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Lambert AT, Sætre DO, Ratajczak-Tretel B, Gleditsch J, Høie G, Al-Ani R, Pesonen M, Atar D, Aamodt AH. Imaging features for the identification of atrial fibrillation in cryptogenic stroke patients. J Neurol 2024:10.1007/s00415-024-12397-y. [PMID: 38904781 DOI: 10.1007/s00415-024-12397-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Whether specific imaging aspects can be used to identify cryptogenic stroke (CS) patients with high risk of underlying atrial fibrillation (AF) remains unclear. The purpose of this study was to evaluate brain-imaging features in CS patients and their utility as AF predictors. METHODS The Nordic Atrial Fibrillation and Stroke study was a prospective observational study of CS and transient ischemic attack patients undergoing 12-month cardiac-rhythm monitoring, biomarker and clinical assessments. In this imaging sub-study, brain magnetic resonance imaging and computed tomography scans from 106 patients were assessed for acute and chronic ischemic lesions in relation to AF occurrence and included in a score to predict AF. Receiver operating characteristics (ROC) curve was used to evaluate the discriminative ability of the score and for its dichotomization for predictive model. RESULTS Age, periventricular white-matter hyperintensities (PVWMH), acute lesion size, and vessel occlusion were significantly associated with AF. Acute and chronic cortical infarcts as well as chronic cerebellar infarcts were numerically more frequent in the AF group than the non-AF group. A score consisting of six features (0-6 points) was proposed (age ≥ 65 years, chronic cortical or cerebellar lesions, acute cortical lesions, PVWMH ≥ 2 in Fazekas scale, vessel occlusion, and acute lesion size ≥ 10 mm). Area under ROC curve was 0.735 and a score of ≥ 3 points was a predictor of AF. CONCLUSIONS The suggested score was shown to identify CS patients with an increased risk of underlying AF.
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Affiliation(s)
- Anna Tancin Lambert
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dag Ottar Sætre
- Dapartment of Radiology, Østfold Hospital Trust, Grålum, Norway
| | - Barbara Ratajczak-Tretel
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jostein Gleditsch
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Dapartment of Radiology, Østfold Hospital Trust, Grålum, Norway
| | - Gudrun Høie
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | - Riadh Al-Ani
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | - Maiju Pesonen
- Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway.
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Zhu C. Effect and clinical evaluation of butylphthalide combined with ureklin on ischemic low perfusion area in patients with acute cerebral infarction. Minerva Med 2023; 114:575-577. [PMID: 35822857 DOI: 10.23736/s0026-4806.22.08258-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Chunyu Zhu
- Department of Neurology, Daqing Oilfield General Hospital, Daqing, China -
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Simaan N, Fahoum L, Filioglo A, Aladdin S, Beiruti KW, Honig A, Leker R. Characteristics of Multiple Acute Concomitant Cerebral Infarcts Involving Different Arterial Territories. J Clin Med 2023; 12:3973. [PMID: 37373666 DOI: 10.3390/jcm12123973] [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: 04/02/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Multiple acute concomitant cerebral infarcts (MACCI) are relatively uncommon. Data regarding the characteristics and outcomes of patients with MACCI are lacking. We, therefore, aimed to characterize the clinical features of MACCI. (2) Methods: Patients with MACCI were identified from a prospective registry of stroke patients admitted to a tertiary teaching center. Patients with an acute single embolic stroke (ASES) involving only one vascular bed served as controls. (3) Results: MACCI was diagnosed in 103 patients who were compared to 150 patients with ASES. MACCI patients were significantly older (p = 0.010), more often had a history of diabetes (p = 0.011) and had lower rates of ischemic heart disease (p = 0.022). On admission, MACCI patients had significantly higher rates of focal signs (p < 0.001), an altered mental state (p < 0.001) and seizures (p = 0.036). The favorable functional outcome was significantly less common in patients with MACCI (p = 0.006). In the multivariable analysis, MACCI was associated with lower chances of achieving favorable outcomes (odds ratio: 0.190, 95% CI: 0.070-0.502). (4) Conclusions: There are important differences in clinical presentation, comorbidities and outcomes between MACCI and ASES. MACCI is less often associated with favorable outcomes and could represent a more severe form of a stroke compared with a single embolic stroke.
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Affiliation(s)
- Naaem Simaan
- Department of Neurology, Ziv Medical Center, Safed 13100, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 52900, Israel
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Leen Fahoum
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Andrei Filioglo
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Shorooq Aladdin
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | | | - Asaf Honig
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Ronen Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
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4
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Sha Y, Han G, Hong Y, Wu J, Tang M, Zhu Y, Zhou L, Ni J. Distinct lesion features and underlying mechanisms in patients with acute multiple infarcts in multiple cerebral territories. Front Neurol 2023; 13:1102505. [PMID: 36726748 PMCID: PMC9885093 DOI: 10.3389/fneur.2022.1102505] [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: 11/19/2022] [Accepted: 12/31/2022] [Indexed: 01/18/2023] Open
Abstract
Objective To determine the etiology spectrum and lesion distribution patterns of patients with acute multiple infarcts in multiple cerebral territories (AMIMCT) and provide guidance for treatment and prevention strategies in these patients. Methods Patients with acute ischemic stroke diagnosed using diffusion-weighted imaging (DWI) were consecutively included in this study between June 2012 and Apr 2022. AMIMCT was defined as non-contiguous focal lesions located in more than one cerebral territory with acute neurological deficits. We retrospectively analyzed the clinical and imaging characteristics, etiology spectra and underlying mechanisms in patients with and without AMIMCT. Infarct lesion patterns on DWI and their relevance to etiology were further discussed. Results A total of 1,213 patients were enrolled, of whom 145 (12%) were diagnosed with AMIMCT. Patients with AMIMCT tended to be younger (P = 0.016), more often female (P = 0.001), and exhibited less common conventional vascular risk factors (P < 0.05) compared to those without AMIMCT. The constitution of the Trial of Org 10,172 in Acute Stroke Treatment classification was significantly different between patients with and without AMIMCT (P = 0.000), with a higher proportion of stroke of other determined causes (67.6% vs. 12.4%). For detailed etiologies, autoimmune or hematologic diseases were the most common (26.2%) etiologies of AMIMCT, followed by periprocedural infarcts (15.2%), cardioembolism (12.4%), tumor (12.4%), large artery atherosclerosis (10.3%), and sudden drop in blood pressure (8.3%). Hypercoagulability and systemic hypoperfusion are common underlying mechanisms of AMIMCT. Distinctive lesion distribution patterns were found associated with stroke etiologies and mechanisms in AMIMCT. Most of patients with large artery atherosclerosis (73.3%), autoimmune/hematologic diseases (57.9%) manifested the disease as multiple infarct lesions located in bilateral supratentorial regions. However, 66.7% of cardioembolism and 83.8% of cardiovascular surgery related stroke presented with both supratentorial and infratentorial infarct lesions. Conclusion The etiologies and mechanisms of patients with AMIMCT were more complex than those without AMIMCT. The distribution characteristics of infarct lesions might have important implications for the identification of etiology and mechanism in the future, which could further guide and optimize clinical diagnostic strategies.
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Affiliation(s)
| | | | | | | | | | | | | | - Jun Ni
- *Correspondence: Jun Ni ✉
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5
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Bonkhoff AK, Ullberg T, Bretzner M, Hong S, Schirmer MD, Regenhardt RW, Donahue KL, Nardin MJ, Dalca AV, Giese AK, Etherton MR, Hancock BL, Mocking SJT, McIntosh EC, Attia J, Cole JW, Donatti A, Griessenauer CJ, Heitsch L, Holmegaard L, Jood K, Jimenez-Conde J, Kittner SJ, Lemmens R, Levi CR, McDonough CW, Meschia JF, Phuah CL, Ropele S, Rosand J, Roquer J, Rundek T, Sacco RL, Schmidt R, Sharma P, Slowik A, Sousa A, Stanne TM, Strbian D, Tatlisumak T, Thijs V, Vagal A, Woo D, Zand R, McArdle PF, Worrall BB, Jern C, Lindgren AG, Maguire J, Wu O, Frid P, Rost NS, Wasselius J. Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics. Front Neurosci 2022; 16:994458. [PMID: 36090258 PMCID: PMC9453031 DOI: 10.3389/fnins.2022.994458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background purpose A substantial number of patients with acute ischemic stroke (AIS) experience multiple acute lesions (MAL). We here aimed to scrutinize MAL in a large radiologically deep-phenotyped cohort. Materials and methods Analyses relied upon imaging and clinical data from the international MRI-GENIE study. Imaging data comprised both Fluid-attenuated inversion recovery (FLAIR) for white matter hyperintensity (WMH) burden estimation and diffusion-weighted imaging (DWI) sequences for the assessment of acute stroke lesions. The initial step featured the systematic evaluation of occurrences of MAL within one and several vascular supply territories. Associations between MAL and important imaging and clinical characteristics were subsequently determined. The interaction effect between single and multiple lesion status and lesion volume was estimated by means of Bayesian hierarchical regression modeling for both stroke severity and functional outcome. Results We analyzed 2,466 patients (age = 63.4 ± 14.8, 39% women), 49.7% of which presented with a single lesion. Another 37.4% experienced MAL in a single vascular territory, while 12.9% featured lesions in multiple vascular territories. Within most territories, MAL occurred as frequently as single lesions (ratio ∼1:1). Only the brainstem region comprised fewer patients with MAL (ratio 1:4). Patients with MAL presented with a significantly higher lesion volume and acute NIHSS (7.7 vs. 1.7 ml and 4 vs. 3, p FDR < 0.001). In contrast, patients with a single lesion were characterized by a significantly higher WMH burden (6.1 vs. 5.3 ml, p FDR = 0.048). Functional outcome did not differ significantly between patients with single versus multiple lesions. Bayesian analyses suggested that the association between lesion volume and stroke severity between single and multiple lesions was the same in case of anterior circulation stroke. In case of posterior circulation stroke, lesion volume was linked to a higher NIHSS only among those with MAL. Conclusion Multiple lesions, especially those within one vascular territory, occurred more frequently than previously reported. Overall, multiple lesions were distinctly linked to a higher acute stroke severity, a higher total DWI lesion volume and a lower WMH lesion volume. In posterior circulation stroke, lesion volume was linked to a higher stroke severity in multiple lesions only.
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Affiliation(s)
- Anna K. Bonkhoff
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Teresa Ullberg
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
- Department of Radiology and Neuroradiology, Skåne University Hospital, Lund, Sweden
| | - Martin Bretzner
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- U1171 – LilNCog (JPARC) – Lille Neurosciences Cognition and University of Lille, Inserm, CHU Lille, Lille, France
| | - Sungmin Hong
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Markus D. Schirmer
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Robert W. Regenhardt
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Kathleen L. Donahue
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Marco J. Nardin
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Adrian V. Dalca
- Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Boston, MA, United States
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Anne-Katrin Giese
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark R. Etherton
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Brandon L. Hancock
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Steven J. T. Mocking
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Elissa C. McIntosh
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - John Attia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - John W. Cole
- Department of Neurology, University of Maryland, School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, United States
| | - Amanda Donatti
- School of Medical Sciences, The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas (UNICAMP), Campinas, Brazil
| | - Christoph J. Griessenauer
- Department of Neurosurgery, Geisinger, Danville, PA, United States
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Laura Heitsch
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, United States
- Department of Neurology, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States
| | - Lukas Holmegaard
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jordi Jimenez-Conde
- Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d’Investigacions Mèdiques), Universitat Pompeu Fabra, Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Steven J. Kittner
- Department of Neurology, University of Maryland, School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, United States
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience, Disease (LIND), KU Leuven - University of Leuven, Leuven, Belgium
- Laboratory of Neurobiology, Department of Neurology, Vesalius Research Center (VIB), University Hospitals Leuven, Leuven, Belgium
| | - Christopher R. Levi
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
- Department of Pharmacotherapy, Translational Research, Center for Pharmacogenomics, University of Florida, Gainesville, FL, United States
| | | | - James F. Meschia
- Department of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria
| | - Chia-Ling Phuah
- Department of Neurology, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States
| | - Stefan Ropele
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
| | - Jonathan Rosand
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jaume Roquer
- Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d’Investigacions Mèdiques), Universitat Pompeu Fabra, Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Tatjana Rundek
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Ralph L. Sacco
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Reinhold Schmidt
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
| | - Pankaj Sharma
- Institute of Cardiovascular Research, St Peter’s, Ashford Hospitals, Royal Holloway University of London (ICR2UL), Egham, United Kingdom
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - Alessandro Sousa
- School of Medical Sciences, The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas (UNICAMP), Campinas, Brazil
| | - Tara M. Stanne
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Vincent Thijs
- Division of Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Achala Vagal
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Daniel Woo
- Department of Neurology, Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Ramin Zand
- Department of Neurology, Pennsylvania State University, Hershey, PA, United States
| | - Patrick F. McArdle
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Bradford B. Worrall
- Department of Neurology, University of Virginia, Charlottesville, VA, United States
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Christina Jern
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Arne G. Lindgren
- Department of Neurology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
| | - Jane Maguire
- University of Technology, Faculty of Health, Sydney, NSW, Australia
| | - Ona Wu
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Petrea Frid
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
| | - Natalia S. Rost
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Johan Wasselius
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
- Department of Radiology and Neuroradiology, Skåne University Hospital, Lund, Sweden
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Deep Learning-Based Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Ischemic Penumbra in Early Cerebral Infarction. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:6270700. [PMID: 35291425 PMCID: PMC8901298 DOI: 10.1155/2022/6270700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 12/01/2022]
Abstract
The prefiltered image was imported into the local higher-order singular value decomposition (HOSVD) denoising algorithm (GL-HOSVD)-optimized diffusion-weighted imaging (DWI) image, which was compared with the deviation correction nonlocal mean (NL mean) and low-level edge algorithm (LR + edge). Regarding the peak signal-to-noise ratio (PSNR), root mean square error (RMSE), sensitivity, specificity, accuracy, and consistency, the application effect of the GL-HOSVD algorithm in DWI was investigated, and its adoption effect in the examination of ischemic penumbra (IP) of early acute cerebral infarction (ACI) patients was evaluated. A total of 210 patients with ACI were selected as the research subjects, who were randomly rolled into two groups. Those who were checked by conventional DWI were set as the control group, and those who used DWI based on the GL-HOSVD denoising algorithm were set as the observation group, with 105 people in each. Positron emission tomography (PET) test results were set as the gold standard to evaluate the application value of the two examination methods. It was found that under different noise levels, the peak signal-to-noise ratio (PSNR) of the GL-HOSVD algorithm and the root mean square error (RMSE) of the FA parameter were better than those of the nonlocal means (NL-means) of deviation correction and low-rank edge algorithm (LR + edge). The sensitivity, specificity, accuracy, and consistency (8.76%, 81.25%, 87.62%, and 0.52) of the observation group were higher than those of the control group (57.78%, 53.33%, 57.14%, and 0.35) (P < 0.05). Moreover, the apparent diffusion coefficient (ADC) of the DWI images of the observation group was basically consistent with that of the PET images, while the control group had a poor display effect and low definition. In summary, under different noise levels, the GL-HOSVD algorithm had a good denoising effect and greatly reduced fringe artifacts. DWI after denoising had high sensitivity, specificity, accuracy, and consistency in the detection of IP, which was worthy of clinical application and promotion.
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Hassan AE, Dibas M, Sarraj A, Ghozy S, El-Qushayri AE, Dmytriw AA, Tekle WG. First pass effect vs multiple passes complete reperfusion: A retrospective study. Neuroradiol J 2021; 35:306-312. [PMID: 34464222 DOI: 10.1177/19714009211042886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE First pass effect (FPE) is defined as achieving modified treatment in cerebral infarction (mTICI) grade 2c/3 reperfusion from the first pass and is associated with more favorable outcomes. We aimed to compare FPE and non-FPE using a large database and further compare first-pass mTICI 2b with multiple passes mTICI 3. METHODS A retrospective cohort study of acute ischemic stroke patients who received mechanical thrombectomy at a high-volume center was performed. Baseline characteristics and outcomes including rates of discharge and 90-day functional independence (modified Rankin Scale ≤2), mortality, symptomatic, and asymptomatic intracerebral hemorrhage were compared. RESULTS Of the 637 patients included, 294 achieved FPE; 161 patients had multiple passes mTICI 3 and 36 had first pass mTICI 2b. Propensity-score matching resulted in 211 matched pairs for FPE vs non-FPE, and 30 matched pairs for multiple passes mTICI 3 vs first pass mTICI 2b. The FPE group had significantly more instances of discharge (33.6% vs 19.4%, p = 0.001) and 90-day functional independence (51.7% vs 40.8%, p = 0.032), and lower rates of mortality (18.0% vs 27.5%, p = 0.027) compared to non-FPE. There was no significant difference between first pass mTICI 2b and multiple passes mTICI 3 concerning any studied outcomes. CONCLUSIONS First pass mTICI 2c/3 is safer and is associated with higher rates of functional independence. We did not observe a significant difference between first pass mTICI 2b and multiple passes mTICI 3. The limitations of this study prevent us from drawing conclusions related to the difference between them and calls for future large-scale studies to explore that further.
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Affiliation(s)
- Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA
| | - Mahmoud Dibas
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA.,Sulaiman Al Rajhi University, College of Medicine, Saudi Arabia
| | - Amrou Sarraj
- Department of Neurology, University of Texas at Houston Stroke Center, Houston, TX, USA
| | - Sherief Ghozy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, Egypt
| | | | - Adam A Dmytriw
- Neuroradiology and Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wondwossen G Tekle
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA
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8
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Novotny V, Aarli SJ, Netland Khanevski A, Bjerkreim AT, Elnan Kvistad C, Fromm A, Waje‐Andreassen U, Naess H, Thomassen L, Logallo N. Clinical manifestation of acute cerebral infarcts in multiple arterial territories. Brain Behav 2021; 11:e2296. [PMID: 34333856 PMCID: PMC8413735 DOI: 10.1002/brb3.2296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/18/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We aimed to assess frequencies and radiological aspects of single- and multiterritory clinical manifestation among patients with acute cerebral infarcts in multiple arterial territories (MACI). MATERIALS & METHODS We retrospectively reviewed admission records and diffusion-weighted magnetic resonance imaging of patients with MACI admitted to our stroke unit between 2006 and 2017. MACI was defined as acute cerebral ischemic lesions in at least two out of three arterial cerebral territories, that is, the left anterior, right anterior and the bilateral posterior territory. Patients with single- and multiterritory clinical manifestation were then compared for topographical distribution of the ischemic lesions, the number of ischemic lesions, and The Oxfordshire Community Stroke Project classification. RESULTS Out of 311 patients with MACI, 222 (71.4%) presented with single-territory clinical manifestation. Involvement of the left hemisphere (OR = 0.37, 95% CI 0.16-0.82), less than five ischemic lesions (OR = 0.58, 95% CI 0.35-0.97), and partial anterior circulation infarct clinical stroke syndrome (OR = 0.57, 95% CI 0.34-0.97) were associated with single-territory clinical manifestation. Involvement of all three territories (OR = 2.58, 95% = 1.48-4.50), more than 10 ischemic lesions (OR = 2.30, 95% CI 1.32-4.01) and total anterior circulation infarct clinical stroke syndrome (OR = 3.31, 95% CI 1.39-7.86) were associated with multiterritory clinical manifestation. CONCLUSION Most patients with MACI present with single-territory clinical manifestation on admission. Diffusion-weighted magnetic resonance imaging is therefore necessary for a definite diagnosis.
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Affiliation(s)
- Vojtech Novotny
- Department of NeurologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Sander Johan Aarli
- Department of NeurologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | | | - Anna Therese Bjerkreim
- Department of NeurologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Christopher Elnan Kvistad
- Department of NeurologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Annette Fromm
- Department of NeurologyHaukeland University HospitalBergenNorway
| | | | - Halvor Naess
- Department of NeurologyHaukeland University HospitalBergenNorway
- Centre for Age‐related MedicineStavanger University HospitalStavangerNorway
| | - Lars Thomassen
- Department of NeurologyHaukeland University HospitalBergenNorway
| | - Nicola Logallo
- Department of NeurosurgeryHaukeland University HospitalBergenNorway
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9
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Tanaka K, Matsumoto S, Furuta K, Yamada T, Nagano S, Takase KI, Hatano T, Yamasaki R, Kira JI. Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator. J Thromb Thrombolysis 2021; 49:545-550. [PMID: 31848874 PMCID: PMC7182629 DOI: 10.1007/s11239-019-02015-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Early neurological deterioration (END) following intravenous recombinant tissue plasminogen activator (rt-PA) treatment is a serious clinical event that can be caused by hemorrhagic or ischemic insult. We investigated the differences in predictive factors for END due to hemorrhagic and END due to ischemic insults. Consecutive patients from four hospitals who received 0.6 mg/kg intravenous rt-PA for acute ischemic stroke were retrospectively recruited. END was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points within 24 h compared with baseline. END was classified into those due to hemorrhagic (ENDh) or ischemic (ENDi) insult based on computed tomography (CT) or magnetic resonance imaging. Risk factors associated with ENDh and ENDi were investigated by comparison with non-END cases. A total of 744 patients (452 men, median 75 years old) were included. END was observed in 79 patients (10.6%), including 22 ENDh (3.0%) and 57 ENDi (7.7%), which occurred within a median of 7 h after treatment. Multivariate analyses showed that higher pretreatment NIHSS score (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00–1.13) and pretreatment with antiplatelets (OR 2.84, 95% CI 1.08–7.72) were associated with ENDh. Extensive early ischemic change (Alberta Stroke Program Early CT Score ≤ 7 on CT or ≤ 6 on diffusion-weighted imaging; OR 2.80, 95% CI 1.36–5.64) and large artery occlusions (OR 3.09, 95% CI 1.53–6.57) were associated with ENDi. Distinct factors were predictive for the END subtypes. These findings could help develop preventative measures for END in patients with the identified risk factors.
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Affiliation(s)
- Koji Tanaka
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Shoji Matsumoto
- Department of Neurology, Kokura Memorial Hospital, Kitakyushu, Japan.,Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Konosuke Furuta
- Department of Neurology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Yamada
- Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Sukehisa Nagano
- Department of Neurology, Fukuoka City Hospital, Fukuoka, Japan
| | | | - Taketo Hatano
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ryo Yamasaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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10
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Liu HY, Wu JY, Chung CP, Lee IH, Lin CJ, Lin CJ, Hsu LC, Chao TF. Premature Atrial Contractions and Their Association with Stroke Features and Outcome. J Stroke Cerebrovasc Dis 2020; 29:105118. [PMID: 32912526 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105118] [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: 03/07/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Frequent premature atrial contractions (PACs) are associated with atrial fibrillation, stroke, and mortality. However, the cut-off value for PAC counts that could identify patients with different stroke features is unclear, and the association of PACs to outcome is not determined. METHODS The study retrospectively included patients with acute ischemic stroke who had underwent both a 24 h Holter recording and a brain MRI in Taipei Veterans General Hospital from January 2015 to May 2016. Patients were categorized into four groups according to their PAC frequencies on 24 h Holter recording. We compared the clinical severity, neuroimage features, stroke subtypes, and functional outcome among the four groups of patients. RESULTS Among the 278 patients, the lower, middle, and upper quartiles of the PAC counts were 23, 74, and 459.5, respectively. In contrast to the 1st quartile of patients, the 3rd (PAC 75-459/24 h) and the 4th (PAC ≥460/24 h) quartiles of patients had higher NIH Stroke Scale (NIHSS) at admission (p = 0.014 and p = 0.002, respectively). The frequencies of cryptogenic stroke were not different among the 4 quartiles of the patients, but cryptogenic stroke patients with ≥ 75PACs/24hours had higher stroke severity compared to those with PACs < 75counts/24 h (NIHSS 9.1 vs. 5.2, p = 0.043). There was an increased trend in infarcts of multiple vascular territories and in mortality at 1 year among the four groups of patients with increased PAC frequency (p = 0.045 and p = 0.002, respectively). The 4th PAC quartile was associated with poor functional outcome (modified Rankin Scale ≥ 4) at 3 months in univariate analysis (OR: 5.66, CI: 2.69-11.91, p < 0.001), but was not an independent predictor after controlling for initial stroke severity. CONCLUSIONS PACs ≥ 75 counts/24 h was associated with higher clinical severity in patients with acute ischemic stroke.
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Affiliation(s)
- Hung-Yu Liu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Jiun-Yi Wu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Ping Chung
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - I-Hui Lee
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Jung Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Radiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Jen Lin
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Chi Hsu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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11
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Drake M, Frid P, Hansen BM, Wu O, Giese AK, Schirmer MD, Donahue K, Cloonan L, Irie RE, Bouts MJRJ, McIntosh EC, Mocking SJT, Dalca AV, Sridharan R, Xu H, Giralt-Steinhauer E, Holmegaard L, Jood K, Roquer J, Cole JW, McArdle PF, Broderick JP, Jiménez-Conde J, Jern C, Kissela BM, Kleindorfer DO, Lemmens R, Meschia JF, Rundek T, Sacco RL, Schmidt R, Sharma P, Slowik A, Thijs V, Woo D, Worrall BB, Kittner SJ, Mitchell BD, Rosand J, Golland P, Lindgren A, Rost NS, Wassélius J. Diffusion-Weighted Imaging, MR Angiography, and Baseline Data in a Systematic Multicenter Analysis of 3,301 MRI Scans of Ischemic Stroke Patients-Neuroradiological Review Within the MRI-GENIE Study. Front Neurol 2020; 11:577. [PMID: 32670186 PMCID: PMC7330135 DOI: 10.3389/fneur.2020.00577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/19/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Magnetic resonance imaging (MRI) serves as a cornerstone in defining stroke phenotype and etiological subtype through examination of ischemic stroke lesion appearance and is therefore an essential tool in linking genetic traits and stroke. Building on baseline MRI examinations from the centralized and structured radiological assessments of ischemic stroke patients in the Stroke Genetics Network, the results of the MRI-Genetics Interface Exploration (MRI-GENIE) study are described in this work. Methods: The MRI-GENIE study included patients with symptoms caused by ischemic stroke (N = 3,301) from 12 international centers. We established and used a structured reporting protocol for all assessments. Two neuroradiologists, using a blinded evaluation protocol, independently reviewed the baseline diffusion-weighted images (DWIs) and magnetic resonance angiography images to determine acute lesion and vascular occlusion characteristics. Results: In this systematic multicenter radiological analysis of clinical MRI from 3,301 acute ischemic stroke patients according to a structured prespecified protocol, we identified that anterior circulation infarcts were most prevalent (67.4%), that infarcts in the middle cerebral artery (MCA) territory were the most common, and that the majority of large artery occlusions 0 to 48 h from ictus were in the MCA territory. Multiple acute lesions in one or several vascular territories were common (11%). Of 2,238 patients with unilateral DWI lesions, 52.6% had left-sided infarct lateralization (P = 0.013 for χ2 test). Conclusions: This large-scale analysis of a multicenter MRI-based cohort of AIS patients presents a unique imaging framework facilitating the relationship between imaging and genetics for advancing the knowledge of genetic traits linked to ischemic stroke.
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Affiliation(s)
- Mattias Drake
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden.,Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden
| | - Petrea Frid
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Malmö, Sweden
| | - Björn M Hansen
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden.,Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden
| | - Ona Wu
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| | - Anne-Katrin Giese
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Markus D Schirmer
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Department of Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Kathleen Donahue
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Lisa Cloonan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert E Irie
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| | - Mark J R J Bouts
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| | - Elissa C McIntosh
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| | - Steven J T Mocking
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| | - Adrian V Dalca
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States.,Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, United States
| | - Ramesh Sridharan
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, United States
| | - Huichun Xu
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Eva Giralt-Steinhauer
- Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), University at Autonoma de Barcelona, Barcelona, Spain
| | - Lukas Holmegaard
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jaume Roquer
- Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), University at Autonoma de Barcelona, Barcelona, Spain
| | - John W Cole
- Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, United States
| | - Patrick F McArdle
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Joseph P Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Jordi Jiménez-Conde
- Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), University at Autonoma de Barcelona, Barcelona, Spain
| | - Christina Jern
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Brett M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Dawn O Kleindorfer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium.,Department of Neurology, VIB, Vesalius Research Center, Laboratory of Neurobiology, University Hospitals Leuven, Leuven, Belgium
| | - James F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | - Tatjana Rundek
- Department of Neurology and the Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Ralph L Sacco
- Department of Neurology and the Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Reinhold Schmidt
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University Graz, Graz, Austria
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, United Kingdom.,Ashford and St Peter's Hospital, Surrey, United Kingdom
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia.,Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Bradford B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Steven J Kittner
- Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, United States
| | - Braxton D Mitchell
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.,Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, MD, United States
| | - Jonathan Rosand
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Henry and Allison McCancer Center for Brain Health and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Polina Golland
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, United States
| | - Arne Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden
| | - Natalia S Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Johan Wassélius
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden.,Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden
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12
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Powers WJ, Kam CH, Ritter VS, Fine JP. Diagnostic accuracy of acute infarcts in multiple cerebral circulations for cardioembolic stroke: Literature review and meta-analysis. J Stroke Cerebrovasc Dis 2020; 29:104849. [PMID: 32402721 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104849] [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: 02/01/2020] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To determine the diagnostic value of acute infarcts in multiple cerebral circulations (AIMCC) on MRI diffusion-weighted imaging (DWI) for cardioembolism (CE) stroke subtype in adult patients hospitalized with acute ischemic stroke, we conducted a systematic literature review and meta-analysis. METHODS MEDLINE was searched via PubMed for articles reporting patients hospitalized with acute ischemic stroke with MRI DWI categorized as AIMCC vs other and use of Trial of Org 10172 in Acute Stroke Treatment (TOAST) Criteria for cardioembolism subtype. Measures of diagnostic accuracy were calculated from the retrieved studies. RESULTS Seven eligible articles comprised 5813 patients. Bivariate random effects models estimated sensitivity 0.19 (95% CI, 0.13 to 0.27), specificity 0.89 (0.86 to 0.91), positive predictive value 0.37 (0.30 to 0.45), negative predictive value 0.76 (0.7 to 0.82), positive likelihood ratio 1.70 (1.13 to 2.57) and negative likelihood ratio 0.91 (0.83 to 1). INTERPRETATION The pattern of AIMCC on DWI is of limited diagnostic value. It is not sufficiently accurate to exclude cardiac pathology by a negative test nor does a positive test indicate a major increase in the probability of identifying a potential cardioembolic source.
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Affiliation(s)
- William J Powers
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, United States.
| | - Candice H Kam
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, United States.
| | - Victor S Ritter
- Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States.
| | - Jason P Fine
- Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States.
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13
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Kamran S, Akhtar N, George P, Singh R, Imam Y, Salam A, Babu B, Burke P, Own A, Vattoth S, Perkins J, Parray A, Qadri S, Hamid T. Embolic Pattern of Stroke Associated with Cardiac Wall Motion Abnormalities; Narrowing the Embolic Stroke of Undetermined Source Category. J Stroke Cerebrovasc Dis 2020; 29:104509. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/29/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022] Open
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14
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Novotny V, Khanevski AN, Bjerkreim AT, Kvistad CE, Fromm A, Waje-Andreassen U, Næss H, Thomassen L, Logallo N. Short-Term Outcome and In-Hospital Complications After Acute Cerebral Infarcts in Multiple Arterial Territories. Stroke 2019; 50:3625-3627. [DOI: 10.1161/strokeaha.119.027049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Patients with acute cerebral infarcts in multiple arterial territories (MACI) represent a substantial portion of the stroke population. There are no data on short-term outcome and in-hospital complications in patients with MACI. We compared patients with MACI with patients having acute cerebral infarct(s) in a single arterial territory.
Methods—
We analyzed 3343 patients with diffusion-weighted imaging-confirmed acute cerebral infarcts. MACI was defined as at least 2 acute cerebral ischemic lesions in at least 2 arterial cerebral territories. Patients with MACI were compared with patients with acute cerebral infarct(s) in a single arterial territory for relevant in-hospital complications and short-term outcome, namely National Institutes of Health Stroke Scale and modified Rankin Scale at day 7 after admission or at discharge when earlier.
Results—
A total of 311 patients (9.3%) met the definition of MACI. Both median National Institutes of Health Stroke Scale (2 [1–7] versus 1 [0–4]) and modified Rankin Scale (3 [1–4] versus 2 [1–3]) were higher in patients with MACI. MACI was independently associated with higher National Institutes of Health Stroke Scale and modified Rankin Scale. Deep venous thrombosis, myocardial infarction, and any complications were more frequent in patients with MACI.
Conclusions—
In-hospital complications were more frequent in patients with MACI, which may adversely affect short-term clinical and functional outcome. Closer follow-up of patients with MACI during hospitalization may prevent such events and negative progression.
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Affiliation(s)
- Vojtech Novotny
- From the Department of Neurology, Center for Neurovascular Diseases (V.N., A.N.K., A.T.B., C.E.K., A.F., U.W.-A., H.N., L.T), Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway (V.N., A.N.K., A.T.B., C.E.K., A.F., L.T., N.L.)
| | - Andrej N. Khanevski
- From the Department of Neurology, Center for Neurovascular Diseases (V.N., A.N.K., A.T.B., C.E.K., A.F., U.W.-A., H.N., L.T), Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway (V.N., A.N.K., A.T.B., C.E.K., A.F., L.T., N.L.)
- The National Association for Public Health, Oslo, Norway (A.N.K.)
| | - Anna T. Bjerkreim
- From the Department of Neurology, Center for Neurovascular Diseases (V.N., A.N.K., A.T.B., C.E.K., A.F., U.W.-A., H.N., L.T), Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway (V.N., A.N.K., A.T.B., C.E.K., A.F., L.T., N.L.)
| | - Christopher E. Kvistad
- From the Department of Neurology, Center for Neurovascular Diseases (V.N., A.N.K., A.T.B., C.E.K., A.F., U.W.-A., H.N., L.T), Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway (V.N., A.N.K., A.T.B., C.E.K., A.F., L.T., N.L.)
| | - Annette Fromm
- From the Department of Neurology, Center for Neurovascular Diseases (V.N., A.N.K., A.T.B., C.E.K., A.F., U.W.-A., H.N., L.T), Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway (V.N., A.N.K., A.T.B., C.E.K., A.F., L.T., N.L.)
| | - Ulrike Waje-Andreassen
- From the Department of Neurology, Center for Neurovascular Diseases (V.N., A.N.K., A.T.B., C.E.K., A.F., U.W.-A., H.N., L.T), Haukeland University Hospital, Bergen, Norway
| | - Halvor Næss
- From the Department of Neurology, Center for Neurovascular Diseases (V.N., A.N.K., A.T.B., C.E.K., A.F., U.W.-A., H.N., L.T), Haukeland University Hospital, Bergen, Norway
- Center for Age-related Medicine, Stavanger University Hospital, Norway (H.N.)
| | - Lars Thomassen
- From the Department of Neurology, Center for Neurovascular Diseases (V.N., A.N.K., A.T.B., C.E.K., A.F., U.W.-A., H.N., L.T), Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway (V.N., A.N.K., A.T.B., C.E.K., A.F., L.T., N.L.)
| | - Nicola Logallo
- Department of Neurosurgery (N.L.), Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway (V.N., A.N.K., A.T.B., C.E.K., A.F., L.T., N.L.)
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15
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Clinical significance of acute and chronic ischaemic lesions in multiple cerebral vascular territories. Eur Radiol 2018; 29:1338-1347. [DOI: 10.1007/s00330-018-5684-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/09/2018] [Accepted: 07/27/2018] [Indexed: 01/10/2023]
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16
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Zaidat OO, Castonguay AC, Linfante I, Gupta R, Martin CO, Holloway WE, Mueller-Kronast N, English JD, Dabus G, Malisch TW, Marden FA, Bozorgchami H, Xavier A, Rai AT, Froehler MT, Badruddin A, Nguyen TN, Taqi MA, Abraham MG, Yoo AJ, Janardhan V, Shaltoni H, Novakovic R, Abou-Chebl A, Chen PR, Britz GW, Sun CHJ, Bansal V, Kaushal R, Nanda A, Nogueira RG. First Pass Effect. Stroke 2018; 49:660-666. [PMID: 29459390 DOI: 10.1161/strokeaha.117.020315] [Citation(s) in RCA: 428] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 12/01/2017] [Accepted: 01/16/2018] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
In acute ischemic stroke, fast and complete recanalization of the occluded vessel is associated with improved outcomes. We describe a novel measure for newer generation devices: the first pass effect (FPE). FPE is defined as achieving a complete recanalization with a single thrombectomy device pass.
Methods—
The North American Solitaire Acute Stroke Registry database was used to identify a FPE subgroup. Their baseline features and clinical outcomes were compared with non-FPE patients. Clinical outcome measures included 90-days modified Rankin Scale score, National Institutes of Health Stroke Scale score, mortality, and symptomatic intracranial hemorrhage. Multivariate analyses were performed to determine whether FPE independently resulted in improved outcomes and to identify predictors of FPE.
Results—
A total of 354 acute ischemic stroke patients underwent thrombectomy in the North American Solitaire Acute Stroke registry. FPE was achieved in 89 out of 354 (25.1%). More middle cerebral artery occlusions (64% versus 52.5%) and fewer internal carotid artery occlusions (10.1% versus 27.7%) were present in the FPE group. Balloon guide catheters were used more frequently with FPE (64.0% versus 34.7%). Median time to revascularization was significantly faster in the FPE group (median 34 versus 60 minutes;
P
=0.0003). FPE was an independent predictor of good clinical outcome (modified Rankin Scale score ≤2 was seen in 61.3% in FPE versus 35.3% in non-FPE cohort;
P
=0.013; odds ratio, 1.7; 95% confidence interval, 1.1–2.7). The independent predictors of achieving FPE were use of balloon guide catheters and non-internal carotid artery terminus occlusion.
Conclusions—
The achievement of complete revascularization from a single Solitaire thrombectomy device pass (FPE) is associated with significantly higher rates of good clinical outcome. The FPE is more frequently associated with the use of balloon guide catheters and less likely to be achieved with internal carotid artery terminus occlusion.
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Affiliation(s)
- Osama O. Zaidat
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Alicia C. Castonguay
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Italo Linfante
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Rishi Gupta
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Coleman O. Martin
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - William E. Holloway
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Nils Mueller-Kronast
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Joey D. English
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Guilherme Dabus
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Tim W. Malisch
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Franklin A. Marden
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Hormozd Bozorgchami
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Andrew Xavier
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Ansaar T. Rai
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Michael T. Froehler
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Aamir Badruddin
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Thanh N. Nguyen
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - M. Asif Taqi
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Michael G. Abraham
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Albert J. Yoo
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Vallabh Janardhan
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Hashem Shaltoni
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Roberta Novakovic
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Alex Abou-Chebl
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Peng R. Chen
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Gavin W. Britz
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Chung-Huan J. Sun
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Vibhav Bansal
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Ritesh Kaushal
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Ashish Nanda
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
| | - Raul G. Nogueira
- From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke’s Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J
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17
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Selvik HA, Bjerkreim AT, Thomassen L, Waje-Andreassen U, Naess H, Kvistad CE. When to Screen Ischaemic Stroke Patients for Cancer. Cerebrovasc Dis 2018; 45:42-47. [PMID: 29402826 DOI: 10.1159/000484668] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/25/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Ischemic stroke can be the first manifestation of cancer and it is therefore important to ascertain which stroke patients should be considered for cancer-diagnostic investigations. We aimed to determine the frequency of active cancer in patients with acute ischemic stroke and to compare clinical findings in stroke patients with active cancer to ischemic stroke patients with no history of cancer. Finally, we aimed to develop a predictive and feasible score for clinical use to uncover underlying malignancy. METHODS All ischemic stroke patients admitted to the stroke unit in the Department of Neurology, Haukeland University Hospital were consecutively included in the Norwegian Stroke Research Registry (NORSTROKE). Stroke etiology was determined by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Data on cancer diagnoses was obtained from patients' medical records and the Cancer Registry of Norway. Active cancer was defined as cancer diagnosis, metastasis of known cancer, recurrent cancer or receiving cancer treatment, all within 12 months before or after the index stroke. Based on variables independently associated with active cancer, a predictive score was developed using the area under the receiver operating characteristic (AUC-ROC) curves. Bayes' theorem was used to calculate post-test probabilities of active cancer. RESULTS Of the 1,646 ischemic stroke patients included, 82 (5.0%) had active cancer. Increased D-dimer (OR = 1.1, 95% CI: 1.1-1.2, p = <0.001), lower Hb (OR = 0.6, 95% CI: 0.5-0.7, p = <0.001), smoking (OR = 2.2, 95% CI: 1.2-4.3, p = 0.02) and suffering a stroke of undetermined etiology (OR = 1.9, 95% CI: 1.1-3.3, p = 0.03) were factors independently associated with active cancer. These were included in the final predictive score which gave an AUC of 0.73 (95% CI: 0.65-0.81) in patients younger than 75 years of age. Assuming the prevalence of cancer to be 5%, the score shows that if a patient fulfills all 3 score points, the probability of active cancer is 53%. CONCLUSIONS Active cancer was found in 5% of our ischemic stroke patients. We found that a clinical score comprising elevated D-dimer ≥3 mg/L, lower Hb ≤12.0 g/dL and previous or current smoking is feasible for predicting active cancer in ischemic stroke patients.
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Affiliation(s)
- Henriette Aurora Selvik
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Anna Therese Bjerkreim
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Lars Thomassen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Ulrike Waje-Andreassen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Halvor Naess
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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18
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Cheng B, Knaack C, Forkert ND, Schnabel R, Gerloff C, Thomalla G. Stroke subtype classification by geometrical descriptors of lesion shape. PLoS One 2017; 12:e0185063. [PMID: 29216218 PMCID: PMC5720627 DOI: 10.1371/journal.pone.0185063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/06/2017] [Indexed: 01/24/2023] Open
Abstract
Background and purpose Inference of etiology from lesion pattern in acute magnetic resonance imaging is valuable for management and prognosis of acute stroke patients. This study aims to assess the value of three-dimensional geometrical lesion-shape descriptors for stroke-subtype classification, specifically regarding stroke of cardioembolic origin. Methods Stroke Etiology was classified according to ASCOD in retrospectively selected patients with acute stroke. Lesions were segmented on diffusion-weighed datasets, and descriptors of lesion shape quantified: surface area, sphericity, bounding box volume, and ratio between bounding box and lesion volume. Morphological measures were compared between stroke subtypes classified by ASCOD and between patients with embolic stroke of cardiac and non-cardiac source. Results 150 patients (mean age 77 years; 95% CI, 65–80 years; median NIHSS 6, range 0–22) were included. Group comparison of lesion shape measures demonstrated that lesions caused by small-vessel disease were smaller and more spherical compared to other stroke subtypes. No significant differences of morphological measures were detected between patients with cardioembolic and non-cardioembolic stroke. Conclusion Stroke lesions caused by small vessel disease can be distinguished from other stroke lesions based on distinctive morphological properties. However, within the group of embolic strokes, etiology could not be inferred from the morphology measures studied in our analysis.
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Affiliation(s)
- Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Christian Knaack
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Renate Schnabel
- Department of General and Interventional Cardiology, German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, University Heart Center Hamburg Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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19
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Sousa JA, Mendes-Pinto M, Sargento-Freitas J, Silva F, Cecília C, Macário C, Gouveia A, Machado C, Rodrigues B, Santo GC, Lima A, Veiga R, Cunha L, Freire-Gonçalves A. Cerebrovascular Dissemination in Time and Space as a Predictor of Cardioembolism. J Stroke Cerebrovasc Dis 2017; 26:1407-1413. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/09/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022] Open
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