acute basilar artery occlusion is very poor: Early recanalization remains the main factor that can improve outcomes. The baseline extent of brain stem ischemic damage can also influence outcomes. We evaluated the validity of an easy-to-use DWI score to predict clinical outcome in patients with acute basilar artery occlusion treated by mechanical thrombectomy. MATERIALS AND METHODS We analyzed the baseline clinical and DWI parameters of 31 patients with acute basilar artery occlusion, treated within 24 hours of symptom onset by using a Solitaire FR device. The DWI score of the brain stem was assessed with a 12-point semiquantitative score that separately considered each side of the medulla, pons, and midbrain. Clinical outcome was assessed at 180 days by using the mRS. According to receiver operating characteristic analyses, the cutoff score determined the optimal positive predictive value for outcome. The Spearman rank correlation coefficient assessed the correlation between the DWI brain stem score and baseline characteristics. RESULTS Successful recanalization (Thrombolysis in Cerebral Infarction 3-2b) was achieved in 23 patients (74%). A favorable outcome (mRS ≤ 2) was observed in 11 patients (35%). An optimal DWI brain stem score of <3 predicted a favorable outcome. The probability of a very poor outcome (mRS ≥ 5) if the DWI brain stem score was ≥5 reached 80% (positive predictive value) and 100% if this score was ≥6. Interobserver reliability of the DWI brain stem score was excellent, with an intraclass correlation coefficient of 0.97 (95% CI, 0.96-0.99). The DWI brain stem score was significantly associated with baseline tetraplegia (P = .001) and coma (P = .005). CONCLUSIONS In patients with acute basilar artery occlusion treated by mechanical thrombectomy, the baseline DWI brain lesion score seems to predict clinical outcome.
Collapse
Affiliation(s)
- I Mourand
- From the Departments of Neurology (I.M., C.A., D.M.)
| | - P Machi
- Neuroradiology (P.M., V.C., A.B.), University Hospital Center of Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | - E Nogué
- Unit of Clinical Research and Epidemiology (E.N., M.-C.P.), Department of Medical Information, University Hospital Center of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - C Arquizan
- From the Departments of Neurology (I.M., C.A., D.M.)
| | - V Costalat
- Neuroradiology (P.M., V.C., A.B.), University Hospital Center of Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | - M-C Picot
- Unit of Clinical Research and Epidemiology (E.N., M.-C.P.), Department of Medical Information, University Hospital Center of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - A Bonafé
- Neuroradiology (P.M., V.C., A.B.), University Hospital Center of Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | - D Milhaud
- From the Departments of Neurology (I.M., C.A., D.M.)
| |
Collapse
|
92
|
Ibatullin MM, Kalinin MN, Kurado AT, Valeeva AA, Khasanova DR. [Multimodal imaging protocols and their predictive role in acute stroke functional outcome]. Zh Nevrol Psikhiatr Im S S Korsakova 2014; 114:9-15. [PMID: 25726796 DOI: 10.17116/jnevro20141141229-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Brain imaging plays a central role in the assessment of patients with acute ischemic stroke. Within a few minutes, modern multimodal imaging protocols can provide one with comprehensive information about prognosis, management, and outcome of the disease, and may detect changes in the intracranial structures reflecting severity of the ischemic injury depicted by four Ps: parenchyma (of the brain), pipes (i.e., the cerebral blood vessels), penumbra, and permeability (of the blood brain barrier). In this article, we have reviewed neuroradiological predictors of stroke functional outcome in the light of the aforementioned four Ps.
Collapse
Affiliation(s)
- M M Ibatullin
- GBOU VPO "Kazanskiĭ gosudarstvennyĭ meditsinskiĭ universitet"
| | - M N Kalinin
- GBOU VPO "Kazanskiĭ gosudarstvennyĭ meditsinskiĭ universitet"
| | - A T Kurado
- GAUZ "Mezhregional'nyĭ kliniko-diagnosticheskiĭ tsentr", Kazan'
| | - A A Valeeva
- GBOU VPO "Kazanskiĭ gosudarstvennyĭ meditsinskiĭ universitet"
| | - D R Khasanova
- GBOU VPO "Kazanskiĭ gosudarstvennyĭ meditsinskiĭ universitet"
| |
Collapse
|
93
|
Baek JM, Yoon W, Kim SK, Jung MY, Park MS, Kim JT, Kang HK. Acute basilar artery occlusion: outcome of mechanical thrombectomy with Solitaire stent within 8 hours of stroke onset. AJNR Am J Neuroradiol 2013; 35:989-93. [PMID: 24335542 DOI: 10.3174/ajnr.a3813] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy with a stent retriever applied shortly after symptom onset could increase good functional outcomes and improve survival in patients with acute basilar artery occlusion, but this has not yet been studied. This study evaluated the efficacy and safety of mechanical thrombectomy with a Solitaire stent within 8 hours of stroke onset in patients with acute basilar artery occlusion. MATERIALS AND METHODS We analyzed 25 consecutive patients with acute basilar artery occlusion who were treated with mechanical thrombectomy by use of the Solitaire stent within 8 hours of stroke symptom onset. Successful recanalization was defined as TICI grade 2b or 3. Good outcome was defined as mRS score of 0-2 at 3 months. Clinical and radiologic data in patients with good outcomes were compared with those with poor outcomes. RESULTS Successful recanalization was achieved in 96% (24/25) of patients, and 48% (12/25) of patients had good outcomes. Eighty-eight percent (22/25) of patients survived to 3 months. The median NIHSS score on admission was significantly lower in patients with good outcomes than in those with poor outcomes (9.5 versus 14, P = .005). Procedure-related complications occurred in 2 patients (8%). No symptomatic intracerebral hemorrhages occurred. CONCLUSIONS The current study suggests that mechanical thrombectomy by use of a Solitaire stent within 8 hours of stroke onset increases good outcomes and improves survival in patients with acute basilar artery occlusion.
Collapse
Affiliation(s)
- J M Baek
- From the Departments of Radiology (J.M.B., W.Y., S.K.K., M.Y.J., H.K.K.)
| | - W Yoon
- From the Departments of Radiology (J.M.B., W.Y., S.K.K., M.Y.J., H.K.K.)
| | - S K Kim
- From the Departments of Radiology (J.M.B., W.Y., S.K.K., M.Y.J., H.K.K.)
| | - M Y Jung
- From the Departments of Radiology (J.M.B., W.Y., S.K.K., M.Y.J., H.K.K.)
| | - M S Park
- Neurology (M.S.P., J.T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - J T Kim
- Neurology (M.S.P., J.T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - H K Kang
- From the Departments of Radiology (J.M.B., W.Y., S.K.K., M.Y.J., H.K.K.)
| |
Collapse
|
94
|
Predictive factors of outcome and hemorrhage after acute ischemic stroke treated by mechanical thrombectomy with a stent-retriever. Neuroradiology 2013; 55:977-987. [PMID: 23644538 DOI: 10.1007/s00234-013-1191-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
|
95
|
Mourand I, Machi P, Milhaud D, Picot MC, Lobotesis K, Arquizan C, Costalat V, Héroum C, Sablot D, Bouly S, Lalu T, Bonafé A. Mechanical thrombectomy with the Solitaire device in acute basilar artery occlusion. J Neurointerv Surg 2013; 6:200-4. [PMID: 23645572 DOI: 10.1136/neurintsurg-2012-010629] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate the efficacy and safety of mechanical thrombectomy with the Solitaire FR device in revascularization of patients with acute basilar artery occlusion (ABAO) and to identify the predictive factors for clinical outcome. METHODS This prospective single-center study included 31 patients with acute ischemic stroke attributable to ABAO treated within the first 24 h after onset of symptoms with the Solitaire device. Nineteen patients simultaneously received intravenous thrombolysis. Recanalization rates after stent retrieval were determined and the clinical outcome and mortality rate were assessed 180 days after treatment. RESULTS The mean ±SD age of the patients was 61±17 years, the median prethrombectomy NIH Stroke Scale score was 38 (IQR 9-38) and the median Glasgow Coma Scale (GCS) score was 7 (IQR 4-14). Successful recanalization (TICI 3 or 2b) was achieved in 23 patients (74%). Five symptomatic intracranial hemorrhages were related to the procedure. Ten symptomatic distal migrations of thrombotic material occurred. A favorable outcome, defined as a modified Rankin Score (mRS) of 0-2, was observed in 35% of patients (11/31). Overall mortality rate was 32% (10/31). In the univariate analysis, elevated baseline glucose (p=0.008) was significantly associated with a poor outcome (mRS >2), whereas a tendency towards significance was observed with age (p=0.06), GCS on admission (p=0.07) and symptom-related lesions on T2 sequences (p=0.10). Patients with successful recanalization tended to have a better outcome (p=0.20). CONCLUSION Mechanical thrombectomy with the Solitaire FR device can rapidly and effectively contribute to a high rate of recanalization and improve functional outcome in patients with ABAO and has an acceptable complication rate.
Collapse
Affiliation(s)
- Isabelle Mourand
- Neurology Department, University Hospital Center of Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
96
|
Abstract
Traditionally non-contrast CT has been considered the first choice imaging modality for acute stroke. Acute ischemic stroke patients presenting to the hospital within 3-hours from symptom onset and without any visible hemorrhages or large lesions on CT images are considered optimum reperfusion therapy candidates. However, non-contrast CT alone has been unable to identify best reperfusion therapy candidates outside this window. New advanced imaging techniques are now being used successfully for this purpose. Non-invasive CT or MR angiography images can be obtained during initial imaging evaluation for identification and characterization of vascular lesions, including occlusions, aneurysms, and malformations. Either CT-based perfusion imaging or MRI-based diffusion and perfusion imaging performed immediately upon arrival of a patient to the hospital helps estimate the extent of fixed core and penumbra in ischemic lesions. Patients having occlusive lesions with small fixed cores and large penumbra are preferred reperfusion therapy candidates.
Collapse
|
97
|
Turc G, Apoil M, Naggara O, Calvet D, Lamy C, Tataru AM, Méder JF, Mas JL, Baron JC, Oppenheim C, Touzé E. Magnetic Resonance Imaging-DRAGON Score. Stroke 2013; 44:1323-8. [DOI: 10.1161/strokeaha.111.000127] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The DRAGON score, which includes clinical and computed tomographic scan parameters, showed a high specificity to predict 3-month outcome in patients with acute ischemic stroke treated by intravenous tissue plasminogen activator. We adapted the score for patients undergoing MRI as the first-line diagnostic tool.
Methods—
We reviewed patients with consecutive anterior circulation ischemic stroke treated ≤4.5 hour by intravenous tissue plasminogen activator between 2003 and 2012 in our center, where MRI is systematically implemented as first-line diagnostic work-up. We derived the MRI-DRAGON score keeping all clinical parameters of computed tomography-DRAGON (age, initial National Institutes of Health Stroke Scale and glucose level, prestroke handicap, onset to treatment time), and considering the following radiological variables: proximal middle cerebral artery occlusion on MR angiography instead of hyperdense middle cerebral artery sign, and diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI ASPECTS) ≤5 instead of early infarct signs on computed tomography. Poor 3-month outcome was defined as modified Rankin scale >2. We calculated c-statistics as a measure of predictive ability and performed an internal cross-validation.
Results—
Two hundred twenty-eight patients were included. Poor outcome was observed in 98 (43%) patients and was significantly associated with all parameters of the MRI-DRAGON score in multivariate analysis, except for onset to treatment time (nonsignificant trend). The c-statistic was 0.83 (95% confidence interval, 0.78–0.88) for poor outcome prediction. All patients with a MRI-DRAGON score ≤2 (n=22) had a good outcome, whereas all patients with a score ≥8 (n=11) had a poor outcome.
Conclusions—
The MRI-DRAGON score is a simple tool to predict 3-month outcome in acute stroke patients screened by MRI then treated by intravenous tissue plasminogen activator and may help for therapeutic decision.
Collapse
Affiliation(s)
- Guillaume Turc
- From the Service de Neurologie (G.T., M.A., D.C., C.L., A.M.T., J.-L.M., J.-C.B., E.T.) and Service de Neuroradiologie (O.N., J.-F.M., C.O.), Sorbonne Paris Cité, INSERM UMR S894, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France; and Service de Neurologie, INSERM U919, GIP Cyceron, CHU Côte de Nacre, Université de Caen Basse Normandie, Caen, France (M.A.)
| | - Marion Apoil
- From the Service de Neurologie (G.T., M.A., D.C., C.L., A.M.T., J.-L.M., J.-C.B., E.T.) and Service de Neuroradiologie (O.N., J.-F.M., C.O.), Sorbonne Paris Cité, INSERM UMR S894, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France; and Service de Neurologie, INSERM U919, GIP Cyceron, CHU Côte de Nacre, Université de Caen Basse Normandie, Caen, France (M.A.)
| | - Olivier Naggara
- From the Service de Neurologie (G.T., M.A., D.C., C.L., A.M.T., J.-L.M., J.-C.B., E.T.) and Service de Neuroradiologie (O.N., J.-F.M., C.O.), Sorbonne Paris Cité, INSERM UMR S894, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France; and Service de Neurologie, INSERM U919, GIP Cyceron, CHU Côte de Nacre, Université de Caen Basse Normandie, Caen, France (M.A.)
| | - David Calvet
- From the Service de Neurologie (G.T., M.A., D.C., C.L., A.M.T., J.-L.M., J.-C.B., E.T.) and Service de Neuroradiologie (O.N., J.-F.M., C.O.), Sorbonne Paris Cité, INSERM UMR S894, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France; and Service de Neurologie, INSERM U919, GIP Cyceron, CHU Côte de Nacre, Université de Caen Basse Normandie, Caen, France (M.A.)
| | - Catherine Lamy
- From the Service de Neurologie (G.T., M.A., D.C., C.L., A.M.T., J.-L.M., J.-C.B., E.T.) and Service de Neuroradiologie (O.N., J.-F.M., C.O.), Sorbonne Paris Cité, INSERM UMR S894, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France; and Service de Neurologie, INSERM U919, GIP Cyceron, CHU Côte de Nacre, Université de Caen Basse Normandie, Caen, France (M.A.)
| | - Alina M. Tataru
- From the Service de Neurologie (G.T., M.A., D.C., C.L., A.M.T., J.-L.M., J.-C.B., E.T.) and Service de Neuroradiologie (O.N., J.-F.M., C.O.), Sorbonne Paris Cité, INSERM UMR S894, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France; and Service de Neurologie, INSERM U919, GIP Cyceron, CHU Côte de Nacre, Université de Caen Basse Normandie, Caen, France (M.A.)
| | - Jean-François Méder
- From the Service de Neurologie (G.T., M.A., D.C., C.L., A.M.T., J.-L.M., J.-C.B., E.T.) and Service de Neuroradiologie (O.N., J.-F.M., C.O.), Sorbonne Paris Cité, INSERM UMR S894, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France; and Service de Neurologie, INSERM U919, GIP Cyceron, CHU Côte de Nacre, Université de Caen Basse Normandie, Caen, France (M.A.)
| | - Jean-Louis Mas
- From the Service de Neurologie (G.T., M.A., D.C., C.L., A.M.T., J.-L.M., J.-C.B., E.T.) and Service de Neuroradiologie (O.N., J.-F.M., C.O.), Sorbonne Paris Cité, INSERM UMR S894, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France; and Service de Neurologie, INSERM U919, GIP Cyceron, CHU Côte de Nacre, Université de Caen Basse Normandie, Caen, France (M.A.)
| | - Jean-Claude Baron
- From the Service de Neurologie (G.T., M.A., D.C., C.L., A.M.T., J.-L.M., J.-C.B., E.T.) and Service de Neuroradiologie (O.N., J.-F.M., C.O.), Sorbonne Paris Cité, INSERM UMR S894, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France; and Service de Neurologie, INSERM U919, GIP Cyceron, CHU Côte de Nacre, Université de Caen Basse Normandie, Caen, France (M.A.)
| | - Catherine Oppenheim
- From the Service de Neurologie (G.T., M.A., D.C., C.L., A.M.T., J.-L.M., J.-C.B., E.T.) and Service de Neuroradiologie (O.N., J.-F.M., C.O.), Sorbonne Paris Cité, INSERM UMR S894, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France; and Service de Neurologie, INSERM U919, GIP Cyceron, CHU Côte de Nacre, Université de Caen Basse Normandie, Caen, France (M.A.)
| | - Emmanuel Touzé
- From the Service de Neurologie (G.T., M.A., D.C., C.L., A.M.T., J.-L.M., J.-C.B., E.T.) and Service de Neuroradiologie (O.N., J.-F.M., C.O.), Sorbonne Paris Cité, INSERM UMR S894, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France; and Service de Neurologie, INSERM U919, GIP Cyceron, CHU Côte de Nacre, Université de Caen Basse Normandie, Caen, France (M.A.)
| |
Collapse
|
98
|
Kim SH, Lee JY, Kim DH, Ham JH, Song YK, Lim EJ, Park CI, Chang SJ, Lee SS. Factors Related to the Initial Stroke Severity of Posterior Circulation Ischemic Stroke. Cerebrovasc Dis 2013; 36:62-8. [DOI: 10.1159/000351512] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 04/15/2013] [Indexed: 11/19/2022] Open
|
99
|
Leonards CO, Ipsen N, Malzahn U, Fiebach JB, Endres M, Ebinger M. White matter lesion severity in mild acute ischemic stroke patients and functional outcome after 1 year. Stroke 2012; 43:3046-51. [PMID: 22935398 DOI: 10.1161/strokeaha.111.646554] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To determine if severity of visually assessed white matter disease is associated with disability after ischemic stroke. METHODS In this Berlin "Cream & Sugar" substudy, all first ischemic stroke patients who received magnetic resonance imaging and completed follow-up between January 2009 and December 2010, were enrolled. Severity of white matter disease was assessed on fluid-attenuated inversion recovery or T2-weighted sequences using the Wahlund and Fazekas visual scales. Functional outcome was assessed after 1 year using the modified Rankin Scale (follow-up [FU] modified Rankin Scale [mRS]). RESULTS Of 101 patients (37% female; median age, 67 years; interquartile range, 54-75; National Institutes of Health Stroke Scale score, 1; interquartile range, 0-2), median FU mRS was 1 (interquartile range, 0-2). Binary logistical regression adjusted for age (at 5-year intervals), acute National Institutes of Health Stroke Scale scores, fasting glucose, insulin, glycosylated hemoglobin, creatinine, C-reactive protein quartiles, waist circumference, and systolic blood pressure revealed that Fazekas scores of 2 and 3 independently associated with FU mRS (Fazekas score 2: adjusted odds ratio, 8.4; 95% confidence interval, 2.35-30.09; P=0.001; Fazekas score 3: adjusted odds ratio, 4.2; 95% confidence interval, 1.04-16.96; P=0.044). Wahlund scores>10 were significantly associated with FU mRS when fasting glucose levels were removed from the regression analysis (adjusted odds ratio, 12.17; 95% confidence interval, 1.91-77.54; P=0.008). CONCLUSIONS Severe white matter disease defined by standard criteria in acute ischemic stroke patients is associated with disability at 1 year and can be assessed quickly using visual rating scales. CLINICAL TRIAL REGISTRATION INFORMATION URLs: http://www.clinicaltrials.gov and https://eudract.ema.europa.eu. Unique identifiers: NCT 01378468 and 2009-010356-97.
Collapse
Affiliation(s)
- Christopher O Leonards
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Campus Mitte, Charité Platz 1, D-10117 Berlin, Germany
| | | | | | | | | | | |
Collapse
|
100
|
Soize S, Kadziolka K, Estrade L, Serre I, Bakchine S, Pierot L. Mechanical thrombectomy in acute stroke: prospective pilot trial of the solitaire FR device while under conscious sedation. AJNR Am J Neuroradiol 2012; 34:360-5. [PMID: 22821923 DOI: 10.3174/ajnr.a3200] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The best approach between general anesthesia and conscious sedation to perform mechanical thrombectomy remains unknown. The goal of our study was to evaluate the feasibility, safety, and efficacy of mechanical thrombectomy under conscious sedation in patients with acute ischemic stroke, using the Solitaire FR device, in a prospective, single-center, single-arm study. MATERIALS AND METHODS The study included consecutive patients with acute ischemic stroke due to a large artery occlusion within 6 hours of symptom onset for the anterior circulation, and within 24 hours for the posterior circulation. After intravenous thrombolysis (when no contraindications), thrombectomy was performed with the Solitaire device in patients under conscious sedation. Primary efficacy and safety end points were good functional outcome (mRS ≤2) at 3 months and mortality at 3 months. Secondary end points were recanalization (TICI ≥2) and failure rate. RESULTS From May 2010 to July 2011, 36 patients were treated. Median baseline NIHSS score was 17.5. The occlusion site was MCA in 21 patients (58.4%), ICA-MCA tandem occlusion in 9 patients (25.0%), terminal ICA in 2 patients (5.5%), and basilar artery in 4 patients (11.1%). Twenty-three patients (63.9%) received intravenous thrombolysis. Superselective catheterization of the occluded vessel was not feasible in 5/36 cases (13.9%). Successful revascularization was achieved in 28/36 patients (77.8%). After 3 months, 22 patients (61.1%) showed good functional outcome (mRS ≤2) and the median NIHSS score was 8.5. Overall mortality rate at 3 months was 22.2% (8/36). CONCLUSIONS In acute ischemic stroke, mechanical thrombectomy while under conscious sedation is feasible in a large percentage of cases (86.1%) and is associated with a short procedure delay and a high percentage of good functional outcomes at 3 months (61.1%).
Collapse
Affiliation(s)
- S Soize
- Service de Radiologie, Hôpital Maison Blanche, Université de Reims, Reims, France
| | | | | | | | | | | |
Collapse
|