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Hidayat R, Ulwanda RS, Irfannadhira AC, Rachmawati EZK, Pangeran D, Yunus RE, Mesiano T, Kurniawan M, Rasyid A, Harris S. Obstructive sleep apnea exaggeration as predictor of poor outcome post thrombolytic stroke. Radiol Case Rep 2024; 19:3324-3328. [PMID: 38860268 PMCID: PMC11163142 DOI: 10.1016/j.radcr.2024.04.069] [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: 12/12/2023] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 06/12/2024] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep disordered breathing in stroke patients. This case report aimed to show the presence of OSA in stroke can contribute to the increasing chance of mortality and morbidity. We presented a case of first-time stroke in a 64-year-old female with a history of pre-stroke OSA. She underwent intravenous thrombolysis as main therapy within the time limit under 4.5 hours since the stroke onset. She had prolonged hospital stay due to complications from OSA, even though she only had a small ischemic core (9 mL) in follow-up radiological imaging and was discharged with a greater National Institutes of Health Stroke Scale (NIHSS) score than admission (5 to 10). OSA can be one of warning signs for poor prognosis in stroke patients. Understanding the presence of OSA not only can be beneficial toward choosing the next steps of therapy, but also important for the rehabilitation and recovery period of stroke patients.
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Affiliation(s)
- Rakhmad Hidayat
- Faculty of Medicine Universitas Indonesia, Indonesia
- Dr. Cipto Mangunkusumo Hospital, Indonesia
| | | | | | | | | | - Reyhan Eddy Yunus
- Faculty of Medicine Universitas Indonesia, Indonesia
- Dr. Cipto Mangunkusumo Hospital, Indonesia
| | - Taufik Mesiano
- Faculty of Medicine Universitas Indonesia, Indonesia
- Dr. Cipto Mangunkusumo Hospital, Indonesia
| | - Mohammad Kurniawan
- Faculty of Medicine Universitas Indonesia, Indonesia
- Dr. Cipto Mangunkusumo Hospital, Indonesia
| | - Al Rasyid
- Faculty of Medicine Universitas Indonesia, Indonesia
- Dr. Cipto Mangunkusumo Hospital, Indonesia
| | - Salim Harris
- Faculty of Medicine Universitas Indonesia, Indonesia
- Dr. Cipto Mangunkusumo Hospital, Indonesia
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Yedavalli V, Koneru M, Hamam O, Hoseinyazdi M, Marsh EB, Llinas R, Urrutia V, Leigh R, Gonzalez F, Xu R, Caplan J, Huang J, Lu H, Wintermark M, Heit J, Guenego A, Albers G, Nael K, Hillis A. Pretreatment CTP Collateral Parameters Predict Good Outcomes in Successfully Recanalized Middle Cerebral Artery Distal Medium Vessel Occlusions. Clin Neuroradiol 2024; 34:341-349. [PMID: 38155255 DOI: 10.1007/s00062-023-01371-2] [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: 09/05/2023] [Accepted: 11/23/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND/PURPOSE Distal medium vessel occlusions (DMVOs) account for a large percentage of vessel occlusions resulting in acute ischemic stroke (AIS) with disabling symptoms. We aim to assess whether pretreatment quantitative CTP collateral status (CS) parameters can serve as imaging biomarkers for good clinical outcomes prediction in successfully recanalized middle cerebral artery (MCA) DMVOs. METHODS We performed a retrospective analysis of consecutive patients with AIS secondary to primary MCA-DMVOs who were successfully recanalized by mechanical thrombectomy (MT) defined as modified thrombolysis in cerebral infarction (mTICI) 2b, 2c, or 3. We evaluated the association between the CBV index and HIR independently with good clinical outcomes (modified Rankin score 0-2) using Spearman rank correlation, logistic regression, and ROC analyses. RESULTS From 22 August 2018 to 18 October 2022 8/22/2018 to 10/18/2022, 60 consecutive patients met our inclusion criteria (mean age 71.2 ± 13.9 years old [mean ± SD], 35 female). The CBV index (r = -0.693, p < 0.001) and HIR (0.687, p < 0.001) strongly correlated with 90-day mRS. A CBV index ≥ 0.7 (odds ratio, OR, 2.27, range 6.94-21.23 [OR] 2.27 [6.94-21.23], p = 0.001)) and lower likelihood of prior stroke (0.13 [0.33-0.86]), p = 0.024)) were independently associated with good outcomes. The ROC analysis demonstrated good performance of the CBV index in predicting good 90-day mRS (AUC 0.73, p = 0.003) with a threshold of 0.7 for optimal sensitivity (71% [52.0-85.8%]) and specificity (76% [54.9-90.6%]). The HIR also demonstrated adequate performance in predicting good 90-day mRS (AUC 0.77, p = 0.001) with a threshold of 0.3 for optimal sensitivity (64.5% [45.4-80.8%]) and specificity (76.0% [54.9-90.6%]). CONCLUSION A CBV index ≥ 0.7 may be independently associated with good clinical outcomes in our cohort of AIS caused by MCA-DMVOs that were successfully treated with MT. Furthermore, a HIR < 0.3 is also associated with good clinical outcomes. This is the first study of which we are aware to identify a CBV index threshold for MCA-DMVOs.
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Affiliation(s)
- Vivek Yedavalli
- Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Phipps B112-D, 21287, Baltimore, MD, USA.
- Department of Neurology, Stanford University School of Medicine, Stanford, Ca, USA.
| | - Manisha Koneru
- Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Phipps B112-D, 21287, Baltimore, MD, USA
| | - Omar Hamam
- Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Phipps B112-D, 21287, Baltimore, MD, USA
| | - Meisam Hoseinyazdi
- Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Phipps B112-D, 21287, Baltimore, MD, USA
| | | | - Raf Llinas
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Victor Urrutia
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Richard Leigh
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Fernando Gonzalez
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Justin Caplan
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Phipps B112-D, 21287, Baltimore, MD, USA
| | - Max Wintermark
- Department of Radiology, University of Texas, MD Anderson, TX, USA
| | - Jeremy Heit
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Adrien Guenego
- Department of Radiology, Université libre de Bruxelles, Bruxelles, Belgium
| | - Greg Albers
- Department of Radiology, Université libre de Bruxelles, Bruxelles, Belgium
| | - Kambiz Nael
- Department of Radiology, David Geffen UCLA School of Medicine, Los Angeles, Ca, USA
| | - Argye Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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