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Elder TA, Verhey LH, Schultz H, Smith ES, Adel JG. Cervical carotid occlusion in acute ischemic stroke: Should we give tPA? Surg Neurol Int 2022; 13:177. [PMID: 35509556 PMCID: PMC9063023 DOI: 10.25259/sni_176_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Acute ischemic stroke (AIS) due to cervical internal carotid artery (cICA) occlusion is challenging to treat, with the lower revascularization rates, higher risk for complications, and poor response to thrombolytic therapy compared to isolated intracranial occlusions. While emergent revascularization through mechanical thrombectomy (MT) improves outcomes, the impact of tissue plasminogen activator (tPA) on outcomes in this subgroup of patients remains unclear. The objective of this study is to report our preliminary experience in treating AIS with cICA occlusions secondary to severe atherosclerotic stenosis and to establish the need for further clinical studies to determine the optimal intervention strategy for these lesions. Methods: Data were collected on patients who presented with acute cICA occlusion who underwent MT and either acute or staged carotid angioplasty and stenting. We compare patients who received tPA to those who did not, analyzing revascularization times, outcomes, and complications between the two populations, and discuss how this influenced our preferred treatment approach. Results: Twenty-one patients met inclusion criteria, seven of who received tPA and 14 did not receive tPA before surgical intervention. Procedural and functional outcomes were similar between the two populations. TPA administration correlated with a higher rate of vessel reocclusion in staged procedures and trended toward higher rates of symptomatic ICH and 90-day mortality. Conclusion: Emergent revascularization with acute cICA stenting carries advantages, but its safety is precluded by tPA administration. We suggest a trial which randomizes patients with cICA occlusions to receiving either tPA or dual antiplatelet therapy before surgical intervention, aiming to ultimately improved outcomes in these patients.
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Affiliation(s)
- Theresa A. Elder
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio,
| | - Leonard H. Verhey
- Department of Clinical Neurosciences, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids,
| | - Haritha Schultz
- Department of Internal Medicine, Central Michigan University College of Medicine,
| | - Eleanor S. Smith
- Department of Neurosurgery, Central Michigan University College of Medicine,
| | - Joseph G. Adel
- Department of Neuroscience, Ascension St Mary’s Hospital, Saginaw, Michigan, United States
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LIANG CHUNCHIEH, PAN LUNGFA, CHEN MINGHSIANG, DENG JIE, YANG DENGHO, LIN CHIHSHENG, PAN LUNGKWANG. TIMING OPTIMIZATION OF HEAD AND NECK CT ANGIOGRAPHY VIA THE INVERSE PROBLEM ALGORITHM: in vivo SURVEY FOR 1001 PATIENTS IN 2020–2021. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421400558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study processed the recent in vivo survey results for over a thousand patients and optimized their neck and head CT angiography triggered timing (CTA-TT) via the inverse problem algorithm, which ensured the maximal ratio of both left and right arterial to upper sinuses (LRA/US). These results are instrumental in examining the ischemic stroke syndromes along the neck and head. These 1001 patients were randomly categorized into test surveyed (802 patients) and verification group (199 patients), then a six factors semi-empirical formula was constructed by the STATISTICA program. The six factors were assigned a patient’s biological data and preset of the CTA facility; namely Age, mean arterial pressure (MAP), heart rate (HR), contrast media dose (CMD), Pre (injected pressure of CMD), and body surface area (BSA). Each factor was normalized into dimensionless values and incorporated into the dataset matrix [Formula: see text] to analyze the coefficient matrix [Formula: see text]. The derived semi-empirical formula closely correlated with experimental data, according to the loss function [Formula: see text], correlation coefficient [Formula: see text], and variance of 0.8965. The formula verification for 199 more patients (verification group) yielded a correlation coefficient [Formula: see text]. Thus, it can be used for the CTA-TT estimation of patients without their preliminary tests, avoiding unnecessary irradiation. The estimated LRA/US was [Formula: see text] for the verification group in this study. A simplified three-factor formula, featuring only age, MAP, and BSA, was also proposed.
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Affiliation(s)
- CHUN-CHIEH LIANG
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
- Division of Neurosurgery, Department of Surgery, Taichung Armed-Forces General Hospital, Taichung, Taiwan, ROC
- Division of Neurosurgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - LUNG-FA PAN
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
- Department of Cardiology, Taichung Armed Forces General Hospital, Taichung 411, Taiwan, ROC
| | - MING-HSIANG CHEN
- Department of Logistics Support Division, BenQ Medical Center, The Affiliated BenQ Hospital of the Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - JIE DENG
- Department of Radiology, BenQ Medical Center, The Affiliated BenQ Hospital of the Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - DENG-HO YANG
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed-Forces General Hospital, Taichung, Taiwan, ROC
- Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - CHIH-SHENG LIN
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
- Department of Radiology, BenQ Medical Center, The Affiliated BenQ Hospital of the Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - LUNG-KWANG PAN
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
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LIN CHIHSHENG, CHEN YUNGFU, DENG JIE, YANG DENGHO, PAN LUNGFA, PAN LUNGKWANG. A SIX-PARAMETER SEMI-QUANTITATIVE ANALYSIS OF 251 PATIENTS FOR THE ENHANCED TRIGGERED TIMING OF HEAD AND NECK CT ANGIOGRAPHY SCANNING VIA THE INVERSE PROBLEM ALGORITHM. J MECH MED BIOL 2020. [DOI: 10.1142/s021951942040045x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this study, the correlation between triggered timing for head and neck CT angiography (TT CTA) scanning and the average of CT values of both left and right arterial to upper sinuses (LRA/US) reaching a maximal ratio was surveyed and explored using the inverse problem algorithm according to a six-factor semi-quantitative analysis of 251 patients. Six risk factors, namely TT CTA, mean arterial pressure (MAP), heart rate (HR), contrast media solution (CMS), given pressure (Pre), and body surface area (BSA) were used to identify a nonlinear first-order regression correlation between projected and actual LRA/US values. The respective 22 terms were derived via the STATISTICA program. In doing so, a customized loss function ([Formula: see text]) was defined according to the total fluctuation between theoretically projected and actual LRA/US values for all 216 patients. Thus, [Formula: see text] individual data points were included in the algorithm to optimize the compromised solution array [[Formula: see text]] of LRA/US values. The results exhibited a close correlation with loss function [Formula: see text], correlation coefficient [Formula: see text], and a 93.13% variance. Another group of 35 patients with similar symptoms was selected to verify the prediction accuracy and exhibited a high coincidence, although the reverse calculation-based correlation between CC CTA and LRA/US was still controversial from a clinical viewpoint. The proposed algorithm is considered quite instrumental in predicting the LRA/US with ischemic stroke symptoms in the CTA examination.
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Affiliation(s)
- CHIH-SHENG LIN
- Department of Radiology, BenQ Medical Center, The Affiliated BenQ Hospital of the Nanjing Medical University, Nanjing, Jiangsu, P. R. China
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
| | - YUNG-FU CHEN
- Department of Dental Technology & Materials Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
- Department of Health Services Administration, China Medical University, Taichung 404, Taiwan, ROC
| | - JIE DENG
- Department of Radiology, BenQ Medical Center, The Affiliated BenQ Hospital of the Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - DENG-HO YANG
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed-Forces General Hospital, Taichung, Taiwan, ROC
- Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - LUNG-FA PAN
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
- Department of Cardiology, Taichung Armed Forces General Hospital, Taichung 411, Taiwan, ROC
| | - LUNG-KWANG PAN
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
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LIN YAHUI, CHIU SHAOWEN, LIN YINGCHE, LIN CHIENCHUNG, PAN LUNGKWANG. INVERSE PROBLEM ALGORITHM APPLICATION TO SEMI-QUANTITATIVE ANALYSIS OF 272 PATIENTS WITH ISCHEMIC STROKE SYMPTOMS: CAROTID STENOSIS RISK ASSESSMENT FOR FIVE RISK FACTORS. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420400217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study proposes the inverse problem algorithm (IPA) with five risk factors applied to the semi-quantitative analysis of carotid stenosis 272 patients with suspected ischemic stroke. The IPA is known to provide a substantiated machine learning-based prediction of the expected outcomes by solving an inverse matrix of variable coefficients. In case of carotid stenosis prediction, such risk factors as patient’s age, mean arterial pressure (MAP), glucose AC, low-density lipoprotein-cholesterol (LDL-C), and C-Reactive protein (CRP) were assessed for the main group of 217 patients. Their results were processed by the STATISTICA program with a customized loss function ([Formula: see text]), yielding the first-order nonlinear semi-empirical formula with 16 terms. The loss function was calculated via the total mismatch between the theoretical predictions and true carotid stenosis cases (%) for all 217 patients. Thus, the carotid stenosis (%) compromised solution array [[Formula: see text]] was optimized using [Formula: see text] individual data points via the proposed algorithm. The results showed a complete regression with loss function [Formula: see text]=2.3543, variance [Formula: see text]=87.46%, and correlation coefficient [Formula: see text]. The reference group of 55 more patients with the same preliminary diagnosis and symptoms was selected to validate the method predictive feasibility, which was found quite satisfactory. The decreasing order of three dominant risk factors was as follows: CRP, glucose AC, and MAP, whereas age and LDL-C weakly influenced the program computation results. The IPA showed a strong convergence by its default characteristic. The reduction of the number of variables in computation deteriorated the prediction accuracy, exhibiting the algorithm’s high sensitivity to the number of variables.
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Affiliation(s)
- YA-HUI LIN
- College of Nursing, Central Taiwan, University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
- Department of Clinical Pharmacy, Taichung Armed Forces General Hospital, Taichung 406, Taiwan, ROC
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
| | - SHAO-WEN CHIU
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
- Healthcare Technology Business Division, Healthcare Department, International Integrated Systems, Inc., Taipei 103, Taiwan, ROC
| | - YING-CHE LIN
- Neurology Department, Taichung Armed Forces General Hospital, Taichung 406, Taiwan, ROC
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, ROC
| | - CHIEN-CHUNG LIN
- College of Nursing, Central Taiwan, University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
- Orthopedic Department, Taichung Armed Forces General Hospital, Taichung 406, Taiwan, ROC
- Department of Orthopedic Surgery Tri-Service General Hospital, National Defense Medical Center Taipei 114, Taiwan, ROC
| | - LUNG-KWANG PAN
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
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Oyama Y, Miyamoto M, Onuki T, Uno T, Ito A, Yamane F, Sakamoto T, Matsuno A. A Case of Intravascular Treatment for Acute Ischemic Stroke with Internal Carotid Artery Stenosis That Developed While Driving. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:313-318. [PMID: 37502175 PMCID: PMC10370597 DOI: 10.5797/jnet.cr.2019-0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 04/19/2020] [Indexed: 07/29/2023]
Abstract
Objective We report a case of acute cerebral infarction that may have been associated with high-energy trauma due to onset while driving. Case Presentation A 67-year-old man had a traffic accident. His neurological symptoms were left hemiplegia and contrast CT revealed right middle cerebral artery occlusion. Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) and intravascular treatment were performed. Right carotid artery angiography demonstrated internal carotid artery stenosis. Middle cerebral artery (MCA) revascularization was performed only by percutaneous transluminal angioplasty (PTA) of the internal carotid artery. Thoracic hemorrhage was observed a few hours after surgery, and hemostasis was performed by thoracotomy. Carotid artery stenting (CAS) was performed 8 days after onset. The patient was transferred to a convalescent rehabilitation hospital. Conclusion Rt-PA and acute CAS were not recommended for cerebral infarction due to traffic accident.
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Affiliation(s)
- Yuta Oyama
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
- Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine, Tokyo, Japan
| | - Michiyuki Miyamoto
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takahiro Onuki
- Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine, Tokyo, Japan
| | - Takeshi Uno
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Akihiro Ito
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Fumitaka Yamane
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine, Tokyo, Japan
| | - Akira Matsuno
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
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