scholarly journals Rate of Infarct–Edema Growth on CT Predicts Need for Surgical Intervention and Clinical Outcome in Patients with Cerebellar Infarction

2021 ◽  
Author(s):  
Yan Wang ◽  
Michael M. Binkley ◽  
Min Qiao ◽  
Amanda Pardon ◽  
Salah Keyrouz ◽  
...  
Keyword(s):  
Growth Rate ◽  
Clinical Outcome ◽  
Odds Ratio ◽  
Surgical Intervention ◽  
Ct Scans ◽  
Cerebellar Infarction ◽  
Vascular Territory ◽  
Poor Clinical Outcome ◽  
Edema Volume ◽  
Surgical Group

Abstract Background Up to 20% of patients with cerebellar infarcts will develop malignant edema and deteriorate clinically. Radiologic measures, such as initial infarct size, aid in identifying individuals at risk. Studies of anterior circulation stroke suggest that mapping early edema formation improves the ability to predict deterioration; however, the kinetics of edema in the posterior fossa have not been well characterized. We hypothesized that faster edema growth within the first hours after acute cerebellar stroke would be an indicator for individuals requiring surgical intervention and those with worse neurological outcomes. Methods Consecutive patients admitted to the neurological intensive care unit with acute cerebellar infarction were retrospectively identified. Hypodense regions of infarct and associated edema, “infarct–edema”, were delineated by using ABC/2 for all computed tomography (CT) scans up to 14 days from last known well. To examine how rate of infarct–edema growth varied across clinical variables and surgical intervention status, nonlinear and linear mixed-effect models were performed over 2 weeks and 2 days, respectively. In patients with at least two CT scans, multivariable logistic regression examined clinical and radiological predictors of surgical intervention (defined as extraventricular drainage and/or posterior fossa decompression) and poor clinical outcome (discharge to skilled nursing facility, long-term acute care facility, hospice, or morgue). Results Of 150 patients with acute cerebellar infarction, 38 (25%) received surgical intervention and 45 (30%) had poor clinical outcome. Age, admission National Institutes of Health Stroke Scale (NIHSS) score, and baseline infarct–edema volume did not differ, but bilateral/multiple vascular territory involvement was more frequent (87% vs. 50%, p < 0.001) in the surgical group than that in the medical intervention group. On 410 serial CTs, infarct–edema volume progressed rapidly over the first 2 days, followed by a subsequent plateau. Of 112 patients who presented within two days, infarct–edema growth rate was greater in the surgical group (20.1 ml/day vs. 8.01 ml/day, p = 0.002). Of 67 patients with at least two scans, after adjusting for baseline infarct–edema volume, vascular territory, and NIHSS, infarct–edema growth rate over the first 2 days (odds ratio 2.55; 95% confidence interval 1.40–4.65) was an independent, and the strongest, predictor of surgical intervention. Further, early infarct–edema growth rate predicted poor clinical outcome (odds ratio 2.20; 95% confidence interval 1.30–3.71), independent of baseline infarct–edema volume, brainstem infarct, and NIHSS. Conclusions Early infarct–edema growth rate, measured via ABC/2, is a promising biomarker for identifying the need for surgical intervention in patients with acute cerebellar infarction. Additionally, it may be used to facilitate discussions regarding patient prognosis.

Abstract P338: Incidence, Predictors and Impact of Infarct in New Territory in Escape Na1 Trial

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nishita Singh ◽  
Martha Marko ◽  
Petra Cimflova ◽  
Johanna Ospel ◽  
Nima Kashani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Endovascular Therapy ◽  
Randomized Study ◽  
Maximum Diameter ◽  
Vascular Territory ◽  
Poor Clinical Outcome ◽  
Guide Catheter ◽  
Ct And Mri

Introduction: Infarct in new territory (INT) is a known complication of endovascular therapy. We assessed the prevalence, predictors and clinical relevance of INT Methods: We included patients from the ESCAPE-NA1: a multicenter, international randomized study that assessed the efficacy of intravenous nerinetide in patients with acute ischemic stroke who underwent EVT within 12 hours from onset. All imaging was re-evaluated, and INT was defined by presence of infarct in new vascular territory, outside the baseline target occlusion(s) on follow up CT and MRI. INT’s were classified by maximum diameter (<2mm, 2-20mm and >20mm) and location. Results: Of 1099 analyzed patients in ESCAPE NA1, 107 had INT (9.7%, mean age 67 years, 51.4% females). There were no differences at baseline in those with vs without INT. Most INTs (75.7%) were angiographically occult and 41(38.3%) were > 20mm. The most common INT territory was the ACA alone or in combination with MCA/PCA (30.3%). The presence of emboli in new territory angiographically was significantly associated with INT (OR 16.39, 95%CI 8.14-33.09). Alteplase use, balloon guide catheter use, nerinetide and initial occlusion site did not predict INT. INT patients had higher final median infarct volumes compared to non-INT (44.5cc vs 23.3cc, P<0.001). Large INT (diameter of >20mm) were associated with poor clinical outcome compared to INT (<2mm) OR (mRS 0-2) 0.17, 95%CI 0.05-0.55). Conclusion: Infarcts in new territory are common and are associated with poor outcome.

scholarly journals DWI-pc-ASPECT score in basilar artery occlusion: is 6 points or less always indicative of a bad outcome?

2019 ◽  
Vol 25 (4) ◽  
pp. 371-379 ◽  
Author(s):  
Joong-Goo Kim ◽  
Dongwhane Lee ◽  
Jay Chol Choi ◽  
Yunsun Song ◽  
Deok Hee Lee ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Arterial Occlusion ◽  
Reperfusion Therapy ◽  
Basilar Artery Occlusion ◽  
Poor Clinical Outcome ◽  
Good Clinical Outcome ◽  
Outcome Group ◽  
Initial Symptoms

Background and purpose The prognosis of patients with acute basilar arterial occlusion after endovascular reperfusion therapy with diffusion-weighted imaging – posterior circulation–Alberta Stroke Program Early Computed Tomography Score (DWI-pc-ASPECTS) of 6 or less remains unclear. We aimed to assess the characteristics and prognosis of endovascular reperfusion therapy in patients with acute basilar arterial occlusion and DWI-pc-ASPECTS of 6 or less. Methods We analysed data collected from 1 January 2012 to 31 January 2018 in a prospective neuro-interventional registry of consecutive patients treated with endovascular reperfusion therapy. Clinical and imaging data on patients with DWI-pc-ASPECTS of 6 or less who underwent endovascular reperfusion therapy for acute basilar arterial occlusion were collected for this study. A good clinical outcome was defined as a modified Rankin scale of 2 or less at 90 days. Results Forty-five acute basilar arterial occlusion patients with DWI-pc-ASPECTS of 6 or less were included. Among them, 11 (24.4%) patients had a good clinical outcome at 90 days. Patients with a good clinical outcome had less severe neurological symptoms at presentation (National Institutes of Health Stroke Scale (NIHSS) 19.0 (12.0–25.0) vs. 8.0 (6.0–11.5); P = 0.003) and were younger (72.5 years (57.0–80.0 years) vs. 63.0 years (55.5–69.0 years), P = 0.096) than those with a poor clinical outcome. The symptomatic intracranial haemorrhage rate was significantly higher in the poor clinical outcome group (13 (38.2%)) than in the good clinical outcome group (0 (0.0%)) ( P = 0.045). In particular, in patients aged over 70 years, a favourable outcome was low (18 (52.9%) vs. 1 (9.1%); P = 0.027) even after successful recanalisation. In a multivariate model, a low initial NIHSS score (odds ratio 1.21; 95% confidence interval 1.07–1.44; P = 0.0093) and age over 70 years (odds ratio 15.27; 95% confidence interval 1.85–379.79; P = 0.0321) were independent predictors of poor clinical outcome. Conclusions Even with DWI-pc-ASPECTS of 6 or less, good clinical outcome can be achieved after endovascular reperfusion therapy. Relatively mild initial symptoms and younger age can predict a better outcome in acute basilar arterial occlusion patients with DWI-pc-ASPECTS of 6 or less.

Volumetric Growth of Cervical Schwannoma as a Predictor of Surgical Intervention

2016 ◽  
Vol 156 (1) ◽  
pp. 152-155 ◽  
Author(s):  
A. Sean Alemi ◽  
Chase M. Heaton ◽  
William R. Ryan ◽  
Ivan El-Sayed ◽  
Steven J. Wang
Keyword(s):  
Growth Rate ◽  
Gamma Knife ◽  
Surgical Intervention ◽  
Academic Medical Center ◽  
Benign Tumors ◽  
Entire Group ◽  
Average Growth ◽  
Significant Difference ◽  
Surgical Group

Objective Cervical schwannomas are benign tumors that commonly present as asymptomatic masses and are managed with observation, radiation, or surgery. To our knowledge, the rate of volumetric change seen on serial imaging is not currently used to determine surgical candidacy. We assess average growth rates and determine whether growth rate of cervical schwannoma predicts having undergone surgery. Study Design Case series with chart review. Setting Quaternary academic medical center. Subjects and Methods Patients were identified with at least 2 imaging studies and pathologic or imaging characteristics of cervical schwannoma. Volume was calculated with the formula 4/3π xyz, with x, y, and z representing the 3 orthogonal dimensions. Volume and rate of volume change were compared among observed, surgical, and gamma knife groups. Results Thirteen patients were identified and divided into subgroups: surgical (n = 5), observation (n = 6), and gamma knife (n = 2). Mean follow-up time was 21 months (range, 1-80 months) and not significantly different among subgroups. The average changes in volume were 3.61 cm3/mo (entire group), –2.75 cm3/mo (observation), 11.97 cm3/mo (surgery), and 1.78 cm3/mo (gamma knife). Average initial volume for the entire group was 124.4 cm3 (range, 5-608 cm3) and 142 cm3 (range 5-613) at follow-up. The surgical group had a statistically significant change in volume ( P = .03). A statistically significant difference in growth rate was seen between the surgical and observation groups ( P = .016) and between the surgical group and all nonsurgical patients ( P = .011). Conclusions Rate of tumor growth can be used in the evaluation of patients with cervical schwannoma, and it may predict surgical intervention.

scholarly journals Thrombolysis implementation intervention and clinical outcome: A Secondary analysis of a cluster randomized trial.

2020 ◽  
Author(s):  
Md Golam Hasnain ◽  
Christine L Paul ◽  
John R Attia ◽  
Annika Ryan ◽  
Erin Kerr ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Post Treatment ◽  
Control Group ◽  
Intervention Period ◽  
Poor Clinical Outcome ◽  
Post Intervention ◽  
Individual Level ◽  
Post Intervention Period

Abstract BackgroundMultiple studies have attempted to increase the rate of intravenous thrombolysis for ischemic stroke using interventions to promote adherence to guidelines. Still, many of them did not measure individual-level impact. This study aimed to make a posthoc comparison of the clinical outcomes of patients in the “Thrombolysis ImPlementation in Stroke (TIPS)” study, which aimed to improve rates of intravenous thrombolysis in Australia.MethodsA posthoc analysis was conducted using individual-level patient data. Excellent (Three-month post treatment modified Rankin Score 0-2) and poor clinical outcome (Three-month post treatment modified Rankin Score 5-6) and post treatment parenchymal haematoma were the three main outcomes, and a mixed logistic regression model was used to assess the difference between the intervention and control groups.ResultsThere was a non-significant higher odds of having an excellent clinical outcome of 57% (odds ratio: 1.57; 95% CI: 0.73-3.39) and 33% (odds ratio: 1.33; 95% CI: 0.73-2.44) during the active-and post-intervention period respectively, for the intervention compared to the control group. A non-significant lower odds of having a poor clinical outcome was also found in the intervention, relative to control group of 4% (odds ratio: 0.96; 95% CI: 0.56-2.07) and higher odds of having poor outcome of 44% (odds ratio: 1.44 95% CI: 0.61-3.41) during both active and post-intervention period respectively. Similarly, a non-significant lower odds of parenchymal haematoma was also found for the intervention group during the both active- (odds ratio: 0.53; 95% CI: 0.21-1.32) and post-intervention period (odds ratio: 0.96; 95% CI: 0.36-2.52).ConclusionThe TIPS multi-component implementation approach was not effective in reducing the odds of post-treatment severe disability at 90 days, or post-thrombolysis hemorrhage.Trial registrationClinical Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN12613000939796.

scholarly journals Genomic Gain of 16p13.3 in Prostate Cancer Predicts Poor Clinical Outcome after Surgical Intervention

2017 ◽  
Vol 16 (1) ◽  
pp. 115-123 ◽  
Author(s):  
Yogesh M. Bramhecha ◽  
Karl-Philippe Guérard ◽  
Shaghayegh Rouzbeh ◽  
Eleonora Scarlata ◽  
Fadi Brimo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Outcome ◽  
Surgical Intervention ◽  
Poor Clinical Outcome

scholarly journals Thrombolysis Implementation Intervention and Clinical Outcome: A Secondary Analysis of a Cluster Randomized Trial.

2020 ◽  
Author(s):  
Md Golam Hasnain ◽  
Christine L Paul ◽  
John R Attia ◽  
Annika Ryan ◽  
Erin Kerr ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Control Group ◽  
Intervention Period ◽  
Poor Clinical Outcome ◽  
Post Intervention ◽  
Lower Odds ◽  
Individual Level ◽  
Post Intervention Period

Abstract Background Multiple studies have attempted to increase the rate of intravenous thrombolysis for ischemic stroke using interventions to promote adherence to guidelines. Still, many of them did not measure individual-level impact. This study aimed to make a posthoc comparison of the clinical outcomes of patients in the “Thrombolysis ImPlementation in Stroke (TIPS)” study, which aimed to improve rates of intravenous thrombolysis in Australia.Methods A posthoc analysis was conducted using individual-level patient data. Excellent and poor clinical outcome and parenchymal haematoma were the three main outcomes, and a mixed logistic regression model was used to assess the difference between the intervention and control groups.Results There was a non-significantly higher odds of having an excellent clinical outcome of 57% (odds ratio: 1.57; 95% CI: 0.73–3.39) and 33% (odds ratio: 1.33; 95% CI: 0.73–2.44) during the active-and post-intervention period respectively, for the intervention compared to the control group. A non-significantly lower odds of having a poor clinical outcome was also found in the intervention, relative to control group of 4% (odds ratio: 0.96; 95% CI: 0.56–2.07) and higher odds of having poor outcome of 44% (odds ratio: 1.44 95% CI: 0.61–3.41) during both active and post-intervention period respectively. Similarly, a non-significant lower odds of parenchymal haematoma was also found for the intervention group during the both active- (odds ratio: 0.53; 95% CI: 0.21–1.32) and post-intervention period (odds ratio: 0.96; 95% CI: 0.36–2.52).Conclusion The TIPS multi-component implementation approach was not effective in reducing the odds of post-treatment severe disability at 90 days, or post-thrombolysis hemorrhage.Trial registration Clinical Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN12613000939796.

Stroke Patients With Faster Core Growth Have Greater Benefit From Endovascular Therapy

Stroke ◽  
2021 ◽  
Author(s):  
Longting Lin ◽  
Hao Zhang ◽  
Chushuang Chen ◽  
Andrew Bivard ◽  
Kenneth Butcher ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Growth Rate ◽  
Clinical Outcome ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Stroke Onset ◽  
Stroke Patients ◽  
Good Clinical Outcome ◽  
Perfusion Computed Tomography ◽  
Infarction Volume

Background and Purpose: This study aimed to explore whether the therapeutic benefit of endovascular thrombectomy (EVT) was mediated by core growth rate. Methods: This retrospective cohort study identified acute ischemic stroke patients with large vessel occlusion and receiving reperfusion treatment, either EVT or intravenous thrombolysis (IVT), within 4.5 hours of stroke onset. Patients were divided into 2 groups: EVT versus IVT only patients (who had no access to EVT). Core growth rate was estimated by the acute core volume on perfusion computed tomography divided by the time from stroke onset to perfusion computed tomography. The primary clinical outcome was good outcome defined by 3-month modified Rankin Scale score of 0–2. Tissue outcome was the final infarction volume. Results: A total of 806 patients were included, 429 in the EVT group (recanalization rate of 61.6%) and 377 in the IVT only group (recanalization rate of 44.7%). The treatment effect of EVT versus IVT only was mediated by core growth rate, showing a significant interaction between EVT treatment and core growth rate in predicting good clinical outcome (interaction odds ratio=1.03 [1.01–1.05], P =0.007) and final infarct volume (interaction odds ratio=−0.44 [−0.87 to −0.01], P =0.047). For patients with fast core growth of >25 mL/h, EVT treatment (compared with IVT only) increased the odds of good clinical outcome (adjusted odds ratio=3.62 [1.21–10.76], P =0.021) and resulted in smaller final infarction volume (37.5 versus 73.9 mL, P =0.012). For patients with slow core growth of <15 mL/h, there were no significant differences between the EVT and the IVT only group in either good clinical outcome (adjusted odds ratio=1.44 [0.97–2.14], P =0.070) or final infarction volume (22.6 versus 21.9 mL, P =0.551). Conclusions: Fast core growth was associated with greater benefit from EVT compared with IVT in the early <4.5-hour time window.

Futile Recanalization With Poor Clinical Outcome Is Associated With Increased Edema Volume After Ischemic Stroke

2019 ◽  
Vol 54 (5) ◽  
pp. 282-287 ◽  
Author(s):  
Jawed Nawabi ◽  
Fabian Flottmann ◽  
Uta Hanning ◽  
Matthias Bechstein ◽  
Gerhard Schön ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Poor Clinical Outcome ◽  
Edema Volume

Abstract 63: Infarct Volume and Rate of Edema Growth Predicts Need for Intervention in Patients With Cerebellar Infarction

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Yan Wang ◽  
Michael Binkley ◽  
Amanda Pardon ◽  
Salah Keyrouz ◽  
Rajat Dhar ◽  
...  
Keyword(s):  
Growth Rate ◽  
Multivariate Analysis ◽  
Subgroup Analysis ◽  
Surgical Intervention ◽  
Infarct Volume ◽  
Tertiary Care ◽  
Surgical Decompression ◽  
Cerebellar Infarction ◽  
Ventricular Drainage ◽  
Over Time

Background: Predictors of malignant edema in patients with acute cerebellar infarction are understudied. We hypothesized that greater infarct volume and CT-defined edema growth would predict individuals requiring acute intervention. Methods: Admissions to a tertiary care neurological ICU with acute cerebellar infarction over three year period were identified. Primary endpoint was defined as needing medical and/or surgical “intervention”: osmotic therapy, extra-ventricular drainage, or surgical decompression. Visible regions of infarct-related hypodensity in the cerebellum were manually outlined on serial CTs to ascertain infarct volumes. Infarct ratio was defined as the ratio of infarct volume to posterior fossa volume on initial CT showing ischemia. Rate in infarct-related edema growth was measured as the change in infarct ratio over time between sequential head CTs. Results: Of the 60 patients identified, 27 (45%) received interventions. All except one received osmotic therapy, while 15 patients underwent surgical intervention. Compared with the no-intervention cohort, intervention cohort was more likely to have diabetes (21% vs 48%, p = 0.03) and larger initial infarct ratio (0.12 vs 0.22, p = 0.001). Diabetes (OR, 6.3 95% CI, 1.6-25.3) and infarct ratio (OR, 3.2; 95% Cl, 1.6-6.3) were independent predictors of intervention. The rate of edema growth was faster in the intervention cohort (time*cohort p =0.005) (Fig A). A subgroup analysis of 34 patients with at least 3 CTs showed the intervention cohort had greater edema growth rate (-0.0001/hr vs 0.0044/hr, p = 0.02). Multivariate analysis showed edema growth independently predicted intervention (Fig B) and improved the AUC from 0.78 to 0.90 (Fig C), while diabetes was not retained (p=0.056). Conclusion: Baseline infarct ratio and rate of edema growth within the first 4 days may provide clinically useful markers to select patients with cerebellar infarction who will benefit from intervention.

Sign in / Sign up

Export Citation Format

Share Document