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Karamchandani RR, Satyanarayana S, Yang H, Rhoten JB, Strong D, Clemente JD, Defilipp G, Patel NM, Bernard JD, Stetler WR, Parish JM, Hines AU, Patel HN, Helms AM, Macko L, Williams L, Retelski J, Guzik AK, Wolfe SQ, Asimos AW. Predictors of devastating functional outcome despite successful basilar thrombectomy. Interv Neuroradiol 2023:15910199231216516. [PMID: 37990546 DOI: 10.1177/15910199231216516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Basilar thrombosis frequently leads to poor functional outcomes, even with good endovascular reperfusion. We studied factors associated with severe disability or death in basilar thrombectomy patients achieving revascularization. METHODS We retrospectively analyzed records from a health system's code stroke registry, including successful basilar thrombectomy patients from January 2017 to May 2023 who were evaluated with pretreatment computed tomography perfusion. The primary outcome was devastating functional outcome (90-day modified Rankin Scale [mRS] score 5-6). A multivariable logistic regression model was constructed to determine independent predictors of the primary outcome. The area under the receiver operator characteristics curve (AUC) was calculated for the model distinguishing good from devastating outcome. RESULTS Among 64 included subjects, with mean (standard deviation) age 65.6 (14.1) years and median (interquartile range) National Institutes of Health Stroke Scale (NIHSS) 18 (5.75-24.5), the primary outcome occurred in 28 of 64 (43.8%) subjects. Presenting NIHSS (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.01-1.14, p = 0.02), initial glucose (OR 0.99, 95% CI 0.97-1.00, p < 0.05), and proximal occlusion site (OR 7.38, 95% CI 1.84-29.60, p < 0.01) were independently associated with 90-day mRS 5-6. The AUC for the multivariable model distinguishing outcomes was 0.81 (95% CI 0.70-0.92). CONCLUSION We have identified presenting stroke severity, lower glucose, and proximal basilar occlusion as predictors of devastating neurological outcome in successful basilar thrombectomy patients. These factors may be used in medical decision making or for patient selection in future clinical trials.
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Affiliation(s)
| | | | - Hongmei Yang
- Information and Analytics Services, Atrium Health, Charlotte, NC, USA
| | - Jeremy B Rhoten
- Department of Neurology, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
| | - Dale Strong
- Information and Analytics Services, Atrium Health, Charlotte, NC, USA
| | - Jonathan D Clemente
- Charlotte Radiology, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
| | - Gary Defilipp
- Charlotte Radiology, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
| | - Nikhil M Patel
- Department of Internal Medicine, Pulmonary and Critical Care, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
| | - Joe D Bernard
- Carolina Neurosurgery and Spine Associates, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
| | - William R Stetler
- Carolina Neurosurgery and Spine Associates, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
| | - Jonathan M Parish
- Carolina Neurosurgery and Spine Associates, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
| | - Andrew U Hines
- Charlotte Radiology, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
| | - Harsh N Patel
- Department of Neurology, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
| | - Anna Maria Helms
- Department of Neurology, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
| | - Lauren Macko
- Department of Neurology, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
| | - Laura Williams
- Department of Neurology, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
| | - Julia Retelski
- Department of Neurology, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
| | - Amy K Guzik
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Stacey Q Wolfe
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Andrew W Asimos
- Department of Emergency Medicine, Neurosciences Institute, Atrium Health, Charlotte, NC, USA
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Zoetmulder R, Konduri PR, Obdeijn IV, Gavves E, Išgum I, Majoie CB, Dippel DW, Roos YB, Goyal M, Mitchell PJ, Campbell BCV, Lopes DK, Reimann G, Jovin TG, Saver JL, Muir KW, White P, Bracard S, Chen B, Brown S, Schonewille WJ, van der Hoeven E, Puetz V, Marquering HA. Automated Final Lesion Segmentation in Posterior Circulation Acute Ischemic Stroke Using Deep Learning. Diagnostics (Basel) 2021; 11:1621. [PMID: 34573963 PMCID: PMC8466415 DOI: 10.3390/diagnostics11091621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
Final lesion volume (FLV) is a surrogate outcome measure in anterior circulation stroke (ACS). In posterior circulation stroke (PCS), this relation is plausibly understudied due to a lack of methods that automatically quantify FLV. The applicability of deep learning approaches to PCS is limited due to its lower incidence compared to ACS. We evaluated strategies to develop a convolutional neural network (CNN) for PCS lesion segmentation by using image data from both ACS and PCS patients. We included follow-up non-contrast computed tomography scans of 1018 patients with ACS and 107 patients with PCS. To assess whether an ACS lesion segmentation generalizes to PCS, a CNN was trained on ACS data (ACS-CNN). Second, to evaluate the performance of only including PCS patients, a CNN was trained on PCS data. Third, to evaluate the performance when combining the datasets, a CNN was trained on both datasets. Finally, to evaluate the performance of transfer learning, the ACS-CNN was fine-tuned using PCS patients. The transfer learning strategy outperformed the other strategies in volume agreement with an intra-class correlation of 0.88 (95% CI: 0.83-0.92) vs. 0.55 to 0.83 and a lesion detection rate of 87% vs. 41-77 for the other strategies. Hence, transfer learning improved the FLV quantification and detection rate of PCS lesions compared to the other strategies.
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Affiliation(s)
- Riaan Zoetmulder
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands; (R.Z.); (P.R.K.); (I.V.O.); (I.I.)
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands;
- Informatics Institute, University of Amsterdam, 1097 Amsterdam, The Netherlands;
| | - Praneeta R. Konduri
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands; (R.Z.); (P.R.K.); (I.V.O.); (I.I.)
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands;
| | - Iris V. Obdeijn
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands; (R.Z.); (P.R.K.); (I.V.O.); (I.I.)
| | - Efstratios Gavves
- Informatics Institute, University of Amsterdam, 1097 Amsterdam, The Netherlands;
| | - Ivana Išgum
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands; (R.Z.); (P.R.K.); (I.V.O.); (I.I.)
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands;
- Informatics Institute, University of Amsterdam, 1097 Amsterdam, The Netherlands;
| | - Charles B.L.M. Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands;
| | - Diederik W.J. Dippel
- Department of Neurology, Erasmus MC University Medical Center, 3015 Rotterdam, The Netherlands;
| | - Yvo B.W.E.M. Roos
- Department of Neurology, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands;
| | - Mayank Goyal
- Radiology, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada;
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Peter J. Mitchell
- Department of Radiology, The University of Melbourne & The Royal Melbourne Hospital, Melbourne, VIC 3050, Australia;
| | - Bruce C. V. Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3052, Australia;
| | - Demetrius K. Lopes
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Gernot Reimann
- Department of Neurology, Community Hospital Klinikum Dortmund, 44137 Dortmund, Germany;
| | - Tudor G. Jovin
- Cooper Neurological Institute, Cooper University Medical Center, Camden, NJ 08103, USA;
| | - Jeffrey L. Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA;
| | - Keith W. Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow G12 8QB, UK;
| | - Phil White
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
- Department of Neuroradiology, Newcastle upon Tyne Hospitals, Newcastle upon Tyne NE1 4LP, UK
| | - Serge Bracard
- INSERM U1254, IADI, University Hospital, Neuroradiology, 54511 Nancy, France;
| | - Bailiang Chen
- INSERM CIC-IT 1433, University Hospital, 54511 Nancy, France;
| | - Scott Brown
- Altair Biostatistics, St Louis Park, MN 55416, USA;
| | | | - Erik van der Hoeven
- Department of Radiology, St. Antonius Hospital, P.O. Box 2500, 3430 Nieuwegein, The Netherlands;
| | - Volker Puetz
- Department of Neurology, Dresden University Stroke Centre, Technical University Dresden, Fetscherstraße 74, 01307 Dresden, Germany;
| | - Henk A. Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands; (R.Z.); (P.R.K.); (I.V.O.); (I.I.)
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands;
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Liu Z, Lin W, Lu Q, Wang J, Liu P, Lin X, Wang F, Shi Y, Wang Q, Liu G, Wu S. Risk factors affecting the 1-year outcomes of minor ischemic stroke: results from Xi'an stroke registry study of China. BMC Neurol 2020; 20:379. [PMID: 33081723 PMCID: PMC7574206 DOI: 10.1186/s12883-020-01954-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The prevalence of stroke recurrence, disability, and all-cause mortality of patients with minor ischemic stroke (MIS) remains problematic. The aim of the present study was to identify risk factors associated with adverse outcomes at 1 year after MIS in the Xi'an region of China. METHODS This prospective cohort study included MIS patients above 18 years old with National Institutes of Health Stroke Scale (NIHSS) score ≤ 3 who were treated in any of four hospitals in Xi'an region of China between January and December 2015. The 1-year prevalence of stroke recurrence, disability, and all-cause mortality were evaluated, respectively. Multivariate logistic regression analysis was performed to assess the association between the identified risk factors and clinical outcomes. RESULTS In this study, 131(10.5%, 131/1252) patients were lost to follow-up at 1 year. A total of 1121 patients were included for analysis, the prevalence of stroke recurrence, disability, and all-cause mortality at 1 year after MIS were 3.4% (38/1121), 9.3% (104/1121), and 3.3% (37/1121), respectively. Multivariate logistic regression analysis identified age, current smoking, and pneumonia as independent risk factors for stroke recurrence. Age, pneumonia, and alkaline phosphatase were independent risk factors for all-cause mortality. Independent risk factors for disability were age, pneumonia, NIHSS score on admission, and leukocyte count. CONCLUSIONS The 1-year outcomes of MIS in Xi'an region of China were not optimistic, especially with a high prevalence of disability. The present study indicated that age and pneumonia were the common independent risk factors affecting the 1-year outcomes of MIS in Xi'an region of China.
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Affiliation(s)
- Zhongzhong Liu
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Wenjuan Lin
- College of life Science, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Qingli Lu
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Jing Wang
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Pei Liu
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Xuemei Lin
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Fang Wang
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Yaling Shi
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Qing Wang
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Guozheng Liu
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Songdi Wu
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China. .,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China. .,College of life Science, Northwest University, Xi'an, 710069, Shaanxi, China.
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