Cerebral collaterals in acute ischaemia: Implications for acute ischaemic stroke patients receiving reperfusion therapy

Background Data on outcome of endovascular treatment in patients with acute ischaemic stroke due to large vessel occlusion suffering from intravenous thrombolysis-associated intracranial haemorrhage prior to mechanical thrombectomy remain scarce. Addressing this subject, we report our multicentre experience. Methods A retrospective analysis of consecutive acute ischaemic stroke patients treated with mechanical thrombectomy due to large vessel occlusion despite the pre-interventional occurrence of intravenous thrombolysis-associated intracranial haemorrhage was performed at five tertiary care centres between January 2010–September 2020. Baseline demographics, aetiology of stroke and intracranial haemorrhage, angiographic outcome assessed by the Thrombolysis in Cerebral Infarction score and clinical outcome evaluated by the modified Rankin Scale at 90 days were recorded. Results In total, six patients were included in the study. Five individuals demonstrated cerebral intraparenchymal haemorrhage on pre-interventional imaging; in one patient additional subdural haematoma was observed and one patient suffered from isolated subarachnoid haemorrhage. All patients except one were treated by the ‘drip-and-ship’ paradigm. Successful reperfusion was achieved in 4/6 (67%) individuals. In 5/6 (83%) patients, the pre-interventional intracranial haemorrhage had aggravated in post-interventional computed tomography with space-occupying effect. Overall, five patients had died during the hospital stay. The clinical outcome of the survivor was modified Rankin Scale=4 at 90 days follow-up. Conclusion Mechanical thrombectomy in patients with intravenous thrombolysis-associated intracranial haemorrhage is technically feasible. The clinical outcome of this subgroup of stroke patients, however, appears to be devastating with high mortality and only carefully selected patients might benefit from endovascular treatment.

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Obesity in acute ischaemic stroke patients treated with intravenous thrombolysis therapy

Neurological Research ◽

10.1080/01616412.2021.1939486 ◽

2021 ◽

pp. 1-8

Author(s):

Hongmin Li ◽

Suliman Khan ◽

Rabeea Siddique ◽

Qian Bai ◽

Yang Liu ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

Thrombolysis Therapy

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Outcome estimation based on multimodal computed tomography examination in acute ischaemic stroke patients treated with mechanical thrombectomy

Videosurgery and Other Miniinvasive Techniques ◽

10.5114/wiitm.2019.84761 ◽

2019 ◽

Vol 14 (4) ◽

pp. 560-566

Author(s):

Bartłomiej Łasocha ◽

Paweł Brzegowy ◽

Agnieszka Słowik ◽

Paweł Latacz ◽

Roman Pułyk ◽

...

Keyword(s):

Computed Tomography ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Mechanical Thrombectomy ◽

Stroke Patients

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High On-Treatment Platelet Reactivity in Danish Hyper-Acute Ischaemic Stroke Patients

Frontiers in Neurology ◽

10.3389/fneur.2018.00712 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 3

Author(s):

Charlotte L. Rath ◽

Niklas Rye Jørgensen ◽

Troels Wienecke

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Platelet Reactivity ◽

Stroke Patients

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Plasma D-Dimer Level in Different Types of Acute Ischaemic Stroke Patients: Experience at a Tertiary Hospital in Dhaka City

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v5i1.42162 ◽

2019 ◽

Vol 5 (1) ◽

pp. 13-17

Author(s):

Paritosh Kumar Sarkar ◽

Anwar Israil ◽

Mohammad Sayeed Hassan ◽

Abu Nayeem ◽

Md Azharul Hoque ◽

...

Keyword(s):

Internal Medicine ◽

Ischemic Stroke ◽

Ischaemic Stroke ◽

Clinical Diagnosis ◽

Acute Ischaemic Stroke ◽

Stroke Patients ◽

College Hospital ◽

Medical College ◽

Different Types ◽

D Dimer

Background: Plasma D-Dimer is a biomarker of thrombo-embolism. Objective: The purpose of the present study was to see the plasma D-dimer level in different types of acute ischaemic stroke patients. Methodology: This cross-sectional study was conducted in the Department of Neurology & Department of Internal Medicine at Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2010 to June 2012 for a period of two (02) years. Patients with ischemic stroke with history within 7 days attending in the stroke clinic of Department of Neurology or admitted in the Department of Neurology and Internal Medicine through the outpatient and emergency Department of Dhaka Medical College Hospital (DMCH) were selected as study population for this study. Analysis of plasma D-Dimer was done in the Department of Hematology of DMCH.b Result: A total of 50 cases were recruited for this study. There were 24.0% lacunar infarcts, 40.0% atherothrombotic and 36.0% embolic infarcts in the study group. Highest level of plasma D-Dimer was observed in embolic (1700±964 ηg/ml) followed by atherothrombotic group (536±234 ηg/ml). The plasma D-Dimer was lowest (100±0 ηg/ml) in lacunar group. Concentration of Plasma D-Dimer showed significant correlation with clinical diagnosis in different subtypes of ischemic stroke (r=0.902; p=0.001) and also with risk factors, example, diabetes (r=0.319; p=0.012) and valvular heart disease (r=0.281; p=0.024), but no significant correlation with age, hypertension, hyperlipidaemia and smoking. Conclusion: In conclusion plasma D-Dimer is an important bio-marker in the clinical diagnosis and subtypes of ischemic stroke patients. Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 13-17

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Developing a multivariable prediction model for functional outcome after reperfusion therapy for acute ischaemic stroke: study protocol for the Targeting Optimal Thrombolysis Outcomes (TOTO) multicentre cohort study

BMJ Open ◽

10.1136/bmjopen-2020-038180 ◽

2020 ◽

Vol 10 (4) ◽

pp. e038180 ◽

Cited By ~ 1

Author(s):

Elizabeth Holliday ◽

Thomas Lillicrap ◽

Timothy Kleinig ◽

Philip M C Choi ◽

Jane Maguire ◽

...

Keyword(s):

Cohort Study ◽

Ischaemic Stroke ◽

Functional Outcome ◽

Acute Ischaemic Stroke ◽

Significant Risk ◽

Intravenous Thrombolysis ◽

Reperfusion Therapy ◽

Stroke Severity ◽

Local Health ◽

Predictive Algorithms

IntroductionIntravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) is the only approved pharmacological reperfusion therapy for acute ischaemic stroke. Despite population benefit, IVT is not equally effective in all patients, nor is it without significant risk. Uncertain treatment outcome prediction complicates patient treatment selection. This study will develop and validate predictive algorithms for IVT response, using clinical, radiological and blood-based biomarker measures. A secondary objective is to develop predictive algorithms for endovascular thrombectomy (EVT), which has been proven as an effective reperfusion therapy since study inception.Methods and analysisThe Targeting Optimal Thrombolysis Outcomes Study is a multicenter prospective cohort study of ischaemic stroke patients treated at participating Australian Stroke Centres with IVT and/or EVT. Patients undergo neuroimaging using multimodal CT or MRI at baseline with repeat neuroimaging 24 hours post-treatment. Baseline and follow-up blood samples are provided for research use. The primary outcome is good functional outcome at 90 days poststroke, defined as a modified Rankin Scale (mRS) Score of 0–2. Secondary outcomes are reperfusion, recanalisation, infarct core growth, change in stroke severity, poor functional outcome, excellent functional outcome and ordinal mRS at 90 days. Primary predictive models will be developed and validated in patients treated only with rt-PA. Models will be built using regression methods and include clinical variables, radiological measures from multimodal neuroimaging and blood-based biomarkers measured by mass spectrometry. Predictive accuracy will be quantified using c-statistics and R2. In secondary analyses, models will be developed in patients treated using EVT, with or without prior IVT, reflecting practice changes since original study design.Ethics and disseminationPatients, or relatives when patients could not consent, provide written informed consent to participate. This study received approval from the Hunter New England Local Health District Human Research Ethics Committee (reference 14/10/15/4.02). Findings will be disseminated via peer-reviewed publications and conference presentations.

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