scholarly journals Association of High Serum Levels of Growth Factors with Good Outcome in Ischemic Stroke: a Multicenter Study

2019 ◽  
Vol 11 (4) ◽  
pp. 653-663 ◽  
Author(s):  
Tomás Sobrino ◽  
Manuel Rodríguez-Yáñez ◽  
Francisco Campos ◽  
Ramón Iglesias-Rey ◽  
Mónica Millán ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Growth Factors ◽  
Functional Outcome ◽  
Multicenter Study ◽  
Serum Levels ◽  
High Serum ◽  
Outcome Variable ◽  
Lesion Volume ◽  
Good Outcome ◽  
Good Functional Outcome

AbstractThe main objective of this research work was to study the association of serum levels of growth factors (GF) and SDF-1α with the functional outcome and reduction of lesion volume in ischemic stroke patients. In this multicenter study, 552 patients with non-lacunar stroke (male, 62.1%; mean age, 68.2 ± 11.4) were included within 24 h from symptom onset. The main outcome variable was good functional outcome (modified Rankin Scale [mRS] ≤ 2) at 12 months. Secondary outcome variable was infarct volume (in mL) after 6 ± 3 months. Serum levels of VEGF, Ang-1, G-CSF, BDNF, and SDF-1α were measured by ELISA at admission, 7 ± 1 days, at 3 ± 1 months, and 12 ± 3 months. Except for BDNF, all GF and SDF-1α serum levels showed a peak value at day 7 and remained elevated during the first 3 months (all p < 0.01). High serum levels at day 7 of VEGF (OR, 19.3), Ang-1 (OR, 14.7), G-CSF (OR, 9.6), and SDF-1α (OR, 28.5) were independently associated with good outcome at 12 months (all p < 0.0001). On the other hand, serum levels of VEGF (B, − 21.4), G-CSF (B, − 14.0), Ang-1 (B, − 13.3), and SDF-1α (B, − 44.6) measured at day 7 were independently associated with lesion volume at 6 months (p < 0.01). In summary, high serum levels of VEGF, Ang-1, G-CSF, and SDF-1α at day 7 and 3 months after ischemic stroke are associated with good functional outcome and smaller residual lesion at 1 year of follow-up.

scholarly journals High Serum Levels of Growth Factors Are Associated with Good Outcome in Intracerebral Hemorrhage

2009 ◽  
Vol 29 (12) ◽  
pp. 1968-1974 ◽  
Author(s):  
Tomás Sobrino ◽  
Susana Arias ◽  
Raquel Rodríguez-González ◽  
David Brea ◽  
Yolanda Silva ◽  
...  
Keyword(s):  
Growth Factors ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Serum Levels ◽  
Experimental Models ◽  
High Serum ◽  
Outcome Variable ◽  
Lesion Volume ◽  
Good Outcome ◽  
Good Functional Outcome

In experimental models, growth factors (GFs) such as vascular endothelial growth factor (VEGF), Angiopoietin 1 (Ang-1), or granulocyte-colony stimulating factor (G-CSF) mediate brain recovery after intracerebral hemorrhage (ICH). Our aim was to study the association between serum levels of GF and clinical outcome in patients with ICH. A total of 95 patients with primary ICH (male, 66.3%; mean age, 67.8±9.8 years) were prospectively included in the study within 12 h from symptoms onset. The main outcome variable was good functional outcome at 3 months (modified Rankin scale 2). Median serum levels of GF at 72 h from stroke onset were significantly higher in patients with good outcome ( n=39) compared with those with poor outcome (all P<0.0001). Serum levels of VEGF 330 pg/mL, G-CSF 413 pg/mL, and Ang-1 35 ng/mL at 72 h were independently associated with good functional outcome (odds ratio (OR), 11.2; 95% confidence interval (CI): 2.9 to 43.0; OR, 19.6; 95% CI: 3.9 to 97.9; and OR, 14.7; 95% CI: 3.6 to 60.0, respectively), neurologic improvement (all P<0.0001) and reduced residual cavity at 3 months (all P<0.01). These results illustrate that high serum levels of GF are associated with good functional outcome and reduced lesion volume in ICH.

Abstract W P18: General Anesthesia is Associated With Reduced Likelihood of Good Functional Outcome After Endovascular Intervention for Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Michael Mlynash ◽  
Jeremy D Fields ◽  
Matus Straka ◽  
Roland Bammer ◽  
Stephanie Kemp ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
General Anesthesia ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Multivariable Analysis ◽  
Antiplatelet Agents ◽  
Endovascular Intervention ◽  
Lesion Volume ◽  
Glucose Levels ◽  
Good Functional Outcome

Background: Retrospective studies have suggested that the use of general anesthesia (GA) is associated with unfavorable outcomes in patients undergoing endovascular intervention for acute ischemic strokes. We aimed to assess this association in DEFUSE 2, a prospective cohort study of patients treated with endovascular therapy. Methods: In the DEFUSE 2 study, MRI was performed before, within 12 hours after, and 5 days after endovascular intervention. Good functional outcome was defined as mRS 0-2 at 90 days. All patients who underwent catheter angiography were included in the present analysis. Baseline characteristics and outcomes were compared between patients managed with general anesthesia (GA) vs. conscious sedation (CS). Variables that were associated with good functional outcome in univariate analyses (α<0.1) were entered into a multivariable analysis. Variables that were significant at α<0.05 after a backward elimination procedure were retained. Results: GA was utilized in 39/110 patients (35%) and CS in the remainder. Compared to the group managed with CS, those undergoing GA were older (70±13 vs. 63±17 years old), had higher SBP (156±29 vs. 144±21 mmHg), higher blood glucose levels (149±64 vs. 126±35 mg/dL), and higher NIHSS (median [IQR]: 18 [14-21] vs. 14 [9-19]). The GA group was more likely to have had a previous stroke or TIA (36% vs. 17%) and prior treatment with antiplatelet agents (46% vs. 26%). Rates of reperfusion were similar (49% vs. 65%, p=0.15) between patients managed with GA and CS. Patients managed with GA had a substantially lower rate of good functional outcome (21% vs. 55%, p=0.001). Age, DWI lesion volume, reperfusion status and GA were retained in the multivariable model as independent predictors of good functional outcome. The adjusted odds ratio for good functional outcome with GA was 0.21 (95% CI 0.07 - 0.66). Conclusion: In general, GA should be avoided in patients undergoing endovascular treatment for acute ischemic stroke as it is associated with worse clinical outcomes. The mechanisms underlying this association should be investigated.

scholarly journals Associations of Ischemic Lesion Volume With Functional Outcome in Patients With Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (5) ◽  
pp. 1233-1240 ◽  
Author(s):  
Amber Bucker ◽  
Anna M. Boers ◽  
Joseph C.J. Bot ◽  
Olvert A. Berkhemer ◽  
Hester F. Lingsma ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Lesion Volume ◽  
Ischemic Lesion

Abstract WP7: Leukoaraiosis And Outcomes After Intra-arterial Therapy In Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Dan-Victor V Giurgiutiu ◽  
Albert J Yoo ◽  
Kaitlin Fitzpatrick ◽  
Zeshan Chaudhry ◽  
Lee H Schwamm ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Artery Occlusion ◽  
Post Stroke ◽  
Good Functional Outcome ◽  
Grade 3 ◽  
Risk Of Hemorrhage

Background: Selecting patients most likely to benefit (MLTB) from intra-arterial therapy (IAT) is essential to assure favorable outcomes after intervention for acute ischemic stroke (AIS). Leukoaraiosis (LA) has been linked to infarct growth, risk of hemorrhage after IV rt-PA, and poor post-stroke outcomes. We investigated whether LA severity is associated with AIS outcomes after IAT. Methods: We analyzed consecutive AIS subjects from our institutional GWTG-Stroke database enrolled between 01/01/2007-06/30/2009, who met our pre-specified criteria for MLTB: CTA and MRI within 6 hours from last known well, NIHSS score ≥8, baseline DWI volume (DWIv) ≤ 100 cc, and proximal artery occlusion and were treated with IAT. LA volume (LAv) was assessed on FLAIR using validated, semi-automated protocols. We analyzed CTA to assess collateral grade; post-IAT angiogram for recanalization status (TICI score ≥2B); and the 24-hour CT for symptomatic ICH (sICH). Logistic regression was used to determine independent predictors of good functional outcome (mRS≤ 2) and mortality at 90 days post-stroke. Results: There were 48 AIS subjects in this analysis (mean age 69.2, SD±13.8; 55% male; median LAv 4cc, IQR 2.2-8.8cc; median NIHSS 15, IQR 13-19; median DWIv 15.4cc, IQR 9.2-20.3cc). Of these, 34 (72%) received IV rt-PA; 3 (6%) had sICH; 21 (44.7%) recanalized; and 23 (50%) had collateral grade ≥3. At 90 days, 15/48 (36.6%) were deceased and 15/48 had mRS≤ 2. In univariate analysis, recanalization (OR 6.2, 95%CI 1.5-25.5), NIHSS (OR 0.8 per point, 95%CI 0.64-0.95), age (OR 0.95 per yr, 95%CI 0.89-0.99) were associated with good outcome, whereas age (OR 1.1, 95%CI 1.01-1.14) and HTN (OR 5.6, 95%CI 1.04-29.8) were associated with mortality. In multivariable analysis including age, NIHSS, recanalization, collateral grade, and LAv, only recanalization independently predicted good functional outcome (OR 21.3, 95%CI 2.3-199.9) and reduced mortality (OR 0.15, 95%CI 0.02-1.12) after IAT. Conclusions: LA severity is not associated with poor outcome in patients selected MLTB for IAT. Among AIS patients considered likely to benefit from IAT, only recanalization independently predicted good functional outcome and decreased mortality.

Abstract TP63: Lacunarization After Endovascular Treatment: a Surrogate Marker of Good Functional Outcome

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Pedro Cardona ◽  
Helena Quesada ◽  
Blanca Lara ◽  
Nuria Cayuela ◽  
Xavier Ustrell ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Surrogate Marker ◽  
Source Image ◽  
Stroke Patients ◽  
Good Functional Outcome ◽  
Lacunar Syndrome ◽  
Contrast Ct

Introduction: Multiple randomized trials have demonstrated that endovascular treatment (EVT) in selected stroke patients is associated with good clinical outcome (90 days mRankin 0-2: 44-60%). However the percentage of good functional outcome could be improved if we consider patients without cortical clinical impairment with presentation of classical lacunar syndrome despite non-lacunar radiological infarct. Methods: Consecutive patients with ischemic stroke who received endovascular reperfusion were retrospectively analyzed between May 2010 and April 2015. On admission NCCT (non-contrast CT) and CTASI (CT Angiography Source Image) were performed in stroke patients according to our hospital guidelines. We independently applied the ASPECT score in all baselines NCCT, CTASI and follow-up NCCT 24H, and magnetic resonance (MR) during hospitalization. Five pure clinical lacunar syndromes (CLS) were recorded within 24h exam after EVT in our stroke unit and 90 days follow-up Results: We review 428 thrombectomies of patients with acute ischemic stroke. Ninety-five percent of occlusions were located in middle cerebral artery or terminal internal carotid, (49% women, mean age 65+/-13 years; NIHSS at admission: 17; baseline mRS 0-1:96%). Successful recanalization (TICI 2b-3) was achieved in 81%. At 3 months good functional outcome (mRS 0-2) was seen in 51% and death occurred in 13%. CLS were indentified in 42% patients within 24h after EVT. This clinical syndromes were associated to ASPECT score in 24 NCCT and CTASI in patients with recanalization 2b-3 (p:0.003), but only 4% had a defined radiological lacunar stroke on MR. CLS turned out to be one of independence predictors of good outcomes (Rankin 0-2 at 90d) after adjustment for ages, sex and baseline NIHSS scores (OR 1.85; CI:1.4-3.1; p:0.001). Also CLS were still present in 34% of patients with Rankin>2 at 90d (Rankin 3:26%; Rankin 4:7%) Conclusions: These results suggest that a neurological exam 24h after EVT with identification of pure lacunar syndrome can predict favorable functional outcome at 90days. This group of patients presents radiological findings with an unusual location and size with regard to CLS. We suggest to consider patients with CLS as good outcome after EVT regardless 90d mRankin>2.

Abstract WMP15: Automated Volumetric Assessment of Infarct Core in Non-Contrast Computed Tomography in Patients With Acute Ischemic Stroke Secondary to Large Vessel Occlusion

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alvaro Garcia-Tornel ◽  
Matias Deck ◽  
Marc Ribo ◽  
David Rodriguez-Luna ◽  
Jorge Pagola ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Infarct Volume ◽  
Large Vessel Occlusion ◽  
Infarct Core ◽  
Vessel Occlusion ◽  
Good Functional Outcome ◽  
Volumetric Assessment

Introduction: Perfusion imaging has emerged as an imaging tool to select patients with acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO) for endovascular treatment (EVT). We aim to compare an automated method to assess the infarct ischemic core (IC) in Non-Contrast Computed Tomography (NCCT) with Computed Tomography Perfusion (CTP) imaging and its ability to predict functional outcome and final infarct volume (FIV). Methods: 494 patients with anterior circulation stroke treated with EVT were included. Volumetric assessment of IC in NCCT (eA-IC) was calculated using eASPECTS™ (Brainomix, Oxford). CTP was processed using availaible software considering CTP-IC as volume of Cerebral Blood Flow (CBF) <30% comparing with the contralateral hemisphere. FIV was calculated in patients with complete recanalization using a semiautomated method with a NCCT performed 48-72 hours after EVT. Complete recanalization was considered as modified Thrombolysis In Cerebral Ischemia (mTICI) ≥2B after EVT. Good functional outcome was defined as modified Rankin score (mRs) ≤2 at 90 days. Statistical analysis was performed to assess the correlation between EA-IC and CTP-IC and its ability to predict prognosis and FIV. Results: Median eA-IC and CTP-IC were 16 (IQR 7-31) and 8 (IQR 0-28), respectively. 419 patients (85%) achieved complete recanalization, and their median FIV was 17.5cc (IQR 5-52). Good functional outcome was achieved in 230 patients (47%). EA-IC and CTP-IC had moderate correlation between them (r=0.52, p<0.01) and similar correlation with FIV (r=0.52 and 0.51, respectively, p<0.01). Using ROC curves, both methods had similar performance in its ability to predict good functional outcome (EA-IC AUC 0.68 p<0.01, CTP-IC AUC 0.66 p<0.01). Multivariate analysis adjusted by confounding factors showed that eA-IC and CTP-IC predicted good functional outcome (for every 10cc and >40cc, OR 1.5, IC1.3-1.8, p<0.01 and OR 1.3, IC1.1-1.5, p<0.01, respectively). Conclusion: Automated volumetric assessment of infarct core in NCCT has similar performance predicting prognosis and final infarct volume than CTP. Prospective studies should evaluate a NCCT-core / vessel occlusion penumbra missmatch as an alternative method to select patients for EVT.

Abstract WP39: Mechanical Embolectomy for Acute Ischemic Stroke Beyond Six Hours From Symptom Onset Using Advanced MR Imaging

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ryan McTaggart ◽  
Shadi Yaghi ◽  
Daniel C Sacchetti ◽  
Richard Haas ◽  
Shawna Cutting ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mr Imaging ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Lesion Volume ◽  
Large Artery ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Good Outcome

Background: There is very limited data on the use of advanced neuroimaging to select patients with acute ischemic stroke and large vessel occlusion for intraarterial therapy beyond 6 hours from onset. Our aim is to report the outcome of patients with acute ischemic stroke and large artery occlusion who presented beyond 6 hours from onset, had favorable MRI imaging profile, and underwent mechanical embolectomy. Methods: This is a single institution retrospective study between December 1st, 2015, and July 30 th , 2016 with acute ischemic stroke and anterior circulation large vessel occlusion (LVO) with ASPECTS of 6 or more and beyond 6 hours from symptoms onset. Favorable imaging profile was defined as 1) DWI lesion volume (as defined as apparent diffusion coefficient < 620 X 10-6 mm2/s) of 70 mL or less AND 2) Penumbra volume (as defined by volume of tissue with Tmax >6 sec) of 15 mL or greater AND 3) A mismatch ratio of 1.8 or more AND 4) Volume of tissue with perfusion lesion with Tmax > 10 sec is less than 100 mL. Good outcome was defined as a 90 day mRS≤2. Results: In the study period, 41 patients met the inclusion criteria; 22 (53.6%) had favorable imaging profile and underwent mechanical embolectomy. The median age was 75 years (59-92), 68.2% were females; the median time from last known normal to groin puncture was 684.5 minutes (range 363-1628) and the median admission NIHSS score was 17.5 (range 4-28). The rate of good outcomes in this series was similar to that in a patient level pooled meta-analysis of the recent endovascular trials (68.2% vs. 46.0%, p=0.07). The rate of good outcome matches that of the EXTEND-IA trial that selected patients using perfusion imaging (68.2% vs. 71.0%, p = 1.00). None of the patients in our cohort had symptomatic intracereberal hemorrhage. Conclusion: Advanced MR imaging may help select patients with acute ischemic stroke and anterior circulation large vessel occlusion for embolectomy beyond the treatment window used in most endovascular trials.

Abstract WMP17: Computerized Tomography Perfusion to Characterize Lack of Clinical Improvement After Recanalization in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alvaro Garcia-Tornel ◽  
Marta Olive-Gadea ◽  
Marc Ribo ◽  
David Rodriguez-Luna ◽  
Jorge Pagola ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Infarct Volume ◽  
Significant Proportion ◽  
Hemorrhagic Transformation ◽  
Vessel Occlusion ◽  
Clinical Recovery ◽  
Good Functional Outcome ◽  
Significant Difference

A significant proportion of patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) present poor functional outcome despite recanalization. We aim to investigate computed tomography perfusion (CTP) patterns after EVT and their association with outcome Methods: Prospective study of anterior large vessel occlusion AIS patients who achieved complete recanalization (defined as modified Thrombolysis in Cerebral Ischemia (TICI) 2b - 3) after EVT. CTP was performed within 30 minutes post-EVT recanalization (POST-CTP): hypoperfusion was defined as volume of time to maximal arrival of contrast (Tmax) delay ≥6 seconds in the affected territory. Hyperperfusion was defined as visual increase in cerebral blood flow (CBF) and volume (CBV) with advanced Tmax compared with the unaffected hemisphere. Dramatic clinical recovery (DCR) was defined as a decrease of ≥8 points in NIHSS score at 24h or NIHSS≤2 and good functional outcome by mRS ≤2 at 3 months. Results: One-hundred and forty-one patients were included. 49 (34.7%) patients did not have any perfusion abnormality on POST-CTP, 60 (42.5%) showed hypoperfusion (median volume Tmax≥6s 17.5cc, IQR 6-45cc) and 32 (22.8%) hyperperfusion. DCR appeared in 56% of patients and good functional outcome in 55.3%. Post-EVT hypoperfusion was related with worse final TICI, and associated worse early clinical evolution, larger final infarct volume (p<0.01 for all) and was an independent predictor of functional outcome (OR 0.98, CI 0.97-0.99, p=0.01). Furthermore, POST-CTP identified patients with delayed improvement: in patients without DCR (n=62, 44%), there was a significant difference in post-EVT hypoperfusion volume according to functional outcome (hypoperfusion volume of 2cc in good outcome vs 11cc in poor outcome, OR 0.97 CI 0.93-0.99, p=0.04), adjusted by confounding factors. Hyperperfusion was not associated with worse outcome (p=0.45) nor symptomatic hemorrhagic transformation (p=0.55). Conclusion: Hypoperfusion volume after EVT is an accurate predictor of functional outcome. In patients without dramatic clinical recovery, hypoperfusion predicts good functional outcome and defines a “stunned-brain” pattern. POST-CTP may help to select EVT patients for additional therapies.

Abstract TP227: Outcomes of a Regionalized Stroke Care System

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Denisse Sequeira ◽  
Christian Martin-Gill ◽  
Gregory Lowry ◽  
Marcus Robinson ◽  
Hinnah Siddiqui ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Stroke Care ◽  
Discharge Diagnosis ◽  
Hospital Data ◽  
Exact Test ◽  
Endovascular Interventions ◽  
Good Functional Outcome ◽  
Suspected Stroke ◽  
Iv Tpa

Introduction: Strokes are one of the leading causes of death and disability. Time-sensitive therapies are available including IV-TPA and endovascular therapies which require rapid and effective triage. Endovascular therapies are available at comprehensive stroke centers (CSC). We evaluated if there was any improvement in outcomes for patients who are transported directly to a CSC. Hypothesis: Patients that receive acute interventions for stroke have improved outcomes when transferred directly to CSC as compared to transport to a PSC and then transferred to a interventional facility. Methods: A retrospective cohort study of 5,188 patients transported from January 2012 to December 2013 with an EMS provider impression of suspected stroke via both air and ground transport. Of these, data was complete for 1,196 patients with a confirmed discharge diagnosis of ischemic stroke. Pre-hospital data was abstracted from EMS charts. Ischemic strokes were identified by final hospital discharge diagnosis and good functional status was defined as a modified Rankin scale <3 at discharge. Categorical outcomes were tested using Fishers Exact Test and Ordinal outcomes using the Mann Whitney Test. Results: For those with complete data mortality was 10% (CI 8.3-11.7) in this cohort with good functional outcomes in 37% (CI 34.3-39.7) of patients. IV- TPA was administered to 293 (24%) and endovascular interventions were performed in 167 (14%). There were 739 (63%) inter-facility transfers and 442 (37%) received directly from the scene. Transport to the CSC occurred by air in 798 (67%) cases as compared to 398 (33%) by ground. Mortality and good functional outcome did not differ between patients transferred and those taken directly to the CSC. Among patients receiving either TPA or endovascular therapy, direct transport to the CSC is associated with good functional outcome (Fisher’s exact= 0.041) but not with mortality. Conclusions: Among patients with a diagnosis of ischemic stroke presenting to a CSC, there is no difference in mortality and good functional outcome as a function of transfer from the scene or transfer from another facility. However, among those who received tPA or endovascular intervention good functional outcome was associated with direct presentation to the CSC.

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