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Hamon G, Legrand L, Hmeydia G, Turc G, Hassen WB, Charron S, Debacker C, Naggara O, Thirion B, Chen B, Lapergue B, Oppenheim C, Benzakoun J. Multicenter validation of synthetic FLAIR as a substitute for FLAIR sequence in acute ischemic stroke. Eur Stroke J 2024:23969873241263418. [PMID: 39096195 DOI: 10.1177/23969873241263418] [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: 08/05/2024] Open
Abstract
PURPOSE To evaluate performance of synthetic and real FLAIR for identifying early stroke in a multicenter cohort. METHODS This retrospective study was conducted using DWI and FLAIR extracted from the Endovascular Treatment in Ischemic Stroke image registry (2017-2021). The database was partitioned into subsets according to MRI field strength and manufacturer, and randomly divided into training set (70%) used for model fine-tuning, validation set (15%), and test set (15%). In test set, five readers, blinded to FLAIR sequence type, assessed DWI-FLAIR mismatch using real and synthetic FLAIR. Interobserver agreement for DWI-FLAIR rating and concordance between synthetic and real FLAIR were evaluated with kappa statistics. Sensitivity and specificity for identification of ⩽4.5 h AIS were compared in patients with known onset-to-MRI delay using McNemar's test. RESULTS 1454 complete MRI sets (1172 patients, median (IQR) age: 73 years (62-82); 762 women) acquired on 125 MRI units were analyzed. In test set (207 MRI), interobserver reproducibility for DWI-FLAIR mismatch labeling was substantial for real and synthetic FLAIR (Fleiss κ = 0.79 (95%CI: 0.73-0.84) and 0.77 (95%CI: 0.71-0.82), respectively). After consensus, concordance between real and synthetic FLAIR was excellent (κ = 0.85 (95%CI: 0.78-0.92)). In 141 MRI sets with known onset-to-MRI delay, diagnostic performances for ⩽4.5 h AIS identification did not differ between real and synthetic FLAIR (sensitivity: 60/71 (85%) vs 59/71 (83%), p = .56; specificity: 65/70 (93%) vs 65/70 (93%), p > 0.99). CONCLUSION A deep-learning-based FLAIR fine-tuned on multicenter data can provide comparable performances to real FLAIR for early AIS identification. This approach may help reducing MR protocol duration and motion artifacts.
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Affiliation(s)
- Guillaume Hamon
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
| | - Laurence Legrand
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
| | - Ghazi Hmeydia
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Guillaume Turc
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Wagih Ben Hassen
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
| | - Sylvain Charron
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
| | - Clement Debacker
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
| | - Olivier Naggara
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
| | | | - Bailiang Chen
- CIC, Innovation Technologique, Université de Lorraine, INSERM 1433, Nancy, France
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - Catherine Oppenheim
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
| | - Joseph Benzakoun
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
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2
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Wada S, Yoshimura S, Toyoda K, Nakai M, Sasahara Y, Miwa K, Koge J, Ishigami A, Shiozawa M, Ogasawara K, Kitazono T, Nogawa S, Iwanaga Y, Miyamoto Y, Minematsu K, Koga M. Characteristics and outcomes of unknown onset stroke: The Japan Stroke Data Bank. J Neurol Sci 2023; 453:120798. [PMID: 37729754 DOI: 10.1016/j.jns.2023.120798] [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: 02/17/2023] [Revised: 08/14/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Clinical outcomes of unknown onset stroke (UOS) are influenced by the enlargement of the therapeutic time window for reperfusion therapy. This study aimed to investigate and describe the characteristics and clinical outcomes of patients with UOS. METHODS Patients with acute ischemic stroke (AIS) who were admitted within 24 h of their last known well time, from January 2017 to December 2020, were included. Data were obtained from a long-lasting nationwide hospital-based multicenter prospective registry: the Japan Stroke Data Bank. The co-primary outcomes were the National Institutes of Stroke Scale (NIHSS) scores on admission and unfavorable outcomes at discharge, corresponding to modified Rankin Scale (mRS) scores of 3-6. RESULTS Overall, 26,976 patients with AIS were investigated. Patients with UOS (N = 5783, 78 ± 12 years of age) were older than patients with known onset stroke (KOS) (N = 21,193, 75 ± 13 years of age). Age, female sex, higher premorbid mRS scores, atrial fibrillation, and congestive heart failure were associated with UOS in multivariate analysis. UOS was associated with higher NIHSS scores (median = 8 [interquartile range [IQR]: 3-19] vs. 4 [1-10], adjusted incidence rate ratio = 1.37 [95% CI: 1.35-1.38]) and unfavorable outcomes (52.1 vs. 33.6%, adjusted odds ratio = 1.27 [1.14-1.40]). Intergroup differences in unfavorable outcomes were attenuated among females (1.12 [0.95-1.32] vs. males 1.38 [1.21-1.56], P = 0.040) and in the subgroup that received reperfusion therapy (1.10 [0.92-1.33] vs. those who did not receive therapy 1.23 [1.08-1.39], P = 0.012). CONCLUSIONS UOS was associated with unfavorable outcomes but to a lesser degree among females and patients receiving reperfusion therapy.
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Affiliation(s)
- Shinichi Wada
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yusuke Sasahara
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Junpei Koge
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akiko Ishigami
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University Hospital, Yahaba, Iwate, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeru Nogawa
- Department of Neurology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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3
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Ishizuka K, Saito M, Shibata N, Kitagawa K. Cytoskeletal protein breakdown and serum albumin extravasation in MRI DWI-T2WI mismatch area in acute murine cerebral ischemia. Neurosci Res 2023; 190:85-91. [PMID: 36375655 DOI: 10.1016/j.neures.2022.11.005] [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: 06/06/2022] [Revised: 10/12/2022] [Accepted: 11/10/2022] [Indexed: 11/13/2022]
Abstract
MRI diffusion-weighted imaging (DWI)-FLAIR mismatch is known as predictive of symptom onset within 4.5 h. This study assessed the breakdown of cytoskeletal protein and blood-brain barrier (BBB) in DWI-T2 mismatch. We employed occlusion of middle cerebral artery (MCAO) in C57BL/6 mice. We serially measured MRI including DWI and T2WI. After MRI, we prepared brain sections or samples and examined microtubule-associated protein 2 (MAP2) expression, alpha-fodrin degradation, extravasation of albumin and claudin-5 expression. In permanent or transient MCAO for 45 min, DWI hyperintensities was already found at 60 min without change of T2, showing DWI-T2 mismatch. In permanent MCAO, MAP2 expressions were preserved, and no extravasation of albumin was observed. In transient MCAO, MAP2 immunoreaction was already lost in the lateral part of the striatum. In both models, alpha-fodrin degradation was already detected. At 180 min, T2 hyperintensities appeared, where MAP2 signal was lost and albumin extravasation was found. At 24 h, hyperintensities of DWI and T2WI was found in the whole MCA territory, where MAP2 signal was completely lost with marked albumin extravasation and alpha-fodrin degradation. Immunoreaction for claudin-5 was preserved up to 180 min. DWI-T2 mismatch area may not always indicate intactness of cytoskeletal protein but shows preservation of BBB.
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Affiliation(s)
- Kentaro Ishizuka
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | - Moeko Saito
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | - Noriyuki Shibata
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan.
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4
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Stösser S, Bode FJ, Meissner JN, Weller JM, Kindler C, Sauer M, Paech D, Riegler C, Nolte CH, Pourian A, Röther J, Selo N, Ernemann U, Poli S, Eckert RM, Bohner G, Scherling K, Dorn F, Petzold GC. Outcome of Stroke Patients with Unknown Onset and Unknown Time Last Known Well Undergoing Endovascular Therapy. Clin Neuroradiol 2023; 33:107-112. [PMID: 35796854 PMCID: PMC10014703 DOI: 10.1007/s00062-022-01188-5] [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: 03/25/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Endovascular treatment (ET) in patients with large vessel occlusion stroke (LVOS) with unknown onset or an extended time window can be safe and effective if patients are selected by defined clinical and imaging criteria; however, it is unclear if these criteria should also be applied to patients with unknown onset and unknown time last known well. In this study, we aimed to assess whether absent information on the time patients were last known to be well impacts outcome in patients with unknown onset LVOS. METHODS We analyzed patients who were enrolled in the German Stroke Registry-Endovascular Treatment between 2015 and 2019. Patients with unknown onset and unknown time last known well (LKWu) were compared to patients with known onset (KO) and to patients with unknown onset but known time last known well (LKWk) regarding clinical and imaging baseline characteristics and outcome. RESULTS Out of 5909 patients, 561 presented with LKWu (9.5%), 1849 with LKWk (31.3%) and 3499 with KO (59.2%). At 90 days, functional independency was less frequent in LKWu (27.0%) compared to KO (42.6%) and LKWk patients (31.8%). These differences were not significant after adjusting for confounders. A main confounder was the initial Alberta stroke program early CT score. CONCLUSION The LKWu patients had a similar outcome after ET as KO and LKWk patients after adjusting for confounders. Thus, ET should not be withheld if the time last known well is unknown. Instead, LKWu patients may be selected for ET using the same criteria as in LKWk patients.
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Affiliation(s)
- Sebastian Stösser
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Felix J Bode
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julius N Meissner
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Johannes M Weller
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christine Kindler
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Malte Sauer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Paech
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Christoph Riegler
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Amitis Pourian
- Department of Neurology, Asklepios Hospital Hamburg Altona, Semmelweis University Campus Hamburg, Hamburg, Germany
| | - Joachim Röther
- Department of Neurology, Asklepios Hospital Hamburg Altona, Semmelweis University Campus Hamburg, Hamburg, Germany
| | - Nadja Selo
- Department of Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Ulrike Ernemann
- Department of Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Sven Poli
- Department of Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Rosa Marie Eckert
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Bohner
- Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Korbinian Scherling
- Department of Neuroradiology, Ludwig Maximilians University Munich, Campus Grosshadern, Munich, Germany
| | - Franziska Dorn
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Gabor C Petzold
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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5
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Zheng T, Lai X, Lu J, Chen Q, Wei D. Three Dimensional-Arterial Spin Labeling Evaluation of Improved Cerebral Perfusion After Limb Remote Ischemic Preconditioning in a Rat Model of Focal Ischemic Stroke. Front Neuroanat 2022; 16:893953. [PMID: 35847828 PMCID: PMC9280338 DOI: 10.3389/fnana.2022.893953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the application value of 3D arterial spin labeling (3D-ASL) for evaluating distal limb ischemic preconditioning to improve acute ischemic stroke (AIS) perfusion. Materials and Methods A total of 40 patients with AISs treated in our hospital from January 2020 to December 2020 were recruited, and 15 healthy individuals who were examined in our hospital during the same period were included as the control group; all of these participants were scored on the National Institutes of Health Stroke Scale (NIHSS) and examined by MRI. Sequences included conventional sequences, diffusion-weighted imaging (DWI), magnetic resonance angiography (MRA), and 3D-ASL, and cerebral infarct volume and cerebral blood flow (CBF) in the area of the infarct lesion were measured. After 3 months of treatment, patients with AIS were scored on the modified Rankin Scale (mRS) and divided into good prognosis and poor prognosis groups. In total, 55 adult male Sprague–Dawley rats were divided randomly into three groups: 20 in the middle cerebral artery occlusion (MCAO) group, 20 in the MCAO + limb remote ischemic preconditioning (LRP) group, and 15 in the sham group. In total, 48 h after the procedures, conventional MRI, DWI, and 3D-ASL sequence data were collected, and 2,3,5-trphenyltetrazolium chloride monohydrate (TTC) staining and behavioral scoring were performed. CBF was recorded in the infarct lesion area and the corresponding contralateral area, and the affected/contralateral relative values (rCBF) were calculated to compare the differences in rCBF between different groups. The pathological changes in brain tissues were observed by HE staining, and the expression of vascular endothelial growth factor (VEGF) and platelet endothelial cell adhesion molecule-1 (PECAM-1/CD31) in brain tissues was detected by immunofluorescence and real-time quantitative polymerase chain reaction (RT-qPCR). The protein expression of VEGF was detected by western blotting. Results Hypertension and internal carotid atherosclerosis are high-risk factors for ischemic stroke, and CBF values in the infarct area are significantly lower than those in the corresponding areas on the contralateral side. NIHSS and mRS scores and CBF values have higher specificity and sensitivity for the prognosis of patients with AIS. LRP significantly reduces the infarct area, improves behavioral deficits in rats with cerebral ischemia, reduces neurological injury and histological damage, protects vascular structures, and promotes neovascularization. In addition, 3D-ASL showed a significant increase in brain tissue perfusion in the ischemic area after LRP, and the expression of VEGF and CD31 showed a significant positive correlation with CBF values. Conclusion Three dimensional (3D) ASL can be used to evaluate LRP to improve stroke perfusion, and its protective effect may be closely related to LRP-induced vascular regeneration.
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Affiliation(s)
- Tianxiu Zheng
- Department of Radiology, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, China
| | - Xiaolan Lai
- Department of Hematology, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, China
| | - Jiaojiao Lu
- Department of Central Laboratory, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, China
| | - Qiuyan Chen
- Department of Radiology, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, China
| | - Dingtai Wei
- Department of Radiology, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, China
- *Correspondence: Dingtai Wei,
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6
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Qin B, Gao W, Qin H, Zhao L, Yang M. Endovascular treatment for wake-up stroke and daytime unwitnessed stroke: A meta-analysis. J Clin Neurosci 2022; 101:252-258. [PMID: 35660760 DOI: 10.1016/j.jocn.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 04/18/2022] [Accepted: 05/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evidence from sources outside the typical clinical research setting, such as a real-world setting, may complement evidence from randomised controlled trials (RCTs). The aim of the present study was to carry out a meta-analysis of available real-world evidence that focused on the efficacy and safety of endovascular treatment in patients with wake-up stroke (WUS) or daytime unwitnessed stroke (DUS) compared to that in patients treated ≤ 6 h after the onset of an ischemic stroke. METHODS Data mining was conducted on 1 May 2021 from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials Cochrane Library. The study reviewed all published that assessed the effect of endovascular treatment in WUS and DUS compared to that received by patients with ischemic stroke. Relevant data were extracted and the narrative was reviewed and analysed. The results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). FINDINGS The meta-analysis showed no significant differences between the two groups in the rates of functional independence (OR, 0.81; 95% CI, 0.65-1.02; P = 0.07), symptomatic intracerebral haemorrhage (OR, 0.86; 95% CI, 0.57-1.30; P = 0.470), and all-cause mortality (OR, 0.92; 95% CI, 0.73-1.16; P = 0.50). There was also no heterogeneity between the trials. CONCLUSION The pooled analysis provided evidence to support the use of endovascular treatment in WUS and DUS with favourable perfusion imaging. The meta-analysis confirmed the main findings of RCTs of endovascular treatment in WUS and DUS in a real-world setting and therefore strengthens the validity of this treatment strategy.
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Affiliation(s)
- Bin Qin
- Department of Neurology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi, China
| | - Wen Gao
- Department of Neurology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi, China; Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Huixun Qin
- Department of Neurology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi, China
| | - Libo Zhao
- Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Mingxiu Yang
- Department of Neurology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi, China.
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7
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Sancho Saldaña A, Tejada Meza H, Serrano Ponz M, Aladrén Sangrós JÁ, Navasa Melado JM, Seral Moral P, Marta Moreno J. Incidence, outcomes, and associated factors of isolated striatocapsular infarct after mechanical thrombectomy. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:250-256. [PMID: 35595400 DOI: 10.1016/j.nrleng.2019.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 01/09/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe baseline and procedural characteristics and clinical outcomes of isolated striatocapsular infarct (iSCI) after mechanical thrombectomy in patients with large-vessel occlusion of the anterior cerebral circulation and its clinical outcome. METHODS We performed a longitudinal study including all patients treated with mechanical thrombectomy at our centre between 2015 and 2017; patients were divided into 2 groups (iSCI and non-iSCI) according to whether they presented iSCI in a control CT scan at 24 hours. RESULTS Of the 83 patients identified, 22.9% developed an iSCI. There were no statically significant differences in baseline characteristics or in reperfusion times. Patients presenting iSCI showed better collateral circulation and better reperfusion rates in the bivariate analysis. No significant difference was observed for mortality at discharge or at 3 months, or for functional prognosis at 3 months. CONCLUSIONS Even if successful reperfusion is achieved, iSCI is a common sequela, independently of reperfusion time, especially in patients with good collateral circulation.
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Affiliation(s)
- A Sancho Saldaña
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - H Tejada Meza
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - M Serrano Ponz
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - J Á Aladrén Sangrós
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - J M Navasa Melado
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - P Seral Moral
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - J Marta Moreno
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
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8
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Sancho Saldaña A, Tejada Meza H, Serrano Ponz M, Aladrén Sangrós JŸ, Navasa Melado JM, Seral Moral P, Marta Moreno J. Incidence, outcomes, and associated factors of isolated striatocapsular infarct after mechanical thrombectomy. Neurologia 2022; 37:250-256. [PMID: 31064665 DOI: 10.1016/j.nrl.2019.01.005] [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: 02/22/2018] [Revised: 01/04/2019] [Accepted: 01/09/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To describe baseline and procedural characteristics and clinical outcomes of isolated striatocapsular infarct (iSCI) after mechanical thrombectomy in patients with large-vessel occlusion of the anterior cerebral circulation andits clinical outcome. METHODS We performed a longitudinal study including all patients treated with mechanical thrombectomy at our centre between 2015 and 2017; patients were divided into 2 groups (iSCI and non-iSCI) according to whether they presented iSCI in a control CT scan at 24h. RESULTS Of the 83 patients identified, 22.9% developed an iSCI. There were no statically significant differences in baseline characteristics or in reperfusion times. Patients presenting iSCI showed better collateral circulation and better reperfusion rates in the bivariate analysis. No significant difference was observed for mortality at discharge or at 3 months, or for functional prognosis at 3 months. CONCLUSIONS Even if successful reperfusion is achieved, iSCI is a common sequela, independently of reperfusion time, especially in patients with good collateral circulation.
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Affiliation(s)
- A Sancho Saldaña
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - H Tejada Meza
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M Serrano Ponz
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Ÿ Aladrén Sangrós
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J M Navasa Melado
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - P Seral Moral
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Marta Moreno
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
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Benzakoun J, Deslys MA, Legrand L, Hmeydia G, Turc G, Hassen WB, Charron S, Debacker C, Naggara O, Baron JC, Thirion B, Oppenheim C. Synthetic FLAIR as a Substitute for FLAIR Sequence in Acute Ischemic Stroke. Radiology 2022; 303:153-159. [PMID: 35014901 DOI: 10.1148/radiol.211394] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background In acute ischemic stroke (AIS), fluid-attenuated inversion recovery (FLAIR) is used for treatment decisions when onset time is unknown. Synthetic FLAIR could be generated with deep learning from information embedded in diffusion-weighted imaging (DWI) and could replace acquired FLAIR sequence (real FLAIR) and shorten MRI duration. Purpose To compare performance of synthetic and real FLAIR for DWI-FLAIR mismatch estimation and identification of patients presenting within 4.5 hours from symptom onset. Materials and Methods In this retrospective study, all pretreatment and early follow-up (<48 hours after symptom onset) MRI data sets including DWI (b = 0-1000 sec/mm2) and FLAIR sequences obtained in consecutive patients with AIS referred for reperfusion therapies between January 2002 and May 2019 were included. On the training set (80%), a generative adversarial network was trained to produce synthetic FLAIR with DWI as input. On the test set (20%), synthetic FLAIR was computed without real FLAIR knowledge. The DWI-FLAIR mismatch was evaluated on both FLAIR data sets by four independent readers. Interobserver reproducibility and DWI-FLAIR mismatch concordance between synthetic and real FLAIR were evaluated with κ statistics. Sensitivity and specificity for identification of AIS within 4.5 hours were compared in patients with known onset time by using McNemar test. Results The study included 1416 MRI scans (861 patients; median age, 71 years [interquartile range, 57-81 years]; 375 men), yielding 1134 and 282 scans for training and test sets, respectively. Regarding DWI-FLAIR mismatch, interobserver reproducibility was substantial for real and synthetic FLAIR (κ = 0.80 [95% CI: 0.74, 0.87] and 0.80 [95% CI: 0.74, 0.87], respectively). After consensus, concordance between real and synthetic FLAIR was almost perfect (κ = 0.88; 95% CI: 0.82, 0.93). Diagnostic value for identifying AIS within 4.5 hours did not differ between real and synthetic FLAIR (sensitivity: 107 of 131 [82%] vs 111 of 131 [85%], P = .2; specificity: 96 of 104 [92%] vs 96 of 104 [92%], respectively, P > .99). Conclusion Synthetic fluid-attenuated inversion recovery (FLAIR) had diagnostic performances similar to real FLAIR in depicting diffusion-weighted imaging-FLAIR mismatch and in helping to identify early acute ischemic stroke, and it may accelerate MRI protocols. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Carroll and Hurley in this issue.
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Affiliation(s)
- Joseph Benzakoun
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Marc-Antoine Deslys
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Laurence Legrand
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Ghazi Hmeydia
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Guillaume Turc
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Wagih Ben Hassen
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Sylvain Charron
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Clément Debacker
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Olivier Naggara
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Jean-Claude Baron
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Bertrand Thirion
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
| | - Catherine Oppenheim
- From the Departments of Neuroradiology (J.B., L.L., G.H., W.B.H., O.N., C.O.) and Neurology (G.T., J.C.B.), GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; INSERM U1266, Paris, France (J.B., M.A.D., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); Université de Paris, FHU Neurovasc, Paris, France (J.B., L.L., G.T., W.B.H., S.C., C.D., O.N., J.C.B., C.O.); and PARIETAL Team, INRIA, Saclay, France (B.T.)
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Polson J, Zhang H, Nael K, Salamon N, Yoo B, Kim N, Kang DW, Speier W, Arnold CW. A Semi-Supervised Learning Framework to Leverage Proxy Information for Stroke MRI Analysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:2258-2261. [PMID: 34891736 DOI: 10.1109/embc46164.2021.9631098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Treating acute ischemic stroke (AIS) patients is a time-sensitive endeavor, as therapies target areas experiencing ischemia to prevent irreversible damage to brain tissue. Depending on how an AIS is progressing, thrombolytics such as tissue-plasminogen activator (tPA) may be administered within a short therapeutic window. The underlying conditions for optimal treatment are varied. While previous clinical guidelines only permitted tPA to be administered to patients with a known onset within 4.5 hours, clinical trials demonstrated that patients with signal intensity differences between diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences in an MRI study can benefit from thrombolytic therapy. This intensity difference, known as DWI-FLAIR mismatch, is prone to high inter-reader variability. Thus, a paradigm exists where onset time serves as a weak proxy for DWI-FLAIR mismatch. In this study, we sought to detect DWI-FLAIR mismatch in an automated fashion, and we compared this to assessments done by three expert neuroradiologists. Our approach involved training a deep learning model on MRI to classify tissue clock and leveraging time clock as a weak proxy label to supplement training in a semi-supervised learning (SSL) framework. We evaluate our deep learning model by testing it on an unseen dataset from an external institution. In total, our proposed framework was able to improve detection of DWI-FLAIR mismatch, achieving a top ROC-AUC of 74.30%. Our study illustrated that incorporating clinical proxy information into SSL can improve model optimization by increasing the fidelity of unlabeled samples included in the training process.
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11
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Jing M, Yeo JYP, Holmin S, Andersson T, Arnberg F, Bhogal P, Yang C, Gopinathan A, Tu TM, Tan BYQ, Sia CH, Teoh HL, Paliwal PR, Chan BPL, Sharma V, Yeo LLL. Preprocedural Imaging : A Review of Different Radiological Factors Affecting the Outcome of Thrombectomy. Clin Neuroradiol 2021; 32:13-24. [PMID: 34709411 DOI: 10.1007/s00062-021-01095-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/25/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endovascular treatment (EVT) has strong evidence for its effectiveness in treatment of acute ischemic stroke (AIS); however, up to half of the patients who undergo EVT still do not have good functional outcomes. Various prethrombectomy radiological factors have been shown to be associated with good clinical outcomes and may be the key to better functional outcomes, reduced complications, and reduced mortality. In this paper, we reviewed the current literature on these imaging parameters so they can be employed to better estimate the probability of procedural success, therefore allowing for more effective preprocedural planning of EVT strategies. We reviewed articles in the literature related to imaging factors which have been shown to be associated with EVT success. The factors which are reviewed in this paper included: anatomical factors such as 1) the type of aortic arch and its characteristics, 2) the characteristics of the thrombus such as length, clot burden, permeability, location, 3) the middle cerebral artery features including the tortuosity and underlying intracranial stenosis, 4) perfusion scans estimating the volume of infarct and the penumbra and 5) the effect of collaterals on the procedure. The prognostic effect of each factor on the successful outcome of EVT is described. The identification of preprocedural thrombectomy imaging factors can help to improve the chances of recanalization, functional outcomes, and mortality. It allows the interventionist to make time-sensitive decisions in the treatment of acute ischemic stroke.
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Affiliation(s)
- Mingxue Jing
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joshua Y P Yeo
- Department of Medicine, National University Health System, Singapore, Singapore
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Tommy Andersson
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Department of Medical Imaging, AZ Groeninge, 8500, Kortrijk, Belgium
| | - Fabian Arnberg
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Paul Bhogal
- Department of Neuroradiology, St.Bartholomew's and the Royal London Hospital, London, UK
| | - Cunli Yang
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anil Gopinathan
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Benjamin Yong Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching Hui Sia
- National University Heart Centre, National University Health System, Singapore, Singapore
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Prakash R Paliwal
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bernard P L Chan
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vijay Sharma
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore.
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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12
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Kubota Y, Yokota H, Sakai T, Yoneyama M, Ohira K, Uno T. Clinical feasibility of single-shot fluid-attenuated inversion recovery with wide inversion recovery pulse designed to reduce cerebrospinal fluid and motion artifacts for evaluation of uncooperative patients in acute stroke protocol. J Magn Reson Imaging 2020; 53:1833-1838. [PMID: 33368729 DOI: 10.1002/jmri.27483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 11/06/2022] Open
Abstract
Fluid-attenuated inversion recovery (FLAIR) imaging is a key sequence for stroke assessment. Motion artifact reduction with short acquisition time is still challenging, but necessary in the magnetic resonance (MR) stroke protocol, especially for uncooperative patients suspected of stroke. The aim of this study is to investigate the feasibility of modified single-shot FLAIR with wide inversion recovery pulses for use in stroke patients. This is a prospective study, which included 30 patients clinically suspected of stroke who were examined by MR stroke protocol from January 2018 to September 2018. A 1.5 T, multi-shot-turbo spin-echo (TSE) conventional FLAIR, and single-shot-TSE-FLAIR with wide inversion recovery pulse were used. Modified single-shot FLAIR was obtained for 30 patients with suspected stroke who moved during conventional FLAIR scan. Motion artifacts were randomly and independently scored using a 5-grade scale by three radiologists in blinded fashion. Whether the FLAIR vessel hyperintensity sign was present was visually evaluated. Statistical tests included Wilcoxon-signed rank test and weighted Cohen's kappa statistics. The motion artifact score was significantly lower in single-shot FLAIR than in conventional FLAIR (0.37 ± 0.56 vs. 1.83 ± 1.18; p < 0.05. The vessel hyperintensity sign was visualized in 6 and 5 patients on single-shot and conventional FLAIR images, respectively. This study demonstrates the value of single-shot FLAIR for stroke assessment. Single-shot FLAIR reduced motion artifact and visualized vessel hyperintensity sign more than conventional FLAIR. LEVEL OF EVIDENCE: 2. TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Yoshihiro Kubota
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, Chiba, Japan
| | | | - Kenji Ohira
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Sakakibara F, Yoshimura S, Numa S, Uchida K, Kinjo N, Morimoto T. Diffusion-Weighted Imaging-Fluid-Attenuated Inversion Recovery Mismatch Is Associated with 90-Day Functional Outcomes in Patients Undergoing Mechanical Thrombectomy. Cerebrovasc Dis 2020; 49:292-300. [PMID: 32544919 DOI: 10.1159/000508369] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted imaging-fluid-attenuated inversion recovery (DWI-FLAIR) mismatch is an early sign of acute ischemic stroke. DWI-FLAIR mismatch was reported to be valuable to select patients with unknown onset stroke who are eligible to receive intravenous thrombolysis (IVT), but its utility is less studied in patients undergoing mechanical thrombectomy (MT) for acute large vessel occlusion (LVO). We thus investigated the functional outcomes at 90 days between patients with DWI-FLAIR mismatch and those with match who underwent MT for LVO. METHODS We conducted a historical cohort study in consecutive patients who were evaluated by magnetic resonance imaging for suspected stroke at a single center. We enrolled patients with occlusion of internal carotid artery or horizontal or vertical segment of middle cerebral artery who underwent MT within 24 h after they were last known to be well. DWI-FLAIR mismatch was defined when a visible acute ischemic lesion was present on DWI without traceable parenchymal hyperintensity on FLAIR. Image analysis was done by 2 stroke neurologists independently. We estimated the adjusted odds ratio (OR) of DWI-FLAIR mismatch relative to DWI-FLAIR match for moderate outcome defined as modified Rankin Scale (mRS) 0-3, favorable outcome defined as mRS 0-2 and mortality at 90 days after the onset, and symptomatic intracranial hemorrhage (sICH) within 72 h after the onset. RESULTS Of the 380 patients who received MT, 202 were included. Patients with DWI-FLAIR mismatch (146 [72%]) had significantly higher baseline National Institutes of Health Stroke Scale (median 16 vs. 13, p = 0.01), more transferred-in (78 vs. 63%, p = 0.02), more IVT (45 vs. 18%, p = 0.0003), more cardioembolism (69 vs. 54%, p = 0.03), and shorter onset-to-hospital door times (median 175 vs. 371 min, p < 0.0001) than patients with DWI-FLAIR match. Patients with DWI-FLAIR mismatch had more moderate outcome than those with DWI-FLAIR match (61 vs. 52%, p = 0.24), and the adjusted OR was 3.12 (95% confidence interval [CI]: 1.35-7.19, p = 0.008). sICH within 72 h was less frequent in the DWI-FLAIR mismatch group (10 vs. 20%, p = 0.06), with an adjusted OR of 0.36 (95% CI: 0.13-0.97, p = 0.044). The adjusted ORs for favorable outcome and mortality were 0.87 (95% CI: 0.39-1.94, p = 0.73) and 0.63 (95% CI: 0.20-2.05, p = 0.44), respectively. CONCLUSIONS DWI-FLAIR mismatch was associated with more moderate outcome and less sICH in the adjusted analysis in patients receiving MT for acute LVO. DWI-FLAIR mismatch could be useful to select patients with unknown onset stroke who are eligible to receive MT for acute LVO.
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Affiliation(s)
- Fumihiro Sakakibara
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Soichiro Numa
- Department of Neurology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Norito Kinjo
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan,
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Li X, Wu L, Xie H, Bao Y, He D, Luo X. Endovascular treatment for ischemic stroke beyond the time window: A meta-analysis. Acta Neurol Scand 2020; 141:3-13. [PMID: 31494924 DOI: 10.1111/ane.13161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/11/2019] [Accepted: 09/02/2019] [Indexed: 12/16/2022]
Abstract
Currently, endovascular treatment has been proven to be effective when conducted within 6 hours of symptom onset. However, when patients have symptoms for more than 6 hours, have a daytime-unwitnessed stroke (DUS) or wake up with a stroke (wake-up stroke, WUS), the safety and efficacy of endovascular treatment need to be further elucidated. Therefore, we performed a systematic review and meta-analysis to compare the clinical outcomes of endovascular treatment in patients with ischemic stroke beyond the time window with that ≤6 hours. PubMed, EMBASE, and Ovid MEDLINE were searched from inception to November 2018. The following outcomes were evaluated by a random-effects model: efficacy outcomes, that is, functional independence and successful recanalization, and safety outcomes, that is, symptomatic intracranial hemorrhage and mortality. Subgroup analyses were also performed to examine whether patient or study characteristics were associated with the outcomes. Nine observational studies, including 5192 patients (1414 patients with extended time windows [ETWs]; 3778 patients ≤6 hours), were eligible for analysis. The overall analysis demonstrated that the functional independence was worse in patients with ETWs vs those ≤6 hours (OR, 0.78; 95% CI, 0.68-0.90, P = .0006). However, subgroup analysis showed that there was no significant difference in functional independence between the two groups when patients were selected for a perfusion mismatch by imaging (OR, 1.00; 95% CI, 0.70-1.43, P = 1.000). Therefore, compared with a window ≤6 hours, endovascular treatment with ETWs for ischemic stroke may not result in poor outcomes when patients are typically selected by perfusion techniques.
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Affiliation(s)
- Xuefei Li
- Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Lingshan Wu
- Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Hongxian Xie
- Department of Neurology National Key Clinical Department and Key Discipline of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
| | - Yuxian Bao
- The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
| | - Dan He
- Department of Neurology National Key Clinical Department and Key Discipline of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
| | - Xiang Luo
- Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
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Tortuyaux R, Ferrigno M, Dequatre-Ponchelle N, Djelad S, Cordonnier C, Hénon H, Leys D. Cerebral ischaemia with unknown onset: Outcome after recanalization procedure. Rev Neurol (Paris) 2019; 176:75-84. [PMID: 31627892 DOI: 10.1016/j.neurol.2019.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Stroke of unknown time of onset (UTOS) accounts for one-third of contra-indications for revascularization procedures. With modern neuroimaging techniques it is possible to differentiate the core infarcts and the presence of penumbra. OBJECTIVE To evaluate outcomes in patients with UTOS, treated with intravenous (i.v.) recombinant tissue-plasminogen activator (rt-PA), mechanical thrombectomy (MT), or both. METHOD We conducted this observational study in patients treated by i.v. rt-PA, MT, or both, selected by a diffusion-weighted image/fluid-attenuated inversion recovery mismatch. We evaluated outcomes with the modified Rankin scale (mRS) at 3 months. RESULTS Of 992 consecutive patients (522 women, 52.6%; median age 76 years; median baseline national institutes of health stroke scale [NIHSS] 10), 153 (15.4%) had UTOS, including 101 with wake-up strokes. Compared to other patients, they were more likely to have pre-existing mRS scores >2 (P=0.022), multiple infarcts (P<0.001), middle cerebral artery occlusions (P=0.023), and to undergo MT (P=0.003), and less likely to receive i.v. rt-PA (P<0.001). They had higher NIHSS scores (P<0.001) and longer discovery to treatment initiation times (P<0.001). They were more likely to develop pulmonary (P=0.001) and urinary (P=0.006) infections, and pulmonary embolism (P=0.019), and tended to have a higher mortality rate (P=0.052) within 7 days. After adjustment, there was no association of UTOS with any of these outcome measures anymore. CONCLUSION Patients with UTOS have more severe strokes and more comorbidities, but after adjustment, their outcomes did not differ from those of other patients.
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Affiliation(s)
- R Tortuyaux
- Univ. Lille, INSERM U 1171, Degenerative & vascular cognitive disorders, CHU Lille, Department of Neurology, 59000 Lille, France
| | - M Ferrigno
- Univ. Lille, INSERM U 1171, Degenerative & vascular cognitive disorders, CHU Lille, Department of Neurology, 59000 Lille, France
| | - N Dequatre-Ponchelle
- Univ. Lille, INSERM U 1171, Degenerative & vascular cognitive disorders, CHU Lille, Department of Neurology, 59000 Lille, France
| | - S Djelad
- Univ. Lille, INSERM U 1171, Degenerative & vascular cognitive disorders, CHU Lille, Department of Neurology, 59000 Lille, France
| | - C Cordonnier
- Univ. Lille, INSERM U 1171, Degenerative & vascular cognitive disorders, CHU Lille, Department of Neurology, 59000 Lille, France
| | - H Hénon
- Univ. Lille, INSERM U 1171, Degenerative & vascular cognitive disorders, CHU Lille, Department of Neurology, 59000 Lille, France
| | - D Leys
- Univ. Lille, INSERM U 1171, Degenerative & vascular cognitive disorders, CHU Lille, Department of Neurology, 59000 Lille, France.
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16
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Bhogal P, AlMatter M, Hellstern V, Pérez MA, Ganslandt O, Bäzner H, Henkes H. Mechanical thrombectomy for recurrent large vessel occlusion. J Clin Neurosci 2019; 66:107-112. [PMID: 31113697 DOI: 10.1016/j.jocn.2019.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 04/13/2019] [Accepted: 05/07/2019] [Indexed: 11/16/2022]
Abstract
Although mechanical thrombectomy (MT) has been shown in numerous trials to be a successful treatment option for patients with large vessel occlusion (LVO), there is limited information on the safety and effectiveness of the technique in cases of recurrent LVO. To this end, we performed a retrospective review of our prospectively maintained database to identify all patients that had undergone more than one MT procedure January 2008 and January 2018. The data collected on these patients included baseline demographics and any history of diabetes mellitus, hypercholesterolaemia, hypertension, atrial fibrillation or smoking. We also recorded when the symptoms had started, the patient's NIHSS and ASPECT scores, the number of passes taken, the patient's final TICI score, any complications which arose and the patient's mRS at 90 days. Our dataset encompassed 25 patients (of which 17 (68%) were female) who had undergone a total number of 52 MT's. Average age at 1st presentation was 70 ± 12.8 years. The median time between one stroke and the next was 71 days (range 1-1059, IQR 183 days). The majority of the strokes were deemed cardioembolic (86.5%) in origin. There was no significant difference in the procedure times, number of passes or TICI scores. There was a significant difference in the mRS after the 1st and 2nd events (p = 0.014) but no significant difference if the 2nd event occurred contralateral to the 1st event (p = 0.66) (n = 22). It is therefore concluded that recurrent thrombectomy can be safely performed with no significant difference in the technical aspects of the procedure.
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Affiliation(s)
- P Bhogal
- The Royal London Hospital, Whitechapel Road, London, UK.
| | - M AlMatter
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Germany
| | - V Hellstern
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Germany
| | - M Aguilar Pérez
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Germany
| | - O Ganslandt
- Neurosurgical Clinic, Neurocenter, Klinikum Stuttgart, Germany
| | - H Bäzner
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Germany
| | - H Henkes
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Germany; Medical Faculty, University Duisburg-Essen, Germany
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17
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Guenego A, Khoury N, Blanc R, Mazighi M, Smajda S, Redjem H, Ciccio G, Desilles JP, Escalard S, Zuber K, Chamard P, Hamdani M, Brikci-Nigassa N, Ben Maacha M, Piotin M, Fahed R. Gadolinium-Enhanced Extracranial MRA Prior to Mechanical Thrombectomy Is Not Associated With an Improved Procedure Speed. Front Neurol 2019; 9:1171. [PMID: 30687224 PMCID: PMC6333645 DOI: 10.3389/fneur.2018.01171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 12/18/2018] [Indexed: 01/01/2023] Open
Abstract
Objectives: To assess whether performing a pre-intervention gadolinium-enhanced extracranial magnetic resonance angiogram (MRA) in addition to intracranial vascular imaging is associated with improved thrombectomy time metrics. Methods: Consecutive patients treated by MT at a large comprehensive stroke center between January 2012 and December 2017 who were screened using pre-intervention MRI were included. Patients characteristics and procedural data were collected. Univariate and multivariate analysis were performed to compare MT speed, efficacy, complications, and clinical outcomes between patients with and without pre-intervention gadolinium-enhanced extracranial MRA. Results: A total of 912 patients were treated within the study period, including 288 (31.6%) patients with and 624 (68.4%) patients without extracranial MRA. Multivariate analysis showed no significant difference between groups in groin puncture to clot contact time (RR = 0.93 [0.85-1.02], p = 0.14) or to recanalization time (RR = 0.92 [0.83-1.03], p = 0.15), rates of successful recanalization (defined as a mTICI 2b or 3, RR = 0.93 [0.62-1.42], p = 0.74), procedural complications (RR = 0.81 [0.51-1.27], p = 0.36), and good clinical outcome (defined by a mRS ≤ 2 at 3 months follow-up, RR = 1.05 [0.73-1.52], p = 0.79). Conclusion: Performing a pre-intervention gadolinium-enhanced extracranial MRA in addition to non-contrast intracranial MRA at stroke onset does not seem to be associated with a delay or shortening of procedure times.
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Affiliation(s)
- Adrien Guenego
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Naim Khoury
- HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL, United States
| | - Raphaël Blanc
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Hocine Redjem
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Gabriele Ciccio
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | | | - Simon Escalard
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Kevin Zuber
- Biostatistics, Fondation Rothschild Hospital, Paris, France
| | | | - Mylène Hamdani
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Nahida Brikci-Nigassa
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Malek Ben Maacha
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Robert Fahed
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
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18
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Ducroux C, Khoury N, Lecler A, Blanc R, Chetrit A, Redjem H, Ciccio G, Smajda S, Escalard S, Desilles J, Mazighi M, Ben Maacha M, Piotin M, Fahed R. Application of the
DAWN
clinical imaging mismatch and
DEFUSE
3 selection criteria: benefit seems similar but restrictive volume cut‐offs might omit potential responders. Eur J Neurol 2018; 25:1093-1099. [DOI: 10.1111/ene.13660] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- C. Ducroux
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - N. Khoury
- HSHS Neuroscience Center HSHS St John's Hospital Springfield IL USA
| | - A. Lecler
- Diagnostic Radiology Unit Fondation Rothschild Hospital ParisFrance
| | - R. Blanc
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - A. Chetrit
- Diagnostic Radiology Unit Fondation Rothschild Hospital ParisFrance
| | - H. Redjem
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - G. Ciccio
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - S. Smajda
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - S. Escalard
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - J.‐P. Desilles
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - M. Mazighi
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - M. Ben Maacha
- Research and Biostatistics Unit Fondation Rothschild Hospital Paris France
| | - M. Piotin
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
| | - R. Fahed
- Interventional Neuroradiology Unit Fondation Rothschild Hospital Paris France
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19
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Li J, Feng S, Xia Z. The dawn of unknown-onset strokes. Eur J Neurol 2018; 25:e55. [PMID: 29667354 DOI: 10.1111/ene.13597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J Li
- Department of Rehabilitation, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - S Feng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Z Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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