P35-10 Clinical factors related to intracranial arterial stenosis in acute stroke patients

2010 ◽  
Vol 121 ◽  
pp. S313
Author(s):  
J.H. Lee ◽  
S.H. Hwang ◽  
J.H. Park
Keyword(s):  
Acute Stroke ◽  
Arterial Stenosis ◽  
Clinical Factors ◽  
Intracranial Arterial Stenosis ◽  
Stroke Patients

Abstract 82: Differences Between Caucasians and Asians in Intracranial Arterial Stenosis Among TIA and Minor Stroke Patients: Comparisons of Two Contemporary Cohorts

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Xinyi Leng ◽  
Robert Hurford ◽  
Xueyan Feng ◽  
Ka Lung Chan ◽  
Linxin Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ct Angiography ◽  
Interobserver Agreement ◽  
Arterial Stenosis ◽  
Minor Stroke ◽  
Intracranial Arterial Stenosis ◽  
Stroke Patients ◽  
Stroke Registry ◽  
The Difference ◽  
Ischemic Attack

Background: Despite numerous reports indicating ethnic difference in intracranial arterial stenosis (ICAS) between Caucasians and Asians, there has been no direct comparison in disease burden and clinical correlates of ICAS in stroke patients in the two populations with the same criteria to define ICAS. Methods: Acute minor stroke or transient ischemic attack patients who received cerebral MR/CT angiography exam in two cohorts were analyzed: Oxford Vascular Study (OXVASC, 2011-2018) with predominantly Caucasians, and the Chinese University of Hong Kong (CUHK) stroke registry (2011-2015) with predominantly Chinese. ICAS was defined as ≥50% stenosis in any major intracranial artery in MR/CT angiography. Interobserver agreement between 2 investigators for presence of ICAS was assessed in 50 cases with Cohen’s kappa. We compared the burden and risk factors of ICAS in the two cohorts. Results: Overall, 1,287 patients from OXVASC (mean age 69 years) and 640 from the CUHK cohort (mean age 66 years) were analyzed. Interobserver agreement for presence of ICAS was good (kappa=0.82). Prevalence of ICAS was significantly higher in Chinese than in Caucasians: 43.6% in the CUHK cohort versus 20.0% in OXVASC (crude OR 3.10; age-adjusted OR 3.81, 95% CI 3.06-4.75; p<0.001). Mean ages of patients with ICAS in the two cohorts were 75 and 68 years, respectively. The difference between Caucasians and Chinese in ICAS prevalence was smaller in those aged ≥70 years (28.1% versus 51.9%) than those <70 years (9.8% versus 38.0%) (Figure). ICAS shared similar risk factors in the two cohorts, including older age, and history of hypertension and diabetes. Conclusions: Chinese are more susceptible to ICAS, with an earlier onset age than Caucasians, but the ICAS burden in Caucasians was higher than previously estimated, especially in older patients.

Abstract WP2: Intracranial Stenting with the use of the Wingspan Intracranial Stent for Patients Presenting with Acute Stroke Symptoms and Critical Intracranial Arterial Stenosis.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Arash Padidar ◽  
Pejman Taghavi ◽  
Reza Malek ◽  
Ursula Tolley ◽  
Linda Catalli ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Perfusion ◽  
Intravenous Thrombolysis ◽  
Intracranial Stenosis ◽  
Arterial Stenosis ◽  
Treatment Modalities ◽  
Intracranial Arterial Stenosis ◽  
Intracranial Stenting ◽  
Intracranial Stent ◽  
Increased Risk

Introduction: Patients with pre-existing severe intracranial arterial stenosis are at increased risk of re-current stroke. The treatment modalities for patients presenting with acute stroke symptoms are limited due to risk of re-occlusion after thrombolysis. Following re-canalization of an occluded stenotic vessel, stenting can prevent re-occlusion. Currently the only FDA approved stent specifically indicated for intracranial stenosis is the wingspan stent which is listed as a Humanitarian Use Device (HUD). With the efficacy and safety of intracranial stenting still in question we present a 3 year retrospective review of a community based hospitals outcomes with stenting in an acute stroke setting. Methods: Between 2009-2012 our group treated 47 patients with intracranial stenosis presenting with acute ischemic stroke. These patients had failure of intravenous thrombolysis or had contraindications for its use, had symptomatic intracranial stenosis or tandem lesions, had evidence of salvageable tissue determined by CT perfusion scanning and had an acute infarct not exceeding 1/3 of the affected vascular territory. All patients were treated within 12 hours of the acute event and received the Wingspan intracranial stent after successful thrombolysis. Fifteen patients had posterior circulation stenosis and 32 patients had anterior circulation stenosis. Results: The 30 day post-procedural stroke rate was 12.8%, with a total early mortality rate of 8.4% (Table). The 35 patients with no complications had an average of 4 points improvement in NIHSS post procedure (Figure). Of these patients 15 were discharged home, 10 discharged to acute rehabilitation facilities, and 10 were transferred to nursing homes. Conclusion: Intracranial stenting using the Wingspan device results in significant clinical improvement in patients with acutely symptomatic intracranial stenosis, with acceptable mortality and low rate of symptomatic intracranial hemorrhage.

scholarly journals Asymmetrical cortical vein sign predicts early neurological deterioration in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wei Li ◽  
Wei-Min Xiao ◽  
Gen-Pei Luo ◽  
Yong-Lin Liu ◽  
Jian-Feng Qu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Neurological Deterioration ◽  
Arterial Stenosis ◽  
Signal Loss ◽  
Intracranial Arterial Stenosis ◽  
Stroke Patients ◽  
Cortical Vein ◽  
Early Neurological Deterioration

Abstract Background Susceptibility weighted imaging (SWI) provides an approximate assessment of tissue perfusion and shows prominent hypointense cortical veins in the ischemic territory because of the increased concentration of deoxyhemoglobin. We aimed to evaluate whether asymmetrical prominent cortical vein sign (APCVS) on SWI can predict early neurological deterioration (END) in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion (SIASO). Methods One hundred and nine acute ischemic stroke patients with SIASO who underwent SWI were retrospectively recruited. END was defined as an increase in the National Institutes of Health Stroke Scale score ≧2 points despite standard treatment in the first 72 h after admission. The APCVS was defined as more and/or large vessels with greater signal loss than those in the opposite hemisphere on SWI. Results Thirty out of the 109 (27.5%) patients developed END. Sixty (55.0%) patients presented with APCVS on SWI. APCVS occurred in 24 (80%) patients with END, whereas it only occurred in 36 (45.6%) patients without END (P = 0.001). Patients with APCVS were more likely to have END (40.0%, vs. 12.2%, P = 0.001) than those without END. Multivariate logistic regression indicated that APCVS (OR = 4.349, 95% C.I. = 1.580–11.970, P = 0.004) was a significant predictor of END in acute ischemic stroke patients with SIASO, adjusted for previous stroke history and acute infarct volume. Conclusions In acute ischemic stroke patients with SIASO, the APCVS might be a useful neuroimaging marker for predicting END, which suggests the importance of evaluation of perfusion status.

scholarly journals Asymmetrical Cortical Vein Sign Predicts Early Neurological Deterioration in Acute Ischemic Stroke Patients with Severe Intracranial Arterial Stenosis or Occlusion

2020 ◽  
Author(s):  
Wei Li ◽  
Wei-Min Xiao ◽  
Gen-Pei Luo ◽  
Yong-Lin Liu ◽  
Jian-feng Qu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Neurological Deterioration ◽  
Arterial Stenosis ◽  
Signal Loss ◽  
Intracranial Arterial Stenosis ◽  
Stroke Patients ◽  
Cortical Vein ◽  
Early Neurological Deterioration

Abstract Background: Susceptibility weighted imaging (SWI) provides a rough assessment of tissue perfusion with the prominent hypointense cortical veins in the ischemic territory due to increased concentration of deoxyhemoglobin. We aimed to evaluate whether asymmetrical prominent cortical vein sign (APCVS) on SWI can predict early neurological deterioration (END) in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion (SIASO).Results: One hundred and nine acute ischemic stroke patients with SIASO who underwent SWI were retrospectively recruited. END was defined as a National Institutes of Health Stroke Scale (NIHSS) increasement≧2 points despite standard treatment in the first 72h after admission. APCVS was defined as more and/or large vessels with greater signal loss than those in the opposite hemisphere on SWI. Thirty out of the 109 (27.5%) patients developed END. Sixty (55.0%) patients presented with APCVS on SWI. APCVS occurred in 24 (80%) patients with END, whereas it only occurred in 36 (45.6%) patients without END (P=0.001). Patient with APCVS were more likely to have END (40.0%, vs. 12.2%, P=0.001), in comparation with those without END. Multivariate logistic regression indicated that APCVS (OR=4.349, 95% C.I.=1.580-11.970, P=0.004) was a significant predictor of END in acute ischemic stroke patients with SIASO, adjusted for previous stroke history and acute infarct volume.Conclusions: In acute ischemic stroke patients with SIASO, APCVS might be a useful neuroimaging marker for predicting END, suggesting the importance of evaluation of perfusion status.

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