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Morimoto T, Yoshimoto N, Kuragaichi T, Taki J, Yamada K. Mechanical thrombectomy for cerebrovascular occlusion in a patient with situs inversus. Radiol Case Rep 2024; 19:3488-3491. [PMID: 38872738 PMCID: PMC11170093 DOI: 10.1016/j.radcr.2024.05.012] [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: 02/02/2024] [Revised: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024] Open
Abstract
Situs inversus is a rare congenital abnormality characterized by mirror-image transposition of the major visceral organs and vessels. Few reports have discussed the use of mechanical thrombectomy in acute ischemic stroke with situs inversus. We present such a case, to raise awareness and deepen the knowledge on these cases. A 44-year-old man was admitted to our hospital with sudden-onset dysarthria and left-sided paresis. Computed tomography (CT) angiography revealed situs inversus and occlusion in the internal carotid artery. First, intravenous tissue plasminogen activator was administered, followed by immediate reperfusion with mechanical thrombectomy. We achieved thrombolysis in cerebral infarction grade 3. After the procedure, the patient fully recovered. Prompt diagnosis is crucial for rapid recanalization in patients with vascular anomalies such as situs inversus.
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Affiliation(s)
- Takaaki Morimoto
- Department of Neurosurgery, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
| | - Naoya Yoshimoto
- Department of Neurosurgery, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
| | - Takashi Kuragaichi
- Department of Cardiology, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
| | - Junya Taki
- Department of Neurosurgery, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
| | - Keisuke Yamada
- Department of Neurosurgery, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
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Tanaka K, Kaveeta C, Pensato U, Zhang J, Bala F, Alhabli I, Horn M, Ademola A, Almekhlafi M, Ganesh A, Buck B, Tkach A, Catanese L, Dowlatshahi D, Shankar J, Poppe AY, Shamy M, Qiu W, Swartz RH, Hill MD, Sajobi TT, Menon BK, Demchuk AM, Singh N. Combining Early Ischemic Change and Collateral Extent for Functional Outcomes After Endovascular Therapy: An Analysis From AcT Trial. Stroke 2024; 55:1758-1766. [PMID: 38785076 DOI: 10.1161/strokeaha.123.046056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/12/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Early ischemic change and collateral extent are colinear with ischemic core volume (ICV). We investigated the relationship between a combined score using the Alberta Stroke Program Early Computed Tomography Score and multiphase computed tomography angiography (mCTA) collateral extent, named mCTA-ACE score, on functional outcomes in endovascular therapy-treated patients. METHODS We performed a post hoc analysis of a subset of endovascular therapy-treated patients from the Alteplase Compared to Tenecteplase trial which was conducted between December 2019 and January 2022 at 22 centers across Canada. Ten-point mCTA collateral corresponding to M2 to M6 regions of the Alberta Stroke Program Early Computed Tomography Score grid was evaluated as 0 (poor), 1 (moderate), or 2 (normal) and additively combined with the 10-point Alberta Stroke Program Early Computed Tomography Score to produce a 20-point mCTA-ACE score. We investigated the association of mCTA-ACE score with modified Rankin Scale score ≤2 and return to prestroke level of function at 90 to 120 days using mixed-effects logistic regression. In the subset of patients who underwent baseline computed tomography perfusion imaging, we compared the mCTA-ACE score and ICV for outcome prediction. RESULTS Among 1577 intention-to-treat population in the trial, 368 (23%; 179 men; median age, 73 years) were included, with Alberta Stroke Program Early Computed Tomography Score, mCTA collateral, and combination of both (mCTA-ACE score: median [interquartile range], 8 [7-10], 9 [8-10], and 17 [16-19], respectively). The probability of modified Rankin Scale score ≤2 and return to prestroke level of function increased for each 1-point increase in mCTA-ACE score (odds ratio, 1.16 [95% CI, 1.06-1.28] and 1.22 [95% CI, 1.06-1.40], respectively). Among 173 patients in whom computed tomography perfusion data was assessable, the mCTA-ACE score was inversely correlated with ICV (ρ=-0.46; P<0.01). The mCTA-ACE score was comparable to ICV to predict a modified Rankin Scale score ≤2 and return to prestroke level of function (C statistics 0.71 versus 0.69 and 0.68 versus 0.64, respectively). CONCLUSIONS The mCTA-ACE score had a significant positive association with functional outcomes after endovascular therapy and had a similar predictive performance as ICV.
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Affiliation(s)
- Koji Tanaka
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Chitapa Kaveeta
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (C.K.)
| | - Umberto Pensato
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Biomedical Sciences, Humanitas University, Milan, Italy (U.P.)
- IRCCS Humanitas Research Hospital, Milan, Italy (U.P.)
| | - Jianhai Zhang
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Fouzi Bala
- Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, France (F.B.)
| | - Ibrahim Alhabli
- Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - MacKenzie Horn
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Ayoola Ademola
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Mohammed Almekhlafi
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Brian Buck
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (B.B.)
| | - Aleksander Tkach
- Department of Neurosciences, Kelowna General Hospital, BC, Canada (A.T.)
| | - Luciana Catanese
- Department of Medicine, McMaster University, Hamilton, ON, Canada (L.C.)
| | - Dar Dowlatshahi
- Department of Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M.S.)
| | - Jai Shankar
- Department of Radiology, Health Sciences Center (J.S.), University of Manitoba, Winnipeg, Canada
| | - Alexandre Y Poppe
- Department of Clinical Neurosciences, Université de Montréal, QC, Canada (A.Y.P.)
| | - Michel Shamy
- Department of Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M.S.)
| | - Wu Qiu
- Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan, China (W.Q.)
| | - Richard H Swartz
- Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (R.H.S.)
| | - Michael D Hill
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Medicine (M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Nishita Singh
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada
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3
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Horn M, Teleg E, Tanaka K, Al Sultan A, Kasickova L, Ohara T, Ojha P, Wasyliw S, Marzoughi S, Banerjee A, Kulkarni G, Horn K, Bobyn A, Neweduk A, Singh N, Qiu W, Rodriguez-Luna D, Dowlatshahi D, Goyal M, Menon BK, Demchuk AM. Timing of Spot Sign Appearance, Spot Sign Volume, and Leakage Rate among Phases of Multiphase CTA Predict Intracerebral Hemorrhage Growth. AJNR Am J Neuroradiol 2024; 45:693-700. [PMID: 38782592 DOI: 10.3174/ajnr.a8254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/23/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND AND PURPOSE The presence of spot sign is associated with a high risk of hematoma growth. Our aim was to investigate the timing of the appearance, volume, and leakage rate of the spot sign for predicting hematoma growth in acute intracerebral hemorrhage using multiphase CTA. MATERIALS AND METHODS In this single-center retrospective study, multiphase CTA in 3 phases was performed in acute intracerebral hemorrhage (defined as intraparenchymal ± intraventricular hemorrhages). Phases of the spot sign first appearance, spot sign volumes (microliter), and leakage rates among phases (microliter/second) were measured. Associations between baseline clinical and imaging variables including spot sign volume parameters (volume and leakage rate divided by median) and hematoma growth (>6 mL) were investigated using regression models. Receiver operating characteristic analysis was used as appropriate. RESULTS Two hundred seventeen patients (131 men; median age, 70 years) were included. The spot sign was detected in 21.7%, 30.0%, and 29.0% in the first, second, and third phases, respectively, with median volumes of 19.7, 31.4, and 34.8 μl in these phases. Hematoma growth was seen in 44 patients (20.3%). By means of modeling, the following variables, namely the spot sign appearing in the first phase, first phase spot sign volume, spot sign appearing in the second or third phase, and spot sign positive and negative leakage rates, were associated with hematoma growth. Among patients with a spot sign, the absolute leakage rate accounting for both positive and negative leakage rates was also associated with hematoma growth (per 1-μl/s increase; OR, 1.26; 95% CI, 1.04-1.52). Other hematoma growth predictors were stroke history, baseline NIHSS score, onset-to-imaging time, and baseline hematoma volume (all P values < .05). CONCLUSIONS The timing of the appearance of the spot sign, volume, and leakage rate were all associated with hematoma growth. Development of automated software to generate these spot sign volumetric parameters would be an important next step to maximize the potential of temporal intracerebral hemorrhage imaging such as multiphase CTA for identifying those most at risk of hematoma growth.
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Affiliation(s)
- MacKenzie Horn
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Ericka Teleg
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Koji Tanaka
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Abdulaziz Al Sultan
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Linda Kasickova
- Department of Neurology (L.K.), University Ostrava, Ostrava, Czech Republic
| | - Tomoyuki Ohara
- Department of Neurology (T.O.), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Piyush Ojha
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Sanchea Wasyliw
- Department of Medicine (S.W.), Division of Neurology, University of Saskatchewan, Saskatoon, Canada
| | - Sina Marzoughi
- Department of Medicine (S.M.), Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ankur Banerjee
- Department of Medicine (A. Banerjee), Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Girish Kulkarni
- Department of Neurology (G.K.), National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Kennedy Horn
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Amy Bobyn
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Anneliese Neweduk
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Nishita Singh
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Wu Qiu
- Department of Biomedical Engineering (W.Q.), Huazhong University of Science and Technology, Wuhan, China
| | - David Rodriguez-Luna
- Department of Neurology (D.R.-L.), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dar Dowlatshahi
- Department of Medicine (D.D.), Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | - Mayank Goyal
- Department of Radiology (M.G., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
- Hotchikiss Brain Institute (M.G., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Bijoy K Menon
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
- Department of Radiology (M.G., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences (B.K.M.), University of Calgary, Calgary, Alberta, Canada
- Hotchikiss Brain Institute (M.G., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Andrew M Demchuk
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
- Department of Radiology (M.G., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
- Hotchikiss Brain Institute (M.G., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada
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Kaur H, Yuki I, Shimizu T, Paganini-Hill A, Xu J, Golshani K, Hsu FPK, Nguyen T, Jin CM, Suzuki S. Follow-up care compliance among patients diagnosed with unruptured intracranial aneurysms. J Stroke Cerebrovasc Dis 2024; 33:107786. [PMID: 38782166 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107786] [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: 11/30/2023] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES Periodic imaging follow-up for patients with unruptured intracranial aneurysms (UIA) is crucial, as studies indicate higher rupture risk with aneurysm growth. However, few studies address patient adherence to follow-up recommendations. This study aims to identify compliance rates and factors influencing follow-up adherence. METHODS Patients with a UIA were identified from our institution's database from 2011-2021. Follow-up imaging (CT/MR Angiogram) was advised at specific intervals. Patients were categorized into compliant and non-compliant groups based on first-year compliance. Factors contributing to compliance were assessed through multivariate logistic regression. Phone interviews were conducted with non-compliant patients to understand reasons for non-adherence. RESULTS Among 923 UIA diagnosed patients, 337 were randomly selected for analysis. The median follow-up period was 1.4 years, with a 42% first-year compliance rate. The mean aneurysm size was 3.3 mm. Five patients had a rupture during follow-up, of which 4 died. Compared with patients consulting specialists at the initial diagnosis, those seen by non-specialists exhibited lower compliance (OR 0.25, p < 0.001). Loss to follow-up was greatest during transition from emergency service to specialist appointments. Patients who spoke languages other than English exhibited poorer compliance than those speaking English (OR 0.20, p = 0.01). CONCLUSIONS Significant amounts of UIA patients at low rupture risk were lost to follow-up before seeing UIA specialists. Main non-compliance factors include inadequate comprehension of follow-up instructions, poor care transfer from non-specialists to specialist, and insurance barriers.
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Affiliation(s)
- Hemdeep Kaur
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Ichiro Yuki
- Department of Neurosurgery, University of California, Irvine, CA, United States.
| | - Timothy Shimizu
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | | | - Jordan Xu
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Kiarash Golshani
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Frank P K Hsu
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Tracy Nguyen
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Chloe M Jin
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Shuichi Suzuki
- Department of Neurosurgery, University of California, Irvine, CA, United States
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5
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Ma Y, Chen S, Xiong H, Yao R, Zhang W, Yuan J, Duan H. LVONet: automatic classification model for large vessel occlusion based on the difference information between left and right hemispheres. Phys Med Biol 2024; 69:035012. [PMID: 38211308 DOI: 10.1088/1361-6560/ad1d6a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/11/2024] [Indexed: 01/13/2024]
Abstract
Objective.Stroke is a highly lethal condition, with intracranial vessel occlusion being one of its primary causes. Intracranial vessel occlusion can typically be categorized into four types, each requiring different intervention measures. Therefore, the automatic and accurate classification of intracranial vessel occlusions holds significant clinical importance for assessing vessel occlusion conditions. However, due to the visual similarities in shape and size among different vessels and variations in the degree of vessel occlusion, the automated classification of intracranial vessel occlusions remains a challenging task. Our study proposes an automatic classification model for large vessel occlusion (LVO) based on the difference information between the left and right hemispheres.Approach.Our approach is as follows. We first introduce a dual-branch attention module to learn long-range dependencies through spatial and channel attention, guiding the model to focus on vessel-specific features. Subsequently, based on the symmetry of vessel distribution, we design a differential information classification module to dynamically learn and fuse the differential information of vessel features between the two hemispheres, enhancing the sensitivity of the classification model to occluded vessels. To optimize the feature differential information among similar vessels, we further propose a novel cooperative learning loss function to minimize changes within classes and similarities between classes.Main results.We evaluate our proposed model on an intracranial LVO data set. Compared to state-of-the-art deep learning models, our model performs optimally, achieving a classification sensitivity of 93.73%, precision of 83.33%, accuracy of 89.91% and Macro-F1 score of 87.13%.Significance.This method can adaptively focus on occluded vessel regions and effectively train in scenarios with high inter-class similarity and intra-class variability, thereby improving the performance of LVO classification.
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Affiliation(s)
- Yuqi Ma
- College of Computer and Information Science, Southwest University, Chongqing, 400715, People's Republic of China
| | - Shanxiong Chen
- College of Computer and Information Science, Southwest University, Chongqing, 400715, People's Republic of China
| | - Hailing Xiong
- College of Electronic and Information Engineering, Southwest University, Chongqing, 400715, People's Republic of China
| | - Rui Yao
- College of Computer and Information Science, Southwest University, Chongqing, 400715, People's Republic of China
| | - Wang Zhang
- College of Computer and Information Science, Southwest University, Chongqing, 400715, People's Republic of China
| | - Jiang Yuan
- College of Computer and Information Science, Southwest University, Chongqing, 400715, People's Republic of China
| | - Haowei Duan
- College of Computer and Information Science, Southwest University, Chongqing, 400715, People's Republic of China
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6
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Sakseranee J, Sethabouppha P, Pattarasakulchai T, Klaewkla T, Thiankhaw K. The diagnostic tests and functional outcomes of acute ischemic stroke or transient ischemic attack in young adults: A 4-year hospital-based observational study. PLoS One 2023; 18:e0292274. [PMID: 37792783 PMCID: PMC10550126 DOI: 10.1371/journal.pone.0292274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Ischemic strokes in young adults have been a significant concern due to various potential etiologies and had substantial clinical and public health impacts. We aimed to study the diagnostic tests, etiologies, and functional outcomes of acute ischemic stroke (AIS) and transient ischemic attack (TIA) in young adult patients. METHODS The data were retrieved from the Chiang Mai University Hospital Stroke Registry between January 2018 and December 2021. Consecutive AIS or TIA patients were included if they were 18-50 years and had no stroke mimics. Study outcomes were proportions of positive diagnostic tests, and 90-day modified Rankin Scale (mRS). RESULTS Of 244 enrolled patients, 59.0% (n = 144) were male, and 38.1% (n = 93) were aged 18-40, classified as the younger age group. There was a high incidence of diabetes (24.5%) and dyslipidemia (54.3%) among patients aged 41-50, associated with small-vessel occlusion and large-artery atherosclerosis stroke classification in this age group. Patients aged 18-40 years had more other determined etiologies (39.8%), with hypercoagulability (8.2%), arterial dissection (7.8%), and cardiac sources (6.6%) being the first three causes, which were associated with higher anticoagulant treatment. The cerebrovascular study, cardiac evaluation using echocardiography, and antiphospholipid syndrome testing were commonly performed, of which computed tomography angiography provided a high proportion of positive results (80.3%). 76.3% of young adult patients had excellent functional outcomes (mRS 0-1) with a median mRS of 0 (interquartile range 0-1) at 90-day follow-up. CONCLUSIONS Stroke of other determined etiology remained the common cause of stroke in young adults, and most affected individuals had excellent clinical outcomes. Blood tests for arterial hypercoagulability and noninvasive vascular and cardiac evaluations are encouraged in selected patients to determine the stroke etiology and guide for appropriate preventive strategies.
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Affiliation(s)
| | | | | | | | - Kitti Thiankhaw
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- The Northern Neuroscience Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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7
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Fransson V, Mellander H, Ramgren B, Andersson H, Arena F, Ydström K, Ullberg T, Wassélius J. Image quality of spectral brain computed tomography angiography using halved dose of iodine contrast medium. Neuroradiology 2023; 65:1333-1342. [PMID: 37452885 PMCID: PMC10425475 DOI: 10.1007/s00234-023-03190-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Reduction in iodinated contrast medium (CM) dose is highly motivated. Our aim was to evaluate if a 50% reduction of CM, while preserving image quality, is possible in brain CT angiography (CTA) using virtual monoenergetic images (VMI) on spectral CT. As a secondary aim, we evaluated if VMI can salvage examinations with suboptimal CM timing. METHODS Consecutive patients older than 18 years without intracranial stenosis/occlusion were included. Three imaging protocols were used: group 1, full CM dose; group 2, 50% CM dose suboptimal timing; and group 3, 50% CM dose optimized timing. Attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured in the internal carotid artery, M2 segment of the middle cerebral artery, and white matter for conventional images (CI) and VMI (40-200 keV). Qualitative image quality for CI and VMI (50 and 60 keV) was rated by 4 experienced reviewers. RESULTS Qualitatively and quantitatively, VMI (40-60 keV) improved image quality within each group. Significantly higher attenuation and CNR was found for group 3 VMI 40-50 keV, with unchanged SNR, compared to group 1 CI. Group 3 VMI 50 keV also received significantly higher rating scores than group 1 CI. Group 2 VMI (40-50 keV) had significantly higher CNR compared to group 3 CI, but the subjective image quality was similar. CONCLUSION VMI of 50 keV with 50% CM dose increases qualitative and quantitative image quality over CI with full CM dose. Using VMI reduces non-diagnostic examinations and may salvage CTA examinations deemed non-diagnostic due to suboptimal timing.
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Affiliation(s)
- Veronica Fransson
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Helena Mellander
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Birgitta Ramgren
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Henrik Andersson
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Francesco Arena
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden
| | - Kristina Ydström
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Teresa Ullberg
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Johan Wassélius
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden.
- Department of Clinical Sciences, Lund University, Lund, Sweden.
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Khalil F, Asleh R, Perue RK, Weinstein JM, Solomon A, Betesh-Abay B, Briasoulis A, Alnsasra H. Vascular Function in Continuous Flow LVADs: Implications for Clinical Practice. Biomedicines 2023; 11:biomedicines11030757. [PMID: 36979735 PMCID: PMC10045906 DOI: 10.3390/biomedicines11030757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
Left ventricular assist devices (LVADs) have been increasingly used in patients with advanced heart failure, either as a destination therapy or as a bridge to heart transplant. Continuous flow (CF) LVADs have revolutionized advanced heart failure treatment. However, significant vascular pathology and complications have been linked to their use. While the newer CF-LVAD generations have led to a reduction in some vascular complications such as stroke, no major improvement was noticed in the rate of other vascular complications such as gastrointestinal bleeding. This review attempts to provide a comprehensive summary of the effects of CF-LVAD on vasculature, including pathophysiology, clinical implications, and future directions.
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Affiliation(s)
- Fouad Khalil
- Department of Internal Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
| | - Rabea Asleh
- Heart Institute, Hadassah University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem P.O. Box 12000, Israel
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Radha Kanneganti Perue
- Department of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Jean-Marc Weinstein
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva P.O. Box 653, Israel
- Department of Cardiology, Soroka University Medical Center, Rager Av., Beersheva P.O. Box 84101, Israel
| | - Adam Solomon
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva P.O. Box 653, Israel
| | - Batya Betesh-Abay
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva P.O. Box 653, Israel
| | - Alexandros Briasoulis
- Department of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Hilmi Alnsasra
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55902, USA
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva P.O. Box 653, Israel
- Department of Cardiology, Soroka University Medical Center, Rager Av., Beersheva P.O. Box 84101, Israel
- Correspondence: ; Tel.: +972-507107535
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9
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Harrar DB, Sun LR, Segal JB, Lee S, Sansevere AJ. Neuromonitoring in Children with Cerebrovascular Disorders. Neurocrit Care 2023; 38:486-503. [PMID: 36828980 DOI: 10.1007/s12028-023-01689-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/31/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Cerebrovascular disorders are an important cause of morbidity and mortality in children. The acute care of a child with an ischemic or hemorrhagic stroke or cerebral sinus venous thrombosis focuses on stabilizing the patient, determining the cause of the insult, and preventing secondary injury. Here, we review the use of both invasive and noninvasive neuromonitoring modalities in the care of pediatric patients with arterial ischemic stroke, nontraumatic intracranial hemorrhage, and cerebral sinus venous thrombosis. METHODS Narrative review of the literature on neuromonitoring in children with cerebrovascular disorders. RESULTS Neuroimaging, near-infrared spectroscopy, transcranial Doppler ultrasonography, continuous and quantitative electroencephalography, invasive intracranial pressure monitoring, and multimodal neuromonitoring may augment the acute care of children with cerebrovascular disorders. Neuromonitoring can play an essential role in the early identification of evolving injury in the aftermath of arterial ischemic stroke, intracranial hemorrhage, or sinus venous thrombosis, including recurrent infarction or infarct expansion, new or recurrent hemorrhage, vasospasm and delayed cerebral ischemia, status epilepticus, and intracranial hypertension, among others, and this, is turn, can facilitate real-time adjustments to treatment plans. CONCLUSIONS Our understanding of pediatric cerebrovascular disorders has increased dramatically over the past several years, in part due to advances in the neuromonitoring modalities that allow us to better understand these conditions. We are now poised, as a field, to take advantage of advances in neuromonitoring capabilities to determine how best to manage and treat acute cerebrovascular disorders in children.
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Affiliation(s)
- Dana B Harrar
- Division of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
| | - Lisa R Sun
- Divisions of Pediatric Neurology and Vascular Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Bradley Segal
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Arnold J Sansevere
- Division of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
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Simaan N, Jubeh T, Wiegler KB, Sharabi-Nov A, Honig A, Shahien R. Comparison of Doppler Ultrasound and Computerized Tomographic Angiography in Evaluation of Cervical Arteries Stenosis in Stroke Patients, a Retrospective Single-Center Study. Diagnostics (Basel) 2023; 13:diagnostics13030459. [PMID: 36766564 PMCID: PMC9914439 DOI: 10.3390/diagnostics13030459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
There are different diagnostic modalities to investigate atherosclerosis cervical artery disease in suspected stroke patients. We aimed to test the concordance of findings of the two most widely used diagnostic modalities in stroke patients: duplex ultrasound (DUS) and computerized tomographic angiography (CTA). A total of 100 stroke patients were retrospectively included in the study, all of them had DUS followed by CTA. Discrepancies of DUS compared to the CTA results in both the internal carotid and vertebral arteries were found in 44% of the patients. The patients with significant differences in diagnostic results were characterized by older age. Evaluation of the degree of carotid artery stenosis revealed vast differences in patients with 50-69% stenosis found by DUS, in which 45.5% of them had a different percentage of stenosis found by CTA. In studying the degree of stenosis of the vertebral artery, only 47.1% of the patients with more than 50% stenosis found by DUS had the same results with CTA, while the remaining revealed normal or less than 50% stenosis by CTA. The current study emphasizes that CTA is more accurate than DUS in the evaluation of stenosis of the cervical arteries including both the internal carotid and vertebral arteries.
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Affiliation(s)
- Naaem Simaan
- Department of Neurology, Ziv Medical Center, Safed 1311001, Israel
- Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Tamer Jubeh
- Department of Neurology, Ziv Medical Center, Safed 1311001, Israel
| | | | - Adi Sharabi-Nov
- Research Wing, Ziv Medical Center, Safed 1311001, Israel
- Statistics Department, Tel-Hai Academic College, Qiryat Shemona 1220800, Israel
| | - Asaf Honig
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel
| | - Radi Shahien
- Department of Neurology, Ziv Medical Center, Safed 1311001, Israel
- Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
- Correspondence:
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11
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Cardiovascular Nanotechnology. Nanomedicine (Lond) 2023. [DOI: 10.1007/978-981-16-8984-0_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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12
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Saito T, Itabashi R, Uchida K, Kawabata Y, Igasaki S, Sato K, Chiba T, Morimoto T, Yazawa Y. Identifying large vessel occlusion using the hyperdense artery sign in patients treated with mechanical thrombectomy. J Stroke Cerebrovasc Dis 2023; 32:106846. [PMID: 36379137 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The hyperdense artery sign on non-contrast computed tomography-reconstructed images is useful for identifying large vessel occlusion in acute ischemic stroke. This study aimed to assess its efficacy in patients with large vessel occlusion treated with mechanical thrombectomy. MATERIALS AND METHODS This retrospective and prospective single-centered study from June 2019 to May 2021 evaluated the use of non-contrast computed tomography-reconstructed images for detecting hyperdense artery sign to identify large vessel occlusion from June 2020 to May 2021. We registered consecutive potential candidates for mechanical thrombectomy due to suspected stroke and assessed the accuracy of hyperdense artery sign on non-contrast computed tomography-reconstructed images for large vessel occlusion in the hyperacute setting. Non-contrast computed tomography images were reconstructed into maximum intensity projection images with iterative reconstruction algorithms to detect hyperdense artery signs. We compared the door-to-puncture time and functional outcome at 90 days before and after employing non-contrast computed tomography-reconstructed images in patients with large vessel occlusion treated with mechanical thrombectomy. RESULTS The cohort included 82 patients, wherein 47 were treated with mechanical thrombectomy. The sensitivity (96%) and specificity (94%) of hyperdense artery sign on non-contrast computed tomography-reconstructed images for large vessel occlusion were performed. The door-to-puncture time was significantly shortened after using non-contrast computed tomography-reconstructed images (49 versus 28 min, p = 0.001), but the functional outcome at 90 days remained unchanged. CONCLUSIONS Non-contrast computed tomography-reconstructed images, as a vascular imaging tool for mechanical thrombectomy, can reduce workflow time in hospitals by identifying large vessel occlusion with high sensitivity and specificity.
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Affiliation(s)
- Takuya Saito
- Department of Stroke Neurology, Kohnan Hospital, 4-20-1, Nagamachi-minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan.
| | - Ryo Itabashi
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Japan.
| | - Kazutaka Uchida
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuichi Kawabata
- Department of Stroke Neurology, Kohnan Hospital, 4-20-1, Nagamachi-minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan.
| | - Shota Igasaki
- Department of Stroke Neurology, Kohnan Hospital, 4-20-1, Nagamachi-minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan.
| | - Kazuhiko Sato
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | | | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Yukako Yazawa
- Department of Stroke Neurology, Kohnan Hospital, 4-20-1, Nagamachi-minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan.
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Itabashi R, Shigehatake Y, Saito T, Endo K, Fukuma K, Kobayashi Y, Kawabata Y, Yazawa Y, Matsumoto Y, Inoue M, Koga M. Rapid Evaluation of Large Vessel Occlusion for Mechanical Thrombectomy Using Carotid Duplex Ultrasound. Intern Med 2023; 62:703-710. [PMID: 36858621 PMCID: PMC10037017 DOI: 10.2169/internalmedicine.0029-22] [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] [Indexed: 03/03/2023] Open
Abstract
Objectives This study clarified the usefulness of carotid duplex ultrasound (CDU) in evaluating large vessel occlusion (LVO) in patients with acute stroke planned to be treated with mechanical thrombectomy (MT). Methods This study was single-center, prospective, observational trial. If the ratio of end-diastolic velocity in the common carotid arteries was ≥1.4, or diastolic flow in the affected internal carotid artery (ICA) was absent on CDU, patients were immediately transferred to the angio-suite without additional cerebrovascular imaging. Clinical parameters, including time metrics and outcomes, were evaluated in participants. Patients We enrolled stroke patients with a National Institutes of Health Stroke Scale score ≥6 and Alberta Stroke Program Early CT score ≥6 in whom MT could be initiated within 6 hours of the stroke onset. Results Among 140 patients screened during the study period, 48 were ultimately enrolled. Twenty-seven patients were diagnosed with LVO by CDU alone. CDU offered 83% sensitivity and 82% specificity for identifying the occlusion of the ICA or M1 segment of the middle cerebral artery. Among the 29 total patients treated with MT, 20 (67%) showed a modified Rankin Scale score ≤2 at 90 days. The door-to-puncture time was significantly shorter in patients evaluated by CDU alone (34 minutes) than in those evaluated by magnetic resonance angiography after CDU (47.5 minutes, p<0.001). Conclusion CDU might reduce the time metrics for early initiation of MT with good sensitivity and specificity in identifying LVO.
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Affiliation(s)
- Ryo Itabashi
- Department of Stroke Neurology, Kohnan Hospital, Japan
| | | | - Takuya Saito
- Department of Stroke Neurology, Kohnan Hospital, Japan
| | - Kaoru Endo
- Department of Stroke Neurology, Kohnan Hospital, Japan
| | - Kazuki Fukuma
- Department of Stroke Neurology, Kohnan Hospital, Japan
| | | | | | - Yukako Yazawa
- Department of Stroke Neurology, Kohnan Hospital, Japan
| | | | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan
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Chung KJ, Khaw AV, Pandey SK, Lee DH, Mandzia JL, Lee TY. Feasibility of deconvolution-based multiphase CT angiography perfusion maps in acute ischemic stroke: Simulation and concordance with CT perfusion. J Stroke Cerebrovasc Dis 2022; 31:106844. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/20/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
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15
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Radiation Dose Reduction Opportunities in Vascular Imaging. Tomography 2022; 8:2618-2638. [PMID: 36287818 PMCID: PMC9607049 DOI: 10.3390/tomography8050219] [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: 09/30/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Computed tomography angiography (CTA) has been the gold standard imaging modality for vascular imaging due to a variety of factors, including the widespread availability of computed tomography (CT) scanners, the ease and speed of image acquisition, and the high sensitivity of CTA for vascular pathology. However, the radiation dose experienced by the patient during imaging has long been a concern of this image acquisition method. Advancements in CT image acquisition techniques in combination with advancements in non-ionizing radiation imaging techniques including magnetic resonance angiography (MRA) and contrast-enhanced ultrasound (CEUS) present growing opportunities to reduce total radiation dose to patients. This review provides an overview of advancements in imaging technology and acquisition techniques that are helping to minimize radiation dose associated with vascular imaging.
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Kobayashi Y, Morizumi T, Okumura G, Nagamatsu K, Shimizu Y, Sasaki T, Sato A, Sekijima Y, Hongo K. Visualization of thrombus using iterative reconstruction and maximum intensity projection of thin-slice CT images. Neuroradiology 2022; 64:2373-2379. [PMID: 35705738 PMCID: PMC9200622 DOI: 10.1007/s00234-022-02996-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Iterative reconstruction (IR) is a noise reduction method that facilitates the synthesis of maximum intensity projection (MIP) from a larger number of slices while maintaining resolution. The present study aimed to analyze whether CT evaluation using IR and MIP is ideal for thrombus evaluation of large vessel occlusions in patients with acute ischemic stroke. METHODS Three types of images for each patient were reconstructed and categorized into three groups: the "conventional group," evaluated using 0.5-mm slice CT, the "MIP group," evaluated using 0.5-mm slice CT processed with MIP, and the "IR + MIP group," evaluated with 0.5-mm slice CT processed with IR and MIP. Noise and image quality were evaluated with noise standard deviation (Noise SD) and contrast-to-noise ratio (CNR). Three experts evaluated the thrombus edge coordinates, made a visual assessment, and compared the data with the digital subtraction angiography (DSA) of the mechanical thrombectomy. RESULTS Twenty-nine patients with cerebral infarction having large vessel occlusion were included in this study. The IR + MIP group had a lower Noise SD and a statistically higher CNR, leading to more favorable image evaluations. The thrombus assessment showed no inter-rater variability in thrombus edge identification, and the visual assessment and comparison with DSA were statistically better in the IR + MIP group. CONCLUSIONS IR reduces noise and improves resolution. MIP in combination with IR facilitates visualization of thrombus.
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Affiliation(s)
- Yuya Kobayashi
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan.
| | - Teruya Morizumi
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Gaku Okumura
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Kiyoshiro Nagamatsu
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Yusaku Shimizu
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Tetsuo Sasaki
- Department of Neurosurgery, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Atsushi Sato
- Department of Neurosurgery, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
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Validation of a machine learning software tool for automated large vessel occlusion detection in patients with suspected acute stroke. Neuroradiology 2022; 64:2245-2255. [PMID: 35606655 DOI: 10.1007/s00234-022-02978-x] [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: 02/27/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE CT angiography (CTA) is the imaging standard for large vessel occlusion (LVO) detection in patients with acute ischemic stroke. StrokeSENS LVO is an automated tool that utilizes a machine learning algorithm to identify anterior large vessel occlusions (LVO) on CTA. The aim of this study was to test the algorithm's performance in LVO detection in an independent dataset. METHODS A total of 400 studies (217 LVO, 183 other/no occlusion) read by expert consensus were used for retrospective analysis. The LVO was defined as intracranial internal carotid artery (ICA) occlusion and M1 middle cerebral artery (MCA) occlusion. Software performance in detecting anterior LVO was evaluated using receiver operator characteristics (ROC) analysis, reporting area under the curve (AUC), sensitivity, and specificity. Subgroup analyses were performed to evaluate if performance in detecting LVO differed by subgroups, namely M1 MCA and ICA occlusion sites, and in data stratified by patient age, sex, and CTA acquisition characteristics (slice thickness, kilovoltage tube peak, and scanner manufacturer). RESULTS AUC, sensitivity, and specificity overall were as follows: 0.939, 0.894, and 0.874, respectively, in the full cohort; 0.927, 0.857, and 0.874, respectively, in the ICA occlusion cohort; 0.945, 0.914, and 0.874, respectively, in the M1 MCA occlusion cohort. Performance did not differ significantly by patient age, sex, or CTA acquisition characteristics. CONCLUSION The StrokeSENS LVO machine learning algorithm detects anterior LVO with high accuracy from a range of scans in a large dataset.
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Al Saiegh F, Munoz A, Velagapudi L, Theofanis T, Suryadevara N, Patel P, Jabre R, Chen CJ, Shehabeldin M, Gooch MR, Jabbour P, Tjoumakaris S, Rosenwasser RH, Herial NA. Patient and procedure selection for mechanical thrombectomy: Toward personalized medicine and the role of artificial intelligence. J Neuroimaging 2022; 32:798-807. [PMID: 35567418 DOI: 10.1111/jon.13003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 12/27/2022] Open
Abstract
Mechanical thrombectomy (MT) for ischemic stroke due to large vessel occlusion is standard of care. Evidence-based guidelines on eligibility for MT have been outlined and evidence to extend the treatment benefit to more patients, particularly those at the extreme ends of a stroke clinical severity spectrum, is currently awaited. As patient selection continues to be explored, there is growing focus on procedure selection including the tools and techniques of thrombectomy and associated outcomes. Artificial intelligence (AI) has been instrumental in the area of patient selection for MT with a role in diagnosis and delivery of acute stroke care. Machine learning algorithms have been developed to detect cerebral ischemia and early infarct core, presence of large vessel occlusion, and perfusion deficit in acute ischemic stroke. Several available deep learning AI applications provide ready visualization and interpretation of cervical and cerebral arteries. Further enhancement of AI techniques to potentially include automated vessel probe tools in suspected large vessel occlusions is proposed. Value of AI may be extended to assist in procedure selection including both the tools and technique of thrombectomy. Delivering personalized medicine is the wave of the future and tailoring the MT treatment to a stroke patient is in line with this trend.
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Affiliation(s)
- Fadi Al Saiegh
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alfredo Munoz
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lohit Velagapudi
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Thana Theofanis
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Neil Suryadevara
- Department of Neurology, Upstate Medical University, Syracuse, New York, USA
| | - Priyadarshee Patel
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Roland Jabre
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mohamed Shehabeldin
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Reid Gooch
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Robert H Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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19
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Cardiovascular Nanotechnology. Nanomedicine (Lond) 2022. [DOI: 10.1007/978-981-13-9374-7_12-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Plecash AR, Byrne D, Flexman A, Toma M, Field TS. Stroke in Patients with Left Ventricular Assist Devices. Cerebrovasc Dis 2021; 51:3-13. [PMID: 34510039 DOI: 10.1159/000517454] [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: 01/20/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Left ventricular assist devices (LVADs) are artificial pumps used in end-stage heart failure to support the circulatory system. These cardiac assist devices work in parallel to the heart, diverting blood from the left ventricle through an outflow graft and into the ascending aorta. LVADs have allowed patients with end-stage heart failure to live longer and with improved quality of life compared to best medical therapy alone. However, they are associated with significant risks related to both thrombosis and bleeding in this medically complex patient population. As LVADs continue to be used more widely, stroke neurologists need to become familiar with the unique physical exam and vascular imaging findings associated with this population. SUMMARY Reported rates of LVAD-associated stroke at 2 years post-implantation range from 10 to 30%, which is significantly higher than in age-matched controls. There are approximately equal rates of ischemic and hemorrhagic strokes, and rates are highest during the peri-implantation period and in the first year of therapy. Risk factors associated with ischemic and hemorrhagic stroke in this cohort can be grouped into treatment-related factors, including specific devices and antithrombotic/anticoagulation strategy, and patient-related factors. Evidence for reperfusion therapy for acute stroke in this population is limited. Intravenous tissue plasminogen activator (IV-tPA) is often contraindicated as events may occur in the perioperative setting, or in the context of therapeutic anticoagulation. Endovascular therapy with successful recanalization is reported, but there is little experience documented in the published literature. Key messages: LVAD use is increasingly common. Given the high associated risks of stroke, neurologists will need to become increasingly familiar with an approach to assessment and therapy for LVAD patients with cerebrovascular issues.
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Affiliation(s)
- Alyson R Plecash
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada,
| | - Danielle Byrne
- Division of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alana Flexman
- Division of Anesthesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mustafa Toma
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Stroke Program, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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21
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Myint MZ, Yeo LL, Tan BYQ, The EZ, Lim MC, Sia CH, Teoh HL, Sharma VK, Chan B, Ahmad A, Paliwal P, Gopinathan A, Yang C, Makmur A, Andersson T, Arnberg F, Holmin S. Internal cerebral vein asymmetry is an independent predictor of poor functional outcome in endovascular thrombectomy. J Neurointerv Surg 2021; 14:683-687. [PMID: 34353888 DOI: 10.1136/neurintsurg-2021-017684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/26/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Endovascular thrombectomy (EVT) in large vessel occlusion (LVO) in anterior circulation acute ischaemic stroke (AIS) results in good functional outcomes in only approximately 60% of the patients. Internal cerebral veins (ICVs) are easily visible, with a consistent midline location, and are linked to stroke outcomes. We hypothesize that ICV asymmetry on multiphasic CT angiogram (mCTA) can be an adjunctive predictor for poor functional outcomes. METHODS We studied consecutive AIS patients from 2017 to 2019 with anterior circulation LVO treated with EVT regardless of intravenous thrombolysis. Asymmetrical ICV was defined as the presence of hypodensity (less opacification) on the ipsilateral occlusion side as compared with the contralateral side. The primary outcome was modified Rankin Score (mRS) score at 3 months. Secondary outcomes were good recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3), symptomatic hemorrhage, and mortality. RESULTS A total of 185 patients were included with a median age of 70 years (IQR 59-77); 87 patients (47%) were female. 82 patients (44.3%) achieved good functional outcomes (mRS 0-2) at 3 months. On multivariate analysis, National Institutes of Health Stroke Scale (NIHSS) (OR 1.076, 95% CI 1.015 to 1.140; p<0.013), poor collateral score (OR 0.285, 95% CI 0.162 to 0.501; p<0.001), asymmetrical ICV on the peak venous phase (OR 2.47, 95% CI 1.115 to 5.471; p<0.026), and late venous phase of the mCTA (OR 2.642, 95% CI 1.161 to 6.016; p<0.021) were independent risks factors of poor outcomes. CONCLUSION ICV asymmetry is a novel radiological sign which is independently associated with poor functional outcomes in EVT, even after correction for collateral circulation. Further studies are needed to validate this finding.
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Affiliation(s)
- May Zin Myint
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard Ll Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Benjamin Y Q Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ei Zune The
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Mei Chin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Diagnostic Imaging, National University Health System, Singapore
| | - Ching-Hui Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Center, Singapore
| | - Hock-Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vijay Kumar Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bernard Chan
- Division of Neurology, Department of Medicine, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Aftab Ahmad
- Division of Neurology, Ng Teng Fong General Hospital, Singapore
| | - Prakash Paliwal
- Division of Neurology, Department of Medicine, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anil Gopinathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Diagnostic Imaging, National University Health System, Singapore
| | - Cunli Yang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Diagnostic Imaging, National University Health System, Singapore
| | - Andrew Makmur
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Diagnostic Imaging, National University Health System, Singapore
| | - Tommy Andersson
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Fabian Arnberg
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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22
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Controversies in Imaging of Patients with Acute Ischemic Stroke: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 217:1027-1037. [PMID: 34106758 DOI: 10.2214/ajr.21.25846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The development of reperfusion therapies has profoundly impacted stroke care, initially with the advent of IV thrombolytic (IVT) treatment and, more recently, with the development and refinement of endovascular treatment (EVT). Progress in neuroimaging has supported the paradigm shift of stroke care, and advanced neuroimaging now has a fundamental role in triaging patients for both IVT and EVT. As the standard of care for acute ischemic stroke (AIS) evolves, controversies remain in certain clinical scenarios. This article explores the use of multimodality imaging for treatment selection of AIS in the context of recent guidelines, highlighting controversial topics and providing guidance for clinical practice. Results of major randomized trials supporting EVT are reviewed. Advantages and disadvantages of CT, CTA, MRI, and MRA in stroke diagnosis are summarized, with attention to level 1 evidence supporting the role of vascular imaging and perfusion imaging. Patient selection is compared between approaches based on time thresholds and physiologic approaches based on infarct core measurement using imaging. Moreover, various imaging approaches to core measurement are described. As ongoing studies push treatment boundaries, advanced imaging is expected to help identify a widening range of patients who may benefit from therapy.
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23
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Amukotuwa SA, Wu A, Zhou K, Page I, Brotchie P, Bammer R. Time-to-Maximum of the Tissue Residue Function Improves Diagnostic Performance for Detecting Distal Vessel Occlusions on CT Angiography. AJNR Am J Neuroradiol 2021; 42:65-72. [PMID: 33431503 DOI: 10.3174/ajnr.a6891] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/28/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Detecting intracranial distal arterial occlusions on CTA is challenging but increasingly relevant to clinical decision-making. Our purpose was to determine whether the use of CTP-derived time-to-maximum of the tissue residue function maps improves diagnostic performance for detecting these occlusions. MATERIALS AND METHODS Seventy consecutive patients with a distal arterial occlusion and 70 randomly selected controls who underwent multimodal CT with CTA and CTP for a suspected acute ischemic stroke were included in this retrospective study. Four readers with different levels of experience independently read the CTAs in 2 separate sessions, with and without time-to-maximum of the tissue residue function maps, recording the presence or absence of an occlusion, diagnostic confidence, and interpretation time. Accuracy for detecting distal occlusions was assessed using receiver operating characteristic analysis, and areas under curves were compared to assess whether accuracy improved with use of time-to-maximum of the tissue residue function. Changes in diagnostic confidence and interpretation time were assessed using the Wilcoxon signed rank test. RESULTS Mean sensitivity for detecting occlusions on CTA increased from 70.7% to 90.4% with use of time-to-maximum of the tissue residue function maps. Diagnostic accuracy improved significantly for the 4 readers (P < .001), with areas under the receiver operating characteristic curves increasing by 0.186, 0.136, 0.114, and 0.121, respectively. Diagnostic confidence and speed also significantly increased. CONCLUSIONS All assessed metrics of diagnostic performance for detecting distal arterial occlusions improved with the use of time-to-maximum of the tissue residue function maps, encouraging their use to aid in interpretation of CTA by both experienced and inexperienced readers. These findings show the added diagnostic value of including CTP in the acute stroke imaging protocol.
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Affiliation(s)
- S A Amukotuwa
- From the Department of Diagnostic Imaging (S.A.A., A.W., K.Z.), Monash Health, Clayton, Australia .,Department of Radiology (S.A.A., P.B.), Barwon Health, Geelong, Australia
| | - A Wu
- From the Department of Diagnostic Imaging (S.A.A., A.W., K.Z.), Monash Health, Clayton, Australia
| | - K Zhou
- From the Department of Diagnostic Imaging (S.A.A., A.W., K.Z.), Monash Health, Clayton, Australia
| | - I Page
- Department of Radiology (I.P., R.B.), The Royal Melbourne Hospital, Parkville, Australia
| | - P Brotchie
- Department of Radiology (S.A.A., P.B.), Barwon Health, Geelong, Australia
| | - R Bammer
- Department of Radiology (I.P., R.B.), The Royal Melbourne Hospital, Parkville, Australia
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24
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Abstract
PURPOSE OF REVIEW This article describes how imaging can be used by physicians in diagnosing, determining prognosis, and making appropriate treatment decisions in a timely manner in patients with acute stroke. RECENT FINDINGS Advances in acute stroke treatment, including the use of endovascular thrombectomy in patients with large vessel occlusion and, more recently, of IV thrombolysis in an extended time window, have resulted in a paradigm shift in how imaging is used in patients with acute stroke. This paradigm shift, combined with the understanding that "time is brain," means that imaging must be fast, reliable, and available around the clock for physicians to make appropriate clinical decisions. CT has therefore become the primary imaging modality of choice. Recognition of a large vessel occlusion using CT angiography has become essential in identifying patients for endovascular thrombectomy, and techniques such as imaging collaterals on CT angiography or measuring blood flow to predict tissue fate using CT perfusion have become useful tools in selecting patients for acute stroke therapy. Understanding the use of these imaging modalities and techniques in dealing with an emergency such as acute stroke has therefore become more important than ever for physicians treating patients with acute stroke. SUMMARY Imaging the brain and the blood vessels supplying it using modern tools and techniques is a key step in understanding the pathophysiology of acute stroke and making appropriate and timely clinical decisions.
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25
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Li X, Gachagan A, Murray P. Design of 2D Sparse Array Transducers for Anomaly Detection in Medical Phantoms. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5370. [PMID: 32961726 PMCID: PMC7570994 DOI: 10.3390/s20185370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 02/01/2023]
Abstract
Aperiodic sparse 2D ultrasonic array configurations, including random array, log spiral array, and sunflower array, have been considered for their potential as conformable transducers able to image within a focal range of 30-80 mm, at an operating frequency of 2 MHz. Optimisation of the imaging performance of potential array patterns has been undertaken based on their simulated far field directivity functions. Two evaluation criteria, peak sidelobe level (PSL) and integrated sidelobe ratio (ISLR), are used to access the performance of each array configuration. Subsequently, a log spiral array pattern with -19.33 dB PSL and 2.71 dB ISLR has been selected as the overall optimal design. Two prototype transducers with the selected log spiral array pattern have been fabricated and characterised, one using a fibre composite element composite array transducer (CECAT) structure, the other using a conventional 1-3 composite (C1-3) structure. The CECAT device demonstrates improved coupling coefficient (0.64 to 0.59), reduced mechanical cross-talk between neighbouring array elements (by 10 dB) and improved operational bandwidth (by 16.5%), while the C1-3 device performs better in terms of sensitivity (~50%). Image processing algorithms, such as Hough transform and morphological opening, have been implemented to automatically detect and dimension particles located within a fluid-filled tube structure, in a variety of experimental scenarios, including bespoke phantoms using tissue mimicking material. Experiments using the fabricated CECAT log spiral 2D array transducer demonstrated that this algorithmic approach was able to detect the walls of the tube structure and stationary anomalies within the tube with a precision of ~0.1 mm.
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Affiliation(s)
- Xiaotong Li
- Department of Electronic and Electrical Engineering, University of Strathclyde, Glasgow G1 1XW, UK; (A.G.); (P.M.)
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26
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Blood flow simulations in patient-specific geometries of the carotid artery: A systematic review. J Biomech 2020; 111:110019. [PMID: 32905972 DOI: 10.1016/j.jbiomech.2020.110019] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/07/2020] [Accepted: 08/26/2020] [Indexed: 12/21/2022]
Abstract
Computational Fluid Dynamics (CFD) and Fluid-Structure Interaction (FSI) are currently widely applied in the study of blood flow parameters and their alterations under pathological conditions, which are important indicators for diagnosis of atherosclerosis. In this manuscript, a systematic review of the published literature was conducted, according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, on the simulation studies of blood flow in patient-specific geometries of the carotid artery bifurcation. Scopus, PubMed and ScienceDirect databases were used in the literature search, which was completed on the 3rd of August 2020. Forty-nine articles were included after the selection process and were organized in two distinct categories: the CFD studies (36/49 articles), which comprise only the fluid analysis and the FSI studies (13/49 articles), which includes both fluid and Fluid-Structure domain in the analysis. The data of the research works was structured in different categories (Geometry, Viscosity models, Type of Flow, Boundary Conditions, Flow Parameters, Type of Solver and Validation). The aim of this systematic review is to demonstrate the methodology in the modelling, simulation and analysis of carotid blood flow and also identify potential gaps and challenges in this research field.
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27
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Zhang N, Ashikuzzaman M, Rivaz H. Clutter suppression in ultrasound: performance evaluation and review of low-rank and sparse matrix decomposition methods. Biomed Eng Online 2020; 19:37. [PMID: 32466753 PMCID: PMC7254711 DOI: 10.1186/s12938-020-00778-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/07/2020] [Indexed: 11/10/2022] Open
Abstract
Vessel diseases are often accompanied by abnormalities related to vascular shape and size. Therefore, a clear visualization of vasculature is of high clinical significance. Ultrasound color flow imaging (CFI) is one of the prominent techniques for flow visualization. However, clutter signals originating from slow-moving tissue are one of the main obstacles to obtain a clear view of the vascular network. Enhancement of the vasculature by suppressing the clutters is a significant and irreplaceable step for many applications of ultrasound CFI. Currently, this task is often performed by singular value decomposition (SVD) of the data matrix. This approach exhibits two well-known limitations. First, the performance of SVD is sensitive to the proper manual selection of the ranks corresponding to clutter and blood subspaces. Second, SVD is prone to failure in the presence of large random noise in the dataset. A potential solution to these issues is using decomposition into low-rank and sparse matrices (DLSM) framework. SVD is one of the algorithms for solving the minimization problem under the DLSM framework. Many other algorithms under DLSM avoid full SVD and use approximated SVD or SVD-free ideas which may have better performance with higher robustness and less computing time. In practice, these models separate blood from clutter based on the assumption that steady clutter represents a low-rank structure and that the moving blood component is sparse. In this paper, we present a comprehensive review of ultrasound clutter suppression techniques and exploit the feasibility of low-rank and sparse decomposition schemes in ultrasound clutter suppression. We conduct this review study by adapting 106 DLSM algorithms and validating them against simulation, phantom, and in vivo rat datasets. Two conventional quality metrics, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), are used for performance evaluation. In addition, computation times required by different algorithms for generating clutter suppressed images are reported. Our extensive analysis shows that the DLSM framework can be successfully applied to ultrasound clutter suppression.
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Affiliation(s)
- Naiyuan Zhang
- Department of Electrical and Computer Engineering, Concordia, Rue Sainte-Catherine O, Montreal, Canada
| | - Md Ashikuzzaman
- Department of Electrical and Computer Engineering, Concordia, Rue Sainte-Catherine O, Montreal, Canada
| | - Hassan Rivaz
- Department of Electrical and Computer Engineering, Concordia, Rue Sainte-Catherine O, Montreal, Canada.
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28
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Detection of emergent large vessel occlusion stroke with CT angiography is high across all levels of radiology training and grayscale viewing methods. Eur Radiol 2020; 30:4447-4453. [PMID: 32232790 DOI: 10.1007/s00330-020-06814-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/28/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES CT angiography (CTA) is essential in acute stroke to detect emergent large vessel occlusions (ELVO) and must be interpreted by radiologists with and without subspecialized training. Additionally, grayscale inversion has been suggested to improve diagnostic accuracy in other radiology applications. This study examines diagnostic performance in ELVO detection between neuroradiologists, non-neuroradiologists, and radiology residents using standard and grayscale inversion viewing methods. METHODS A random, counterbalanced experimental design was used, where 18 radiologists with varying experiences interpreted the same patient images with and without grayscale inversion. Confirmed positive and negative ELVO cases were randomly ordered using a balanced design. Sensitivity, specificity, positive and negative predictive values as well as confidence, subjective assessment of image quality, time to ELVO detection, and overall interpretation time were examined between grayscale inversion (on/off) by experience level using generalized mixed modeling assuming a binary, negative binomial, and binomial distributions, respectively. RESULTS All groups of radiologists had high sensitivity and specificity for ELVO detection (all > .94). Neuroradiologists were faster than non-neuroradiologists and residents in interpretation time, with a mean of 47 s to detect ELVO, as compared with 59 and 74 s, respectively. Residents were subjectively less confident than attending physicians. With respect to grayscale inversion, no differences were observed between groups with grayscale inversion vs. standard viewing for diagnostic performance (p = 0.30), detection time (p = .45), overall interpretation time (p = .97), and confidence (p = .20). CONCLUSIONS Diagnostic performance in ELVO detection with CTA was high across all levels of radiologist training level. Grayscale inversion offered no significant detection advantage. KEY POINTS • Stroke is an acute vascular syndrome that requires acute vascular imaging. • Proximal large vessel occlusions can be identified quickly and accurately by radiologists across all training levels. • Grayscale inversion demonstrated minimal detectable benefit in the detection of proximal large vessel occlusions.
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29
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Mayer SA, Viarasilpa T, Panyavachiraporn N, Brady M, Scozzari D, Van Harn M, Miller D, Katramados A, Hefzy H, Malik S, Marin H, Kole M, Chebl A, Lewandowski C, Mitsias PD. CTA-for-All: Impact of Emergency Computed Tomographic Angiography for All Patients With Stroke Presenting Within 24 Hours of Onset. Stroke 2019; 51:331-334. [PMID: 31684848 DOI: 10.1161/strokeaha.119.027356] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- We sought to evaluate the impact of a Computed Tomographic Angiography (CTA) for All emergency stroke imaging protocol on outcome after large vessel occlusion (LVO). Methods- On July 1, 2017, the Henry Ford Health System implemented the policy of performing CTA and noncontrast computed tomography together as an initial imaging study for all patients with acute ischemic stroke (AIS) presenting within 24 hours of last known well, regardless of baseline National Institutes of Health Stroke Scale score. Previously, CTA was reserved for patients presenting within 6 hours with a National Institutes of Health Stroke Scale score ≥6. We compared treatment processes and outcomes between patients with AIS admitted 1 year before (n=388) and after (n=515) protocol implementation. Results- After protocol implementation, more AIS patients underwent CTA (91% versus 61%; P<0.001) and had CTA performed at the same time as the initial noncontrast computed tomography scan (78% versus 35%; P<0.001). Median time from emergency department arrival to CTA was also shorter (29 [interquartile range, 16-53] versus 43 [interquartile range, 29-112] minutes; P<0.001), more cases of LVO were detected (166 versus 96; 32% versus 25% of all AIS; P=0.014), and more mechanical thrombectomy procedures were performed (108 versus 68; 21% versus 18% of all AIS; P=0.196). Among LVO patients who presented within 6 hours of last known well, median time from last known well to mechanical thrombectomy was shorter (3.5 [interquartile range, 2.8-4.8] versus 4.1 [interquartile range, 3.3-5.6] hours; P=0.038), and more patients were discharged with a favorable outcome (Glasgow Outcome Scale 4-5, 53% versus 37%; P=0.029). The odds of having a favorable outcome after protocol implementation was not significant (odds ratio, 1.84 [95% CI, 0.98-3.45]; P=0.059) after controlling for age and baseline National Institutes of Health Stroke Scale score. Conclusions- Performing CTA and noncontrast computed tomography together as an initial assessment for all AIS patients presenting within 24 hours of last known well improved LVO detection, increased the mechanical thrombectomy treatment population, hastened intervention, and was associated with a trend toward improved outcome among LVO patients presenting within 6 hours of symptom onset.
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Affiliation(s)
- Stephan A Mayer
- From the Departments of Neurology (S.A.M., T.V., N.P., M.B., D.S., D.M., A.K., H.H., S.M., A.C., P.D.M.), Henry Ford Hospital Detroit, MI.,Department of Neurology, Wayne State School of Medicine, Detroit, MI (S.A.M., D.M., A.K., H.H., S.M., C.L., P.D.M.)
| | - Tanuwong Viarasilpa
- From the Departments of Neurology (S.A.M., T.V., N.P., M.B., D.S., D.M., A.K., H.H., S.M., A.C., P.D.M.), Henry Ford Hospital Detroit, MI.,Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.V., N.P.)
| | - Nicha Panyavachiraporn
- From the Departments of Neurology (S.A.M., T.V., N.P., M.B., D.S., D.M., A.K., H.H., S.M., A.C., P.D.M.), Henry Ford Hospital Detroit, MI.,Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.V., N.P.)
| | - Megan Brady
- From the Departments of Neurology (S.A.M., T.V., N.P., M.B., D.S., D.M., A.K., H.H., S.M., A.C., P.D.M.), Henry Ford Hospital Detroit, MI
| | - Dawn Scozzari
- From the Departments of Neurology (S.A.M., T.V., N.P., M.B., D.S., D.M., A.K., H.H., S.M., A.C., P.D.M.), Henry Ford Hospital Detroit, MI
| | | | - Daniel Miller
- From the Departments of Neurology (S.A.M., T.V., N.P., M.B., D.S., D.M., A.K., H.H., S.M., A.C., P.D.M.), Henry Ford Hospital Detroit, MI.,Department of Neurology, Wayne State School of Medicine, Detroit, MI (S.A.M., D.M., A.K., H.H., S.M., C.L., P.D.M.)
| | - Angelos Katramados
- From the Departments of Neurology (S.A.M., T.V., N.P., M.B., D.S., D.M., A.K., H.H., S.M., A.C., P.D.M.), Henry Ford Hospital Detroit, MI.,Department of Neurology, Wayne State School of Medicine, Detroit, MI (S.A.M., D.M., A.K., H.H., S.M., C.L., P.D.M.)
| | - Hebah Hefzy
- From the Departments of Neurology (S.A.M., T.V., N.P., M.B., D.S., D.M., A.K., H.H., S.M., A.C., P.D.M.), Henry Ford Hospital Detroit, MI.,Department of Neurology, Wayne State School of Medicine, Detroit, MI (S.A.M., D.M., A.K., H.H., S.M., C.L., P.D.M.)
| | - Shaneela Malik
- From the Departments of Neurology (S.A.M., T.V., N.P., M.B., D.S., D.M., A.K., H.H., S.M., A.C., P.D.M.), Henry Ford Hospital Detroit, MI.,Department of Neurology, Wayne State School of Medicine, Detroit, MI (S.A.M., D.M., A.K., H.H., S.M., C.L., P.D.M.)
| | - Horia Marin
- Radiology (H.M.), Henry Ford Hospital Detroit, MI
| | | | - Alex Chebl
- From the Departments of Neurology (S.A.M., T.V., N.P., M.B., D.S., D.M., A.K., H.H., S.M., A.C., P.D.M.), Henry Ford Hospital Detroit, MI
| | - Christopher Lewandowski
- Emergency Medicine (C.L.), Henry Ford Hospital Detroit, MI.,Department of Neurology, Wayne State School of Medicine, Detroit, MI (S.A.M., D.M., A.K., H.H., S.M., C.L., P.D.M.)
| | - Panayiotis D Mitsias
- From the Departments of Neurology (S.A.M., T.V., N.P., M.B., D.S., D.M., A.K., H.H., S.M., A.C., P.D.M.), Henry Ford Hospital Detroit, MI.,Department of Neurology, Wayne State School of Medicine, Detroit, MI (S.A.M., D.M., A.K., H.H., S.M., C.L., P.D.M.).,Department of Neurology, School of Medicine and University General Hospital, University of Crete, Heraklion, Greece (P.D.M.)
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30
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Cibuzar MP, Dannenberg SG, Waterman R. A Commercially Available Ruthenium Compound for Catalytic Hydrophosphination. Isr J Chem 2019. [DOI: 10.1002/ijch.201900070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Michael P. Cibuzar
- Department of Chemistry University of Vermont, Burlington Vermont 05405-0125 United States
| | - Steven G. Dannenberg
- Department of Chemistry University of Vermont, Burlington Vermont 05405-0125 United States
| | - Rory Waterman
- Department of Chemistry University of Vermont, Burlington Vermont 05405-0125 United States
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Woo HG, Jung C, Sunwoo L, Bae YJ, Choi BS, Kim JH, Kim BJ, Han MK, Bae HJ, Jung S, Cha SH. Dichotomizing Level of Pial Collaterals on Multiphase CT Angiography for Endovascular Treatment in Acute Ischemic Stroke: Should It Be Refined for 6-Hour Time Window? Neurointervention 2019; 14:99-106. [PMID: 31302985 PMCID: PMC6736504 DOI: 10.5469/neuroint.2019.00080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Although endovascular treatment is currently thought to only be suitable for patients who have pial arterial filling scores >3 as determined by multiphase computed tomography angiography (mpCTA), a cut-off score of 3 was determined by a study, including patients within 12 hours after symptom onset. We aimed to investigate whether a cut-off score of 3 for endovascular treatment within 6 hours of symptom onset is an appropriate predictor of good functional outcome at 3 months. Materials and Methods From April 2015 to January 2016, acute ischemic stroke patients treated with mechanical thrombectomy within 6 hours of symptom onset were enrolled into this study. Pial arterial filling scores were semi-quantitatively assessed using mpCTA, and clinical and radiological parameters were compared between patients with favorable and unfavorable outcomes. Multivariate logistic regression analysis was then performed to investigate the independent association between clinical outcome and pial collateral score, with the predictive power of the latter assessed using C-statistics. Results Of the 38 patients enrolled, 20 (52.6%) had a favorable outcome and 18 had an unfavorable outcome, with the latter group showing a lower mean pial arterial filling score (3.6±0.8 vs. 2.4±1.2, P=0.002). After adjusting for variables with a P-value of <0.1 in univariate analysis (i.e., age and National Institutes of Health Stroke Scale score at admission), pial arterial filling scores higher than a cut-off of 2 were found to be independently associated with favorable clinical outcomes (P=0.012). C-statistic analysis confirmed that our model had the highest prediction power when pial arterial filling scores were dichotomized at >2 vs. ≤2. Conclusion A pial arterial filling cut-off score of 2 as determined by mpCTA appears to be more suitable for predicting clinical outcomes following endovascular treatment within 6 hours of symptom onset than the cut-off of 3 that had been previously suggested.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Korea
| | - Leonard Sunwoo
- Department of Radiology, Seoul National University Bundang Hospital, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Korea
| | - Byung Se Choi
- Department of Radiology, Seoul National University Bundang Hospital, Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Korea
| | - Seunguk Jung
- Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sang-Hoon Cha
- Department of Radiology, Chungbuk National University College of Medicine, Cheongju, Korea
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Gropen TI, Gazi M, Minor M, Fadairo A, Acker J. Centrally Guided Identification of Patients With Large Vessel Occlusion: Lessons From Trauma Systems. J Stroke Cerebrovasc Dis 2019; 28:2388-2397. [PMID: 31320270 DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/06/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Improve prehospital identification of acute ischemic stroke patients with large vessel occlusion (LVO) by using a trauma system-based emergency communication center (ECC) to guide the emergency medical service (EMS). METHODS We trained 24 ECC paramedics in the Emergency Medical Stroke Assessment (EMSA). ECC-guided EMS in performance of the EMSA on patients with suspected stroke. During the second half of the study, we provided focused feedback to ECC after reviewing recorded ECC-EMS interactions. We compared the sensitivity, specificity, and area under the receiver operator characteristics curve (AUC) and 95% confidence interval of ECC-guided EMSA to the NIH Stroke Scale (NIHSS) for predicting a discharge diagnosis of LVO. RESULTS We enrolled 569 patients from September 2016 through February 2018. Of 463 patients analyzed, 236 (51%) had a discharge diagnosis of stroke and 227 (49%) had a nonstroke diagnosis. There were 45 (19%) stroke patients with LVO. For predicting LVO, there was no significant difference between the EMSA AUC = .68 (.59-.77) and the NIHSS AUC = .73 (.65-.81). An EMSA score greater than or equal to 4 had sensitivity = 75.6 (60.5-87.1) and specificity = 62.4 (57.6-67.1) for LVO. During the first 9 months of the study, the EMSA AUC = .61 (.44-.77) compared to an AUC = .74 (.64-.84) during the second 9 months. CONCLUSIONS ECC-guided prehospital EMSA is feasible, has similar ability to predict LVO compared to the NIHSS, and has sustained performance over time.
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Affiliation(s)
- Toby I Gropen
- University of Alabama at Birmingham Comprehensive Stroke Center, Birmingham, Alabama.
| | - Melissa Gazi
- University of Alabama at Birmingham Comprehensive Stroke Center, Birmingham, Alabama
| | - Michael Minor
- University of Alabama at Birmingham Comprehensive Stroke Center, Birmingham, Alabama
| | - Abimbola Fadairo
- University of Alabama at Birmingham Comprehensive Stroke Center, Birmingham, Alabama
| | - Joe Acker
- University of Alabama at Birmingham Comprehensive Stroke Center, Birmingham, Alabama
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Xu S, Wang L, Zhao L. Clinical application value of brain CT perfusion imaging in the treatment of acute ischemic stroke thrombolytic therapy. Exp Ther Med 2019; 17:3971-3976. [PMID: 30988778 PMCID: PMC6447903 DOI: 10.3892/etm.2019.7431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/01/2019] [Indexed: 12/14/2022] Open
Abstract
Clinical application value of CT perfusion (CTP) imaging in the treatment of acute ischemic stroke (AIS) thrombolytic therapy was investigated. Retrospective analysis of 185 suspected AIS patients in Liaocheng Brain Hospital from April 2012 to December 2017 were involved. We observed the non-contrast CT (NCCT) and CTP in the diagnosis of AIS patients, and recorded as well as compared CTP parameters of AIS patients. The National Institute of Health Stroke Scale (NIHSS) rating was conducted, and the correlation between the prognosis of NIHSS scores and CTP parameters was investigated. A total of 177 patients were diagnosed with AIS. The sensitivity levels of CTP examination for diagnosis of AIS patients was significantly higher than that of the NCCT examination (P<0.050). The diagnostic compliance rates of CTP examination was significantly higher than that of the NCCT examination (P<0.050). The cerebral blood volume (CBV) in the abnormal perfusion area was significantly lower than that in the mirror side zone (t=21.160, P<0.001). The prognostic NIHSS score was negatively correlated with CBV in patients with thrombolytic therapy (r=−0.912, P<0.001). The cerebral blood flow (CBF) in the abnormal perfusion zone was significantly lower than that in the mirror side zone (t=19.170, P<0.001). The prognosis of patients with thrombolytic therapy was negatively correlated with CBF (r=−0.915, P<0.001). The mean transit time (MTT) in the abnormal perfusion zone was higher than that in the mirror side zone (t=13.480, P<0.001). NIHSS scores were obtained 3 months after thrombolytic therapy and found that the prognostic NIHSS scores were positively correlated with MTT (r=0.887, P<0.001). The results indicated that brain CTP has a high diagnostic value for intravenous thrombolytic therapy in AIS and there was a significant correlation between the prognosis scores of patients. Thus, it is worthy of being promoted in the clinical diagnosis and treatment of AIS patients.
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Affiliation(s)
- Shiming Xu
- Department of Imaging, Liaocheng Brain Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Li Wang
- Department of Imaging, Liaocheng Brain Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Lidong Zhao
- Department of Imaging, Liaocheng Brain Hospital, Liaocheng, Shandong 252000, P.R. China
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Almekhlafi MA, Holodinsky JK, Hill MD, Kamal N, Goyal M. Organizing stroke systems in the field for patients with suspected large vessel occlusion acute stroke. Expert Rev Cardiovasc Ther 2018; 17:3-9. [PMID: 30451541 DOI: 10.1080/14779072.2019.1550717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: The dawn of endovascular stroke therapy has reshaped stroke care. Eligible patients need to be rushed to capable centers for intervention. This may entail bypassing closer hospitals that could confirm the diagnosis, administer thrombolytic therapy, then transfer patients for intervention. This has created a set of challenges: identifying endovascular candidates in the field, determining the best transport destination, and getting patients there quickly. Areas covered: This review provides a context for these emerging challenges. Current and emerging clinical prediction instruments for large vessel occlusion (LVO) are reviewed. The workflow in the thrombolysis-only primary stroke centers is reviewed, and interventions aimed at minimizing delays are highlighted. Innovations using mathematical modeling and devices for detection of LVO are reviewed. Expert commentary: More patients are expected to receive endovascular therapy as we push the boundaries for time and imaging criteria. Advances in detection and decision-making aids will improve the speed of treatment. Some patients will arrive at thrombolysis-only centers. This need to be triaged, diagnosed, treated, and transported promptly. Therefore, education of practitioners in these centers is paramount. Creating and facilitating infrastructure for imaging acquisition and sharing in such centers will reflect better care for stroke patients overall.
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Affiliation(s)
- Mohammed A Almekhlafi
- a Department of Clinical Neurosciences , Cumming School of Medicine, University of Calgary , Calgary , Canada.,b Hotchkiss Brain Institute, Cumming School of Medicine , University of Calgary , Calgary , Canada.,c Department of Radiology, Cumming School of Medicine , University of Calgary , Calgary , Canada.,d Department of Community Health Sciences, Cumming School of Medicine , University of Calgary , Calgary , Canada
| | - Jessalyn K Holodinsky
- b Hotchkiss Brain Institute, Cumming School of Medicine , University of Calgary , Calgary , Canada.,d Department of Community Health Sciences, Cumming School of Medicine , University of Calgary , Calgary , Canada
| | - Michael D Hill
- a Department of Clinical Neurosciences , Cumming School of Medicine, University of Calgary , Calgary , Canada.,b Hotchkiss Brain Institute, Cumming School of Medicine , University of Calgary , Calgary , Canada.,c Department of Radiology, Cumming School of Medicine , University of Calgary , Calgary , Canada.,d Department of Community Health Sciences, Cumming School of Medicine , University of Calgary , Calgary , Canada
| | - Noreen Kamal
- a Department of Clinical Neurosciences , Cumming School of Medicine, University of Calgary , Calgary , Canada.,b Hotchkiss Brain Institute, Cumming School of Medicine , University of Calgary , Calgary , Canada
| | - Mayank Goyal
- a Department of Clinical Neurosciences , Cumming School of Medicine, University of Calgary , Calgary , Canada.,c Department of Radiology, Cumming School of Medicine , University of Calgary , Calgary , Canada
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Sugrue G, O'Reilly MK, Byrne D, Crockett MT, Murphy S, Kavanagh EC. CT cervico-cerebral angiography in acute stroke. Can we justify aortic arch imaging? Ir J Med Sci 2018; 188:661-666. [PMID: 30143966 DOI: 10.1007/s11845-018-1888-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 08/14/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Computed tomography cervico-cerebral angiography (CTCCA) plays a pivotal role in the evaluation of acute stroke. Currently no evidence justifies the inclusion of the upper chest in the CTCCA field of view. The aim of this study was to assess the prevalence and clinical significance of vascular findings identified on CTCCA in the head, neck, and upper chest regions in patients presenting with acute stroke symptoms. METHODS A retrospective review of radiology images and reports of 900 consecutive patients (425 men, 475 women; mean age 63.2 years, age range 19-99 years) with a suspected acute stroke who underwent CTCCA in the emergency department between January 2011 and July 2016. Clinically significant vascular CTCCA findings were recorded for each patient within the head, neck, and upper chest regions, respectively. RESULTS Of the 900 patients, clinically significant vascular CTCCA findings were identified in 404/900 (44.8%) patients. 218/900 (24.2%) were located within the head region; 174/900 (19.3%) within the neck; and 12/900 (2.4%) in the upper chest. Of the 12 vascular findings located within the upper chest, 3/900 (0.33%) were related to a clinically significant posterior circulation infarct. CONCLUSIONS Routine inclusion of the upper chest on CTCCA is currently difficult to justify in the evaluation of a suspected acute anterior circulation stroke, contributing significantly to total radiation dose without demonstrating significant extra-cranial vascular findings. Prospective studies adopting narrower fields of view excluding the upper chest are necessary.
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Affiliation(s)
- Gavin Sugrue
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland.
| | - Michael K O'Reilly
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Danielle Byrne
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Matthew T Crockett
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Sean Murphy
- Department of Stroke Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Eoin C Kavanagh
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Graham BR, Menon BK, Coutts SB, Goyal M, Demchuk AM. Computed tomographic angiography in stroke and high-risk transient ischemic attack: Do not leave the emergency department without it! Int J Stroke 2018; 13:673-686. [PMID: 29664350 DOI: 10.1177/1747493018764172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Stroke is a major cause of morbidity and mortality worldwide, and effective treatment requires rapid diagnosis and recognition of relevant vascular lesions. In this review we will discuss the usefulness and versatility of computed tomography angiography in the setting of stroke, be it ischemic or hemorrhagic, minor or disabling. Furthermore, we also highlight how we use computed tomography angiography in decision making in transient ischemic attacks, acute disabling ischemic stroke, and hemorrhagic stroke.
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Affiliation(s)
- Brett R Graham
- 1 Department of Clinical Neurosciences, University of Calgary, Canada
| | - Bijoy K Menon
- 1 Department of Clinical Neurosciences, University of Calgary, Canada.,2 Department of Radiology, University of Calgary, Canada.,4 Hotchkiss Brain Institute, University of Calgary, Canada
| | - Shelagh B Coutts
- 1 Department of Clinical Neurosciences, University of Calgary, Canada.,2 Department of Radiology, University of Calgary, Canada.,3 Department of Community Health Sciences, University of Calgary, Canada.,4 Hotchkiss Brain Institute, University of Calgary, Canada
| | - Mayank Goyal
- 1 Department of Clinical Neurosciences, University of Calgary, Canada.,2 Department of Radiology, University of Calgary, Canada.,4 Hotchkiss Brain Institute, University of Calgary, Canada
| | - Andrew M Demchuk
- 1 Department of Clinical Neurosciences, University of Calgary, Canada.,2 Department of Radiology, University of Calgary, Canada.,3 Department of Community Health Sciences, University of Calgary, Canada.,4 Hotchkiss Brain Institute, University of Calgary, Canada
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Rodriguez-Luna D, Coscojuela P, Rodriguez-Villatoro N, Juega JM, Boned S, Muchada M, Pagola J, Rubiera M, Ribo M, Tomasello A, Demchuk AM, Goyal M, Molina CA. Multiphase CT Angiography Improves Prediction of Intracerebral Hemorrhage Expansion. Radiology 2017; 285:932-940. [DOI: 10.1148/radiol.2017162839] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- David Rodriguez-Luna
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Pilar Coscojuela
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Noelia Rodriguez-Villatoro
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Jesús M. Juega
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Sandra Boned
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Marián Muchada
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Jorge Pagola
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Marta Rubiera
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Marc Ribo
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Alejandro Tomasello
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Andrew M. Demchuk
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Mayank Goyal
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Carlos A. Molina
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
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Byrne D, Walsh JP, Sugrue G, Stanley E, Marnane M, Walsh CD, Kelly P, Murphy S, Kavanagh EC, MacMahon PJ. Subtraction multiphase CT angiography: A new technique for faster detection of intracranial arterial occlusions. Eur Radiol 2017; 28:1731-1738. [DOI: 10.1007/s00330-017-5124-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/01/2017] [Accepted: 10/09/2017] [Indexed: 11/29/2022]
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Abstract
PURPOSE OF REVIEW The purpose of the review is to examine recent evidence on the effects of intravenous thrombolysis and identify the remaining uncertainties. RECENT FINDINGS We review the results of two large trials (the third International Stroke Trial (IST-3) and The Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED)) and the publications from the individual patient data analyses of the trials of alteplase conducted by the Stroke Thrombolysis Trialists Collaboration. Despite about a 2% risk of fatal intracerebral haemorrhage, on average, adult patients of all ages treated with 0.9 mg/kg alteplase within 4.5 h will have better long-term functional outcome. The use of a lower dose of alteplase (0.6 mg/kg) is associated with a lower risk of haemorrhage but its effect on functional outcome has not been proven to be non-inferior to standard dose therapy. Some clinicians feel confident to treat selected patients who present beyond 4.5 h or have unknown time of onset, but many also agree that the current trials and other research is needed to reliably define the optimum imaging methods and treatment eligibility criteria.
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Affiliation(s)
- Peter A G Sandercock
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Stefano Ricci
- UO Neurologia, USL Umbria 1, Ospedale, Via Angelini 10 - 06012, Citta' di Castello, PG, Italy
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Assis ZA, Menon BK, Goyal M. Imaging department organization in a stroke center and workflow processes in acute stroke. Eur J Radiol 2017; 96:120-124. [PMID: 28711339 DOI: 10.1016/j.ejrad.2017.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/18/2017] [Indexed: 01/08/2023]
Abstract
The imaging department is an integral part of the stroke management task force and plays a critical role. Accurate and timely interpretation of images obtained in the emergency department and involvement in decision-making has contributed immensely in stroke care. In fact, the treatment paradigm has changed considerably after the recent positive endovascular clinical trials; and so is the hospital workflow and treatment site. As a result, the imaging department has become the site of maximum activity during an acute stroke protocol. Time management, teamwork and standardized institutional protocols contribute to improve functional outcome. In this review article, we emphasize the critical role an Imaging department's organization plays in a stroke center and the workflow involved in management of acute stroke.
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Affiliation(s)
- Zarina Abdul Assis
- Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Alberta, T2N2T9 Canada
| | - Bijoy K Menon
- Calgary Stroke Program and the Department of Radiology, Clinical Neurosciences and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Radiology, Seaman Family MR Research Centre, 3330 Hospital Drive NW Calgary, AB T2E 4N1, Canada.
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Catanese L, Tarsia J, Fisher M. Acute Ischemic Stroke Therapy Overview. Circ Res 2017; 120:541-558. [DOI: 10.1161/circresaha.116.309278] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/30/2016] [Accepted: 08/14/2016] [Indexed: 12/21/2022]
Abstract
The treatment of acute ischemic stroke has undergone dramatic changes recently subsequent to the demonstrated efficacy of intra-arterial (IA) device-based therapy in multiple trials. The selection of patients for both intravenous and IA therapy is based on timely imaging with either computed tomography or magnetic resonance imaging, and if IA therapy is considered noninvasive, angiography with one of these modalities is necessary to document a large-vessel occlusion amenable for intervention. More advanced computed tomography and magnetic resonance imaging studies are available that can be used to identify a small ischemic core and ischemic penumbra, and this information will contribute increasingly in treatment decisions as the therapeutic time window is lengthened. Intravenous thrombolysis with tissue-type plasminogen activator remains the mainstay of acute stroke therapy within the initial 4.5 hours after stroke onset, despite the lack of Food and Drug Administration approval in the 3- to 4.5-hour time window. In patients with proximal, large-vessel occlusions, IA device-based treatment should be initiated in patients with small/moderate-sized ischemic cores who can be treated within 6 hours of stroke onset. The organization and implementation of regional stroke care systems will be needed to treat as many eligible patients as expeditiously as possible. Novel treatment paradigms can be envisioned combining neuroprotection with IA device treatment to potentially increase the number of patients who can be treated despite long transport times and to ameliorate the consequences of reperfusion injury. Acute stroke treatment has entered a golden age, and many additional advances can be anticipated.
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Affiliation(s)
- Luciana Catanese
- From the Department of Neurology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA
| | - Joseph Tarsia
- From the Department of Neurology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA
| | - Marc Fisher
- From the Department of Neurology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA
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Uneda A, Kanda T, Suzuki K, Hirashita K, Yunoki M, Yoshino K. Acute Cerebral Artery Occlusion by a Calcified Embolus with False Patency Sign on Computed Tomographic Angiography. J Stroke Cerebrovasc Dis 2017; 26:e5-e7. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/18/2016] [Accepted: 09/22/2016] [Indexed: 11/24/2022] Open
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Volny O, Cimflova P, Kadlecova P, Vanek P, Vanicek J, Menon BK, Mikulik R. Single-Phase Versus Multiphase CT Angiography in Middle Cerebral Artery Clot Detection-Benefits for Less Experienced Radiologists and Neurologists. J Stroke Cerebrovasc Dis 2016; 26:19-24. [PMID: 27612627 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 08/09/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES CT angiography (CTA) is recommended as a standard of stroke imaging. We investigated accuracy and precision of standard or single-phase CTA as compared with novel technique or multiphase CTA in clot detection in the middle cerebral artery. METHODS Twenty single-phase CTA and twenty multiphase CTA with prevailing M2 occlusion were assessed by 10 radiologists and 10 neurologists blinded to clinical information (7 less experienced and 3 experienced). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated as compared with reading by two seniors. Reliability was calculated using Krippendorff's alpha (K-alpha). RESULTS Sensitivity, specificity, PPV, and NPV of single-phase CTA compared with multiphase CTA for M2 clot presence were, respectively, .86, .75, .90, and .67 versus .88, .82, .92, and .72. For secondary or distal clots, sensitivity, specificity, PPV, and NPV of single-phase CTA compared with multiphase CTA were .41, .83, .50, and .78 versus .65, .77, .71, and .67. Agreement increased significantly in favor of multiphase CTA for detection of primary clots from moderate (.43) to substantial (.65) in less experienced radiologists and from slight (.10) to moderate (.30) in less experienced neurologists. Agreement significantly increased for distal or secondary clot detection in favor of multiphase CTA from fair (.24) to moderate (.49) in experienced radiologists and from slight (.12) to moderate (.46) in experienced neurologists. CONCLUSIONS Multiphase CTA is a reliable imaging tool in M2 clot detection and might represent a beneficial imaging tool in clot detection for less experienced physicians.
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Affiliation(s)
- Ondrej Volny
- Stroke Research Program, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Department of Neurology, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Brno, Czech Republic.
| | - Petra Cimflova
- Stroke Research Program, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Department of Medical Imaging, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Pavla Kadlecova
- Stroke Research Program, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Petr Vanek
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Vanicek
- Department of Medical Imaging, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Bijoy K Menon
- Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Robert Mikulik
- Stroke Research Program, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Department of Neurology, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
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Yu AYX, Zerna C, Assis Z, Holodinsky JK, Randhawa PA, Najm M, Goyal M, Menon BK, Demchuk AM, Coutts SB, Hill MD. Multiphase CT angiography increases detection of anterior circulation intracranial occlusion. Neurology 2016; 87:609-16. [PMID: 27385749 DOI: 10.1212/wnl.0000000000002951] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/27/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate whether the use of multiphase CT angiography (CTA) improves interrater agreement for intracranial occlusion detection between stroke neurology trainees and an expert neuroradiologist. METHODS A neuroradiologist and 2 stroke neurology fellows independently reviewed 100 prospectively collected single-phase and multiphase CTA scans from acute ischemic stroke patients with mild symptoms (NIH Stroke Scale score ≤5). The presence and location of a vascular occlusion(s) were documented. Interrater agreement single- and multiphase CTA was quantified using unweighted κ statistics. We assessed for any occlusions, anterior vs posterior occlusions, and pial vessel asymmetry. RESULTS Using multiphase CTA, the neuroradiologist detected 50 scans with anterior circulation occlusions and 15 scans with posterior circulation occlusions. Median reading time was 2 minutes per scan. Median reading time for the neurologists was 3 minutes per multiphase CTA scan. Interrater agreement was fair between the 2 neurologists and neuroradiologist when using single-phase CTA (κ = 0.45 and 0.32). Agreement improved minimally when stratified by anterior vs posterior circulation. When using multiphase CTA, agreement was high for detection of occlusion or asymmetry of pial vessels in the anterior circulation (κ = 0.80 and 0.84). CONCLUSIONS Multiphase CTA improves diagnostic accuracy in minor ischemic stroke for detection of anterior circulation intracranial occlusion. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that multiphase CTA, compared to single-phase CTA, improves the interrater agreement between stroke neurology trainees and an expert neuroradiologist for detecting anterior circulation intracranial vascular occlusion in patients with minor acute ischemic strokes.
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Affiliation(s)
- Amy Y X Yu
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., P.A.R., M.N., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), Community Health Sciences (A.Y.X.Y., J.K.H., B.K.M., S.B.C., M.D.H.), Department of Radiology (Z.A., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), and Hotchkiss Brain Institute (M.G., B.K.M., A.M.D., S.B.C., M.D.H.), University of Calgary, Canada
| | - Charlotte Zerna
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., P.A.R., M.N., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), Community Health Sciences (A.Y.X.Y., J.K.H., B.K.M., S.B.C., M.D.H.), Department of Radiology (Z.A., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), and Hotchkiss Brain Institute (M.G., B.K.M., A.M.D., S.B.C., M.D.H.), University of Calgary, Canada
| | - Zarina Assis
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., P.A.R., M.N., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), Community Health Sciences (A.Y.X.Y., J.K.H., B.K.M., S.B.C., M.D.H.), Department of Radiology (Z.A., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), and Hotchkiss Brain Institute (M.G., B.K.M., A.M.D., S.B.C., M.D.H.), University of Calgary, Canada
| | - Jessalyn K Holodinsky
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., P.A.R., M.N., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), Community Health Sciences (A.Y.X.Y., J.K.H., B.K.M., S.B.C., M.D.H.), Department of Radiology (Z.A., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), and Hotchkiss Brain Institute (M.G., B.K.M., A.M.D., S.B.C., M.D.H.), University of Calgary, Canada
| | - Privia A Randhawa
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., P.A.R., M.N., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), Community Health Sciences (A.Y.X.Y., J.K.H., B.K.M., S.B.C., M.D.H.), Department of Radiology (Z.A., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), and Hotchkiss Brain Institute (M.G., B.K.M., A.M.D., S.B.C., M.D.H.), University of Calgary, Canada
| | - Mohamed Najm
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., P.A.R., M.N., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), Community Health Sciences (A.Y.X.Y., J.K.H., B.K.M., S.B.C., M.D.H.), Department of Radiology (Z.A., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), and Hotchkiss Brain Institute (M.G., B.K.M., A.M.D., S.B.C., M.D.H.), University of Calgary, Canada
| | - Mayank Goyal
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., P.A.R., M.N., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), Community Health Sciences (A.Y.X.Y., J.K.H., B.K.M., S.B.C., M.D.H.), Department of Radiology (Z.A., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), and Hotchkiss Brain Institute (M.G., B.K.M., A.M.D., S.B.C., M.D.H.), University of Calgary, Canada
| | - Bijoy K Menon
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., P.A.R., M.N., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), Community Health Sciences (A.Y.X.Y., J.K.H., B.K.M., S.B.C., M.D.H.), Department of Radiology (Z.A., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), and Hotchkiss Brain Institute (M.G., B.K.M., A.M.D., S.B.C., M.D.H.), University of Calgary, Canada
| | - Andrew M Demchuk
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., P.A.R., M.N., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), Community Health Sciences (A.Y.X.Y., J.K.H., B.K.M., S.B.C., M.D.H.), Department of Radiology (Z.A., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), and Hotchkiss Brain Institute (M.G., B.K.M., A.M.D., S.B.C., M.D.H.), University of Calgary, Canada
| | - Shelagh B Coutts
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., P.A.R., M.N., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), Community Health Sciences (A.Y.X.Y., J.K.H., B.K.M., S.B.C., M.D.H.), Department of Radiology (Z.A., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), and Hotchkiss Brain Institute (M.G., B.K.M., A.M.D., S.B.C., M.D.H.), University of Calgary, Canada
| | - Michael D Hill
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., P.A.R., M.N., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), Community Health Sciences (A.Y.X.Y., J.K.H., B.K.M., S.B.C., M.D.H.), Department of Radiology (Z.A., M.G., B.K.M., A.M.D., S.B.C., M.D.H.), and Hotchkiss Brain Institute (M.G., B.K.M., A.M.D., S.B.C., M.D.H.), University of Calgary, Canada.
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Ajili N, Decroix JP, Preda C, Labreuche J, Lopez D, Bejot Y, Michel P, Sévin-Allouet M, Sibon I, Vergnet S, Wang A, Sanda N, Mazighi M, Bourdain F, Lapergue B. Impact of thrombolysis in acute ischaemic stroke without occlusion: an observational comparative study. Eur J Neurol 2016; 23:1380-6. [PMID: 27222165 DOI: 10.1111/ene.13042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 04/04/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The impact of intravenous recombinant tissue plasminogen activator (IV-rtPA) in patients with acute ischaemic stroke (AIS) but no arterial occlusion is currently a matter of debate. This study aimed to assess functional outcome of such patients with respect to IV-rtPA use. METHODS A retrospective case-control analysis was performed comparing the outcome of AIS patients without arterial occlusion with or without IV-rtPA use. Patients were selected from prospective consecutive observational registries of five European university hospitals. The primary study outcome was excellent outcome at 3 months after stroke, as defined by a modified Rankin Scale (mRS) 0-1. RESULTS A total of 488 patients without arterial occlusion documented by angiography were included in the present study; 300 received IV-rtPA and 188 did not. No between-group difference was found for excellent outcome before and after adjustment for baseline characteristics (adjusted odds ratio for no IV-rtPA use 0.79, 95% confidence interval 0.51-1.24, P = 0.31). Similar results were found for favourable outcome (defined as a 90-day mRS of 0-2) whereas a higher rate of early neurological improvement was found in IV-rtPA-treated patients (adjusted odds ratio 1.99; 95% confidence interval 1.29-3.07, P = 0.002). Sensitivity analyses yielded similar results. CONCLUSIONS Our study suggests that AIS patients without visible arterial occlusion treated with IV-rtPA may have no better outcome at 3 months than those untreated. However, only a randomized controlled trial would provide a definitive answer about the impact of rtPA in acute stroke patients without occlusion. Until then, these patients should be treated by rtPA as recommended.
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Affiliation(s)
- N Ajili
- Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
| | - J P Decroix
- Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
| | - C Preda
- Laboratoire de Mathématiques Paul Painlevé, UMR CNRS 8524, Lille, France
| | - J Labreuche
- Department of Biostatistics, Lille University Medical Centre, Lille, France
| | - D Lopez
- Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
| | - Y Bejot
- Department of Neurology, University Hospital and Medical School of Dijon, Dijon, France
| | - P Michel
- Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - M Sévin-Allouet
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - I Sibon
- Université Bordeaux 2, CHU Bordeaux, Pole de Neurosciences Cliniques, Unité neuro-vasculaire, Bordeaux, France
| | - S Vergnet
- Université Bordeaux 2, CHU Bordeaux, Pole de Neurosciences Cliniques, Unité neuro-vasculaire, Bordeaux, France
| | - A Wang
- Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
| | - N Sanda
- Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
| | - M Mazighi
- Department of Neurology and Stroke Centre, Lariboisière Hospital, Paris, France
| | - F Bourdain
- Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
| | - B Lapergue
- Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
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