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Kuceyeski A, Kamel H, Navi BB, Raj A, Iadecola C. Predicting future brain tissue loss from white matter connectivity disruption in ischemic stroke. Stroke 2014; 45:717-22. [PMID: 24523041 DOI: 10.1161/strokeaha.113.003645] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE The Network Modification (NeMo) Tool uses a library of brain connectivity maps from normal subjects to quantify the amount of structural connectivity loss caused by focal brain lesions. We hypothesized that the Network Modification Tool could predict remote brain tissue loss caused by poststroke loss of connectivity. METHODS Baseline and follow-up MRIs (10.7±7.5 months apart) from 26 patients with acute ischemic stroke (age, 74.6±14.1 years, initial National Institutes of Health Stroke Scale, 3.1±3.1) were collected. Lesion masks derived from diffusion-weighted images were superimposed on the Network Modification Tool's connectivity maps, and regional structural connectivity losses were estimated via the Change in Connectivity (ChaCo) score (ie, the percentage of tracks connecting to a given region that pass through the lesion mask). ChaCo scores were correlated with subsequent atrophy. RESULTS Stroke lesions' size and location varied, but they were more frequent in the left hemisphere. ChaCo scores, generally higher in regions near stroke lesions, reflected this lateralization and heterogeneity. ChaCo scores were highest in the postcentral and precentral gyri, insula, middle cingulate, thalami, putamen, caudate nuclei, and pallidum. Moderate, significant partial correlations were found between baseline ChaCo scores and measures of subsequent tissue loss (r=0.43, P=4.6×10(-9); r=0.61, P=1.4×10(-18)), correcting for the time between scans. CONCLUSIONS ChaCo scores varied, but the most affected regions included those with sensorimotor, perception, learning, and memory functions. Correlations between baseline ChaCo and subsequent tissue loss suggest that the Network Modification Tool could be used to identify regions most susceptible to remote degeneration from acute infarcts.
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Affiliation(s)
- Amy Kuceyeski
- From the Department of Radiology (A.K., A.R.), Brain and Mind Research Institute (A.K., H.K., B.B.N., A.R., C.I.), and Department of Neurology (H.K., B.B.N., C.I.), Weill Cornell Medical College, New York, NY
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Flint AC, Faigeles BS, Cullen SP, Kamel H, Rao VA, Gupta R, Smith WS, Bath PM, Donnan GA, Lees K, Alexandrov A, Bath P, Bluhmki E, Bornstein N, Claesson L, Davis S, Donnan G, Diener H, Fisher M, Gregson B, Grotta J, Hacke W, Hennerici M, Hommel M, Kaste M, Lyden P, Marler J, Muir K, Sacco R, Shuaib A, Teal P, Wahlgren N, Warach S, Weimar C. THRIVE Score Predicts Ischemic Stroke Outcomes and Thrombolytic Hemorrhage Risk in VISTA. Stroke 2013; 44:3365-9. [DOI: 10.1161/strokeaha.113.002794] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background and Purpose—
In previous studies, the Totaled Health Risks in Vascular Events (THRIVE) score has shown broad utility, allowing prediction of clinical outcome, death, and risk of hemorrhage after tissue-type plasminogen activator (tPA) treatment, irrespective of the type of acute stroke therapy applied to the patient.
Methods—
We used data from the Virtual International Stroke Trials Archive to further validate the THRIVE score in a large cohort of patients receiving tPA or no acute treatment, to confirm the relationship between THRIVE and hemorrhage after tPA, and to compare the THRIVE score with several other available outcome prediction scores.
Results—
The THRIVE score strongly predicts clinical outcome (odds ratio, 0.55 for good outcome [95% CI, 0.53–0.57];
P
<0.001), mortality (odds ratio, 1.57 [95% confidence interval, 1.50–1.64];
P
<0.001), and risk of intracerebral hemorrhage after tPA (odds ratio, 1.34 [95% confidence interval, 1.22–1.46];
P
<0.001). The relationship between THRIVE score and outcome is not influenced by the independent relationship of tPA administration and outcome. In receiver operator characteristic curve analysis, the THRIVE score was superior to several other available outcome prediction scores in the prediction of clinical outcome and mortality.
Conclusions—
The THRIVE score is a simple-to-use tool to predict clinical outcome, mortality, and risk of hemorrhage after thrombolysis in patients with ischemic stroke. Despite its simplicity, the THRIVE score performs better than several other outcome prediction tools. A free Web calculator for the THRIVE score is available at
http://www.thrivescore.org
.
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Affiliation(s)
- Alexander C. Flint
- From the Department of Neuroscience, Kaiser Permanente, Redwood City, CA (A.C.F., B.S.F., S.P.C., V.A.R.); Department of Neurology and Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.); Departments of Neurology, Neurosurgery, and Radiology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.G.); Department of Neurology, University of California San Francisco (W.S.S.); Stroke Trials Unit, University
| | - Bonnie S. Faigeles
- From the Department of Neuroscience, Kaiser Permanente, Redwood City, CA (A.C.F., B.S.F., S.P.C., V.A.R.); Department of Neurology and Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.); Departments of Neurology, Neurosurgery, and Radiology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.G.); Department of Neurology, University of California San Francisco (W.S.S.); Stroke Trials Unit, University
| | - Sean P. Cullen
- From the Department of Neuroscience, Kaiser Permanente, Redwood City, CA (A.C.F., B.S.F., S.P.C., V.A.R.); Department of Neurology and Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.); Departments of Neurology, Neurosurgery, and Radiology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.G.); Department of Neurology, University of California San Francisco (W.S.S.); Stroke Trials Unit, University
| | - Hooman Kamel
- From the Department of Neuroscience, Kaiser Permanente, Redwood City, CA (A.C.F., B.S.F., S.P.C., V.A.R.); Department of Neurology and Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.); Departments of Neurology, Neurosurgery, and Radiology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.G.); Department of Neurology, University of California San Francisco (W.S.S.); Stroke Trials Unit, University
| | - Vivek A. Rao
- From the Department of Neuroscience, Kaiser Permanente, Redwood City, CA (A.C.F., B.S.F., S.P.C., V.A.R.); Department of Neurology and Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.); Departments of Neurology, Neurosurgery, and Radiology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.G.); Department of Neurology, University of California San Francisco (W.S.S.); Stroke Trials Unit, University
| | - Rishi Gupta
- From the Department of Neuroscience, Kaiser Permanente, Redwood City, CA (A.C.F., B.S.F., S.P.C., V.A.R.); Department of Neurology and Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.); Departments of Neurology, Neurosurgery, and Radiology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.G.); Department of Neurology, University of California San Francisco (W.S.S.); Stroke Trials Unit, University
| | - Wade S. Smith
- From the Department of Neuroscience, Kaiser Permanente, Redwood City, CA (A.C.F., B.S.F., S.P.C., V.A.R.); Department of Neurology and Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.); Departments of Neurology, Neurosurgery, and Radiology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.G.); Department of Neurology, University of California San Francisco (W.S.S.); Stroke Trials Unit, University
| | - Philip M. Bath
- From the Department of Neuroscience, Kaiser Permanente, Redwood City, CA (A.C.F., B.S.F., S.P.C., V.A.R.); Department of Neurology and Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.); Departments of Neurology, Neurosurgery, and Radiology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.G.); Department of Neurology, University of California San Francisco (W.S.S.); Stroke Trials Unit, University
| | - Geoffrey A. Donnan
- From the Department of Neuroscience, Kaiser Permanente, Redwood City, CA (A.C.F., B.S.F., S.P.C., V.A.R.); Department of Neurology and Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.); Departments of Neurology, Neurosurgery, and Radiology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.G.); Department of Neurology, University of California San Francisco (W.S.S.); Stroke Trials Unit, University
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