Topographic distribution of cerebral infarct probability in patients with acute ischemic stroke: mapping of intra-arterial treatment effect

2016 ◽  
Vol 9 (5) ◽  
pp. 431-436 ◽  
Author(s):  
A M M Boers ◽  
O A Berkhemer ◽  
C H Slump ◽  
W H van Zwam ◽  
Y B W E M Roos ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Brain Tissue ◽  
Treatment Effect ◽  
Cerebral Infarct ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Probability Maps ◽  
Treatment Type ◽  
Topographic Distribution

BackgroundSince proof emerged that IA treatment (IAT) is beneficial for patients with acute ischemic stroke, it has become the standard method of care. Despite these positive results, recovery to functional independence is established in only about one-third of treated patients. The effect of IAT is commonly assessed by functional outcome, whereas its effect on brain tissue salvage is considered a secondary outcome measure (at most). Because patient and treatment selection needs to be improved, understanding the treatment effect on brain tissue salvage is of utmost importance.ObjectiveTo introduce infarct probability maps to estimate the location and extent of tissue damage based on patient baseline characteristics and treatment type.MethodsCerebral infarct probability maps were created by combining automatically segmented infarct distributions using follow-up CT images of 281 patients from the MR CLEAN trial. Comparison of infarct probability maps allows visualization and quantification of probable treatment effects. Treatment impact was calculated for 10 Alberta Stroke Program Early CT Score (ASPECTS) and 27 anatomical regions.ResultsThe insular cortex had the highest infarct probability in both control and IAT populations (47.2% and 42.6%, respectively). Comparison showed significant lower infarct probability in 4 ASPECTS and 17 anatomical regions in favor of IAT. Most salvaged tissue was found within the ASPECTS M2 region, which was 8.5% less likely to infarct.ConclusionsProbability maps intuitively visualize the topographic distribution of infarct probability due to treatment, which makes it a promising tool for estimating the effect of treatment.

scholarly journals Collateral status and tissue outcome after intra-arterial therapy for patients with acute ischemic stroke

2016 ◽  
Vol 37 (11) ◽  
pp. 3589-3598 ◽  
Author(s):  
Anna MM Boers ◽  
Ivo GH Jansen ◽  
Olvert A Berkhemer ◽  
Albert J Yoo ◽  
Hester F Lingsma ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Linear Regression ◽  
Acute Ischemic Stroke ◽  
Brain Tissue ◽  
Treatment Effect ◽  
Significant Interaction ◽  
Standard Care ◽  
Treatment Groups ◽  
Interaction Terms ◽  
Grade 3

Intra-arterial therapy (IAT) for ischemic stroke aims to save brain tissue. Collaterals are thought to contribute to prolonged penumbra sustenance. In this study, we investigate the effect of collateral status on brain tissue salvage with IAT. In 500 patients randomized between IAT and standard care, collateral status was graded from 0 (absent) to 3 (good). Final infarct volumes (FIV) were calculated on post-treatment CT. FIVs were compared between treatment groups per collateral grade. Multivariable linear regression with interaction terms was performed to study whether collaterals modified IAT effect on FIV. Four-hundred-forty-nine patients were included in the analysis. Median FIV for the IAT group was significantly lower with 54.5 mL (95% IQR: 21.8–145.0) than for the controls with 81.8 mL (95% IQR: 40.0–154.0) ( p = 0.020). Treatment effect differed across collateral grades, although there was no significant interaction (unadjusted p = 0.054; adjusted p = 0.105). For grade 3, IAT resulted in a FIV reduction of 30.1 mL ( p = 0.024). For grade 2 and 1, this difference was, respectively, 28.4 mL ( p = 0.028) and 28.4 mL ( p = 0.29). For grade 0, this was 88.6 mL ( p = 0.28) in favour of controls. IAT saves substantially more brain tissue as compared to standard care. We observed a trend of increasing effect of IAT with higher collateral grades.

scholarly journals KADAR FIBRIN MONOMER DAN UKURAN INFARK DI STROK ISKEMIK AKUT

2016 ◽  
Vol 20 (3) ◽  
pp. 171
Author(s):  
Ani Kartini ◽  
Mansyur Arif ◽  
Hardjoeno Hardjoeno
Keyword(s):  
Ischemic Stroke ◽  
Infarct Size ◽  
Acute Ischemic Stroke ◽  
Thrombus Formation ◽  
Infarct Volume ◽  
Cross Sectional Study ◽  
Cerebral Infarct ◽  
Cross Sectional ◽  
Fibrin Monomer ◽  
Significant Difference

Coagulation activation and thrombosis frequently exist in ischemic stroke, thrombus formation can be detected early by the presence of fibrin monomer. The purpose of this study was to know the correlation of fibrin monomer level with cerebral infarct size in acute ischemic stroke patients. This was a cross sectional study with a total of 39 samples. The fibrin monomer level was determined by immunoturbidimetry method using STA-Compact and the measurement of the infarct size was done by CT scan of the head using Broderick formula. The results of this study showed that the median level of fibrin monomer in acute ischemic stroke with nonlacunar infarct type and lacunar infarct type were 14.46 μg/mL and 4.29 μg/mL, respectively. Mann-Whitney test showed there was a significant difference of fibrin monomer levels between nonlacunar infarct type and the lacunar type, p=0.000. The cut-off point analysis result of the fibrin monomer level was 5.96 μg/mL with a sensitivity of 88.9% and specificity of 76.4%, respectively. Spearman correlation test showed that fibrin monomer level was positively correlated with cerebral infarct volume in acute ischemic stroke (r=0.56, p=0.000). Based on this study, it can be concluded that fibrin monomer level can be used as a marker to predict the type of cerebral infarct and volume of acute ischemic stroke as well.

scholarly journals Emergency Extracranial-Intracranial Bypass to Revascularize Salvageable Brain Tissue in Acute Ischemic Stroke Patients

2018 ◽  
Vol 109 ◽  
pp. e476-e485 ◽  
Author(s):  
Jan-Karl Burkhardt ◽  
Sebastian Winklhofer ◽  
Jorn Fierstra ◽  
Susanne Wegener ◽  
Giuseppe Esposito ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Brain Tissue ◽  
Stroke Patients

scholarly journals Prediction of Tissue Outcome and Assessment of Treatment Effect in Acute Ischemic Stroke Using Deep Learning

Stroke ◽  
2018 ◽  
Vol 49 (6) ◽  
pp. 1394-1401 ◽  
Author(s):  
Anne Nielsen ◽  
Mikkel Bo Hansen ◽  
Anna Tietze ◽  
Kim Mouridsen
Keyword(s):  
Ischemic Stroke ◽  
Deep Learning ◽  
Acute Ischemic Stroke ◽  
Treatment Effect

Abstract WMP24: Reperfusion Into Severely Damaged Brain Tissue is Associated With Impending Parenchymal Hemorrhage in Acute Ischemic Stroke Patients

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Songlin Yu ◽  
Samantha J Ma ◽  
David S Liebeskind ◽  
Lirong Yan ◽  
Fabien Scalzo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Brain Tissue ◽  
Stroke Patients

Acute ischemic stroke diagnosis using brain tissue pulsations

2020 ◽  
Vol 419 ◽  
pp. 117164
Author(s):  
Jonathan Ince ◽  
Caroline Banahan ◽  
Sara Venturini ◽  
Meshal Alharbi ◽  
Poppy Turner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Brain Tissue ◽  
Stroke Diagnosis

scholarly journals Endovascular thrombectomy in acute ischemic stroke patients with COVID-19: prevalence, demographics, and outcomes

2020 ◽  
Vol 12 (11) ◽  
pp. 1045-1048 ◽  
Author(s):  
Adam de Havenon ◽  
Shadi Yaghi ◽  
Eva A Mistry ◽  
Alen Delic ◽  
Samuel Hohmann ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Unit Length ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Systemic Complications ◽  
Endovascular Thrombectomy ◽  
Lower Odds ◽  
Coronary Syndrome

BackgroundWe aimed to compare the outcome of acute ischemic stroke (AIS) patients who received endovascular thrombectomy (EVT) with confirmed COVID-19 to those without.MethodsWe performed a retrospective analysis using the Vizient Clinical Data Base and included hospital discharges from April 1 to July 31 2020 with ICD-10 codes for AIS and EVT. The primary outcome was in-hospital death and the secondary outcome was favorable discharge, defined as discharge home or to acute rehabilitation. We compared patients with laboratory-confirmed COVID-19 to those without. As a sensitivity analysis, we compared COVID-19 AIS patients who did not undergo EVT to those who did, to balance potential adverse events inherent to COVID-19 infection.ResultsWe identified 3165 AIS patients who received EVT during April to July 2020, in which COVID-19 was confirmed in 104 (3.3%). Comorbid COVID-19 infection was associated with younger age, male sex, diabetes, black race, Hispanic ethnicity, intubation, acute coronary syndrome, acute renal failure, and longer hospital and intensive care unit length of stay. The rate of in-hospital death was 12.4% without COVID-19 vs 29.8% with COVID-19 (P<0.001). In mixed-effects logistic regression that accounted for patient clustering by hospital, comorbid COVID-19 increased the odds of in-hospital death over four-fold (OR 4.48, 95% CI 3.02 to 6.165). Comorbid COVID-19 was also associated with lower odds of a favorable discharge (OR 0.43, 95% CI 0.30 to 0.61). In the sensitivity analysis, comparing AIS patients with COVID-19 who did not undergo EVT (n=2139) to the AIS EVT patients with COVID-19, there was no difference in the rate of in-hospital death (30.6% vs 29.8%, P=0.868), and AIS EVT patients had a higher rate of favorable discharge (32.4% vs 47.1%, P=0.002).ConclusionIn AIS patients treated with EVT, comorbid COVID-19 infection was associated with in-hospital death and a lower odds of favorable discharge compared with patients without COVID-19, but not compared with AIS patients with COVID-19 who did not undergo EVT. AIS EVT patients with COVID-19 were younger, more likely to be male, have systemic complications, and almost twice as likely to be black and over three times as likely to be Hispanic.

scholarly journals Current Smoking Does Not Modify the Treatment Effect of Intravenous Thrombolysis in Acute Ischemic Stroke Patients—A Post-hoc Analysis of the WAKE-UP Trial

2019 ◽  
Vol 10 ◽  
Author(s):  
Ludwig Schlemm ◽  
Anna Kufner ◽  
Florent Boutitie ◽  
Alexander Heinrich Nave ◽  
Christian Gerloff ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Treatment Effect ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Current Smoking ◽  
Post Hoc Analysis ◽  
Post Hoc

Dielectric properties of brain tissue at 1 GHz in acute ischemic stroke: Experimental study on swine

2016 ◽  
Vol 38 (2) ◽  
pp. 158-163 ◽  
Author(s):  
Serguei Semenov ◽  
Toan Huynh ◽  
Thomas Williams ◽  
Brian Nicholson ◽  
Anna Vasilenko
Keyword(s):  
Experimental Study ◽  
Ischemic Stroke ◽  
Dielectric Properties ◽  
Acute Ischemic Stroke ◽  
Brain Tissue
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