Brain imaging abnormalities and outcome after acute ischaemic stroke: the ENCHANTED trial

ObjectiveTo test the hypothesis that imaging signs of ‘brain frailty’ and acute ischaemia predict clinical outcomes and symptomatic intracranial haemorrhage (sICH) after thrombolysis for acute ischaemic stroke (AIS) in the alteplase dose arm of ENhanced Control of Hypertension ANd Thrombolysis strokE stuDy (ENCHANTED).MethodsBlinded assessors coded baseline images for acute ischaemic signs (presence, extent, swelling and attenuation of acute lesions; and hyperattenuated arteries) and pre-existing changes (atrophy, leucoaraiosis and old ischaemic lesions). Logistic regression models assessed associations between imaging features and death at 7 and 90 days; good recovery (modified Rankin Scale scores 0–2 at 90 days) and sICH. Data are reported with adjusted ORs and 95% CIs.Results2916 patients (67±13 years, National Institutes of Health Stroke Scale 8 (5–14)) were included. Visible ischaemic lesions, severe hypoattenuation, large ischaemic lesion, swelling and hyperattenuated arteries were associated with 7-day death (OR (95% CI): 1.52 (1.06 to 2.18); 1.51 (1.01 to 2.18); 2.67 (1.52 to 4.71); 1.49 (1.03 to 2.14) and 2.17 (1.48 to 3.18)) and inversely with good outcome. Severe atrophy was inversely associated with 7-day death (0.52 (0.29 to 0.96)). Atrophy (1.52 (1.08 to 2.15)) and severe leucoaraiosis (1.74 (1.20 to 2.54)) were associated with 90-day death. Hyperattenuated arteries were associated with sICH (1.71 (1.01 to 2.89)). No imaging features modified the effect of alteplase dose.ConclusionsNon-expert-defined brain imaging signs of brain frailty and acute ischaemia contribute to the prognosis of thrombolysis-treated AIS patients for sICH and mortality. However, these imaging features showed no interaction with alteplase dose.

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Prognostic significance of international normalised ratio and prothrombin time in Chinese acute ischaemic stroke patients

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2021-141204 ◽

2022 ◽

pp. postgradmedj-2021-141204

Author(s):

Shoujiang You ◽

Qiao Han ◽

Xiaofeng Dong ◽

Chongke Zhong ◽

Huaping Du ◽

...

Keyword(s):

Logistic Regression ◽

Ischaemic Stroke ◽

Prothrombin Time ◽

Hospital Discharge ◽

Acute Ischaemic Stroke ◽

Regression Models ◽

Logistic Regression Models ◽

Risk Of Death ◽

Increased Risk ◽

International Normalised Ratio

BackgroundWe investigated the association between international normalised ratio (INR) and prothrombin time (PT) levels on hospital admission and in-hospital outcomes in acute ischaemic stroke (AIS) patients.MethodsA total of 3175 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included. We divided patients into four groups according to their level of admission INR: (<0.92), Q2 (0.92–0.98), Q3 (0.98–1.04) and Q4 (≥1.04) and PT. Logistic regression models were used to estimate the effect of INR and PT on death or major disability (modified Rankin Scale score (mRS)>3), death and major disability (mRS scores 4–5) separately on discharge in AIS patients.ResultsHaving an INR level in the highest quartile (Q4) was associated with an increased risk of death or major disability (OR 1.69; 95% CI 1.23 to 2.31; P-trend=0.001), death (OR, 2.64; 95% CI 1.12 to 6.19; P-trend=0.002) and major disability on discharge (OR, 1.56; 95% CI 1.13 to 2.15; P-trend=0.008) in comparison to Q1 after adjusting for potential covariates. Moreover, in multivariable logistic regression models, having a PT level in the highest quartile also significantly increased the risk of death (OR, 2.38; 95% CI 1.06 to 5.32; P-trend=0.006) but not death or major disability (P-trend=0.240), major disability (P-trend=0.606) on discharge.ConclusionsHigh INR at admission was independently associated with death or major disability, death and major disability at hospital discharge in AIS patients and increased PT was also associated with death at hospital discharge.

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Imaging features of acute ischaemic stroke

Medicine ◽

10.1016/j.mpmed.2020.05.012 ◽

2020 ◽

Vol 48 (8) ◽

pp. 555-558

Author(s):

Matthew Wheeler ◽

Stefan T. Schwarz

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Imaging Features

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SPET brain imaging with 201 diethyldithiocarbamate in acute ischaemic stroke

European Journal of Nuclear Medicine ◽

10.1007/bf00812365 ◽

1990 ◽

Vol 17 (5) ◽

pp. 248-251 ◽

Cited By ~ 9

Author(s):

J. Frits de Bruïne ◽

Martien Limburg ◽

Eric A. van Royen ◽

Albert Hijdra ◽

Thomas C. Hill ◽

...

Keyword(s):

Ischaemic Stroke ◽

Brain Imaging ◽

Acute Ischaemic Stroke

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A pragmatic approach to sonothrombolysis in acute ischaemic stroke: the Norwegian randomised controlled sonothrombolysis in acute stroke study (NOR-SASS)

BMC Neurology ◽

10.1186/s12883-015-0359-4 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 11

Author(s):

Aliona Nacu ◽

Christopher E. Kvistad ◽

Nicola Logallo ◽

Halvor Naess ◽

Ulrike Waje-Andreassen ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Stroke ◽

Acute Ischaemic Stroke ◽

Pragmatic Approach ◽

Stroke Study ◽

Randomised Controlled

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

European Journal of Neuroscience ◽

10.1111/ejn.14955 ◽

2020 ◽

Author(s):

Abina Vishni Ravindran ◽

Murray C. Killingsworth ◽

Sonu Bhaskar

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Reperfusion Therapy ◽

Stroke Patients ◽

Acute Ischaemia

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Cytokines, Selectins and Adhesion Molecules Plasma Levels in Acute Ischaemic Stroke: Relationship with Stroke Subtype, Ischaemic Lesion Site and Clinical Outcome

High Blood Pressure & Cardiovascular Prevention ◽

10.2165/00151642-200714030-00146 ◽

2007 ◽

Vol 14 (3) ◽

pp. 145-196

Author(s):

A Tuttolomondo ◽

A Pinto ◽

D Di Raimondo ◽

S Corrao ◽

R Di Sciacca ◽

...

Keyword(s):

Clinical Outcome ◽

Ischaemic Stroke ◽

Adhesion Molecules ◽

Acute Ischaemic Stroke ◽

Plasma Levels ◽

Lesion Site ◽

Stroke Subtype ◽

Ischaemic Lesion

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Predicting 90-day modified Rankin Scale score with discharge information in acute ischaemic stroke patients following treatment

BMJ Neurology Open ◽

10.1136/bmjno-2021-000177 ◽

2021 ◽

Vol 3 (1) ◽

pp. e000177

Author(s):

Andrew K ElHabr ◽

Jeffrey M Katz ◽

Jason Wang ◽

Mehrad Bastani ◽

Gabriela Martinez ◽

...

Keyword(s):

Ischaemic Stroke ◽

Scale Score ◽

Acute Ischaemic Stroke ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Long Term Outcome ◽

Predictive Values ◽

Discharge Disposition ◽

Home Discharge ◽

Scale Scores

ObjectivesTo understand variability in modified Rankin Scale scores from discharge to 90 days in acute ischaemic stroke patients following treatment, and examine prediction of 90-day modified Rankin Scale score by using discharge modified Rankin Scale and discharge disposition.Materials and methodsRetrospective analysis of acute ischaemic stroke patients following treatment was performed from January 2016 to March 2020. Data collection included demographic and clinical characteristics and outcomes data (modified Rankin Scale score at discharge, 30 days and 90 days and discharge disposition). Pearson’s χ2 test assessed statistical differences in distribution of modified Rankin Scale scores at discharge, 30 days and 90 days. The predictive power of discharge modified Rankin Scale score and disposition quantified the association with 90-day outcome.ResultsA total of 280 acute ischaemic stroke patients (65.4% aged ≥65 years, 47.1% female, 60.7% white) were included in the analysis. The modified Rankin Scale score significantly changed between 30 and 90 days from discharge (p<0.001) after remaining stable from discharge to 30 days (p=0.665). The positive and negative predictive values of an unfavourable long-term outcome for discharge modified Rankin Scale scores of 3–5 were 67.7% (95% CI 60.4% to 75.0%) and 82.0% (95% CI 75.1% to 88.8%), and for non-home discharge disposition were 72.4% (95% CI 64.5% to 80.2%) and 74.5% (95% CI 67.8% to 81.3%), respectively.ConclusionsDischarge modified Rankin Scale score and non-home discharge disposition are good individual predictors of 90-day modified Rankin Scale score for ischaemic stroke patients following treatment.

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Voxelwise computed diffusion-weighted imaging for the detection of cytotoxic oedema in brain imaging: a pilot study

The Neuroradiology Journal ◽

10.1177/1971400918789382 ◽

2018 ◽

Vol 31 (5) ◽

pp. 518-522

Author(s):

Ferdinand Seith ◽

Holger Schmidt ◽

Konstantin Nikolaou ◽

Ulrike Ernemann ◽

Georg Bier

Keyword(s):

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Ischaemic Stroke ◽

Brain Imaging ◽

Acute Ischaemic Stroke ◽

Diffusion Weighted Imaging ◽

Diffusion Weighted ◽

Coefficients Of Variation ◽

Apparent Diffusion ◽

Fluid Attenuated Inversion Recovery

Aim To evaluate voxelwise computed diffusion-weighted imaging (vcDWI) for the detection of cytotoxic oedema in brain imaging and to quantify the benefit of lesion contrast in comparison to standard b = 1000 s/mm2 by the example of acute ischaemic stroke. Materials and methods A retrospective evaluation of 66 patients (63 ± 15.9 years) suspected for acute ischaemic stroke who received diffusion-weighted magnetic resonance imaging and fluid-attenuated inversion recovery sequence. A neuroradiologist evaluated all examinations for acute ischaemic stroke based on diffusion-weighted imaging, the apparent diffusion coefficient and fluid-attenuated inversion recovery (reference standard) and 6 weeks later the vcDWI in a randomised manner. Time of analysis was noted. Signal intensities were acquired in lesions, in healthy tissue as well as in the cerebrospinal fluid. Contrast ratios and coefficients of variation were computed. Results A total of 218 lesions was found in 46/66 patients. vcDWI identified all patients and lesions correctly. The median evaluation time was 36 seconds (4–126 s) for the vcDWI and 44 seconds (9–186 s; P < 0.001) for the diffusion-weighted imaging/apparent diffusion coefficient reading. The contrast ratio in vcDWI (mean value 2.57, range 1.73–4.11) was higher than in b = 1000 s/mm2 (2.33, 0.83–3.85, P = 0.03) and the apparent diffusion coefficient map (1.83, 1.00–3.00, P < 0.001), respectively. Coefficients of variation in lesions and tissue did not differ significantly between vcDWI and b = 1000 s/mm2 ( P = 0.81/ P = 0.26). The signal intensity of cerebrospinal fluid was lower in vcDWI than in b = 1000 mm2/s (0.08 and 34.8, P < 0.001). Conclusion It could be shown that vcDWI has the potential to accelerate the detection of diffusion-restricted lesions in neuroimaging by improving the contrast ratios and reducing the T2 shine-through effect in comparison to standard diffusion-weighted imaging in brain imaging.

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