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Saghebdoust S, Qoorchi Moheb Seraj F, Najafi S, Kheradmand D, Mirbolouk MH, Mowla A, Pahlavan H, Sadeghian A, Mortezaei A, Esmaeilzadeh M, Sasannejad P, Zabihyan S, Baharvahdat H. Low-Profile Visualized Intraluminal Support Device for Y-Stent-Assisted Coiling of Wide-Neck Intracranial Aneurysms: A Single-Center Experience. World Neurosurg 2024; 187:e534-e542. [PMID: 38677648 DOI: 10.1016/j.wneu.2024.04.122] [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: 11/13/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The Low-Profile Visualized Intraluminal Support (LVIS) device has been frequently used as an intracranial stent for treating intracranial aneurysms. However, the feasibility and efficacy of LVIS devices in Y-stent-assisted coiling (Y-SAC) have remained contentious. This study aimed to evaluate long-term angiographic and clinical outcomes of Y-SAC using LVIS devices. METHODS We retrospectively reviewed the clinical presentation and angiography data of patients treated with Y-SAC using LVIS stents. The vascular angle geometry between the parent and the 2 branch vessels, before and after stent deployment and after coiling, were analyzed. Based on the Raymond-Roy Occlusion Classification (RROC), aneurysm occlusion status was classified. Clinical outcomes were assessed using the modified Rankin Scale. RESULTS Forty patients with 40 aneurysms were included in this study. Immediate postprocedural angiograms showed complete/near-complete occlusion (RROC 1 and 2) in 31 aneurysms (77.5%). The long-term follow-up angiographic studies were available in 32 patients and showed RROC class 1 and 2 in 93.8% of patients. Y-SAC with LVIS devices significantly decreased the angle between the bifurcation branches from 171.90° ± 48.0° (standard deviation) to 130.21° ± 46.3° (standard deviation) (P < 0.0001). Periprocedural complications occurred in 5 patients (12.5%) including 4 in-stent thromboses (10.5%). Thirty-six patients (90.0%) had favorable clinical outcomes at the final follow-up. Univariate analysis showed that World Federation of Neurological Societies grade 3-5, thickness of subarachnoid hemorrhage on head computed tomography, intraprocedural complications, and in-stent thrombosis were predictors of poor outcome. CONCLUSIONS Y-SAC using the LVIS device for intracranial bifurcation aneurysms is a feasible and relatively safe procedure with favorable long-term angiographic and clinical outcomes.
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Affiliation(s)
- Sajjad Saghebdoust
- Neuroendovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farid Qoorchi Moheb Seraj
- Neuroendovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sajjad Najafi
- Neuroendovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; Neurosurgical Department, Mazandaran University of Medical Sciences, Sari, Iran
| | - Daniel Kheradmand
- Neuroendovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Hashem Pahlavan
- Neuroendovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Sadeghian
- Neuroendovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Mortezaei
- Neuroendovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Esmaeilzadeh
- Neuroendovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Payam Sasannejad
- Neuroendovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Zabihyan
- Neuroendovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Humain Baharvahdat
- Neuroendovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.
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Chen S, Kang H, Wang D, Li Y, Aikebaier J, Li Y, Wu X, Guan Y, Zhang Y. Neuroform atlas stent treatment for 533 intracranial aneurysms in a large Chinese cohort: complication risk factor analysis. BMC Neurol 2024; 24:195. [PMID: 38858627 PMCID: PMC11163780 DOI: 10.1186/s12883-024-03695-z] [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: 12/14/2023] [Accepted: 05/29/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND The newest generation of Neuroform Atlas stent™ (Stryker, Fremont, California) represents a recent advance of cerebral laser-cut microstents for the treatment of intracranial wide-necked aneurysms, and postoperative complications have been observed among Western patients. We assessed predictors of complications, morbidity, and unfavourable outcomes in a large cohort of patients with aneurysms that were treated with Neuroform Atlas stents in China. METHODS This retrospective study included subjects who were treated with Atlas stents in China from November 2020 to January 2022. RESULTS A total of 522 consecutive patients (mean age, 58.9 ± 9.9 years; female, 65.3% [341/522]) with 533 aneurysms were included in the study. In the early postoperative period, the neurological morbidity rate was 7.3% (38/522), the ischaemic stroke rate was 5.0% (26/522), the aneurysm rupture subarachnoid haemorrhage rate was 2.3% (12/522), and the mRS score deterioration rate was 5.4% (28/522). The mortality rate was 0.8% (4/522) in the postoperative period. The rate of neurological morbidity during the follow-up period was 1.2% (6/486). In the multifactor prediction analysis, cerebral infarction, Hunt-Hess grade (3-5), procedure duration, stent length and coil protrusion into the parent artery were found to be independent predictors of neurologic morbidity. The procedure duration, stent length and coil protrusion into the parent artery were found to be independent predictors of mRS score deterioration. CONCLUSIONS The incidence of SCA (stent-assisted coiling)-related complications with the Atlas stent in this study population was comparable to that in Western populations. We identified the procedure duration and stent length as novel independent predictors of SCA-related ischaemic stroke, neurological morbidity, and mRS score deterioration among the Chinese population.
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Affiliation(s)
- Shibao Chen
- Department of Neurology, People's Hospital of Bayingoleng Mongolia Autonomous Prefecture, No. 41 Renmin East Road, Korla, 841000, Xinjiang, China
| | - Huibin Kang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dili Wang
- People's Hospital of Jiangxia District, Wuhan, China
| | - Yan Li
- Third People's Hospital of Jinan, Jinan, China
| | - Jamali Aikebaier
- Department of Neurology, People's Hospital of Bayingoleng Mongolia Autonomous Prefecture, No. 41 Renmin East Road, Korla, 841000, Xinjiang, China
| | - Yabo Li
- Department of Neurology, People's Hospital of Bayingoleng Mongolia Autonomous Prefecture, No. 41 Renmin East Road, Korla, 841000, Xinjiang, China
| | - Xinshan Wu
- Department of Neurology, People's Hospital of Bayingoleng Mongolia Autonomous Prefecture, No. 41 Renmin East Road, Korla, 841000, Xinjiang, China
| | - Yuhua Guan
- Department of Neurology, People's Hospital of Bayingoleng Mongolia Autonomous Prefecture, No. 41 Renmin East Road, Korla, 841000, Xinjiang, China.
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Fengtai District, Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Beijing, 100050, China.
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Shen Y, Ni H, Li J, Jia Z, Cao Y, Shi H, Zhao L, Liu S. Initial and mid-term results of LEO Baby stent-assisted coiling of intracranial aneurysms located in small arteries: A single-center experience with 131 consecutive patients. Front Neurol 2022; 13:990532. [PMID: 36176553 PMCID: PMC9513362 DOI: 10.3389/fneur.2022.990532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purpose Low-profile intracranial stents such as the LEO Baby stents are considered to be advantageous for the treatment of intracranial aneurysms originating from small arteries. This study aimed to evaluate the initial and mid-term clinical and angiographic results of LEO Baby stents in stent-assisted coiling of intracranial aneurysms with small parent arteries (<2.5 mm). Methods We performed a retrospective study to identify 131 patients with aneurysms arising from small parent arteries treated with Leo Baby stent-assisted coiling in a single institution between October 2018 and June 2021. We assessed the immediate and progressive aneurysm occlusion rates, procedure-related complications, and clinical outcomes. Results A total of 131 patients with 135 aneurysms were identified, including 65 (48.1%) cases of acutely ruptured aneurysms. Technical success was achieved in all cases (100%). The immediate angiography showed complete occlusion in 111 aneurysms (82.2%), neck remnants in 19 (14.1%), and residual sac in 5 (3.7%). Procedure-related complications occurred in 14 cases (10.3%), including 13 (9.6%) thromboembolic complications and 1 (0.7%) hemorrhagic complication. Six-month follow-up angiography was achieved in 106 (78.5%) aneurysms, which showed complete occlusion in 102 (96.2%) aneurysms, neck remnants in 2 (1.9%), and residual sac in 2 (1.9%). Clinical follow-up was available in all patients with a median duration of 6.8 months, and favorable clinical outcomes (modified Rankin Scale score: 0–2) reached 91.6%. The mortality rate was 4.6%. Conclusion Our results demonstrate that stent-assisted coiling of intracranial aneurysms located on small arteries using LEO Baby stents is technically feasible, highly effective, and has midterm durability in aneurysmal occlusion.
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Yıldırım İO, Kolu M, Durak MA, Tetik B, Paşahan R, Gürbüz Ş, Saraç K. Y-stent assisted coiling of ruptured wide neck intracranial aneurysm in the acute phase. Interv Neuroradiol 2021; 27:638-647. [PMID: 33779378 DOI: 10.1177/15910199211005331] [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: 11/16/2022] Open
Abstract
BACKGROUND The objective of the present study is to analyze the outcomes of patients with subarachnoid hemorrhage (SAH) in the acute phase after treatment with Y-stent-assisted coiling (YSAC) embolization. METHODS This retrospective study assessed of 30 patients with acutely ruptured wide-neck aneurysms following YSAC treatment between April 2013 and October 2019. The demographic data, aneurysm occlusion grade, procedural and periprocedural complications, and clinical outcomes were assessed. RESULTS The procedure was completed in 30 cases (90.1%) and technical failure occurred in 3 cases (9.1%). Immediate control angiography revealed that total occlusion Raymond-Ray Class 1 (RR1) was achieved in 21 (70%), neck filling (RR2) in eight (26.6%) and sac filling (RR1) in one (3.3%) aneurysm. Upon angiographic follow-up, RR1 occlusion was observed in 15 (71.4%) patients, RR2 in three (14.3%) patients and RR3 in three (14.3%) patients. In-stent thrombus developed in five (16.6%) patients; procedural ischemic events were observed in four (13.3%) patients; and two (6.6%) patients were symptomatic. A periprocedural asymptomatic intracranial hemorrhage was detected in two patients. At discharge, 17 (56.6%) patients were in good clinical condition, six (20%) were in a severe disability condition, and seven (23.3%) patients had died. At the final follow-up visit (mean: 18.9 months), 16 (76,2%) of 21 patients were in a good clinical condition and five (23.8%) had severe disabilities. CONCLUSIONS Y-stent assisted coiling in might be a feasible and promising option for treatment in acute phase in selected wide-necked ruptured intracranial aneurysms.
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Affiliation(s)
| | - Mehmet Kolu
- Department of Radiology, Harran University School of Medicine, Şanlıurfa, Turkey
| | - Mehmet Akif Durak
- Department of Neurosurgery, Inonu University School of Medicine, Malatya, Turkey
| | - Bora Tetik
- Department of Neurosurgery, Inonu University School of Medicine, Malatya, Turkey
| | - Ramazan Paşahan
- Department of Neurosurgery, Inonu University School of Medicine, Malatya, Turkey
| | - Şükrü Gürbüz
- Department of Emergency, Inonu University School of Medicine, Malatya, Turkey
| | - Kaya Saraç
- Department of Radiology, Inonu University School of Medicine, Malatya, Turkey
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Zarmehri B, Shahi B, Rahmani S, Dehghan Tafti F, Foroughian M. Association of platelet count and mean platelet volume (MPV) index with types of stroke. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 11:398-402. [PMID: 33680381 PMCID: PMC7911760 DOI: 10.22088/cjim.11.4.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Stroke is known to be the third most prominent cause of death in the developing countries and the most common debilitating neurologic disease. This study aimed to investigate the association of platelet count (PC) and mean platelet volume (MPV) index with various stroke types. Methods: This cross-sectional study was carried out on patients over the age of 18 years who presented with signs and symptoms of the first acute stroke. Exclusion criteria were underlying chronic liver or renal disease and the time more than 6 hours from symptom initiation, hematological and infectious disorders in patients. After recording of demographic data, a complete blood cell count (CBC) test was performed. Results: From 150 patients, who enrolled in the study, 54.7% of patients were males. The initial brain CT scan was normal in 13 (8.7%) patients and showed evidence of brain infarction and intracranial hemorrhage in 84 (56%) and 53 (35.3%) patients respectively. Patients with intracranial hemorrhage had significantly higher mean of MPV index than the patients with normal brain-CT scan and patients with evidence of brain infarction (p<0.001). Conclusion: The MVP index can be a predictor of the type of hemorrhagic or ischemic finding in emergency CT scan in stroke patients. This relationship may help to better understand the physiopathologic role of platelets in the development of stroke (hemorrhagic or ischemic), but will not replace cerebral computed tomography to diagnose the type of stroke, or it may not initiate treatment for hemorrhagic stroke.
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Affiliation(s)
- Bahram Zarmehri
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Shahi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shaghayegh Rahmani
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mahdi Foroughian
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Russo R, Bradac GB, Castellan L, Gallesio I, Garbossa D, Iannucci G, Mardighian D, Menozzi R, Pitrone A, Romano G, Venturi F, Bergui M. Neuroform Atlas stent-assisted coiling of ruptured intracranial aneurysms: A multicenter study. J Neuroradiol 2020; 48:479-485. [PMID: 32205256 DOI: 10.1016/j.neurad.2020.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess efficacy, safety and to discuss optimal medical therapy of stent-assisted coiling of ruptured intracranial aneurysms. METHODS Ruptured intracranial aneurysms treated with stent-assisted coiling in eight different institutions were retrospectively reviewed. Medical treatment regimens varied among the centers, mainly regarding heparin administration and post-procedural single or double antiplatelet therapy. Clinical and angiographic results, including complications and outcomes were analyzed and related to the different therapies. RESULTS Sixty-one consecutive patients (male/female 23/38), aged 59.1 years (36-86) underwent stent-assisted coiling for ruptured intracranial aneurysm without antiplatelet pre-medication. Intravenous acetylsalicylic acid (ASA) 500mg was administered to all patients immediately after stent deployment. At the same time heparin was given as bolus in 15 patients (24.6%) as part of local protocol. Intravenous glycoprotein 2b/3a inhibitors (antiGP2b3a) were used as bail-out therapy for stent thrombosis. Stent thrombosis occurred in 22 patients (36.1%), of which 4 (6.5%) lead to incomplete and 18 (29.6) to complete occlusion of the stent. Heparin administration had no effect on thrombosis rate. Thrombosis resolution occurred in all cases with intravenous antiGP2b3a (7 tirofiban, 15 abciximab), without increasing overall complication rate. Single antiplatelet therapy with ASA (28 patients, 45.9%) or double antiplatelet therapy including ASA and clopidogrel (33 patients, 54.1%) were administered after procedure, depending on local protocols and on neurointerventionists' experience. Overall complication rate, including ischemia and hemorrhage was higher in patients in which only ASA was administered (21.4% vs. 12.1%). No late stent thrombosis was seen, regardless of whether a single or double antiplatelet regimen was used. Nevertheless, the small sample size suggests caution in interpreting these results. Moreover, a possible bias may arise from the decision whether to modify the maintenance therapy or not depending on the severity of the intracranial hemorrhage in a case-by-case assessment. At three months, 34 out of 38 patients with HH grade 1-2 (89.4%), and 11 out of 23 with Hunt-Hess grade of 3-4 (47.8%) were independent (Modified Ranking Scale 0-2). CONCLUSION Stent assisted coiling of ruptured intracranial aneurysms is a feasible option when simple coiling is not possible. Optimal medical treatment is still controversial because balance between hemorrhagic and ischemic risks is difficult to evaluate. In our series, heparin bolus had no effect on subsequent stent thrombosis. In all cases peri-operative stent thrombosis was successfully managed using bail-out intravenous antiGP2b3a, which did not increase post-procedural hemorrhage rates. A non-significant trend towards increased complications rate was noticed in patients treated with single antiplatelet therapy versus double antiplatelet therapy.
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Affiliation(s)
- Riccardo Russo
- Department of Surgical Sciences, Radiology Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, corso bramante 88, Turin, Italy.
| | - Gianni Boris Bradac
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
| | - Lucio Castellan
- Neuroradiology Unit, IRCCS San Martino University Hospital, Genoa, Italy
| | - Ivan Gallesio
- Department of Radiology, Neuroradiological Unit, Azienda ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | - Diego Garbossa
- Department of Neuroscience, Neurosurgery Section, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
| | | | | | - Roberto Menozzi
- Interventional Neuroradiology Unit, Azienda Ospedaliera Universitaria, Parma, Italy
| | - Antonio Pitrone
- Neuroradiology Unit, Biomedical Sciences and of Morphologic and Functional Images, AOU Policlinico G. Martino, Messina, Italy
| | - Giuseppe Romano
- Neuroradiology Unit, S. Croce e Carle Hospital, Cuneo, Italy
| | - Fabrizio Venturi
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
| | - Mauro Bergui
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
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Chen Z, Mo J, Xu J, Qin H, Zheng H, Pan Y, Meng X, Jing J, Xiang X, Wang Y. Risk Profile of Ischemic Stroke Caused by Small-Artery Occlusion vs. Deep Intracerebral Hemorrhage. Front Neurol 2019; 10:1213. [PMID: 31827458 PMCID: PMC6890715 DOI: 10.3389/fneur.2019.01213] [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: 08/18/2019] [Accepted: 10/30/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Small-artery occlusion (SAO) subtype accounts for a quarter of the cases of ischemic stroke and is mainly caused by pathological changes in cerebral small vessels, which also involve in deep intracerebral hemorrhage (dICH). However, the factors that drive some cases to SAO and others to dICH remained incompletely defined. Material and Methods: This study is a cross-sectional study from the China National Stroke Registry that included consecutive patients with ischemic stroke or intracerebral hemorrhage between August 2007 and September 2008. We compared the risk profile between the two subgroups using multivariable logistic regression. Results: A total of 1,135 patients with SAO stroke and 1,125 dICH patients were included for analyses. Generally, patients with SAO stroke were more likely to be male (odds ratio = 0.74, confidence interval = 0.58-0.94) and have diabetes (0.30, 0.22-0.40), higher atherogenic lipid profiles, higher body mass index (0.96, 0.94-0.99), higher waist/height ratio (0.12, 0.03-0.48), higher platelet count (0.84, 0.77-0.91), and higher proportion of abnormal estimated glomerular filtration rate (<90, ml/min/1.73 m2) (0.77, 0.62-0.95). Conversely, patients with dICH were more likely to have higher blood pressure parameters, inflammation levels (white blood cell count: 1.61, 1.48-1.76; high sensitivity C-reactive protein: 2.07, 1.36-3.16), and high-density lipoprotein-c (1.57, 1.25-1.98). Conclusions: The risk profile between SAO stroke and dICH were different. Furthermore, despite of traditional indexes, waist/height ratio, platelet count, inflammation levels, lipid profile, and estimated glomerular filtration rate also play important roles in driving arteriolosclerosis into opposite ends.
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Affiliation(s)
- Zimo Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jinglin Mo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jie Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Haiqiang Qin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Huaguang Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xianglong Xiang
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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8
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Sadeghi F, Kovács S, Zsóri KS, Csiki Z, Bereczky Z, Shemirani AH. Platelet count and mean volume in acute stroke: a systematic review and meta-analysis. Platelets 2019; 31:731-739. [PMID: 31657263 DOI: 10.1080/09537104.2019.1680826] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Changes of mean platelet volume (MPV) and platelet count (PC) could be a marker or a predictor of acute stroke (AS). We conducted a systematic review and meta-analysis of the published literature on the reporting of MPV and PC in AS. Studies were included in accordance with Patient Population or Problem, Intervention, Comparison, Outcomes, and Setting framework. The PRISMA strategy was used to report findings. Risk of bias was assessed with the Newcastle-Ottawa Scale. We included 34 eligible articles retrieved from the literature. PC was significantly lower in AS patients [standardized mean difference (SMD) = - 0.30, (95% CI: - 0.49 to - 0.11), N = 2492, P = .002] compared with controls (N = 3615). The MPV was significantly higher [SMD = 0.52 (95% CI: 0.28-0.76), N = 2739, P < .001] compared with controls (N = 3810). Subgroup analyses showed significantly lower PC in both ischemic stroke (Difference SMD = -0.18, 95% CI: -0.35-0.01) and hemorrhagic stroke (-0.94, -1.62 to -0.25), but only samples by citrate anticoagulant showed significantly lower result for patients compared to controls (-0.36, -0.68 to -0.04). Ischemic stroke patients had higher MPV (0.57, 0.31-0.83), and samples by Ethylenediaminetetraacetic acid (EDTA) anticoagulant showed significantly higher result for patients compared to controls (0.86, 0.55-1.17). PC and MPV appeared to be significantly different between patients with AS and control populations. MPV was significantly higher in ischemic stroke and PC was significantly lower in both ischemic and hemorrhagic strokes. These characteristics might be related to AS and associated with it. It is advisable to pay attention to elapsed time between phlebotomy and hematology analysis, anticoagulant and hemocytometer types in AS. SYSTEMATIC REVIEW REGISTRATION This meta-analysis is registered on the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42017067864 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=67864).
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Affiliation(s)
- Farzaneh Sadeghi
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen , Debrecen, Hungary
| | - Sándor Kovács
- Department of Research Methodology and Statistics, Institute of Sectorial Economics and Methodology, Faculty of Economics and Business, Debrecen University , Debrecen, Hungary
| | | | - Zoltán Csiki
- Department of Medicine, Debrecen University , Debrecen, Hungary
| | - Zsuzsanna Bereczky
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen , Debrecen, Hungary
| | - Amir Houshang Shemirani
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen , Debrecen, Hungary.,Central Laboratory, Erzsébet hospital , Sátoraljaújhely, Hungary
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9
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Lauridsen SV, Hvas AM, Sandgaard E, Gyldenholm T, Rahbek C, Hjort N, Tønnesen EK, Hvas CL. Coagulation Profile after Spontaneous Intracerebral Hemorrhage: A Cohort Study. J Stroke Cerebrovasc Dis 2018; 27:2951-2961. [PMID: 30072172 DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/14/2018] [Accepted: 06/17/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) causes death or disability and the incidence increases with age. Knowledge of acute hemostatic function in patients with ICH without anticoagulant and antiplatelet therapy is sparse. Increased knowledge of the coagulation profile in the acute phase of ICH could improve acute treatment and recovery. We investigated coagulation at admission and changes in coagulation during the first 24hours after symptom onset. METHODS Enrolled were 41 ICH patients without anticoagulant or antiplatelet therapy admitted to Aarhus University Hospital, Denmark. Blood samples were collected at admission, 6, and 24hours after symptom onset. Thromboelastometry (ROTEM), thrombin generation, and thrombin-antithrombin (TAT) complex were analyzed. Clinical outcome was evaluated using the National Institute of Health Stroke Scale, the Modified Rankin Score, and mortality. RESULTS At admission, compared with healthy individuals, ICH patients had increased maximum clot firmness (EXTEM P < .0001; INTEM P < .0001; FIBTEM P < .0001), increased platelet maximum clot elasticity (P < .0001) in ROTEM, higher peak thrombin (P < .0001) and endogenous thrombin potential (P = .01) in thrombin generation, and elevated TAT complex levels. During 24hours after significantly, while thrombin generation showed decreased peak thrombin (P < .0001) and endogenous thrombin potential (P < .0001). Coagulation test results did not differ between patients when stratified according to clinical outcome. CONCLUSIONS ICH patients without anticoagulant or antiplatelet therapy demonstrated activated coagulation at admission and within 24hours after symptom onset.
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Affiliation(s)
| | - Anne-Mette Hvas
- Center for Hemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University, Hospital, Aarhus, Denmark
| | - Emilie Sandgaard
- Center for Hemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University, Hospital, Aarhus, Denmark
| | - Tua Gyldenholm
- Center for Hemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University, Hospital, Aarhus, Denmark
| | - Christian Rahbek
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Hjort
- Department of Neurology, Danish Stroke Center, Aarhus University Hospital, Aarhus, Denmark
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Ho MJ, Göricke SL, Mummel P, Mönninghoff C, Wrede K, Wanke I. Stent-assisted treatment of ruptured intracranial aneurysms in the acute phase: A single center experience. eNeurologicalSci 2018; 10:31-36. [PMID: 29736426 PMCID: PMC5933999 DOI: 10.1016/j.ensci.2018.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction The purpose of this study was to analyze the results of patients with ruptured aneurysms who were treated with a specific microstent in the acute phase of subarachnoid hemorrhage. Methods Data from patients with acutely-ruptured intracranial aneurysm treated with the Neuroform stent in the period between 2003 and 2016 were retrospectively assessed, addressing aneurysm occlusion and clinical outcome with a focus on periprocedural complications. Results Twenty-nine consecutive patients with ruptured intracranial aneurysms were included in the analysis. Periprocedural hemorrhagic complications were stated in six patients, leading to death in four. Thromboembolic complications were observed in seven patients, among whom only one affected the clinical outcome with death due to basilar thrombosis. Immediate complete occlusion and occlusion with residual neck was achieved in 79.3% of cases. Conclusion Stent-assisted coiling of acutely-ruptured aneurysms achieves good immediate aneurysm occlusion. Rates of intra- and periprocedural adverse events observed in this series were significant, but did not translate to corresponding morbidity and mortality in all cases. The retrospective analysis did not allow assessing the overall risks of endovascular therapy with stent use in ruptured and complex aneurysm when compared to the overall risks with other alternative options. SAC of acutely ruptured aneurysms achieves good immediate aneurysm occlusion. Adverse events were frequent, but did not translate to morbidity and mortality in all cases. SAC was only applied when alternative strategies would not be considered safe and sufficient.
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Key Words
- AComA, Anterior communicating artery
- AICA, anterior inferior cerebellar artery
- Aneurysm treatment
- BA, Basilar artery
- Cerebral ruptured aneurysm
- DSA, Digital subtraction angiography
- DWI, Diffusion-weighted imaging
- EVD, External ventricular drainage
- HH, Hunt and Hess
- Hemorrhagic complications
- ICA, Internal carotid artery
- MR, Magnetic resonance
- PICA, Posterior inferior cerebellar artery
- PcomA, Posterior communicating artery
- Stent assisted coil embolization
- Subarachnoid hemorrhage
- TOF, Time of flight
- VA, Vertebral artery
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Affiliation(s)
- Michael J Ho
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Sophia L Göricke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Petra Mummel
- Department of Neurology, University Hospital of Essen, Germany
| | - Christoph Mönninghoff
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital Essen, Germany
| | - Isabel Wanke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.,Klinik Hirslanden, Neuroradiology, Zurich, Switzerland
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11
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Bahloul M, Regaieg K, Chtara K, Turki O, Baccouch N, Chaari A, Bouaziz M. [Posttraumatic thromboembolic complications: Incidence, risk factors, pathophysiology and prevention]. Ann Cardiol Angeiol (Paris) 2017; 66:92-101. [PMID: 28110934 DOI: 10.1016/j.ancard.2016.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 12/08/2016] [Indexed: 06/06/2023]
Abstract
Venous thromboembolism (VTE) remains a major challenge in critically ill patients. Subjects admitted in intensive care unit (ICU), in particular trauma patients, are at high-risk for both deep vein thrombosis (DVT) and pulmonary embolism (PE). The rate of symptomatic PE in injured patients has been reported previously ranging from 1 to 6%. The high incidence of posttraumatic venous thromboembolic events is well known. In fact, major trauma is a hypercoagulable state. Several factors placing the individual patient at a higher risk for the development of DVT and PE have been suggested: high ISS score, meningeal hemorrhage and spinal cord injuries have frequently been reported as a significant risk factor for VTEs after trauma. Posttraumatic pulmonary embolism traditionally occurs after a period of at least 5 days from trauma. The prevention can reduce the incidence and mortality associated with the pulmonary embolism if it is effective. There is no consensus is now available about the prevention of venous thromboembolism in trauma patients.
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Affiliation(s)
- M Bahloul
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie.
| | - K Regaieg
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - K Chtara
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - O Turki
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - N Baccouch
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - A Chaari
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - M Bouaziz
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
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Du J, Wang Q, He B, Liu P, Chen JY, Quan H, Ma X. Association of mean platelet volume and platelet count with the development and prognosis of ischemic and hemorrhagic stroke. Int J Lab Hematol 2016; 38:233-9. [PMID: 26992440 DOI: 10.1111/ijlh.12474] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 12/31/2015] [Indexed: 11/30/2022]
Affiliation(s)
- J. Du
- Department of Neurology; The Nuclear Industry 416 Hospital; Chengdu Sichuan China
- Department of Health and Social Behavior; West China School of Public Health, Sichuan University; Chengdu Sichuan China
| | - Q. Wang
- Department of Neurology; The Nuclear Industry 416 Hospital; Chengdu Sichuan China
| | - B. He
- Department of Health and Social Behavior; West China School of Public Health, Sichuan University; Chengdu Sichuan China
| | - P. Liu
- Department of Health and Social Behavior; West China School of Public Health, Sichuan University; Chengdu Sichuan China
| | - J.-Y. Chen
- Department of Health and Social Behavior; West China School of Public Health, Sichuan University; Chengdu Sichuan China
| | - H. Quan
- Department of Neurology; The Nuclear Industry 416 Hospital; Chengdu Sichuan China
| | - X. Ma
- Department of Neurology; The Nuclear Industry 416 Hospital; Chengdu Sichuan China
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The Predictor of Mortality within Six-Months in Patients with Spontaneous Cerebellar Hemorrhage: A Retrospective Study. PLoS One 2015; 10:e0132975. [PMID: 26186721 PMCID: PMC4506143 DOI: 10.1371/journal.pone.0132975] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/19/2015] [Indexed: 12/19/2022] Open
Abstract
Background and Purpose The mortality rate of cerebellar hemorrhage (CH) is generally higher than other types of intracranial hemorrhage. Recently, the increased survey rate of CH has come from improved clinical imaging and earlier surgical intervention. Hence, the predictors of intermittent- (1 to 6 months) and long-term (> 6months) mortality are clinically practical use for educational and therapeutic decisions. Unfortunately, the factors predictive mortality within six-month had not yet been systematically investigated. Methods Seventy-two patients with acute spontaneous CH were retrospectively analyzed. The patients were divided into the six-month mortality group (n = 21, died within 6 months after CH onset) and survival group (n = 51, survived beyond 6 months). The independent predictors of six-month mortality were investigated by multivariate Cox proportional hazards regression. Results The radiological brainstem compression (hazard ratios = 23.5; p < 0.001) was independent predictor of mortality within six-month after CH onset. The median onset time of six-month mortality was 5 days in patients with brainstem compression (p < 0.001) and the hazard ratios for the onset time was 13.1 compared with those without brainstem compression (95% CI, 4.7 to 36.3, p < 0.001). Conclusions We report the first study that radiological brainstem compression predicted the mortality within six-month after onset of CH. Patients with radiological brainstem compression were about 23 times more likely to die within 6 months after CH than those without radiological brainstem compression.
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Lin CY, Chang CY, Sun CH, Li TY, Chen LC, Chang ST, Wu YT. Platelet count and early outcome in patients with spontaneous cerebellar hemorrhage: a retrospective study. PLoS One 2015; 10:e0119109. [PMID: 25781880 PMCID: PMC4364557 DOI: 10.1371/journal.pone.0119109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 01/28/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The importance of coagulation, hematology, and biochemical variables have been investigated in the stroke population but have not been systemically surveyed in cerebellar hemorrhage (CH) population. The aim of the study was to explore the predictive value of these factors for early outcome in this population. MATERIALS AND METHODS Eighty patients with acute spontaneous CH were retrospectively analyzed. Clinical and laboratory data were collected on admission for analysis. The patients were divided by Glasgow outcome scale (GOS) score at discharge into the good outcome group (GOS score 4 or 5) and the poor outcome group (GOS score 1, 2, or 3). The association between early outcome and clinical or laboratory variables were investigated by binary logistic regression. RESULTS There were 46 (57.5%) patients in the poor outcome group and 34 (42.5%) in the good outcome group. The platelet count (PC) was significantly lower in the poor outcome group (187.3 ± 53.0 × 10(9)/l) compared with good outcome group (244.9 ± 63.9 × 10(9)/l) (p < 0.001). Moreover, PC (OR 0.97; p = 0.004) was the strong predictor with poor early outcome. CONCLUSIONS We firstly show that lower PC is the independent predictor for poor early outcome in patients with spontaneous CH.
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Affiliation(s)
- Ching-Yueh Lin
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan East Road, Neihu District, Taipei, Taiwan
| | - Chih-Ya Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan East Road, Neihu District, Taipei, Taiwan
| | - Chia-Hung Sun
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan East Road, Neihu District, Taipei, Taiwan
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan East Road, Neihu District, Taipei, Taiwan
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan East Road, Neihu District, Taipei, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan East Road, Neihu District, Taipei, Taiwan
- Department of Rehabilitation, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung, Taiwan
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan East Road, Neihu District, Taipei, Taiwan
- * E-mail:
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Kawano-Castillo J, Ward E, Elliott A, Wetzel J, Hassler A, McDonald M, Parker SA, Archeval-Lao J, Tremont C, Cai C, Pivalizza E, Rahbar MH, Grotta JC. Thrombelastography detects possible coagulation disturbance in patients with intracerebral hemorrhage with hematoma enlargement. Stroke 2014; 45:683-8. [PMID: 24425123 PMCID: PMC4115455 DOI: 10.1161/strokeaha.113.003826] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage (ICH) has high morbidity, and hematoma enlargement (HE) causes worse outcome. Thrombelastography (TEG) measures the dynamics of clot formation and dissolution, and might be useful for assessing bleeding risk. We used TEG to detect changes in clotting in patients with and without HE after ICH. METHODS This prospective study included 64 patients with spontaneous ICH admitted from 2009 to 2013. TEG was performed within 6 hours of symptom onset and after 36 hours. Brain imaging was obtained at baseline and at 36±12 hours, and HE was defined as total volume increase>6 cc or >33%. TEG was also obtained from 57 controls. RESULTS Compared with controls, patients with ICH demonstrated faster and stronger clot formation; shorter R and delta (P<0.0001) at baseline; and higher MA and G (P<0.0001) at 36 hours; 11 patients had HE. After controlling for potential confounders, baseline K and delta were longer in HE+ compared with HE- patients, indicating that HE+ patients had slower clot formation (P<0.05). TEG was not different between HE+ and HE- patients at 36 hours. CONCLUSIONS TEG may detect important coagulation changes in patients with ICH. Clotting may be faster and stronger in immediate response to ICH, and a less robust response may be associated with HE. These findings deserve further investigation.
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Affiliation(s)
- Jorge Kawano-Castillo
- From the Department of Neurology, The University of Texas Medical School, Houston (J.K.-C., E.W., A.E., J.W., A.H., M.M., S.A.P., J.A.-L., C.T., E.P., J.C.G.); and Center for Clinical and Translational Sciences, University of Texas at Houston (C.C., M.H.R.)
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Zheng HW, Wang YL, Lin JX, Li N, Zhao XQ, Liu GF, Liu LP, Jiao Y, Gu WK, Wang DZ, Wang YJ. Circulating MicroRNAs as potential risk biomarkers for hematoma enlargement after intracerebral hemorrhage. CNS Neurosci Ther 2013. [PMID: 23190933 DOI: 10.1111/cns.12019] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE MicroRNAs have recently been shown to regulate the downstream bioprocesses of intracerebral hemorrhage. The aim of this study was to investigate whether miRNAs can be used as biomarkers to predict secondary hematoma enlargement (HE) in patients with ICH. METHODS Consecutively, 79 ICH patients admitted within 6 h of symptom onset and 30 healthy individuals were enrolled in this study. Whole-genome miRNA expression profiles were generated in 32 patients (HE/non-HE: 14/18). Representative differentially expressed miRNAs were measured in all cases (HE/non-HE: 30/49) and normal controls (n = 30) by real-time PCR. RESULTS Thirty miRNAs showed differential expressions in the plasma samples from patients with HE as compared with the non-HE controls. Compared to the hierarchical cluster analysis with all probes on microarray, all patients were separated into two main branches with only four exceptions by 30 differentially expressed miRNAs, improving the overall accuracy from 47.62 to 77.78% in the HE and 72.73 to 100% in the non-HE group. Further support vector machine (SVM) test can discriminate the two groups with 100% accuracy with 10 differentially expressed miRNAs. CONCLUSIONS We demonstrated that multiple miRNAs are differentially expressed in the plasma of ICH patients with or without HE and may serve as circulating biomarkers for predicting HE after ICH.
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Affiliation(s)
- Hong-Wei Zheng
- Department of Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China
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Turner JD, Mammis A, Prestigiacomo CJ. Erythropoietin for the Treatment of Subarachnoid Hemorrhage: A Review. World Neurosurg 2010; 73:500-7. [DOI: 10.1016/j.wneu.2010.02.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 02/10/2010] [Indexed: 12/20/2022]
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Mayda-Domaç F, Mısırlı H, Yılmaz M. Prognostic Role of Mean Platelet Volume and Platelet Count in Ischemic and Hemorrhagic Stroke. J Stroke Cerebrovasc Dis 2010; 19:66-72. [DOI: 10.1016/j.jstrokecerebrovasdis.2009.03.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 03/06/2009] [Indexed: 12/12/2022] Open
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