Abstract 2511: Reperfusion Measured by Mean Transit Time Predicts Clinical Improvement in Hyperacute Ischemic Stroke Patients Better Than Time-to-Peak and Tmax

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Andria L Ford ◽  
Hongyu An ◽  
Katie D Vo ◽  
William J Powers ◽  
Weili Lin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Linear Regression ◽  
Acute Ischemic Stroke ◽  
Clinical Improvement ◽  
Independent Predictor ◽  
Mean Transit Time ◽  
Perfusion Deficit ◽  
Perfusion Parameter ◽  
Stroke Patients ◽  
Time To Peak

Background: Early reperfusion is associated with improved clinical outcome in acute ischemic stroke; however, there is no consensus regarding which perfusion parameter may best serve as a marker of clinical improvement. We compared three commonly used MRI perfusion parameters, mean transit time (MTT), time-to-peak (TTP), and Tmax, to identify which method of measuring reperfusion best predicted clinical improvement. Methods: Acute ischemic stroke patients underwent two MR scans: within 4.5 hours (tp1) and at 6 hours (tp2) after stroke onset. Co-registered MTT, TTP, and Tmax maps were generated to measure regions of perfusion deficit at tp1 and tp2. Perfusion deficit was defined as prolongation of MTT, TTP, or Tmax beyond four pre-specified thresholds for each parameter (4 thresholds were chosen to ensure results were not spuriously based on one threshold). Commonly-used thresholds (relative to contralateral median) were selected for each parameter: for MTT: >3, 4, 5, or 6 seconds (s), for TTP: >2, 4, 6, or 8s, and for Tmax: >2, 4, 6, and 8s. The volume of reperfusion (Vreperf) was defined as the volume of tissue with perfusion deficit at tp1 and no perfusion deficit at tp2. Clinical improvement was defined as: Admission NIH Stroke Scale (NIHSS) - 1 month NIHSS (ΔNIHSS). A multivariable linear regression model identified if Vreperf as measured by MTT, TTP, or Tmax was an independent predictor of clinical improvement after adjusting for patient age, admission NIHSS, tPA treatment, and volume of tp1 perfusion deficit. Results: Thirty-nine acute ischemic stroke patients were prospectively scanned at 2.8±.8hr (tp1) and 6.4±.4hr (tp2) after stroke onset (mean age=64, 44% female, 36% Black, mean NIHSS=14, 74% received IV tPA). Across the four thresholds, mean volume of perfusion deficit ranged from 58-96ml for MTT, 56-116ml for TTP, and 51-113ml for Tmax. Mean Vreperf ranged from 15-22ml for MTT, 15-23ml for TTP, and 14-21ml for Tmax. In the multivariable linear regression analysis, after adjusting for age, admission NIHSS, tPA treatment, and volume of tp1 perfusion deficit, Vreperf predicted ΔNIHSS for MTT=4s (p=0.007), MTT=5s (p=0.005), and MTT=6s (p=0.010), whereas Vreperf did not predict ΔNIHSS for any TTP or Tmax threshold ( Table ). Conclusion: Reperfusion, defined by MTT, was an independent predictor of clinical improvement, while reperfusion defined by TTP and Tmax were not. Therefore, MTT may be the best time-based perfusion parameter to define clinically-relevant reperfusion after stroke.

Abstract WP38: Early Progressive Ischemia Predicts Worse Clinical Outcome In Acute Ischemic Stroke and Is Decreased With tPA Treatment

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Andria L Ford ◽  
Hongyu An ◽  
Katie D Vo ◽  
William J Powers ◽  
Weili Lin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Mean Transit Time ◽  
Multivariable Analysis ◽  
Brain Regions ◽  
Perfusion Deficit ◽  
Stroke Patients ◽  
Median Volume ◽  
Multivariable Regression

Background: While some ischemic stroke patients improve rapidly after onset, many show no improvement or even worsening in the first days after stroke. We hypothesized that development of brain regions with “progressive ischemia” within hours of stroke onset may predict poor clinical outcome. Methods: Acute ischemic stroke patients underwent two MR scans: within 4.5 hrs (tp1) and at 6 hrs (tp2) after onset. Mean transit time (MTT) maps measured tp1 and tp2 perfusion deficits. “Perfusion deficit” was defined as MTT > 6 s longer than the contralateral median. Volume of progressive ischemia (V PR ) was defined by regions of normal perfusion (MTT<6) at tp1 which became abnormal (MTT>6) at tp2. Bivariate analyses between V PR and ΔNIHSS from admission to 1 month, V PR and 1 month mRS, and V PR and 1 month mortality were performed. Multivariable regression identified if V PR predicted ΔNIHSS, mRS, and mortality after adjusting for admission NIHSS, volume of reperfusion (V rep ), and volume of tp1 perfusion deficit (V tp1 ). Regression analysis determined if tPA treatment predicted V PR after adjusting for admission NIHSS and V tp1 . Results: Fifty patients were scanned at 2.9 (tp1) and 6.4 hrs (tp2) after onset. Mean NIHSS=14; 74% received IV tPA. Progressive ischemia was found in 34 (68%) patients (Fig. shows patient example). Mean V tp1 , V rep , and V PR were 50, 14.4, and 6.4ml, respectively. V PR correlated with ΔNIHSS (r=-.25, p=0.096), mRS (r=.44, p=0.002), and mortality (r=.31, p=0.034). In multivariable analysis, V PR predicted less improvement in ΔNIHSS (β=-.19, p=0.019) and greater disability on mRS (β=0.06, p=0.016). In multivariable analysis, tPA treatment negatively predicted V PR (β=-3.6, p=0.050). Conclusion: Progressive ischemia, identified in 2/3 of our cohort, predicted worse outcomes. As tPA treatment predicted less progressive ischemia, therapies aimed at preventing progressive ischemia in acute ischemic stroke may be considered in addition to promoting reperfusion.

Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tae-Jin Song ◽  
Jinkwon Kim ◽  
Dongbeom Song ◽  
Yong-Jae Kim ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Independent Predictor ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

scholarly journals Delay of late-venous phase cortical vein filling in acute ischemic stroke patients: Associations with collateral status

2016 ◽  
Vol 37 (2) ◽  
pp. 671-682 ◽  
Author(s):  
Sonu Bhaskar ◽  
Andrew Bivard ◽  
Mark Parsons ◽  
Michael Nilsson ◽  
John R Attia ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Computed Tomography Angiography ◽  
Dynamic Computed Tomography ◽  
Stroke Patients ◽  
Cortical Vein ◽  
Arterial Enhancement ◽  
Time To Peak ◽  
Venous Phase

Evaluation of the venous system may be useful in stroke prognostication and patient selection for acute intervention strategies. We report a novel phenomenon, delayed-late venous phase cortical vein filling, observed on dynamic computed tomography angiography obtained using multidetector computed tomography scanner, in acute ischemic stroke patients. The aim of this study was to examine the frequency of delayed-late venous phase cortical vein filling and assess its association to baseline collateral status. Dynamic computed tomography angiography images of acute ischemic stroke patients, being assessed for reperfusion therapy, were prospectively studied. Delayed-late venous phase cortical vein filling was defined by late venous phase opacification of cortical veins despite contrast clearance from contralateral cortical veins on dynamic computed tomography angiography. Time to peak of maximum arterial enhancement was recorded. A total of 117 patients (mean age = 70.6 ± 13.3 years; males = 48%) with hemispheric ischemic stroke who underwent acute dynamic computed tomography angiography were included in the study. Overall, 56 (48%) demonstrated delayed-late venous phase cortical vein filling. Poor collateralization (OR = 13.50; 95% CI = (4.2, 43); p ≤ 0.0001) and longer time to peak of maximum arterial enhancement (OR = 3.2; 95% CI = (1.96, 5.3); p  ≤ 0.0001) were positively associated with delayed-late venous phase cortical vein filling. Delayed-late venous phase cortical vein filling was independently associated with poor baseline collateral status (75% vs. 15%, p ≤ 0.0001; OR = 14.38; 95% CI = (4.33, 47.8); p ≤ 0.0001). Delayed-late venous phase cortical vein filling is frequently seen in patients with acute ischemic stroke and is associated with poor baseline collateralization.

scholarly journals Higher fasting C-peptide is associated with post-stroke depression: a multicenter prospective cohort study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanyan Wang ◽  
Wenzhe Sun ◽  
Jinfeng Miao ◽  
Xiuli Qiu ◽  
Yan Lan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Rating Scale ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Stroke Onset ◽  
Stroke Patients ◽  
C Peptide ◽  
Post Stroke ◽  
Post Stroke Depression

Abstract Background Fasting C-peptide (FCP) has been shown to play an important role in the pathophysiology of mood disorders including depression and schizophrenia, but it is unknown whether it also predicts post-stroke depression (PSD). This study examined the association between FCP and PSD at 6 months after acute ischemic-stroke onset among Chinese subjects. Methods A total of 656 stroke patients were consecutively recruited from three hospitals of Wuhan city, Hubei province. Clinical and laboratory data were collected on admission. PSD status was evaluated by DSM-V criteria and 17-item Hamilton Rating Scale for Depression (HAMD-17) at 6 months after acute ischemic stroke. The χ2-test, Mann-Whitney U-test, and t-test were used to check for statistical significance. Multivariate logistic regression model was used to explore independent predictor of PSD. Results In the univariate analysis, significant differences were found between the PSD and non-PSD groups in terms of FCP level (p = 0.009). After multivariate adjustments, FCP remained a significant independent predictor of PSD, with an adjusted odds ratio of 1.179 (95%CI: 1.040–1.337, p = 0.010). Conclusions Higher FCP levels on admission were found to be associated with PSD at 6 months after acute ischemic-stroke onset. For stroke patients, doctors should pay attention to the baseline FCP for screening high-risk PSD in clinical practice.

Perfusion patterns in migraine with aura

Cephalalgia ◽  
2014 ◽  
Vol 34 (11) ◽  
pp. 870-876 ◽  
Author(s):  
Alex Förster ◽  
Holger Wenz ◽  
Hans U Kerl ◽  
Marc A Brockmann ◽  
Christoph Groden
Keyword(s):  
Ischemic Stroke ◽  
Migraine With Aura ◽  
Clinical Symptoms ◽  
Mean Transit Time ◽  
Moderate Increase ◽  
Migraine Aura ◽  
Vascular Territory ◽  
Stroke Patients ◽  
Time To Peak ◽  
Ischemic Attack

Objectives Migraine with aura is a common neurological disorder, and differentiation from transient ischemic attack or stroke based on clinical symptoms may be difficult. Methods From an MRI report database we identified 33 patients with migraine with aura and compared these to 33 age-matched ischemic stroke patients regarding perfusion patterns on perfusion-weighted imaging (PWI)-derived maps: time to peak (TTP), mean transit time (MTT), and cerebral blood flow and volume (CBF, CBV). Results In 18/33 (54.5%) patients with migraine with aura, TTP showed areas of hypoperfusion, most of these not limited to the territory of a specific artery but affecting two or more vascular territories. In patients with migraine with aura, TTP (1.09 ± 0.05 vs. 1.47 ± 0.40, p < 0.001) and MTT ratios (1.01 ± 0.10 vs. 1.19 ± 0.21, p = 0.003) were significantly lower compared to patients with ischemic stroke. In contrast to this, CBF and CBV ratios did not differ significantly between both groups. Conclusions Migraine aura is usually associated with a perfusion deficit not limited to a specific vascular territory, and only a moderate increase of TTP. Thus, hypoperfusion restricted to a single vascular territory in combination with a marked increase of TTP or MTT may be regarded as atypical for migraine aura and suggestive of acute ischemic stroke.

scholarly journals Safety and Efficacy of Low-Dose Tirofiban Combined With Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischemic Stroke: A Matched-Control Analysis From a Nationwide Registry

2021 ◽  
Vol 12 ◽  
Author(s):  
Gaoting Ma ◽  
Shuo Li ◽  
Baixue Jia ◽  
Dapeng Mo ◽  
Ning Ma ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Propensity Score ◽  
Acute Ischemic Stroke ◽  
Propensity Score Matching ◽  
Clinical Improvement ◽  
Low Dose ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
Stroke Patients

Purpose: Tirofiban administration to acute ischemic stroke patients undergoing mechanical thrombectomy with preceding intravenous thrombolysis remains controversial. The aim of the current study was to evaluate the safety and efficacy of low-dose tirofiban during mechanical thrombectomy in patients with preceding intravenous thrombolysis.Methods: Patients with acute ischemic stroke undergoing mechanical thrombectomy and preceding intravenous thrombolysis were derived from “ANGEL-ACT,” a multicenter, prospective registry study. The patients were dichotomized into tirofiban and non-tirofiban groups based on whether tirofiban was administered. Propensity score matching was used to minimize case bias. The primary safety endpoint was symptomatic intracerebral hemorrhage (sICH), defined as an intracerebral hemorrhage (ICH) associated with clinical deterioration as determined by the Heidelberg Bleeding Classification. All ICHs and hemorrhage types were recorded. Clinical outcomes included successful recanalization, dramatic clinical improvement, functional independence, and mortality at the 3-month follow-up timepoint. Successful recanalization was defined as a modified Thrombolysis in Cerebral Ischemia score of 2b or 3. Dramatic clinical improvement at 24 h was defined as a reduction in NIH stroke score of ≥10 points compared with admission, or a score ≤1. Functional independence was defined as a Modified Rankin Scale (mRS) score of 0–2 at 3-months.Results: The study included 201 patients, 81 in the tirofiban group and 120 in the non-tirofiban group, and each group included 68 patients after propensity score matching. Of the 201 patients, 52 (25.9%) suffered ICH, 15 (7.5%) suffered sICH, and 18 (9.0%) died within 3-months. The median mRS was 3 (0–4), 99 (49.3%) achieved functional independence. There were no statistically significant differences in safety outcomes, efficacy outcomes on successful recanalization, dramatic clinical improvement, or 3-month mRS between the tirofiban and non-tirofiban groups (all p &gt; 0.05). Similar results were obtained after propensity score matching.Conclusion: In acute ischemic stroke patients who underwent mechanical thrombectomy and preceding intravenous thrombolysis, low-dose tirofiban was not associated with increased risk of sICH or ICH. Further randomized clinical trials are needed to confirm the effects of tirofiban in patients undergoing bridging therapy.

Abstract T P27: Early Blood Brain Barrier Disruption in the Ischemic Core

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Richard Leigh
Keyword(s):  
Ischemic Stroke ◽  
Linear Regression ◽  
Acute Ischemic Stroke ◽  
Blood Brain Barrier ◽  
Brain Barrier ◽  
Restricted Diffusion ◽  
Stroke Patients ◽  
Adc Value ◽  
Blood Brain ◽  
Ischemic Core

Background: Animal models of cerebral ischemia have identified an early, reversible opening of the blood brain barrier (BBB) which is separate from the delayed secondary opening caused by neuroinflamation. A recent study found BBB disruption was frequently detected in acute ischemic stroke patients with MRI permeability imaging (Leigh et al., Stroke, 2014). Hypothesis: More severe restricted diffusion will be associated with higher degrees of BBB damage in acute ischemic stroke patients. Methods: The MRI scans of 13 acute ischemic stroke patients were analyzed. Diffusion weighted images (DWI) and perfusion weighted images (PWI) where co-registered to allow for a voxel based analysis. Blood-brain permeability images (BBPI) were generated from the PWI source images as described in the aforementioned study. Only voxels of tissue which had an apparent diffusion coefficient (ADC) < 700 were included. Linear regression was performed to determine if there was a relationship between ADC and BBPI. Results: From the 13 patients, 535 mL of brain tissue was included in the analysis. The figure shows a scatter plot and regression line of ADC value vs mean fraction of gadolinium leakage on BBPI. Univariate linear regression with ADC as the independent variable and BBPI as the dependent variable found them to be significantly correlated (p<0.001). Multivariate analysis found time-to-MRI (p<0.001) but not patient age (p=0.71) to be significantly correlated with BBPI in addition to ADC (p<0.001). Conclusions: Early BBB damage was detected within the ischemic core of acute stroke patients. The degree of restricted diffusion was significantly correlated with the degree of BBB damage.

scholarly journals Perfusion Angiography in Acute Ischemic Stroke

2016 ◽  
Vol 2016 ◽  
pp. 1-14 ◽  
Author(s):  
Fabien Scalzo ◽  
David S. Liebeskind
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Ground Truth ◽  
Cerebrovascular Diseases ◽  
Time To Peak ◽  
Imaging Tool ◽  
The Impact

Visualization and quantification of blood flow are essential for the diagnosis and treatment evaluation of cerebrovascular diseases. For rapid imaging of the cerebrovasculature, digital subtraction angiography (DSA) remains the gold standard as it offers high spatial resolution. This paper lays out a methodological framework, named perfusion angiography, for the quantitative analysis and visualization of blood flow parameters from DSA images. The parameters, including cerebral blood flow (CBF) and cerebral blood volume (CBV), mean transit time (MTT), time-to-peak (TTP), andTmax, are computed using a bolus tracking method based on the deconvolution of the time-density curve on a pixel-by-pixel basis. The method is tested on 66 acute ischemic stroke patients treated with thrombectomy and/or tissue plasminogen activator (tPA) and also evaluated on an estimation task with known ground truth. This novel imaging tool provides unique insights into flow mechanisms that cannot be observed directly in DSA sequences and might be used to evaluate the impact of endovascular interventions more precisely.

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