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Lin Y, Guo Y, Han J. External validation of different predictive scores for symptomatic intracranial hemorrhage after intravenous thrombolysis in Asian stroke patients. Clin Neurol Neurosurg 2024; 245:108500. [PMID: 39116795 DOI: 10.1016/j.clineuro.2024.108500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE This study aimed to externally validate different predictive scores for symptomatic intracranial hemorrhage (SICH) after intravenous thrombolysis (IVT), with a particular focus on their predictive abilities in Asian stroke patients. METHODS We retrospectively enrolled stroke patients who received a standard dose of alteplase within 4.5 hours from symptom onset at the First Affiliated Hospital of Dalian Medical University from July 2010 to August 2023. SICH was defined as the hemorrhagic transformation detected on the head CT scan completed within 48 h post-IVT, accompanied by a clinical deterioration of at least a 4-point increase in NIHSS score. Predictive abilities of the HAT, MSS, SEDAN, SPAN-100, and GRASPS scores were tested. Discrimination and calibration were performed using the area under the receiver operating characteristic curve (ROC-AUC), DeLong test, and Hosmer-Lemeshow (H-L) goodness-of-fit test. RESULTS The study included 1007 stroke patients, of whom 31 (3.08 %) developed SICH. ROC-AUCs for predicting SICH were: 0.796 (95 %CI: 0.726-0.866) for the GRASPS score, 0.724 (95 %CI: 0.644-0.804) for the MSS score, 0.715 (95 %CI: 0.619-0.811) for the SEDAN score, 0.714 (95 %CI: 0.611-0.817) for the HAT score, and 0.605 (95 %CI: 0.491-0.720) for the SPAN-100 score (all P < 0.05). DeLong tests showed that the GRASPS score demonstrated significantly better discrimination than the MSS score (P = 0.010), the SEDAN score (P = 0.009), the HAT score (P = 0.049), and the SPAN-100 score (P = 0.000). H-L tests indicated good calibrations which were ranked HAT > SEDAN > MSS > SPAN-100 > GRASPS scores. CONCLUSION The GRASPS score showed reasonable predictive ability for SICH, indicating its potential utility for Asian stroke patients receiving IVT.
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Affiliation(s)
- Yanan Lin
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Yan Guo
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Jie Han
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China.
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Orscelik A, Senol YC, Bilgin C, Kobeissi H, Ghozy S, Musmar B, Bilgin GB, Zandpazandi S, Pakkam M, Arul S, Brinjikji W, Kallmes DF. Outcomes of mechanical thrombectomy in M1 occlusion patients with or without hyperdense middle cerebral artery sign: A systematic review and meta-analysis. Neuroradiol J 2024; 37:454-461. [PMID: 38146685 DOI: 10.1177/19714009231224446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND The comparison of mechanical thrombectomy (MT) outcomes between patients with the hyperdense middle cerebral artery sign (HMCAS) and non-HMCAS is important to evaluate the impact of this radiological finding on treatment efficacy. This meta-analysis aimed to assess the association between HMCAS and clinical outcomes in patients undergoing thrombectomy, comparing the outcomes over non-HMCAS. METHODS A systematic literature search was conducted in PubMed, Ovid Embase, Google Scholar, and Cochrane Library to identify studies on MT outcomes for M1 occlusions of HMCAS over non-HMCAS. Inclusion criteria encompassed modified Rankin Scale (mRS) score, mortality, symptomatic intracranial hemorrhage (sICH), and successful recanalization. Using R software version 4.1.2, we calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI). RESULTS The meta-analysis was performed for 5 studies with 724 patients. There was no association found between presence of HMCAS and achieving mRS 0-2 (OR = 0.65, 95% CI: 0.29-1.47; p = .544). Mortality analysis also showed no significant association with presence of HMCAS (OR = 0.78, 95% CI: 0.37-1.65; p = .520). No significant difference in sICH risk (OR = 1.54, 95% CI: 0.24-9.66; p = .646) was found between groups. Recanalization analysis showed a non-significant positive association (OR = 1.23, 95% CI: 0.67-2.28; p = .501). Heterogeneity was observed in all analyses. CONCLUSION Our findings showed that there is no statistically significant difference in mRS scores, mortality, sICH, and recanalization success rates between the HMCAS and non-HMCAS groups.
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Affiliation(s)
- Atakan Orscelik
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Yigit Can Senol
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Basel Musmar
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Sara Zandpazandi
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Madona Pakkam
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Santhosh Arul
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
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Zhang L, Xue H, Bu X, Liao J, Tang G, Chen Y, Zhao L, Yang D, Liu L, Liu S. Patchy profile sign in RAPID software: a specific marker for intracranial atherosclerotic stenosis in acute ischemic stroke. Front Neurol 2024; 15:1414959. [PMID: 38872825 PMCID: PMC11169934 DOI: 10.3389/fneur.2024.1414959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024] Open
Abstract
Purpose Identifying the etiology of acute ischemic stroke (AIS) before endovascular treatment (EVT) is important but challenging. In CT perfusion imaging processed by perfusion software, we observed a phenomenon called patchy profile sign (PPS), that is, the hypoperfusion morphology in RAPID software is a discontinuous sheet pattern. This phenomenon is predominantly observed in patients diagnosed with intracranial atherosclerotic stenosis (ICAS). The study intends to assess whether the PPS can be used to differentiate ICAS from intracranial embolism. Method Patients with AIS due to M1 segment occlusion of the MCA who underwent mechanical thrombectomy were retrospectively enrolled. The receiver operating characteristic (ROC) curve analysis was performed to assess the value of PPS in predicting ICAS. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the PPS for prediction of ICAS were calculated. Results A total of 51 patients were included in the study. The PPS was observed in 10 of 19 (52.6%) patients with ICAS, and in 2 of 32 (6.3%) patients with intracranial embolism (p < 0.001). Interobserver agreement for identifying PPS was excellent (κ = 0.944). The sensitivity, specificity, PPV, NPV, and accuracy of the PPS for predicting ICAS were 52.6, 93.8, 83.3, 76.9, and 78.4%, respectively. Conclusion The PPS on RAPID software is an imaging marker with high specificity for ICAS. Larger sample sizes are imperative to validate the findings.
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Affiliation(s)
- Lingwen Zhang
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Xue
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoqing Bu
- Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Juan Liao
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Ge Tang
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Chen
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Libo Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Deyu Yang
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Li Liu
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Department of Health Management, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Shudong Liu
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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Gharaibeh K, Aladamat N, Samara M, Mierzwa AT, Ali A, Zaidi S, Jumaa M. Hyperdense sign as a predictor for successful recanalization and clinical outcome in acute ischemic stroke: A systematic review and meta-analysis. Interv Neuroradiol 2024:15910199241235431. [PMID: 38415302 DOI: 10.1177/15910199241235431] [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: 02/29/2024] Open
Abstract
OBJECTIVE To assess the prognostic values of hyperdense sign on pretreatment non-contrast head CT scan for successful recanalization (mTICI ≥2b) and 90-day good functional outcome (mRs 0-2) in patients with acute ischemic stroke undergoing mechanical thrombectomy (MT). METHODS Literature search on PubMed, EMBASE, and Cochrane databases from inception up to 1 November 2023 was conducted. Twelve studies which reported hyperdense sign, recanalization and clinical outcomes were included in qualitative synthesis and meta-analysis. RESULTS Pooled analysis demonstrated a statistically significant association between successful recanalization and hyperdense sign-positive patients who underwent MT (odd ratios (OR) = 1.47, 95% confidence interval (CI) = 1.03-2.10, p = 0.04). No statistically significant association was demonstrated between presence of hyperdense sign and good functional outcome (OR = 1.04, 95% CI: 0.72-1.49, p = 0.85) or symptomatic intracranial hemorrhage sICH (OR: 1.80, 95% CI 0.72-4.47, p = 0.21). CONCLUSIONS This meta-analysis demonstrated that pre-intervention hyperdense sign on CT imaging might be useful in prediction of successful recanalization after MT.
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Affiliation(s)
- Khaled Gharaibeh
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Nameer Aladamat
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
| | - Mohammad Samara
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
| | - Adam T Mierzwa
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Ahsan Ali
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Syed Zaidi
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
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Ospel JM, Mirza M, Clarençon F, Siddiqui A, Doyle K, Consoli A, Mokin M, Ullberg T, Zaidat O, Bourcier R, Kulcsar Z, Gounis MJ, Liebeskind DS, Fiehler J, Narata AP, Ribo M, Jovin T, Sakai N, Rai A, McCarthy R, Dorn F, Andersson T, Majoie CBLM, Hanel R, Jadhav A, Riedel C, Chamorro A, Brinjikji W, Costalat V, DeMeyer SF, Nogueira RG, Cognard C, Montaner J, Leung TW, Molina C, van Beusekom H, Davalos A, Weisel J, Chapot R, Möhlenbruch M, Brouwer P. What is a Challenging Clot? : A DELPHI Consensus Statement from the CLOTS 7.0 Summit. Clin Neuroradiol 2023; 33:1007-1016. [PMID: 37284876 DOI: 10.1007/s00062-023-01301-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/27/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Predicting a challenging clot when performing mechanical thrombectomy in acute stroke can be difficult. One reason for this difficulty is a lack of agreement on how to precisely define these clots. We explored the opinions of stroke thrombectomy and clot research experts regarding challenging clots, defined as difficult to recanalize clots by endovascular approaches, and clot/patient features that may be indicative of such clots. METHODS A modified DELPHI technique was used before and during the CLOTS 7.0 Summit, which included experts in thrombectomy and clot research from different specialties. The first round included open-ended questions and the second and final rounds each consisted of 30 closed-ended questions, 29 on various clinical and clot features, and 1 on number of passes before switching techniques. Consensus was defined as agreement ≥ 50%. Features with consensus and rated ≥ 3 out of 4 on the certainty scale were included in the definition of a challenging clot. RESULTS Three DELPHI rounds were performed. Panelists achieved consensus on 16/30 questions, of which 8 were rated 3 or 4 on the certainty scale, namely white-colored clots (mean certainty score 3.1), calcified clots under histology (3.7) and imaging (3.7), stiff clots (3.0), sticky/adherent clots (3.1), hard clots (3.1), difficult to pass clots (3.1) and clots that are resistant to pulling (3.0). Most panelists considered switching endovascular treatment (EVT) techniques after 2-3 unsuccessful attempts. CONCLUSION This DELPHI consensus identified 8 distinct features of a challenging clot. The varying degree of certainty amongst the panelists emphasizes the need for more pragmatic studies to enable accurate a priori identification of such occlusions prior to EVT.
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Affiliation(s)
- Johanna M Ospel
- Departments of Diagnostic Imaging and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, T2N2T9, Calgary, AB, Canada.
| | | | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Adnan Siddiqui
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, NY, USA
| | - Karen Doyle
- Department of Physiology and CURAM-SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Arturo Consoli
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, France
| | - Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Teresa Ullberg
- Departments of Neurology and Diagnostic Imaging, Skåne University Hospital, and Department of clinical sciences, Neurology, Lund University, Lund, Sweden
| | - Osama Zaidat
- Neuroscience and Stroke Center, Mercy Health Bon Secours St Vincent Hospital, Toledo, OH, USA
| | - Romain Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Nantes, Pays de la Loire, France
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, USA
| | - David S Liebeskind
- UCLA Stroke Center and Department of Neurology, University of California, Los Angeles, USA
| | - Jens Fiehler
- Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ana Paula Narata
- Department of Interventional Neuroradiology, University Hospital of Southampton, Southampton, UK
| | - Marc Ribo
- Unitat d'Ictus, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Tudor Jovin
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ansaar Rai
- Neuroradiology Department, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, USA
| | - Ray McCarthy
- Research and Development, Cerenovus, Galway, Ireland
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital of Bonn, Bonn, Germany
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Intitutet, Stockholm, Sweden
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Ricardo Hanel
- Baptist neurological institute, Baptist Health, Jacksonville, FL, USA
| | - Ashutosh Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Christian Riedel
- Department of Neuroradiology, University Hospital Göttingen, Georg-August-University, Göttingen, Germany
| | - Angel Chamorro
- Hospital Clinic of Barcelona and Institut d'Investigaçions Biomèdicas August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Waleed Brinjikji
- Department of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Vincent Costalat
- Neuroradiology department, University Hospital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - Simon F DeMeyer
- Laboratory For Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Raul G Nogueira
- Department of Neurology, University of Pittsburgh Medical Centre, Pittsburgh, USA
| | - Christophe Cognard
- Department of diagnostic and therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR) Barcelona, Barcelona, Spain
| | - Thomas W Leung
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Carlos Molina
- Stroke Center Vall d'Hebron Hospital, Barcelona, Spain
| | - Heleen van Beusekom
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Antoni Davalos
- Department of Neuroscience, University Autònoma de Barcelona, Barcelona, Spain
| | - John Weisel
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Rene Chapot
- Department of Neuroradiology, Alfried Krupp Krankenhaus Ruttenscheid, Essen, Germany
| | - Markus Möhlenbruch
- Department of Interventional Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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Wei C, Wu Q, Liu J, Wang Y, Liu M. Key CT markers for predicting haemorrhagic transformation after ischaemic stroke: a prospective cohort study in China. BMJ Open 2023; 13:e075106. [PMID: 38000813 PMCID: PMC10680015 DOI: 10.1136/bmjopen-2023-075106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/09/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES Limited studies have systematically addressed the CT markers of predicting haemorrhagic transformation (HT). We aimed to (1) investigate the predictive ability of the imaging factors on multimodal CT for HT and (2) identify the key CT markers that can accurately predict HT while maintaining easy and rapid assessment in the early stage of stroke. DESIGN AND SETTING This was a prospective cohort study conducted in a tertiary hospital in Southwest China. PARTICIPANTS Patients with ischaemic stroke admitted within 24 hours after onset were included. OUTCOME MEASURES The primary outcome was measured as the overall HT. The secondary outcomes were the presence of parenchymal haematoma, symptomatic HT and spontaneous HT. RESULTS A total of 763 patients were included. The early hypodensity >1/3 of the middle cerebral artery (MCA) territory, Alberta Stroke Programme Early CT Score≤7, midline shift, hyperdense middle cerebral artery sign (HMCAS), poor collateral circulation, infarct core and penumbra was independently associated with the increased risk of HT (all p < 0.05). The sensitivity of midline shift for predicting HT was only 3.5%, whereas its specificity was 99.8%. The combination of the early hypodensity >1/3 of the MCA territory, midline shift and HMCAS showed a good predictive performance for HT (area under the curve 0.80, 95% CI 0.75 to 0.84). CONCLUSIONS Seven imaging factors on multimodal CT were independently associated with HT. The high specificity of midline shift suggests the need to consider it as an imaging indicator when assessing the risk of HT. The early hypodensity >1/3 of the MCA territory, midline shift and HMCAS was identified as the key CT markers for the early prediction of HT. The coexistence of the three key factors might be a valuable index for identifying individuals at high bleeding risk and guiding further treatments.
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Affiliation(s)
- Chenchen Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qian Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanan Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Zhang L, Li J, Yang B, Li W, Wang X, Zou M, Song H, Shi L, Duan Y. The risk and outcome of malignant brain edema in post-mechanical thrombectomy: acute ischemic stroke by anterior circulation occlusion. Eur J Med Res 2023; 28:435. [PMID: 37833809 PMCID: PMC10571427 DOI: 10.1186/s40001-023-01414-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND PURPOSE Malignant brain edema (MBE) occurring after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) could lead to severe disability and mortality. We aimed to investigate the incidence, predictors, and clinical outcomes of MBE in patients with AIS after MT. METHODS The clinical and imaging data of 155 patients with AIS of anterior circulation after MT were studied. Standard non-contrast CT was used to evaluate baseline imaging characteristics at admission. Clinical outcomes were measured using the 90-day modified Rankin Scale (mRS) score. Based on the follow-up CT scans performed within 72 h after MT, the patients were classified into MBE and non-MBE group. MBE was defined as a midline shift of ≥ 5 mm with signs of local brain swelling. Univariate and multivariate regression analyses were used to analyze the relationship between MBE and clinical outcomes and identify the predictors that correlate with MBE. RESULTS MBE was observed in 19.4% of the patients who underwent MT and was associated with a lower rate of favorable 90-day clinical outcomes. Significant differences were observed in both MBE and non-MBE groups: baseline Alberta Stroke Program Early CT (ASPECT) score, hyperdense middle cerebral artery sign (HMCAS), baseline signs of early infarct, angiographic favorable collaterals, number of retrieval attempts, and revascularization rate. Multivariate analysis indicated that low baseline ASPECT score, absent HMCAS, angiographic poor collaterals, more retrieval attempt count, and poor revascularization independently influenced the occurrence of MBE in AIS patients with anterior circulation after MT. CONCLUSION MBE was associated with a lower rate of favorable 90-day clinical outcomes. Low baseline ASPECT score, absent HMCAS, angiographic poor collaterals, more retrieval attempt count and poor revascularization were independently associated with MBE after MT.
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Affiliation(s)
- Luojin Zhang
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China
- Department of Radiology, Shanxi Fenyang Hospital, Shanxi, China
| | - Jinze Li
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China
- Northern Theater Command Postgraduate Training Base of Jinzhou Medical University General Hospital, Shenyang, China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Wei Li
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xinrui Wang
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China
| | - Mingyu Zou
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China
| | - Hongyan Song
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China
| | - Lin Shi
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China
| | - Yang Duan
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China.
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Oliveira R, Correia MA, Marto JP, Carvalho Dias M, Mohamed GA, Nguyen TN, Nogueira RG, Aboul-Nour H, Marin H, Bou Chebl A, Mohammaden MH, Al-Bayati AR, Haussen DC, Abdalkader M, Fifi JT, Ortega-Gutierrez S, Yavagal DR, Mayer SA, Tsivgoulis G, Neto LL, Aguiar de Sousa D. Reocclusion after successful endovascular treatment in acute ischemic stroke: systematic review and meta-analysis. J Neurointerv Surg 2023; 15:964-970. [PMID: 36328479 DOI: 10.1136/jnis-2022-019382] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Endovascular treatment (EVT) is the standard of care for selected patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). OBJECTIVE To systematically review the available data on: (1) incidence, predictors, and outcomes of patients with reocclusion after successful EVT for AIS and, (2) the characteristics, complications, and outcomes of patients with reocclusion treated with repeated EVT (rEVT) within 30 days of the first procedure. METHODS PubMed was searched (between January 2012 and April 2021) to identify studies reporting reocclusion following successful EVT (Thrombolysis in Cerebral Infarction ≥2b) in patients with AIS due to LVO. Pooled incidence of reocclusion per 100 patients with successful recanalization following EVT was calculated using a random-effects model with Freeman-Tukey double arcsine transformation. Extracted incidences of reocclusion according to etiology and use of intravenous thrombolysis were pooled using random-effects meta-analytic models. RESULTS A total of 840 studies was identified and seven studies qualified for the quantitative analysis, which described 91 same-vessel reocclusions occurring within the first 7 days after treatment among 2067 patients (4.9%; 95% CI 3% to 7%, I2=70.2%). Large vessel atherosclerosis was associated with an increased risk of reocclusion (OR=3.44, 95% CI 1.12 to 10.61, I2=50%). We identified 90 patients treated with rEVT for recurrent LVO, described in five studies. The rates of procedural complications, mortality, and unfavorable functional outcome at 3 months were 18.0%, 18.9%, and 60.3%, respectively. CONCLUSION In cohorts of patients with AIS due to LVO, 5% of patients experienced reocclusion within 7 days after successful EVT. Repeated EVT can be a safe and effective treatment for selected patients with reocclusion.
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Affiliation(s)
- Renato Oliveira
- Department of Neurology, Hospital da Luz Lisboa, Lisboa, Portugal
- Department of Geriatrics, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Manuel A Correia
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Lisboa, Portugal
| | - Mariana Carvalho Dias
- Department of Neurology, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Ghada A Mohamed
- Department of Neurology, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Raul G Nogueira
- Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hassan Aboul-Nour
- Department of Neurology, Emory University Hospitals, Atlanta, Georgia, USA
| | - Horia Marin
- Department of Radiology, Henry Ford Health, Detroit, Michigan, USA
| | - Alex Bou Chebl
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Alhamza R Al-Bayati
- Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Diogo C Haussen
- Department of Neurology and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Johanna T Fifi
- Departments of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
| | - Stephan A Mayer
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - Lia Lucas Neto
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
- Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Diana Aguiar de Sousa
- Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Stroke Center, Lisbon Central University Hospital, Lisbon, Portugal
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9
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Rodríguez MJ, Graziani A, Seoane JS, Di Napoli L, Pérez Akly M, Besada C. Radiological predictors of final infarct volume in patients with proximal vascular occlusion. RADIOLOGIA 2023; 65:414-422. [PMID: 37758332 DOI: 10.1016/j.rxeng.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 12/22/2021] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Various clinical and radiologic variables impact the neurologic prognosis of patients with ischemic cerebrovascular accidents. About 30% of ischemic cerebrovascular accidents are caused by proximal obstruction of the anterior circulation; in these cases, systemic thrombolysis is of limited usefulness. CT angiography is indicated in candidates for endovascular treatment. Various radiologic factors, including the grade of leptomeningeal collateral circulation, as well as the length, density, and extension of the thrombus, have been identified as predictors of neurologic prognosis after anterior ischemic cerebrovascular accidents due to proximal vascular obstruction. Final infarct volume correlations with mortality and long-term functional outcome in these patients. This study aimed to determine the best predictors of final infarct volume on CT angiography in patients with ischemic cerebral accidents due to proximal occlusion. MATERIALS AND METHODS This retrospective observational study included adults with ischemic cerebrovascular accidents due to obstruction of the anterior circulation diagnosed by CT angiography in the period comprising June 2009 through December 2019. We measured the length and density of the thrombus in unenhanced CT images, and we used the clot burden score to record the grade of leptomeningeal collateral circulation and the extension of the thrombus. Then we measured the final infarct volume on follow-up CT and analyzed the correlations among these radiologic factors in the infarct volume. RESULTS We included 54 patients [mean age, 82 y; 41 (75%) women] with ischemic cerebrovascular accidents due to proximal occlusion. About 60% of the cerebrovascular accidents affected the right cerebral hemisphere, and the most commonly affected vessel was the M1 segment of the medial cerebral artery (40.7%). Final infarct volume correlated with the grade of leptomeningeal collateral circulation (p=0.03) and with the clot burden score (p=0.01). Neither the length nor the density of the thrombus correlated with final infarct volume. CONCLUSION The final infarct volume can be estimated on the initial CT angiogram. Nevertheless, we found no useful predictive factors in unenhanced CT images. The best independent radiologic predictors of the final infarct volume are the grade of collateral circulation and the clot burden score, especially in patients who did not undergo mechanical thrombectomy, because mechanical thrombectomy improves outcomes. These factors are important for decision making in the management of patients with ischemic cerebrovascular accidents due to proximal occlusion.
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Affiliation(s)
- M J Rodríguez
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - A Graziani
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J S Seoane
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L Di Napoli
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Pérez Akly
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - C Besada
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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10
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Baek JH, Kim BM, Kim DJ, Heo JH, Nam HS, Kim YD, Rho MH, Chung PW, Won YS, Chung Y. Preprocedural determination of an occlusion pathomechanism in endovascular treatment of acute stroke: a machine learning-based decision. J Neurointerv Surg 2023; 15:e2-e8. [PMID: 35710314 DOI: 10.1136/neurintsurg-2022-018946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/17/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate whether an occlusion pathomechanism can be accurately determined by common preprocedural findings through a machine learning-based prediction model (ML-PM). METHODS A total of 476 patients with acute stroke who underwent endovascular treatment were retrospectively included to derive an ML-PM. For external validation, 152 patients from another tertiary stroke center were additionally included. An ML algorithm was trained to classify an occlusion pathomechanism into embolic or intracranial atherosclerosis. Various common preprocedural findings were entered into the model. Model performance was evaluated based on accuracy and area under the receiver operating characteristic curve (AUC). For practical utility, a decision flowchart was devised from an ML-PM with a few key preprocedural findings. Accuracy of the decision flowchart was validated internally and externally. RESULTS An ML-PM could determine an occlusion pathomechanism with an accuracy of 96.9% (AUC=0.95). In the model, CT angiography-determined occlusion type, atrial fibrillation, hyperdense artery sign, and occlusion location were top-ranked contributors. With these four findings only, an ML-PM had an accuracy of 93.8% (AUC=0.92). With a decision flowchart, an occlusion pathomechanism could be determined with an accuracy of 91.2% for the study cohort and 94.7% for the external validation cohort. The decision flowchart was more accurate than single preprocedural findings for determining an occlusion pathomechanism. CONCLUSIONS An ML-PM could accurately determine an occlusion pathomechanism with common preprocedural findings. A decision flowchart consisting of the four most influential findings was clinically applicable and superior to single common preprocedural findings for determining an occlusion pathomechanism.
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Affiliation(s)
- Jang-Hyun Baek
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Moon Kim
- Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Joon Kim
- Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Hoe Heo
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Suk Nam
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Dae Kim
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myung Ho Rho
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yu Sam Won
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeongu Chung
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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11
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Yoshimoto T. Imaging diagnosis of intracranial atherosclerosis stenosis-related large vessel occlusion before and during endovascular therapy. Front Neurol 2023; 14:1168004. [PMID: 37416315 PMCID: PMC10320000 DOI: 10.3389/fneur.2023.1168004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/26/2023] [Indexed: 07/08/2023] Open
Abstract
It is becoming increasingly important to identify the type of stroke, especially the mechanism of occlusion, before and during its treatment. In the case of intracranial atherosclerotic stenosis-related large vessel occlusion, it is necessary to develop a treatment strategy that includes not only mechanical thrombectomy but also adjunctive therapies such as primary or rescue therapy (percutaneous angioplasty, intracranial/carotid stenting, local fibrinolysis) and perioperative antithrombotic therapy. However, in clinical practice we often encounter cases where it is difficult to identify the occlusive mechanism before endovascular treatment because of insufficient information in the minimal circumstances of the hyperacute phase of stroke. Here we focus on the imaging diagnosis before and during treatment of intracranial atherosclerotic stenosis-related large vessel occlusion with in situ thrombotic occlusion as the mechanism of thrombotic occlusion, based on previous reports. We describe the diagnosis of intracranial atherosclerotic stenosis-related large vessel occlusion from the perspectives of "thrombus imaging," "perfusion," and "occlusion margin."
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12
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Chen Y, Diana F, Mofatteh M, Zhou S, Chen J, Huang Z, Wu W, Yang Y, Zeng Z, Zhang W, Ouyang Z, Nguyen TN, Yang S, Baizabal-Carvallo JF, Liao X. Functional and technical outcomes in acute ischemic stroke patients with hyperdense middle cerebral artery sign treated with endovascular thrombectomy. Front Neurol 2023; 14:1150058. [PMID: 37305752 PMCID: PMC10247996 DOI: 10.3389/fneur.2023.1150058] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/04/2023] [Indexed: 06/13/2023] Open
Abstract
Background and objective The hyperdense middle cerebral artery sign (HMCAS) is observed in a proportion of patients with acute ischemic stroke (AIS). This sign reflects the presence of an intravascular thrombus rich in red blood cells. Several studies have demonstrated that HMCAS increases the risk of poor outcomes in AIS patients treated with IV thrombolysis or no reperfusion therapy; however, whether HMCAS predicts a poor outcome in patients treated with endovascular thrombectomy (EVT) is less clear. We aimed to evaluate the functional outcome by the modified Rankin scale (mRS) at 90 days and technical challenges in patients with HMCAS undergoing EVT. Methods We studied 143 consecutive AIS patients with middle cerebral artery M1 segment or internal carotid artery + M1 occlusions who underwent EVT. Results There were 73 patients (51%) with HMCAS. Patients with HMCAS had a higher frequency of cardioembolic stroke (p = 0.038); otherwise, no other baseline difference was observed. No differences in functional outcomes (mRS) at 90 days (p = 0.698), unfavorable outcomes (mRS > 2) (p = 0.929), frequency of symptomatic intracranial hemorrhage (p = 0.924), and mortality (mRS-6) (p = 0.736) were observed between patients with and without HMCAS. In patients with HMCAS, EVT procedures were 9 min longer, requiring a higher number of passes (p = 0.073); however, optimal recanalization scores (modified thrombolysis in cerebral infarction: 2b-3) were equally achieved by both groups. Conclusion Patients with HMCAS treated with EVT do not have a worse outcome at 3 months compared with no-HMCAS patients. Patients with HMCAS required a greater number of thrombus passes and longer procedure times.
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Affiliation(s)
- Yimin Chen
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
| | - Francesco Diana
- Department of Neuroradiology, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Sijie Zhou
- Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Juanmei Chen
- The Second Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Zhou Huang
- Department of Radiology, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
| | - Weijuan Wu
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
| | - Yajie Yang
- The First School of Clinical Medicine, Southern Medical University, Foshan, China
| | - Zhiyi Zeng
- Department of Scientific Research and Education, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
| | - Weijian Zhang
- Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Ziqi Ouyang
- Department of Neurosurgery, Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
| | - Thanh N. Nguyen
- Department of Neurology and Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Shuiquan Yang
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
| | - José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States
- Department of Sciences and Engineering, University of Guanajuato, León, Mexico
| | - Xuxing Liao
- Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan, Guangdong, China
- Department of Neurosurgery, Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
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Dai Y, Xu H, Fang X, Xiong X, Song Z, Hu S, Yu Y, Hu C, Zhang Y. Dual-energy CT in assessment of thrombus perviousness and its application in predicting outcomes after intravenous thrombolysis in acute ischemic stroke. Eur J Radiol 2023; 164:110861. [PMID: 37167682 DOI: 10.1016/j.ejrad.2023.110861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/02/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE To evaluate the feasibility of using iodine overlay maps reconstructed from dual-energy CT (DECT) to assess thrombus perviousness and investigate its value in predicting outcomes after intravenous thrombolysis in patients with acute ischemic stroke. METHOD 86 patients with proximal intracranial occlusions of the anterior circulation who underwent intravenous thrombolysis were included in this study. Thrombus iodine concentrations (ICthrombus) and normalized iodine concentrations (NICthrombus) were compared to conventional perviousness parameters (thrombus attenuation increase, TAI; void fraction, ε and CTA-index). The associations between perviousness parameters and outcomes were analyzed by Spearman's correlation and regression analysis. RESULTS ICthrombus and NICthrombus were significantly correlated with conventional perviousness parameters (P < 0.001). The median ICthrombus was 6.81 (interquartile range [IQR], 4.76-8.73) mg/ml in the favorable functional outcome group, which was higher than 3.52 (IQR, 2.08-6.86) mg/ml in the unfavorable outcome group (P = 0.001). The median NICthrombus was 0.095 (IQR, 0.068-0.116) and 0.054 (IQR, 0.031-0.083) in the favorable and unfavorable outcome groups, respectively (P < 0.001). NICthrombus predicted favorable outcome with a higher area under the curve (AUC) of 0.755 than any conventional perviousness parameter (P < 0.05). In the multivariable regression model, ICthrombus was independently associated with favorable outcome (odds ratio [OR] = 1.472, 95 % CI: 1.154-1.877, P = 0.002) and successful recanalization (OR = 1.356, 95 % CI: 1.093-1.681, P = 0.006). ICthrombus was negatively correlated with the final infarct volume (FIV) (r = -0.262, P = 0.020). Results for NICthrombus were similar. CONCLUSIONS DECT is of great value in assessing thrombus perviousness. NICthrombus is a meaningful predictor of stroke prognosis and recanalization after intravenous thrombolysis in acute ischemic stroke.
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Affiliation(s)
- Yao Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215124, China
| | - Haimin Xu
- Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215124, China
| | - Xiang Fang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xing Xiong
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ziyang Song
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yixing Yu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
| | - Yu Zhang
- Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215124, China.
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14
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Kang Z, Wu L, Sun D, Zhou G, Wu X, Qiu H, Mei B, Zhang J. Proximal hyperdense middle cerebral artery sign is associated with increased risk of asymptomatic hemorrhagic transformation after endovascular thrombectomy: a multicenter retrospective study. J Neurol 2023; 270:1587-1599. [PMID: 36446912 PMCID: PMC9971136 DOI: 10.1007/s00415-022-11500-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether hyperdense middle cerebral artery sign (HMCAS) on pretreatment no-contrast CT (NCCT) is associated with hemorrhagic transformation (HT) after endovascular thrombectomy (EVT). METHODS Patients with acute middle cerebral artery (MCA) occlusion who received EVT in three comprehensive hospitals were retrospectively evaluated. They were divided into four groups based on the presence or absence of HMCAS and corresponding CTA findings, among whom differences were compared. Univariate and multivariate logistic regression analyses were performed to investigate the association between HMCAS and HT and its subtypes. RESULTS 318 patients were included, among whom 149 (46.9%) had HMCAS. Patients in the proximal positive HMCAS group had higher National Institute of Health Stroke Scale scores and lower Alberta Stroke Program Early CT Scores (ASPECTS) than those in the proximal negative HMCAS group. The rate of HT was higher in the proximal positive HMCAS group than that in the proximal negative HMCAS group. In multivariate logistic regression analysis, the proximal HMCAS were independently associated with HT (adjusted OR = 2.073, 95% CI 1.211-3.551, p = 0.008) and aHT (adjusted OR = 2.271, 95% CI 1.294-3.986, p = 0.004), but not with sHT. Patients who developed HT, including aHT and sHT, had a lower rate of good outcome. CONCLUSION Proximal HMCAS on initial NCCT was independently associated with aHT in patients who received EVT for acute MCA occlusion. Both aHT and sHT had a detrimental effect on clinical outcome.
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Affiliation(s)
- Zhiming Kang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lishuo Wu
- Department of Neurology, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, 530022, China
| | - Dong Sun
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Gang Zhou
- Department of Neurology, Huanggang Central Hospital, Huanggang, 438000, China
| | - Xiangbo Wu
- Department of Neurology, Huanggang Central Hospital, Huanggang, 438000, China
| | - Han Qiu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Bin Mei
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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Hyperdense middle cerebral artery sign predicts favorable outcome in patients undergoing mechanical thrombectomy. J Thromb Thrombolysis 2023; 55:312-321. [PMID: 36434302 DOI: 10.1007/s11239-022-02731-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/26/2022]
Abstract
Non-contrast computer tomography detects the presence of hyperdense middle cerebral artery sign (HMCAS). Studies on the prognostic value of HMCAS among patients undergoing mechanical thrombectomy (MT) are conflicting. A retrospective analysis of consecutive patients with acute ischemic stroke due to middle cerebral artery occlusion, presenting with or without HMCAS, who underwent MT, was performed. We enrolled 191 patients (HMCAS +, n = 140; HMCAS -, n = 51). Prevalence of successful recanalization was significantly higher in patients with HMCAS than in those without HMCAS (92.1% versus 74.5%, p = 0.001). Patients with HMCAS had a better clinical outcome than those HMCAS - (54.3% versus 37.3%, p = 0.037, for three-month favorable outcome; 62.9% versus 39.3%, p = 0.004, for major neurological improvement at discharge; 8.6% versus 19.6%, p = 0.035, for in-hospital mortality; 14.3% versus 27.5%, p = 0.035, for intracranial hemorrhage; 2.9% versus 17.6%, p = 0.001, for symptomatic intracranial hemorrhage). Multivariate analyses confirmed that HMCAS represents an independent predictor of three-month favorable outcome (OR 2.48, 95% CI 1.10-5.58, p = 0.028), major neurological improvement at discharge (OR 2.40, 95% CI 1.09-5.20, p = 0.030), in-hospital mortality (OR 0.29, 95% CI 0.010-0.81, p = 0.018), presence of ICH (OR 0.49, 95% CI 0.25-0.97, p = 0.042) and presence of SICH (OR 0.16, 95% CI 0.04-0.63, p = 0.009). HMCAS presence predicts favorable outcome in patients undergoing MT. This result may indicate that hyperdense clots are more likely to respond to MT than isodense ones. This effect is mediated by reduction in hemorrhagic transformation.
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Sun J, Lam C, Christie L, Blair C, Li X, Werdiger F, Yang Q, Bivard A, Lin L, Parsons M. Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis. Front Neurol 2023; 14:1079205. [PMID: 36891475 PMCID: PMC9986457 DOI: 10.3389/fneur.2023.1079205] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
Background Hemorrhagic transformation (HT) following reperfusion therapies for acute ischaemic stroke often predicts a poor prognosis. This systematic review and meta-analysis aims to identify risk factors for HT, and how these vary with hyperacute treatment [intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT)]. Methods Electronic databases PubMed and EMBASE were used to search relevant studies. Pooled odds ratio (OR) with 95% confidence interval (CI) were estimated. Results A total of 120 studies were included. Atrial fibrillation and NIHSS score were common predictors for any intracerebral hemorrhage (ICH) after reperfusion therapies (both IVT and EVT), while a hyperdense artery sign (OR = 2.605, 95% CI 1.212-5.599, I 2 = 0.0%) and number of thrombectomy passes (OR = 1.151, 95% CI 1.041-1.272, I 2 = 54.3%) were predictors of any ICH after IVT and EVT, respectively. Common predictors for symptomatic ICH (sICH) after reperfusion therapies were age and serum glucose level. Atrial fibrillation (OR = 3.867, 95% CI 1.970-7.591, I 2 = 29.1%), NIHSS score (OR = 1.082, 95% CI 1.060-1.105, I 2 = 54.5%) and onset-to-treatment time (OR = 1.003, 95% CI 1.001-1.005, I 2 = 0.0%) were predictors of sICH after IVT. Alberta Stroke Program Early CT score (ASPECTS) (OR = 0.686, 95% CI 0.565-0.833, I 2 =77.6%) and number of thrombectomy passes (OR = 1.374, 95% CI 1.012-1.866, I 2 = 86.4%) were predictors of sICH after EVT. Conclusion Several predictors of ICH were identified, which varied by treatment type. Studies based on larger and multi-center data sets should be prioritized to confirm the results. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=268927, identifier: CRD42021268927.
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Affiliation(s)
- Jiacheng Sun
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Christina Lam
- Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Lauren Christie
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Allied Health Research Unit, St Vincent's Health Network Sydney, Sydney, NSW, Australia.,Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
| | - Christopher Blair
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia
| | - Xingjuan Li
- Queensland Department of Agriculture and Fisheries, Brisbane, QLD, Australia
| | - Freda Werdiger
- Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Qing Yang
- Apollo Medical Imaging Technology Pty Ltd., Melbourne, VIC, Australia
| | - Andrew Bivard
- Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Longting Lin
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Mark Parsons
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia
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17
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Wu Q, Wei C, Liu J, Wang Y, Liu M. Effects of Hyperferritinemia on Functional Outcome in Acute Ischemic Stroke Patients with Admission Hyperglycemia. Cerebrovasc Dis 2022; 52:511-518. [PMID: 36516789 DOI: 10.1159/000527860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/26/2022] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Hyperferritinemia, presented as elevated serum ferritin level, is an indicator of high iron status which plays roles in secondary brain injury after acute ischemic stroke (AIS). However, the effects of hyperferritinemia and poor outcomes remain uncertain. Additionally, admission hyperglycemia quite frequently accompanies AIS patients, which is associated with unfavorable outcome. Thus, we aimed to investigate the effects of hyperferritinemia on 3-month and 1-year functional outcomes in AIS patients and especially those with admission hyperglycemia. METHODS AIS patients within 24 h of onset were enrolled at West China Hospital from October 2016 to December 2019. Serum ferritin and blood glucose levels were tested on admission. Poor functional outcome at 3 months and 1 year was defined as modified Rankin Scale score ≥3. Multivariable analysis was used to investigate the associations between hyperferritinemia and 3-month and 1-year outcomes. Subgroup analysis was performed in patients with and without hyperglycemia. RESULTS Of 723 patients (mean age 68.11 years, 60.6% males) finally included, 347 (48.0%) had hyperferritinemia. The incidence of poor outcome was 45.2% at 3 months and 41.2% at 1 year. Patients with hyperferritinemia had a higher frequency of poor 3-month outcome (51.8% vs. 39.2%, p = 0.001) and poor 1-year outcome (46.8% vs. 36.1%, p = 0.004). In all AIS patients, hyperferritinemia was not independently associated with poor functional outcome at 3 months or 1 year after adjusting for confounders (all p > 0.05). In AIS patients with hyperglycemia, hyperferritinemia was an independent factor correlated with poor 3-month outcome (OR = 1.711, 95% CI 1.093-2.681, p = 0.019) but not with poor 1-year outcome (p > 0.05). CONCLUSIONS High iron status, presented as hyperferritinemia, is associated with poor 3-month functional outcome in AIS patients with hyperglycemia. Evaluating serum ferritin level may be conducive to assess the risk of short-term poor outcome in AIS patients with hyperglycemia. Further studies will be required to confirm our findings.
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Affiliation(s)
- Qian Wu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China,
| | - Chenchen Wei
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Junfeng Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Yanan Wang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
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18
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Zhou Y, Jing Y, Ospel J, Goyal M, McDonough R, Yue X, Ren Y, Sun Y, Li B, Yu W, Yang P, Zhang Y, Zhang L, Li Z, Duan G, Ye X, Hong B, Shi H, Han H, Li S, Liu S, Liu J. CT Hyperdense Artery Sign and the Effect of Alteplase in Endovascular Thrombectomy after Acute Stroke. Radiology 2022; 305:410-418. [PMID: 35819327 DOI: 10.1148/radiol.212358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Recent evidence suggests that presence of an intracranial arterial thrombus with a hyperdense artery sign (HAS) at noncontrast CT (NCCT) is associated with better response to intravenous alteplase. Patients with HAS may benefit more from combined intravenous alteplase and endovascular treatment (EVT). Purpose To investigate whether HAS at NCCT modifies the treatment effect of adding intravenous alteplase on clinical outcome in patients with acute large-vessel occlusion undergoing EVT. Materials and Methods This study is a secondary analysis of a prospective randomized trial (Direct Intra-arterial thrombectomy in order to Revascularize AIS patients with large-vessel occlusion Efficiently in Chinese Tertiary hospitals: A Multicenter randomized clinical Trial [DIRECT-MT]), which compared adding alteplase to EVT versus EVT alone in participants with acute large-vessel occlusion between February 2018 and July 2019. Participants with catheter angiograms and adequate NCCT for HAS evaluation were included. HAS was determined visually by two independent investigators at baseline NCCT. Treatment effect of intravenous alteplase administration according to presence of HAS on the primary clinical outcome (modified Rankin Scale [mRS] score at 90 days) and secondary and safety outcomes were assessed using adjusted multivariable regression models. Results Among 633 included participants (356 men [56%]; median age, 69 years), HAS was observed in 283 participants (45%): 142 of 313 participants (45%) in the EVT-only group and 141 of 320 participants (44%) in the group with added intravenous alteplase. Treatment-by-HAS interaction was observed for the primary outcome (P < .001), whereby a shift in favor of better outcomes with added intravenous alteplase occurred in participants with HAS (adjusted odds ratio [OR]: 1.82; 95% CI: 1.18, 2.79), while an adverse effect was seen in participants without HAS (adjusted OR: 0.62; 95% CI: 0.42, 0.91). This also held true for three secondary outcomes (excellent outcome [mRS score of 0-1 at 90 days], P = .005; good outcome [mRS score of 0-2 at 90 days], P = .008; final successful reperfusion, P = .04) in the adjusted models. Conclusion After acute ischemic stroke, presence of hyperdense artery sign (HAS) at baseline noncontrast CT indicated better outcomes when alteplase was added to endovascular treatment, but adding alteplase to endovascular treatment resulted in worse outcomes in participants without HAS. Clinical trial registration no. NCT03469206 © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Yu Zhou
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Yantao Jing
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Johanna Ospel
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Mayank Goyal
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Rosalie McDonough
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Xincan Yue
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Yuwei Ren
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Yan Sun
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Biao Li
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Wenkai Yu
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Pengfei Yang
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Yongwei Zhang
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Lei Zhang
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Zifu Li
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Guoli Duan
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Xiaofei Ye
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Bo Hong
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Huaizhang Shi
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Hongxing Han
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Shuai Li
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Sheng Liu
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
| | - Jianmin Liu
- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
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- From the Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (Y. Zhou, P.Y., Y. Zhang, L.Z., Z.L., G.D., B.H., J.L.); Neurosurgery Intensive Care Unit, ZhouKou Center Hospital, He'nan, China (Y.J., X. Yue, Y.R., Y.S., B.L., W.Y., S. Li); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.O.); Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Canada (M.G., R.M.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.M.); Health Statistics Department, Naval Medical University, Shanghai, China (X. Ye); Department of Neurosurgery, First Hospital Affiliate to Harbin Medical University, Harbin, China (H.S.); Department of Neurology, Linyi People's Hospital, Shandong, China (H.H.); Department of Radiology, Jiangsu People's Hospital, Jiangsu, China (S. Liu)
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Oguro S, Mugikura S, Ota H, Bito S, Asami Y, Sotome W, Ito Y, Kaneko H, Suzuki K, Higuchi N, Takase K. Usefulness of maximum intensity projection images of non-enhanced CT for detection of hyperdense middle cerebral artery sign in acute thromboembolic ischemic stroke. Jpn J Radiol 2022; 40:1046-1052. [PMID: 35612726 PMCID: PMC9529686 DOI: 10.1007/s11604-022-01289-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/20/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the sensitivity of the hyperdense middle cerebral artery (MCA) sign between maximum intensity projection (MIP) and conventional averaged images in patients with acute focal neurological deficits with acute thromboembolic MCA occlusion (MCA occlusion group) and patients with acute focal neurological deficits without MCA occlusion (control group). MATERIALS AND METHODS Initial computed tomography (CT) scans on admission were reconstructed with 5 mm thickness at every 3 mm interval for averaged and MIP images from 1 mm thickness non-contrast axial source images. Images were obtained from 30 cases each in the MCA occlusion and control groups. The CT values in the region of interests (ROIs) on the affected and unaffected sides of the MCA were compared. To compare CT values among subjects, the CT values were normalized by obtaining a ratio on the affected and unaffected sides, and the normalized CT values were analyzed using the receiver operating characteristic (ROC) curve. RESULTS The hyperdense MCA sign was visually detected on MIP images in 90% cases and on 5 mm averaged images in only 57% cases in the MCA occlusion group. Based on the ROC analysis of the normalized ratio on the affected and unaffected sides, area under the curve of MIP image and averaged image was 0.941 and 0.655, respectively. On MIP images, the optimal threshold of the ratio on the affected and unaffected sides was 1.152 (sensitivity: 90.0%, and specificity: 93.3%). CONCLUSION The hyperdense MCA sign sensitivity on 5 mm MIP images was significantly higher than that on conventional 5 mm averaged CT images. This could be useful for the early initiation of proper therapy for patients with acute focal neurological deficits.
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Affiliation(s)
- Sota Oguro
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Seiji Bito
- Department of Internal Medicine, Tokyo Medical Center, Tokyo, Japan
| | - Yuta Asami
- Department of Diagnostic Radiology, Tokyo Medical Center, Tokyo, Japan
| | - Wataru Sotome
- Department of Diagnostic Radiology, Tokyo Medical Center, Tokyo, Japan
| | - Yoshiaki Ito
- Department of Diagnostic Radiology, Tokyo Medical Center, Tokyo, Japan
| | - Hideki Kaneko
- Department of Diagnostic Radiology, Tokyo Medical Center, Tokyo, Japan
| | - Kazuyo Suzuki
- Department of Diagnostic Radiology, Tokyo Medical Center, Tokyo, Japan
| | - Nobuya Higuchi
- Department of Diagnostic Radiology, Tokyo Medical Center, Tokyo, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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20
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Hu J, He W, Zheng B, Huang F, Lv K, Liao J, Chen Z, Jiang H, Wang K, Wang H, Lei Y, Liao J, Sang H, Liu S, Luo W, Sun R, Yang J, Huang J, Song J, Li F, Zi W, Long C, Yang Q. Hyperdense Artery Sign and Clinical Outcomes After Endovascular Treatment in Acute Basilar Artery Occlusion. Front Neurol 2022; 13:830705. [PMID: 35547375 PMCID: PMC9081764 DOI: 10.3389/fneur.2022.830705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to investigate the association between the hyperdense basilar artery sign (HBAS) on non-enhanced computed tomography (CT) and clinical outcomes in patients with acute basilar artery occlusion (BAO) who underwent endovascular treatment (EVT). Methods Eligible patients who underwent EVT due to acute BAO between January 2014 and May 2019 were divided into two groups based on HBAS. HBAS was assessed by two neuroradiologists using five grades on nonenhanced CT. The primary outcome was a favorable functional outcome (defined as a modified Rankin Scale [mRS] of 0-3) at 90 days. Secondary outcomes included successful recanalization and mortality within 90 days. Results Among 829 patients with BAO as assessed with CT angiography, magnetic resonance angiography, or digital subtraction angiography, 643 patients were treated with EVT. Of these, 51.32% (330/643) had HBAS. Patients with HBAS were older and had more severe neurological deficits and a higher frequency of atrial fibrillation than those without HBAS. There was no significant difference in favorable outcome (adjusted odds ratio [aOR]: 1.354, 95% confidence interval [CI]: 0.906-2.024; p = 0.14), successful recanalization (aOR: 0.926, 95% CI: 0.616--1.393; p = 0.71), and mortality (aOR: 1.193, 95% CI: 0.839-1.695; p = 0.33) between patients with or without HBAS. Subgroup analysis showed that the HBAS predicted a favorable outcome in patients aged <60 years (aOR: 2.574, 95% CI: 1.234-5.368; p = 0.01) and patients with vertebral artery-V4 segment occlusion (aOR: 3.738, 95% CI: 1.212-11.530; p = 0.02). In patients with HBAS, the baseline National Institutes of Health Stroke Scale (NIHSS) score, posterior circulation-Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS), and stent retriever were associated with successful recanalization. Conclusions Our study did not find a significant association between HBAS and favorable outcomes and successful recanalization in patients with BAO who underwent EVT. Moreover, large prospective studies are warranted to further investigate this relationship.
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Affiliation(s)
- Jinrong Hu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wencheng He
- Department of Neurology, Guiping People's Hospital, Guiping, China
| | - Bo Zheng
- Department of Neurology, Yaan Peoples's Hospital, Yaan, China
| | - Fang Huang
- Department of Neurology, People's Hospital of Yuxi City, Yuxi, China
| | - Kefeng Lv
- Department of Neurology, Dongguan People's Hospital of Southern Medical University, Dongguan, China
| | - Jiasheng Liao
- Department of Neurology, Suining No.1 People's Hospital, Suining, China
| | - Zhao Chen
- Department of Neurology, Yaan Peoples's Hospital, Yaan, China
| | - He Jiang
- Department of Neurology, The First People's Hospital of Neijiang, Neijiang, China
| | - Kuiyun Wang
- Department of Neurology, The Jintang First People's Hospital, Jintang, China
| | - Hongjun Wang
- Department of Neurology, Fengdu People's Hospital, Fengdu, China
| | - Yang Lei
- Department of Neurology, Wulong District People's Hospital, Chongqing, China
| | - Jiachuan Liao
- Department of Neurology, Santai County People's Hospital of North Sichuan Medical College, Santai, China
| | - Hongfei Sang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shuai Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Weidong Luo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ruidi Sun
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chen Long
- Department of Emergency, Xiangtan Central Hospital, Chongqing, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Rao J, Tao Z, Bao Q, Xu M, Jiang M, Weng X, Yin B, Li D, Li Y, Cai X, Fu F. Mechanical Thrombectomy for Acute Ischemic Stroke in Patients With Cardiac Myxoma: A Case Series and Pooled Analysis. Front Neurol 2022; 13:877056. [PMID: 35509996 PMCID: PMC9058073 DOI: 10.3389/fneur.2022.877056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Acute ischemic stroke (AIS) is a common and life-threatening complication of patients with cardiac myxoma (CM). The role of the mechanical thrombectomy (MT) technique in CM-AIS patients remains unclear, and no guidelines exist for this population. Therefore, we conducted a case series study of MT in CM-AIS patients to investigate its safety and efficacy via a pooled analysis of published literature. Methods Eleven CM-AIS patients who underwent MT between 2016 and 2021 were screened from multicenter stroke databases. Clinical, procedural, and outcome data were obtained from medical records. A systematic review was conducted to identify additional cases from published studies by searching PubMed and China National Knowledge Infrastructure databases. We then performed a pooled analysis of the published cases. Results In the case series study, most patients were male (81.8%), with a median age of 51 years. All patients had CM located in the left atrium. The rate of successful reperfusion using the first-line thrombectomy technique was 100% with stent retriever (SR) and 66.7% with direct aspiration (DA), which resulted in overall successful reperfusion in 94.1% of all occlusions. The retrieved emboli of the five patients who underwent histopathology examination were identified as myxoma components. Hemorrhagic transformation was observed in five (45.5%) patients, of whom one was symptomatic (9.1%). Three-month favorable functional outcomes were achieved in five (45.5%) patients with a 3-month mortality rate of 18.2%. For the literature review, 35 cases with 51 target vessel occlusions were identified and included in the pooled analysis. The rate of successful reperfusion following first-line thrombectomy did not differ between SR (30 patients, 90.9%) and DA (10 patients, 83.3%). The overall successful reperfusion rate was 91.8% of all occlusions. Three-month favorable functional outcomes were achieved in 21 (60.0%) patients, and the mortality rate was 8.6%. Conclusions Our findings suggest that MT is not only an effective technique but also a safe option for CM-AIS patients with large vessel occlusion. MT has several advantages for this population, which include a high recanalization rate, low bleeding risk, and the ability to evaluate the source of emboli and the etiology of stroke.
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Affiliation(s)
- Jie Rao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Zi Tao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiongqiong Bao
- Department of Neurology, Affiliated Yueqing Hospital, Wenzhou Medical University, Wenzhou, China
| | - Mengbei Xu
- Department of Neurology, Ningbo Second Hospital, Ningbo, China
| | - Mingxia Jiang
- Department of Rehabilitation, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiongpeng Weng
- Department of Neurology, Huangyan Hospital, Wenzhou Medical University, Taizhou, China
| | - Bo Yin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dandong Li
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yan Li
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xueli Cai
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
- Xueli Cai
| | - Fangwang Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Fangwang Fu
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22
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Shi C, Killingsworth MC, Bhaskar SMM. Prognostic capacity of hyperdense middle cerebral artery sign in anterior circulation acute ischaemic stroke patients receiving reperfusion therapy: a systematic review and meta-analysis. Acta Neurol Belg 2022; 122:423-435. [PMID: 34095978 PMCID: PMC8180356 DOI: 10.1007/s13760-021-01720-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/31/2021] [Indexed: 12/29/2022]
Abstract
Pre-intervention CT imaging-based biomarkers, such as hyperdense middle cerebral artery sign (HMCAS) may have a role in acute ischaemic stroke prognostication. However, the clinical utility of HMCAS in settings of reperfusion therapy and the level of prognostic association is still unclear. This systematic review and meta-analysis investigated the association of HMCAS sign with clinical outcomes and its prognostic capacity in acute ischaemic stroke patients treated with reperfusion therapy. Prospective and retrospective studies from the following databases were retrieved from EMBASE, MEDLINE and Cochrane. Association of HMCAS with functional outcome, symptomatic intracerebral haemorrhage (sICH) and mortality were investigated. The random effect model was used to calculate the risk ratio (RR). Subgroup analyses were performed for subgroups of patients receiving thrombolysis (tPA), mechanical thrombectomy (EVT) and/or combined therapy (tPA + EVT). HMCAS significantly increased the rate of poor functional outcome by 1.43-fold in patients (RR 1.43; 95% CI 1.30-1.57; p < 0.0001) without any significant differences in sICH rates (RR 0.91; 95% CI 0.68-1.23; p = 0.546) and mortality (RR 1.34; 95% CI 0.72-2.51; p = 354) in patients with positive HMCAS as compared to negative HMCAS. In subgroup analyses, significant association between HMCAS and 90 days functional outcome was observed in patients receiving tPA (RR 1.53; 95% CI 1.40-1.67; p < 0.0001) or both therapies (RR 1.40; 95% CI 1.08-1.80; p = 0.010). This meta-analysis demonstrated that pre-treatment HMCAS increases risk of poor functional outcomes. However, its prognostic sensitivity and specificity in predicting long-term functional outcome, mortality and sICH after reperfusion therapy is poor.
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Affiliation(s)
- Chenyu Shi
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW Australia
| | - Murray C. Killingsworth
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- NSW Brain Clot Bank, NSW Health Statewide Biobank and NSW Health Pathology, Sydney, NSW Australia
- Correlative Microscopy Facility, Ingham Institute for Applied Medical Research, Sydney, Australia
- Department of Anatomical Pathology, NSW Health Pathology and Liverpool Hospital, Liverpool, NSW Australia
| | - Sonu Menachem Maimonides Bhaskar
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- South West Sydney Local Health District (SWSLHD), Sydney, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- NSW Brain Clot Bank, NSW Health Statewide Biobank and NSW Health Pathology, Sydney, NSW Australia
- Thrombolysis and Endovascular WorkFLOw Network (TEFLON), Sydney, Australia
- Present Address: Department of Neurology and Neurophysiology, Liverpool Hospital, Clinical Sciences Building, Elizabeth St, Liverpool, NSW 2170 Australia
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23
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Predictores radiológicos del volumen final del infarto cerebral en pacientes con obstrucción vascular proximal. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Ždraljević M, Pekmezović T, Stanarčević P, Vukašinović I, Berisavac I, Ercegovac M, Vitošević F, Nestorović D, Cvetić V, Padjen V, Budimkić MS, Medjedović TŠ, Jovanović DR. Influence of Thrombocytopenia on the Outcome of Mechanical Thrombectomy in Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2021; 31:106240. [PMID: 34915307 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106240] [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] [Received: 07/22/2021] [Revised: 11/08/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Mechanical thrombectomy (MT) has become leading treatment option for acute ischemic stroke (AIS) due to large vessels occlusion (LVO). Platelet counts may affect outcome in patients with AIS or transient ischemic attack. The aim of our study was to determine the influence of thrombocytopenia on the safety and efficacy of MT in patients with AIS due to anterior circulation LVO. MATERIALS AND METHODS This study included 127 consecutive adult patients with AIS due to anterior circulation LVO who underwent MT. The patients were divided into 2 groups based on initial platelet count: with thrombocytopenia (<150 × 109/L) and without thrombocytopenia (≥150 × 109/L). Primary safety outcome was symptomatic intracerebral haemorrhage (SICH), while secondary safety outcome was stroke-related mortality. Efficacy outcome was functional independence, defined as modified Rankin Scale (mRS) score 0-2. Follow- up time was 90 days. RESULTS Initial thrombocytopenia (<150 × 109/L) was detected in 19 (15%) patients. Multivariable analysis showed that initial thrombocytopenia did not increase the risk of SICH and did not affect the short-term functional outcome (p = 0.587). However, initial thrombocytopenia increased the risk for stroke-related mortality (aOR 3.639, 95% CI 1.079-12.641, p = 0.037). The main cause of mortality in the group with thrombocytopenia was malignant cerebral infarction (44.4%). CONCLUSIONS Thrombocytopenia does not affect the efficacy and the risk of SICH in patients with AIS caused by anterior circulation LVO treated with MT. However, the risk of mortality is higher in patients with thrombocytopenia, mainly due to malignant cerebral infarction.
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Affiliation(s)
- Mirjana Ždraljević
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia
| | - Tatjana Pekmezović
- Institute of Epidemiology, Faculty of Medicine, Višegradska Street 26, 11 000 Belgrade, Serbia
| | - Predrag Stanarčević
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia
| | - Ivan Vukašinović
- Center for Radiology and MRI, Clinic for Neurosurgery, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
| | - Ivana Berisavac
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia
| | - Marko Ercegovac
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia
| | - Filip Vitošević
- Center for Radiology and MRI, Clinic for Neurosurgery, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
| | - Dragoslav Nestorović
- Center for Radiology and MRI, Clinic for Neurosurgery, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
| | - Vladimir Cvetić
- Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Dr Koste Todorovića Street 6, 11 000 Belgrade, Serbia
| | - Višnja Padjen
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia
| | - Maja Stefanović- Budimkić
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia
| | - Tamara Švabić Medjedović
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia
| | - Dejana R Jovanović
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia.
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Implications of the Presence of Hyperdense Middle Cerebral Artery Sign in Determining the Subtypes of Stroke Etiology. Stroke Res Treat 2021; 2021:6593541. [PMID: 34840717 PMCID: PMC8612777 DOI: 10.1155/2021/6593541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background Identifying stroke subtypes is crucial in choosing appropriate treatment, predicting outcomes, and managing recurrent stroke prevention. Objectives To study the association of hyperdense middle cerebral artery sign (HMCAS) on noncontrast computed tomography (NCCT) brain and subtypes of stroke etiology. Methods This is a retrospective hypothesis testing study. Patients aged 18 or over who had middle cerebral artery occlusion symptoms with HMCAS with verification on brain NCCT and received intravenous thrombolysis between January 2016 and June 2019 were enrolled. The demographic data, clinical outcomes, stroke subtypes, and characteristics of HMCAS were collected from medical records. Results Ninety-nine out of 299 enrolled patients presented with HMCAS. The most common stroke subtype was cardioembolism (59%). Of the baseline characteristics, hypertension was more common in cases of large-artery atherosclerosis (LAA) (86.4%), and atrial fibrillation (AF) was the highest in cardioembolism (44.8%). HMCAS disappearance in cardioembolism was lowest compared to LAA and others (63% vs. 91% vs. 94.7%, respectively). The univariable analysis found that HMCAS disappearance is significantly associated with all stroke subtypes (Odds ratio, 95% confidence interval 10.58, 1.31-85.43; P = 0.027 for other and 5.88, 1.24-27.85; P = 0.026 for LAA). Multinomial logistic regression found that body weight and hypertension were associated with the LAA subtype. AF and intracranial hemorrhage (ICH) were associated with cardioembolism. Conclusion The most likely diagnosis from the presence of HMCAS is cardioembolism, but the definite stroke etiologic subtype can not be identified. Combining the patient risk factors, including body weight, hypertension, and AF, with HMCAS and its characteristics will predict stroke subtypes more accurately.
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Joundi RA, Menon BK. Thrombus Composition, Imaging, and Outcome Prediction in Acute Ischemic Stroke. Neurology 2021; 97:S68-S78. [PMID: 34785606 DOI: 10.1212/wnl.0000000000012796] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES New imaging techniques have advanced our ability to capture thrombus characteristics and burden in real time. An improved understanding of recanalization rates with thrombolysis and endovascular thrombectomy based on thrombus characteristics has spurred interest in new therapies for acute stroke. METHODS AND RESULTS This article reviews the biochemical, structural, and imaging characteristics of intracranial thrombi in acute ischemic stroke; the relationship between thrombus composition and response to lytic and endovascular therapies; and current and future directions for improving outcomes in patients with acute stroke based on thrombus characteristics. DISCUSSION Thrombus composition, size, location, and timing from stroke onset correlate with imaging findings in acute ischemic stroke and are associated with clinical outcome. Further research across multiple domains could assist in better applying our knowledge of thrombi to patient selection and individualization of acute therapies.
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Affiliation(s)
- Raed A Joundi
- From the Department of Neurosciences and Community Health Sciences, Calgary Stroke Program (R.J.), and Department of Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute (B.K.M.), Cumming School of Medicine, University of Calgary, Canada
| | - Bijoy K Menon
- From the Department of Neurosciences and Community Health Sciences, Calgary Stroke Program (R.J.), and Department of Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute (B.K.M.), Cumming School of Medicine, University of Calgary, Canada.
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27
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Jing M, Yeo JYP, Holmin S, Andersson T, Arnberg F, Bhogal P, Yang C, Gopinathan A, Tu TM, Tan BYQ, Sia CH, Teoh HL, Paliwal PR, Chan BPL, Sharma V, Yeo LLL. Preprocedural Imaging : A Review of Different Radiological Factors Affecting the Outcome of Thrombectomy. Clin Neuroradiol 2021; 32:13-24. [PMID: 34709411 DOI: 10.1007/s00062-021-01095-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/25/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endovascular treatment (EVT) has strong evidence for its effectiveness in treatment of acute ischemic stroke (AIS); however, up to half of the patients who undergo EVT still do not have good functional outcomes. Various prethrombectomy radiological factors have been shown to be associated with good clinical outcomes and may be the key to better functional outcomes, reduced complications, and reduced mortality. In this paper, we reviewed the current literature on these imaging parameters so they can be employed to better estimate the probability of procedural success, therefore allowing for more effective preprocedural planning of EVT strategies. We reviewed articles in the literature related to imaging factors which have been shown to be associated with EVT success. The factors which are reviewed in this paper included: anatomical factors such as 1) the type of aortic arch and its characteristics, 2) the characteristics of the thrombus such as length, clot burden, permeability, location, 3) the middle cerebral artery features including the tortuosity and underlying intracranial stenosis, 4) perfusion scans estimating the volume of infarct and the penumbra and 5) the effect of collaterals on the procedure. The prognostic effect of each factor on the successful outcome of EVT is described. The identification of preprocedural thrombectomy imaging factors can help to improve the chances of recanalization, functional outcomes, and mortality. It allows the interventionist to make time-sensitive decisions in the treatment of acute ischemic stroke.
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Affiliation(s)
- Mingxue Jing
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joshua Y P Yeo
- Department of Medicine, National University Health System, Singapore, Singapore
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Tommy Andersson
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Department of Medical Imaging, AZ Groeninge, 8500, Kortrijk, Belgium
| | - Fabian Arnberg
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Paul Bhogal
- Department of Neuroradiology, St.Bartholomew's and the Royal London Hospital, London, UK
| | - Cunli Yang
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anil Gopinathan
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Benjamin Yong Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching Hui Sia
- National University Heart Centre, National University Health System, Singapore, Singapore
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Prakash R Paliwal
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bernard P L Chan
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vijay Sharma
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore.
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Mowla A, Razavi SM, Lail NS, Mohammadi P, Shirani P, Kavak KS, Sawyer RN, Kamal H. Hyperdense middle cerebral artery sign and response to combination of mechanical Thrombectomy plus intravenous thrombolysis in acute stroke patients. J Neurol Sci 2021; 429:117618. [PMID: 34418800 DOI: 10.1016/j.jns.2021.117618] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/20/2021] [Accepted: 08/15/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Combining intra-arterial mechanical thrombectomy (IAMT) and intravenous thrombolysis (IVT) has shown to have an excellent recanalization rate and better clinical outcome in acute ischemic stroke (AIS) patients. Hyperdense middle cerebral artery sign (HMCAS) on pretreatment non-contrast head CT scan of AIS patients is one of the early ischemic radiological findings in middle cerebral artery territory AIS. We aimed to evaluate whether the presence of HMCAS predicts the outcome of AIS patients receiving combination therapy with IAMT and IVT. METHODS We retrospectively reviewed medical records and cerebrovascular images of the patients treated with IAMT and IVT for AIS in our center. Patients with occlusion in the terminal internal carotid artery or middle cerebral artery on pretreatment CT angiogram of the head were included. Clinical outcome was compared between subjects with HMCAS and those without. Modified Rankin Score (mRS) and symptomatic intracranial hemorrhage (sICH) were used as measures of efficacy and safety, respectively. RESULTS Of 93 patients, 46 (49%) had HMCAS on their initial head CT scan. Both groups had comparable baseline characteristics and stroke severity. After adjusting for age, NIHSS score, time from symptom onset to starting IVT, and history of diabetes mellitus in multivariate logistic regression analysis, there was no difference in terms of a poor outcome (mRS >2) (OR = 0.5 [CI 0.2-1.4], p = 0.188) or rate of sICH (OR = 3.3 [CI 0.6-19.0], p = 0.190) between the two groups. CONCLUSIONS HMCAS is not a predictor of poor outcome in AIS patients receiving combination therapy with IAMT and IVT and does not affect treatment safety.
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Affiliation(s)
- Ashkan Mowla
- Division of Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, United States of America.
| | - Seyed-Mostafa Razavi
- Division of Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, United States of America; Heart and Rhythm Clinic, San Jose, CA, United States of America
| | - Navdeep S Lail
- Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY, United States of America
| | - Pegah Mohammadi
- Department of Medicine, Eisenhower Medical Center, Rancho Mirage, CA, USA
| | - Peyman Shirani
- Departments of Neurology and Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, United States of America
| | - Katelyn S Kavak
- Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY, United States of America
| | - Robert N Sawyer
- Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY, United States of America
| | - Haris Kamal
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America
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Ye G, Cao R, Lu J, Qi P, Hu S, Chen K, Tan T, Chen J, Wang D. Histological composition behind CT-based thrombus density and perviousness in acute ischemic stroke. Clin Neurol Neurosurg 2021; 207:106804. [PMID: 34304067 DOI: 10.1016/j.clineuro.2021.106804] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clot composition could impact recanalization outcomes of thrombectomy, and preoperative imaging markers may help know about the histological components of thrombus. METHODS Consecutive patients who underwent thrombectomy from June 2017 to December 2019 were reviewed. The mean Hounsfield unit (HU) of thrombus (aHU) and contralateral artery (cHU) were recorded based on non-enhanced CT. The relative thrombus density was calculated (dHU=aHU-cHU). Hyperdense artery sign (HAS) was identified if dHU≥ 4HU. The clot perviousness was evaluated via thrombus attenuation increase (δHU) on contrast-enhanced CT compared to non-enhanced CT. Pervious clots were identified when δHU≥ 11HU. Tissue quantification for thrombus was based on Martius Scarlet Blue staining, using the Orbit Imaging Analysis Software. Spearman rank correlations was used to detect the association between imaging markers and clot composition. The differences in clinical characteristics were compared according to the presence of HAS or pervious clots. RESULTS Fifty-three patients were included. The dHU was positively correlated with erythrocyte fractions (r = 0.337, p = 0.014), while there was no significant association between aHU and erythrocyte components (r = 0.146, p = 0.296). HAS (+) patients showed a comparable proportion of modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3 (94.6% vs. 87.5%, p = 0.740) and modified Rankin Scale score (mRS) 0-2 (35.1% vs. 56.3%, p = 0.152) compared with those HAS (-). Forty-seven cases were available for the analysis of clot perviousness. Clot perviousness was negatively associated with platelet fractions (r = -0.577, p < 0.001). Patients with pervious clots also showed a comparable proportion of mTICI 2b-3 (86.2% vs. 100%, p = 0.283) and mRS 0-2 (37.9% vs. 50.0%, p = 0.416) compared with impervious clots. CONCLUSIONS This study suggests that relative thrombus density was positively correlated with erythrocyte fractions, while clot perviousness showed a negative relationship with platelet components. Yet, the presence of HAS or pervious clots did not show significant associations with recanalization and clinical outcomes. The conclusions should be drawn with caution.
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Affiliation(s)
- Gengfan Ye
- Department of Neurosurgery, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, PR China
| | - Ruoyao Cao
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Shen Hu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Kunpeng Chen
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Tianhua Tan
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China
| | - Juan Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China.
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Filep RC, Marginean L, Stoian A, Bajko Z. Diagnostic and prognostic computed tomography imaging markers in basilar artery occlusion (Review). Exp Ther Med 2021; 22:954. [PMID: 34335896 PMCID: PMC8290397 DOI: 10.3892/etm.2021.10386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/04/2021] [Indexed: 01/05/2023] Open
Abstract
Acute ischemic stroke treatment has been revolutionized by the addition of mechanical and aspiration thrombectomy. Randomized controlled trials have proven beyond doubt, the substantial clinical impact of endovascular interventions in anterior circulation territory strokes. Unfortunately, patients with vertebrobasilar ischemic stroke could not be included in these early trials due to inherent clinical, radiological, and prognostic particularities of posterior circulation ischemia; thus, indications for the treatment of posterior fossa strokes and basilar artery occlusion (BAO) are mainly based on retrospective studies and registries. BAO carries high morbidity and mortality, despite the new improvements in endovascular therapy. Identifying patients who will likely benefit from invasive treatment and have a good clinical outcome resides in discovering clinical, biological, or imaging markers, that have prognostic implications. Such imaging markers have been described, especially in the last decade. Hyperdense Basilar Artery Sign (HDBA), Posterior Circulations-Alberta Stroke Program Early CT Score (pc-ASPECTS), Pons-Midbrain Index (PMI), Posterior Circulation Collateral Score (pc-CS), Posterior Circulation CT Angiography Score (pc-CTA), and Basilar Artery on CT Prognostic Score (BATMAN), are computed tomography (CT) markers with properties that can aid the diagnosis of BAO and can independently predict clinical outcome. This paper aims to present a comprehensive review of these imaging signs to have a thorough understanding of their diagnostic and prognostic attributes.
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Affiliation(s)
- Rares Cristian Filep
- PhD School of Medicine, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
| | - Lucian Marginean
- PhD School of Medicine, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
| | - Adina Stoian
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
| | - Zoltan Bajko
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
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You J, Yu PLH, Tsang ACO, Tsui ELH, Woo PPS, Lui CSM, Leung GKK, Mahboobani N, Chu CY, Chong WH, Poon WL. 3D dissimilar-siamese-u-net for hyperdense Middle cerebral artery sign segmentation. Comput Med Imaging Graph 2021; 90:101898. [PMID: 33857830 DOI: 10.1016/j.compmedimag.2021.101898] [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] [Received: 08/25/2020] [Revised: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 11/16/2022]
Abstract
The hyperdense middle cerebral artery sign (HMCAS) representing a thromboembolus has been declared as a vital CT finding for intravascular thrombus in the diagnosis of acute ischemia stroke. Early recognition of HMCAS can assist in patient triage and subsequent thrombolysis or thrombectomy treatment. A total of 624 annotated head non-contrast-enhanced CT (NCCT) image scans were retrospectively collected from multiple public hospitals in Hong Kong. In this study, we present a deep Dissimilar-Siamese-U-Net (DSU-Net) that is able to precisely segment the lesions by integrating Siamese and U-Net architectures. The proposed framework consists of twin sub-networks that allow inputs of left and right hemispheres in head NCCT images separately. The proposed Dissimilar block fully explores the feature representation of the differences between the bilateral hemispheres. Ablation studies were carried out to validate the performance of various components of the proposed DSU-Net. Our findings reveal that the proposed DSU-Net provides a novel approach for HMCAS automatic segmentation and it outperforms the baseline U-Net and many state-of-the-art models for clinical practice.
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Affiliation(s)
- Jia You
- Department of Statistics and Actuarial Science, The University of Hong Kong, Run Run Shaw Building, Pokfulam Road, Hong Kong
| | - Philip L H Yu
- Department of Statistics and Actuarial Science, The University of Hong Kong, Run Run Shaw Building, Pokfulam Road, Hong Kong; Department of Mathematics and Information Technology, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong.
| | - Anderson C O Tsang
- Division of Neurosurgery, Department of Surgery, The University of Hong Kong, Room 701, Administration Building, Queen Mary Hospital, Pokfulam Road, Hong Kong
| | - Eva L H Tsui
- Department of Statistics and Data Science, Hospital Authority, Hospital Authority Building, 147B Argyle Street, Ma Tau Wai, Hong Kong
| | - Pauline P S Woo
- Department of Statistics and Data Science, Hospital Authority, Hospital Authority Building, 147B Argyle Street, Ma Tau Wai, Hong Kong
| | - Carrie S M Lui
- Department of Statistics and Data Science, Hospital Authority, Hospital Authority Building, 147B Argyle Street, Ma Tau Wai, Hong Kong
| | - Gilberto K K Leung
- Division of Neurosurgery, Department of Surgery, The University of Hong Kong, Room 701, Administration Building, Queen Mary Hospital, Pokfulam Road, Hong Kong
| | - Neeraj Mahboobani
- Department of Radiology and Imaging, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, Hong Kong
| | - Chi-Yeung Chu
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
| | - Wing-Ho Chong
- Department of Radiology, Tuen Mun Hospital, 23 Tsing Chung Kong Road, Tuen Mun, Hong Kong
| | - Wai-Lun Poon
- Department of Radiology and Imaging, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, Hong Kong
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Ume KL, Dandapat S, Weber MW, Zevallos CB, Fifer A, Levy A, Delfino K, Ortega-Gutierrez S, Siddiqui FM. Absent hyperdense middle cerebral artery sign is associated with poor functional outcome after mechanical thrombectomy. Int J Stroke 2021; 17:101-108. [PMID: 33557722 DOI: 10.1177/1747493021991972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The hyperdense middle cerebral artery sign on computed tomography indicates proximal middle cerebral artery occlusion. Recent reports suggest an association between the hyperdense sign and successful reperfusion. The prognostic value of the hyperdense middle cerebral artery sign in patients receiving mechanical thrombectomy has not been extensively studied. AIMS Our study aims to evaluate the association between the hyperdense middle cerebral artery sign and functional outcome in patients with M1 occlusions that had undergone mechanical thrombectomy. METHODS We conducted a single-center retrospective observational cohort study of 102 consecutive patients presenting with acute M1 occlusions that had undergone mechanical thrombectomy. Patients were stratified into cohorts based on the presence of hyperdense middle cerebral artery sign visually assessed on computed tomography by two readers. The outcomes of interests were functional disability measured by the ordinal Modified Rankin Scale (mRS) at 90 days, mortality, reperfusion status and hemorrhagic conversion. RESULTS Out of the 102 patients with M1 occlusions, 71 had hyperdense middle cerebral artery sign. There was no significant difference between the cohorts in age, baseline mRS, NIHSS, ASPECTS, and time to reperfusion. The absence of hyperdense middle cerebral artery sign was associated with increased odds of being dependent or dying (higher mRS) (OR: 3.24, 95% CI: 1.30-8.06, p = 0.011) after adjusting for other significant predictors, including age, female sex, hypertension, presenting serum glucose, ASPECTS, CTA collateral score, and successful reperfusion. CONCLUSION The absence of hyperdense middle cerebral artery sign is associated with worse functional outcome in patients presenting with M1 occlusions undergoing thrombectomy.
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Affiliation(s)
- Kiddy L Ume
- Department of Neurology, 12249Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Sudeepta Dandapat
- Department of Neurology, University of Iowa Medical Center, Iowa City, IA, USA
| | - Matthew W Weber
- Department of Neurology, 12249Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Cynthia B Zevallos
- Department of Neurology, University of Iowa Medical Center, Iowa City, IA, USA
| | - Amber Fifer
- Department of Neurology, 12249Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Abigail Levy
- Department of Neurology, 12249Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Kristin Delfino
- Department of Neurology, 12249Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Medical Center, Iowa City, IA, USA.,Department of Neurosurgery and Radiology, University of Iowa Medical Center, Iowa City, IA, USA
| | - Fazeel M Siddiqui
- Department of Neurology, 12249Southern Illinois University School of Medicine, Springfield, IL, USA.,Department of Neurology, Metro Health University of Michigan, Grand Rapids, MI, USA
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Jin X, Shi F, Chen Y, Zheng X, Zhang J. Jet-Like Appearance in Angiography as a Predictive Image Marker for the Occlusion of Intracranial Atherosclerotic Stenosis. Front Neurol 2020; 11:575567. [PMID: 33193024 PMCID: PMC7661688 DOI: 10.3389/fneur.2020.575567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/31/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Identifying intracranial atherosclerotic stenosis-related occlusion (ICAS-O) in acute ischemic stroke has important clinical significance. Correct identification would help operators devise an optimal recanalization strategy. However, it is often hard to make accurate judgments in emergency situations before thrombectomy. Here, we propose a new image marker for ICAS-O based on the appearance of occluded vessels on baseline digital subtraction angiography. Materials and Methods: We retrospectively reviewed patients with acute ischemic stroke who underwent endovascular therapy from August 2017 to February 2020 at our center. ICAS-O was identified by residual focal stenosis at occluded vessels after successful recanalization. The jet-like appearance was defined as appearance of pencil-tip-like or line-linked contrast filling of the occlusion edge. A non-jet-like appearance was defined as appearance of convex, concave, or flat edge contrast filling. The proportion of jet-like appearance in different occlusion etiologies and occluded vessels was determined. The diagnostic value of jet-like appearance for ICAS-O was assessed. Results: A total of 164 patients diagnosed with ICAS-O were enrolled. Jet-like appearance was detected in 34 (20.7%) patients with younger age (68.0 ± 11.9 years vs. 62.7 ± 10.2, p = 0.019), patients with lower baseline NIHSS scores (16.6 ± 7.1 vs. 12.4 ± 6.5, p = 0.002) and patients with more past stroke or transit ischemic events (31.4 vs. 13.2%, p = 0.011). ICAS-O rate was higher in the jet-like appearance group (82.9 vs. 8.5%, p < 0.001), and rescue methods were more frequently used (74.3 vs. 12.4%, p < 0.001). Jet-like appearance was mostly found at the origin of the middle cerebral artery (MCA) (44.1%), followed by the first segment trunk of MCA (20.6%) and internal carotid artery (ICA) supraclinoid (11.8%). Logistic regression showed that jet-like appearance was independently associated with ICAS-O [OR 180.813, 95% CI (17.966, 1,819.733), p < 0.001]. The sensitivity, specificity, and accuracy values for predicting ICAS-O was 96, 78, and 83%. Conclusion: The jet-like appearance on the angiogram was an image marker for ICAS-O, with relatively high sensitivity and specificity, which could help operators predict underlying intracranial atherosclerotic stenosis in a timely manner and choose the optimal intervention strategy during endovascular therapy.
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Affiliation(s)
- Xing Jin
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Feina Shi
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yigang Chen
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xu Zheng
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinhua Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Baek JH, Kim BM, Kim JW, Kim DJ, Heo JH, Nam HS, Kim YD. Utility of Leptomeningeal Collaterals in Predicting Intracranial Atherosclerosis-Related Large Vessel Occlusion in Endovascular Treatment. J Clin Med 2020; 9:jcm9092784. [PMID: 32872197 PMCID: PMC7564225 DOI: 10.3390/jcm9092784] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/22/2022] Open
Abstract
Earlier or preprocedural identification of occlusion pathomechanism is crucial for effective endovascular treatment. As leptomeningeal collaterals tend to develop well in chronic ischemic conditions such as intracranial atherosclerosis (ICAS), we investigated whether leptomeningeal collaterals can be a preprocedural marker of ICAS-related large vessel occlusion (ICAS-LVO) in endovascular treatment. A total of 226 patients who underwent endovascular treatment were retrospectively reviewed. We compared the pattern of leptomeningeal collaterals between patients with ICAS-LVO and without. Leptomeningeal collaterals were assessed by preprocedural computed tomography angiography (CTA) and basically categorized by three different collateral assessment methods. Better leptomeningeal collaterals were significantly associated with ICAS-LVO, although they were not independent for ICAS-LVO. When leptomeningeal collaterals were dichotomized to incomplete (<100%) and complete (100%), the latter was significantly more frequent in patients with ICAS-LVO (52.5% versus 20.4%) and remained an independent factor for ICAS-LVO (odds ratio, 3.32; 95% confidence interval, 1.52-7.26; p = 0.003). The area under the curve (AUC) value of complete leptomeningeal collateral supply was 0.660 for discrimination of ICAS-LVO. Incomplete leptomeningeal collateral supply was not likely ICAS-LVO, based on the high negative predictive value (88.6%). Considering its negative predictive value and the independent association between complete leptomeningeal collateral supply and ICAS-LVO, leptomeningeal collaterals could be helpful in the preprocedural determination of occlusion pathomechanism.
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Affiliation(s)
- Jang-Hyun Baek
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea;
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.H.H.); (H.S.N.); (Y.D.K.)
| | - Byung Moon Kim
- Interventional Neuroradiology, Severance Stroke Center, Severance Hospital, Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea;
- Correspondence: ; Tel.: +82-2-2228-7400
| | - Jin Woo Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Dong Joon Kim
- Interventional Neuroradiology, Severance Stroke Center, Severance Hospital, Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Ji Hoe Heo
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.H.H.); (H.S.N.); (Y.D.K.)
| | - Hyo Suk Nam
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.H.H.); (H.S.N.); (Y.D.K.)
| | - Young Dae Kim
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.H.H.); (H.S.N.); (Y.D.K.)
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Jodaitis L, Ligot N, Chapusette R, Bonnet T, Gaspard N, Naeije G. The Hyperdense Middle Cerebral Artery Sign in Drip-and-Ship Models of Acute Stroke Management. Cerebrovasc Dis Extra 2020; 10:36-43. [PMID: 32344421 PMCID: PMC7289154 DOI: 10.1159/000506971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Large vessel occlusion (LVO) leads to debilitating stroke and responds modestly to recombinant tissue plasminogen activator (rt-TPA). Early thrombectomy improves functional outcomes in selected patients with proximal occlusion but it is not available in all medical facilities. The best imaging modality for triage in an acute stroke setting in drip-and-ship models is still the subject of debate. Objectives We aimed to assess the diagnostic value of millimeter-sliced noncontrast computed tomography (NCCT) hyperdense middle cerebral artery sign (HMCAS) in itself or associated with clinical data for early detection of LVO in drip-and-ship models of acute stroke management. Methods NCCT of patients admitted to the Erasme Hospital, ULB, Brussels, Belgium, for suspicion of acute ischemic stroke between January 1 and July 31, 2017, were collected. Patients with brain hemorrhages were excluded, leading to 122 cases. The presence of HMCAS on NCCT was determined via visual assessment by 6 raters blinded to all other data. An independent rater assessed the presence of LVO on digital subtraction angiography imaging or contrast-enhanced CT angiography (CTA). The sensitivity, false-positive rate (FPR), and accuracy of HMCAS and the dot sign to detect LVO were calculated. The interobserver agreement of HMCAS was assessed using Gwet's AC1 coefficient. Then, on a separate occasion, the first 2 observers rereviewed all NCCT provided with clinical clues. The sensitivity, FPR, and accuracy of HMCAS were recalculated. Results HMCAS was found in 21% of the cases and a dot sign was found in 9%. The mean HMCAS sensitivity was 62% (95% CI 45–79%) and its accuracy was 86% (95% CI 79–92%) for detecting LVO. The interobserver reliability coefficient was 80% for HMCAS. Combined with clinical information, HMCAS sensitivity increased to 81% (95% CI 68–94; p = 0.041) and accuracy increased to 91% (95% CI 86–96%). Conclusion When clinical data are provided, detection of HMCAS on thinly sliced NCCT could be enough to decide on transfer for thrombectomy in drip-and-ship models of acute stroke management, especially in situations where CTA is less available and referral centers for thrombectomy fewer and further apart.
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Affiliation(s)
- Lise Jodaitis
- Department of Neurology, Erasme Hospital, ULB, Brussels, Belgium,
| | - Noémie Ligot
- Department of Neurology, Erasme Hospital, ULB, Brussels, Belgium
| | - Rudy Chapusette
- Department of Radiology, Erasme Hospital, ULB, Brussels, Belgium
| | - Thomas Bonnet
- Department of Interventional Neuroradiology, Erasme Hospital, ULB, Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology, Erasme Hospital, ULB, Brussels, Belgium
| | - Gilles Naeije
- Department of Neurology, Erasme Hospital, ULB, Brussels, Belgium
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Sun H, Liu Y, Gong P, Zhang S, Zhou F, Zhou J. Intravenous thrombolysis for ischemic stroke with hyperdense middle cerebral artery sign: A meta-analysis. Acta Neurol Scand 2020; 141:193-201. [PMID: 31598961 DOI: 10.1111/ane.13177] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/28/2019] [Accepted: 10/01/2019] [Indexed: 01/01/2023]
Abstract
Hyperdense middle cerebral artery sign (HMCAS) on admitting to neuroimaging is reported to have prognostic value for poor outcomes after thrombolysis, while evidence from studies comprising a sufficiently large sample size is limited. To detect prognostic predictors after thrombolysis could help improve therapeutic clinical strategies for acute ischemic stroke. We included prospective and retrospective studies of stroke patients that were treated with intravenous thrombolysis, in which functional outcomes (ie, a modified Rankin scale [mRS]) and systematic intracranial hemorrhage (sICH) were assessed in relation to HMCAS during pretreatment head CT. Random-effects models were used to calculate pooled risk ratios (RR) of poor outcomes and sICH for HMCAS patients as compared to patients without HMCAS. Eleven studies permitted identification of 11 818 patients. The risk of poor outcome at 3 months in the HMCAS-positive group was 1.56-fold the negative group (RR, 1.56; 95% CI 1.50-1.62; P < .001). The sICH risk when comparing both groups was found to be non-significant. Sensitivity analysis regarding studies performing thrombolysis within 3 hours also exhibited significant differences in their functional outcomes (RR, 1.56, 95% CI 1.49-1.62; P < .001) in patients with HMCAS as compared to non-HMCAS patients, although this was true for sICH risk. The presence of HMCAS on pretreatment CT predicts a poor outcome at 3 months after intravenous thrombolysis, while its relationship with the incidence of sICH was found to have no statistic value. Our study implies that more aggressive treatment should be considered for HMCAS patients.
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Affiliation(s)
- Huanhuan Sun
- Department of Neurology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - Yukai Liu
- Department of Neurology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - Pengyu Gong
- Department of Neurology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - Shuting Zhang
- Department of Neurology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - Feng Zhou
- Department of Neurology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - Junshan Zhou
- Department of Neurology Nanjing First Hospital Nanjing Medical University Nanjing China
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Ye G, Qi P, Chen K, Tan T, Cao R, Chen J, Lu J, Wang D. Risk of secondary embolism events during mechanical thrombectomy for acute ischemic stroke: A single-center study based on histological analysis. Clin Neurol Neurosurg 2020; 193:105749. [PMID: 32203703 DOI: 10.1016/j.clineuro.2020.105749] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/23/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Secondary embolism (SE) is a common adverse event during mechanical thrombectomy (MT) for acute intracranial large vessel occlusion, which could lead to incomplete revascularization and increased maneuvers. However, the mechanisms behind SE are still unclear. In this study, we aimed to investigate the risk factors of SE, with a focus on clot composition. PATIENTS AND METHODS Consecutive patients with retrieved clots were reviewed. Histologic examination for thrombus included Hematoxylin and eosin, Martius Scarlet Blue, immunohistochemistry for von Willebrand factor (VWF). Patients included were assigned to SE or no SE group. The differences in histological composition and clinical characteristics were compared, and logistic regression was conducted for predictors of SE. RESULTS Fifty-four patients were included, of which 19 were identified as having an SE. For patients with SE, there was more history of stroke or transient cerebral ischemia (TIA) (57.9 % vs. 28.6 %, p = 0.035), more occlusion located in terminal internal carotid artery (ICA) (63.2 % vs. 25.7 %, p = 0.007), relatively more contact aspiration used as frontline strategy (68.4 % vs. 45.7 %, p = 0.110), and less eTICI2c-3 recanalization achieved (52.6 % vs. 91.4 %, p = 0.003). As for histologic composition, the clots in SE group showed a higher proportion of erythrocyte fractions (42.9 % vs. 26.8 %, p = 0.045), while the other components were comparable with the non-SE group. Multivariate analysis suggested that a history of stroke or TIA (OR 6.45, 95 %CI 1.41-29.44, p = 0.016) and ICA occlusion (OR 8.05, 95 %CI 1.80-36.10, p = 0.006) could independently predict SE. CONCLUSION History of TIA or stroke and occlusion in the terminal ICA were found to be independent predictors for SE. Thrombus with a higher erythrocyte fractions might be more fragile. Further studies are needed.
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Affiliation(s)
- Gengfan Ye
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Kunpeng Chen
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Tianhua Tan
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China
| | - Ruoyao Cao
- Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Juan Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China.
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China.
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Ye G, Cao R, Lu J, Qi P, Chen J, Wang D. Association Between Thrombus Density and Reperfusion Outcomes Using Different Thrombectomy Strategies: A Single-Center Study and Meta-Analysis. Front Neurol 2019; 10:843. [PMID: 31474924 PMCID: PMC6706902 DOI: 10.3389/fneur.2019.00843] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/22/2019] [Indexed: 01/01/2023] Open
Abstract
Background: For patients with acute ischemic stroke (AIS), the thrombus density on non-enhanced CT (NECT) indicates the composition of the thrombus, a characteristic that impacts the efficacy of mechanical thrombectomy (MT). A previous meta-analysis suggested a correlation between higher thrombus density and successful reperfusion, but some new studies have drawn different conclusions. This single-center study and meta-analysis aimed to detect the association between thrombus density and reperfusion outcomes based on various thrombectomy strategies. Methods: We reviewed AIS patients who underwent MT at our center between July 2015 and May 2019. Thrombus density was recorded as mean Hounsfield Unit (HU) value on 1-mm reconstructed NECT, and expanded Thrombolysis In Cerebral Infarction (eTICI) scale was used to evaluate the reperfusion grade. The difference in thrombus density was examined according to reperfusion outcomes. Then, we systematically searched relevant literature on this issue. The random effect model was used to calculate standardized mean difference (SMD), and subgroup analysis was conducted according to MT strategies employed, including stent retriever (SR), contact aspiration (CA), Solumbra (a combination of SR and aspiration), and multiple thrombectomy modalities. Results: Sixty-four patients with anterior circulation AIS were included in our single-center study with 57 (89.1%) achieving successful reperfusion (eTICI2b-3). Retrospective analysis showed no significant difference in thrombus density between eTICI2b-3 and eTICI0-2a reperfusion (65.27 vs. 62.19, p = 0.462). As for systematic review, 11 studies were included in qualitative analysis, among which 6 had data available for meta-analysis. Pooled result showed that a comparable thrombus density between eTICI2b-3 and eTICI0-2a reperfusion (SMD 0.14, 95%CI −0.28 to 0.57, p = 0.50). Interestingly, in the SR subgroup, eTICI2b-3 reperfusion showed a significant higher thrombus density (SMD 0.53, 95%CI 0.10 to 0.96, p = 0.02), while an inverse trend was observed in the CA subgroup (SMD −0.48, 95%CI −0.88 to −0.07, p = 0.02). Conclusions: Although the pooled result of meta-analysis did not show a significant association between thrombus density and successful reperfusion, subgroup analysis implicated that the SR technique might be prone to retrieve high-density thrombus, while the CA subgroup showed an opposite tendency. Further studies are needed to confirm these results and to investigate its role in the optimization of thrombectomy strategy.
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Affiliation(s)
- Gengfan Ye
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Ruoyao Cao
- Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Juan Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
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Fitzgerald S, Mereuta OM, Doyle KM, Dai D, Kadirvel R, Kallmes DF, Brinjikji W. Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome. J Neurosurg Sci 2019; 63:292-300. [PMID: 30514073 PMCID: PMC8693286 DOI: 10.23736/s0390-5616.18.04629-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Mechanical thrombectomy has become the stand of care for patients with large vessel occlusions, yet major improvements in thrombectomy speed, efficacy, and completeness can still be achieved. High rates of clot fragmentation and failure to remove the clot resulting in poor neurological outcomes suggest that in order to further advance the field of stroke intervention we must turn our attention towards understanding the science of clot. Accurately identifying the composition of the occlusive clot prior to intervention could significantly influence the success of the revascularization strategy used to treat them. Numerous features of thromboemboli could be studied and characterized, including quantitative histomorphometry and diagnostic imaging characteristics. Each of these features might logically predict superior thrombectomy outcomes with one device or another. This article aims to review the current literature on histopathological composition of acute ischemic stroke clots, with a particular focus on the correlation between clot composition and diagnostic imaging, stroke etiology and revascularization outcomes.
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Affiliation(s)
- Seán Fitzgerald
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Oana M Mereuta
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Karen M Doyle
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA -
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
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40
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Baek JH, Kim BM. Angiographical Identification of Intracranial, Atherosclerosis-Related, Large Vessel Occlusion in Endovascular Treatment. Front Neurol 2019; 10:298. [PMID: 31040811 PMCID: PMC6476938 DOI: 10.3389/fneur.2019.00298] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/08/2019] [Indexed: 01/01/2023] Open
Abstract
Identification of intracranial, atherosclerosis-related, large vessel occlusion (ICAS-LVO) is important to set up an optimal endovascular treatment strategy, as most ICAS-LVOs require specific endovascular modalities for efficient recanalization. However, there is currently no decisive way to identify ICAS-LVO for endovascular treatment. Instead of the few, non-specific, clinical and imaging findings that operators have depended on, this review focused on the occlusion type, one of angiographical methods to identify the ICAS-LVO. Occlusion type was originally devised for predicting procedural details and endovascular outcomes of ICAS-LVO. Among occlusion types, truncal-type occlusion is regarded as a surrogate marker for ICAS-LVO. Although rare, false positives or negatives in truncal-type occlusion are possible. Nonetheless, occlusion type was easy to apply and reliably predictive of procedural outcomes. Furthermore, occlusion type can be determined prior to the procedure, which could allow it to be more helpful in setting up an optimal strategy before starting endovascular treatment.
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Affiliation(s)
- Jang-Hyun Baek
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Moon Kim
- Department of Radiology, Interventional Neuroradiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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41
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Park H, Baek JH, Kim BM. Endovascular Treatment of Acute Stroke Due to Intracranial Atherosclerotic Stenosis-Related Large Vessel Occlusion. Front Neurol 2019; 10:308. [PMID: 31001193 PMCID: PMC6454085 DOI: 10.3389/fneur.2019.00308] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/11/2019] [Indexed: 12/21/2022] Open
Abstract
Endovascular treatment (EVT) has become a standard treatment for acute ischemic stroke due to large vessel occlusion (LVO) in the anterior circulation. However, whether EVT tools used for intracranial atherosclerotic stenosis (ICAS)-related LVO are as safe and effective as for use in embolic LVO remains unclear. There have been only a few studies about EVT for ICAS-related LVO, and these studies revealed that mechanical thrombectomy with a stent retriever or contact aspiration was less effective and more time consuming in ICAS-related LVO than in embolic LVO. Because fast and successful recanalization (defined as modified Thrombolysis in Cerebral Ischemia grade, 2b or 3) is the most critical factor influencing favorable outcomes, it is important to determine the appropriate EVT strategy for fast recanalization of ICAS-related LVO. In this report, we review the results of mechanical thrombectomy using stent retriever or contact aspiration and rescue treatments after failure of mechanical thrombectomy for ICAS-related LVO. Finally, we propose the EVT strategy appropriate for ICAS-related LVO based on a literature review and our experience.
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Affiliation(s)
- Hyungjong Park
- Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Jang-Hyun Baek
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Moon Kim
- Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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42
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Brinjikji W, Duffy S, Burrows A, Hacke W, Liebeskind D, Majoie CBLM, Dippel DWJ, Siddiqui AH, Khatri P, Baxter B, Nogeuira R, Gounis M, Jovin T, Kallmes DF. Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome: a systematic review. J Neurointerv Surg 2017; 9:529-534. [PMID: 27166383 PMCID: PMC6697418 DOI: 10.1136/neurintsurg-2016-012391] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 04/15/2016] [Accepted: 04/22/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Studying the imaging and histopathologic characteristics of thrombi in ischemic stroke could provide insights into stroke etiology and ideal treatment strategies. We conducted a systematic review of imaging and histologic characteristics of thrombi in acute ischemic stroke. MATERIALS AND METHODS We identified all studies published between January 2005 and December 2015 that reported findings related to histologic and/or imaging characteristics of thrombi in acute ischemic stroke secondary to large vessel occlusion. The five outcomes examined in this study were (1) association between histologic composition of thrombi and stroke etiology; (2) association between histologic composition of thrombi and angiographic outcomes; (3) association between thrombi imaging and histologic characteristics; (4) association between thrombi imaging characteristics and angiographic outcomes; and (5) association between imaging characteristics of thrombi and stroke etiology. A meta-analysis was performed using a random effects model. RESULTS There was no significant difference in the proportion of red blood cell (RBC)-rich thrombi between cardioembolic and large artery atherosclerosis etiologies (OR 1.62, 95% CI 0.1 to 28.0, p=0.63). Patients with a hyperdense artery sign had a higher odds of having RBC-rich thrombi than those without a hyperdense artery sign (OR 9.0, 95% CI 2.6 to 31.2, p<0.01). Patients with a good angiographic outcome had a mean thrombus Hounsfield unit (HU) of 55.1±3.1 compared with a mean HU of 48.4±1.9 for patients with a poor angiographic outcome (mean standard difference 6.5, 95% CI 2.7 to 10.2, p<0.001). There was no association between imaging characteristics and stroke etiology (OR 1.13, 95% CI 0.32 to 4.00, p=0.85). CONCLUSIONS The hyperdense artery sign is associated with RBC-rich thrombi and improved recanalization rates. However, there was no association between the histopathological characteristics of thrombi and stroke etiology and angiographic outcomes.
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Affiliation(s)
| | - Sharon Duffy
- Department of Engineering, Galway-Mayo Institute of Technology, Galway, Ireland
| | - Anthony Burrows
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Werner Hacke
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - David Liebeskind
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Charles B L M Majoie
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Diederik W J Dippel
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Adnan H Siddiqui
- Department of Neurosurgery, University of Buffalo, Buffalo, New York, USA
| | - Pooja Khatri
- Department of Neurology, University of Cincinatti, Cincinatti, Ohio, USA
| | - Blaise Baxter
- Department of Radiology, University of Tennessee Medical Center, Chatanooga, Tennessee, USA
| | - Raul Nogeuira
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Matt Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Tudor Jovin
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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