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Wang Z, Ji K, Fang Q. Endovascular thrombectomy with or without intravenous alteplase in large-core ischemic stroke: a systematic review and meta-analysis. Neurol Sci 2024:10.1007/s10072-024-07653-y. [PMID: 38896187 DOI: 10.1007/s10072-024-07653-y] [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: 02/29/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
The role of bridging intravenous thrombolysis (IVT) with alteplase before endovascular thrombectomy (EVT) in treating large core ischemic stroke remains uncertain. We aimed to compare clinical outcomes and safety of EVT with or without bridging IVT in patients with anterior circulation large vessel occlusion (ACLVO) and baseline Alberta Stroke Program Early CT Score (ASPECTS) ≤ 5. We systematically searched PubMed, Web of Science, Cochrane Library, and Embase from inception until November 2023. The primary outcome was 90-day functional independence (modified Rankin Scale [mRS] 0-2). Secondary outcomes included 90-day independent ambulation (mRS 0-3), successful recanalization, any intracranial hemorrhage (ICH), symptomatic ICH (sICH) and 90-day mortality. A random-effects model was used for data pooling. Five high-quality studies, incorporating 2124 patients (41% treated with bridging IVT), were included. Across both unadjusted and adjusted analyses, no significant differences were found between the bridging IVT and EVT-alone groups in terms of functional independence (odds ratios [OR] = 1.36, 95% confidence interval [CI]: 0.90-2.07, P = 0.14; adjusted OR [aOR] = 1.19, 95% CI: 0.68-2.09, P = 0.53) or independent ambulation (OR = 1.14, 95% CI: 0.80-1.62, P = 0.47; aOR = 1.18, 95% CI: 1.00-1.39, P = 0.05) at 90 days. Furthermore, no differences were observed in successful recanalization, any ICH, sICH, and 90-day mortality between the two treatment groups. Bridging IVT exhibits similar functional and safety outcomes compared to EVT alone in ACLVO patients with baseline ASPECTS ≤ 5. Further research is warranted to confirm these findings.
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Affiliation(s)
- Zekun Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, No.899 Pinghai Road, Gusu District, Suzhou, 215031, Jiangsu Province, China.
| | - Kangxiang Ji
- Department of Neurology, The First Affiliated Hospital of Soochow University, No.899 Pinghai Road, Gusu District, Suzhou, 215031, Jiangsu Province, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, No.899 Pinghai Road, Gusu District, Suzhou, 215031, Jiangsu Province, China.
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Zeng H, Zhou J, Xue Q, Zhao F, Liu T, Zhu Q. Clinical Observation of Infarct Volume ≥150 mL in Endovascular Thrombectomy Treatment. Neurologist 2024:00127893-990000000-00144. [PMID: 38888296 DOI: 10.1097/nrl.0000000000000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Whether patients with infarct volume ≥150 mL could benefit from endovascular thrombectomy (EVT) remains unclear. METHODS Patients (n=104) with anterior circulation Alberta Stroke Program Early Computed Tomography Score <6 were screened for infarct volume ≥150 mL using the Pullicino formula × (1-22%). The following were compared with the baseline at 90 days: the modified Rankin scale score (mRS) ≤3, mortality rate, symptomatic intracranial hemorrhage and any intracranial hemorrhage within 48 hours, and modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b between the EVT and drug therapy (DT) groups. RESULTS In patients with infarct volumes ≥150 mL, mRS≤3 at 90 days was higher in the EVT group than in the DT group [adjusted odds risk (aOR), 5.52; 95% CI: 1.10-28.24, P=0.04), and mTICI ≥2b at 82.8%. Intracranial hemorrhage within 48 hours occurred in 7 (24.1%) patients in the EVT group and 5 (14.7%) in the DT group (aOR, 0.75; 95% CI: 0.16-3.46; P=0.71). Older age (aOR, 0.94; 95% CI: 0.90-0.99, P=0.01), EVT treatment (aOR, 4.51; 95% CI: 1.60-12.78, P=0.01), and infarct volume ≥150 mL (aOR, 0.11; 95% CI: 0.04-0.31, P<0.01) were significantly associated with patient prognosis. CONCLUSIONS Patients with infarct volume ≥150 mL who received EVT had a higher proportion of mRS≤3 compared with those who received DT. However, there was no statistically significant difference in intracranial hemorrhage and death between the groups. EVT, smaller infarct volume, and younger age were associated with a good prognosis. The findings require large sample data verification.
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Affiliation(s)
- Hai Zeng
- Department of Neurosurgery, Second Hospital of Shanxi Medical University, Taiyuan
| | - Jia Zhou
- Department of Neurosurgery, Second Hospital of Shanxi Medical University, Taiyuan
| | - Qing Xue
- Department of Neurology, Yuncheng Central Hospital, Shanxi Province, Yuncheng, China
| | - Fengli Zhao
- Department of Neurology, Yuncheng Central Hospital, Shanxi Province, Yuncheng, China
| | - Tingyu Liu
- Department of Neurosurgery, Second Hospital of Shanxi Medical University, Taiyuan
| | - Qingfeng Zhu
- Department of Neurosurgery, Second Hospital of Shanxi Medical University, Taiyuan
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Dogariu OA, Gheorman V, Dogariu I, Berceanu MC, Albu CV, Gheonea IA. Correlation between DWI-ASPECTS Score, Ischemic Stroke Volume on DWI, Clinical Severity and Short-Term Prognosis: A Single-Center Study. Brain Sci 2024; 14:577. [PMID: 38928577 PMCID: PMC11201519 DOI: 10.3390/brainsci14060577] [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: 05/12/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Ischemic stroke is a significant public health concern, with its incidence expected to double over the next 40 years, particularly among individuals over 75 years old. Previous studies, such as the DAWN trial, have highlighted the importance of correlating clinical severity with ischemic stroke volume to optimize patient management. Our study aimed to correlate the clinical severity of ischemic stroke, as assessed by the NIHSS score, with ischemic stroke volume measured using DWI, and short-term prognosis quantified by the mRS score at discharge. Conducted at the largest hospital in Gorj County from January 2023 to December 2023, this study enrolled 43 consecutive patients with acute ischemic stroke. In our patient cohort, we observed a strong positive correlation between NIHSS score and ischemic stroke volume (Spearman correlation coefficient = 0.982, p < 0.01), and a strong negative correlation between ASPECTS-DWI score and mRS score (Spearman correlation coefficient = -0.952, p < 0.01). Multiple linear regression analysis revealed a significant collective relationship between ASPECTS score, ischemic stroke volume, and NIHSS score (F(1, 41) = 600.28, p < 0.001, R2 = 0.94, R2adj = 0.93). These findings underscore the importance of DWI in assessing ischemic stroke severity and prognosis, warranting further investigation for its integration into clinical practice.
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Affiliation(s)
- Oana Andreea Dogariu
- Ph.D. School Department, University of Medicine and Pharmacy of Craiova, Petru Rareș 2 Str., 200349 Craiova, Romania;
| | - Veronica Gheorman
- Department Medical Semiology, University of Medicine and Pharmacy of Craiova, Petru Rareș 2 Str., 200349 Craiova, Romania
| | - Ioan Dogariu
- Department of Neurology, Emergency County Hospital Targu-Jiu, Progresului 18 Str., 210218 Targu Jiu, Romania;
| | - Mihaela Corina Berceanu
- Department of Cardiology, County Hospital of Craiova, University of Medicine and Pharmacy of Craiova, Tabaci 1 Str., 200642 Craiova, Romania;
| | - Carmen Valeria Albu
- Department of Neurology, Neuropsychiatry Hospital Craiova, University of Medicine and Pharmacy of Craiova, Calea Bucuresti 99 Str., 200473 Craiova, Romania;
| | - Ioana Andreea Gheonea
- Department of Radiology, Emergency County Hospital Craiova, University of Medicine and Pharmacy of Craiova, Tabaci 1 Str., 200642 Craiova, Romania;
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Ebrahimian M, Hosein Mohamadi M, Mahyad M, Rezaeitalab F. Association of early seizures after ischemic stroke with diffusion-weighted imaging-alberta stroke program early CT score (DWI-ASPECTS) and neutrophil-to-lymphocyte ratio. Epilepsy Behav 2024; 155:109752. [PMID: 38640725 DOI: 10.1016/j.yebeh.2024.109752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/10/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Post-stroke seizure (PSS) is a common considerable complication of acute ischemic stroke (AIS). Early risk assessment can clinical practitioners to plan effective prevention and management. We aimed to determine whether assessing Diffusion-Weighted Imaging-Alberta Stroke Program Early CT Score (DWI-ASPECTS), and neutrophil indices allows for identifying patients at risk of PSS. METHODS This prospective study included AIS patients with cortical involvement admitted to a single academic center between January 2020 to October 2023. For all included subjects, DWI-Brain MRI, blood neutrophils, and platelet counts were obtained and the DWI-ASPECTS score was calculated. Then, the patients were followed up for 6 months in terms of PSS occurrence. Based on the occurrence of PSS, patients were divided into two groups of PSS and non-PSS. For analysis, imaging and laboratory data were compared between two groups. Logistic regression was applied to determine the relationship between DWI-ASPECTS and neutrophil indices, with early PSS. Finally, the sensitivity and specificity of these variables for PSS were estimated. RESULTS A total of 309 were included in the final statistical analysis. DWI-ASPECT and neutrophil-to-lymphocyte ratio (NLR) were significantly associated with early PSS with OR of 0.74 and OR of 1.13, respectively (P < 0.05). Further analysis showed that, a combination of DWI-ASPECTS, NLR had an area under the curve (AUC) of 0.72 for predicting the occurrence of early PSS. CONCLUSION DWI-ASPECTS and NLR are associated with the occurrence of early PSS after cortical ischemic stroke. A combination of these predictors had higher sensitivity and specificity for PSS rather than each factor alone. These findings may be helpful for determining the risk of PSS if validated in future studies.
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Affiliation(s)
- Maryam Ebrahimian
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mahshid Mahyad
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariborz Rezaeitalab
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Neurocsience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Yuan G, Zhang J, Ye Z, Sun J, Huo X, Pan Y, Wang M, Peng X, Zheng C, Lei X, Miao Z, Cai X. Effectiveness and safety of bridging therapy and endovascular therapy in patients with large cerebral infarctions: from ANGEL-ASPECT. Stroke Vasc Neurol 2024:svn-2024-003120. [PMID: 38777348 DOI: 10.1136/svn-2024-003120] [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: 01/15/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND AND PURPOSE The benefits of thrombolytic therapy before endovascular thrombectomy in cases of acute ischaemic stroke, with a large infarction volume, remain unclear. This analysis aims to evaluate the effectiveness and safety of bridging therapy and endovascular therapy among patients with large cerebral infarctions. METHODS In this post-hoc analysis of the multicentre prospective study of ANGEL-ASPECT (Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core), participants were divided into two groups: an endovascular therapy group and a bridging therapy group. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. The primary safety outcome was symptomatic intracranial haemorrhage. Ordinal logistic regression was performed to compare the primary endpoint between the two groups. Subgroup analyses were conducted to further explore potential risk factors associated with the outcomes. RESULTS 122 patients were included, of whom 77 (63%) underwent endovascular therapy and 45 (37%) underwent bridging therapy. The median scores on mRS at 90 days of the bridging therapy group and the endovascular therapy group were 3 (2-5) and 4 (2-6), with no significant differences (common OR 1.36; 95% CI 0.71 to 2.61). Symptomatic intracranial haemorrhage was reported in three patients who were in the endovascular and bridging therapy groups (relative risk (RR) 1.71; 95% CI 0.36 to 8.12). The mortality between two groups did not differ (RR 0.75; 95% CI 0.37 to 1.54). CONCLUSIONS Our study indicated that endovascular therapy alone might be a viable option for patients with large cerebral infarctions, displaying no noticeable disparity in outcomes compared with bridging therapy.
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Affiliation(s)
- Guangxiong Yuan
- Emergency, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Jun Zhang
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zekang Ye
- Department of Neurology, Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Jingping Sun
- Department of Neurology, Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Mengxing Wang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiao Peng
- Department of Neurology, Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Chanjuan Zheng
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Xueyao Lei
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xueli Cai
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Neurology, Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
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Jiang Z, Xu D, Li H, Wu X. A Novel Nomogram to Predict Symptomatic Intracranial Hemorrhage in Ischemic Stroke Patients After Intravenous Thrombolysis. Ther Clin Risk Manag 2023; 19:993-1003. [PMID: 38050618 PMCID: PMC10693780 DOI: 10.2147/tcrm.s436145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023] Open
Abstract
Objective This study aimed to create and validate a novel nomogram to predict the risk of symptomatic intracranial hemorrhage (sICH) in patients with acute ischemic stroke (AIS) who underwent intravenous thrombolysis (IVT). Methods In this retrospective study, 784 patients with AIS who received IVT were enrolled. The patients were randomly divided into two groups: a training set (n=550, 70%) and a testing set (n=234, 30%). Utilizing multivariable logistic regression analysis, relevant factors for the predictive nomogram were selected. The performance of the nomogram was evaluated using various metrics, including the area under the receiver operating characteristic curve (AUC-ROC), the Hosmer-Lemeshow goodness-of-fit test, calibration plots, and decision curve analysis (DCA). Results Multivariable logistic regression analysis showed that specific factors, including National Institutes of Health Stroke Scale (NIHSS) scores, Early infarct signs (EIS), and serum sodium, were identified as independent predictors of sICH. Subsequently, a nomogram was constructed using these predictors. The AUC-ROC values of the nomogram were 0.864 (95% CI: 0.810-0.919) and 0.831 (95% CI: 0.770-0.891) in the training and the validation sets, respectively. Both the calibration plots and the Hosmer-Lemeshow goodness-of-fit test showed favorable agreement in both the training and the validation sets. Additionally, the DCA indicated the practical clinical utility of the nomogram. Conclusion The novel nomogram, which included NIHSS, EIS and serum sodium as variables, had the potential for predicting the risk of sICH in patients with AIS after IVT.
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Affiliation(s)
- Zhuangzhuang Jiang
- Department of Neurology, Dongyang People’s Hospital, Affiliated to Wenzhou Medical University, Dongyang, Zhejiang, People’s Republic of China
| | - Dongjuan Xu
- Department of Neurology, Dongyang People’s Hospital, Affiliated to Wenzhou Medical University, Dongyang, Zhejiang, People’s Republic of China
| | - Hongfei Li
- Department of Neurology, Dongyang People’s Hospital, Affiliated to Wenzhou Medical University, Dongyang, Zhejiang, People’s Republic of China
| | - Xiaolan Wu
- Department of Neurology, Dongyang People’s Hospital, Affiliated to Wenzhou Medical University, Dongyang, Zhejiang, People’s Republic of China
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Wei C, Wu Q, Liu J, Wang Y, Liu M. Key CT markers for predicting haemorrhagic transformation after ischaemic stroke: a prospective cohort study in China. BMJ Open 2023; 13:e075106. [PMID: 38000813 PMCID: PMC10680015 DOI: 10.1136/bmjopen-2023-075106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/09/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES Limited studies have systematically addressed the CT markers of predicting haemorrhagic transformation (HT). We aimed to (1) investigate the predictive ability of the imaging factors on multimodal CT for HT and (2) identify the key CT markers that can accurately predict HT while maintaining easy and rapid assessment in the early stage of stroke. DESIGN AND SETTING This was a prospective cohort study conducted in a tertiary hospital in Southwest China. PARTICIPANTS Patients with ischaemic stroke admitted within 24 hours after onset were included. OUTCOME MEASURES The primary outcome was measured as the overall HT. The secondary outcomes were the presence of parenchymal haematoma, symptomatic HT and spontaneous HT. RESULTS A total of 763 patients were included. The early hypodensity >1/3 of the middle cerebral artery (MCA) territory, Alberta Stroke Programme Early CT Score≤7, midline shift, hyperdense middle cerebral artery sign (HMCAS), poor collateral circulation, infarct core and penumbra was independently associated with the increased risk of HT (all p < 0.05). The sensitivity of midline shift for predicting HT was only 3.5%, whereas its specificity was 99.8%. The combination of the early hypodensity >1/3 of the MCA territory, midline shift and HMCAS showed a good predictive performance for HT (area under the curve 0.80, 95% CI 0.75 to 0.84). CONCLUSIONS Seven imaging factors on multimodal CT were independently associated with HT. The high specificity of midline shift suggests the need to consider it as an imaging indicator when assessing the risk of HT. The early hypodensity >1/3 of the MCA territory, midline shift and HMCAS was identified as the key CT markers for the early prediction of HT. The coexistence of the three key factors might be a valuable index for identifying individuals at high bleeding risk and guiding further treatments.
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Affiliation(s)
- Chenchen Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qian Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanan Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Shindo S, Uchida K, Yoshimura S, Sakai N, Yamagami H, Toyoda K, Matsumaru Y, Matsumoto Y, Kimura K, Ishikura R, Inoue M, Sakakibara F, Nakajima M, Ueda M, Morimoto T. Intravenous alteplase before endovascular therapy for acute large vessel occlusion with large ischemic core: subanalysis of a randomized clinical trial. J Neurointerv Surg 2023:jnis-2023-020846. [PMID: 37890987 DOI: 10.1136/jnis-2023-020846] [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: 07/24/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The efficacy of endovascular therapy (EVT) in patients with large ischemic core has been reported, but it remains unclear whether IV alteplase (IVT) has beneficial effects in addition to EVT in such patients. We evaluated the efficacy and safety of EVT with or without IVT. METHODS The RESCUE-Japan LIMIT was an open-label, prospective, multicenter, randomized clinical trial to evaluate the efficacy and safety of EVT in stroke patients with large ischemic core, defined as Alberta Stroke Program Early CT Score (ASPECTS) 3-5. This subanalysis evaluated the differences in the effects of EVT with medical care (EVT group) compared with medical care alone (No-EVT group) between those who received IVT (IVT stratum) and those who did not (No-IVT stratum) before EVT. RESULTS Among 202 enrolled patients, 147 (73%) did not receive IVT. In the No-IVT stratum, the modified Rankin Scale (mRS) score of 0-3 at 90 days was significantly higher in the EVT group than in the No-EVT group (31.1% vs 12.3%, OR 3.21 (95% CI 1.37 to 7.53)). In the IVT stratum, the mRS score of 0-3 was 30.8% in the EVT group and 13.8% in the No-EVT group (OR 2.78 (95% CI 0.72 to 10.7)) (interaction p=0.77). The incidence of symptomatic intracranial hemorrhage was not different between the two groups in the No-IVT stratum (OR 1.20 (95% CI 0.35 to 4.12)), but it was significantly higher in the EVT group than in the No-EVT group in the IVT stratum (11.5% vs 0%, p=0.03). CONCLUSIONS There was no difference in efficacy of EVT with or without IVT, while IVT before EVT might increase symptomatic intracranial hemorrhage in patients with large ischemic core. TRIAL REGISTRATION INFORMATION NCT03702413.
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Affiliation(s)
- Seigo Shindo
- Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
- Department of Neurology, Kumamoto University, Kumamoto, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Matsumoto
- Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Japan
| | - Reiichi Ishikura
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Fumihiro Sakakibara
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Makoto Nakajima
- Department of Neurology, Kumamoto University, Kumamoto, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Kumamoto University, Kumamoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
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Sakakibara F, Uchida K, Yoshimura S, Sakai N, Yamagami H, Toyoda K, Matsumaru Y, Matsumoto Y, Kimura K, Ishikura R, Inoue M, Ando K, Yoshida A, Tanaka K, Yoshimoto T, Koge J, Beppu M, Shirakawa M, Morimoto T. Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT. J Stroke 2023; 25:388-398. [PMID: 37813673 PMCID: PMC10574299 DOI: 10.5853/jos.2023.01641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/17/2023] [Accepted: 08/21/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND AND PURPOSE Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core. METHODS The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan-Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3-5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum. RESULTS Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65-2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46-16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008). CONCLUSION Patients with ASPECTS of 3-5 on MRI benefitted more from EVT than those with ASPECTS of 3-5 on CT.
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Affiliation(s)
- Fumihiro Sakakibara
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Nobuyuki Sakai
- Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yasushi Matsumoto
- Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Reiichi Ishikura
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kumiko Ando
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Atsushi Yoshida
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kanta Tanaka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Yoshimoto
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Junpei Koge
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mikiya Beppu
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - for the RESCUE-Japan LIMIT Investigators
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
- Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
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Hashimoto H, Maruo T, Kimoto Y, Nakamura M, Fujinaga T, Nakamura H, Ushio Y. The association between diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score and the outcome following mechanical thrombectomy of anterior circulation occlusion. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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11
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Uchida K, Shindo S, Yoshimura S, Toyoda K, Sakai N, Yamagami H, Matsumaru Y, Matsumoto Y, Kimura K, Ishikura R, Yoshida A, Inoue M, Beppu M, Sakakibara F, Shirakawa M, Morimoto T. Association Between Alberta Stroke Program Early Computed Tomography Score and Efficacy and Safety Outcomes With Endovascular Therapy in Patients With Stroke From Large-Vessel Occlusion: A Secondary Analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism-Japan Large Ischemic Core Trial (RESCUE-Japan LIMIT). JAMA Neurol 2022; 79:1260-1266. [PMID: 36215044 PMCID: PMC9552045 DOI: 10.1001/jamaneurol.2022.3285] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/19/2022] [Indexed: 01/14/2023]
Abstract
Importance Endovascular therapy (EVT) has been found to reduce functional disability in patients with acute stroke due to large-vessel occlusion. However, the extent of the ischemic region, measured using Alberta Stroke Program Early Computed Tomography Scores, may limit the efficacy of EVT. Objective To compare the efficacy and safety of EVT according to ASPECTS 3 or less vs 4 to 5. Design, Setting, and Participants The Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism-Japan Large Ischemic Core Trial (RESCUE-Japan LIMIT) was an open-label randomized clinical trial conducted from November 2018 to December 2021 at 45 stroke centers across Japan. The trial enrolled adult patients with acute ischemic stroke with a large ischemic region, defined as ASPECTS 3 to 5 primarily determined by magnetic resonance imaging, with occlusion site at the internal carotid artery or middle cerebral artery segment 1. Among 203 enrolled patients, 1 withdrew consent and 202 were included in the original trial and secondary analysis. This secondary analysis was conducted in April 2022. Interventions Patients were randomly assigned to EVT with medical therapy or medical therapy alone. Main Outcomes and Measures Modified Rankin Scale (mRS) score at 90 days and symptomatic and any intracranial hemorrhage within 48 hours. Results Among 202 patients, 106 (52%) had ASPECTS 3 or less (mean [SD] age, 76.7 [9.6] years; 54 female individuals [50.9%]) and 96 had ASPECTS 4 to 5 (mean [SD] age, 75.6 [10.6] years; 36 female individuals [37.5%]). Of patients with ASPECTS 3 or less, 12 (21.4%) in the EVT group and 9 (18.0%) in the no EVT group had an mRS score of 0 to 3 (odds ratio [OR], 1.24; 95% CI, 0.47-3.26). Of patients with ASPECTS 4 to 5, 19 patients (43.2%) in the EVT group and 4 (7.7%) in the no EVT group had an mRS score of 0 to 3 at 90 days (OR, 9.12; 95% CI, 2.80-29.70; interaction P = .01). The ordinal shift across the range of mRS scores toward a better outcome was not significant in those with ASPECTS or 3 or less (common OR, 1.56; 95% CI, 0.79-3.10) but was significant in those with ASPECTS 4 to 5 (common OR, 4.48; 95% CI, 2.07-9.71; interaction P = .046). The risk of intracranial hemorrhage was significantly increased in patients with ASPECTS 3 or less when EVT was conducted (OR, 4.14; 95% CI, 1.84-9.32) and nonsignificantly increased in those with ASPECTS 4 to 5 (OR, 2.05; 95% CI, 0.89-4.73; interaction P = .24). Conclusions and Relevance In this study, EVT was associated with improved 90-day functional outcomes in patients with acute large vessel occlusive stroke and ASPECTS was 4 to 5 but not in those with ASPECTS 3 or less. Trial Registration ClinicalTrials.gov Identifier: NCT03702413.
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Affiliation(s)
- Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Seigo Shindo
- Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yasushi Matsumoto
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Reiichi Ishikura
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Astushi Yoshida
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mikiya Beppu
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Fumihiro Sakakibara
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
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12
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Zhao D, Zhu J, Cai Q, Zeng F, Fu X, Hu K. The value of diffusion weighted imaging-alberta stroke program early CT score in predicting stroke-associated pneumonia in patients with acute cerebral infarction: a retrospective study. PeerJ 2022; 10:e12789. [PMID: 35111405 PMCID: PMC8783557 DOI: 10.7717/peerj.12789] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/22/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In this study, we aimed to investigate the value of Diffusion-Weighted Imaging-Alberta Stroke Program Early CT Score (DWI-ASPECTS) in predicting stroke-associated pneumonia (SAP) in patients with acute ischemic stroke. METHODS A total of 291 patients who suffered acute cerebral infarction for the first time were included in this retrospective study. DWI-ASPECTS was assessed and clinical data were collected in order to find the risk factors of SAP, and a logistic regression model was used to investigate the effect of predicting SAP. Furthermore, correlation analysis was used to explore the relationship between DWI-ASPECTS and the immume status of the body. RESULTS Among the 291 patients, 74 (25.4%) subjects were diagnosed with SAP. Compared with non-SAP, the patients with SAP were older and had a higher rate of atrial fibrillation (AF), National Institutes of Health Stroke Scale (NIHSS) scores. The SAP group also had a significantly lower DWI-ASPECTS than did the non-SAP group (P < 0.01). In the multivariable logistic regression analysis, the DWI-ASPECTS (adjusted odds ratio [aOR] = 1.438; 95% CI [1.158-1.787]; P < 0.01) remained significant after adjusting for confounders. What's more, the predictive ability of DWI-ASPECTS (AUC = 0.743 >0.7, 95% CI [0.678-0.800]) had acceptable discriminatory abilities. By the correlation analysis, DWI-ASPECTS was found to be negatively correlated with the count of white blood cell, neutrophils, monocytes, neutrophil-to-monocyte ratio and neutrophil-to-lymphocyte ratio, and positively correlated with the count of lymphocytes. CONCLUSIONS DWI-ASPECTS grades could predict stroke-associated pneumonia for patients with acute ischemic stroke, and combining grade with age, AF, or NIHSS could predict SAP events more accurately.
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Affiliation(s)
- Dong Zhao
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qiang Cai
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Feifei Zeng
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiujuan Fu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
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13
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Liebeskind DS, Saber H, Bhuva P, Xiang B, Yoo AJ, Jadhav AP, Haussen DC, Budzik RF, Bonafe A, Yavagal DR, Hanel RA, Ribo M, Cognard C, Sila C, Hassan AE, Smith WS, Saver JL, Nogueira RG, Jovin TG. Serial ASPECTS in the DAWN Trial: Infarct Evolution and Clinical Impact. Stroke 2021; 52:3318-3324. [PMID: 34281376 DOI: 10.1161/strokeaha.120.033477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The impact of baseline ischemia on Alberta Stroke Program Early CT Score (ASPECTS) and evolution over 24 hours may be distinct in late thrombectomy. We analyzed predictors of serial ASPECTS and clinical outcomes in the DAWN trial (Diffusion-Weighted Imaging or CTP Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo). METHODS The DAWN Imaging Core Laboratory independently scored ASPECTS at baseline and 24 hours. Descriptive statistics characterized ASPECTS on computed tomography/magnetic resonance imaging at baseline and 24 hours, delineating ASPECTS change over 24 hours. RESULTS 206 subjects (mean age 70.0±13.7 years; 54.9% (n=113) female; baseline National Institutes of Health Stroke Scale median (interquartile range) 17 (13, 21) were included. Baseline ASPECTS was median (interquartile range) 8.0 (7-8), with 92/205 (44.9%) between 0 and 7 and 113/205 (55.1%) 8 and 10. 24-hour ASPECTS was median 6.0 (4-8), with ASPECTS change or infarct evolution having median -1, ranging from -8 to +2. Multivariable logistic regression showed older age (odds ratio [OR] for 10-year interval, 1.26 [95% CI, 1.02-1.55], P=0.030) and dyslipidemia (OR, 1.84 [95% CI, 1.06-3.19], P=0.031) were independently associated with higher baseline ASPECTS. Higher 24-hour ASPECTS was predicted by endovascular treatment (OR, 2.76 [95% CI, 1.58-4.81], P=0.0004), baseline glucose <150 mg/dL (OR, 2.86 [95% CI, 1.50-5.46], P=0.001), lower baseline National Institutes of Health Stroke Scale (OR, 0.93 [95% CI, 0.89-0.98], P=0.010), and older age (OR for 10-year interval, 1.25 [95% CI, 1.01-1.55], P=0.041). Internal carotid artery lesion location (OR, 0.47 [95% CI, 0.24-0.89], P=0.021) was inversely related to 24-hour ASPECTS. Good clinical outcome (day 90 modified Rankin Scale score 0-2) was predicted by 24-hour ASPECTS (OR, 1.46 [95% CI, 1.08-1.96], P=0.014). Extensive infarct evolution (ASPECTS decrease ≥6) occurred in 14/201 (7.0%). Elevated baseline serum glucose ≥150 mg/dL was a predictor of ASPECTS decrease of ≥4 points (OR, 2.78 [95% CI, 1.21-6.35] P=0.016) as was internal carotid artery occlusion (OR, 2.49 [95% CI, 1.05-5.88]; P=0.038). ASPECTS change was influenced by treatment arm (P=0.001 by Wilcoxon), including 0 ASPECTS change in 42/105 (40.0%) of the endovascular arm and only 20/96 (20.8%) of the medical arm. CONCLUSIONS DAWN subjects enrolled with small infarct cores had a broad range of baseline ASPECTS. Twenty-four-hour ASPECTS, strikingly influenced by endovascular therapy, predicted good clinical outcomes. REGISTRATION: https://www.clinicaltrials.gov; Unique identifier: NCT02142283.
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Affiliation(s)
- David S Liebeskind
- Neurovascular Imaging Research Core, UCLA, Los Angeles, CA (D.S.L., H.S.)
| | - Hamidreza Saber
- Neurovascular Imaging Research Core, UCLA, Los Angeles, CA (D.S.L., H.S.)
| | - Parita Bhuva
- Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.)
| | - Bin Xiang
- Prospect Analytical, Inc, San Jose, CA (B.X.)
| | - Albert J Yoo
- Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.)
| | | | - Diogo C Haussen
- Emory University School of Medicine/Grady Memorial Hospital, Atlanta, GA (D.C.H., R.G.N.)
| | - Ronald F Budzik
- OhioHealth Riverside Methodist Hospital, Columbus, OH (R.F.B.)
| | - Alain Bonafe
- Hôpital Gui-de-Chauliac, Montpellier, France (A.B.)
| | - Dileep R Yavagal
- University of Miami Miller School of Medicine-Jackson Memorial Hospital, FL (D.R.Y.)
| | | | - Marc Ribo
- Hosp Vall d'Hebrón, Barcelona, Spain (M.R.)
| | | | - Cathy Sila
- University Hospital of Cleveland, OH (C.S.)
| | - Ameer E Hassan
- University of Texas Rio Grande Valley - Valley Baptist Medical Center, Harlingen (A.E.H.)
| | - Wade S Smith
- University of California, San Francisco (W.S.S.)
| | | | - Raul G Nogueira
- Emory University School of Medicine/Grady Memorial Hospital, Atlanta, GA (D.C.H., R.G.N.)
| | - Tudor G Jovin
- University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.)
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14
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Zheng Q, Liu X, Yan K, He L, Chen Y. ASPECT scores of patients with focal intracerebral hemorrhage were correlated with their short- and medium-term functional outcomes. Neurol Res 2021; 43:970-976. [PMID: 34240679 DOI: 10.1080/01616412.2021.1948747] [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: 10/20/2022]
Abstract
PURPOSE The Alberta Stroke Program Early CT Score (ASPECTS) is widely used to guide thrombolytic therapy and predict the functional outcome of patients with acute ischemic stroke (AIS). Whether ASPECTS can predict the functional outcome of patients with intracerebral hemorrhage (ASPECTS-H) remains unclear. METHODS Patients with primary intracerebral hemorrhage (ICH) were collected and retrospectively analyzed. ASPECTS-H was assessed at admission. Patients were followed up at 30 days and 90 days after the onset of ICH. Occurrence of death within 90 days after ICH was the primary endpoint. Modified Rankin Scale (mRS) ≥ 3 was considered a poor functional outcome. RESULTS A total of 149 patients met eligibility criteria; 61 (40.9%) had poor functional outcome at 30 days, and 37 (24.8%) had poor functional outcome at 90 days. Using binary logistic regression modeling, we found that a low ASPECTS-H was associated with a poor functional outcome. The risk ratio of a low ASPECTS-H was 2.31 at 30 days (P = 0.000; 95% CI, 1.560-3.421) and 2.711 at 90 days (P = 0.000; 95% CI, 1.677-4.381). The optimal cutoff value of ASPECTS-H to discriminate good and poor 30-day and 90-day outcomes was 7.5 (Sensitivity30-day = 0.636, 1-Specificity30 - day = 0.311; Sensitivity90-day = 0.580, 1-Specificity90-day = 0.270). CONCLUSIONS A low ASPECTS-H was an indicator of poor short-term and long-term functional outcomes of ICH.
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Affiliation(s)
- Qiuyue Zheng
- The Department of Neurology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu China.,Graduate School, Dalian Medical University, Dalian, Liaoning, China
| | - Xiaojie Liu
- The Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu China
| | - Ke Yan
- The Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu China
| | - Liang He
- The Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu China
| | - Yingzhu Chen
- The Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu China
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15
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Tanaka K, Matsumoto S, Furuta K, Yamada T, Nagano S, Takase KI, Hatano T, Yamasaki R, Kira JI. Modified diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score including deep white matter lesions predicts symptomatic intracerebral hemorrhage following intravenous thrombolysis. J Thromb Thrombolysis 2021; 50:174-180. [PMID: 31745858 PMCID: PMC7293975 DOI: 10.1007/s11239-019-01979-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is widely used for the assessment of early ischemic changes (EICs) before thrombolysis. However, for symptomatic intracerebral hemorrhage (sICH) following intravenous recombinant tissue plasminogen activator (rt-PA), the prediction abilities of CT-ASPECTS, diffusion-weighted imaging (DWI)-ASPECTS, and DWI-ASPECTS including EICs in deep white matter (DWI-ASPECTS + W) are unclear. We investigated associations between each score and sICH following intravenous rt-PA. Data from consecutive patients who received intravenous rt-PA for acute ischemic stroke from 2005 to 2015 in four hospitals were retrospectively screened. We included data from patients who had undergone both CT and magnetic resonance imaging before thrombolysis and without evidence of posterior circulation stroke. We analyzed the ability of CT-ASPECTS, DWI-ASPECTS, and DWI-ASPECTS + W to predict sICH, accompanied by an increase in the National Institutes of Health Stroke Scale (NIHSS) score of ≥ 4 within the initial 36 h. Of 455 patients (273 men, median 75 years old), sICH occurred in 15 patients (3.3%). Receiver operating characteristics curve analysis showed that the optimal cut-offs of CT-ASPECTS, DWI-ASPECTS, and DWI-ASPECTS + W for predicting sICH were ≤ 9 (sensitivity 60.0%, specificity 59.8%, c-statistic 0.625), ≤ 6 (sensitivity 53.3%, specificity 80.9%, c-statistic 0.718), and ≤ 8 (sensitivity 86.7%, specificity 55.9%, c-statistic 0.756), respectively. A DWI-ASPECTS + W of ≤ 8 was independently associated with sICH (odds ratio 5.21, 95% confidence interval 1.30–35.31) after adjustment for pretreatment with antithrombotic agents, pretreatment NIHSS score, and large artery occlusions. DWI-ASPECTS + W predicted sICH in patients with acute anterior circulation stroke receiving intravenous rt-PA.
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Affiliation(s)
- Koji Tanaka
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Shoji Matsumoto
- Department of Neurology, Kokura Memorial Hospital, Kitakyushu, Japan.,Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Konosuke Furuta
- Department of Neurology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Yamada
- Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Sukehisa Nagano
- Department of Neurology, Fukuoka City Hospital, Fukuoka, Japan
| | | | - Taketo Hatano
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ryo Yamasaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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16
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Maros ME, Brekenfeld C, Broocks G, Leischner H, McDonough R, Deb-Chatterji M, Alegiani A, Thomalla G, Fiehler J, Flottmann F. Number of Retrieval Attempts Rather Than Procedure Time Is Associated With Risk of Symptomatic Intracranial Hemorrhage. Stroke 2021; 52:1580-1588. [PMID: 33813864 PMCID: PMC8078115 DOI: 10.1161/strokeaha.120.031242] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: Endovascular therapy is the standard of care in the treatment of acute ischemic stroke due to large-vessel occlusion. A direct association between the number of device passes and the occurrence of symptomatic intracranial hemorrhage (SICH) has been suggested. This study represents an in-depth investigation of the hypothesis that >3 retrieval attempts is associated with an increased rate of SICH in a large multicenter patient cohort. Methods: Two thousand six hundred eleven patients from the prospective German Stroke Registry were analyzed. Patients who received Endovascular therapy for acute large-vessel occlusion of the anterior circulation with known admission National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score, final Thrombolysis in Cerebral Infarction, and number of retrieval passes were included. The primary outcome was defined as SICH. The secondary outcome was any type of radiologically confirmed intracranial hemorrhage within the first 24 hours. Multivariate mixed-effects models were used to adjust for cluster effects of the participating centers, as well as for confounders. Results: Five hundred ninety-three patients fulfilled the inclusion criteria. The median number of retrieval passes was 2 [interquartile range, 1–3]. SICH occurred in 26 cases (4.4%), whereas intracranial hemorrhage was identified by neuroimaging in 85 (14.3%) cases. More than 3 retrieval passes was the strongest predictor for SICH (odds ratio, 3.61 [95% CI, 1.38–9.42], P=0.0089) following adjustment for age, admission National Institutes of Health Stroke Scale, admission Alberta Stroke Program Early CT Score, and Thrombolysis in Cerebral Infarction, as well as time from symptom onset to flow restoration. Baseline Alberta Stroke Program Early CT Score of 8 to 9 (odds ratio, 0.26 [95% CI, 0.07–0.89], P=0.032) or 10 (odds ratio, 0.21 [95% CI, 0.06–0.78], P=0.020) were significant protective factors against the occurrence of SICH. Conclusions: More than 3 retrieval attempts is associated with a significant increase in SICH risk, regardless of patient age, baseline National Institutes of Health Stroke Scale, or procedure time. This should be considered when deciding whether to continue a procedure, especially in patients with large baseline infarctions. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03356392.
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Affiliation(s)
- Máté Elöd Maros
- Department of Diagnostic and Interventional Neuroradiology (M.E.M., C.B., G.B., H.L., R.M., J.F., F.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neuroradiology (M.E.M.), Heidelberg University, Mannheim, Germany.,Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim (M.E.M.), Heidelberg University, Mannheim, Germany
| | - Caspar Brekenfeld
- Department of Diagnostic and Interventional Neuroradiology (M.E.M., C.B., G.B., H.L., R.M., J.F., F.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology (M.E.M., C.B., G.B., H.L., R.M., J.F., F.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannes Leischner
- Department of Diagnostic and Interventional Neuroradiology (M.E.M., C.B., G.B., H.L., R.M., J.F., F.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rosalie McDonough
- Department of Diagnostic and Interventional Neuroradiology (M.E.M., C.B., G.B., H.L., R.M., J.F., F.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Milani Deb-Chatterji
- Department of Neurology (M.D.-C., A.A., G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Alegiani
- Department of Neurology (M.D.-C., A.A., G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology (M.D.-C., A.A., G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology (M.E.M., C.B., G.B., H.L., R.M., J.F., F.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology (M.E.M., C.B., G.B., H.L., R.M., J.F., F.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Tsivgoulis G, Kargiotis O, De Marchis G, Kohrmann M, Sandset EC, Karapanayiotides T, de Sousa DA, Sarraj A, Safouris A, Psychogios K, Vadikolias K, Leys D, Schellinger PD, Alexandrov AV. Off-label use of intravenous thrombolysis for acute ischemic stroke: a critical appraisal of randomized and real-world evidence. Ther Adv Neurol Disord 2021; 14:1756286421997368. [PMID: 33737956 PMCID: PMC7934037 DOI: 10.1177/1756286421997368] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
Intravenous thrombolysis (IVT) represents the only systemic reperfusion therapy able to reverse neurological deficit in patients with acute ischemic stroke (AIS). Despite its effectiveness in patients with or without large vessel occlusion, it can be offered only to a minority of them, because of the short therapeutic window and additional contraindications derived from stringent but arbitrary inclusion and exclusion criteria used in landmark randomized controlled clinical trials. Many absolute or relative contraindications lead to disparities between the official drug label and guidelines or expert recommendations. Based on recent advances in neuroimaging and evidence from cohort studies, off-label use of IVT is increasingly incorporated into the daily practice of many stroke centers. They relate to extension of therapeutic time windows, and expansion of indications in co-existing conditions originally listed in exclusion criteria, such as use of alternative thrombolytic agents, pre-treatment with antiplatelets, anticoagulants or low molecular weight heparins. In this narrative review, we summarize recent randomized and real-world data on the safety and efficacy of off-label use of IVT for AIS. We also make some practical recommendations to stroke physicians regarding the off-label use of thrombolytic agents in complex and uncommon presentations of AIS or other conditions mimicking acute cerebral ischemia. Finally, we provide guidance on the risks and benefits of IVT in numerous AIS subgroups, where equipoise exists and guidelines and treatment practices vary.
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Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, National & Kapodistrian University of Athens, School of Medicine, Iras 39, Gerakas Attikis, Athens 15344, Greece
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Gianmarco De Marchis
- Neurology and Stroke Center, Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Martin Kohrmann
- Department of Neurology, Universitätsklinikum Essen, Essen, Germany
| | | | - Theodore Karapanayiotides
- Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Diana Aguiar de Sousa
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Amrou Sarraj
- Department of Neurology, The University of Texas at Houston, Houston, TX, USA
| | - Apostolos Safouris
- Second Department of Neurology, National & Kapodistiran University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
- Stroke Unit, Metropolitan Hospital, Piraeus, Greece
| | | | - Konstantinos Vadikolias
- Department of Neurology, University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece
| | - Didier Leys
- Department of Neurology (Stroke Unit), Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), Lille, France
| | - Peter D. Schellinger
- Department of Neurology, Johannes Wesling Medical Center Minden, UK RUB Minden, Germany
| | - Andrei V. Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
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18
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Kaesmacher J, Meinel TR, Nannoni S, Olivé-Gadea M, Piechowiak EI, Maegerlein C, Goeldlin M, Pierot L, Seiffge DJ, Mendes Pereira V, Heldner MR, Grunder L, Costalat V, Arnold M, Dobrocky T, Gralla J, Mordasini P, Fischer U. Bridging May Increase the Risk of Symptomatic Intracranial Hemorrhage in Thrombectomy Patients With Low Alberta Stroke Program Early Computed Tomography Score. Stroke 2021; 52:1098-1104. [PMID: 33504188 DOI: 10.1161/strokeaha.120.030508] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Whether intravenous thrombolysis (IVT) increases the risk for symptomatic intracranial hemorrhage (sICH) in patients treated with mechanical thrombectomy (MT) is a matter of debate. Purpose of this study was to evaluate the extent of early ischemia as a possible factor influencing the risk for sICH after IVT+MT versus direct MT. METHODS An explorative analysis of the BEYOND-SWIFT (Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy) multicenter cohort was performed. We hypothesized that the sICH risk between IVT+MT versus direct MT differs across the strata of Alberta Stroke Program Early CT Scores (ASPECTS). For this purpose, all patients with ICA, M1, and M2 vessel occlusions and available noncontrast computed tomography or diffusion-weighed imaging ASPECTS (n=2002) were analyzed. We used logistic regression analysis in subgroups, as well as interaction terms, to address the risk of sICH in IVT+MT versus direct MT patients across the ASPECTS strata. RESULTS In 2002 patients (median age, 73.7 years; 50.7% women; median National Institutes of Health Stroke Scale score, 16), the overall rate of sICH was 6.5% (95% CI, 5.5%-7.7%). Risk of sICH differed across ASPECTS groups (9-10: 6.3%; 6-8: 5.6% and ≤5 9.8%; P=0.042). With decreasing ASPECTS, the risks of sICH in the IVT+MT versus the direct MT group increased from adjusted odds ratio of 0.61 ([95% CI, 0.24-1.60] ASPECTS 9-10), to 1.72 ([95% CI, 0.69-4.24] ASPECTS 6-8) and 6.31 ([95% CI, 1.87-21.29] ASPECTS ≤5), yielding a positive interaction term (1.91 [95% CI, 1.01-3.63]). Sensitivity analyses regarding diffusion-weighed imaging versus noncontrast computed tomography ASPECTS did not alter the primary observations. CONCLUSIONS The extent of early ischemia may influence relative risks of sICH in IVT+MT versus direct MT patients, with an excess sICH risk in IVT+MT patients with low ASPECTS. If confirmed in post hoc analyses of randomized controlled trial data, IVT may be administered more carefully in patients with low ASPECTS eligible for and with direct access to MT.
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Affiliation(s)
- Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology (J.K., E.P., T.D., J.G., P.M.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,University Institute of Diagnostic and Interventional and Pediatric Radiology (J.K., L.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Thomas R Meinel
- Department of Neurology (T.R.M., M.G., D.S., M.R.H., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Stefania Nannoni
- Stroke Centre and Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland (S.N.)
| | - Marta Olivé-Gadea
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain (M.O.-G.)
| | - Eike I Piechowiak
- University Institute of Diagnostic and Interventional Neuroradiology (J.K., E.P., T.D., J.G., P.M.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M.)
| | - Martina Goeldlin
- Department of Neurology (T.R.M., M.G., D.S., M.R.H., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | | | - David J Seiffge
- Department of Neurology (T.R.M., M.G., D.S., M.R.H., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Vitor Mendes Pereira
- Joint Department of Medical Imaging, Toronto Western Hospital, ON, Canada (V.M.P.)
| | - Mirjam R Heldner
- Department of Neurology (T.R.M., M.G., D.S., M.R.H., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Lorenz Grunder
- University Institute of Diagnostic and Interventional and Pediatric Radiology (J.K., L.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | | | - Marcel Arnold
- Department of Neurology (T.R.M., M.G., D.S., M.R.H., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Tomas Dobrocky
- University Institute of Diagnostic and Interventional Neuroradiology (J.K., E.P., T.D., J.G., P.M.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology (J.K., E.P., T.D., J.G., P.M.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology (J.K., E.P., T.D., J.G., P.M.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Urs Fischer
- Department of Neurology (T.R.M., M.G., D.S., M.R.H., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
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19
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Liu C, Xie J, Sun S, Li H, Li T, Jiang C, Chen X, Wang J, Le A, Wang J, Li Z, Wang J, Wang W. Hemorrhagic Transformation After Tissue Plasminogen Activator Treatment in Acute Ischemic Stroke. Cell Mol Neurobiol 2020; 42:621-646. [PMID: 33125600 DOI: 10.1007/s10571-020-00985-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/22/2020] [Indexed: 12/17/2022]
Abstract
Hemorrhagic transformation (HT) is a common complication after thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) in ischemic stroke. In this article, recent research progress of HT in vivo and in vitro studies was reviewed. We have discussed new potential mechanisms and possible experimental models of HT development, as well as possible biomarkers and treatment methods. Meanwhile, we compared and analyzed rodent models, large animal models and in vitro BBB models of HT, and the limitations of these models were discussed. The molecular mechanism of HT was investigated in terms of BBB disruption, rt-PA neurotoxicity and the effect of neuroinflammation, matrix metalloproteinases, reactive oxygen species. The clinical features to predict HT were represented including blood biomarkers and clinical factors. Recent progress in neuroprotective strategies to improve HT after stroke treated with rt-PA is outlined. Further efforts need to be made to reduce the risk of HT after rt-PA therapy and improve the clinical prognosis of patients with ischemic stroke.
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Affiliation(s)
- Chengli Liu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Jie Xie
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Shanshan Sun
- Department of Ultrasound Imaging, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Hui Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Tianyu Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Chao Jiang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xuemei Chen
- Department of Anatomy, College of Basic Medical Sciences, Zhengzhou University, Henan, 450000, People's Republic of China
| | - Junmin Wang
- Department of Anatomy, College of Basic Medical Sciences, Zhengzhou University, Henan, 450000, People's Republic of China
| | - Anh Le
- Washington University in St. Louis, Saint Louis, MO, 63130, USA
| | - Jiarui Wang
- The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Zhanfei Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Jian Wang
- Department of Anatomy, College of Basic Medical Sciences, Zhengzhou University, Henan, 450000, People's Republic of China.
| | - Wei Wang
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
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20
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Klahr AC, Kosior JC, Dowlatshahi D, Buck BH, Beaulieu C, Gioia LC, Kalashyan H, Wilman AH, Jeerakathil T, Emery DJ, Shuaib A, Butcher KS. Lower Blood Pressure Is Not Associated With Decreased Arterial Spin Labeling Estimates of Perfusion in Intracerebral Hemorrhage. J Am Heart Assoc 2020; 8:e010904. [PMID: 31131671 PMCID: PMC6585347 DOI: 10.1161/jaha.118.010904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Subacute ischemic lesions in intracerebral hemorrhage (ICH) have been hypothesized to result from hypoperfusion. Although studies of cerebral blood flow (CBF) indicate modest hypoperfusion in ICH, these investigations have been limited to early time points. Arterial spin labeling (ASL), a magnetic resonance imaging technique, can be used to measure CBF without a contrast agent. We assessed CBF in patients with ICH using ASL and tested the hypothesis that CBF is related to systolic blood pressure (SBP). Methods and Results In this cross‐sectional study, patients with ICH were assessed with ASL at 48 hours, 7 days, and/or 30 days after onset. Relative CBF (rCBF; ratio of ipsilateral/contralateral perfusion) was measured in the perihematomal regions, hemispheres, border zones, and the perilesional area in patients with diffusion‐weighted imaging hyperintensities. Twenty‐patients (65% men; mean±SD age, 68.5±12.7 years) underwent imaging with ASL at 48 hours (N=12), day 7 (N=6), and day 30 (N=11). Median (interquartile range) hematoma volume was 13.1 (6.3–19.3) mL. Mean±SD baseline SBP was 185.4±25.5 mm Hg. Mean perihematomal rCBF was 0.9±0.2 at 48 hours at all time points. Baseline SBP and other SBP measurements were not associated with a decrease in rCBF in any of the regions of interest (P≥0.111). rCBF did not differ among time points in any of the regions of interest (P≥0.097). Mean perilesional rCBF was 1.04±0.65 and was unrelated to baseline SBP (P=0.105). Conclusions ASL can be used to measure rCBF in patients with acute and subacute ICH. Perihematomal CBF was not associated with SBP changes at any time point. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00963976.
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Affiliation(s)
- Ana C Klahr
- 1 Division of Neurology University of Alberta Edmonton Alberta Canada
| | - Jayme C Kosior
- 1 Division of Neurology University of Alberta Edmonton Alberta Canada
| | | | - Brian H Buck
- 1 Division of Neurology University of Alberta Edmonton Alberta Canada
| | - Christian Beaulieu
- 2 Department of Biomedical Engineering University of Alberta Edmonton Alberta Canada
| | - Laura C Gioia
- 1 Division of Neurology University of Alberta Edmonton Alberta Canada
| | | | - Alan H Wilman
- 2 Department of Biomedical Engineering University of Alberta Edmonton Alberta Canada
| | | | - Derek J Emery
- 3 Department of Radiology and Diagnostic Imaging University of Alberta Edmonton Alberta Canada
| | - Ashfaq Shuaib
- 1 Division of Neurology University of Alberta Edmonton Alberta Canada
| | - Kenneth S Butcher
- 1 Division of Neurology University of Alberta Edmonton Alberta Canada.,5 Prince of Wales Clinical School University of New South Wales Sydney New South Wales Australia
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21
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Watanabe S, Oda J, Nakahara I, Matsumoto S, Suyama Y, Hasebe A, Suzuki T, Tanabe J, Suyama K, Hirose Y. Experimental Analysis of Intra-luminal Pressure by Contrast Injection during Mechanical Thrombectomy: Simulation of Rupture Risk of Hidden Cerebral Aneurysm in Tandem Occlusion with Blind Alley. Neurol Med Chir (Tokyo) 2020; 60:286-292. [PMID: 32448828 PMCID: PMC7301125 DOI: 10.2176/nmc.oa.2019-0265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Mechanical thrombectomy using a retrograde approach is performed for tandem occlusion of the internal carotid artery (ICA). In our patient, a guiding catheter was easily passed by the stenosed lesion despite severe stenosis at the ICA origin. Therefore, we aimed to recanalize the occlusion of the terminal ICA without angioplasty for the stenosed lesion. When contrast was injected, a massive extravasation of contrast from the C2 portion of the ICA was observed. It was speculated that the bleeding was caused by rupture of an aneurysm at that site due to increased intra-arterial pressure caused by the contrast injection to a blind alley, which was created by a wedged guiding catheter at severe stenosis at the ICA origin and the occlusion of the terminal ICA. Our simulation experiment using a silicon vascular model in this situation demonstrated that the elevation of intra-arterial pressure in such blind alley reached over 50, 100, and 200 mmHg by injection of contrast from a microcatheter, a 4-Fr inner catheter, and a 9-Fr balloon-guiding catheter, respectively. When a retrograde approach is planned for tandem occlusion of the ICA, even when the proximal lesion is easily passed, prior angioplasty for the proximal lesion should be considered to avoid wedging by catheter.
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Affiliation(s)
- Sadayoshi Watanabe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine
| | - Jumpei Oda
- Department of Comprehensive Strokology, Fujita Health University School of Medicine
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine
| | - Shoji Matsumoto
- Department of Comprehensive Strokology, Fujita Health University School of Medicine
| | - Yoshio Suyama
- Department of Comprehensive Strokology, Fujita Health University School of Medicine
| | - Akiko Hasebe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine
| | - Takeya Suzuki
- Department of Comprehensive Strokology, Fujita Health University School of Medicine
| | - Jun Tanabe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine
| | - Kenichiro Suyama
- Department of Comprehensive Strokology, Fujita Health University School of Medicine
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University School of Medicine
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22
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Nishi H, Oishi N, Ishii A, Ono I, Ogura T, Sunohara T, Chihara H, Fukumitsu R, Okawa M, Yamana N, Imamura H, Sadamasa N, Hatano T, Nakahara I, Sakai N, Miyamoto S. Deep Learning–Derived High-Level Neuroimaging Features Predict Clinical Outcomes for Large Vessel Occlusion. Stroke 2020; 51:1484-1492. [DOI: 10.1161/strokeaha.119.028101] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
For patients with large vessel occlusion, neuroimaging biomarkers that evaluate the changes in brain tissue are important for determining the indications for mechanical thrombectomy. In this study, we applied deep learning to derive imaging features from pretreatment diffusion-weighted image data and evaluated the ability of these features in predicting clinical outcomes for patients with large vessel occlusion.
Methods—
This multicenter retrospective study included patients with anterior circulation large vessel occlusion treated with mechanical thrombectomy between 2013 and 2018. We designed a 2-output deep learning model based on convolutional neural networks (the convolutional neural network model). This model employed encoder-decoder architecture for the ischemic lesion segmentation, which automatically extracted high-level feature maps in its middle layers, and used its information to predict the clinical outcome. Its performance was internally validated with 5-fold cross-validation, externally validated, and the results compared with those from the standard neuroimaging biomarkers Alberta Stroke Program Early CT Score and ischemic core volume. The prediction target was a good clinical outcome, defined as a modified Rankin Scale score at 90-day follow-up of 0 to 2.
Results—
The derivation cohort included 250 patients, and the validation cohort included 74 patients. The convolutional neural network model showed the highest area under the receiver operating characteristic curve: 0.81±0.06 compared with 0.63±0.05 and 0.64±0.05 for the Alberta Stroke Program Early CT Score and ischemic core volume models, respectively. In the external validation, the area under the curve for the convolutional neural network model was significantly superior to those for the other 2 models.
Conclusions—
Compared with the standard neuroimaging biomarkers, our deep learning model derived a greater amount of prognostic information from pretreatment neuroimaging data. Although a confirmatory prospective evaluation is needed, the high-level imaging features derived by deep learning may offer an effective prognostic imaging biomarker.
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Affiliation(s)
- Hidehisa Nishi
- From the Department of Neurosurgery (H.N., A.I., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Japan
| | - Naoya Oishi
- Medical Innovation Center (N.O.), Kyoto University Graduate School of Medicine, Japan
| | - Akira Ishii
- From the Department of Neurosurgery (H.N., A.I., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Japan
| | - Isao Ono
- From the Department of Neurosurgery (H.N., A.I., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Japan
| | - Takenori Ogura
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan (T.O., H.C.)
| | - Tadashi Sunohara
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan (T.S., R.F., H.I., N.S.)
| | - Hideo Chihara
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan (T.O., H.C.)
| | - Ryu Fukumitsu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan (T.S., R.F., H.I., N.S.)
| | - Masakazu Okawa
- From the Department of Neurosurgery (H.N., A.I., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Japan
| | | | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan (T.S., R.F., H.I., N.S.)
| | - Nobutake Sadamasa
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan (T.S., R.F., H.I., N.S.)
| | | | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Japan (I.N.)
| | - Nobuyuki Sakai
- Department of Neurosurgery, Koseikai Takeda Hospital, Kyoto, Japan (N.S.)
| | - Susumu Miyamoto
- From the Department of Neurosurgery (H.N., A.I., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Japan
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23
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Caparros F, Kuchcinski G, Drelon A, Casolla B, Moulin S, Dequatre-Ponchelle N, Henon H, Cordonnier C, Pruvo JP, Leys D. Use of MRI to predict symptomatic haemorrhagic transformation after thrombolysis for cerebral ischaemia. J Neurol Neurosurg Psychiatry 2020; 91:402-410. [PMID: 32015090 DOI: 10.1136/jnnp-2019-321904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE Predictors of symptomatic haemorrhagic transformation (s-HT) of cerebral ischaemia after intravenous recombinant tissue-plasminogen activator (rt-PA) were identified in studies using CT scans. We evaluated whether MRI can identify other predictors. METHOD We analysed predictors of s-HT in a cohort of consecutive patients who received intravenous rt-PA for cerebral ischaemia after MRI at baseline. We used receiver operating characteristic curves considering an area under the curve (AUC) of 0.70 or higher as indicating acceptable discrimination. RESULTS Of 944 patients, 49 patients (5.2%) developed s-HT. Clinical factors independently associated with s-HT were age (adjusted OR (adjOR) 1.03 for 1 year increase; 95% CI 1.01 to 1.05), excessive alcohol consumption (adjOR 3.13; 95% CI 1.32 to 7.42), recent transient ischaemic attack (adjOR 2.88; 95% CI 1.04 to 7.95) and baseline national institutes of health stroke scale score (adjOR 1.06 for 1 point increase; 95% CI 1.02 to 1.10). MRI predictors were vascular hyperintensities (adjOR 3.89; 95% CI 1.50 to 10.08), old infarcts (adjOR 2.01; 95% CI 1.11 to 3.66) and volume of diffusion-weighted imaging (DWI) abnormality (adjOR 1.02 for 1 cm3 increase; 95% CI 1.01 to 1.03). The only variable with an acceptable discrimination was volume of DWI abnormality (AUC 0.72; 95% CI 0.64 to 0.79), a value of 4 cm3 predicting s-HT with a 78% sensitivity and 58% specificity. Variables that can be assessed only with MRI did not predict s-HT. CONCLUSION Although the volume of DWI abnormality predicts s-HT, other imaging characteristics that can only be assessed with MRI were not significantly associated with s-HT. Trial registration number NCT01614080.
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Affiliation(s)
- François Caparros
- Departments of Neurology and Neuroradiology, University of Lille, Inserm U1171-1, CHU Lille. Lille, France, Lille, France
| | - Gregory Kuchcinski
- Departments of Neurology and Neuroradiology, University of Lille, Inserm U1171-1, CHU Lille. Lille, France, Lille, France
| | - Agathe Drelon
- Departments of Neurology and Neuroradiology, University of Lille, Inserm U1171-1, CHU Lille. Lille, France, Lille, France
| | - Barbara Casolla
- Departments of Neurology and Neuroradiology, University of Lille, Inserm U1171-1, CHU Lille. Lille, France, Lille, France
| | - Solene Moulin
- Departments of Neurology and Neuroradiology, University of Lille, Inserm U1171-1, CHU Lille. Lille, France, Lille, France
| | - Nelly Dequatre-Ponchelle
- Departments of Neurology and Neuroradiology, University of Lille, Inserm U1171-1, CHU Lille. Lille, France, Lille, France
| | - Hilde Henon
- Departments of Neurology and Neuroradiology, University of Lille, Inserm U1171-1, CHU Lille. Lille, France, Lille, France
| | - Charlotte Cordonnier
- Departments of Neurology and Neuroradiology, University of Lille, Inserm U1171-1, CHU Lille. Lille, France, Lille, France
| | - Jean-Pierre Pruvo
- Departments of Neurology and Neuroradiology, University of Lille, Inserm U1171-1, CHU Lille. Lille, France, Lille, France
| | - Didier Leys
- Departments of Neurology and Neuroradiology, University of Lille, Inserm U1171-1, CHU Lille. Lille, France, Lille, France
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24
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Elsaid N, Mustafa W, Saied A. Radiological predictors of hemorrhagic transformation after acute ischemic stroke: An evidence-based analysis. Neuroradiol J 2020; 33:118-133. [PMID: 31971093 PMCID: PMC7140299 DOI: 10.1177/1971400919900275] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hemorrhagic transformation (HT) is one of the most common adverse events related to acute ischemic stroke (AIS) that affects the treatment plan and clinical outcome. Identification of a sensitive radiological marker may influence the controversial thrombolytic decision in the setting of AIS and may at a minimum indicate more intensive monitoring or further prophylactic interventions. In this article we summarize possible radiological biomarkers and the role of different radiological modalities including computed tomography (CT), magnetic resonance imaging, angiography, and ultrasound in predicting HT. Different radiological indices of early ischemic changes, large ischemic lesion volume, severe blood flow restriction, blood-brain barrier disruption, poor collaterals and high blood flow velocities have been reported to be associated with higher risk of HT. The current levels of evidence of the available studies highlight the role of the different CT perfusion parameters in predicting HT. Further large standardized studies are recommended to compare the sensitivity and specificity of the different radiological markers combined and delineate the most reliable predictor.
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Affiliation(s)
- Nada Elsaid
- Department of Neurology, University of Mansoura
Faculty of Medicine, Egypt
| | - Wessam Mustafa
- Department of Neurology, University of Mansoura
Faculty of Medicine, Egypt
| | - Ahmed Saied
- Department of Neurology, University of Mansoura
Faculty of Medicine, Egypt
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Mackay MT, Slavova N, Pastore-Wapp M, Grunt S, Stojanovski B, Donath S, Steinlin M. Pediatric ASPECTS predicts outcomes following acute symptomatic neonatal arterial stroke. Neurology 2020; 94:e1259-e1270. [DOI: 10.1212/wnl.0000000000009136] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/05/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo test the hypothesis that the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is useful in determining outcomes after neonatal arterial ischemic stroke (NAIS), we assessed accuracy of the modified pediatric ASPECTS (pedASPECTS) to predict cerebral palsy (CP), neurologic impairment, and epilepsy.MethodsCross-sectional study included newborns with acute NAIS whose outcomes were assessed at ≥18 months after stroke. PedASPECTS accuracy to predict outcomes was determined by sensitivity, specificity, and receiver operator characteristic (ROC) curves, and correlation between pedASPECTS and infarct volume was determined by the Spearman correlation coefficient.ResultsNinety-six children met the inclusion criteria. Median percentage infarct to supratentorial brain volume was 6.8% (interquartile range [IQR] 3.0%–14.3%). Median pedASPECTS was 7 (IQR 4–10). At a median age of 2.1 years, 35% developed CP, 43% had neurologic impairment, and 7% had epilepsy. Median pedASPECTS predicted outcomes of interest: CP (10, IQR 8–12) vs no CP (5, IQR 4–8) (p < 0.0001), poor (9, IQR 7–12) vs good (6, IQR 4–8) neurologic outcomes (p < 0.0001), and epilepsy (10, IQR 8–12) vs no epilepsy (7, IQR 4–10) (p = 0.033). PedASPECTS accuracy was good for CP (ROC 0.811) and fair for neurologic impairment (ROC 0.760) and epilepsy (ROC 0.761). A pedASPECTS ≥8 had ≥69% sensitivity and ≥54% specificity for clinical outcomes. PedASPECTS correlated with infarct volume (Spearman rank 0.701, p < 0.0001).ConclusionsThis study provides Class II evidence that pedASPECTS has fair to good accuracy for predicting CP, neurologic impairment, and epilepsy after NAIS and correlates with infarct volume. PedASPECTS may assist with early identification of babies requiring close developmental surveillance.
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Yoshimoto T, Inoue M, Yamagami H, Fujita K, Tanaka K, Ando D, Sonoda K, Kamogawa N, Koga M, Ihara M, Toyoda K. Use of Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) and Ischemic Core Volume to Determine the Malignant Profile in Acute Stroke. J Am Heart Assoc 2019; 8:e012558. [PMID: 31698986 PMCID: PMC6915267 DOI: 10.1161/jaha.119.012558] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/04/2019] [Indexed: 12/27/2022]
Abstract
Background Malignant profiles were identified by imaging profiles and unfavorable outcomes that have poor response to reperfusion therapy. Many trials have used this profile in their inclusion criteria including large-vessel occlusion acute ischemic stroke trials. We aimed to redefine the cutoff values for malignant profile in acute ischemic stroke patients with large-vessel occlusion regardless of reperfusion therapy. Methods and Results Consecutive acute ischemic stroke patients with anterior large-vessel occlusion were prospectively extracted from the National Cerebral and Cardiovascular Center Stroke Registry between March 2014 and December 2017. Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) and diffusion-weighted imaging lesion ischemic core volume (VolDWI) were measured in acute ischemic stroke patients with large-vessel occlusion with or without treatment. Unfavorable outcome was defined as a modified Rankin Scale score 5 to 6 at 3 months, and optimal DWI-ASPECTS and VolDWI for unfavorable outcome were assessed. In total, 198 patients (111 men, 77±13 years old) were enrolled. Median DWI-ASPECTS was 7 (5-9), and median VolDWI was 55 (6-134) mL. Among the patients, 72 (36%) patients underwent reperfusion therapy, and 83 (42%) had unfavorable outcomes. The threshold values for a malignant profile on receiver operating characteristic curve analysis for DWI-ASPECTS and VolDWI were 4 (area under the curve 0.78, P<0.01; sensitivity 0.71, specificity 0.75) and 71 mL (area under the curve 0.80, P<0.01; sensitivity 0.76, specificity 0.77), respectively. Conclusions The cutoff values for our redefined malignant profile were DWI-ASPECTS 4 and VolDWI 71 mL with no selection bias for reperfusion therapy in the real-world clinical practice. Clinical Trial Registration URL: http://www.clinicaltrials.gov Unique identifier: NCT02251665.
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Affiliation(s)
- Takeshi Yoshimoto
- Department of NeurologyNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Manabu Inoue
- Department of Cerebrovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
- Division of Stroke Care UnitNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Hiroshi Yamagami
- Division of Stroke Care UnitNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Kyohei Fujita
- Department of Cerebrovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Kanta Tanaka
- Division of Stroke Care UnitNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Daisuke Ando
- Department of Cerebrovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Kazutaka Sonoda
- Division of Stroke Care UnitNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Naruhiko Kamogawa
- Department of Cerebrovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Masatoshi Koga
- Department of Cerebrovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Masafumi Ihara
- Department of NeurologyNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Kazunori Toyoda
- Department of Cerebrovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
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Song L, Lyu C, Shen G, Guo T, Wang J, Wang W, Qiu X, Lerner A, Wintermark M, Gao B. Application of FLAIR Vascular Hyperintensity-DWI Mismatch in Ischemic Stroke Depending on Semi-Quantitative DWI-Alberta Stroke Program Early CT Score. Front Neurol 2019; 10:994. [PMID: 31611838 PMCID: PMC6776088 DOI: 10.3389/fneur.2019.00994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023] Open
Abstract
Objective: Diffusion-weighted imaging (DWI)-Alberta Stroke Program Early CT Score (ASPECTS) is a simple, widely used method to estimate the size of the infarct. Our aim is to determine whether there is a relationship between DWI-ASPECTS and fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH)-DWI mismatch and to better quantify FVH-DWI mismatch to assess the prognosis of cerebral infarction. Materials and Methods: A retrospective analysis of 109 patients with MCA stenosis or occlusion with cerebral infarction was performed by dividing this cohort into FVH-DWI match group and FVH-DWI mismatch group based on FVH and DWI results. The clinical and imaging data of these two groups of patients were reviewed and analyzed to identify associations between FVH-DWI mismatch and prognosis of patients for preservation of neurological function. Correlation between DWI-ASPECTS and FVH-DWI mismatch was also performed. Results: FVH-DWI mismatch was present in 66/109 (60.55%) patients, and FVH-DWI match was present in 43/109 (39.45%). Patients with FVH-DWI mismatch had higher DWI-ASPECTS (7.0 vs. 4.0, P < 0.001) and lower mRS at 3 months (3.0 vs. 4.0, P < 0.001) than patients without FVH-DWI mismatch. Multiple regression analysis suggested that DWI-ASPECTS (OR = 4.7, 95% CI = 2.5–9.2, P < 0.001) remained significantly associated with FVH-DWI mismatch. Two threshold points for DWI-ASPECTS of 3 and 8 can be used to distinguish whether there is a mismatch in FVH-DWI by smooth curve fitting. Conclusions: The DWI-ASPECTS score was an independent predictor of FVH-DWI mismatch. At DWI-ASPECTS ≤ 3, the FVH-DWI mismatch offers no prognostic value; whereas, at DWI-ASPECTS ≥ 8, the FVH-DWI mismatch had the highest prognostic value. DWI-ASPECTS can roughly determine whether there is a FVH-DWI mismatch in order to select optimal clinical treatment and accurately assess prognosis.
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Affiliation(s)
- Lei Song
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Cui Lyu
- Healthcare Examination Center, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Guiquan Shen
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Tingting Guo
- Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Jiangtao Wang
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Wanbi Wang
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Xiaoming Qiu
- Department of Radiology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China
| | - Alexander Lerner
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine University of Southern California, Los Angeles, CA, United States
| | - Max Wintermark
- Neuroradiology Section, Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
| | - Bo Gao
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Kim YC, Lee JE, Yu I, Song HN, Baek IY, Seong JK, Jeong HG, Kim BJ, Nam HS, Chung JW, Bang OY, Kim GM, Seo WK. Evaluation of Diffusion Lesion Volume Measurements in Acute Ischemic Stroke Using Encoder-Decoder Convolutional Network. Stroke 2019; 50:1444-1451. [DOI: 10.1161/strokeaha.118.024261] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yoon-Chul Kim
- From the Clinical Research Institute (Y.-C.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Ji-Eun Lee
- Department of Neurology (J.-E.L., I.Y., H.-N.S., I.-Y.B., J.-W.C., O.Y.B., G.-M.K., W.-K.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Inwu Yu
- Department of Neurology (J.-E.L., I.Y., H.-N.S., I.-Y.B., J.-W.C., O.Y.B., G.-M.K., W.-K.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Ha-Na Song
- Department of Neurology (J.-E.L., I.Y., H.-N.S., I.-Y.B., J.-W.C., O.Y.B., G.-M.K., W.-K.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - In-Young Baek
- Department of Neurology (J.-E.L., I.Y., H.-N.S., I.-Y.B., J.-W.C., O.Y.B., G.-M.K., W.-K.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Joon-Kyung Seong
- Department of Biomedical Engineering, Korea University, Seoul (J.-K.S.)
| | - Han-Gil Jeong
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seong Nam, Republic of Korea (H.-G.J., B.J.K.)
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seong Nam, Republic of Korea (H.-G.J., B.J.K.)
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University, Seoul, Republic of Korea (H.S.N.)
| | - Jong-Won Chung
- Department of Neurology (J.-E.L., I.Y., H.-N.S., I.-Y.B., J.-W.C., O.Y.B., G.-M.K., W.-K.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Oh Young Bang
- Department of Neurology (J.-E.L., I.Y., H.-N.S., I.-Y.B., J.-W.C., O.Y.B., G.-M.K., W.-K.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Gyeong-Moon Kim
- Department of Neurology (J.-E.L., I.Y., H.-N.S., I.-Y.B., J.-W.C., O.Y.B., G.-M.K., W.-K.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology (J.-E.L., I.Y., H.-N.S., I.-Y.B., J.-W.C., O.Y.B., G.-M.K., W.-K.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (W.-K.S.)
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Jiang S, Peng Y, Jing CH, Fei AH, Wang HR, Gao CJ, Chen M, Li Y, Pan S. Endovascular thrombectomy can be beneficial to acute ischemic stroke patients with large infarcts. J Neurosurg 2019; 130:1383-1390. [PMID: 29749914 DOI: 10.3171/2017.11.jns171297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 11/04/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to assess whether patients with acute ischemic stroke (AIS) and large infarct lesions benefit from reperfusion management. To determine the efficacy of different recanalization managements on AIS patients with Alberta Stroke Program Early CT Score (ASPECTS) < 6, the authors retrospectively analyzed hospitalized patients with AIS. METHODS Eighty-nine patients with AIS and ASPECTS < 6 were screened from 13,285 hospitalized patients treated by thrombolysis, thrombectomy, or conventional care in two stroke medical centers. Logistic regression or Fisher's exact test was performed for comparison of the outcome and risk events between patients treated by thrombectomy (or thrombolysis) and conventional care. The modified Rankin Scale (mRS) score was used to assess the major clinical outcome of patients 3 months after disease onset. Disease outcome was also examined by analyzing symptom improvement at discharge. In particular, mortality and symptomatic intracranial hemorrhage (sICH) were evaluated as risk factors. RESULTS This study included 21 patients who received thrombolysis, 36 patients receiving thrombectomy, and 32 patients receiving conventional treatment. Among these 3 treatments, only the thrombectomy group clearly showed the most encouraging clinical outcome (mRS score 0-2; p < 0.05, Fisher's exact test) and marked improvement (OR 25.84, 95% CI 2.44-273.59) compared with conventional treatment. It is noteworthy that the mortality rate of the thrombectomy and thrombolysis group was similar to that of the conventional group, and thrombectomy and thrombolysis increased the risk of sICH in comparison with conventional care (p < 0.05, Fisher's exact test). CONCLUSIONS Patients with AIS and ASPECTS < 6 definitely benefited from thrombectomy with higher sICH risk, whereas thrombolysis management showed similar efficacy to the control group.
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Affiliation(s)
- Shaowei Jiang
- 1Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Ya Peng
- 3Cerebral Vascular Disease Center, The First People's Hospital of Changzhou, Soochow University, Changzhou, China
| | - Chao-Hui Jing
- 2Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; and
| | - Ai-Hua Fei
- 1Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Hai-Rong Wang
- 1Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Cheng-Jin Gao
- 1Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Miao Chen
- 1Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Yi Li
- 2Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; and
| | - Shuming Pan
- 1Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
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Seo KD, Suh SH, Heo JH, Kim BM, Lee KY. Increased Risk of Intracranial Hemorrhage and Mortality Following Thrombolysis in Patients with Stroke and Active Cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.31728/jnn.2018.00020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Nave AH, Kufner A, Bücke P, Siebert E, Kliesch S, Grittner U, Bäzner H, Liebig T, Endres M, Fiebach JB, Nolte CH, Ebinger M, Henkes H. Hyperintense Vessels, Collateralization, and Functional Outcome in Patients With Stroke Receiving Endovascular Treatment. Stroke 2018; 49:675-681. [DOI: 10.1161/strokeaha.117.019588] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Fluid-attenuated inversion recovery hyperintense vessels (FHV) are frequently observed on magnetic resonance imaging in acute stroke patients with proximal vessel occlusion. Whether FHV can serve as a surrogate for the collateral status and predict functional outcome of patients is still a matter of debate.
Methods—
Acute ischemic stroke patients with M1-middle cerebral artery occlusion who received magnetic resonance imaging before endovascular treatment in 3 hospitals in Germany between January 2007 and June 2016 were eligible. Quantification of FHV was performed using an FHV–Alberta Stroke Program Early CT Score (ASPECTS) rating system. Functional outcome was evaluated with the modified Rankin Scale 3 months after stroke. Collateral status of patients was graded on baseline angiography using the American Society of Interventional and Therapeutic Neuroradiology grading system. Odds for good outcome (modified Rankin Scale score, 0–2) were determined using logistic regression analyses.
Results—
Overall, 116 patients were analyzed (median age, 74; interquartile range [IQR], 64–79; median National Institutes of Health Stroke Scale, 14; IQR, 10–19). The median FHV-ASPECTS was 2 (IQR, 1–3). Good collateral status (American Society of Interventional and Therapeutic Neuroradiology grade 3–4) on angiography was more frequently observed in patients with FHV-ASPECTS ≤2 (83% versus 57%;
P
=0.025). Patients with an FHV-ASPECTS ≤2 had a better functional outcome after 3 months (median modified Rankin Scale score, 2; IQR, 0–5), compared with patients with an FHV-ASPECTS >2 (median modified Rankin Scale score, 4; IQR, 3–6;
P
=0.015). In multiple regression analyses, FHV-ASPECTS ≤2 was independently associated with good functional outcome (adjusted odds ratio, 5.3; 95% confidence interval, 1.5–18.2).
Conclusions—
Low FHV-ASPECTS is associated with both better collateral status and better 3-month functional outcome in acute stroke patients with M1 vessel occlusion.
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Affiliation(s)
- Alexander H. Nave
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Anna Kufner
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Philipp Bücke
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Eberhard Siebert
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Stefan Kliesch
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Ulrike Grittner
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Hansjörg Bäzner
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Thomas Liebig
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Matthias Endres
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Jochen B. Fiebach
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Christian H. Nolte
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Martin Ebinger
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
| | - Hans Henkes
- From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité–Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin
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Liu L, Wu B, Zhao J, Cao Y, Dedhia N, Caplan LR, Wang Q. Computed Tomography Perfusion Alberta Stroke Program Early Computed Tomography Score Is Associated with Hemorrhagic Transformation after Acute Cardioembolic Stroke. Front Neurol 2017; 8:591. [PMID: 29163351 PMCID: PMC5681936 DOI: 10.3389/fneur.2017.00591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/23/2017] [Indexed: 02/05/2023] Open
Abstract
Alberta Stroke Program Early Computed Tomography (CT) score (ASPECTS) has been applied to CT perfusion (CTP) with good interrater agreement to predict early ischemic stroke, and it can be useful in decision making in acute ischemic stroke. The aim of the present study was to assess the predictive value of CTP ASPECTS of hemorrhagic transformation (HT) in acute cardioembolic stroke. This is a single-enter, retrospective study. All patients hospitalized with acute cardioembolic stroke from January 2008 to September 2013 were included. ASPECTS of baseline non-contrast CT, CTP maps of cerebral blood volume (CBV), cerebral blood flow, and mean transit time were collected from 52 consecutive patients with less than 12-h anterior circulation ischemic stroke. MRI scan was performed within 72 h of symptom onset after index stroke including T2*-weighted gradient echo to identify HT. For bleeding risk assessment, CTP and diffusion-weighted imaging ASPECTS were categorized into 0–7 or 8–10. Baseline characteristics, ASPCETS scores and HT were compared. Eighteen (34.6%) patients had HT and four (7.7%) developed symptomatic HT. On univariate analysis, the proportion of patients with CBV-ASPECTS 0–7 was significantly higher in HT patients as compared to patients without HT (44 versus 9%, P = 0.005). CBV ASPECTS 0–7 remained independent prognostic factors for HT after adjustment for clinical baseline variables. CBV ASPECTS could be of value to predict HT risk after acute cardioembolic stroke and may be a quick risk assessment approach before reperfusion therapy.
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Affiliation(s)
- Lan Liu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Wu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinglong Zhao
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanyan Cao
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nikita Dedhia
- Department of Neurology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| | - Louis R Caplan
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Qiaoshu Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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33
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Abstract
The Alberta Stroke Program Early CT score (ASPECTS) is a 10-point semiquantitative topographic scoring system developed for the assessment of early ischemic changes (EICs) on noncontrast-enhanced computed tomography (NCCT) in patients with acute ischemic stroke involving the middle cerebral artery (MCA) territory. One point is subtracted from a total score of 10, if an EIC is present in any part of each of the ASPECTS regions. Higher ASPECTS has been associated with better outcomes and a lower risk of symptomatic intracerebral hemorrhage. To date, there are still controversies regarding the utility of ASPECTS for selecting patients for intravenous and intra-arterial therapies. This article provides a comprehensive review regarding methodology, limitations, and interobserver reproducibility of ASPECTS, as well as application of ASPECTS in clinical care. The focus of this review is ASPECTS evaluation on NCCT. The application of ASPECTS on multimodal computed tomography and magnetic resonance imaging (MRI) is briefly described.
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Affiliation(s)
- Supada Prakkamakul
- *Department of Radiology, King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Bangkok, Thailand †Division of Neurointervention, Texas Stroke Institute, Plano, TX
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34
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Gioia L, Klahr A, Kate M, Buck B, Dowlatshahi D, Jeerakathil T, Emery D, Butcher K. The intracerebral hemorrhage acutely decreasing arterial pressure trial II (ICH ADAPT II) protocol. BMC Neurol 2017; 17:100. [PMID: 28525977 PMCID: PMC5437568 DOI: 10.1186/s12883-017-0884-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/10/2017] [Indexed: 11/19/2022] Open
Abstract
Background Aggressively lowering blood pressure (BP) in acute intracerebral hemorrhage (ICH) may improve outcome. Although there is no evidence that BP reduction changes cerebral blood flow, retrospective magnetic resonance imaging (MRI) studies have demonstrated sub-acute ischemic lesions in ICH patients. The primary aim of this study is to assess ischemic lesion development in patients randomized to two different BP treatment strategies. We hypothesize aggressive BP reduction is not associated with ischemic injury after ICH. Methods The Intracerebral Hemorrhage Acutely Decreasing Blood Pressure Trial II (ICH ADAPT II) is a phase II multi-centre randomized open-label, blinded-endpoint trial. Acute ICH patients (N = 270) are randomized to a systolic blood pressure (SBP) target of <140 or <180 mmHg. Acute ICH patients within 6 h of onset and two SBP measurements ≥140 mmHg recorded >2 mins apart qualify. SBP is managed with a pre-defined treatment protocol. Patients undergo MRI at 48 h, Days 7 and 30, with clinical assessment at Day 30 and 90. The primary outcome is diffusion weighted imaging (DWI) lesion frequency at 48 h. Secondary outcomes include cumulative DWI lesion rate frequency within 30 days, absolute hematoma growth, prediction of DWI lesion incidence, 30-day mortality rates, day 90 functional outcome, and cognitive status. Discussion This trial will assess the impact of hypertensive therapies on physiological markers of ischemic injury. The findings of this study will provide evidence for the link, or lack thereof, between BP reduction and ischemic injury in ICH patients. Trial registration This study is registered with clinicaltrials.gov (NCT02281838, first received October 29, 2014). Electronic supplementary material The online version of this article (doi:10.1186/s12883-017-0884-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Gioia
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | - Ana Klahr
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | - Mahesh Kate
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | - Brian Buck
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | | | - Thomas Jeerakathil
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | - Derek Emery
- Department of Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Kenneth Butcher
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada.
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35
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Kaesmacher J, Kaesmacher M, Maegerlein C, Zimmer C, Gersing AS, Wunderlich S, Friedrich B, Boeckh-Behrens T, Kleine JF. Hemorrhagic Transformations after Thrombectomy: Risk Factors and Clinical Relevance. Cerebrovasc Dis 2017; 43:294-304. [PMID: 28343220 DOI: 10.1159/000460265] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hemorrhagic transformation (HT) is a major complication of acute ischemic stroke, potentially associated with clinical deterioration. We attempted to identify risk factors and evaluated clinical relevance of minor and major HTs following endovascular thrombectomy (ET) in isolated middle cerebral artery (MCA) occlusions. METHODS This is a retrospective single-center analysis of 409 patients with isolated MCA occlusion treated with ET. Patients' and procedural characteristics, severity of HT according to the European Cooperative Acute Stroke Study criteria, and clinical outcomes were analyzed. Multivariate logistic regression models with standard retention criteria (p < 0.1) were used to determine risk factors and clinical relevance of HT. Results are shown as adjusted OR (aOR) and respective 95% CIs. Good neurologic short-term outcome was defined as National Institutes of Health Stroke Scale (NIHSS) score <5 at the day of discharge. RESULTS Of 299 patients included, hemorrhagic infarction (HI) was detected in 87 patients, while 13 patients developed parenchymal hematoma (PH). Higher age (aOR 0.970, 95% CI 0.947-0.993, p = 0.012), eligibility for intravenous recombinant tissue plasminogen activator (IV rtPA; aOR 0.512, 95% CI 0.267-0.982, p = 0.044), and complete recanalization (TICI 3, aOR 0.408, 95% CI 0.210-0.789, p = 0.008) were associated with a lower risk of HI. Risk factors for HI included higher admission NIHSS score (aOR 1.080, 95% CI 1.010-1.153, p = 0.024) and higher admission glucose levels (aOR 1.493, 95% CI 1.170-1.904, p = 0.001). Further, female sex tended to be associated with a lower risk of HI (aOR 0.601, 95% CI 0.316-1.143, p = 0.121), while a statistical trend was observable for proximal MCA occlusion (aOR 1.856, 95% CI 0.945-3.646, p = 0.073) and a history of hypertension (aOR 2.176, 95% CI 0.932-5.080, p = 0.072) to increase risk of HI. Longer intervals from symptom onset to first digital subtraction angiography runs (aOR 1.013, 95% CI 1.003-1.022, p = 0.009), lower preinterventional Alberta Stroke Program Early CT score (aOR 0.536, 95% CI 0.307-0.936, p = 0.028) and wake-up stroke (aOR 18.540, 95% CI 1.352-254.276, p = 0.029) were associated with PH. Both, PH and HI were independently associated with lower rates of good neurologic outcome (aOR 0.086, 95% CI 0.008-0.902, p = 0.041 and aOR 0.282, 95% CI 0.131-0.606, p = 0.001). CONCLUSION Risk of HI following MCA occlusion and subsequent ET is mainly determined by factors influencing infarct severity. Good recanalization results seem to be protective against subsequent HI. Our results support the notion that occurrence of PH after ET is time dependent and risk increases with more extensive early ischemic damage. Both, HI and PH do not seem to be facilitated by bridging therapy with IV rtPA or the use of oral anticoagulants, but were independently associated with more severe neurologic disability. These results support the notion that HI is not a "benign" imaging sign.
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Affiliation(s)
- Johannes Kaesmacher
- Department of Neuroradiology, Klinikum rechts der Isar, TU München, Munich, Germany
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36
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Khan M, Baird GL, Goddeau RP, Silver B, Henninger N. Alberta Stroke Program Early CT Score Infarct Location Predicts Outcome Following M2 Occlusion. Front Neurol 2017; 8:98. [PMID: 28352248 PMCID: PMC5348492 DOI: 10.3389/fneur.2017.00098] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/28/2017] [Indexed: 11/13/2022] Open
Abstract
Background Although it is generally thought that patients with distal middle cerebral artery (M2) occlusion have a favorable outcome, it has previously been demonstrated that a substantial minority will have a poor outcome by 90 days. We sought to determine whether assessing the Alberta Stroke Program Early CT Score (ASPECTS) infarct location allows for identifying patients at risk for a poor 90-day outcome. Methods We retrospectively analyzed patients with isolated acute M2 occlusion admitted to a single academic center between January 2010 and August 2012. Infarct regions were defined according to ASPECTS system on the initial head computed tomography. Discriminant function analysis was used to define specific ASPECTS regions that are predictive of the 90-day functional outcome as defined as a modified Rankin Scale score of 3–6. In addition, logistic regression was used to model the relationship between each individual ASPECT region with poor outcome; for evaluation and comparison, odds ratios, c-statistics, and Akaike information criterion values were estimated for each region. Results Ninety patients with isolated M2 were included in the final analysis. ASPECTS score ≤6 predicted poor outcome in this cohort (sensitivity = 0.591, specificity = 0.838, p < 0.001). Using multiple approaches, we found that infarction in ASPECTS regions M3 and M6 were strongly associated with poor functional status by 90 days. Conclusion Infarction in ASPECTS regions M3 and M6 are key predictors of functional outcome following isolated distal M2 occlusion. These findings will be helpful in stratifying outcomes if validated in future studies.
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Affiliation(s)
- Muhib Khan
- Neuroscience Institute, Division of Neurology, Spectrum Health, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Grayson L Baird
- Lifespan Biostatistics Core, Rhode Island Hospital , Providence, RI , USA
| | - Richard P Goddeau
- Department of Neurology, University of Massachusetts Medical School , Worcester, MA , USA
| | - Brian Silver
- Department of Neurology, Warren Alpert Medical School of Brown University , Providence, RI , USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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37
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Payabvash S, Benson JC, Taleb S, Rykken JB, Hoffman B, Oswood MC, McKinney AM. Prominent cortical and medullary veins on susceptibility-weighted images of acute ischaemic stroke. Br J Radiol 2017; 89:20160714. [PMID: 27805839 DOI: 10.1259/bjr.20160714] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To determine the clinical and imaging implications of prominent cortical and medullary veins on susceptibility-weighted images (SWI) of patients with acute stroke. METHODS Consecutive patients with acute ischaemic stroke who had SWI scan within 24 h of symptom onset or time last-seen-well were included. The SWI series were reviewed for the presence of prominent cortical and medullary veins and were graded independently by two neuroradiologists. The correlations between prominent vein grades with different imaging and clinical variables were determined. RESULTS Among 213 patients, prominent SWI cortical and medullary veins were identified in 35 (16.4%) patients and 20 (9.4%) patients, respectively. There was fair interobserver agreement (k = 0.314-0.338, p ≤ 0.001) for grading, and moderate agreement (k = 0.406-0.413, p ≤ 0.001) for the presence of prominent veins. Both prominent cortical and medullary veins were associated with the presence of arterial occlusion (rho = 0.232, p = 0.001; rho = 0.180, p = 0.008; respectively) and larger infarct volume (rho = 0.445, p < 0.001; rho = 0.167, p = 0.015; respectively). However, neither cortical nor medullary cortical veins were associated with the severity of symptoms at admission or clinical outcome. Prominent cortical veins were independent predictors of arterial occlusion (p = 0.018), whereas prominent medullary veins were more strongly associated with larger infarct volumes (p < 0.001). CONCLUSION There were small but significant correlations between cortical and medullary veins on SWI with arterial occlusion and large infarct volume in acute ischaemic stroke. Advances in knowledge: In consecutive patients with acute ischaemic stroke within anterior and posterior circulation territories, prominent cortical and medullary veins on SWI series are associated with imaging biomarkers of poor clinical outcome (i.e. large infarct volume and major arterial occlusion).
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Affiliation(s)
| | - John C Benson
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Shayandokht Taleb
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey B Rykken
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin Hoffman
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.,2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Mark C Oswood
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.,2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Alexander M McKinney
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.,2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
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38
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Tamm AS, McCourt R, Gould B, Kate M, Kosior JC, Jeerakathil T, Gioia LC, Dowlatshahi D, Hill MD, Coutts SB, Demchuk AM, Buck BH, Emery DJ, Shuaib A, Butcher KS. Cerebral Perfusion Pressure is Maintained in Acute Intracerebral Hemorrhage: A CT Perfusion Study. AJNR Am J Neuroradiol 2016; 37:244-51. [PMID: 26450534 PMCID: PMC7959964 DOI: 10.3174/ajnr.a4532] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/14/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Although blood pressure reduction has been postulated to result in a fall in cerebral perfusion pressure in patients with intracerebral hemorrhage, the latter is rarely measured. We assessed regional cerebral perfusion pressure in patients with intracerebral hemorrhage by using CT perfusion source data. MATERIALS AND METHODS Patients with acute primary intracerebral hemorrhage were randomized to target systolic blood pressures of <150 mm Hg (n = 37) or <180 mm Hg (n = 36). Regional maps of cerebral blood flow, cerebral perfusion pressure, and cerebrovascular resistance were generated by using CT perfusion source data, obtained 2 hours after randomization. RESULTS Perihematoma cerebral blood flow (38.7 ± 11.9 mL/100 g/min) was reduced relative to contralateral regions (44.1 ± 11.1 mL/100 g/min, P = .001), but cerebral perfusion pressure was not (14.4 ± 4.6 minutes(-1) versus 14.3 ± 4.8 minutes(-1), P = .93). Perihematoma cerebrovascular resistance (0.34 ± 0.11 g/mL) was higher than that in the contralateral region (0.30 ± 0.10 g/mL, P < .001). Ipsilateral and contralateral cerebral perfusion pressure in the external (15.0 ± 4.6 versus 15.6 ± 5.3 minutes(-1), P = .15) and internal (15.0 ± 4.8 versus 15.0 ± 4.8 minutes(-1), P = .90) borderzone regions were all similar. Borderzone cerebral perfusion pressure was similar to mean global cerebral perfusion pressure (14.7 ± 4.7 minutes(-1), P ≥ .29). Perihematoma cerebral perfusion pressure did not differ between blood pressure treatment groups (13.9 ± 5.5 minutes(-1) versus 14.8 ± 3.4 minutes(-1), P = .38) or vary with mean arterial pressure (r = -0.08, [-0.10, 0.05]). CONCLUSIONS Perihematoma cerebral perfusion pressure is maintained despite increased cerebrovascular resistance and reduced cerebral blood flow. Aggressive antihypertensive therapy does not affect perihematoma or borderzone cerebral perfusion pressure. Maintenance of cerebral perfusion pressure provides physiologic support for the safety of blood pressure reduction in intracerebral hemorrhage.
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Affiliation(s)
- A S Tamm
- Department of Diagnostic Imaging (A.S.T., D.J.E.), University of Alberta, Edmonton, Alberta, Canada
| | - R McCourt
- From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.)
| | - B Gould
- From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.)
| | - M Kate
- From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.)
| | - J C Kosior
- From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.)
| | - T Jeerakathil
- From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.)
| | - L C Gioia
- From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.)
| | - D Dowlatshahi
- Division of Neurology (D.D.), University of Ottawa, Ottawa, Ontario, Canada
| | - M D Hill
- Department of Clinical Neurosciences (M.D.H., S.B.C., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - S B Coutts
- Department of Clinical Neurosciences (M.D.H., S.B.C., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - A M Demchuk
- Department of Clinical Neurosciences (M.D.H., S.B.C., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - B H Buck
- From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.)
| | - D J Emery
- Department of Diagnostic Imaging (A.S.T., D.J.E.), University of Alberta, Edmonton, Alberta, Canada
| | - A Shuaib
- From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.)
| | - K S Butcher
- From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.)
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39
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Kim SK, Yoon W, Park MS, Heo TW, Baek BH, Lee YY. Outcomes Are Not Different between Patients with Intermediate and High DWI-ASPECTS after Stent-Retriever Embolectomy for Acute Anterior Circulation Stroke. AJNR Am J Neuroradiol 2016; 37:1080-5. [PMID: 26767711 DOI: 10.3174/ajnr.a4663] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/23/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Questions remain as to what benefits embolectomy provides to patients presented with considerable early ischemic changes on baseline imaging studies. This study aimed to investigate the impact of the Alberta Stroke Program Early CT Score applied to DWI on treatment outcomes in patients with acute stroke undergoing stent-retriever embolectomy. MATERIALS AND METHODS We retrospectively analyzed the clinical and DWI data from 171 patients with acute anterior circulation stroke who were treated with stent-retriever embolectomy within 6 hours of symptom onset. DWI-ASPECTS scores were analyzed with the full scale or were dichotomized (4-6 versus 7-10). Patients with DWI-ASPECTS ≤3 were excluded from the study. Associations between outcome and clinical and radiologic factors were determined with a multivariate logistic regression analysis. A good outcome was defined as a modified Rankin Scale score of 0-2 at 3 months. RESULTS The median DWI-ASPECTS was 7 (interquartile range, 6-8). The rates of good outcome, symptomatic hemorrhage, and mortality were not different between high DWI-ASPECTS (scores of 7-10) and intermediate DWI-ASPECTS (scores of 4-6) groups. In patients with an intermediate DWI-ASPECTS, good outcome was achieved in 46.5% (20/43) of patients with successful revascularization, whereas no patients without successful revascularization had a good outcome (P = .016). In multivariate logistic regression analysis, independent predictors of good outcome were age and successful revascularization. CONCLUSIONS Our study suggested that there were no differences in outcomes between patients with a high DWI-ASPECTS and those with an intermediate DWI-ASPECTS who underwent stent-retriever embolectomy for acute anterior circulation stroke. Thus, patients with an intermediate DWI-ASPECTS otherwise eligible for endovascular therapy may not be excluded from stent-retriever embolectomy or stroke trials.
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Affiliation(s)
- S K Kim
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., B.H.B., Y.Y.L.)
| | - W Yoon
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., B.H.B., Y.Y.L.)
| | - M S Park
- Neurology (M.S.P.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - T W Heo
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., B.H.B., Y.Y.L.)
| | - B H Baek
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., B.H.B., Y.Y.L.)
| | - Y Y Lee
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., B.H.B., Y.Y.L.)
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40
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Nogueira RG, Haussen DC, Dehkharghani S, Rebello LC, Lima A, Bowen M, Belagaje S, Anderson A, Frankel M. Large Volumes of Critically Hypoperfused Penumbral Tissue Do Not Preclude Good Outcomes After Complete Endovascular Reperfusion. Stroke 2016; 47:94-8. [DOI: 10.1161/strokeaha.115.011360] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/21/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Acute ischemic stroke patients with large volumes of severe hypoperfusion (
T
max
>10 s>100 mL) on magnetic resonance imaging have a higher likelihood of intracranial hemorrhage and poor outcomes after reperfusion. We aim to evaluate the impact of the extent of
T
max
>10 s CTP lesions in patients undergoing successful treatment.
Methods—
Retrospective database review of endovascular acute ischemic stroke treatment between September 2010 and March 2015 for patients with anterior circulation occlusions with baseline RAPID CTP and full reperfusion (mTICI 3). The primary outcome was the impact of the
T
max
>10 s lesion spectrum on infarct growth. Secondary safety and efficacy outcomes included parenchymal hematomas and good clinical outcomes (90-day modified Rankin Scale score, 0–2).
Results—
Of 684 treated patients, 113 patients fit the inclusion criteria.
T
max
>10 s>100 mL patients (n=37) had significantly higher baseline National Institutes of Health Stroke Scale (20.7±3.8 versus 17.0±5.9;
P
<0.01), more internal carotid artery terminus occlusions (29% versus 9%;
P
=0.02), and larger baseline (38.6±29.6 versus 11.7±15.8 mL;
P
<0.01) and final (60.7±60.0 versus 29.4±33.9 mL;
P
<0.01) infarct volumes when compared with patients without
T
max
>10 s>100 mL (n=76); however, the 2 groups were otherwise well balanced. There were no significant differences in infarct growth (22.1±51.6 versus 17.8±32.4 mL;
P
=0.78), severe intracranial hemorrhage (PH2: 2% versus 4%;
P
=0.73), good outcomes (90-day mRS score, 0–2: 56% versus 59%;
P
=0.83), or 90-day mortality (16% versus 7%;
P
=0.28). On multivariate analysis, only baseline National Institutes of Health Stroke Scale (odds ratio, 1.19; 95% confidence interval, 1.06–1.34;
P
<0.01) and baseline infarct core volume (odds ratio, 1.05; 95% confidence interval, 1.02–1.08;
P
<0.01) were independently associated with
T
max
>10 s>100 mL. There was no association between
T
max
>10 s>100 mL with any PH, good outcome, or infarct growth.
Conclusions—
In the setting of limited baseline ischemic cores, large
T
max
>10 s lesions on computed tomographic perfusion do not seem to be associated with a higher risk of parenchymal hematomas and do not preclude good outcomes in patients undergoing endovascular reperfusion with contemporary technology.
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Affiliation(s)
- Raul G. Nogueira
- From the Department of Neurology (R.G.N., D.C.H., L.C.R., A.L., S.B., A.A., M.F.) and the Department of Radiology (S.D., M.B.), Emory University and Grady Memorial Hospital - Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Diogo C. Haussen
- From the Department of Neurology (R.G.N., D.C.H., L.C.R., A.L., S.B., A.A., M.F.) and the Department of Radiology (S.D., M.B.), Emory University and Grady Memorial Hospital - Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Seena Dehkharghani
- From the Department of Neurology (R.G.N., D.C.H., L.C.R., A.L., S.B., A.A., M.F.) and the Department of Radiology (S.D., M.B.), Emory University and Grady Memorial Hospital - Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Leticia C. Rebello
- From the Department of Neurology (R.G.N., D.C.H., L.C.R., A.L., S.B., A.A., M.F.) and the Department of Radiology (S.D., M.B.), Emory University and Grady Memorial Hospital - Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Andrey Lima
- From the Department of Neurology (R.G.N., D.C.H., L.C.R., A.L., S.B., A.A., M.F.) and the Department of Radiology (S.D., M.B.), Emory University and Grady Memorial Hospital - Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Meredith Bowen
- From the Department of Neurology (R.G.N., D.C.H., L.C.R., A.L., S.B., A.A., M.F.) and the Department of Radiology (S.D., M.B.), Emory University and Grady Memorial Hospital - Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Samir Belagaje
- From the Department of Neurology (R.G.N., D.C.H., L.C.R., A.L., S.B., A.A., M.F.) and the Department of Radiology (S.D., M.B.), Emory University and Grady Memorial Hospital - Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Aaron Anderson
- From the Department of Neurology (R.G.N., D.C.H., L.C.R., A.L., S.B., A.A., M.F.) and the Department of Radiology (S.D., M.B.), Emory University and Grady Memorial Hospital - Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Michael Frankel
- From the Department of Neurology (R.G.N., D.C.H., L.C.R., A.L., S.B., A.A., M.F.) and the Department of Radiology (S.D., M.B.), Emory University and Grady Memorial Hospital - Marcus Stroke and Neuroscience Center, Atlanta, GA
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Fiebach JB, Stief JD, Ganeshan R, Hotter B, Ostwaldt AC, Nolte CH, Villringer K. Reliability of Two Diameters Method in Determining Acute Infarct Size. Validation as New Imaging Biomarker. PLoS One 2015; 10:e0140065. [PMID: 26447761 PMCID: PMC4598169 DOI: 10.1371/journal.pone.0140065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/20/2015] [Indexed: 11/18/2022] Open
Abstract
Background In order to select patients most likely to benefit for thrombolysis and to predict patient outcome in acute ischemic stroke, the volumetric assessment of the infarcted tissue is used. However, infarct volume estimation on Diffusion weighted imaging (DWI) has moderate interrater variability despite the excellent contrast between ischemic lesion and healthy tissue. In this study, we compared volumetric measurements of DWI hyperintensity to a simple maximum orthogonal diameter approach to identify thresholds indicating infarct size >70 ml and >100 ml. Methods Patients presenting with ischemic stroke with an NIHSS of ≥ 8 were examined with stroke MRI within 24 h after symptom onset. For assessment of the orthogonal DWI lesion diameters (od-values) the image with the largest lesion appearance was chosen. The maximal diameter of the lesion was determined and a second diameter was measured perpendicular. Both diameters were multiplied. Od-values were compared to volumetric measurement and od-value thresholds identifying a lesion size of > 70 ml and > 100 ml were determined. In a selected dataset with an even distribution of lesion sizes we compared the results of the od value thresholds with results of the ABC/2 and estimations of lesion volumes made by two resident physicians. Results For 108 included patients (53 female, mean age 71.36 years) with a median infarct volume of 13.4 ml we found an excellent correlation between volumetric measures and od-values (r2 = 0.951). Infarct volume >100 ml corresponds to an od-value cut off of 42; > 70 ml corresponds to an od-value of 32. In the compiled dataset (n = 50) od-value thresholds identified infarcts > 100 ml / > 70 ml with a sensitivity of 90%/ 93% and with a specificity of 98%/ 89%. The od-value offered a higher accuracy in identifying large infarctions compared to both visual estimations and the ABC/2 method. Conclusion The simple od-value enables identification of large DWI lesions in acute stroke. The cutoff of 42 is useful to identify large infarctions with volume larger than 100 ml. Further studies can analyze the therapeutic utility of this new method. Trail Registration ClinicalTrials.org NCT00715533
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Affiliation(s)
- Jochen B. Fiebach
- Center for Stroke Research Berlin (CSB), Department of Neurology, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
- * E-mail:
| | - Jonas D. Stief
- Center for Stroke Research Berlin (CSB), Department of Neurology, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
- Department of Radiology, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ramanan Ganeshan
- Center for Stroke Research Berlin (CSB), Department of Neurology, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Benjamin Hotter
- Center for Stroke Research Berlin (CSB), Department of Neurology, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Ann-Christin Ostwaldt
- Center for Stroke Research Berlin (CSB), Department of Neurology, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
- Massachusetts General Hospital, Center for Human Genetic Research, 185 Cambridge Street, Boston, MA, 02114, United States of America
| | - Christian H. Nolte
- Center for Stroke Research Berlin (CSB), Department of Neurology, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Kersten Villringer
- Center for Stroke Research Berlin (CSB), Department of Neurology, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
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Karaszewski B, Houlden H, Smith EE, Markus HS, Charidimou A, Levi C, Werring DJ. What causes intracerebral bleeding after thrombolysis for acute ischaemic stroke? Recent insights into mechanisms and potential biomarkers. J Neurol Neurosurg Psychiatry 2015; 86:1127-36. [PMID: 25814492 DOI: 10.1136/jnnp-2014-309705] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 03/02/2015] [Indexed: 12/17/2022]
Abstract
The overall population benefit of intravascular recombinant tissue plasminogen activator (rtPA) on functional outcome in ischaemic stroke is clear, but there are some treated patients who are harmed by early symptomatic intracranial haemorrhage (ICH). Although several clinical and radiological factors increase the risk of rtPA-related ICH, none of the currently available risk prediction tools are yet useful for practical clinical decision-making, probably reflecting our limited understanding of the underlying mechanisms. Finding new methods to identify patients at highest risk of rtPA-related ICH, or new measures to limit risk, are urgent challenges in acute stroke therapy research. In this article, we focus on the potential underlying mechanisms of rtPA-related ICH, highlight promising candidate risk biomarkers and suggest future research directions.
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Affiliation(s)
- Bartosz Karaszewski
- University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, Stroke Research Group, London, UK Department of Adult Neurology, Medical University of Gdansk & University Clinical Centre, Gdansk, Poland
| | - Henry Houlden
- Department of Molecular Neuroscience, University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, London, UK
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Hugh S Markus
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | - Andreas Charidimou
- University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, Stroke Research Group, London, UK
| | - Christopher Levi
- Acute Stroke Services, University of Newcastle, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - David J Werring
- University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, Stroke Research Group, London, UK
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Albers GW, Goyal M, Jahan R, Bonafe A, Diener HC, Levy EI, Pereira VM, Cognard C, Yavagal DR, Saver JL. Relationships Between Imaging Assessments and Outcomes in Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke. Stroke 2015; 46:2786-94. [PMID: 26316344 DOI: 10.1161/strokeaha.115.010710] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Imaging findings can predict outcomes in patients with acute stroke. Relationships between imaging findings and clinical and imaging outcomes in patients randomized to intravenous tissue-type plasminogen activator-alone versus tissue-type plasminogen activator plus endovascular therapy (Solitaire device) in the Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) study were assessed. METHODS We evaluated associations between imaging assessments (baseline mismatch profiles/ischemic core volumes and successful reperfusion) with imaging outcomes (27-hour infarct volume/growth) and clinical outcomes (modified Rankin Scale scores at 90 days). Imaging variables that predict favorable clinical outcomes were assessed in both univariate and multivariate models. RESULTS One hundred and ninety-five patients were included. Successful reperfusion and infarct volume (assessed at 27 hours) were powerful independent predictors of favorable clinical outcomes (modified Rankin Scale score of 0-2 at 90 days). Patients with the target mismatch profile at baseline had a higher rate of reperfusion, lesser infarct growth, smaller infarct volumes, and better clinical outcomes in the Solitaire plus tissue-type plasminogen activator (intervention) group than those in the tissue-type plasminogen activator-alone (control) group. Patients with larger mismatch volumes at baseline had a trend toward better treatment response in the intervention group than patients who had smaller (<50 mL) mismatch volumes. CONCLUSIONS Patients who achieved reperfusion had substantially more favorable clinical and imaging outcomes in both the intervention and the control groups. Infarct volume at 27 hours strongly correlated with clinical outcome at 90 days in both treatment groups. SWIFT PRIME patients with the target mismatch profile had a highly favorable response to endovascular therapy on both clinical and imaging outcomes. Both reperfusion and infarct volumes at 27 hours were powerful and independent predictors of 90-day clinical outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01657461.
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Affiliation(s)
- Gregory W Albers
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.).
| | - Mayank Goyal
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Reza Jahan
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Alain Bonafe
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Hans-Christoph Diener
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Elad I Levy
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Vitor M Pereira
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Christophe Cognard
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Dileep R Yavagal
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Jeffrey L Saver
- From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
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Gilgen MD, Klimek D, Liesirova KT, Meisterernst J, Klinger-Gratz PP, Schroth G, Mordasini P, Hsieh K, Slotboom J, Heldner MR, Broeg-Morvay A, Mono ML, Fischer U, Mattle HP, Arnold M, Gralla J, El-Koussy M, Jung S. Younger Stroke Patients With Large Pretreatment Diffusion-Weighted Imaging Lesions May Benefit From Endovascular Treatment. Stroke 2015; 46:2510-6. [PMID: 26251252 DOI: 10.1161/strokeaha.115.010250] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/23/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Lesion volume on diffusion-weighted magnetic resonance imaging (DWI) before acute stroke therapy is a predictor of outcome. Therefore, patients with large volumes are often excluded from therapy. The aim of this study was to analyze the impact of endovascular treatment in patients with large DWI lesion volumes (>70 mL). METHODS Three hundred seventy-two patients with middle cerebral or internal carotid artery occlusions examined with magnetic resonance imaging before treatment since 2004 were included. Baseline data and 3 months outcome were recorded prospectively. DWI lesion volumes were measured semiautomatically. RESULTS One hundred five patients had lesions >70 mL. Overall, the volume of DWI lesions was an independent predictor of unfavorable outcome, survival, and symptomatic intracerebral hemorrhage (P<0.001 each). In patients with DWI lesions >70 mL, 11 of 31 (35.5%) reached favorable outcome (modified Rankin scale score, 0-2) after thrombolysis in cerebral infarction 2b-3 reperfusion in contrast to 3 of 35 (8.6%) after thrombolysis in cerebral infarction 0-2a reperfusion (P=0.014). Reperfusion success, patient age, and DWI lesion volume were independent predictors of outcome in patients with DWI lesions >70 mL. Thirteen of 66 (19.7%) patients with lesions >70 mL had symptomatic intracerebral hemorrhage with a trend for reduced risk with avoidance of thrombolytic agents. CONCLUSIONS There was a growing risk for poor outcome and symptomatic intracerebral hemorrhage with increasing pretreatment DWI lesion volumes. Nevertheless, favorable outcome was achieved in every third patient with DWI lesions >70 mL after successful endovascular reperfusion, whereas after poor or failed reperfusion, outcome was favorable in only every 12th patient. Therefore, endovascular treatment might be considered in patients with large DWI lesions, especially in younger patients.
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Affiliation(s)
- Marc D Gilgen
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Dariusz Klimek
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Kai T Liesirova
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Julia Meisterernst
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Pascal P Klinger-Gratz
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Gerhard Schroth
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.).
| | - Pasquale Mordasini
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Kety Hsieh
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Johannes Slotboom
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Mirjam R Heldner
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Anne Broeg-Morvay
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Marie-Luise Mono
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Urs Fischer
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Heinrich P Mattle
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Marcel Arnold
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Jan Gralla
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Marwan El-Koussy
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
| | - Simon Jung
- From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.)
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Tisserand M, Naggara O, Legrand L, Mellerio C, Edjlali M, Lion S, Rodriguez-Régent C, Souillard-Scemama R, Jbanca CF, Trystram D, Méder JF, Oppenheim C. Patient “candidate” for thrombolysis: MRI is essential. Diagn Interv Imaging 2014; 95:1135-44. [DOI: 10.1016/j.diii.2014.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schröder J, Cheng B, Ebinger M, Köhrmann M, Wu O, Kang DW, Liebeskind DS, Tourdias T, Singer OC, Christensen S, Campbell B, Luby M, Warach S, Fiehler J, Fiebach JB, Gerloff C, Thomalla G. Validity of acute stroke lesion volume estimation by diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomographic Score depends on lesion location in 496 patients with middle cerebral artery stroke. Stroke 2014; 45:3583-8. [PMID: 25316278 DOI: 10.1161/strokeaha.114.006694] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) has been used to estimate diffusion-weighted imaging (DWI) lesion volume in acute stroke. We aimed to assess correlations of DWI-ASPECTS with lesion volume in different middle cerebral artery (MCA) subregions and reproduce existing ASPECTS thresholds of a malignant profile defined by lesion volume ≥100 mL. METHODS We analyzed data of patients with MCA stroke from a prospective observational study of DWI and fluid-attenuated inversion recovery in acute stroke. DWI-ASPECTS and lesion volume were calculated. The population was divided into subgroups based on lesion localization (superficial MCA territory, deep MCA territory, or both). Correlation of ASPECTS and infarct volume was calculated, and receiver-operating characteristics curve analysis was performed to identify the optimal ASPECTS threshold for ≥100-mL lesion volume. RESULTS A total of 496 patients were included. There was a significant negative correlation between ASPECTS and DWI lesion volume (r=-0.78; P<0.0001). With regards to lesion localization, correlation was weaker in deep MCA region (r=-0.19; P=0.038) when compared with superficial (r=-0.72; P<0.001) or combined superficial and deep MCA lesions (r=-0.72; P<0.001). Receiver-operating characteristics analysis revealed ASPECTS≤6 as best cutoff to identify ≥100-mL DWI lesion volume; however, positive predictive value was low (0.35). CONCLUSIONS ASPECTS has limitations when lesion location is not considered. Identification of patients with malignant profile by DWI-ASPECTS may be unreliable. ASPECTS may be a useful tool for the evaluation of noncontrast computed tomography. However, if MRI is used, ASPECTS seems dispensable because lesion volume can easily be quantified on DWI maps.
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Affiliation(s)
- Julian Schröder
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.).
| | - Bastian Cheng
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Martin Ebinger
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Martin Köhrmann
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Ona Wu
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Dong-Wha Kang
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - David S Liebeskind
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Thomas Tourdias
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Oliver C Singer
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Soren Christensen
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Bruce Campbell
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Marie Luby
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Steven Warach
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Jens Fiehler
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Jochen B Fiebach
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Christian Gerloff
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
| | - Götz Thomalla
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)
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Gould B, McCourt R, Gioia LC, Kate M, Hill MD, Asdaghi N, Dowlatshahi D, Jeerakathil T, Coutts SB, Demchuk AM, Emery D, Shuaib A, Butcher K. Acute blood pressure reduction in patients with intracerebral hemorrhage does not result in borderzone region hypoperfusion. Stroke 2014; 45:2894-9. [PMID: 25147326 DOI: 10.1161/strokeaha.114.005614] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial (ICH ADAPT) demonstrated blood pressure (BP) reduction does not affect mean perihematoma or hemispheric cerebral blood flow. Nonetheless, portions of the perihematoma and borderzones may reach ischemic thresholds after BP reduction. We tested the hypothesis that BP reduction after intracerebral hemorrhage results in increased critically hypoperfused tissue volumes. METHODS Patients with Intracerebral hemorrhage were randomized to a target systolic BP (SBP) of <150 or <180 mm Hg and imaged with computed tomographic perfusion 2 hours later. The volumes of tissue below cerebral blood flow thresholds for ischemia (<18 mL/100 g/min) and infarction (<12 mL/100 g/min) were calculated as a percentage of the total volume within the internal and external borderzones and the perihematoma region. RESULTS Seventy-five patients with intracerebral hemorrhage were randomized a median (interquartile range) of 7.8 (13.3) hours from onset. Acute hematoma volume was 17.8 (27.1) mL and mean SBP was 183±22 mm Hg. At the time of computed tomographic perfusion (2.3 [1.0] hours after randomization), SBP was lower in the <150 mm Hg (n=37; 140±18 mm Hg) than in the <180 mm Hg group (n=36; 162±12 mm Hg; P<0.001). BP treatment did not affect the percentage of total borderzone tissue with cerebral blood flow<18 (14.7±13.6 versus 15.6±13.7%; P=0.78) or <12 mL/100 g/min (5.1±5.1 versus 5.8±6.8%; P=0.62). Similar results were found in the perihematoma region. Low SBP load (fraction of time with SBP<150 mmHg) did not predict borderzone tissue volume with cerebral blood flow<18 mL/100 g/min (β=0.023 [-0.073, 0.119]). CONCLUSIONS BP reduction does not increase the volume of critically hypoperfused borderzone or perihematoma tissue. These data support the safety of early BP reduction in intracerebral hemorrhage. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00963976.
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Affiliation(s)
- Bronwen Gould
- From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.)
| | - Rebecca McCourt
- From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.)
| | - Laura C Gioia
- From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.)
| | - Mahesh Kate
- From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.)
| | - Michael D Hill
- From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.)
| | - Negar Asdaghi
- From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.)
| | - Dariush Dowlatshahi
- From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.)
| | - Thomas Jeerakathil
- From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.)
| | - Shelagh B Coutts
- From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.)
| | - Andrew M Demchuk
- From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.)
| | - Derek Emery
- From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.)
| | - Ashfaq Shuaib
- From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.)
| | - Ken Butcher
- From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).
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Relationship Between Magnetic Resonance Angiography–Diffusion-weighted Imaging Mismatch and Clinical Outcome in Endovascular Treatment for Acute Ischemic Stroke: Subgroup Analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism–Japan Registry. J Stroke Cerebrovasc Dis 2014; 23:1471-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 11/29/2013] [Accepted: 12/07/2013] [Indexed: 11/18/2022] Open
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Inoue M, Olivot JM, Labreuche J, Mlynash M, Tai W, Albucher JF, Meseguer E, Amarenco P, Mazighi M. Impact of diffusion-weighted imaging Alberta stroke program early computed tomography score on the success of endovascular reperfusion therapy. Stroke 2014; 45:1992-8. [PMID: 24923724 DOI: 10.1161/strokeaha.114.005084] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In acute ischemic stroke patients treated by intravenous thrombolysis, a diffusion-weighted imaging (DWI) Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is an independent factor of functional outcomes. Our aim was to assess the impact of pretreatment DWI-ASPECTS on outcomes after endovascular therapy, with a specific emphasis on recanalization. METHODS We analyzed data collected between April 2007 and March 2013 in a prospective clinical registry of acute ischemic stroke patients treated by endovascular approach. Every patient with a documented internal carotid artery or middle cerebral artery occlusion who underwent an acute DWI-MRI before treatment was eligible for this study. The primary outcome was a favorable outcome defined by modified Rankin Scale of 0 to 2 at 90 days. RESULTS Two hundred ten patients were included and median DWI-ASPECTS was 7 (interquartile range, 4-8). DWI-ASPECTS≥5 was the optimal threshold to predict a favorable outcome (area under the curve=0.69; sensitivity, 90%; specificity, 38%). In a multivariate analysis including confounding variables, the adjusted odds ratio for favorable outcomes associated with a DWI-ASPECTS of ≥5 was 5.06 (95% confidence interval, 1.86-13.77; P=0.002). Nonetheless, the occurrence of a complete recanalization was associated with an increased rate of favorable outcomes in patients with DWI-ASPECTS under 5 (50% versus 3%, P<0.001). CONCLUSIONS DWI-ASPECTS≥5 seems to be the optimal threshold to predict favorable outcomes among patients undergoing endovascular reperfusion within 6 hours. Selected patients with a DWI-ASPECTS of <5 may still benefit when a complete reperfusion is achieved.
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Affiliation(s)
- Manabu Inoue
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Jean-Marc Olivot
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Julien Labreuche
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Michael Mlynash
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Waimea Tai
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Jean-François Albucher
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Elena Meseguer
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Pierre Amarenco
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Mikael Mazighi
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.).
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Llombart V, Garcia-Berrocoso T, Bustamante A, Fernandez-Cadenas I, Montaner J. Cardioembolic stroke diagnosis using blood biomarkers. Curr Cardiol Rev 2014; 9:340-52. [PMID: 24527683 PMCID: PMC3941099 DOI: 10.2174/1573403x10666140214122633] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 11/12/2013] [Accepted: 02/04/2014] [Indexed: 12/11/2022] Open
Abstract
Stroke is one of the main causes of death and disability in the world. Cardioembolic etiology accounts for approximately
one fifth of all ischemic strokes whereas 25-30% remains undetermined even after an advanced diagnostic
workup. Despite there is not any biomarker currently approved to distinguish cardioembolic stroke among other etiologies
in clinical practice the use of biomarkers represents a promising valuable complement to determine stroke etiology reducing
the number of cryptogenic strokes and aiding in the prescription of the most appropriated primary and secondary
treatments in order to minimize therapeutic risks and to avoid recurrences. In this review we present an update about specific
cardioembolic stroke-related biomarkers at a protein, transcriptomic and genetic level. Finally, we also focused on
reported biomarkers associated with atrial fibrillation (a cardiac illness strongly related with cardioembolic stroke subtype)
thus with a potential to become biomarkers to detect cardioembolic stroke in the future.
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Affiliation(s)
| | | | | | | | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron. Barcelona, Spain. Neurovascular Unit. Department of Neurology. Universitat Autonoma de Barcelona. Hospital Vall d'Hebron. Barcelona. Spain.
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