scholarly journals Detection of Early Ischemic Changes in Noncontrast CT Head Improved with “Stroke Windows”

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Shraddha Mainali ◽  
Mervat Wahba ◽  
Lucas Elijovich
Keyword(s):  
Ischemic Stroke ◽  
Basal Ganglia ◽  
Acute Ischemic Stroke ◽  
Basilar Artery ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Image Evaluation ◽  
Head Ct ◽  
Noncontrast Ct ◽  
Ct Head

Introduction. Noncontrast head CT (NCCT) is the standard radiologic test for patients presenting with acute stroke. Early ischemic changes (EIC) are often overlooked on initial NCCT. We determine the sensitivity and specificity of improved EIC detection by a standardized method of image evaluation (Stroke Windows). Methods. We performed a retrospective chart review to identify patients with acute ischemic stroke who had NCCT at presentation. EIC was defined by the presence of hyperdense MCA/basilar artery sign; sulcal effacement; basal ganglia/subcortical hypodensity; and loss of cortical gray-white differentiation. NCCT was reviewed with standard window settings and with specialized Stroke Windows. Results. Fifty patients (42% females, 58% males) with a mean NIHSS of 13.4 were identified. EIC was detected in 9 patients with standard windows, while EIC was detected using Stroke Windows in 35 patients (18% versus 70%; P<0.0001). Hyperdense MCA sign was the most commonly reported EIC; it was better detected with Stroke Windows (14% and 36%; P<0.0198). Detection of the remaining EIC also improved with Stroke Windows (6% and 46%; P<0.0001). Conclusions. Detection of EIC has important implications in diagnosis and treatment of acute ischemic stroke. Utilization of Stroke Windows significantly improved detection of EIC.

Abstract P176: Improving Door to Needle Times With CT Telestroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Sarah Jamieson ◽  
Alexandra C Lesko ◽  
Elizabeth Baraban ◽  
Lisa R Yanase
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Chart Review ◽  
Group Analysis ◽  
Retrospective Chart Review ◽  
Inclusion Criteria ◽  
Night Time ◽  
Intention To Treat ◽  
The Difference ◽  
Treat Analysis

Introduction: Thrombolytic treatment of acute ischemic stroke (AIS) during night-time hours and weekends is associated with prolonged door to needle (DTN) times. A CT suite telestroke unit (CTTU) was installed at two urban stroke centers to expedite treatment for AIS patients. The purpose of this study was to determine whether CTTU evaluation would decrease DTN times on nights and weekends. Methods: A retrospective chart review included patients 18 years and older presenting with AIS to the emergency department and treated with IV alteplase on a week-night (4pm-8am) or weekend (Friday 4pm - Monday 8am) between January 2019- February 2020. The distribution of median DTN times were compared for the following groups: (1) Pre-CTTU installation (January 1, 2019-July 28, 2019) versus post-CTTU installation (July 29, 2019 - February 29, 2020), regardless of telestroke usage (“intention to treat”), (2) Pre-CTTU (using traditional telestroke and excluding bedside evaluations) versus post-CTTU (using CTTU and excluding bedside evaluations) (“per-protocol”) and (3) Post-CTTU period use of traditional telestroke versus CTTU (“post-CTTU group”). Analyses were performed using the Mann-Whitney U test. Results: A total of 111 patients met inclusion criteria with 44 (39.6%) treated in the pre-CTTU period and 67 (60.4%) treated in the post-CTTU period. After installation, CTTU was utilized in 38.8% (n=26) of cases, traditional telestroke in 44.8% (n=30), and the remaining 16.4% (n=11) were evaluated at bedside. The intention-to-treat analysis showed no difference between the pre-CTTU and post-CTTU groups (44.0 minutes vs 44.0 minutes, p=0.909). The per-protocol analysis showed faster DTN times in the Post-CTTU group compared to the Pre-CTTU group (38.5 minutes vs 44.0 minutes, p=0.128), but the difference was not significant. The post-CTTU group analysis showed median DTN times significantly improved using CTTU compared to traditional telestroke (38.5 minutes vs 48.0 minutes, p=0.011). Conclusion: The use of CT telestroke in the evaluation of acute ischemic stroke patients decreased DTN time when a stroke neurologist is not on-site.

Treatment Delays for Patients With Acute Ischemic Stroke in an Iranian Emergency Department: A Retrospective Chart Review

2019 ◽  
Vol 73 (2) ◽  
pp. 118-129
Author(s):  
Hadi Hassankhani ◽  
Amin Soheili ◽  
Samad S. Vahdati ◽  
Farough A. Mozaffari ◽  
Justin F. Fraser ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Treatment Delays

Contrast stasis on noncontrast computed tomography as a predictor of stroke postthrombolysis

2011 ◽  
Vol 30 (6) ◽  
pp. E13 ◽  
Author(s):  
George M. Ghobrial ◽  
Anil K. Nair ◽  
Richard T. Dalyai ◽  
Pascal Jabbour ◽  
Stavropoula I. Tjoumakaris ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Mr Imaging ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Common Finding ◽  
Single Institution ◽  
Anterior Circulation ◽  
Noncontrast Ct ◽  
Noncontrast Computed Tomography

Multimodal endovascular intervention is becoming more commonplace for the acute intervention of ischemic stroke. Hyperdensity in a portion of the treated territory is a common finding on postthrombolytic noncontrast CT (NCCT), but its significance is poorly understood. The authors conducted a single-institution, retrospective chart review of patients who had intraarterial thrombolysis of the anterior circulation between 2010 and 2011 with evidence of hyperdensity on NCCT following recanalization. Eighteen patients had evidence of postoperative contrast stasis causing hyperdensity on NCCT. One hundred percent of the patients had MR imaging evidence of completed strokes postoperatively in the same distribution as the stasis. Stasis on NCCT after intervention had a sensitivity and specificity of 82% and 0% for predicting stroke, respectively. Furthermore, the positive predictive value was 100%. The presence of contrast stasis on postthrombolytic NCCT correlates well with stroke seen on subsequent MR imaging.

CTA collateral score predicts infarct volume and clinical outcome after endovascular therapy for acute ischemic stroke: a retrospective chart review

2015 ◽  
Vol 8 (6) ◽  
pp. 559-562 ◽  
Author(s):  
Lucas Elijovich ◽  
Nitin Goyal ◽  
Shraddha Mainali ◽  
Dan Hoit ◽  
Adam S Arthur ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Chart Review ◽  
Infarct Volume ◽  
Retrospective Chart Review ◽  
Favorable Outcome ◽  
Good Clinical Outcome

BackgroundAcute ischemic stroke (AIS) due to emergent large-vessel occlusion (ELVO) has a poor prognosis.ObjectiveTo examine the hypothesis that a better collateral score on pretreatment CT angiography (CTA) would correlate with a smaller final infarct volume and a more favorable clinical outcome after endovascular therapy (EVT).MethodsA retrospective chart review of the University of Tennessee AIS database from February 2011 to February 2013 was conducted. All patients with CTA-proven LVO treated with EVT were included. Recanalization after EVT was defined by Thrombolysis in Cerebral Infarction (TICI) score ≥2. Favorable outcome was assessed as a modified Rankin Score ≤3.ResultsFifty patients with ELVO were studied. The mean National Institutes of Health Stroke Scale score was 17 (2–27) and 38 of the patients (76%) received intravenous tissue plasminogen activator. The recanalization rate for EVT was 86.6%. Good clinical outcome was achieved in 32% of patients. Univariate predictors of good outcome included good collateral scores (CS) on presenting CTA (p=0.043) and successful recanalization (p=0.02). Multivariate analysis confirmed both good CS (p=0.024) and successful recanalization (p=0.009) as predictors of favorable outcome. Applying results of the multivariate analysis to our cohort we were able to determine the likelihood of good clinical outcome as well as predictors of smaller final infarct volume after successful recanalization.ConclusionsGood CS predict smaller infarct volumes and better clinical outcome in patients recanalized with EVT. These data support the use of this technique in selecting patients for EVT. Poor CS should be considered as an exclusion criterion for EVT as patients with poor CS have poor clinical outcomes despite recanalization.

scholarly journals Quantifying candidate volume for endovascular therapy for acute ischemic stroke: a retrospective chart review

CMAJ Open ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. E671-E677
Author(s):  
Brian Lauzon ◽  
Catherine Corrigan-Lauzon ◽  
Jonathan Grynspan ◽  
Susan Bursey ◽  
Timo Krings ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Chart Review ◽  
Retrospective Chart Review

Abstract WMP18: CT Work-Up of Patients Suspected of Acute Ischemic Stroke: Perfusion-CT Adds Value Compared to Clinical Evaluation, Noncontrast Head CT and CT-Angiogram in Terms of Predicting Outcome

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Guangming Zhu ◽  
Patrik Michel ◽  
Amin Aghaebrahim ◽  
James T Patrie ◽  
Wenjun Xin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Data ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Perfusion Ct ◽  
Infarct Core ◽  
Head Ct ◽  
Ct Angiogram ◽  
Work Up

BACKGROUND AND PURPOSE: To determine whether Perfusion-CT (PCT) adds value to Noncontrast head CT (NCT), CT-Angiogram (CTA) and clinical assessment in patients suspected of acute ischemic stroke. METHODS: We retrospectively reviewed the clinical and imaging data collected in 165 patients with acute ischemic stroke. ASPECTS score was calculated from NCT. CTA was reviewed for site of occlusion and collateral flow score. PCT was used to calculate the volumes of infarct core and ischemic penumbra on admission. Recanalization status was assessed on follow-up imaging. Clinical data included age, time from onset to baseline imaging, time from baseline imaging to reperfusion therapy, time from baseline imaging to recanalization imaging, NIHSS at baseline, treatment type and modified Rankin score (mRS) at 90 days. In a first multivariate regression analysis, we used volume of PCT penumbra and infarct core as outcome, and assessed whether they could be predicted from clinical variables, NCT and/or CTA. In a second multivariate regression analysis, we used mRS at 90 days as outcome, and determined which imaging and clinical variables predicted it best. RESULTS: 165 patients were identified. Mean±SD time from onset to baseline imaging was 6.7±8.7 hrs. 76 had a good outcome (90-day mRS 0-2), 89 had a poor outcome. Mean±SD PCT infarct was 44.8±46.5 ml. Mean±SD PCT penumbra was 47.0±33.9 ml. PCT infarct could be predicted by clinical data, NCT, CTA, and combinations of this data (P<0.05); the best predictive model included the clinical data, plus NCT and CTA. PCT Penumbra could NOT be predicted by clinical data, NCT, and CTA. In terms of predicting mRS at 90 days, all of variables but NCT and CTA were significantly associated with 90-day mRS outcome. The single most important predictor was recanalization status (P<0.001). PCT penumbra volume (P=0.001) was also a predictor of clinical outcome, especially when considered in conjunction with recanalization through an interaction term (P<0.001). CONCLUSION: PCT penumbra represents independent information, which cannot be predicted by clinical, NCT, and CTA data. PCT penumbra is an important determinant of clinical outcome, and adds relevant clinical information compared to a stroke CT work-up including NCT and CTA.

ISCHEMIC STROKE IN COVID-19 PATIENT: A RARE CASE REPORT.

2021 ◽  
pp. 72-73
Author(s):  
Atul Kaushik ◽  
Showkat Nazir Wani ◽  
Anish Garg ◽  
Dev Kumar
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Rare Case ◽  
Cardiovascular Complications ◽  
Left Middle Cerebral Artery ◽  
Early Evaluation ◽  
Rare Case Report ◽  
Ct Head ◽  
Left Middle ◽  
Middle Cerebral Artery Infarct

Background: COVID-19 is shown to be associated with hypercoagulable state which may cause neurological and cardiovascular complications. COVID-19 has been represented as an independent risk factor for acute ischemic stroke. Objective:We report a case of acute ischemic stroke as a COVID-19 complication. Material and methods: A 62-year-old known hypertensive male was diagnosed with COVID-19. He developed neurological symptoms 10 days after being tested positive. On doing an NC-CT head, a large acute ischemic stroke involving left Middle Cerebral Artery infarct was detected. Result and Conclusion: Our case represents the development of acute ischemic stroke as a neurological manifestation in patient with COVID-19. Early evaluation for acute neurological changes and timely management may reduce morbidity and mortality in such cases.

Abstract T P10: Hounsfield Unit Value and Clot Length in the Acutely Occlude Vessel and Time Required to Achieve Thrombectomy, Complications and Outcome

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Alejandro Spiotta ◽  
Jan Vargas ◽  
Harris Hawk ◽  
Raymond Turner ◽  
Imran Chaudry ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Hounsfield Unit ◽  
Hounsfield Units ◽  
Unit Value ◽  
Procedural Complications ◽  
Noncontrast Ct ◽  
Time Required

Introduction: Intra-arterial therapy for acute ischemic stroke (AIS) now has an established role. We investigated if Hounsfield Units (HU) quantification on noncontrast CT is associated with ease and efficacy of mechanical thrombectomy and outcomes. Methods: We retrospectively studied a prospectively maintained database of cases of acute ischemic stroke that underwent intra-arterial therapy between May 2008 and August 2012. Functional outcome was assessed by ninety-day follow up modified Rankin Scale (mRS). Patients were dichotomized base on time to recanalization. Hounsfield units were calculated on head CT. Thrombus location and length were determined on CT angiography. Simple linear regression was used to analyze the association between clot length, average HU, and other clinical variables. Results: 141 patients were included. There was no difference in clot length or average HU among patients with good recanalization achieved within an hour compared to those in which procedures extended beyond an hour. There was no relationship between clot length or density and recanalization. The thrombus length and density were not significantly different between patients with procedural complications and those without. The presence of post procedure intracranial hemorrhage was not associated with thrombus length or density. Ninety day mRS was not associated with thrombus length or density. Conclusions: We have not found any significant associations between either thrombus length or density and likelihood of recanalization, time to achieve recanalization, intraprocedural complications, postprocedural hemorrhage or functional outcome at ninety days. These results do not support a predictive value for thrombus quantification in the evaluation of AIS.

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