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Puac-Polanco P, Subasinghe S, Omid-Fard N, Zhang L, Oliveira EPD, Tsehmaister-Abitbul V, Chakraborty S, Torres C, Fahed R, Dowlatshahi D, Aviv RI. Influence of Stroke-Onset Location on the Efficacy of Endovascular Thrombectomy: Comparison of Outcomes between In-Hospital versus Community-Onset Strokes. AJNR Am J Neuroradiol 2024:ajnr.A8362. [PMID: 38816016 DOI: 10.3174/ajnr.a8362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND AND PURPOSE Previous studies have suggested that patients experiencing an in-hospital stroke may face delays in treatment and worse outcomes compared with patients with community-onset strokes. However, most studies occurred when IV thrombolysis was the primary treatment. This study aimed to examine the outcomes of patients experiencing an in-hospital stroke in the endovascular thrombectomy era. MATERIALS AND METHODS This was a single-center retrospective cohort study of patients older than 18 years of age with acute ischemic stroke treated with endovascular thrombectomy within 12 hours of stroke onset from January 1, 2015, to April 30, 2021. Patients were classified into 2 groups: in-hospital strokes and community-onset strokes. We compared the time metrics of stroke care delivery, the rate of successful reperfusion, and functional outcome as scored using the mRS score at 90 days (favorable outcome was defined as mRS 0-2). Differences in proportions were assessed using the Fisher exact and χ2 tests as appropriate. For continuous variables, differences in medians between groups were evaluated using Mann-Whitney U tests. RESULTS A total of 676 consecutive patients were included, with 69 (10%) comprising the in-hospital stroke group. Patients experiencing in-hospital stroke were more likely to have diabetes (36% versus 18%, P = .02) and less likely to receive thrombolysis (25% versus 68%, P < .001) than those in the community-onset stroke group, but they were otherwise similar. Patients with in-hospital stroke had significantly faster overall time metrics, most notably from stroke recognition to imaging (median, 70 [interquartile range, 38-141] minutes versus 121 [74-228] minutes, P < .001). Successful recanalization was achieved in >75% in both groups (P = .39), with a median NIHSS score at discharge of <4 (P = .18). The 90-day mRS was similar in both groups, with a trend toward higher in-hospital mortality in the in-hospital stroke group (P = .06). CONCLUSIONS Patients with in-hospital stroke had shorter workflow delays to initiation of endovascular thrombectomy compared with their community counterparts but with a similar rate of successful recanalization and clinical outcomes. Most important, 90-day mortality and mRS scores were equivalent between in-hospital stroke and community-onset stroke groups.
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Affiliation(s)
- Paulo Puac-Polanco
- From the Department of Radiology, Radiation Oncology and Medical Physics (P.P.-P., S.S, N.O.-F., L.Z., E.P.d.O., V.T.-A., S.C., C.T., R.I.A.), University of Ottawa, Ottawa, Ontario, Canada
- Neuroscience Program (P.P.-P., E.P.d.O., S.C., C.T., R.F., D.D., R.I.A.), The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shanelle Subasinghe
- From the Department of Radiology, Radiation Oncology and Medical Physics (P.P.-P., S.S, N.O.-F., L.Z., E.P.d.O., V.T.-A., S.C., C.T., R.I.A.), University of Ottawa, Ottawa, Ontario, Canada
| | - Nima Omid-Fard
- From the Department of Radiology, Radiation Oncology and Medical Physics (P.P.-P., S.S, N.O.-F., L.Z., E.P.d.O., V.T.-A., S.C., C.T., R.I.A.), University of Ottawa, Ottawa, Ontario, Canada
| | - Liying Zhang
- From the Department of Radiology, Radiation Oncology and Medical Physics (P.P.-P., S.S, N.O.-F., L.Z., E.P.d.O., V.T.-A., S.C., C.T., R.I.A.), University of Ottawa, Ottawa, Ontario, Canada
| | - Eduardo Portela de Oliveira
- From the Department of Radiology, Radiation Oncology and Medical Physics (P.P.-P., S.S, N.O.-F., L.Z., E.P.d.O., V.T.-A., S.C., C.T., R.I.A.), University of Ottawa, Ottawa, Ontario, Canada
- Neuroscience Program (P.P.-P., E.P.d.O., S.C., C.T., R.F., D.D., R.I.A.), The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Vered Tsehmaister-Abitbul
- From the Department of Radiology, Radiation Oncology and Medical Physics (P.P.-P., S.S, N.O.-F., L.Z., E.P.d.O., V.T.-A., S.C., C.T., R.I.A.), University of Ottawa, Ottawa, Ontario, Canada
| | - Santanu Chakraborty
- From the Department of Radiology, Radiation Oncology and Medical Physics (P.P.-P., S.S, N.O.-F., L.Z., E.P.d.O., V.T.-A., S.C., C.T., R.I.A.), University of Ottawa, Ottawa, Ontario, Canada
- Neuroscience Program (P.P.-P., E.P.d.O., S.C., C.T., R.F., D.D., R.I.A.), The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Carlos Torres
- From the Department of Radiology, Radiation Oncology and Medical Physics (P.P.-P., S.S, N.O.-F., L.Z., E.P.d.O., V.T.-A., S.C., C.T., R.I.A.), University of Ottawa, Ottawa, Ontario, Canada
- Neuroscience Program (P.P.-P., E.P.d.O., S.C., C.T., R.F., D.D., R.I.A.), The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Fahed
- Division of Neurology (R.F., D.D.), Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Neuroscience Program (P.P.-P., E.P.d.O., S.C., C.T., R.F., D.D., R.I.A.), The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Interventional Radiology (R.F.), Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada
| | - Dar Dowlatshahi
- Division of Neurology (R.F., D.D.), Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Neuroscience Program (P.P.-P., E.P.d.O., S.C., C.T., R.F., D.D., R.I.A.), The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Richard I Aviv
- From the Department of Radiology, Radiation Oncology and Medical Physics (P.P.-P., S.S, N.O.-F., L.Z., E.P.d.O., V.T.-A., S.C., C.T., R.I.A.), University of Ottawa, Ottawa, Ontario, Canada
- Neuroscience Program (P.P.-P., E.P.d.O., S.C., C.T., R.F., D.D., R.I.A.), The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Yedavalli VS, Lakhani DA, Koneru M, Balar AB, Greene C, Hoseinyazdi M, Nabi M, Lu H, Xu R, Luna L, Caplan J, Dmytriw AA, Guenego A, Heit JJ, Albers GW, Wintermark M, Urrutia V, Huang J, Nael K, Leigh R, Marsh EB, Hillis AE, Llinas RH. Simplifying venous outflow: Prolonged venous transit as a novel qualitative marker correlating with acute stroke outcomes. Neuroradiol J 2024:19714009241269475. [PMID: 39067016 DOI: 10.1177/19714009241269475] [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: 07/30/2024] Open
Abstract
BACKGROUND Prolonged venous transit (PVT), defined as presence of time-to-maximum ≥ 10 s within the superior sagittal sinus (SSS) and/or torcula, is a novel, qualitatively assessed computed tomography perfusion surrogate parameter of venous outflow with potential utility in pretreatment acute ischemic stroke imaging for neuroprognostication. We aim to characterize the correlation between PVT and neurological functional outcomes in thrombectomy-treated patients. METHODS A prospectively-collected database of large vessel occlusion acute ischemic stroke patients treated with thrombectomy was retrospectively analyzed. Spearman's rank correlation coefficient and point-biserial correlations were performed between PVT status (i.e., no region, either SSS or torcula, or both), 90-day modified Rankin score (mRS), mortality (mRS 6), and poor functional outcome (mRS 4-6 vs 0-3). RESULTS Of 128 patients, correlation between PVT and 90-day mRS (ρ = 0.35, p < 0.0001), mortality (r = 0.26, p = 0.002), and poor functional outcome (r = 0.27, p = 0.002) were significant. CONCLUSION There is a modest, significant correlation between PVT and severity of neurological functional outcome. Consequently, PVT is an easily-ascertained, qualitative metric that may be useful as an adjunct for anticipating a patient's clinical course. Future analyses will determine the significance of incorporating PVT in clinical decision-making.
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Affiliation(s)
- Vivek S Yedavalli
- Department of Radiology and Radiological Sciences, Johns HopkinsSchool of Medicine, USA
| | | | | | - Aneri B Balar
- Department of Radiology and Radiological Sciences, Johns HopkinsSchool of Medicine, USA
| | - Cynthia Greene
- Department of Radiology and Radiological Sciences, Johns HopkinsSchool of Medicine, USA
| | - Meisam Hoseinyazdi
- Department of Radiology and Radiological Sciences, Johns HopkinsSchool of Medicine, USA
| | - Mehreen Nabi
- Department of Radiology and Radiological Sciences, Johns HopkinsSchool of Medicine, USA
| | - Hanzhang Lu
- Department of Radiology and Radiological Sciences, Johns HopkinsSchool of Medicine, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns HopkinsSchool of Medicine, USA
| | - Licia Luna
- Department of Radiology and Radiological Sciences, Johns HopkinsSchool of Medicine, USA
| | - Justin Caplan
- Department of Neurosurgery, Johns HopkinsSchool of Medicine, USA
| | - Adam A Dmytriw
- Department of Neuroradiology, Massachusetts General Hospital & Harvard Medical School, USA
| | - Adrien Guenego
- Department of Radiology, Université Libre De Bruxelles Hospital Erasme, USA
| | - Jeremy J Heit
- Department of Radiology, Stanford UniversitySchool of Medicine, USA
| | - Gregory W Albers
- Department of Neurology, Stanford UniversitySchool of Medicine, USA
| | - Max Wintermark
- Department of Radiology, University of Texas MD Anderson Center, USA
| | - Victor Urrutia
- Department of Neurology, Johns HopkinsSchool of Medicine, USA
| | - Judy Huang
- Department of Neurosurgery, Johns HopkinsSchool of Medicine, USA
| | - Kambiz Nael
- Department of Radiology, David Geffen School of Medicine at University of California - Los Angeles, USA
| | - Richard Leigh
- Department of Neurology, Johns HopkinsSchool of Medicine, USA
| | | | - Argye E Hillis
- Department of Neurology, Johns HopkinsSchool of Medicine, USA
| | - Rafael H Llinas
- Department of Neurology, Johns HopkinsSchool of Medicine, USA
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Rogalewski A, Klein N, Friedrich A, Kitsiou A, Schäbitz M, Zuhorn F, Gess B, Berger B, Klingebiel R, Schäbitz WR. Functional long-term outcome following endovascular thrombectomy in patients with acute ischemic stroke. Neurol Res Pract 2024; 6:2. [PMID: 38297374 PMCID: PMC10832147 DOI: 10.1186/s42466-023-00301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024] Open
Abstract
Endovascular thrombectomy (EVT) is the most effective treatment for acute ischemic stroke caused by large vessel occlusion (LVO). Yet, long-term outcome (LTO) and health-related quality of life (HRQoL) in these patients have rarely been addressed, as opposed to modified Rankin scale (mRS) recordings. We analysed demographic data, treatment and neuroimaging parameters in 694 consecutive stroke patients in a maximum care hospital. In 138 of these patients with respect on receipt of written informed consent, LTO and HRQoL were collected over a period of 48 months after EVT using a standardised telephone survey (median 2.1 years after EVT). Age < 70 years (OR 4.82), lower NIHSS on admission (OR 1.11), NIHSS ≤ 10 after 24 h (OR 11.23) and complete recanalisation (mTICI3) (OR 7.79) were identified as independent predictors of favourable LTO. Occurrence of an infection requiring treatment within the first 72 h was recognised as a negative predictor for good long-term outcome (OR 0.22). Patients with mRS > 2 according to the telephone survey more often had complaints regarding mobility, self-care, and usual activity domains of the HRQoL. Our results underline a sustainable positive effect of effective EVT on the quality of life in LVO stroke. Additionally, predictive parameters of outcome were identified, that may support clinical decision making in LVO stroke.
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Affiliation(s)
- Andreas Rogalewski
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Schildescher Str. 99, 33611, Bielefeld, Germany.
- Department of Neurology, Sankt Elisabeth Hospital Gütersloh, Catholic Hospital Association of East Westfalia (KHO), Gütersloh, Germany.
| | - Nele Klein
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Schildescher Str. 99, 33611, Bielefeld, Germany
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Anja Friedrich
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Alkisti Kitsiou
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Schildescher Str. 99, 33611, Bielefeld, Germany
| | - Marie Schäbitz
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Schildescher Str. 99, 33611, Bielefeld, Germany
| | - Frédéric Zuhorn
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Schildescher Str. 99, 33611, Bielefeld, Germany
| | - Burkhard Gess
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Schildescher Str. 99, 33611, Bielefeld, Germany
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Björn Berger
- Department of Neuroradiology, Evangelisches Klinikum Bethel EvKB, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Randolf Klingebiel
- Department of Neuroradiology, Evangelisches Klinikum Bethel EvKB, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Wolf-Rüdiger Schäbitz
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Schildescher Str. 99, 33611, Bielefeld, Germany
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Lakhani DA, Balar AB, Koneru M, Hoseinyazdi M, Hyson N, Cho A, Greene C, Xu R, Luna L, Caplan J, Dmytriw A, Guenego A, Wintermark M, Gonzalez F, Urrutia V, Huang J, Nael K, Rai AT, Albers GW, Heit JJ, Yedavalli V. Pretreatment CT perfusion collateral parameters correlate with penumbra salvage in middle cerebral artery occlusion. J Neuroimaging 2024; 34:44-49. [PMID: 38057941 DOI: 10.1111/jon.13178] [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: 10/11/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Acute ischemic stroke due to large vessel occlusion (AIS-LVO) is a major cause of functional dependence. Collateral status (CS) is an important determinant of functional outcomes. Pretreatment CT perfusion (CTP) parameters serve as reliable surrogates of CS. Penumbra Salvage Index (PSI) is another parameter predictive of functional outcomes in AIS-LVO. The aim of this study is to assess the relationship of pretreatment CTP parameters with PSI. METHODS In this prospectively collected, retrospectively reviewed multicenter analysis, inclusion criteria were as follows: (1) CT angiography confirmed middle cerebral artery (MCA) M1-segment and proximal M2-segment occlusion from 9/1/2017 to 9/22/2022; (2) diagnostic CTP; and (3) available diagnostic Magnetic resonance Imaging (MRI) diffusion-weighted images. Pearson correlation analysis was performed to assess the association between cerebral blood volume (CBV) index and hypoperfusion intensity ratio (HIR) with PSI. p value ≤.05 was considered statistically significant. RESULTS In total, 131 patients (n = 86, M1 and n = 45, proximal M2 occlusion) met our inclusion criteria. CBV index showed a modest positive correlation with PSI (r = 0.34, p<.001) in patients with proximal MCA occlusion. Similar trends were noted in subgroup analysis of patients with M1 occlusion, and proximal M2 occlusion. Whereas, HIR did not have a strong trend or correlation with PSI. CONCLUSION CBV index correlates with PSI, whereas HIR does not. Future studies are needed to expand our understanding of the adjunct role of CBV index with other similar pretreatment CTP-based markers in clinical evaluation and decision-making in patients with MCA occlusion.
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Affiliation(s)
- Dhairya A Lakhani
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Aneri B Balar
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Manisha Koneru
- Cooper Medical School, Rowan University, Camden, New Jersey, USA
| | - Meisam Hoseinyazdi
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nathan Hyson
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew Cho
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cynthia Greene
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Licia Luna
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Justin Caplan
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam Dmytriw
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Adrien Guenego
- Department of Radiology, Université Libre De Bruxelles Hospital Erasme, Anderlecht, Belgium
| | - Max Wintermark
- Department of Radiology, University of Texas, MD Anderson Center, Houston, Texas, USA
| | - Fernando Gonzalez
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Victor Urrutia
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kambiz Nael
- Division of Neuroradiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Ansaar T Rai
- Department of Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Gregory W Albers
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Vivek Yedavalli
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
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Widimsky P, Stetkarova I, Tousek P. The importance of interdisciplinary research. Eur Heart J Suppl 2023; 25:E1-E2. [PMID: 37234231 PMCID: PMC10207137 DOI: 10.1093/eurheartjsupp/suad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
| | - Ivana Stetkarova
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Ruska 87, 100 34 Prague 10, Czech Republic
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Kremenova K, Lukavsky J, Holesta M, Peisker T, Lauer D, Weichet J, Malikova H. CT Brain Perfusion in the Prediction of Final Infarct Volume: A Prospective Study of Different Software Settings for Acute Ischemic Core Calculation. Diagnostics (Basel) 2022; 12:diagnostics12102290. [PMID: 36291979 PMCID: PMC9601142 DOI: 10.3390/diagnostics12102290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
CT perfusion (CTP) is used for the evaluation of brain tissue viability in patients with acute ischemic stroke (AIS). We studied the accuracy of three different syngo.via software (SW) settings for acute ischemic core estimation in predicting the final infarct volume (FIV). The ischemic core was defined as follows: Setting A: an area with cerebral blood flow (CBF) < 30% compared to the contralateral healthy hemisphere. Setting B: CBF < 20% compared to contralateral hemisphere. Setting C: area of cerebral blood volume (CBV) < 1.2 mL/100 mL. We studied 47 AIS patients (aged 68 ± 11.2 years) with large vessel occlusion in the anterior circulation, treated in the early time window (up to 6 h), who underwent technically successful endovascular thrombectomy (EVT). FIV was measured on MRI performed 24 ± 2 h after EVT. In general, all three settings correlated with each other; however, the absolute agreement between acute ischemic core volume on CTP and FIV on MRI was poor; intraclass correlation for all three settings was between 0.64 and 0.69, root mean square error of the individual observations was between 58.9 and 66.0. Our results suggest that using CTP syngo.via SW for prediction of FIV in AIS patients in the early time window is not appropriate.
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Affiliation(s)
- Karin Kremenova
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
- Correspondence:
| | - Jiri Lukavsky
- Institute of Psychology, Czech Academy of Sciences, 110 00 Prague, Czech Republic
| | - Michal Holesta
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
| | - Tomas Peisker
- Neurology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
| | - David Lauer
- Neurology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
| | - Jiri Weichet
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
| | - Hana Malikova
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
- Institute of Anatomy, Second Faculty of Medicine, Charles University, 150 00 Prague, Czech Republic
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Malikova H, Weichet J. Diagnosis of Ischemic Stroke: As Simple as Possible. Diagnostics (Basel) 2022; 12:diagnostics12061452. [PMID: 35741262 PMCID: PMC9221735 DOI: 10.3390/diagnostics12061452] [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: 05/16/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
The absolute majority of strokes in high-income countries, roughly 91%, are of ischemic origin. This review is focused on acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation, which is considered the most devastating subtype of AIS. Moreover, stroke survivors impose substantial direct and indirect costs of care as well as costs due to productivity loss. We review of diagnostic possibilities of individual imaging methods such as computed tomography and magnetic resonance imaging, and discuss their pros and cons in the imaging of AIS. The goals of non-invasive imaging in AIS are as follows: (a) to rule out intracranial hemorrhage and to quickly exclude hemorrhagic stroke and contraindications for intravenous thrombolysis; (b) to identify potential LVO and its localization and to quickly provide guidance for endovascular treatment; (c) to assess/estimate the volume or size of the ischemic core. We suggest fast diagnostic management, which is able to quickly satisfy the above-mentioned diagnostic goals in AIS with LVO.
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Affiliation(s)
- Hana Malikova
- Correspondence: ; Tel.: +420-267-162-400; Fax: +420-267-162-409
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