Reperfusion Therapy in Acute Ischemic Stroke with Active Cancer: A Meta-Analysis Aided by Machine Learning

2021 ◽  
Vol 30 (6) ◽  
pp. 105742
Author(s):  
Mi-Yeon Eun ◽  
Eun-Tae Jeon ◽  
Kwon-Duk Seo ◽  
Dongwhane Lee ◽  
Jin-Man Jung
Keyword(s):  
Machine Learning ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Reperfusion Therapy ◽  
Active Cancer

scholarly journals Diagnosis of DWI-negative acute ischemic stroke

Neurology ◽  
2017 ◽  
Vol 89 (3) ◽  
pp. 256-262 ◽  
Author(s):  
Brian L. Edlow ◽  
Shelley Hurwitz ◽  
Jonathan A. Edlow
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Diagnosis ◽  
Clinical Characteristics ◽  
Meta Analysis ◽  
Reperfusion Therapy ◽  
Posterior Circulation ◽  
Anterior Circulation ◽  
Ovid Medline ◽  
Level Data

Objective:To determine the prevalence of diffusion-weighted imaging (DWI)–negative acute ischemic stroke (AIS) and to identify clinical characteristics of patients with DWI-negative AIS.Methods:We systematically searched PubMed and Ovid/MEDLINE for relevant studies between 1992, the year that the DWI sequence entered clinical practice, and 2016. Studies were included based upon enrollment of consecutive patients presenting with a clinical diagnosis of AIS prior to imaging. Meta-analysis was performed to synthesize study-level data, estimate DWI-negative stroke prevalence, and estimate the odds ratios (ORs) for clinical characteristics associated with DWI-negative stroke.Results:Twelve articles including 3,236 AIS patients were included. The meta-analytic synthesis yielded a pooled prevalence of DWI-negative AIS of 6.8%, 95% confidence interval (CI) 4.9–9.3. In the 5 studies that reported proportion data for DWI-negative and DWI-positive AIS based on the ischemic vascular territory (n = 1,023 AIS patients), DWI-negative stroke was strongly associated with posterior circulation ischemia, as determined by clinical diagnosis at hospital discharge or repeat imaging (OR 5.1, 95% CI 2.3–11.6, p < 0.001).Conclusions:A small but significant percentage of patients with AIS have a negative DWI scan. Patients with neurologic deficits consistent with posterior circulation ischemia have 5 times the odds of having a negative DWI scan compared to patients with anterior circulation ischemia. AIS remains a clinical diagnosis and urgent reperfusion therapy should be considered even when an initial DWI scan is negative.

scholarly journals Prognostic value of neutrophil to lymphocyte ratio in acute ischemic stroke after reperfusion therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ying Bi ◽  
Jing Shen ◽  
Sheng-Cai Chen ◽  
Ji-Xiang Chen ◽  
Yuan-Peng Xia
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Meta Analysis ◽  
Credible Interval ◽  
Reperfusion Therapy ◽  
Neutrophil To Lymphocyte Ratio ◽  
Categorical Variables ◽  
Poor Functional Outcome ◽  
Lymphocyte Ratio

AbstractThe purpose of this study was to investigate whether baseline neutrophil to lymphocyte ratio (NLR) was an independent predictor for early symptomatic intracranial hemorrhage (sICH), poor functional outcome and mortality at 3 months after reperfusion therapy in acute ischemic stroke (AIS) patients. Using PubMed and EMBASE, we searched for literature published before January 19th, 2019. Two reviewers independently confirmed each study’s eligibility, assessed risk of bias, and extracted data. One reviewer combined studies using random effects meta-analysis. 9 studies with 3651 patients were pooled in the meta-analysis. Overall, baseline NLR levels were greater in patients with poor outcome. The standardized mean difference (SMD) in the NLR levels between patients with poor functional outcome (mRS > 2) and good functional outcome (mRS ≤ 2) was 0.54 units (95% credible interval [CI] [0.38, 0.70]). Heterogeneity test showed that there were significant differences between individual studies (p = 0.02; I2 = 72.8%). The NLR levels were associated with sICH in four included studies (n = 2003, SMD = 0.78, 95% [CI] [0.18, 1.38], I2 = 73.9%). Higher NLR levels were positively correlated with 3-month mortality (n = 1389, ES = 1.71, 95% CI [1.01,2.42], p < 0.01, I2 = 0%) when data were used as categorical variables. Our meta-analysis suggests that increased NLR levels are positively associated with greater risk of sICH, 3-month poor functional outcome and 3-month mortality in AIS patients undergoing reperfusion treatments. Although there are some deficits in this study, it may be feasible to predict the prognosis of reperfusion therapy in AIS patients with NLR levels.

scholarly journals Using a Multiclass Machine Learning Model to Predict the Outcome of Acute Ischemic Stroke Requiring Reperfusion Therapy

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 80
Author(s):  
I-Min Chiu ◽  
Wun-Huei Zeng ◽  
Chi-Yung Cheng ◽  
Shih-Hsuan Chen ◽  
Chun-Hung Richard Lin
Keyword(s):  
Machine Learning ◽  
Logistic Regression ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Outcome Prediction ◽  
Reperfusion Therapy ◽  
Gradient Boosting ◽  
Stroke Patients ◽  
Extreme Gradient Boosting ◽  
Machine Learning Models

Prediction of functional outcome in ischemic stroke patients is useful for clinical decisions. Previous studies mostly elaborate on the prediction of favorable outcomes. Miserable outcomes, which are usually defined as modified Rankin Scale (mRS) 5–6, should be considered as well before further invasive intervention. By using a machine learning algorithm, we aimed to develop a multiclass classification model for outcome prediction in acute ischemic stroke patients requiring reperfusion therapy. This was a retrospective study performed at a stroke medical center in Taiwan. Patients with acute ischemic stroke who visited between January 2016 and December 2019 and who were candidates for reperfusion therapy were included. Clinical outcomes were classified as favorable outcome, intermediate outcome, and miserable outcome. We developed four different multiclass machine learning models (Logistic Regression, Supportive Vector Machine, Random Forest, and Extreme Gradient Boosting) to predict clinical outcomes and compared their performance to the DRAGON score. A sample of 590 patients was included in this study. Of them, 180 (30.5%) had favorable outcomes and 152 (25.8%) had miserable outcomes. All selected machine learning models outperformed the DRAGON score on accuracy of outcome prediction (Logistic Regression: 0.70, Supportive Vector Machine: 0.67, Random Forest: 0.69, and Extreme Gradient Boosting: 0.67, vs. DRAGON: 0.51, p < 0.001). Among all selected models, Logistic Regression also had a better performance than the DRAGON score on positive predictive value, sensitivity, and specificity. Compared with the DRAGON score, the multiclass machine learning approach showed better performance on the prediction of the 3-month functional outcome of acute ischemic stroke patients requiring reperfusion therapy.

scholarly journals Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

2021 ◽  
Vol 13 (4) ◽  
pp. 608-621
Author(s):  
Akansha Sinha ◽  
Peter Stanwell ◽  
Roy G. Beran ◽  
Zeljka Calic ◽  
Murray C. Killingsworth ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Reperfusion Therapy ◽  
Large Artery ◽  
Cohort Size ◽  
Inclusion Criteria ◽  
Search Terms ◽  
Total Cohort ◽  
Grading Scale

Background: The interplay between collateral status and stroke aetiology may be crucial in the evaluation and management of acute ischemic stroke (AIS). Our understanding of this relationship and its level of association remains sub-optimal. This study sought to examine the association of pre-intervention collateral status with stroke aetiology, specifically large artery atherosclerosis (LAA) and cardio-embolism (CE), in AIS patients receiving reperfusion therapy, by performing a meta-analysis. Methods: Relevant search terms were explored on Medline/PubMed, Embase and Cochrane databases. Studies were included using the following inclusion criteria: (a) patients aged 18 or above; (b) AIS patients; (c) patients receiving reperfusion therapy; (d) total cohort size of >20, and (e) qualitative or quantitative assessment of pre-intervention collateral status on imaging using a grading scale. Random-effects meta-analysis was performed to investigate the association of aetiology with pre-intervention collateral status, and forest plots of risk ratio (RR) were generated. Results: A meta-analysis was conducted on seven studies, with a cumulative cohort of 1235 patients, to assess the association of pre-intervention collateral status with stroke aetiology. Patients with LAA were associated significantly with an increased rate of good collaterals (RR 1.24; 95% CI 1.04–1.50; p = 0.020, z = 2.33). Contrarily, CE aetiology was associated significantly with a decreased rate of good collaterals (RR 0.83; 95% CI 0.71–0.98; p = 0.027, z = −2.213). Conclusions: This study demonstrates that, in AIS patients receiving reperfusion therapy, LAA and CE aetiologies are associated significantly with collateral status.

Endovascular reperfusion therapy for acute ischemic stroke: a meta-analysis

2010 ◽  
Vol 32 (8) ◽  
pp. 787-791 ◽  
Author(s):  
Ronen R. Leker ◽  
Savvas Grigoriadis ◽  
José E. Cohen
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Reperfusion Therapy

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

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