Potential of dual-layer spectral CT for the differentiation between hemorrhage and iodinated contrast medium in the brain after endovascular treatment of ischemic stroke patients

Recent randomized controlled clinical trials (RCTs) have revolutionized acute ischemic stroke care by extending the use of intravenous thrombolysis and endovascular reperfusion therapies in time windows that have been originally considered futile or even unsafe. Both systemic and endovascular reperfusion therapies have been shown to improve outcome in patients with wake-up strokes or symptom onset beyond 4.5 h for intravenous thrombolysis and beyond 6 h for endovascular treatment; however, they require advanced neuroimaging to select stroke patients safely. Experts have proposed simpler imaging algorithms but high-quality data on safety and efficacy are currently missing. RCTs used diverse imaging and clinical inclusion criteria for patient selection during the dawn of this novel stroke treatment paradigm. After taking into consideration the dismal prognosis of nonrecanalized ischemic stroke patients and the substantial clinical benefit of reperfusion therapies in selected late presenters, we propose rescue reperfusion therapies for acute ischemic stroke patients not fulfilling all clinical and imaging inclusion criteria as an option in a subgroup of patients with clinical and radiological profiles suggesting low risk for complications, notably hemorrhagic transformation as well as local or remote parenchymal hemorrhage. Incorporating new data to treatment algorithms may seem perplexing to stroke physicians, since treatment and imaging capabilities of each stroke center may dictate diverse treatment pathways. This narrative review will summarize current data that will assist clinicians in the selection of those late presenters that will most likely benefit from acute reperfusion therapies. Different treatment algorithms are provided according to available neuroimaging and endovascular treatment capabilities.

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Nano-sized Zero-Valent Iron Coupled with Sulfidation and Ferrous Implantation Enhances the Reduction–Oxidation Removal of Iodinated Contrast Medium

ACS ES&T Water ◽

10.1021/acsestwater.1c00199 ◽

2021 ◽

Author(s):

Guannan Zhou ◽

Jia-Qi Chen ◽

Chuan-Shu He ◽

Rongrong Ding ◽

Yang Mu

Keyword(s):

Contrast Medium ◽

Zero Valent Iron ◽

Iodinated Contrast Medium ◽

Iodinated Contrast

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Effect of hyperosmolality and cations on iodinated contrast medium-induced potassium release from human blood cells

Radiation Medicine ◽

10.1007/s11604-007-0170-2 ◽

2007 ◽

Vol 25 (9) ◽

pp. 467-473 ◽

Cited By ~ 2

Author(s):

Katsumi Hayakawa ◽

Tatsuo Nakamura ◽

Yasuhiko Shimizu

Keyword(s):

Contrast Medium ◽

Human Blood ◽

Blood Cells ◽

Potassium Release ◽

Iodinated Contrast Medium ◽

Iodinated Contrast ◽

Human Blood Cells

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Central Venous Catheter Integrity during Mechanical Power Injection of Iodinated Contrast Medium

Radiology ◽

10.1148/radiol.2533081086 ◽

2009 ◽

Vol 253 (3) ◽

pp. 870-878 ◽

Cited By ~ 19

Author(s):

Douglas B. Macha ◽

Rendon C. Nelson ◽

Laurens E. Howle ◽

John W. Hollingsworth ◽

Sebastian T. Schindera

Keyword(s):

Central Venous Catheter ◽

Contrast Medium ◽

Venous Catheter ◽

Mechanical Power ◽

Central Venous ◽

Iodinated Contrast Medium ◽

Iodinated Contrast ◽

Power Injection

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Hyperthyroidism after Iodinated Contrast Medium

New England Journal of Medicine ◽

10.1056/nejm197407042910107 ◽

1974 ◽

Vol 291 (1) ◽

pp. 24-25 ◽

Cited By ~ 38

Author(s):

Manfred Blum ◽

Uzi Weinberg ◽

Louis Shenkman ◽

Charles S. Hollander

Keyword(s):

Contrast Medium ◽

Iodinated Contrast Medium ◽

Iodinated Contrast

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Intranodal CT Lymphangiography with Water-soluble Iodinated Contrast Medium for Imaging of the Central Lymphatic System

Radiology ◽

10.1148/radiol.2021210294 ◽

2021 ◽

Author(s):

Suhag Patel ◽

Saebeom Hur ◽

Tamim Khaddash ◽

Scott Simpson ◽

Maxim Itkin

Keyword(s):

Contrast Medium ◽

Lymphatic System ◽

Water Soluble ◽

Iodinated Contrast Medium ◽

Iodinated Contrast

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Abstract TP274: Orosomucoid-1 Protein Increases Following Ischemic Stroke in the Brain and Periphery

Stroke ◽

10.1161/str.47.suppl_1.tp274 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Hetal Mistry ◽

Madeline Levy ◽

Meaghan Roy-O'Reilly ◽

Louise McCullough

Keyword(s):

Sex Differences ◽

Ischemic Stroke ◽

Rna Sequencing ◽

Multiple Testing ◽

Enzyme Linked Immunosorbent Assay ◽

Mrna Levels ◽

Stroke Patients ◽

Post Stroke ◽

Protein Levels ◽

The Brain

Background and Purpose: Orosomucoid-1 (ORM-1) is an abundant protein with important roles in inflammation and immunosuppression. We utilized RNA sequencing to measure mRNA levels in human ischemic stroke patients, with confirmation by serum ORM-1 protein measurements. A mouse model of ischemic stroke was then used to examine post-stroke changes in ORM-1 within the brain itself. Hypothesis: We tested the hypothesis that ORM-1 levels increase following ischemic stroke, with sex differences in protein dynamics over time. Methods: RNA sequencing was performed on whole blood from ischemic stroke patients (n=23) and controls (n=12), with Benjamini-Hochberg correction for multiple testing. Enzyme-linked immunosorbent assay was performed on serum from ischemic stroke patients (n=28) and controls (n=8), with analysis by T-test. For brain analysis, mice (n=14) were subjected to a 90-minute middle cerebral artery occlusion (MCAO) surgery and sacrificed 6 or 24 hours after stroke. Control mice underwent parallel “sham” surgery without occlusion. Western blotting was used to detect ORM-1 protein levels in whole brain, with analysis by two-way ANOVA. Results: RNA sequencing showed a 2.8-fold increase in human ORM-1 at 24 hours post-stroke (q=.0029), an increase also seen in serum ORM-1 protein levels (p=.011). Western blot analysis of mouse brain revealed that glycosylated (p=0.0003) and naive (p=0.0333) forms of ORM-1 were higher in female mice compared to males 6 hours post-stroke. Interestingly, ORM-1 levels were higher in the brains of stroke mice at 6 hours (p=.0483), while at 24 hours ORM-1 levels in stroke mice were lower than their sham counterparts (p=.0212). In both human and mouse data, no sex differences were seen in ORM-1 levels in the brain or periphery at 24 hours post-stroke. Conclusion: In conclusion, ORM-1 is a sexually dimorphic protein involved in the early (<24 hour) response to ischemic stroke. This research serves as an initial step in determining the mechanism of ORM-1 in the ischemic stroke response and its potential as a future therapeutic target for both sexes.

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Abstract P253: Readmission in Acute Ischemic Stroke Patients Undergoing Endovascular Treatment

Stroke ◽

10.1161/str.52.suppl_1.p253 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Saqib Chaudhry ◽

Ibrahim Laleka ◽

Zelalem Bahiru ◽

Hassan S Gill ◽

Mohammad Rauf Chaudhry ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Stroke Patients ◽

Factors Associated ◽

Representative Study ◽

Post Procedure ◽

Icd 10 ◽

Nationally Representative

Background: Recent trials have demonstrated a reduction in death or disability with endovascular treatment in patients with acute ischemic strokes. However, readmission rates and predictors are not known. Objective: To identify rates and factors associated with 30-day readmission after endovascular treatment in ischemic stroke patients. Methods: Nationwide Readmissions Data (NRD) between 2010 and 2017 was utilized to identify endovascular treatment in acute ischemic stroke patients using ICD-9 and ICD-10 codes. We used hierarchical logistic regression model to identify factors associated with 30-day readmissions. Results: Among 17, 562 acute ischemic stroke patients who survived to discharge after endovascular treatment, 2334 (13.29%) were readmitted within 30-days. Age => 65 years (odds ratio [OR]: 1.23, 95% confidence interval [CI]: 1.09 to 1.39, p =0.0005), chronic kidney disease (OR: 1.28, 95%CI: 1.12 to 1.47, p = 0.0004), congestive heart failure (OR: 1.25, 95%CI: 1.13 to 1.39, p <.0001), post procedure intracranial hemorrhage (OR: 1.09, 95%CI: 0.99 to 1.20, p = 0.04) and diabetes mellitus (OR: 1.09, 95%CI: 0.99 to 1.20, p = .09) during the index hospitalization were associated with readmission within 30 days. Conclusion: In this large nationally representative study, nearly one in 10 patients were readmitted within 30 days after discharge in acute ischemic stroke patients undergoing endovascular treatment. Medical comorbidities and post procedure intracranial hemorrhage were associated with 30-day readmission.

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