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Zheng C, Li R, Shen C, Hu Z, Qiu Z, Yang Q, Guo F. Leukoaraiosis in patients with tirofiban before endovascular thrombectomy: A post hoc analysis of a multicentre randomized clinical trial. J Formos Med Assoc 2024:S0929-6646(24)00391-7. [PMID: 39174395 DOI: 10.1016/j.jfma.2024.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 08/14/2024] [Accepted: 08/18/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the effectiveness and safety of intravenous tirofiban before endovascular thrombectomy in subgroups of acute ischemic stroke patients with different degrees of leukoaraiosis (LA). METHODS Patients of the RESCUE BT trial whose LA grade could be assessed were included. Eligible patients were dichotomized into two strata according to the van Swieten scale (VSS) score, absent-to-moderate LA (VSS score <3) and severe LA (VSS score ≥3). Furthermore, patients were divided into tirofiban and placebo groups in each stratum. The primary outcome was the 90-day modified Rankin Scale (mRS) score. Safety outcome was radiological intracranial hemorrhage within 48 h. RESULTS 861 patients were included, 439 patients with absent-to-moderate LA and 422 patients with severe LA. There were no significant differences in 90-day mRS score between the tirofiban and placebo groups in either stratum (absent-to-moderate LA: adjusted OR 0.92 (95%CI, 0.66-1.28), P = 0.62; severe LA: adjusted OR 0.99 (95% CI, 0.69-1.42), P = 0.96). In the severe LA stratum, the occurrence of radiologic intracranial hemorrhage was greater in the tirofiban group compared to the placebo group. (35.7% vs 26.4%; adjusted OR, 1.72 (95% CI, 1.12-2.66); P = 0.014). However, no difference was observed in the absent-to-moderate LA stratum (33.2% vs 29.3%; adjusted OR, 1.15 (95% CI, 0.76-1.75); P = 0.51). CONCLUSION There was no significant difference in disability severity at 90 days when treating AIS patients using intravenous tirofiban before endovascular therapy, in either absent-to-moderate or severe LA strata. It should be noted that intravenous tirofiban before endovascular therapy increases the incidence of radiologic intracranial hemorrhage in patients with severe LA.
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Affiliation(s)
- Chong Zheng
- Neurology Department, Longyan First Affiliated Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Longyan 364000, China.
| | - Rongtong Li
- Neurology Department, Longyan First Affiliated Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Longyan 364000, China
| | - Chaoxiong Shen
- Neurology Department, Longyan First Affiliated Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Longyan 364000, China
| | - Zhizhou Hu
- Neurology Department, Longyan First Affiliated Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Longyan 364000, China
| | - Zhongming Qiu
- Neurology Department, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University) 183 Xinqiao Main Street, Shapingba District, Chongqing 400037, China
| | - Qingwu Yang
- Neurology Department, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University) 183 Xinqiao Main Street, Shapingba District, Chongqing 400037, China
| | - Fang Guo
- Neurology Department, Longyan First Affiliated Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Longyan 364000, China
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Cheng X, Chen Q, Ren Q, Ma H, Zhao Y, Jiao S. Total cerebral small vessel disease burden and stroke outcomes in large vessel occlusion stroke receiving endovascular treatment: A systematic review and meta-analysis. J Clin Neurosci 2024; 123:179-185. [PMID: 38583374 DOI: 10.1016/j.jocn.2024.04.003] [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: 02/07/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Cerebral small vessel disease (CSVD) is prevalent in the population, especially among the elderly. Various types of CSVD markers commonly coexist, and the neurological function outcome is affected by their combined effect. Studies investigating the association between total CSVD burden and stroke outcomes in large vessel occlusion (LVO) stroke receiving endovascular treatment (EVT) are expanding but have not been systematically assessed. METHODS We systematically searched the PubMed, Embase, and Cochrane databases for relevant clinical studies. The total CSVD burden score summarized the markers of CSVD, including lacunes, white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVSs), which was a comprehensive index of overall CSVD burden. The pooled odds ratios (ORs) were used to calculate the association between high total CSVD burden score and outcomes of EVT in patients with LVO stroke. The primary outcome was poor functional outcome, which was defined as a modified Rankin Scale score (mRS) ≥ 3 at 90 days after EVT. The secondary outcomes were symptomatic intracranial hemorrhage (sICH) and poor collateral flow. RESULTS Overall, 6 eligible studies with 1,774 patients with LVO stroke undergoing EVT were pooled in meta-analysis. High overall CSVD burden score was significantly associated with increased risks of poor functional outcome at 90 days (pooled OR 2.86, 95 % CI 1.31-6.25, p = 0.008). Besides, high overall CSVD burden score was associated with sICH (pooled OR 2.07, 95 % CI 0.38-5.17; p = 0.118) and poor collateral flow (pooled OR 1.57, 95 % CI 0.75-3.27; p = 0.232), but were not statistically significant. CONCLUSIONS High overall CSVD burden was associated with increased risks of unfavorable outcomes in patients with LVO stroke undergoing EVT.
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Affiliation(s)
- Xiaofang Cheng
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, Hebei, China.
| | - Quanhui Chen
- Department of Gastroenterology, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Qiuxia Ren
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Haoyuan Ma
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Yan Zhao
- Medical Service Department, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Shusheng Jiao
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
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Hakim A, Gallucci L, Sperber C, Rezny-Kasprzak B, Jäger E, Meinel T, Seiffge D, Goeldlin M, Westphalen F, Fischer U, Wiest R, Arnold M, Umarova R. The analysis of association between single features of small vessel disease and stroke outcome shows the independent impact of the number of microbleeds and presence of lacunes. Sci Rep 2024; 14:3402. [PMID: 38336856 PMCID: PMC10858245 DOI: 10.1038/s41598-024-53500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
The impact of small vessel disease (SVD) on stroke outcome was investigated either separately for its single features in isolation or for SVD sum score measuring a qualitative (binary) assessment of SVD-lesions. We aimed to investigate which SVD feature independently impacts the most on stroke outcome and to compare the continuous versus binary SVD assessment that reflects pronouncement and presence correspondingly. Patients with a first-ever anterior circulation ischemic stroke were retrospectively investigated. We performed an ordered logistic regression analysis to predict stroke outcome (mRS 3 months, 0-6) using age, stroke severity, and pre-stroke disability as baseline input variables and adding SVD-features (lacunes, microbleeds, enlarged perivascular spaces, white matter hyperintensities) assessed either continuously (model 1) or binary (model 2). The data of 873 patients (age 67.9 ± 15.4, NIHSS 24 h 4.1 ± 4.8) was analyzed. In model 1 with continuous SVD-features, the number of microbleeds was the only independent predictor of stroke outcome in addition to clinical parameters (OR 1.21; 95% CI 1.07-1.37). In model 2 with the binary SVD assessment, only the presence of lacunes independently improved the prediction of stroke outcome (OR 1.48, 1.1-1.99). In a post hoc analysis, both the continuous number of microbleeds and the presence of lacunes were independent significant predictors. Thus, the number of microbleeds evaluated continuously and the presence of lacunes are associated with stroke outcome independent from age, stroke severity, pre-stroke disability and other SVD-features. Whereas the presence of lacunes is adequately represented in SVD sum score, the microbleeds assessment might require another cutoff and/or gradual scoring, when prediction of stroke outcome is needed.
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Affiliation(s)
- Arsany Hakim
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Laura Gallucci
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - Christoph Sperber
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - Beata Rezny-Kasprzak
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Eugen Jäger
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas Meinel
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - Martina Goeldlin
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - Franziska Westphalen
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Roland Wiest
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - Roza Umarova
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland.
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Smolko D, Bartiuk R, Zheliba L, Marunkevych Y, Gordiichuk O, Starynets N, Olkhova I. Brain morphometry and short-term stroke outcome. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:1401-1408. [PMID: 39241139 DOI: 10.36740/wlek202407114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2024]
Abstract
OBJECTIVE Aim: The aim of the research was to investigate associations between brain morphometric changes and short-term stroke outcome. PATIENTS AND METHODS Materials and Methods: In this study, 294 patients with acute stroke were enrolled. All participants underwent magnetic resonance imaging (MRI) and computed tomography (CT) assessment as well as clinical-neurological and cognitive testing. RESULTS Results: In the multivariable regression analysis, bicaudate index (OR = 1.3; 95 % CI 1.1 - 1.7, p=0.018) and ventricular index (OR = 0.7; CI 0.5 - 0.9, p=0.005) were associated with an unfavourable short-term stroke outcome. The univariable regression analysis revealed significant associations between mini-mental state examination scale score (MMSE) and width of the longitudinal cerebral fissure in the anterior part of the frontal lobes (FI) (b -0.8, 95% CI -1.6 - -0.1, p=0.037) as well as width of the cerebral fissure in the area of the skull vault (SW) (b -0.9, 95% CI -1.8 - -0.1, p=0.023). In the multivariable regression model bicaudate index was associated with MMSE score (b coefficient (b) = -1.2; 95 % CI -2.1 - -0.3, p = 0.011). CONCLUSION Conclusions: our results show that altered brain morphometric indices are associated with unfavourable short-term stroke outcome and cognitive decline.
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Affiliation(s)
- Dmytro Smolko
- VINNYTSIA NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
| | - Roman Bartiuk
- VINNYTSIA NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
| | - Lesia Zheliba
- VINNYTSIA NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
| | | | - Olga Gordiichuk
- VINNYTSIA NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
| | - Natalia Starynets
- VINNYTSIA NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
| | - Iryna Olkhova
- VINNYTSIA NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
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Xu Q, Zhu Y, Zhang X, Kong D, Duan S, Guo L, Yin X, Jiang L, Liu Z, Yang W. Clinical features and FLAIR radiomics nomogram for predicting functional outcomes after thrombolysis in ischaemic stroke. Front Neurosci 2023; 17:1063391. [PMID: 36908776 PMCID: PMC9992187 DOI: 10.3389/fnins.2023.1063391] [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: 10/07/2022] [Accepted: 01/13/2023] [Indexed: 02/25/2023] Open
Abstract
Objective We explored whether radiomics features extracted from diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) images can predict the clinical outcome of patients with acute ischaemic stroke. This study was conducted to investigate and validate a radiomics nomogram for predicting acute ischaemic stroke prognosis. Methods A total of 257 patients with acute ischaemic stroke from three clinical centres were retrospectively assessed from February 2019 to July 2022. According to the modified Rankin scale (mRS) at 3 months, the patients were divided into a favourable outcome group (mRS of 0-2) and an unfavourable outcome group (mRS of 3-6). The high-throughput features from the regions of interest (ROIs) within the radiologist-drawn contour by AK software were extracted. We used two feature selection methods, minimum redundancy and maximum (mRMR) and the least absolute shrinkage and selection operator algorithm (LASSO), to select the features. Three radiomics models (DWI, FLAIR, and DWI-FLAIR) were established. A radiomics nomogram with patient characteristics and radiomics signature was built using a multivariate logistic regression model. The performance of the nomogram was evaluated in the test and validation sets. Ultimately, decision curve analysis was implemented to assess the clinical value of the nomogram. Results The FLAIR, DWI, and DWI-FLAIR radiomics model exhibited good prediction performance, with area under the curve (AUCs) of 0.922 (95% CI: 0.876-0.968), 0.875 (95% CI: 0.815-0.935), and 0.895 (95% CI: 0.840-0.950). The radiomics nomogram with clinical characteristics including the overall cerebral small vessel disease (CSVD) burden score, hemorrhagic transformation (HT) and admission National Institutes of Health Stroke Scale score (NIHSS) score and the FLAIR Radscore presented good discriminatory potential in the training set (AUC = 0.94; 95% CI: 0.90-0.98) and test set (AUC = 0.94; 95% CI: 0.87-1), which was validated in the validation set 1 (AUC = 0.95; 95% CI: 0.88-1) and validation set 2 (AUC = 0.90; 95% CI: 0.768-1). In addition, it demonstrated good calibration, and decision curve analysis confirmed the clinical value of this nomogram. Conclusion This non-invasive clinical-FLIAR radiomics nomogram shows good performance in predicting ischaemic stroke prognosis after thrombolysis.
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Affiliation(s)
- Qingqing Xu
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, China
| | - Yan Zhu
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, China
| | - Xi Zhang
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, China
| | - Dan Kong
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, China
| | | | - Lili Guo
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, China
| | - Xindao Yin
- Department of Radiology, Nanjing Medical University Affiliated Nanjing Hospital, Nanjing, China
| | - Liang Jiang
- Department of Radiology, Nanjing Medical University Affiliated Nanjing Hospital, Nanjing, China
| | - Zaiyi Liu
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Wanqun Yang
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong Provincial People’s Hospital, Guangzhou, China
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Lee HJ, Kim T, Koo J, Kim YD, Na S, Choi YH, Song IU, Chung SW. Multiple chronic lacunes predicting early neurological deterioration and long-term functional outcomes according to TOAST classification in acute ischemic stroke. Neurol Sci 2023; 44:611-619. [PMID: 36255539 DOI: 10.1007/s10072-022-06446-5] [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: 09/06/2022] [Accepted: 10/06/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Studies regarding multiple chronic lacunes (MCLs) and clinical outcome according to stroke etiology are scarce. We sought to evaluate the association between MCL and short-term/long-term clinical outcomes according to stroke etiology. PATIENTS AND METHODS We analyzed a prospectively collected stroke registry of acute ischemic stroke patients over 4 years. The enrolled patients were classified as having large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolic (CE) stroke, and other etiology. The early neurological deterioration (END) and favorable outcome at 3 months were assessed. RESULTS A total of 1070 patients were enrolled. Patients with MCL had significantly more END compared to those without MCL both in total population (adjusted odds ratio (OR), 1.7; 95% confidence interval [CI], 1.1-2.5; p = 0.013*) and in the LAA group (adjusted OR, 2.3; 95% CI, 1.3-4.2, p < 0.006). Patients with MCL had a significantly lower OR for favorable outcome at 3 months compared to those without MCL both in total population (adjusted OR, 0.7; 95% CI, 0.5-1.0, p = 0.035) and in the LAA group (adjusted OR, 0.6; 95% CI, 0.3-1.0, p = 0.043). However, MCL was not associated with END or long-term functional outcome in patients with SVO, CE, or other etiology. CONCLUSIONS The presence of MCL was an independent predictive factor for END as well as long-term poor functional outcome in acute ischemic stroke patients. These associations were only observed in patients with LAA, not in those with SVO, CE, or other etiology.
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Affiliation(s)
- Hyuk-Je Lee
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea
| | - Taewon Kim
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea.
| | - Jaseong Koo
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young-Do Kim
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea
| | - Seunghee Na
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea
| | - Yun Ho Choi
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea
| | - In-Uk Song
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea
| | - Sung-Woo Chung
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea
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Cerebral Small Vessel Diseases and Outcomes for Acute Ischemic Stroke Patients after Endovascular Therapy. J Clin Med 2022; 11:jcm11236883. [PMID: 36498456 PMCID: PMC9736173 DOI: 10.3390/jcm11236883] [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: 10/19/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
The correlation between cerebral small vessel disease (CSVD) and the outcomes of acute ischemic stroke (AIS) patients after endovascular therapy (EVT) remains elusive. We aimed to investigate the effect of combined white matter hyperintensities (WMH) and enlarged perivascular spaces (EPVS) as detected in magnetic resonance imaging (MRI) at baseline on clinical outcomes in patients with AIS who underwent EVT. AIS patients that experienced EVT were retrospectively analyzed in this single-center study. Using MRIs taken prior to EVT, we rated WMH and EPVS as the burden of CSVD and dichotomized the population into two groups: absent-to-moderate and severe. Neurological outcome was assessed at day 90 with a modified Rankin Scale (mRS). Symptomatic intracerebral hemorrhage (sICH), early neurological deterioration (END), malignant cerebral edema (MCE), and hospital death were secondary outcomes. Of the 100 patients (64.0% male; mean age 63.71 ± 11.79 years), periventricular WMHs (28%), deep WMHs (41%), EPVS in basal ganglia (53%), and EPVS in centrum semiovale (73%) were observed. In addition, 69% had an absent-to-moderate total CSVD burden and 31.0% had a severe burden. The severe CSVD was not substantially linked to either the primary or secondary outcomes. Patients with AIS who underwent EVT had an elevated risk (OR: 7.89, 95% CI: 1.0, 62.53) of END if they also had EPVS. When considering WMH and EPVS together as a CSVD burden, there seemed to be no correlation between severe CSVD burden and sICH, END, or MCE following EVT for AIS patients. Further studies are warranted to clarify the relationship between CSVD burden and the occurrence, progression, and prognosis of AIS.
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Elucidating the Role of Baseline Leukoaraiosis on Forecasting Clinical Outcome of Acute Ischemic Stroke Patients Undergoing Reperfusion Therapy. Neurol Int 2022; 14:923-942. [PMID: 36412696 PMCID: PMC9680372 DOI: 10.3390/neurolint14040074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
Stroke stands as a major cause of death and disability with increasing prevalence. The absence of clinical improvement after either intravenous thrombolysis (IVT) or mechanical thrombectomy (MT) represents a frequent concern in the setting of acute ischemic stroke (AIS). In an attempt to optimize overall stroke management, it is clinically valuable to provide important insight into functional outcomes after reperfusion therapy among patients presenting with AIS. The aim of the present review is to explore the predictive value of leukoaraiosis (LA) in terms of clinical response to revascularization poststroke. A literature research of two databases (MEDLINE and Scopus) was conducted in order to trace all relevant studies published between 1 January 2012 and 1 November 2022 that focused on the potential utility of LA severity regarding reperfusion status and clinical outcome after revascularization. A total of 37 articles have been traced and included in this review. LA burden assessment is indicative of functional outcome post-intervention and may be associated with hemorrhagic events' incidence among stroke individuals. Nevertheless, LA may not solely guide decision-making about treatment strategy poststroke. Overall, the evaluation of LA upon admission seems to have interesting prognostic potential and may substantially enhance individualized stroke care.
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Zheng L, Leng X, Nie X, Yan H, Tian X, Pan Y, Yang Z, Wen M, Pu Y, Gu W, Miao Z, Leung TW, Liu L. Small vessel disease burden may not portend unfavorable outcome after thrombectomy for acute large vessel occlusion. Eur Radiol 2022; 32:7824-7832. [PMID: 35475935 DOI: 10.1007/s00330-022-08795-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/18/2022] [Accepted: 04/01/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We aimed to investigate the correlation between an overall cerebral small vessel disease (CSVD) burden and outcomes after endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). METHODS In a multicenter registry study, we enrolled patients with EVT for anterior-circulation LVO-stroke. In 3.0-T MR imaging, we assessed 4 CSVD imaging markers, lacunes, white matter hyperintensities, cerebral microbleeds, and enlarged perivascular spaces, each assigned a score of 0 or 1 and summed up to an overall CSVD burden score of 0-4. We dichotomized the overall CSVD severity as none to mild (score 0-2) and moderate to severe (3-4). Primary outcome was 90-day functional dependence or death (modified Rankin Scale (mRS) 3-6). Secondary outcomes included increase in NIH Stroke Scale ≥ 4 within 24 h (early neurological deterioration (END)) and within 7 days, symptomatic intracranial hemorrhage, 90-day mRS 2-6, and 90-day mortality. RESULTS Among 311 patients (63.0% male; mean age 65.1 ± 12.7 years), 260 (83.6%) had none-to-mild and 51 (16.4%) had moderate-to-severe overall CSVD burden. Moderate-to-severe CSVD burden was not significantly associated with the primary outcome (47.1% versus 45.4%; p > 0.05 in univariate and multivariate logistic regression), or the secondary outcomes except for a higher risk of END (11.8% versus 3.1%; p < 0.05 in multivariate analyses). Sensitivity analyses with 0-1 versus 2-4 of the CSVD burden score, and the score as an ordinal variable, showed similar results. CONCLUSIONS An overall moderate-to-severe CSVD burden was not associated with 90-day functional dependence or death, after EVT for anterior-circulation LVO. TRIAL REGISTRATION ChiCTR1900022154 KEY POINTS: • Moderate-to-severe cerebral small vessel disease burden on MRI should not be an exclusion indicator in determining the eligibility of an acute ischemic stroke patient for endovascular treatment.
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Affiliation(s)
- Lina Zheng
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Xinyi Leng
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ximing Nie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 West Road, South 4th Ring, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 West Road, South 4th Ring, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xuan Tian
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 West Road, South 4th Ring, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhonghua Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 West Road, South 4th Ring, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Miao Wen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 West Road, South 4th Ring, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuehua Pu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 West Road, South 4th Ring, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Weibin Gu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Thomas W Leung
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 West Road, South 4th Ring, Fengtai District, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China.
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10
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Sharif MS, Goldberg EB, Walker A, Hillis AE, Meier EL. The contribution of white matter pathology, hypoperfusion, lesion load, and stroke recurrence to language deficits following acute subcortical left hemisphere stroke. PLoS One 2022; 17:e0275664. [PMID: 36288353 PMCID: PMC9604977 DOI: 10.1371/journal.pone.0275664] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
Aphasia, the loss of language ability following damage to the brain, is among the most disabling and common consequences of stroke. Subcortical stroke, occurring in the basal ganglia, thalamus, and/or deep white matter can result in aphasia, often characterized by word fluency, motor speech output, or sentence generation impairments. The link between greater lesion volume and acute aphasia is well documented, but the independent contributions of lesion location, cortical hypoperfusion, prior stroke, and white matter degeneration (leukoaraiosis) remain unclear, particularly in subcortical aphasia. Thus, we aimed to disentangle the contributions of each factor on language impairments in left hemisphere acute subcortical stroke survivors. Eighty patients with acute ischemic left hemisphere subcortical stroke (less than 10 days post-onset) participated. We manually traced acute lesions on diffusion-weighted scans and prior lesions on T2-weighted scans. Leukoaraiosis was rated on T2-weighted scans using the Fazekas et al. (1987) scale. Fluid-attenuated inversion recovery (FLAIR) scans were evaluated for hyperintense vessels in each vascular territory, providing an indirect measure of hypoperfusion in lieu of perfusion-weighted imaging. We found that language performance was negatively correlated with acute/total lesion volumes and greater damage to substructures of the deep white matter and basal ganglia. We conducted a LASSO regression that included all variables for which we found significant univariate relationships to language performance, plus nuisance regressors. Only total lesion volume was a significant predictor of global language impairment severity. Further examination of three participants with severe language impairments suggests that their deficits result from impairment in domain-general, rather than linguistic, processes. Given the variability in language deficits and imaging markers associated with such deficits, it seems likely that subcortical aphasia is a heterogeneous clinical syndrome with distinct causes across individuals.
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Affiliation(s)
- Massoud S. Sharif
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Emily B. Goldberg
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Alexandra Walker
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Cognitive Science, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Erin L. Meier
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
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11
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Tang X, Jiang L, Luo Y, Fan H, Song L, Liu P, Chen Y. Leukoaraiosis and acute ischemic stroke. Eur J Neurosci 2021; 54:6202-6213. [PMID: 34331366 DOI: 10.1111/ejn.15406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
Ischaemic stroke is characterized by high morbidity, high disability rate, high mortality and high recurrence rate, which can have a grave impact on the quality of life of the patients and consequently becomes an economic burden on their families and society. With the developments in imaging technology in recent years, patients with acute cerebral infarction are predominantly more likely to be diagnosed with leukoaraiosis (LA). LA is a common degenerative disease of the nervous system, which is related to cognitive decline, depression, abnormal gait, ischaemic stroke and atherosclerosis. The aetiology of LA is not clear and there is no gold standard for imaging assessment. Related studies have shown that LA has an adverse effect on the prognosis of cerebral infarction, but some experts have contrary beliefs. Hence, we undertook the present review of the literature on the mechanism and the effect of LA on the prognosis of patients with acute ischaemic stroke.
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Affiliation(s)
- Xiaojia Tang
- Department of Rehabilitation Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou City, China
| | - Li Jiang
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou City, China
| | - Yuhan Luo
- Health Management Center, People's Hospital of Deyang City, Deyang City, China
| | - Hongyang Fan
- Department of Neurology, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang City, China
| | - Lilong Song
- Department of Neurology, Shanghai Fourth People's Hospital, Shanghai City, China
| | - Peipei Liu
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou City, China
| | - Yingzhu Chen
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou City, China
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12
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Chen Y, Zheng Z, Mei A, Huang H, Lin F. Claudin-1 and Claudin-3 as Molecular Regulators of Myelination in Leukoaraiosis Patients. Clinics (Sao Paulo) 2021; 76:e2167. [PMID: 34008771 PMCID: PMC8101689 DOI: 10.6061/clinics/2021/e2167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/05/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Leukoaraiosis is described as white matter lesions that are associated with cognitive dysfunction, neurodegenerative disorders, etc. Myelin depletion is a salient pathological feature of, and the loss of oligodendrocytes is one of the most robust alterations evident in, white matter degeneration. Recent studies have revealed that claudin proteins are aberrantly expressed in leukoaraiosis and regulate oligodendrocyte activity. However, the roles of claudin-1 and claudin-3 in oligodendrocytes and leukoaraiosis are still not well-defined. METHODS Quantitative polymerase chain reaction was used to measure the expression of claudin-1 (CLDN1), claudin-3 (CLDN3), and myelinogenesis-related genes such as myelin basic protein (MBP), proteolipid protein (PLP), oligodendrocyte transcription factor 2 (OLIG2), and SRY-box transcription factor 10 (SOX10) in leukoaraiosis patients (n=122) and healthy controls (n=122). The expression of claudin-1 and claudin-3 was either ectopically silenced or augmented in Oli-neu oligodendrocytes, and colony formation, apoptosis, and migration assays were performed. Finally, the expression of myelin proteins was evaluated by western blotting. RESULTS Our results revealed that in addition to SOX10, the expression levels of claudin-1, claudin-3, and myelinogenesis-related proteins were prominently downregulated in leukoaraiosis patients, compared to those in healthy controls. Furthermore, the growth and migration of Oli-neu cells were downregulated upon silencing claudin-1 or claudin-3. However, the overexpression of claudin-1 or claudin-3 resulted in the reduction of the degree of apoptosis in Oli-neu cells. In addition, claudin-1 and claudin-3 promoted the expression of MBP, OLIG2, PLP, and SOX10 at the translational level. CONCLUSION Our data has demonstrated that the abnormal expression of claudin-1 and claudin-3 regulates the pathological progression of leukoaraiosis by governing the viability and myelination of oligodendrocytes. These findings provide novel insights into the regulatory mechanisms underlying the roles of claudin-1 and claudin-3 in leukoaraiosis.
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Affiliation(s)
- Yan Chen
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, P.R. China
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, 350001, P.R. China
- Fujian Key Laboratory of Geriatrics, Fuzhou, 350001, P.R. China
- Fujian Provincial center for Geriatrics, Fuzhou, 350001, P.R. China
| | - Zheng Zheng
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, P.R. China
- Department of Neurology, Fujian Provincial Hospital, Fuzhou, 350001, P.R. China
- *Corresponding author. E-mail:
| | - Ainong Mei
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, P.R. China
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, 350001, P.R. China
- Fujian Key Laboratory of Geriatrics, Fuzhou, 350001, P.R. China
- Fujian Provincial center for Geriatrics, Fuzhou, 350001, P.R. China
| | - Huan Huang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, P.R. China
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, 350001, P.R. China
- Fujian Key Laboratory of Geriatrics, Fuzhou, 350001, P.R. China
- Fujian Provincial center for Geriatrics, Fuzhou, 350001, P.R. China
| | - Fan Lin
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, P.R. China
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, 350001, P.R. China
- Fujian Key Laboratory of Geriatrics, Fuzhou, 350001, P.R. China
- Fujian Provincial center for Geriatrics, Fuzhou, 350001, P.R. China
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13
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Qiu F, Chen C, Fan Z, Qiu J, Chen Q, Shao B. White Matter Hypoperfusion Associated with Leukoaraiosis Predicts Intracranial Hemorrhage after Intravenous Thrombolysis. J Stroke Cerebrovasc Dis 2020; 30:105528. [PMID: 33307291 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES White matter hyperintensity is common in patients receiving intravenous thrombolysis. Some studies have expressed concern about the increased risk of hemorrhagic transformation and poor prognosis for those patients with pre-existing leukoaraiosis. The purpose of this study was to evaluate hypoperfusion associated with leukoaraiosis before thrombolysis using CT perfusion and to explore whether chronic white matter hypoperfusion increases risks of intracranial hemorrhage and poor clinical prognosis. MATERIALS AND METHODS We collected 175 patients underwent intravenous thrombolysis with complete CT perfusion data and follow-up MRI between June 2017 and January 2020. We measured cerebral blood flow, cerebral blood volume, mean transit time and transit time to the peak at both periventricular and subcortical layers in the cerebral hemisphere contralateral to the stroke. The differences of white matter perfusion were compared between groups with different leukoaraiosis severity. Univariate analysis was used to compare in incidence of hemorrhagic transformation and poor prognosis between the hypoperfusion and normal perfusion groups. Further, we examined association between white matter hypoperfusion and intracranial hemorrhage after thrombolysis using logistic regression. RESULTS The length of periventricular transit time to the peak was independently associated with a higher risk of intracranial hemorrhage after thrombolysis (OR=4.740, 95%CI=1.624-13.837, P=0.004). The best predictive value was 4.012. But there was no significant difference in poor prognosis at 3 months between hypoperfusion (periventricular transit time to the peak≥4.012 s) and normal perfusion (periventricular transit time to the peak<4.012 s) group. CONCLUSIONS Image presentations of white matter hypoperfusion reflected the severity of leukoaraiosis. White matter hypoperfusion was independently associated with intracranial hemorrhage after intravenous thrombolysis. However, hypoperfusion would not increase the risk of poor prognosis.
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Affiliation(s)
- Fengzhen Qiu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Cuiping Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Zijian Fan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jiayou Qiu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Qitao Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Bei Shao
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
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14
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Ryu WS, Jeong SW, Kim DE. Total small vessel disease burden and functional outcome in patients with ischemic stroke. PLoS One 2020; 15:e0242319. [PMID: 33180837 PMCID: PMC7660472 DOI: 10.1371/journal.pone.0242319] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/30/2020] [Indexed: 12/28/2022] Open
Abstract
Background Cerebral small vessel disease (SVD) is comprised of lacunes, cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and enlarged perivascular space (EPVS). We investigated the cumulative effect of SVD on 3-month functional outcome following ischemic stroke using the total SVD score. Methods The total SVD score of 477 acute ischemic stroke patients with adequate brain MRI was analyzed. We used multivariable ordinal logistic regression analysis to investigate the independent impact of total SVD score on ordinal modified Rankin Scale (mRS) score at 3-month after ischemic stroke. Results Mean age was 66±14 years, and 61% were men. The distribution of the total SVD score from 0 to 4 was 27%, 24%, 26%, 16%, and 7%, respectively. The proportion of mRS scores 2 or greater was 16% and 47% in total SVD score 0 and 4, respectively. Multivariable ordinal logistic regression analysis results showed that compared with the total SVD score of 0, total SVD scores of 2, 3, and 4 were independently associated with higher mRS scores with adjusted odds ratios (95% confidence intervals) of 1.68 (1.02–2.76), 2.24 (1.25–4.00), and 2.00 (1.02–4.29). Lacunes, CMBs, WMHs but not EPVS were associated with mRS scores at 3 months. However, the impact of each SVD marker on stroke outcome was smaller than that of the total SVD score. Conclusion We found an independent association between total SVD scores and functional outcome at 3 months following ischemic stroke. The total SVD score may be useful for stratification of patients who are at a high-risk of unfavorable outcomes.
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Affiliation(s)
- Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
- Korean Brain MRI Data Center, Goyang, Republic of Korea
- * E-mail:
| | - Sang-Wuk Jeong
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
- Korean Brain MRI Data Center, Goyang, Republic of Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
- Korean Brain MRI Data Center, Goyang, Republic of Korea
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15
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Huo YC, Li Q, Zhang WY, Zou N, Li R, Huang SY, Wang HQ, Song KY, Zhang RR, Qin XY. Total Small Vessel Disease Burden Predicts Functional Outcome in Patients With Acute Ischemic Stroke. Front Neurol 2019; 10:808. [PMID: 31447754 PMCID: PMC6691043 DOI: 10.3389/fneur.2019.00808] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/15/2019] [Indexed: 02/01/2023] Open
Abstract
Background: Cerebral small vessel disease (SVD) is generally considered as a cause of stroke, disability, gait disturbances, vascular cognitive impairment, and dementia. The aim of this study was to investigate whether the total SVD burden can be used to predict functional outcome in patients with acute ischemic stroke. Methods: From April 2017 to January 2018, consecutive patients with acute ischemic stroke who underwent baseline MRI scan were evaluated. The functional outcome was assessed using the modified Rankin Scale (mRS) at 90 days and defined as i) excellent outcome (mRS ≤ 1) and ii) good outcome (mRS ≤ 2). Brain MRI was performed and assessed for lacunes, white matter hyperintensities (WMH), and enlarged perivascular spaces (EPVS). The total SVD burden was calculated based on lacunes, WMH, and EPVS and then summed up to generate an ordinal “total SVD burden” (range 0–3). Bivariate logistic regression models were used to identify the association between SVD and functional outcome. Results: A total of 416 patients were included in the final analysis; 44.0, 33.4, 19.2, and 3.4% of the patients had 0, 1, 2, and 3 features of SVD, respectively. In regard to individual SVD feature, lacunes (OR: 0.48, 95% CI: 0.32–0.71; OR: 0.49, 95% CI: 0.31–0.77) and WMH (OR: 0.53, 95% CI: 0.34–0.82; OR: 0.53, 95% CI: 0.33–0.85) were negatively associated with excellent outcome and good outcome. As to the total burden of SVD, three SVD features had strongest negative associations with functional outcomes (excellent outcome, OR: 0.13, 95% CI: 0.03–0.48; good outcome, OR: 0.18, 95% CI: 0.06–0.54). After adjustment for potential confounders, a high SVD burden (3 features, OR: 0.07, 95% CI: 0.01–0.41) and the score of total SVD burden (OR: 0.64, 95% CI: 0.44–0.93) remained negatively associated with excellent outcome. Conclusion: Total SVD burden negatively associated with functional outcome at 3 months in patients with acute ischemic stroke and is superior to individual SVD feature in prediction of functional outcome. MRI-based assessment of total SVD burden is highly valuable in clinical management of stroke victims and could help guide the allocation of resources to improve outcome.
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Affiliation(s)
- Ying-Chao Huo
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Wen-Yu Zhang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Ning Zou
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Rui Li
- Division of Life Sciences and Medicine, Department of Neurology, The First Affiliated Hospital, University of Science and Technology of China, Hefei, China
| | - Si-Yuan Huang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hui-Qi Wang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Kai-Yi Song
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Rong-Rong Zhang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xin-Yue Qin
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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16
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Arba F, Piccardi B, Palumbo V, Giusti B, Nencini P, Gori AM, Sereni A, Nesi M, Pracucci G, Bono G, Bovi P, Fainardi E, Consoli D, Nucera A, Massaro F, Orlandi G, Perini F, Tassi R, Sessa M, Toni D, Abbate R, Inzitari D. Small Vessel Disease Is Associated with Tissue Inhibitor of Matrix Metalloproteinase-4 After Ischaemic Stroke. Transl Stroke Res 2019; 10:44-51. [PMID: 29687301 DOI: 10.1007/s12975-018-0627-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
Small vessel disease (SVD) is frequent in aging and stroke patients. Inflammation and remodeling of extracellular matrix have been suggested as concurrent mechanisms of SVD. We investigated the relationship between imaging features of SVD and circulating metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in patients with ischaemic stroke. In patients treated with intravenous thrombolysis, we took blood samples before intravenous thrombolysis and 90 days after the acute stroke and analysed levels of MMPs and TIMPs. We assessed leukoaraiosis, number of lacunes and brain atrophy on pre-treatment CT scan and graded global SVD burden combining such features. We investigated associations between single features, global SVD and MMPs and TIMPs at baseline and at follow-up, retaining univariate statistically significant associations in multivariate linear regression analysis and adjusting for clinical confounders. A total of 255 patients [mean (±SD) = 68.6 (± 12.7) years, 154 (59%) males] were included, 107 (42%) had no signs of SVD; 47 (19%) had from moderate to severe SVD burden. A total of 107 (42%) patients had no signs of SVD; 47 (19%) had from moderate to severe SVD burden. After adjustment, only TIMP-4 proved associations with SVD features. Brain atrophy was associated with baseline TIMP-4 (β = 0.20;p = 0.019) and leukoaraiosis with 90 days TIMP-4 (β = 0.19; p = 0.013). Global SVD score was not associated with baseline TIMP-4 levels (β = 0.10; p = 0.072), whereas was associated with 90 days TIMP-4 levels (β = 0.21; p = 0.003). Total SVD burden was associated with higher TIMP-4 levels 90 days after stroke, whereas was not during the acute phase. Our results support a biological relationship between SVD grade and TIMP-4.
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Affiliation(s)
- Francesco Arba
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy.
- Stroke Unit and Neurology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Benedetta Piccardi
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
- Stroke Unit and Neurology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Vanessa Palumbo
- Stroke Unit and Neurology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, Atherothrombotic Diseases Center, AOU Careggi, University of Florence, Florence, Italy
| | - Patrizia Nencini
- Stroke Unit and Neurology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, Atherothrombotic Diseases Center, AOU Careggi, University of Florence, Florence, Italy
| | - Alice Sereni
- Department of Experimental and Clinical Medicine, Atherothrombotic Diseases Center, AOU Careggi, University of Florence, Florence, Italy
| | - Mascia Nesi
- Stroke Unit and Neurology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Giorgio Bono
- Stroke Unit, Department of Neurology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Paolo Bovi
- SSO Stroke Unit, Department of Neurosciences, Azienda Ospedaliera Integrata, Verona, Italy
| | - Enrico Fainardi
- Department of Neuroradiology, Careggi University Hospital, Florence, Italy
| | | | - Antonia Nucera
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
| | | | - Giovanni Orlandi
- Department of Neurosciences, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Francesco Perini
- UOC di Neurologia e Stroke Unit, Ospedale San Bortolo, Vicenza, Italy
| | - Rossana Tassi
- U.O.C. Stroke Unit, Dipartimento di Scienze Neurologiche e Neurosensoriali, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Maria Sessa
- U.O. Neurologia, DAI Neuroscienze-Riabilitazione, Azienda Ospedaliera-Universitaria S. Anna, Ferrara, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Neurological Sciences, Sapienza University of Rome, Rome, Italy
| | - Rosanna Abbate
- Centro Studi Medicina Avanzata (CESMAV), Florence, Italy
| | - Domenico Inzitari
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
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17
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Liu Y, Gong P, Sun H, Zhang S, Zhou J, Zhang Y. Leukoaraiosis is associated with poor outcomes after successful recanalization for large vessel occlusion stroke. Neurol Sci 2019; 40:585-591. [PMID: 30612278 DOI: 10.1007/s10072-018-3698-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/31/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Leukoaraiosis (LA) is related to the dysfunction of the microcirculation and results in the impairment of the perfusion state. We investigated the association of LA and poor outcomes after successful recanalization by thrombectomy. METHODS We retrospectively analyzed 97 patients with anterior large-artery occlusion who underwent thrombectomy and had successful recanalization (modified Treatment in Cerebral Ischemia Scale score 2b or 3). All patients underwent magnetic resonance imaging (MRI). LA was evaluated using fluid-attenuated inversion recovery MRI and graded using the Fazekas scale. Poor functional outcome at day 90 and symptomatic intracerebral hemorrhage (sICH) were compared between patients with absent to mild LA and moderate to severe LA. Logistic regression analyses were performed to determine the association of LA severity and outcomes. RESULTS Moderate and severe LA occurred in 28.9% and 26.8% patients respectively. A higher proportion of poor outcomes were observed in patients with moderate to severe LA compared to patients with absent to mild LA (77.8% vs. 39.5%, p < 0.001). Logistic regression analyses showed patients with moderate to severe LA had 3.77 times (95%CI 1.21-11.76, p = 0.022) higher risk of having poor outcomes compared to patients with absent to mild LA. CONCLUSIONS LA severity may be associated with poor outcomes after successful recanalization for ischemic stroke with anterior large vessel occlusion.
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Affiliation(s)
- Yukai Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China
| | - Pengyu Gong
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China
| | - Huanhuan Sun
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China
| | - Shuting Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China.
| | - Yingdong Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, Jiangsu Province, 210006, People's Republic of China.
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18
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Arba F, Giannini A, Piccardi B, Biagini S, Palumbo V, Giusti B, Nencini P, Maria Gori A, Nesi M, Pracucci G, Bono G, Bovi P, Fainardi E, Consoli D, Nucera A, Massaro F, Orlandi G, Perini F, Tassi R, Sessa M, Toni D, Abbate R, Inzitari D. Small vessel disease and biomarkers of endothelial dysfunction after ischaemic stroke. Eur Stroke J 2018; 4:119-126. [PMID: 31259260 DOI: 10.1177/2396987318805905] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/18/2018] [Indexed: 01/01/2023] Open
Abstract
Introduction Although pathogenesis of small vessel disease is poorly understood, increasing evidence suggests that endothelial dysfunction may have a relevant role in development and progression of small vessel disease. In this cross-sectional study, we investigated the associations between imaging signs of small vessel disease and blood biomarkers of endothelial dysfunction at two different time points in a population of ischaemic stroke patients. Patients and methods In stroke patients treated with intravenous thrombolysis, we analysed blood levels of von Willebrand factor, intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and vascular endothelial growth factor. Three reviewers independently assessed small vessel disease features using computed tomography. At baseline and 90 days after the index stroke, we tested the associations between single and combined small vessel disease features and levels of blood biomarkers using linear regression analysis adjusting for age, sex, hypertension, diabetes, smoke. Results A total of 263 patients were available for the analysis. Mean age (±SD) was 69 (±13) years, 154 (59%) patients were male. We did not find any relation between small vessel disease and endothelial dysfunction at baseline. At 90 days, leukoaraiosis was independently associated with intercellular adhesion molecule-1 (β = 0.21; p = 0.016) and vascular cell adhesion molecule-1 (β = 0.22; p = 0.009), and lacunes were associated with vascular endothelial growth factor levels (β = 0.21; p = 0.009) whereas global small vessel disease burden was associated with vascular endothelial growth factor (β = 0.26; p = 0.006). Discussion Leukoaraiosis and lacunes were associated with endothelial dysfunction, which could play a key role in pathogenesis of small vessel disease. Conclusions Small vessel disease features and total burden were associated with endothelial dysfunction 90 days after the stroke, whereas there was no relation during the acute phase. Our results suggest that endothelial dysfunction, particularly vascular endothelial growth factor, is involved in pathological process of small vessel disease.
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Affiliation(s)
- Francesco Arba
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
- Stroke Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Alessio Giannini
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Benedetta Piccardi
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
- Stroke Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Silvia Biagini
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Vanessa Palumbo
- Stroke Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, Atherothrombotic Diseases Center, AOU Careggi, University of Florence, Florence, Italy
| | - Patrizia Nencini
- Stroke Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, Atherothrombotic Diseases Center, AOU Careggi, University of Florence, Florence, Italy
| | - Mascia Nesi
- Stroke Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Giorgio Bono
- Stroke Unit, Department of Neurology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Paolo Bovi
- SSO Stroke Unit, Department of Neurosciences, Azienda Ospedaliera Integrata, Verona, Italy
| | - Enrico Fainardi
- Department of Neuroradiology, Careggi University Hospital, Florence, Italy
| | | | - Antonia Nucera
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Canada
| | | | - Giovanni Orlandi
- Department of Neurosciences, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Francesco Perini
- UOC di Neurologia e Stroke Unit, Ospedale San Bortolo, Vicenza, Italy
| | - Rossana Tassi
- U.O.C. Stroke Unit, Dipartimento di Scienze Neurologiche e Neurosensoriali, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Maria Sessa
- U.O. Neurologia, Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Domenico Inzitari
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
- Department of Neuroradiology, Careggi University Hospital, Florence, Italy
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Forlivesi S, Cappellari M, Baracchini C, Viaro F, Critelli A, Tamborino C, Tonello S, Guidoni SV, Bruno M, Favaretto S, Burlina A, Turinese E, Ferracci F, Zambito Marsala S, Bazzano S, Orlando F, Turazzini M, Ricci S, Cadaldini M, De Biasia F, Bruno S, Gaudenzi A, Morra M, Danese A, L’Erario R, Russo M, Zanette G, Idone D, Basile AM, Atzori M, Masato M, Menegazzo E, Paladin F, Tonon A, Caneve G, Bozzato G, Campagnaro A, Carella S, Nicolao P, Padoan R, Perini F, De Boni A, Adami A, Bonetti B, Bovi P. Intravenous thrombolysis for ischemic stroke in the Veneto region: the gap between eligibility and reality. J Thromb Thrombolysis 2018; 47:113-120. [DOI: 10.1007/s11239-018-1753-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sillanpää N, Pienimäki JP, Protto S, Seppänen J, Numminen H, Rusanen H. Chronic Infarcts Predict Poor Clinical Outcome in Mechanical Thrombectomy of Sexagenarian and Older Patients. J Stroke Cerebrovasc Dis 2018. [PMID: 29525077 DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND The impact of lacunar and cortical chronic ischemic lesions (CILs) on the clinical outcome of mechanical thrombectomy (MT) has been little studied. Clinical trials suggest that older patients benefit from MT. We investigated the effect of CILs on the clinical outcome of sexagenarian and older patients with acute middle cerebral artery (MCA) or distal internal carotid artery (ICA) stroke who received MT to treat large-vessel occlusion (LVO). METHODS We prospectively collected the clinical and imaging data of 130 consecutive MT patients of which 68 met the inclusion criteria. We limited the analysis to sexagenarian and older subjects and occlusions no distal than the M2 segment. Baseline clinical, procedural and imaging variables, technical outcome, 24-hour imaging outcome, and the clinical outcome were recorded. Differences between patients with and without CILs were studied with appropriate statistical tests and binary logistic regression analysis. RESULTS Twenty-one patients (31%) had at least 1 CIL. Thirty-eight percent of patients with CIL(s) compared with 62% without (P = .06) experienced good clinical outcome (3-month modified Rankin Scale ≤ 2). A similar nonsignificant trend was seen when lacunar lesions, lesion multiplicity, and chronic white matter lesions were examined separately. Absence of CIL increased the odds of good clinical outcome 3.7-fold (95% confidence interval 1.0-10.7, P = .05) in logistic regression modeling. CONCLUSIONS Chronic cortical and lacunar infarcts in admission imaging are associated with poor clinical outcome in sexagenarian and older patients treated with MT for LVO of the MCA or distal ICA.
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Affiliation(s)
- Niko Sillanpää
- Medical Imaging Center, Tampere University Hospital, Tampere, Finland.
| | | | - Sara Protto
- Medical Imaging Center, Tampere University Hospital, Tampere, Finland
| | - Janne Seppänen
- Medical Imaging Center, Tampere University Hospital, Tampere, Finland
| | - Heikki Numminen
- Department of Neurology, Tampere University Hospital, Tampere
| | - Harri Rusanen
- Department of Neurology, Oulu University Hospital, Oulu
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Liu Y, Zhang M, Chen Y, Gao P, Yun W, Zhou X. The degree of leukoaraiosis predicts clinical outcomes and prognosis in patients with middle cerebral artery occlusion after intravenous thrombolysis. Brain Res 2017; 1681:28-33. [PMID: 29288062 DOI: 10.1016/j.brainres.2017.12.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
Abstract
Leukoaraiosis (LA) is common in elderly patients with ischemic stroke on magnetic resonance imaging. In this study, we investigate whether the degree of LA is associated with clinical outcomes and prognosis of patients with middle cerebral artery occlusion following intravenous thrombolytic. Ninety-seven patients were recruited and divided into three groups based on the degree of LA (no, mild and moderate to severe LA) by the Fazekas scale. Clinical outcomes, recurrent stroke, Fugl-Meyer rating scale (FMS) and complications of intravenous thrombolysis were assessed. The association between the degree of LA and functional outcomes was analyzed by multivariable logistic regression model. Patients enrolled were divided into three groups: 26 patients with no LA, 43 patients with mild LA and 28 patients with moderate to severe LA. Impressively, the patients with mild LA were better in early neurological recovery and 90-day FMS score than patients in the other two groups. Multivariate logistic analysis revealed that moderate to severe LA was an independent predictor of poor functional outcome (OR: 10.482; 95% CI: 1.442-76.181; P = .020). Moreover, the patients with moderate to severe LA have a higher rate of hemorrhagic transformation and recurrent stroke as compared with two other groups during 90-day follow-up. Different degrees of LA differentially affect clinical outcome and prognosis in patients with middle cerebral artery occlusion following intravenous thrombolytic. Moderate to severe LA is a risk factor of poor prognosis. Mild LA is associated with early neurological recovery and good motor functional outcome.
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Affiliation(s)
- Yanyan Liu
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Min Zhang
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Yuan Chen
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Ping Gao
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Wenwei Yun
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China.
| | - Xianju Zhou
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China.
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Leung LY, Bartz TM, Rice K, Floyd J, Psaty B, Gutierrez J, Longstreth WT, Mukamal KJ. Blood Pressure and Heart Rate Measures Associated With Increased Risk of Covert Brain Infarction and Worsening Leukoaraiosis in Older Adults. Arterioscler Thromb Vasc Biol 2017; 37:1579-1586. [PMID: 28663254 PMCID: PMC5551454 DOI: 10.1161/atvbaha.117.309298] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/14/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE In people without previous stroke, covert findings on serial magnetic resonance imaging (MRI) of incident brain infarcts and worsening leukoaraiosis are associated with increased risk for ischemic stroke and dementia. We evaluated whether various measures of blood pressure (BP) and heart rate are associated with these MRI findings. APPROACH AND RESULTS In the CHS (Cardiovascular Health Study), a longitudinal cohort study of older adults, we used relative risk regression to assess the associations of mean, variability, and trend in systolic BP, diastolic BP, and heart rate measured at 4 annual clinic visits between 2 brain MRIs with incident covert brain infarction and worsening white matter grade (using a 10-point scale to characterize leukoaraiosis). We included participants who had both brain MRIs, no stroke before the follow-up MRI, and no change in antihypertensive medication status during follow-up. Among 878 eligible participants, incident covert brain infarction occurred in 15% and worsening white matter grade in 27%. Mean systolic BP was associated with increased risk for incident covert brain infarction (relative risk per 10 mm Hg, 1.28; 95% confidence interval, 1.12-1.47), and mean diastolic BP was associated with increased risk for worsening white matter grade (relative risk per 10 mm Hg, 1.45; 95% confidence interval, 1.24-1.69). These findings persisted in secondary and sensitivity analyses. CONCLUSIONS Elevated mean systolic BP is associated with increased risk for covert brain infarction, and elevated mean diastolic BP is associated with increased risk for worsening leukoaraiosis. These findings reinforce the importance of hypertension in the development of silent cerebrovascular diseases, but the pathophysiologic relationships to BP for each may differ.
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Affiliation(s)
- Lester Y Leung
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.).
| | - Traci M Bartz
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Kenneth Rice
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - James Floyd
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Bruce Psaty
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Jose Gutierrez
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - W T Longstreth
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Kenneth J Mukamal
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
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Arba F, Inzitari D, Ali M, Warach SJ, Luby M, Lees KR. Small vessel disease and clinical outcomes after IV rt-PA treatment. Acta Neurol Scand 2017; 136:72-77. [PMID: 28233290 DOI: 10.1111/ane.12745] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Cerebral small vessel disease (SVD) contributes to dementia and disability in the elderly, and may negatively affect stroke outcomes. We aimed to evaluate to what extent single features and global burden of SVD detected with magnetic resonance (MR) are associated with worse outcomes in patients with ischaemic stroke treated with intravenous thrombolysis. METHODS We accessed anonymized data and MR images from the Stroke Imaging Repository (STIR) and the Virtual International Stroke Trials Archive (VISTA) Imaging. We described SVD features using validated scales and quantified the global burden of SVD with a combined score. Our mainoutcome was the modified Rankin Scale (mRS) at 90 days after stroke. We used logistic regression and ordinal regression models (adjusted for age, sex, stroke severity, onset to treatment time) to examine the associations between each SVD feature, SVD global burden and clinical outcomes. RESULTS A total of 259 patients had MR scans available at baseline (mean age±SD=68.7±15.5 years; 131 [49%] males). After adjustment for confounders, severe white matter changes were associated with disability (OR=5.14; 95%CI=2.30-11.48), functional dependency (OR=4.38; 95%CI=2.10-9.13) and worse outcomes in ordinal analysis (OR=2.71; 95%CI=1.25-5.85). SVD score was associated with disability (OR=1.66; 95%CI=1.03-2.66) and functional dependency (OR=1.47; 95%CI=1.00-2.45). Lacunes, enlarged perivascular spaces and brain atrophy showed no association with clinical outcomes. CONCLUSION Our results suggest that SVD negatively affects stroke outcomes after intravenous thrombolysis. Although white matter changes seem to be the major driver in relation to worse outcomes, global estimation of SVD is feasible and may provide helpful information.
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Affiliation(s)
- F. Arba
- NEUROFARBA Department; University of Florence; Florence Italy
- Institute of Cardiovascular and Medical Sciences; Queen Elizabeth University Hospital Glasgow; Glasgow UK
| | - D. Inzitari
- NEUROFARBA Department; University of Florence; Florence Italy
| | - M. Ali
- Institute of Cardiovascular and Medical Sciences; Queen Elizabeth University Hospital Glasgow; Glasgow UK
| | - S. J. Warach
- Department of Neurology; Dell Medical School; University of Texas at Austin; Austin TX USA
| | - M. Luby
- National Institute of Neurological Disorders and Stroke (NINDS); National Institutes of Health (NIH); Bethesda MD USA
| | - K. R. Lees
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
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Paciaroni M, Pantoni L. Thrombolysis in dementia patients with acute stroke: is it justified? Neurol Sci 2016; 38:27-31. [PMID: 27699498 DOI: 10.1007/s10072-016-2725-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
The administration of thrombolytic therapy in elderly patients with dementia and acute ischemic stroke may be controversial, because the reported risk of rt-PA associated intracerebral hemorrhage in these patients is higher compared with that of patients without dementia and because these patients are already disabled. Moreover, there are known risk factors for hemorrhagic transformation in patients with dementia: amyloid angiopathy, leukoaraiosis and the presence of microbleeds. In this review, we describe the impact of dementia on functional outcome following thrombolytic therapy for acute ischemic stroke and discuss some of the issues related to the use of this therapy in this specific patient's population.
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Affiliation(s)
- Maurizio Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, 06126, Perugia, Italy.
| | - Leonardo Pantoni
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy.
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Chen Z, Li W, Sun W, Xiao L, Dai Q, Cao Y, Han Y, Zhu W, Xu G, Liu X. Correlation study between small vessel disease and early neurological deterioration in patients with mild/moderate acute ischemic stroke. Int J Neurosci 2016; 127:579-585. [DOI: 10.1080/00207454.2016.1214825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Association between Leukoaraiosis and Poor Outcome is not due to Reperfusion Inefficiency after Intravenous Thrombolysis. Transl Stroke Res 2016; 7:439-45. [PMID: 27256491 DOI: 10.1007/s12975-016-0473-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
Abstract
Leukoaraiosis (LA) is associated with structural and functional cerebrovascular impairment, which may compromise the capacity of ischemic tissue to maximize reperfusion after intravenous thrombolysis (IVT). We aimed to determine whether severe LA is correlated with reperfusion inefficiency, which contributes to infarct growth and poor functional outcome. We analyzed data from our consecutive acute ischemic stroke (AIS) patients who had acquired baseline and 24-h follow-up diffusion- and perfusion-weighted imaging. Reperfusion was defined as reduction of ≥70 % of hypoperfusion lesion at 24 h from baseline. Severe LA was defined as Fazekas score 2 or 3 on FLAIR images. We investigated the relationship between severity of LA and reperfusion status. Multivariate statistical analysis was carried out for modeling the independent predictors of reperfusion, infarct growth, and functional outcome. Finally, 79 patients were included, among them 30 (37.97 %) had severe LA. Reperfusion was observed in 41 (51.89 %) patients, the proportion of reperfusion was very similar in patients with and without severe LA (53.33 vs 51.02 %, p = 1.000). Large artery occlusion was the only independent unfavorable predictor for reperfusion (OR = 0.202, 95 % confidence interval, 0.060-0.673; p = 0.014). Multiple linear regression analysis revealed that severe LA was independently associated with infarct growth (standardized coefficients = 0.191, p = 0.040). Severe LA was also an independent predictor of poor outcome (mRS ≥ 3) (OR = 4.004, 95 % confidence interval, 1.267-12.656, p = 0.018) after adjusting for reperfusion and baseline severity of stroke. Severe LA was associated with infarct growth and poor outcome independent of reperfusion status, which may expand the notion that LA contributes the intrinsic vulnerability of brain tissue to acute ischemic insults. The burden of LA may not serve as an imaging indicator of reperfusion inefficiency after IVT for AIS patients.
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Zerna C, Hegedus J, Hill MD. Evolving Treatments for Acute Ischemic Stroke. Circ Res 2016; 118:1425-42. [DOI: 10.1161/circresaha.116.307005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/11/2016] [Indexed: 11/16/2022]
Abstract
The purpose of this article is to review advances in stroke treatment in the hyperacute period. With recent evolutions of technology in the fields of imaging, thrombectomy devices, and emergency room workflow management, as well as improvement in statistical methods and study design, there have been ground breaking changes in the treatment of acute ischemic stroke. We describe how stroke presents as a clinical syndrome and how imaging as the most important biomarker will help differentiate between stroke subtypes and treatment eligibility. The evolution of hyperacute treatment has led to the current standard of care: intravenous thrombolysis with tissue-type plasminogen activator and endovascular treatment for proximal vessel occlusion in the anterior cerebral circulation. All patients with acute ischemic stroke are in need of hyperacute secondary prevention because the risk of recurrence is highest closest to the index event. The dominant themes of modern stroke care are the use of neurovascular imaging and speed of diagnosis and treatment.
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Affiliation(s)
- Charlotte Zerna
- From the Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Janka Hegedus
- From the Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Michael D. Hill
- From the Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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