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Zheng C, Li R, Shen C, Hu Z, Qiu Z, Yang Q, Guo F. Leukoaraiosis in patients with tirofiban before endovascular thrombectomy: A post hoc analysis of a multicentre randomized clinical trial. J Formos Med Assoc 2024:S0929-6646(24)00391-7. [PMID: 39174395 DOI: 10.1016/j.jfma.2024.08.023] [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: 05/16/2024] [Revised: 08/14/2024] [Accepted: 08/18/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the effectiveness and safety of intravenous tirofiban before endovascular thrombectomy in subgroups of acute ischemic stroke patients with different degrees of leukoaraiosis (LA). METHODS Patients of the RESCUE BT trial whose LA grade could be assessed were included. Eligible patients were dichotomized into two strata according to the van Swieten scale (VSS) score, absent-to-moderate LA (VSS score <3) and severe LA (VSS score ≥3). Furthermore, patients were divided into tirofiban and placebo groups in each stratum. The primary outcome was the 90-day modified Rankin Scale (mRS) score. Safety outcome was radiological intracranial hemorrhage within 48 h. RESULTS 861 patients were included, 439 patients with absent-to-moderate LA and 422 patients with severe LA. There were no significant differences in 90-day mRS score between the tirofiban and placebo groups in either stratum (absent-to-moderate LA: adjusted OR 0.92 (95%CI, 0.66-1.28), P = 0.62; severe LA: adjusted OR 0.99 (95% CI, 0.69-1.42), P = 0.96). In the severe LA stratum, the occurrence of radiologic intracranial hemorrhage was greater in the tirofiban group compared to the placebo group. (35.7% vs 26.4%; adjusted OR, 1.72 (95% CI, 1.12-2.66); P = 0.014). However, no difference was observed in the absent-to-moderate LA stratum (33.2% vs 29.3%; adjusted OR, 1.15 (95% CI, 0.76-1.75); P = 0.51). CONCLUSION There was no significant difference in disability severity at 90 days when treating AIS patients using intravenous tirofiban before endovascular therapy, in either absent-to-moderate or severe LA strata. It should be noted that intravenous tirofiban before endovascular therapy increases the incidence of radiologic intracranial hemorrhage in patients with severe LA.
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Affiliation(s)
- Chong Zheng
- Neurology Department, Longyan First Affiliated Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Longyan 364000, China.
| | - Rongtong Li
- Neurology Department, Longyan First Affiliated Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Longyan 364000, China
| | - Chaoxiong Shen
- Neurology Department, Longyan First Affiliated Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Longyan 364000, China
| | - Zhizhou Hu
- Neurology Department, Longyan First Affiliated Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Longyan 364000, China
| | - Zhongming Qiu
- Neurology Department, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University) 183 Xinqiao Main Street, Shapingba District, Chongqing 400037, China
| | - Qingwu Yang
- Neurology Department, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University) 183 Xinqiao Main Street, Shapingba District, Chongqing 400037, China
| | - Fang Guo
- Neurology Department, Longyan First Affiliated Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Longyan 364000, China
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van Voorst H, Pitkänen J, van Poppel L, de Vries L, Mojtahedi M, Martou L, Emmer BJ, Roos YBWEM, van Oostenbrugge R, Postma AA, Marquering HA, Majoie CBLM, Curtze S, Melkas S, Bentley P, Caan MWA. Deep learning-based white matter lesion volume on CT is associated with outcome after acute ischemic stroke. Eur Radiol 2024; 34:5080-5093. [PMID: 38285103 DOI: 10.1007/s00330-024-10584-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Intravenous thrombolysis (IVT) before endovascular treatment (EVT) for acute ischemic stroke might induce intracerebral hemorrhages which could negatively affect patient outcomes. Measuring white matter lesions size using deep learning (DL-WML) might help safely guide IVT administration. We aimed to develop, validate, and evaluate a DL-WML volume on CT compared to the Fazekas scale (WML-Faz) as a risk factor and IVT effect modifier in patients receiving EVT directly after IVT. METHODS We developed a deep-learning model for WML segmentation on CT and validated with internal and external test sets. In a post hoc analysis of the MR CLEAN No-IV trial, we associated DL-WML volume and WML-Faz with symptomatic-intracerebral hemorrhage (sICH) and 90-day functional outcome according to the modified Rankin Scale (mRS). We used multiplicative interaction terms between WML measures and IVT administration to evaluate IVT treatment effect modification. Regression models were used to report unadjusted and adjusted common odds ratios (cOR/acOR). RESULTS In total, 516 patients from the MR CLEAN No-IV trial (male/female, 291/225; age median, 71 [IQR, 62-79]) were analyzed. Both DL-WML volume and WML-Faz are associated with sICH (DL-WML volume acOR, 1.78 [95%CI, 1.17; 2.70]; WML-Faz acOR, 1.53 95%CI [1.02; 2.31]) and mRS (DL-WML volume acOR, 0.70 [95%CI, 0.55; 0.87], WML-Faz acOR, 0.73 [95%CI 0.60; 0.88]). Only in the unadjusted IVT effect modification analysis WML-Faz was associated with more sICH if IVT was given (p = 0.046). Neither WML measure was associated with worse mRS if IVT was given. CONCLUSION DL-WML volume and WML-Faz had a similar relationship with functional outcome and sICH. Although more sICH might occur in patients with more severe WML-Faz receiving IVT, no worse functional outcome was observed. CLINICAL RELEVANCE STATEMENT White matter lesion severity on baseline CT in acute ischemic stroke patients has a similar predictive value if measured with deep learning or the Fazekas scale. Safe administration of intravenous thrombolysis using white matter lesion severity should be further studied. KEY POINTS White matter damage is a predisposing risk factor for intracranial hemorrhage in patients with acute ischemic stroke but remains difficult to measure on CT. White matter lesion volume on CT measured with deep learning had a similar association with symptomatic intracerebral hemorrhages and worse functional outcome as the Fazekas scale. A patient-level meta-analysis is required to study the benefit of white matter lesion severity-based selection for intravenous thrombolysis before endovascular treatment.
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Affiliation(s)
- Henk van Voorst
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.
| | - Johanna Pitkänen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura van Poppel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Lucas de Vries
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Mahsa Mojtahedi
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Laura Martou
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, England
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Robert van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, School for Mental health and sciences (Mhens), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Henk A Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Sami Curtze
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paul Bentley
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, England
| | - Matthan W A Caan
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
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He P, Jiang C, Ni J, Zhang X, Wu Z, Chen G, Huang J, Dai Z, Ji W, Li L, Chen K, Shi Y. Identifying gut microbiota with high specificity for ischemic stroke with large vessel occlusion. Sci Rep 2024; 14:14086. [PMID: 38890373 PMCID: PMC11189444 DOI: 10.1038/s41598-024-64819-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 06/13/2024] [Indexed: 06/20/2024] Open
Abstract
Gut microbiota can regulate the metabolic and immunological aspects of ischemic stroke and modulate the treatment effects. The present study aimed to identify specific changes in gut microbiota in patients with large vessel occlusion (LVO) ischemic stroke and assess the potential association between gut microbiota and clinical features of ischemic stroke. A total of 63 CSVD patients, 64 cerebral small vessel disease (CSVD) patients, and 36 matching normal controls (NCs) were included in this study. The fecal samples were collected for all participants and analyzed for gut microbiota using 16S rRNA gene sequencing technology. The abundances of five gut microbiota, including genera Bifidobacterium, Butyricimonas, Blautia, and Dorea and species Bifidobacterium_longum, showed significant changes with high specificity in the LVO patients as compared to the NCs and CSVD patients. In LVO patients, the genera Bifidobacterium and Blautia and species Bifidobacterium_longum were significantly correlated with the National Institutes of Health Stroke Scale (NIHSS) scores at the admission and discharge of the patients. Serum triglyceride levels could significantly affect the association of the abundance of genus Bifidobacterium and species Bifidobacterium_longum with the NIHSS scores at admission and modified Rankin Scale (mRS) at discharge in LVO patients. The identification of five gut microbiota with high specificity were identified in the early stage of LVO stroke, which contributed to performed an effective clinical management for LVO ischemic stroke.
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Affiliation(s)
- Ping He
- Department of Neurosurgery Intensive Care Unit, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, China
- Department of Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Qingyang Road No. 299, Wuxi, 214023, Jiangsu, China
| | - Chen Jiang
- Department of Neurosurgery Intensive Care Unit, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, China
| | - Jianqiang Ni
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Xiaoxuan Zhang
- Department of Neurosurgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, China
| | - Zhifeng Wu
- Department of Neurosurgery Intensive Care Unit, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, China
| | - Gengjing Chen
- Department of Neurosurgery Intensive Care Unit, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, China
| | - Jin Huang
- Department of Neurosurgery Intensive Care Unit, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, China
| | - Zheng Dai
- Department of Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Qingyang Road No. 299, Wuxi, 214023, Jiangsu, China
- Department of Interventional Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, China
| | - Wei Ji
- Department of Neurosurgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, China
- Department of Functional Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Qingyang Road No. 299, Wuxi, 214023, Jiangsu, China
| | - Lei Li
- Department of Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Qingyang Road No. 299, Wuxi, 214023, Jiangsu, China
- Department of Interventional Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, China
| | - Kefei Chen
- Department of Functional Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Qingyang Road No. 299, Wuxi, 214023, Jiangsu, China.
| | - Yachen Shi
- Department of Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Qingyang Road No. 299, Wuxi, 214023, Jiangsu, China.
- Department of Interventional Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, China.
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Zhu H, Liang W, Zhu J, He X, Zou P, Yang K, Li G, Liao B, Deng H, Liang Z, Zhao J, Zhao Z, Chen J, He Q, Ning W. Nomogram to predict ventilator-associated pneumonia in large vessel occlusion stroke after endovascular treatment: a retrospective study. Front Neurol 2024; 15:1351458. [PMID: 38803642 PMCID: PMC11129686 DOI: 10.3389/fneur.2024.1351458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/26/2024] [Indexed: 05/29/2024] Open
Abstract
Background Ventilator-Associated Pneumonia (VAP) severely impacts stroke patients' prognosis after endovascular treatment. Hence, this study created a nomogram to predict the occurrence of VAP after endovascular treatment. Methods The individuals with acute ischemic stroke and large vessel occlusion (AIS-LVO) who received mechanical ventilation and endovascular therapy between July 2020 and August 2023 were included in this retrospective study. The predictive model and nomogram were generated by performing feature selection optimization using the LASSO regression model and multifactor logistic regression analysis and assessed the evaluation, verification and clinical application. Results A total of 184 individuals (average age 61.85 ± 13.25 years, 73.37% male) were enrolled, and the rate of VAP occurrence was found to be 57.07%. Factors such as the Glasgow Coma Scale (GCS) score, duration of stay in the Intensive Care Unit (ICU), dysphagia, Fazekas scale 2 and admission diastolic blood pressure were found to be associated with the occurrence of VAP in the nomogram that demonstrating a strong discriminatory power with AUC of 0.862 (95% CI, 0.810-0.914), and a favorable clinical net benefit. Conclusion This nomogram, comprising GCS score, ICU duration, dysphagia, Fazekas scale 2 and admission diastolic blood pressure, can aid clinicians in predicting the identification of high-risk patients for VAP following endovascular treatment in large vessel occlusion stroke.
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Affiliation(s)
- Huishan Zhu
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Wenfei Liang
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Jingling Zhu
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Xiaohua He
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Pengjuan Zou
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Kangqiang Yang
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Guoshun Li
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Bin Liao
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Huiquan Deng
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Zichong Liang
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Jiasheng Zhao
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Zhan Zhao
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Jingyi Chen
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Qiuxing He
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weimin Ning
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
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Zhang M, Che R, Xu J, Guo W, Chen X, Zhao W, Ren C, Jia M, Ji X. Long term for patients with futile endovascular reperfusion after stroke. CNS Neurosci Ther 2024; 30:e14588. [PMID: 38475869 PMCID: PMC10933383 DOI: 10.1111/cns.14588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 03/14/2024] Open
Abstract
AIMS With the progress of thrombectomy technology, the vascular recanalization rate of patients with stroke has been continuously improved, but the proportion of futile recanalization (FR) is still quite a few. The long-term prognosis and survival of patients with FR and its influencing factors remain unclear. METHODS Consecutive patients who received endovascular treatment (EVT) for ischemic stroke were enrolled between 2013 and 2021 from a single-center prospectively registry study. We evaluated the long-term outcome of these patients by Kaplan-Meier survival analysis, and the multivariable logistic regression curve was performed to analyze influencing factors. RESULTS Among 458 patients with FR, 56.4% of patients survived at 1 year, and 50.4% at 2 years. In the multivariate regression analysis, age, premorbid modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), posterior circulation infarct, general anesthesia, symptomatic intracerebral hemorrhage (sICH), and decompressive craniectomy were found to be related to unfavorable outcomes in long-term. Age, premorbid mRS, NIHSS, general anesthesia, and sICH were predictors of long-term mortality. CONCLUSIONS Futile recanalization accounts for a large proportion of stroke patients after thrombectomy. This study on the long-term prognosis of such patients is beneficial to the formulation of treatment plans and the prediction of therapeutic effects.
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Affiliation(s)
- Mengke Zhang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Ruiwen Che
- Department of Neurology, Beijing ShiJiTan HospitalCapital Medical UniversityBeijingChina
| | - Jiali Xu
- Department of Rehabilitation Medicine, Beijing ShiJiTan HospitalCapital Medical UniversityBeijingChina
| | - Wenting Guo
- Department of NeurologyZhejiang Provincial People's HospitalZhejiangChina
| | - Xi Chen
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Wenbo Zhao
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Changhong Ren
- Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Milan Jia
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xunming Ji
- Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Xuanwu HospitalCapital Medical UniversityBeijingChina
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
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Fan H, Wei L, Zhao X, Zhu Z, Lu W, Roshani R, Huang K. White matter hyperintensity burden and functional outcomes in acute ischemic stroke patients after mechanical thrombectomy: A systematic review and meta-analysis. Neuroimage Clin 2023; 41:103549. [PMID: 38071889 PMCID: PMC10750174 DOI: 10.1016/j.nicl.2023.103549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/13/2023] [Accepted: 12/03/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND The influence of white matter hyperintensity (WMH) on clinical outcomes in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT) remains controversial. We performed a systematic review and meta-analysis to examine whether WMH burden is associated with clinical outcomes in AIS patients after MT. METHODS PubMed, Embase, and Web of Science were searched from inception to Sep 03, 2023. The registration number for PROSPERO is CRD42022340568. Studies reporting an association between the burden of WMH in AIS patients and clinical outcomes after MT were included in the meta-analysis. A random-effects model was used for meta-analysis. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Additionally, the presence of imprecise-study effects was evaluated using Egger's test and funnel plot. RESULTS Fifteen studies with 3,456 patients were enrolled in this meta-analysis. Among AIS patients who underwent MT, moderate/severe WMH had higher odds of 90-day unfavorable functional outcomes (odds ratio [OR] 2.72, 95% confidence interval [CI] 2.14-3.44; I2 = 0.0%; 95% CI 0.0%-42.7%), 90-day mortality (OR 1.94, 95% CI 1.45-2.60; I2 = 19.5%; 95% CI 0.0%-65.2%) and futile recanalization (OR 2.99, 95% CI 1.42-6.28; I2 = 69.7%; 95% CI 0.0%-91.0%) compared with none/mild WMH. However, the two groups had no significant difference in successful recanalization, symptomatic hemorrhagic transformation, and hemorrhagic transformation. A subset analysis of patients from 3 articles showed that WMH volume was not significantly associated with these outcomes. A notable limitation is that this meta-analysis lacks direct adjustment for imbalances in important baseline covariates. CONCLUSIONS Patients with moderate/severe WMH on baseline imaging are associated with substantially increased odds of 90-day unfavorable outcomes, futile recanalization, and 90-day mortality after MT. This association suggests that moderate/severe WMH may contribute to the prediction of clinical outcomes in AIS patients after MT.
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Affiliation(s)
- Huanhuan Fan
- Department of Neurology, Nanfang Hospital, Southern Medical University, China
| | - Lihua Wei
- Department of Neurology, Nanfang Hospital, Southern Medical University, China
| | - Xiaolin Zhao
- Department of Neurology, Nanfang Hospital, Southern Medical University, China
| | - Zhiliang Zhu
- Department of Neurology, Nanfang Hospital, Southern Medical University, China
| | - Wenting Lu
- Department of Neurology, Nanfang Hospital, Southern Medical University, China
| | - Ramzi Roshani
- Department of Neurology, Nanfang Hospital, Southern Medical University, China
| | - Kaibin Huang
- Department of Neurology, Nanfang Hospital, Southern Medical University, China.
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Akarsu FG, Doğan B, Eryıldız ES, Memmedova F, Mehdi Yev Z, Aykaç Ö, Özdemi R AÖ. Too bad to treat? Predicting clinical outcome after mechanical thrombectomy in octogenarians. Clin Neurol Neurosurg 2023; 226:107635. [PMID: 36827838 DOI: 10.1016/j.clineuro.2023.107635] [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: 10/05/2022] [Revised: 01/08/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES We aimed to reveal the effect of the totaled health risk in vascular events (THRIVE) score and the radiological parameters of the Alberta stroke program early computed tomography score (ASPECTS), the Van Swieten Scale (VSS) score, and the Evans Index on clinical outcomes in patients over 80 years of age who underwent endovascular thrombectomy (EVT). MATERIALS AND METHODS We retrospectively analyzed anterior ischemic stroke (AIS) patients over 80 years of age who underwent EVT between May 2017 and April 2022. Good functional outcome was accepted as a 90-day modified Rankin Scale (mRS) score of 0-2. We constructed three models to compare to the mRS (model 1: THRIVE, CTA-ASPECT; model 2: THRIVE, CTA-ASPECT, Evans Index; model 3: THRIVE, CTA-ASPECT, Evans Index, VSS). RESULTS A total of 39 octogenarian patients with thrombolysis in cerebral infarction (TICI) 2c-3 recanalization were selected, and their 90-day mRS scores were compared. Of these, 19 patients (48%) showed good outcomes. In multivariable receiver operating characteristic (ROC) analyses, the AUC of model 1 was 0.797 (95% confidence interval [CI], 0.638-0.909), the AUC of model 2 was 0.862 (95% CI, 0.714-0.951), and the AUC of model 3 was 0.905 (95% CI, 0.768-0.975). CONCLUSIONS Evaluation of the THRIVE score, which measures vascular disease burden and stroke severity, together with the radiological parameters of ASPECTS score, VSS score, and the Evans Index, provides useful guidance in predicting the clinical outcomes of elderly AIS patients after EVT.
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Affiliation(s)
- Fatma Ger Akarsu
- Department of Neurology, Eskisehir Osmangazi University, Eskişehir, Turkey.
| | - Baki Doğan
- Department of Neurology, Ondokuz Mayıs University, Samsun, Turkey
| | | | - Fergane Memmedova
- Department of Neurology, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Zaur Mehdi Yev
- Department of Neurology, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Özlem Aykaç
- Department of Neurology, Eskisehir Osmangazi University, Eskişehir, Turkey
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Impact of leukoaraiosis or blood pressure on clinical outcome, mortality and symptomatic intracerebral hemorrhage after mechanical thrombectomy in acute ischemic stroke. Sci Rep 2022; 12:21750. [PMID: 36526650 PMCID: PMC9758212 DOI: 10.1038/s41598-022-25171-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
We aimed to study the impact of leukoaraiosis (LA) and blood pressure (BP) on clinical outcome, mortality and symptomatic intracerebral hemorrhage (sICH) in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT). We analyzed data retrospectively from 521 patients with anterior large vessel occlusion treated with MT. LA was dichotomized in 0-2 (absent-to-moderate) versus 3-4 (moderate-to-severe) according to the van Swieten scale. Various systolic (SBP) and diastolic (DBP) BP parameters during the first 24 h were collected. Multivariable logistic regressions were performed to identify predictors of a poor 90-day outcome, mortality and sICH. LA was significantly associated with poor outcome (OR 3.2; p < 0.001) and mortality (OR 3.19; p = 0.008), but not sICH (p = 0.19). Higher maximum SBP was significantly associated with poor outcome (OR per 10 mmHg increase = 1.21; p = 0.009) and lower mean DBP was a predictor of mortality (OR per 10 mmHg increase = 0.53; p < 0.001). In the univariate analysis high SBP variability was associated with poor outcome, mortality and sICH, but not in the multivariate model. There was no association between BP and sICH. Severity of LA, SBP variability, high maximum SBP and low DBP are associated with either poor outcome or mortality in AIS patients undergoing MT. However, neither LA nor BP were associated with sICH in our cohort. Thus, mechanisms of the negative impact on outcome remain unclear. Further studies on impact of BP course and its mechanisms and interventions are needed to improve outcome in patients undergoing MT.
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Wang Y, Bai X, Ye C, Yu Y, Wu B. The association between the severity and distribution of white matter lesions and hemorrhagic transformation after ischemic stroke: A systematic review and meta-analysis. Front Aging Neurosci 2022; 14:1053149. [PMID: 36506465 PMCID: PMC9732368 DOI: 10.3389/fnagi.2022.1053149] [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: 09/25/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
Background and purpose As a part of the natural course of ischemic stroke, hemorrhagic transformation (HT) is a serious complication after reperfusion treatment, which may affect the prognosis of patients with ischemic stroke. White matter lesions (WMLs) refer to focal lesions on neuroimaging and have been suggested to indicate a high risk of HT. This systematic review and meta-analysis aimed to summarize current evidence on the relation between WML and HT. Methods This systematic review was prepared with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, Embase, Web of Science, and Cochrane Library databases for publications on WML and HT in patients with ischemic stroke. Odds ratios (ORs) and 95% confidence intervals (CIs) from eligible studies were combined to quantify the association between the severity of WML and the risk of HT. In addition, the descriptive analysis was adopted to evaluate the influence of different WML distributions on predicting HT. Results A total of 2,303 articles were identified after removing duplicates through database searching, and 41 studies were included in our final analysis. The meta-analysis showed that the presence of WML was associated with HT (OR = 1.62, 95%CI 1.08-2.43, p = 0.019) and symptomatic intracerebral hemorrhage (sICH) (OR = 1.64, 95%CI 1.17-2.30, p = 0.004), and moderate-to-severe WML indicated a high risk of HT (OR = 2.03, 95%CI 1.33-3.12, p = 0.001) and sICH (OR = 1.92, 95%CI 1.31-2.81, p < 0.001). The dose-response meta-analysis revealed risk effects of increasing the severity of WML on both HT and ICH. In addition, both periventricular WML (PWML) (five of seven articles) and deep WML (DWML) (five of six articles) were shown to be associated with HT. Conclusions White matter lesions are associated with overall HT and sICH in patients with ischemic stroke, and more severe WMLs indicate a high risk of HT and sICH. In addition, both PWML and DWMLs could be risk factors for HT. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: PROSPERO CRD42022313467.
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Affiliation(s)
- Youjie Wang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xueling Bai
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yifan Yu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Bo Wu
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10
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Li Y, Liu Y, Hong Z, Wang Y, Lu X. Combining machine learning with radiomics features in predicting outcomes after mechanical thrombectomy in patients with acute ischemic stroke. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107093. [PMID: 36055039 DOI: 10.1016/j.cmpb.2022.107093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Some patients with mechanical thrombectomy will have a poor prognosis. This study establishes a model for predicting the prognosis after mechanical thrombectomy in acute stroke based on diffusion-weighted imaging (DWI) omics characteristics. METHODS A total of 260 stroke patients receiving mechanical thrombectomy in our hospital were randomly divided into a training set (n = 182) and a test set (n = 78) in a 7:3 ratio. The regions of interest (ROI) of the imaging features of the DWI infarct area were extracted, and the minimum absolute contraction and selection operator regression model were used to screen the best radiomics features. A support vector machine classifier established the prediction model of the prognosis after mechanical thrombectomy of acute stroke based on the selected features. The prediction efficiency of the model was evaluated by the receiver operating characteristic (ROC) curve. RESULTS A total of 1936 radiomic features were extracted, and six features highly correlated with prognosis were screened after dimensionality reduction. Based on the DWI model, the ROC analysis showed that the area under the curve (AUC) for correct prediction in the training and test sets was 0.945 and 0.920, respectively. CONCLUSION The model based on the characteristics of radiomics and machine learning has high predictive efficiency for the prognosis of acute stroke after mechanical thrombectomy, which can be used to guide personalized clinical treatment.
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Affiliation(s)
- Yan Li
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou Clinical Medical College of Hebei Medical University, Canzhou 061011, China.
| | - Yongchang Liu
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou Clinical Medical College of Hebei Medical University, Canzhou 061011, China
| | - Zhen Hong
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou Clinical Medical College of Hebei Medical University, Canzhou 061011, China
| | - Ying Wang
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou Clinical Medical College of Hebei Medical University, Canzhou 061011, China
| | - Xiuling Lu
- Cangzhou Infectious Disease Hospital, Canzhou 061011, China
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11
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Ni H, Liu X, Hang Y, Jia Z, Cao Y, Shi H, Liu S, Zhao L. Predictors of futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy in late time windows. Front Neurol 2022; 13:958236. [PMID: 36188358 PMCID: PMC9519892 DOI: 10.3389/fneur.2022.958236] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Futile recanalization (FR), defined as functional dependence despite successful reperfusion, is common in patients who experience an acute stroke after thrombectomy. We aimed to determine the predictors of FR in patients who underwent thrombectomy in late time windows (6 h or more after symptom onset). Methods This retrospective review included patients who underwent thrombectomy for acute anterior circulation large vessel occlusion from October 2019 to June 2021. Successful reperfusion was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b/3. Functional dependence at 90 days was defined as a modified Rankin scale score of 3–6. Multivariate analysis and a receiver operating characteristic (ROC) curve were used to identify the predictors of FR in patients treated in delayed time windows. Results Of the 99 patients included, FR was observed in 51 (51.5%). In the multivariate analysis, older age (OR, 1.12; 95% CI, 1.04–1.22; P = 0.005), female sex (OR, 3.79; 95% CI, 1.08–13.40; P = 0.038), a higher National Institutes of Health Stroke Score (NIHSS) score upon admission (OR, 1.11; 95% CI, 1.02–1.22; P = 0.023), and an increased number of passes per procedure (OR, 2.07; 95% CI, 1.11–3.86; P = 0.023) were independently associated with FR after thrombectomy. The ROC curve indicated that the model that combined age, female sex, baseline NIHSS score, and the number of passes per procedure (area under the curve, 0.84; 95% CI, 0.75–0.90, P < 0.001) was able to predict FR accurately. Conclusions Older age, female sex, higher NIHSS score upon admission, and an increased number of passes per procedure were independent predictors of FR in patients who experienced acute ischemic strokes after thrombectomy in late time windows.
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12
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Asgarzadeh A, Fouladi N, Asghariazar V, Sarabi SF, Khiavi HA, Mahmoudi M, Safarzadeh E. Serum Brain-Derived Neurotrophic Factor (BDNF) in COVID-19 Patients and its Association with the COVID-19 Manifestations. J Mol Neurosci 2022; 72:1820-1830. [PMID: 35749045 PMCID: PMC9243868 DOI: 10.1007/s12031-022-02039-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/05/2022] [Indexed: 12/19/2022]
Abstract
COVID-19 is a systematic disease that frequently implies neurological and non-neurological manifestations, predominantly by inducing hypoxia. Brain-derived neurotrophic factor (BDNF) is a key factor in regulating functions of nervous and respiratory systems and has been strongly related to hypoxia. Therefore, this study planned to investigate BDNF association with the COVID-19 manifestations especially neurological impairments and the infection-induced hypoxia. We enrolled sixty-four COVID-19 patients and twenty-four healthy individuals in this study. Patients were divided into two groups, with and without neurological manifestations, and their serum BDNF levels were measured by enzyme-linked immunosorbent assay (ELISA). COVID-19 patients had significantly lower BDNF levels than healthy individuals (p = 0.023). BDNF levels were significantly lower in patients with neurological manifestations compared to healthy individuals (p = 0.010). However, we did not observe a statistically significant difference in BDNF levels between patients with and without neurological manifestations (p = 0.175). BDNF’s levels were significantly lower in patients with CNS manifestations (p = 0.039) and higher in patients with fever (p = 0.03) and dyspnea (p = 0.006). Secondly, BDNF levels have a significant negative association with oxygen therapy requirement (p = 0.015). These results strongly suggest the critical association between dysregulated BDNF and hypoxia in promoting COVID-19 manifestations, particularly neurological impairments.
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Affiliation(s)
- Ali Asgarzadeh
- Students Research Committee, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nasrin Fouladi
- School of Medicine and Allied Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran.,Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Vahid Asghariazar
- Immunology Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.,Deputy of Research and Technology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Shahnaz Fooladi Sarabi
- Fellowship of Critical Care Medicine, Department of Anesthesiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hamid Afzoun Khiavi
- Immunology Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mahsa Mahmoudi
- School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Elham Safarzadeh
- Department of Microbiology, Parasitology, and Immunology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
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Rastogi A, Weissert R, Bhaskar SMM. Leukoaraiosis severity and post-reperfusion outcomes in acute ischaemic stroke: A meta-analysis. Acta Neurol Scand 2022; 145:171-184. [PMID: 34418060 DOI: 10.1111/ane.13519] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Severity of leukoaraiosis may mediate outcomes after reperfusion therapy in acute ischaemic stroke (AIS) patients. However, the level of the association remains poorly understood. We performed a meta-analysis to investigate the impact of leukoaraiosis severity on functional outcome, survival, haemorrhagic complications, and procedural success in AIS patients treated with intravenous thrombolysis and/or endovascular thrombectomy. MATERIALS AND METHODS PubMed, EMBASE and the Cochrane library were searched for studies on leukoaraiosis in AIS receiving reperfusion therapy. A random-effects meta-analysis was conducted for post-reperfusion outcomes in AIS patients with absent-to-mild leukoaraiosis and moderate-to-severe leukoaraiosis. The strength of association between moderate-to-severe leukoaraiosis and poor outcomes was quantified using odds ratios (OR). RESULTS A total of 15 eligible studies involving 6460 patients (1451 with moderate-to-severe leukoaraiosis and 5009 with absent-to-mild leukoaraiosis) were included in the meta-analysis. Moderate-to-severe leukoaraiosis was significantly associated with poor 90-day functional outcome (OR 3.16; 95% confidence interval (CI) 2.69-3.72; p < .0001), 90-day mortality (OR 3.11; 95% CI 2.27-4.26; p < .0001) and increased risk of symptomatic intracerebral haemorrhage (OR 1.69; 95% CI 1.24-2.32; p = .001) after reperfusion therapy. Overall, no significant association of leukoaraiosis severity with haemorrhagic transformation (HT) and angiographic recanalization status were observed. However, subgroup analysis revealed a significant association of WML severity with HT in patients receiving EVT. CONCLUSION Leukoaraiosis is a useful prognostic biomarker in AIS. Patients with moderate-to-severe leukoaraiosis on baseline imaging are likely to have worse clinical and safety outcomes after reperfusion therapy.
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Affiliation(s)
- Aarushi Rastogi
- 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
| | - Robert Weissert
- Department of Neurology Regensburg University Hospital University of Regensburg Regensburg Germany
| | - Sonu Menachem Maimonides Bhaskar
- Neurovascular Imaging Laboratory Clinical Sciences Stream Ingham Institute for Applied Medical Research Sydney Australia
- NSW Brain Clot Bank NSW Health Pathology Sydney Australia
- Department of Neurology and Neurophysiology Liverpool Hospital and South Western Sydney Local Health District Sydney Australia
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Corneal nerve loss as a surrogate marker for poor pial collaterals in patients with acute ischemic stroke. Sci Rep 2021; 11:19718. [PMID: 34611233 PMCID: PMC8492683 DOI: 10.1038/s41598-021-99131-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/17/2021] [Indexed: 01/01/2023] Open
Abstract
In patients with acute ischemic stroke, pial collaterals play a key role in limiting neurological disability by maintaining blood flow to ischemic penumbra. We hypothesized that patient with poor pial collaterals will have greater corneal nerve and endothelial cell abnormalities. In a cross-sectional study, 35 patients with acute ischemic stroke secondary to middle cerebral artery (MCA) occlusion with poor (n = 12) and moderate-good (n = 23) pial collaterals and 35 healthy controls underwent corneal confocal microscopy and quantification of corneal nerve and endothelial cell morphology. In patients with MCA stroke, corneal nerve fibre length (CNFL) (P < 0.001), corneal nerve fibre density (CNFD) (P = 0.025) and corneal nerve branch density (CNBD) (P = 0.002) were lower compared to controls. Age, BMI, cholesterol, triglycerides, HDL, LDL, systolic blood pressure, NIHSS and endothelial cell parameters did not differ but mRS was higher (p = 0.023) and CNFL (p = 0.026) and CNBD (p = 0.044) were lower in patients with poor compared to moderate-good collaterals. CNFL and CNBD distinguished subjects with poor from moderate-good pial collaterals with an AUC of 72% (95% CI 53–92%) and 71% (95% CI 53–90%), respectively. Corneal nerve loss is greater in patients with poor compared to moderate-good pial collaterals and may act as a surrogate marker for pial collateral status in patients with ischemic stroke.
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Puz P, Stryjewska-Makuch G, Żak A, Rybicki W, Student S, Lasek-Bal A. Prognostic Role of Chronic Rhinosinusitis in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy. J Clin Med 2021; 10:jcm10194446. [PMID: 34640464 PMCID: PMC8509423 DOI: 10.3390/jcm10194446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/07/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of the study was to assess the relevance of chronic rhinosinusitis (CRS) CT features to the efficacy of mechanical thrombectomy (MT) in patients with acute ischemic stroke. Methods: This study included 311 patients qualified for MT in whom the CRS features were assessed based on a CT scan, according to the Lund-Mackay (L-M) score. Clinical, inflammatory parameters, patients neurological (NIHSS) and functional status (mRS), and recanalisation efficacy (TICI) were compared between patients with mild lesions (L-M score 0–3 points)-group 1, and patients with more severe lesions (L–M score 4–24)-group 2. Results: There was a significant difference in the NIHSS on day seven after stroke onset-10 points in group 1 and 14 points in group 2, p = 0.02. NIHSS ≤ 6 points on day seven was found in 41.9% of patients in group 1, and in 27.5% in group 2, p = 0.042. There were no significant differences in mRS score and in the TICI score. L-M score, lipid abnormalities and CRP were factors associated with NIHSS ≥ 7 points on day 7. Conclusions: The CT features of CRS may be used as a prognostic tool for early prognosis assessment in stroke patients.
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Affiliation(s)
- Przemysław Puz
- Department of Neurology, School of Health Sciences, Medical University of Silesia, ul. Ziołowa 45, 40-653 Katowice, Poland; (A.Ż.); (A.L.-B.)
- Department of Neurology, Leszek Giec Upper-Silesian Medical Centre, Silesian Medical University, ul. Ziołowa 45, 40-653 Katowice, Poland;
- Correspondence: ; Tel.: +48-323598306
| | - Grażyna Stryjewska-Makuch
- Department of Laryngology and Laryngological Oncology, Leszek Giec Upper-Silesian Medical Centre, Silesian Medical University, ul. Ziołowa 45, 40-653 Katowice, Poland;
| | - Amadeusz Żak
- Department of Neurology, School of Health Sciences, Medical University of Silesia, ul. Ziołowa 45, 40-653 Katowice, Poland; (A.Ż.); (A.L.-B.)
- Department of Neurology, Leszek Giec Upper-Silesian Medical Centre, Silesian Medical University, ul. Ziołowa 45, 40-653 Katowice, Poland;
| | - Wiktor Rybicki
- Department of Neurology, Leszek Giec Upper-Silesian Medical Centre, Silesian Medical University, ul. Ziołowa 45, 40-653 Katowice, Poland;
| | - Sebastian Student
- Biotechnology Center, Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, ul. Akademicka 16, 44-100 Gliwice, Poland;
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia, ul. Ziołowa 45, 40-653 Katowice, Poland; (A.Ż.); (A.L.-B.)
- Department of Neurology, Leszek Giec Upper-Silesian Medical Centre, Silesian Medical University, ul. Ziołowa 45, 40-653 Katowice, Poland;
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16
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Rastogi A, Weissert R, Bhaskar SMM. Emerging role of white matter lesions in cerebrovascular disease. Eur J Neurosci 2021; 54:5531-5559. [PMID: 34233379 DOI: 10.1111/ejn.15379] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/26/2021] [Accepted: 06/26/2021] [Indexed: 12/12/2022]
Abstract
White matter lesions have been implicated in the setting of stroke, dementia, intracerebral haemorrhage, several other cerebrovascular conditions, migraine, various neuroimmunological diseases like multiple sclerosis, disorders of metabolism, mitochondrial diseases and others. While much is understood vis a vis neuroimmunological conditions, our knowledge of the pathophysiology of these lesions, and their role in, and implications to, management of cerebrovascular diseases or stroke, especially in the elderly, are limited. Several clinical assessment tools are available for delineating white matter lesions in clinical practice. However, their incorporation into clinical decision-making and specifically prognosis and management of patients is suboptimal for use in standards of care. This article sought to provide an overview of the current knowledge and recent advances on pathophysiology, as well as clinical and radiological assessment, of white matter lesions with a focus on its development, progression and clinical implications in cerebrovascular diseases. Key indications for clinical practice and recommendations on future areas of research are also discussed. Finally, a conceptual proposal on putative mechanisms underlying pathogenesis of white matter lesions in cerebrovascular disease has been presented. Understanding of pathophysiology of white matter lesions and how they mediate outcomes is important to develop therapeutic strategies.
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Affiliation(s)
- Aarushi Rastogi
- South Western Sydney Clinical School, University of New South Wales (UNSW), Liverpool, New South Wales, Australia.,Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Robert Weissert
- Department of Neurology, Regensburg University Hospital, University of Regensburg, Regensburg, Germany
| | - Sonu Menachem Maimonides Bhaskar
- South Western Sydney Clinical School, University of New South Wales (UNSW), Liverpool, New South Wales, Australia.,Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia.,Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, New South Wales, Australia
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Abu-Rumeileh S, Abdelhak A, Foschi M, Tumani H, Otto M. Guillain-Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. J Neurol 2021; 268:1133-1170. [PMID: 32840686 PMCID: PMC7445716 DOI: 10.1007/s00415-020-10124-x] [Citation(s) in RCA: 229] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023]
Abstract
Since coronavirus disease-2019 (COVID-19) outbreak in January 2020, several pieces of evidence suggested an association between the spectrum of Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most findings were reported in the form of case reports or case series, whereas a comprehensive overview is still lacking. We conducted a systematic review and searched for all published cases until July 20th 2020. We included 73 patients reported in 52 publications. A broad age range was affected (mean 55, min 11-max 94 years) with male predominance (68.5%). Most patients showed respiratory and/or systemic symptoms, and developed GBS manifestations after COVID-19. However, asymptomatic cases for COVID-19 were also described. The distributions of clinical variants and electrophysiological subtypes resemble those of classic GBS, with a higher prevalence of the classic sensorimotor form and the acute inflammatory demyelinating polyneuropathy, although rare variants like Miller Fisher syndrome were also reported. Cerebrospinal fluid (CSF) albuminocytological dissociation was present in around 71% cases, and CSF SARS-CoV-2 RNA was absent in all tested cases. More than 70% of patients showed a good prognosis, mostly after treatment with intravenous immunoglobulin. Patients with less favorable outcome were associated with a significantly older age in accordance with previous findings regarding both classic GBS and COVID-19. COVID-19-associated GBS seems to share most features of classic post-infectious GBS and possibly the same immune-mediated pathogenetic mechanisms. Nevertheless, more extensive epidemiological studies are needed to clarify these issues.
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Affiliation(s)
| | - Ahmed Abdelhak
- Department of Neurology, Ulm University Hospital, 89070, Ulm, Germany
- Department of Neurology and Stroke, University Hospital of Tübingen, 72076, Tübingen, Germany
- Hertie Institute of Clinical Brain Research, University of Tübingen, 72076, Tübingen, Germany
| | - Matteo Foschi
- Neurology Unit, S. Maria delle Croci Hospital-AUSL Romagna, ambito di Ravenna, 48121, Ravenna, Italy
| | - Hayrettin Tumani
- Department of Neurology, Ulm University Hospital, 89070, Ulm, Germany
- Specialty Hospital of Neurology Dietenbronn, 88477, Schwendi, Germany
| | - Markus Otto
- Department of Neurology, Ulm University Hospital, 89070, Ulm, Germany.
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Bersano A, Pantoni L. Stroke care in Italy at the time of the COVID-19 pandemic: a lesson to learn. J Neurol 2020; 268:2307-2313. [PMID: 32954445 PMCID: PMC7502274 DOI: 10.1007/s00415-020-10200-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/23/2022]
Abstract
From March to May 2020, the Italian health care system, as many others, was almost entirely devoted to the fight against the COVID-19 pandemic. In this context, a number of questions arose, from the increased stroke risk due to COVID-19 infection to the quality of stroke patient care. The overwhelming need of COVID-19 patient management made mandatory a complete re-organization of the stroke pathways: many health professionals were reallocated and a number of stroke units was turned into COVID-19 wards. As a result, acute stroke care suffered from a shortage of services and delays in time-dependent treatments and diagnostic work-up. In-patient and out-patient care and rehabilitation facilities for stroke survivors were also reduced or slowed down, to direct resources to COVID-19 patients care and to reduce contagion risks. Overall, this is likely to result in a significant future increased burden of complications and disabilities that will impact the health care systems in the coming months. Thus, while still fighting against COVID-19 disease, authorities need to promptly implement robust action plans, including an increase of workforce, without forgetting the assurance of a high level of stroke care. The medical community and the health care administrators should always keep in mind that stroke was before, and will be after the pandemic, a, sometimes, life-threatening condition, and almost always a disease with a severe impact on the quality of life.
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Affiliation(s)
- Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, Italy.
| | - Leonardo Pantoni
- Stroke and Dementia Lab, "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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19
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Masuccio FG, Barra M, Claudio G, Claudio S. A rare case of acute motor axonal neuropathy and myelitis related to SARS-CoV-2 infection. J Neurol 2020; 268:2327-2330. [PMID: 32940797 PMCID: PMC7497229 DOI: 10.1007/s00415-020-10219-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022]
Abstract
We describe a rare case of post-infective Acute Motor Axonal Neuropathy (AMAN) variant of Guillain-Barrè Syndrome (GBS) associated with myelitis and anti-GD1b positivity after SARS-CoV-2 infection. The patient referred to the hospital reporting a history of ten days lasting moderate fever, myalgia and anosmia, with the onset of progressive quadriparesis and ascending paraesthesias in the four limbs since five days from defervescence. A chest computed tomography demonstrated interstitial pneumonia with “ground glass opacities”, suggesting Coronavirus disease (COVID-19). The patient exhibited three negative reverse-transcription polymerase chain reaction (RT-PCR) nasopharyngeal swabs, while SARS-CoV-2 IgG was found in plasma. The electrophysiological examination demonstrated an AMAN and the spinal cord Magnetic Resonance Imaging (MRI) showed a T2-weighted hyperintense lesion in the posterior part of the spinal cord at the C7-D1 levels. Furthermore, anti-GD1b IgM was detected. GBS and myelitis could exceptionally develop simultaneously. Our findings reasonably support a causality link between COVID-19 and the neurological symptoms, suggesting a post-infective autoimmune reaction.
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Affiliation(s)
- Fabio Giuseppe Masuccio
- Department of Neurorehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone, SNC, 13040, Moncrivello, VC, Italy.
| | - Massimo Barra
- Department of Neurology, ASL TO4 Chivasso, C.so G. Ferraris 3, Chivasso, Italy
| | - Geda Claudio
- Department of Neurology, ASL TO4 Ivrea, P.za Credenza 2, Ivrea, Italy
| | - Solaro Claudio
- Department of Neurorehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone, SNC, 13040, Moncrivello, VC, Italy
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