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Qi S, Shi M, Li C, Song K, Zhou J, Yue F, Zhang W, Wang S. Associations between NIHSS sub-item scores and prognosis and intracranial hemorrhage after endovascular therapy for acute anterior circulation ischemic stroke. Front Neurol 2024; 14:1320055. [PMID: 38259652 PMCID: PMC10800981 DOI: 10.3389/fneur.2023.1320055] [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: 10/11/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose The relationship between sub-item scores on the National Institutes of Health Stroke Scale (NIHSS) scores and prognosis and intracranial hemorrhage in patients with acute ischemic stroke undergoing endovascular treatment (EVT) has been insufficiently studied. The aim of this study was to investigate the correlation between NIHSS sub-item scores, prognosis, and intracranial hemorrhage. Methods This study included patients with acute anterior circulation ischemic stroke undergoing EVT between February 2019 and April 2022. The outcomes included functional independence, defined as a modified Rankin Scale (mRS) score ≤ 2 at 3 months after EVT, intracranial hemorrhage within 24 h after EVT, and mortality within 3 months. A multivariate regression analysis was performed, including NIHSS sub-item scores and other adjusted variables. Results A total of 568 patients were enrolled. Of the 568 patients, 239 (45%) achieved functional independence at 3 months after EVT. The median age in this group was 63 years (IQR 52-69) and 176 (73.6%) were male patients. Intracranial hemorrhage within 24 h after EVT occurred in 170 (30%) patients. The median age in this group was 65 years (IQR 56-71) and 105 (61.8%) were male patients. In a multivariate analysis adjusted for age, gender, and factors with a value of p of <0.05, the NIHSS limb movement sub-item score was strongly associated with prognosis at 3 months (OR 0.833, 95% CI 0.758-0.915) and intracranial hemorrhage within 24 h after EVT (OR 1.161, 95% CI 1.037-1.300). Conclusion Higher limb movement sub-item scores on the NIHSS were independently associated with a poorer prognosis at 3 months and a higher rate of intracranial hemorrhage within 24 h after EVT among patients with acute anterior circulation ischemic stroke.
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Affiliation(s)
| | | | | | | | | | | | | | - Shouchun Wang
- Department of Neurology and Neuroscience, The First Hospital of Jilin University, Changchun, Jilin, China
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Kovács KB, Bencs V, Hudák L, Oláh L, Csiba L. Hemorrhagic Transformation of Ischemic Strokes. Int J Mol Sci 2023; 24:14067. [PMID: 37762370 PMCID: PMC10531605 DOI: 10.3390/ijms241814067] [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: 08/05/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Ischemic stroke, resulting from insufficient blood supply to the brain, is among the leading causes of death and disability worldwide. A potentially severe complication of the disease itself or its treatment aiming to restore optimal blood flow is hemorrhagic transformation (HT) increasing morbidity and mortality. Detailed summaries can be found in the literature on the pathophysiological background of hemorrhagic transformation, the potential clinical risk factors increasing its chance, and the different biomarkers expected to help in its prediction and clinical outcome. Clinicopathological studies also contribute to the improvement in our knowledge of hemorrhagic transformation. We summarized the clinical risk factors of the hemorrhagic transformation of ischemic strokes in terms of risk reduction and collected the most promising biomarkers in the field. Also, auxiliary treatment options in reperfusion therapies have been reviewed and collected. We highlighted that the optimal timing of revascularization treatment for carefully selected patients and the individualized management of underlying diseases and comorbidities are pivotal. Another important conclusion is that a more intense clinical follow-up including serial cranial CTs for selected patients can be recommended, as clinicopathological investigations have shown HT to be much more common than clinically suspected.
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Affiliation(s)
| | | | | | | | - László Csiba
- Department of Neurology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (K.B.K.); (V.B.); (L.H.); (L.O.)
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van der Ende NA, Kremers FC, van der Steen W, Venema E, Kappelhof M, Majoie CB, Postma AA, Boiten J, van den Wijngaard IR, van der Lugt A, Dippel DW, Roozenbeek B. Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: External Validation of Prediction Models. Stroke 2023; 54:476-487. [PMID: 36689584 PMCID: PMC9855739 DOI: 10.1161/strokeaha.122.040065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/09/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Symptomatic intracranial hemorrhage (sICH) is a severe complication of reperfusion therapy for ischemic stroke. Multiple models have been developed to predict sICH or intracranial hemorrhage (ICH) after reperfusion therapy. We provide an overview of published models and validate their ability to predict sICH in patients treated with endovascular treatment in daily clinical practice. METHODS We conducted a systematic search to identify models either developed or validated to predict sICH or ICH after reperfusion therapy (intravenous thrombolysis and/or endovascular treatment) for ischemic stroke. Models were externally validated in the MR CLEAN Registry (n=3180; Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). The primary outcome was sICH according to the Heidelberg Bleeding Classification. Model performance was evaluated with discrimination (c-statistic, ideally 1; a c-statistic below 0.7 is considered poor in discrimination) and calibration (slope, ideally 1, and intercept, ideally 0). RESULTS We included 39 studies describing 40 models. The most frequently used predictors were baseline National Institutes of Health Stroke Scale (NIHSS; n=35), age (n=22), and glucose level (n=22). In the MR CLEAN Registry, sICH occurred in 188/3180 (5.9%) patients. Discrimination ranged from 0.51 (SPAN-100 [Stroke Prognostication Using Age and National Institutes of Health Stroke Scale]) to 0.61 (SITS-SICH [Safe Implementation of Treatments in Stroke Symptomatic Intracerebral Hemorrhage] and STARTING-SICH [STARTING Symptomatic Intracerebral Hemorrhage]). Best calibrated models were IST-3 (intercept, -0.15 [95% CI, -0.01 to -0.31]; slope, 0.80 [95% CI, 0.50-1.09]), SITS-SICH (intercept, 0.15 [95% CI, -0.01 to 0.30]; slope, 0.62 [95% CI, 0.38-0.87]), and STARTING-SICH (intercept, -0.03 [95% CI, -0.19 to 0.12]; slope, 0.56 [95% CI, 0.35-0.76]). CONCLUSIONS The investigated models to predict sICH or ICH discriminate poorly between patients with a low and high risk of sICH after endovascular treatment in daily clinical practice and are, therefore, not clinically useful for this patient population.
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Affiliation(s)
- Nadinda A.M. van der Ende
- Departments of Neurology (N.A.M.v.d.E, F.C.C.K., W.v.d.S, E.V., D.W.J.D., B.R.), Erasmus MC University Medical Center, the Netherlands
- Radiology and Nuclear Medicine (N.A.M.v.d.Ee, W.v.d.S., B.R.), Erasmus MC University Medical Center, the Netherlands
| | - Femke C.C. Kremers
- Departments of Neurology (N.A.M.v.d.E, F.C.C.K., W.v.d.S, E.V., D.W.J.D., B.R.), Erasmus MC University Medical Center, the Netherlands
| | - Wouter van der Steen
- Departments of Neurology (N.A.M.v.d.E, F.C.C.K., W.v.d.S, E.V., D.W.J.D., B.R.), Erasmus MC University Medical Center, the Netherlands
- Radiology and Nuclear Medicine (N.A.M.v.d.Ee, W.v.d.S., B.R.), Erasmus MC University Medical Center, the Netherlands
| | - Esmee Venema
- Departments of Neurology (N.A.M.v.d.E, F.C.C.K., W.v.d.S, E.V., D.W.J.D., B.R.), Erasmus MC University Medical Center, the Netherlands
- Emergency Medicine (E.V.), Erasmus MC University Medical Center, the Netherlands
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine (M.K.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Charles B.L.M. Majoie
- Departments of Neurology (N.A.M.v.d.E, F.C.C.K., W.v.d.S, E.V., D.W.J.D., B.R.), Erasmus MC University Medical Center, the Netherlands
- Radiology and Nuclear Medicine (N.A.M.v.d.Ee, W.v.d.S., B.R.), Erasmus MC University Medical Center, the Netherlands
- Emergency Medicine (E.V.), Erasmus MC University Medical Center, the Netherlands
- Department of Radiology and Nuclear Medicine (M.K.), Amsterdam UMC, University of Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, School for Mental Health and Sciences, Maastricht University Medical Center, the Netherlands (A.A.P.)
- Departments of Neurology (J.B., I.R.v.d.W.), Haaglanden Medical Center, the Netherlands
- Radiology and Nuclear Medicine (I.R.v.d.W.), Haaglanden Medical Center, the Netherlands
| | - Alida A. Postma
- Department of Radiology and Nuclear Medicine, School for Mental Health and Sciences, Maastricht University Medical Center, the Netherlands (A.A.P.)
| | - Jelis Boiten
- Departments of Neurology (J.B., I.R.v.d.W.), Haaglanden Medical Center, the Netherlands
| | - Ido R. van den Wijngaard
- Departments of Neurology (J.B., I.R.v.d.W.), Haaglanden Medical Center, the Netherlands
- Radiology and Nuclear Medicine (I.R.v.d.W.), Haaglanden Medical Center, the Netherlands
| | - Aad van der Lugt
- Departments of Neurology (N.A.M.v.d.E, F.C.C.K., W.v.d.S, E.V., D.W.J.D., B.R.), Erasmus MC University Medical Center, the Netherlands
- Radiology and Nuclear Medicine (N.A.M.v.d.Ee, W.v.d.S., B.R.), Erasmus MC University Medical Center, the Netherlands
- Emergency Medicine (E.V.), Erasmus MC University Medical Center, the Netherlands
- Department of Radiology and Nuclear Medicine (M.K.), Amsterdam UMC, University of Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, School for Mental Health and Sciences, Maastricht University Medical Center, the Netherlands (A.A.P.)
- Departments of Neurology (J.B., I.R.v.d.W.), Haaglanden Medical Center, the Netherlands
- Radiology and Nuclear Medicine (I.R.v.d.W.), Haaglanden Medical Center, the Netherlands
| | - Diederik W.J. Dippel
- Departments of Neurology (N.A.M.v.d.E, F.C.C.K., W.v.d.S, E.V., D.W.J.D., B.R.), Erasmus MC University Medical Center, the Netherlands
| | - Bob Roozenbeek
- Departments of Neurology (N.A.M.v.d.E, F.C.C.K., W.v.d.S, E.V., D.W.J.D., B.R.), Erasmus MC University Medical Center, the Netherlands
- Radiology and Nuclear Medicine (N.A.M.v.d.Ee, W.v.d.S., B.R.), Erasmus MC University Medical Center, the Netherlands
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El‐Qushayri AE, Reda A, Dahy A, Azzam AY, Ghozy S. The impact of COVID 19 on the outcomes of thrombectomy in stroke patients: A systematic review and meta-analysis. Rev Med Virol 2022; 33:e2379. [PMID: 35833712 PMCID: PMC9349746 DOI: 10.1002/rmv.2379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/22/2022] [Accepted: 07/05/2022] [Indexed: 01/28/2023]
Abstract
We aimed to conduct the current meta-analysis to provide better insight into the efficacy of mechanical thrombectomy (MT) in managing COVID-19 patients suffering from a stroke. An electronic search was conducted through eight databases for collecting the current evidence about the efficacy of MT in stroke patients with COVID-19 until 18 December 2021. The results were reported as the pooled prevalence rates and the odds ratios (ORs), with their corresponding 95% confidence intervals (CI). Out of 648 records, we included nine studies. The prevalence of stroke patients with COVID-19 who received MT treatment was with TICI ≥2b 79% (95%CI: 73-85), symptomatic intracranial haemorrhage 6% (95%CI: 3-11), parenchymal haematoma type 1, 11.1% (95%CI: 5-23), and mortality 29% (95%CI: 24-35). On further comparison of MT procedure between stroke patients with COVID 19 to those without COVID-19, we found no significant difference in terms of TICI ≥2b score (OR: 0.85; 95%CI: 0.03-23; p = 0.9). However, we found that stroke patients with COVID-19 had a significantly higher mortality rate than stroke patients without COVID-19 after MT procedure (OR: 2.99; 95%CI: 2.01-4.45; p < 0.001). Stroke patients with COVID-19 can be safely and effectively treated with MT, with comparable reperfusion and complication rates to those without the disease.
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Affiliation(s)
| | | | | | | | - Sherief Ghozy
- Department of NeuroradiologyMayo ClinicRochesterMinnesotaUSA,Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC program)Oxford UniversityOxfordUK
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Tian B, Tian X, Shi Z, Peng W, Zhang X, Yang P, Li Z, Zhang X, Lou M, Yin C, Zhang Y, Lu J, Liu J. Clinical and Imaging Indicators of Hemorrhagic Transformation in Acute Ischemic Stroke After Endovascular Thrombectomy. Stroke 2021; 53:1674-1681. [PMID: 34872341 DOI: 10.1161/strokeaha.121.035425] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Prior studies have investigated the clinical and imaging factors for hemorrhagic transformation (HT), especially symptomatic intracranial hemorrhage (sICH); however, whether alteplase increases the risk of HT after endovascular thrombectomy (EVT) is unknown. This study aimed to assess clinical and imaging features associated with HT, sICH, and parenchymal hematoma (PH) in patients with acute ischemic stroke after EVT, with and without intravenous alteplase in DIRECT-MT (Direct Intraarterial Thrombectomy to Revascularize Acute Ischemic Stroke Patients with Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals: a Multicenter Randomized Clinical Trial). METHODS The DIRECT-MT trial is a randomized trial of EVT alone versus intravenous thrombolysis combined with EVT. HT, sICH, and PH was evaluated on follow-up computed tomography. Multivariable ordinal logistic regression analysis was used to test the association of stepwise selected determinants with HT, sICH, and PH. RESULTS In total, 633 patients were analyzed; 261 (41.2%) had HT; 34 (5.4%) had sICH; and 85 (13.4%) had PH. The median age was 69, and 56.7% were men. The median National Institutes of Health Stroke Scale score was 18, and 320 patients were in combination-therapy group. Symptomatic intracranial hemorrhage was associated with higher baseline National Institutes of Health Stroke Scale score (adjusted odds ratio [OR], 1.06 [95% CI, 1.10-1.12]) and higher glucose level at hospital arrival (adjusted OR, 1.14 [95% CI, 1.00-1.29]). No association was found between alteplase treatment and HT, sICH, or PH. The independent predictor of sICH was higher baseline National Institutes of Health Stroke Scale score (adjusted OR, 1.09 [95% CI, 1.01-1.18]) in EVT alone group, and history of anticoagulant drugs (adjusted OR, 3.75 [95% CI, 1.07-13.06]), higher glucose level at hospital arrival (adjusted OR, 1.19 [95% CI, 1.03-1.38]), >3 passes of device (adjusted OR, 4.42 [95% CI, 1.36-14.32]) in combination-therapy group. CONCLUSIONS In DIRECT-MT, independent predictors of sICH were baseline National Institutes of Health Stroke Scale score and glucose level at hospital arrival. Alteplase treatment did not increase the risk of HT, sICH, or PH after EVT. The independent predictor of sICH was different in EVT alone group and combination-therapy group. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03469206.
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Affiliation(s)
- Bing Tian
- Department of Radiology, Changhai hospital of Shanghai, China. (B.T., X.T., Z.S., W.P., Xuefeng Zhang, J. Lu)
| | - Xia Tian
- Department of Radiology, Changhai hospital of Shanghai, China. (B.T., X.T., Z.S., W.P., Xuefeng Zhang, J. Lu)
| | - Zhang Shi
- Department of Radiology, Changhai hospital of Shanghai, China. (B.T., X.T., Z.S., W.P., Xuefeng Zhang, J. Lu)
| | - Wenjia Peng
- Department of Radiology, Changhai hospital of Shanghai, China. (B.T., X.T., Z.S., W.P., Xuefeng Zhang, J. Lu)
| | - Xuefeng Zhang
- Department of Radiology, Changhai hospital of Shanghai, China. (B.T., X.T., Z.S., W.P., Xuefeng Zhang, J. Lu)
| | - Pengfei Yang
- Neurovascular Center, Changhai hospital of Shanghai, China. (P.Y., Z.L., Xiaoxi Zhang, J. Liu)
| | - Zifu Li
- Neurovascular Center, Changhai hospital of Shanghai, China. (P.Y., Z.L., Xiaoxi Zhang, J. Liu)
| | - Xiaoxi Zhang
- Neurovascular Center, Changhai hospital of Shanghai, China. (P.Y., Z.L., Xiaoxi Zhang, J. Liu)
| | - Min Lou
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, China (M.L.)
| | - Congguo Yin
- Department of Neurology, Hangzhou First People's Hospital of Zhejiang University, China (C.Y.)
| | - Yongwei Zhang
- Neurovascular Center, Changhai hospital of Shanghai, China. (Y.Z.)
| | - Jianping Lu
- Department of Radiology, Changhai hospital of Shanghai, China. (B.T., X.T., Z.S., W.P., Xuefeng Zhang, J. Lu)
| | - Jianmin Liu
- Neurovascular Center, Changhai hospital of Shanghai, China. (P.Y., Z.L., Xiaoxi Zhang, J. Liu)
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