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Kubota Y, Oya F, Higashiyama F. A Case of Carotid Sinus Reflex Caused by Manual Aspiration Thrombectomy Using a Balloon Guide Catheter. Cureus 2024; 16:e56253. [PMID: 38623094 PMCID: PMC11017137 DOI: 10.7759/cureus.56253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/17/2024] Open
Abstract
When starting a mechanical thrombectomy, manual aspiration with balloon guide catheters inserted into the internal carotid artery (ICA) is an efficient method for thrombus aspiration. However, no complications associated with this procedure have been reported. This study describes the case of a 76-year-old man who presented to our hospital with total aphasia and complete right-sided paralysis due to chronic atrial fibrillation and left occlusion of the ICA. When the balloon guide catheter was inserted and inflated at the origin of the left ICA, the patient's systolic blood pressure suddenly decreased from 114 mm Hg to 44 mm Hg. This sudden hypotension may have been caused by the carotid sinus reflex. Hypotension improved following balloon deflation. The procedure was continued, resulting in complete recanalization of the left ICA. The patient died from acute exacerbation of interstitial pneumonia. Although this complication is rare, similar phenomena have been recognized in carotid artery stenting and the use of flow-diverting devices. To the best of our knowledge, this is the first report of a case wherein the carotid sinus reflex was induced by manual aspiration using a balloon guide catheter placed in the ICA. Clinicians should recognize the importance of ensuring that the proximal end of the balloon crosses the carotid sinus when dilating and occluding the ICA with a balloon to avoid the carotid sinus reflex.
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Affiliation(s)
- Yuki Kubota
- Neurosurgery, Shinshu Ueda Medical Center, Ueda, JPN
| | - Fusakazu Oya
- Neurosurgery, Shinshu Ueda Medical Center, Ueda, JPN
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Hirata H, Kaneshiro Y, Urano Y, Murata K. Mechanical Thrombectomy Using Double Stent Retriever Technique for Acute Ischemic Stroke Following Embolism From the Pulmonary Vein Stump After Left Upper Lobectomy: A Case Report. Cureus 2024; 16:e56610. [PMID: 38516287 PMCID: PMC10955183 DOI: 10.7759/cureus.56610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 03/23/2024] Open
Abstract
Acute ischemic stroke (AIS) following pulmonary lobectomy, which is traditionally attributed to air embolism and atrial fibrillation (AF), may occur after thrombus formation in the pulmonary vein stump (PVS). Herein, we document the mechanical thrombectomy (MT) of a carotid bifurcation occlusion post-left upper lobectomy (LUL) to manage AIS. A 76-year-old male with a history of diabetes, dyslipidemia, and a treated dural arteriovenous fistula at the transverse sigmoid junction, with no history of AF, successfully underwent LUL for a pulmonary tumor. The patient independently walked on postoperative day 1. He developed right hemiparesis and total aphasia on the morning of the second day after surgery, which was discovered by the nursing staff. A magnetic resonance imaging (MRI) confirmed an occlusion of the left common carotid artery (CCA). Tissue plasminogen activator (t-PA) was not administered owing to recent surgery. An urgent MT using multiple MT techniques carried out 90 minutes after the discovery of symptoms only achieved partial recanalization. Subsequently, a double stent retriever technique (DSRT) addressed the occlusion in the common and cervical internal carotid artery (ICA). Following this, a T occlusion was encountered, which was addressed with a combined approach using a single stent retriever (SR), achieving a thrombolysis in cerebral infarction (TICI) grade 2b result. However, postoperative aphasia and severe right hemiparesis remained. Postoperative imaging showed a significant left cerebral hemisphere infarction and a thrombus in the PVS. Oral edoxaban was administered, and PVS thrombosis did not recur. The patient was transferred to a rehabilitation facility 190 days post-embolization with a modified Rankin Scale score of 4. In this report, we demonstrate the challenging case of the DSRT in addressing AIS after LUL, which led to the formation of a massive thrombus and occlusion of the carotid artery, as revealed by the PVS. This case emphasizes the importance of collaborative efforts between thoracic surgeons and all staff involved in stroke care in managing such complex scenarios.
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Affiliation(s)
- Haruki Hirata
- Department of Neurosurgery, Shimada General Medical Center, Shimada, JPN
| | - Yuta Kaneshiro
- Department of Neurosurgery, Shimada General Medical Center, Shimada, JPN
| | - Yumiko Urano
- Department of Neurosurgery, Shimada General Medical Center, Shimada, JPN
| | - Keiji Murata
- Department of Neurosurgery, Shimada General Medical Center, Shimada, JPN
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Kara S, Gutierrez Munoz FG, Eckes J, Abdelmoneim SS, Nedd K. Posterior Inferior Cerebellar Artery Stroke Due to a Severe Right Vertebral Artery Stenosis With a Left Cervical Internal Carotid Artery Dissection: What's Next? Cureus 2024; 16:e55598. [PMID: 38586807 PMCID: PMC10994864 DOI: 10.7759/cureus.55598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Guidelines for the treatment and management of ischemic strokes triggered by stenosis versus dissection are well established. However, the presence of both entities in the same patient, although rare, poses challenges for short- and long-term treatment. Here, we describe the case of a 55-year-old man who presented to the emergency department with a 72-hour history of headache, dizziness, unbalanced gait, nausea, and two episodes of vomiting. Stroke was initially suspected, but the computerized tomography (CT) scan showed no hemorrhage. His magnetic resonance imaging (MRI) showed right inferior cerebellar acute ischemia in the territory of the right posterior inferior cerebellar artery (PICA), with smaller foci of early acute infarcts in the bilateral inferior cerebellum. Furthermore, magnetic resonance angiography (MRA) and CT angiography revealed right vertebral artery stenosis and left cervical internal carotid artery dissection (ICAD). This clinical report describes a rare case of stroke secondary to vertebral artery stenosis with concomitant carotid artery dissection. The treatment course and evolution are presented.
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Affiliation(s)
- Sam Kara
- Department of Neurology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | | | - Jeremy Eckes
- Department of Neurology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - Sahar S Abdelmoneim
- Department of Internal Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - Kester Nedd
- Department of Neurology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
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Nagao Y, Inatomi Y, Naganuma M, Yonehara T, Nakajima M. Carotid Free-Floating Thrombus Treated With a Combined Technique Using Embotrap III for Distal Protection. Cureus 2024; 16:e53775. [PMID: 38465097 PMCID: PMC10921119 DOI: 10.7759/cureus.53775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Carotid free-floating thrombus (FFT) is a rare condition in patients with acute ischemic stroke. Recently, endovascular therapy for carotid FFT has been increasingly reported, but the strategy has not yet been established. We report a case of an acute stroke patient with a carotid FFT, who was successfully treated with a combination of the direct aspiration first-pass technique (ADAPT) and the Embotrap III (Cerenovus, Irvine, CA), specifically designed to prevent distal embolization. We propose the utility of distal embolic protection with Embotrap III for the treatment of patients with carotid FFT. A 71-year-old man who presented with sudden left hemiparesis was admitted to our hospital. Ultrasonography on admission revealed severe stenosis and an FFT at the origin of the right internal carotid artery. Thrombectomy with an aspiration catheter, accompanied by a stent retriever with distal basket Embotrap III for distal protection, was performed. After the FFT was safely aspirated, a carotid Wallstent (Boston Scientific, Marlborough, MA) was deployed in the stenosis. Follow-up ultrasonography showed neither FFT nor in-stent protrusion. The patient did not experience recurrence, as per clinical or radiological findings, and was discharged on day 11 without any neurological deficits. Embotrap III may be useful for a patient with a carotid FFT as distal protection during mechanical thrombectomies.
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Affiliation(s)
| | | | | | | | - Makoto Nakajima
- Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, JPN
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Chen YF, Qi S, Yu ZJ, Li JT, Qian TT, Zeng Y, Cao P. Systemic Inflammation Response Index Predicts Clinical Outcomes in Patients With Acute Ischemic Stroke (AIS) After the Treatment of Intravenous Thrombolysis. Neurologist 2023; 28:355-361. [PMID: 37027178 PMCID: PMC10627531 DOI: 10.1097/nrl.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Intravenous thrombolysis (IVT) is one of the most important means of therapy for patients with acute ischemic stroke (AIS). After cerebral infarction, the inflammatory response fulfills an essential role in the pathobiology of stroke, affecting the process of recanalization. Hence, we evaluated the usefulness of the systemic inflammatory response index (SIRI) for the prognosis of patients with AIS. METHODS A total of 161 patients suffering from AIS were retrospectively analyzed. SIRI was introduced and calculated using the absolute neutrophil, monocyte, and lymphocyte numbers from the admission blood work. The study outcomes were determined using a modified Rankin Scale (mRS) at the 3-month timepoint, and a favorable clinical outcome was calculated in the mRS score range of 0 to 2. The analysis of receiver operating characteristic (ROC) curves was performed to determine the values of the optimal cutoff of SIRI for the prediction of clinical outcomes. In addition, multivariate analyses were performed to investigate the association between clinical outcomes and SIRI. RESULTS The ROC curve analysis revealed that the ideal SIRI cutoff was at 2.54 [area under the curve, 78.85%; 95% CI, 71.70% to 86.00%; sensitivity, 70.89%; and specificity, 84.14%]. Multivariate analysis indicated that SIRI ≤2.54 (odds ratio, 1.557, 95% CI, 1.269 to 1.840; P =0.021) was an independent predictor of favorable clinical outcomes in patients suffering from AIS after treatment with IVT. CONCLUSIONS We preliminary speculate that SIRI may serve as an independent predictor of clinical outcomes with AIS following IVT.
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Affiliation(s)
| | - Shuo Qi
- Hepatopancreatobiliary Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zi-Jian Yu
- Hepatopancreatobiliary Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jiang-Tao Li
- Hepatopancreatobiliary Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | | | - Ying Zeng
- First Affiliated Hospital, Departments of Neurology
| | - Peng Cao
- Hepatopancreatobiliary Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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Esteak T, Hasan M, Atiqur Rahman M, Islam DMK, Ray SK, Hosain A, Alam S, Zannat T, Hasan AH, Khan SU. Elevated Troponin I as a Marker for Unfavorable Outcomes in Acute Ischemic Stroke. Cureus 2023; 15:e49568. [PMID: 38156181 PMCID: PMC10753148 DOI: 10.7759/cureus.49568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVE To assess if elevated cardiac troponin I (cTnI) serves as a sign of unfavorable functional outcomes in ischemic stroke. METHODS In this single-center prospective cohort study, 100 consecutive patients admitted with acute ischemic stroke (normal troponin I group n = 52, raised troponin I group n = 48) were included. Hospital mortality was documented in both groups; the remaining patients were followed up to 90 days. Then two groups were compared in terms of unfavorable short-term outcomes (Modified Rankin Scale > 3) and mortality. Multivariate logistic regression was conducted to determine the predictive value of elevated cTnI. The Kaplan-Meier curve was drawn and compared to determine the difference in survival between the two groups. To find out the most probable cut-off level for an unfavorable outcome, a receiver operating characteristic (ROC) analysis was conducted. RESULT A higher frequency of coronary artery disease (p=0.030), higher National Institutes of Health Stroke Scale (NIHSS) (p=0.008) score, and lower Glasgow Coma Scale (GCS) (p=0.002) was observed in raised troponin I group. Even after the exclusion of confounding elevated troponin I was found to be an independent predictor of unfavorable outcomes (adjusted odds ratio, OR 8.25 {95% confidence interval, CI: 2.65-25.75}; p<0.001). The patients with raised troponin I had a significantly lower rate of survival after 90 days (p=0.022). The elevated troponin I was observed to have a significantly high accuracy (p<0.001; area under curve, AUC: 0.768 {moderate accuracy}, 95% CI: 0 .676 to 0.861) in predicting unfavorable outcomes. CONCLUSION Elevated cTnI is independently associated with unfavorable short-term outcomes. It is also associated with a lower rate of survival.
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Affiliation(s)
- Tareq Esteak
- Clinical Neurology, National Institute of Neurosciences and Hospital, Dhaka, BGD
| | - Mashfiqul Hasan
- Endocrinology and Metabolism, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Mohammad Atiqur Rahman
- Endocrinology and Metabolism, National Institute of Neurosciences and Hospital, Dhaka, BGD
| | | | - Swapan Kumar Ray
- Clinical Neurology, National Institute of Neurosciences and Hospital, Dhaka, BGD
| | - Ahmed Hosain
- Pediatric Neurology, National Institute of Neurosciences and Hospital, Dhaka, BGD
| | - Sarah Alam
- Pediatric Neurology, National Institute of Neurosciences and Hospital, Dhaka, BGD
| | - Tahira Zannat
- Clinical Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Atm Hasibul Hasan
- Interventional Neurology, National Institute of Neurosciences and Hospital, Dhaka, BGD
| | - Sharif Uddin Khan
- Clinical Neurology, National Institute of Neurosciences and Hospital, Dhaka, BGD
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Lodeen H, Esmati S, Okan T, Arastu A, Vilendecic D, Singh G, Mangla A, Moshayedi P, Lasic Z. The Simultaneous Occurrence of Acute ST-Elevation Myocardial Infarction, Acute Ischemic Stroke, and Pulmonary Embolism. Cureus 2023; 15:e44222. [PMID: 37767245 PMCID: PMC10522405 DOI: 10.7759/cureus.44222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
Acute ST-elevation myocardial infarction (STEMI), acute ischemic stroke (AIS), and acute pulmonary embolism (PE) are life-threatening conditions, each posing a high risk of morbidity and mortality. When all three of these acute conditions occur simultaneously, the overall prognosis for the patient becomes considerably worse. We report a case of a 70-year-old woman who presented to the emergency department (ED) with a triad of acute STEMI, AIS, and PE as a consequence of atherosclerotic heart disease, atrial fibrillation, and a prolonged transatlantic flight. The diagnoses were promptly confirmed through emergent coronary and cerebral angiography, along with a computerized tomography pulmonary angiogram (CTPA). The patient underwent a combination of medical therapy and endovascular thrombectomy. However, she later developed a subarachnoid hemorrhage and eventually progressed to brain death.
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Affiliation(s)
- Homayoon Lodeen
- Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Saliman Esmati
- Internal Medicine, Jamaica Hospital Medical Center, New York , USA
| | - Tetyana Okan
- Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Azeem Arastu
- Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Dora Vilendecic
- Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Gagandeep Singh
- Cardiology, Northwell Health Lenox Hill Hospital, New York, USA
| | - Aditya Mangla
- Cardiology, Northwell Health Lenox Hill Hospital, New York, USA
| | - Pouria Moshayedi
- Interventional Neurology, Jamaica Hospital Medical Center, New York, USA
| | - Zoran Lasic
- Cardiology, Northwell Health Lenox Hill Hospital, New York, USA
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Liu XT, Ren PW, Peng L, Kang DY, Zhang TL, Wen S, Hong Q, Yang WJ. Effectiveness and safety of ShenXiong glucose injection for acute ischemic stroke: a systematic review and GRADE approach. BMC Complement Altern Med 2016; 16:68. [PMID: 26895969 PMCID: PMC4761180 DOI: 10.1186/s12906-016-1038-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 02/04/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND To appraise critically whether published trials of ShenXiong glucose injection for patients with acute ischemic stroke (AIS) are of sufficient quality, and in addition to rate the quality of evidence by using the GRADE approach (grading of recommendations, assessment, development, and evaluation, GRADE). METHODS A literature search was performed in the Cochrane Library, MEDLINE, EMBASE, CBM, Chinese TCM (traditional Chinese medicine) Database, CNKI, VIP, WanFang Databases until January 2015. The limits were patients with AIS and randomized controlled trials (RCTs) or quasi-RCTs. Studies by which patients suffering intracerebral haemorrhage were excluded. RESULTS Twelve studies fulfilled the inclusion criteria. We found significant benefits of ShenXiong glucose injection compared with conventional treatment in improving activities of daily living function at 4 weeks (MD = 34.12, 95 % CI: 29.07, 39.17), neurological function deficit at 2 weeks (MD = -5.39, 95% CI: -6.90, -3.87), 4 weeks (MD = -5.16, 95 % CI: -6.49, -3.83), and clinical effects at 4 weeks (RR = 1.17, 95% CI: 1.10, 1.24). No trials reported the effects of ShenXiong glucose injection on the risk of early, deterioration, or quality of life. No adverse events were reported within the whole follow-up period. CONCLUSIONS The use of ShenXiong glucose injection may improve rehabilitation for patients with acute ischemic stroke, however, as the GRADE approach indicated low to moderate quality of available evidence as well as insufficient information about harm and patients preference, the recommendations were not provided for ShenXiong glucose injection taking as a therapeutic intervention to patients with acute ischemic stroke.
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Affiliation(s)
- Xue-ting Liu
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - Peng-wei Ren
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - Le Peng
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - De-ying Kang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - Tian-le Zhang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - Shu Wen
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - Qi Hong
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - Wen-jie Yang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
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Yu S, Liebeskind DS, Dua S, Wilhalme H, Elashoff D, Qiao XJ, Alger JR, Sanossian N, Starkman S, Ali LK, Scalzo F, Lou X, Yoo B, Saver JL, Salamon N, Wang DJJ. Postischemic hyperperfusion on arterial spin labeled perfusion MRI is linked to hemorrhagic transformation in stroke. J Cereb Blood Flow Metab 2015; 35:630-7. [PMID: 25564233 PMCID: PMC4420881 DOI: 10.1038/jcbfm.2014.238] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to investigate the relationship between hyperperfusion and hemorrhagic transformation (HT) in acute ischemic stroke (AIS). Pseudo-continuous arterial spin labeling (ASL) with background suppressed 3D GRASE was performed during routine clinical magnetic resonance imaging (MRI) on AIS patients at various time points. Arterial spin labeling cerebral blood flow (CBF) maps were visually inspected for the presence of hyperperfusion. Hemorrhagic transformation was followed during hospitalization and was graded on gradient recalled echo (GRE) scans into hemorrhagic infarction (HI) and parenchymal hematoma (PH). A total of 361 ASL scans were collected from 221 consecutive patients with middle cerebral artery stroke from May 2010 to September 2013. Hyperperfusion was more frequently detected posttreatment (odds ratio (OR) = 4.8, 95% confidence interval (CI) 2.5 to 8.9, P < 0.001) and with high National Institutes of Health Stroke Scale (NIHSS) scores at admission (P<0.001). There was a significant association between having hyperperfusion at any time point and HT (OR = 3.5, 95% CI 2.0 to 6.3, P < 0.001). There was a positive relationship between the grade of HT and time-hyperperfusion with the Spearman's rank correlation of 0.44 (P = 0.003). Arterial spin labeling hyperperfusion may provide an imaging marker of HT, which may guide the management of AIS patients post tissue-type plasminogen activator (tPA) and/or endovascular treatments. Late hyperperfusion should be given more attention to prevent high-grade HT.
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Affiliation(s)
- Songlin Yu
- Department of Neurology, UCLA, Los Angeles, California, USA
| | | | - Sumit Dua
- Department of Radiology, UCLA, Los Angeles, California, USA
| | - Holly Wilhalme
- Department of Medicine Statistics Core, UCLA, Los Angeles, California, USA
| | - David Elashoff
- Department of Medicine Statistics Core, UCLA, Los Angeles, California, USA
| | - Xin J Qiao
- Department of Radiology, UCLA, Los Angeles, California, USA
| | - Jeffry R Alger
- 1] Department of Neurology, UCLA, Los Angeles, California, USA [2] Department of Radiology, UCLA, Los Angeles, California, USA
| | | | - Sidney Starkman
- 1] Department of Neurology, UCLA, Los Angeles, California, USA [2] Department of Emergency Medicine, UCLA, Los Angeles, California, USA
| | - Latisha K Ali
- Department of Neurology, UCLA, Los Angeles, California, USA
| | - Fabien Scalzo
- Department of Neurology, UCLA, Los Angeles, California, USA
| | - Xin Lou
- 1] Department of Neurology, UCLA, Los Angeles, California, USA [2] Department of Radiology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Bryan Yoo
- Department of Radiology, UCLA, Los Angeles, California, USA
| | | | - Noriko Salamon
- Department of Radiology, UCLA, Los Angeles, California, USA
| | - Danny J J Wang
- 1] Department of Neurology, UCLA, Los Angeles, California, USA [2] Department of Radiology, UCLA, Los Angeles, California, USA
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