Abstract 2632: The Relationship Between MRI/PWI-Time Intensity Curve And 3-month Clinical Outcome Of The Acute Ischemic Patients Who Underwent Endovascular Reperfusion Therapy For IC Or MCA Occlusion.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
MASAHITO NAKAZAKI ◽  
Takahisa Mori ◽  
Hiroyuki Tajiri ◽  
Tomonori Iwata ◽  
Yuichi Miayazaki
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Reperfusion Therapy ◽  
Intensity Curve ◽  
Stroke Patients ◽  
Time Intensity Curve ◽  
Favorable Clinical Outcome ◽  
The Relationship

The purpose of our study was to investigate the relationship between MRI/PWI-Time Intensity curve (TIC) and 3-month clinical outcome following endovascular reperfusion therapy in acute ischemic stroke patients with occlusion of the internal carotid artery (ICA) or the middle cerebral artery (MCA). We retrospectively analyzed the acute stroke patients 1) who were admitted to our institution from 2004 to 2010, 2) with serious neurological symptoms, 3) who had total occlusion of the ICA or MCA displayed by MRA with DWI -PWI mismatch and 5) who underwent emergency endovascular reperfusion therapy within 8 hours from stroke onset. We investigated patient's baseline characteristics, emergency MRI findings , successful recanalization defined as TICI 2B or 3,and 3-month modified Rankin scale(3M-mRS). We evaluated PWI findings using TIC types. Region of interests were set at symmetrical positions of the bilateral MCA territories and time-intensity-curves (TICs) were calculated. The types of TICs were classified into four patterns according to the timeto peak (TP) and the reduction value of the peak signal (PV). Comparing the affected side with the contralateral side, we defined type 1 as TPa>TPc and PVaTPc and PVc/2≤PVa<PVc, type 3 as TPa >TPc and PVa≥PVc, and type 4 as TPa=TPc. We analyzed the relationship between the PWI/TIC and mRS at 3 months (3M-mRS) statistically. We defined favorable clinical outcome as 3M-mRS of 0-2, and assessed pre-treatment predictors for favorable clinical outcome and death within 3months by using logistic regression analysis. Seventy one patients were analyzed. Their median age was 75 years, median admission NIHSS was 17, median DWI-ASPECT score was 7, sixty three patients had cadiogenic stroke, successful recanalization was achieved in 38 patients (54.0%), and median 3M-mRS was 3. Twenty three patients (32%) had 3M-mRS of 0-2 and 11 patients (37%) died within 3 months. PWI-TICs of type 1,2,3 and 4 were in 13, 37, 21 and 0 patients, respectively. Type of PWI-TIC was significantly correlated to 3M-mRS (r=-0.24,P=0.047). The higher PWI/TIC type were, the lower 3M-mRS were. Logistic regression analysis demonstrated that independent predictors of favorable clinical outcome (3M-mRS of 0-2) were DWI ASPECTS and age, whereas, independent predictors of death within 3months from onset were type 1 of PWI-TIC (OR,5.71;95%CI,1.28-25.4, P=0.022) and admission NIHSS. Conclusion; In ischemic stroke patients who underwent endovascular reperfusion therapy for the ICA or MCA occlusion within 8hours from onset, type of PWI-TIC was the significant predictor for death within 3months from onset.

scholarly journals Early NT-ProBNP (N-Terminal Probrain Natriuretic Peptide) Elevation Predicts Malignant Edema and Death After Reperfusion Therapy in Acute Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Author(s):  
Xuting Zhang ◽  
Shenqiang Yan ◽  
Wansi Zhong ◽  
Yannan Yu ◽  
Min Lou
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Natriuretic Peptide ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Median Serum ◽  
The Relationship

Background and Purpose: We aimed to investigate the relationship between early NT-proBNP (N-terminal probrain natriuretic peptide) and all-cause death in patients receiving reperfusion therapy, including intravenous thrombolysis and endovascular thrombectomy (EVT). Methods: This study included 1039 acute ischemic stroke patients with early NT-proBNP data at 2 hours after the beginning of alteplase infusion for those with intravenous thrombolysis only or immediately at the end of EVT for those with EVT. We performed natural log transformation for NT-proBNP (Ln(NT-proBNP)). Malignant brain edema was ascertained by using the SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study) criteria. Results: Median serum NT-proBNP level was 349 pg/mL (interquartile range, 89–1250 pg/mL). One hundred twenty-one (11.6%) patients died. Malignant edema was observed in 78 (7.5%) patients. Ln(NT-proBNP) was independently associated with 3-month mortality in patients with intravenous thrombolysis only (odds ratio, 1.465 [95% CI, 1.169–1.836]; P =0.001) and in those receiving EVT (odds ratio, 1.563 [95% CI, 1.139–2.145]; P =0.006). The elevation of Ln(NT-proBNP) was also independently associated with malignant edema in patients with intravenous thrombolysis only (odds ratio, 1.334 [95% CI, 1.020–1.745]; P =0.036), and in those with EVT (odds ratio, 1.455 [95% CI, 1.057–2.003]; P =0.022). Conclusions: An early increase in NT-proBNP levels was related to malignant edema and stroke mortality after reperfusion therapy.

scholarly journals Correlation between Serum Vitamin A and D Levels in Acute Phase Ischemic Stroke and Clinical Outcome

2020 ◽  
Vol 14 (1) ◽  
pp. 6-9
Author(s):  
Alfansuri Kadri ◽  
Hasan Sjahrir ◽  
Rosita J. Sembiring ◽  
Muhammad Ichwan
Keyword(s):  
Vitamin D ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Vitamin A ◽  
Nuclear Receptors ◽  
Acute Phase ◽  
Serum Vitamin ◽  
Serum Levels ◽  
Stroke Patients ◽  
The Relationship

Background: In the last decade, a number of studies have examined the relationship between serum vitamin D concentration and the risk of cerebrovascular events. Besides vitamin D, the latest evidence shows that vitamin A is also a risk factor for cerebrovascular disease. Vitamin A and its derivatives act biologically via specific nuclear receptors that regulate gene transcription. Vitamin A receptors can also interact with other nuclear receptors that have neuroprotective effects such as vitamin D, against stroke. Although many studies suggested the synergism of vitamin A and D, there is still no study that evaluates their levels simultaneously in acute phase ischemic stroke, and the relationship to outcome. Objective: The objective of this study was to analyze the correlation between serum vitamin A and D levels on admission in Acute Ischemic Stroke patients and clinical outcome by using the National Institutes of Health Stroke Scale (NIHSS). Methods: A prospective cohort study was conducted, and samples were followed since the diagnosis of acute-phase Ischemic Stroke was established until the clinical outcome of day 14 after stroke onset. A total of 50 subjects enrolled for this study would be examined for serum levels of vitamins A and D on admission, and on the 14th day were assessed for NIHSS as a clinical outcome. Results: From 50 research subjects, the mean of vitamin A and D level in the acute phase of Ischemic Stroke was 463.35 ± 116.97 µg/L and 21.65 ± 6.51 ng/mL, respectively. By using the Spearman’s correlation test, it was found that the acute phase vitamin A level and NIHSS on day 14 had a significant and strong correlation with p = 0.045 (r = -0.672). Along with it, vitamin D serum levels and NIHSS also had a significant and strong correlation with p = 0.026 (r = -0.754). Both of these results showed that vitamin A and D had an inverse association with NIHSS, meaning that the higher vitamin A and D serum levels, the better the clinical outcome would be. Conclusion: Both serum vitamin A and D levels in the acute phase of Ischemic Stroke was correlated strongly with short time clinical outcome. The higher vitamin A and D serum levels in the acute phase, the better the clinical outcome would be for Ischemic Stroke patients.

Abstract WP35: Penumbra Saved in Acute Stroke Patients Treated with IV Thrombolysis Predicts Minimal Infarct Growth Independent of Onset to Treatment

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Marie Luby ◽  
Zurab Nadareishvili ◽  
Kaylie Cullison ◽  
Richard T Benson ◽  
Amie W Hsia ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Independent Predictor ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Volume Increase ◽  
Multimodal Mri ◽  
Favorable Clinical Outcome ◽  
Iv Tpa

Purpose and Hypothesis: The ability to measure the immediate tissue effects in patients treated with thrombolysis ultra-early relative to their known onset has increased. We hypothesized that shorter onset to treatment times (OTT) would lead to more penumbra saved, calculated using multimodal MRI. Methods: Patients were included in this study if they met the following criteria: (1) were admitted between January 2010 and June 1, 2014 at one of two regional stroke centers, (2) had known last seen normal, acute MRI and IV tPA start times, (3) received an admit diagnosis of ischemic stroke, and (4) were treated with standard IV tPA. Penumbral volumes were calculated using the baseline MRI-defined mismatch regions minus the infarcted regions defined by the co-registered DWI at 24 hours. Patients were categorized to the “early” IV tPA cohort if their OTT was ≤ 120 minutes. Infarct growth was quantitatively defined as lesion volume increase > 5 mL from baseline DWI to 5-day FLAIR. Favorable clinical outcome was defined as discharge or later mRS < 2. Results: Sixty-three patients, 23 early- and 40 late-treated, were included in the study with mean age 75 (±15) years, 48% female, median [IQR]: admit NIHSS 10 [5-19], OTT 139 [109-185] minutes, baseline DWI volume 11.2mL [3.5-39.6], baseline MTT volume 120.9mL [37.8-220.7], and baseline mismatch volume 119.3mL [34.6-200.7]. Aside from time-based variables, only the amount of penumbra infarcted at 24 hours (p=0.015) was significantly different between the early- (9mL [1.7-19.7] and late-treated (2.4mL [0.7-7]) cohorts. The patients with favorable outcome were younger (p=0.012) with less severe admit NIHSS (p=0.026), smaller baseline DWI volume (p=0.017), smaller 24 hour DWI volume (p=0.041), and greater percentage of penumbra saved at 24 hours (p=0.010) but no difference in OTT (p=0.267). Using binomial logistic regression, percentage of penumbra saved at 24 hours (95%CI:0.000-0.011, p=0.010) was the only independent predictor of no infarct growth. Conclusions: This study establishes that significantly larger penumbral tissue saved at 24 hours, not early OTT, is predictive of both favorable clinical outcome and no infarct growth.

Abstract TP53: Simple And Easy Way Using Time-Intensity Curve of Perfusion-Weighted Images to Find Penumbra In Stroke Patients Within 4.5 Hours Of Onset Due To The Carotid Artery Occlusion

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Takahisa Mori ◽  
Tomonori Iwata ◽  
Yuichi Miyazaki ◽  
Masahito Nakazaki ◽  
Yoichiro Takahashi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Hospital Death ◽  
Emergency Setting ◽  
Intensity Curve ◽  
Stroke Patients ◽  
Time Intensity Curve

[Purpose] It is not clear how to find penumbra from MR-PWI for reperfusion therapy (RT). The aim of our retrospective study was to investigate whether or not a simple way using time-intensity curve (TIC) of PWI can find penumbra in stroke patients admitted within 4.5 hours from sudden onset due to acute carotid artery occlusion. [Subjects and Methods] Included for analysis were stroke patients 1) who were admitted within 4.5 hours of onset between Jan 2006 and January 2011, 2) who presented NIHSS score of 6 or more on admission, and 3) who underwent emergency MR imaging , which suggested the affected carotid artery occlusion. We assessed, NIHSS on admission (NIH adm), DWI-ASPECT score, TIC types, successful recanalization (SR), NIHSS on the 7th day (NIH 7 th ), and in-hospital death. Early neurological improvement (ENI) was defined as NIH adm - NIH 7 th >0. TICs were generated on region of interests set at symmetrical positions of the bilateral MCA territories. According to the time to peak (TP) and the peak signal (PS) comparing the affected side (a) with the contralateral side (c), we classified TIC pattern into four types and defined type 1 as TPa>TPc and PSa<PSc/2, type2 as TPa>TPc and PSc/2≦PSa<PSc, type 3 as TPa >TPc and PSa≧PSc, and type 4 as TPa=TPc. Relationship between TIC types, in-hospital death and ENI were assessed. [Result] Eighty-seven patients were analyzed. There were 36, 39, 12 and 0 patients in TIC type 1, 2, 3 and 4, 39 patients (44.8%: 39/87) underwent RT and SR was achieved in 18 patients (46.2%), and 29 patients died. Among variables, TIC type 1 was the only determinant of in-hospital death (p<0.01) and SR coupled with TIC type 2 was the determinant of ENI (p<0.01). [Conclusion] TIC type 1 predetermines poor clinical outcome and type 2 means penumbra, where SR may early improve neurological symptoms. TIC is an easy way to find penumbra in an emergency setting.

Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients

2020 ◽  
Vol 13 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Noel van Horn ◽  
Helge Kniep ◽  
Hannes Leischner ◽  
Rosalie McDonough ◽  
Milani Deb-Chatterji ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Logistic Regression Analysis ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Poor Clinical Outcome ◽  
Poor Outcome

BackgroundIn patients suffering from acute ischemic stroke from large vessel occlusion (LVO), mechanical thrombectomy (MT) often leads to successful reperfusion. Only approximately half of these patients have a favorable clinical outcome. Our aim was to determine the prognostic factors associated with poor clinical outcome following complete reperfusion.MethodsPatients treated with MT for LVO from a prospective single-center stroke registry between July 2015 and April 2019 were screened. Complete reperfusion was defined as Thrombolysis in Cerebral Infarction (TICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3–6 was defined as ‘poor outcome’. A logistic regression analysis was performed with poor outcome as a dependent variable, and baseline clinical data, comorbidities, stroke severity, collateral status, and treatment information as independent variables.Results123 patients with complete reperfusion (TICI 3) were included in this study. Poor clinical outcome was observed in 67 (54.5%) of these patients. Multivariable logistic regression analysis identified greater age (adjusted OR 1.10, 95% CI 1.04 to 1.17; p=0.001), higher admission National Institutes of Health Stroke Scale (NIHSS) (OR 1.14, 95% CI 1.02 to 1.28; p=0.024), and lower Alberta Stroke Program Early CT Score (ASPECTS) (OR 0.6, 95% CI 0.4 to 0.84; p=0.007) as independent predictors of poor outcome. Poor outcome was independent of collateral score.ConclusionPoor clinical outcome is observed in a large proportion of acute ischemic stroke patients treated with MT, despite complete reperfusion. In this study, futile recanalization was shown to occur independently of collateral status, but was associated with increasing age and stroke severity.

Abstract TP159: Unilateral Spatial Neglect as an Independent Prognostic Factor for Poor Fim Efficiency in Patients With Mild to Moderate Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ryo Shimomura ◽  
Takahiro Himeno ◽  
Yuka Terasawa ◽  
Kota Sato ◽  
Atsuhito Nakamichi ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Reperfusion Therapy ◽  
Efficiency Score ◽  
Spatial Neglect ◽  
Stroke Patients ◽  
Unilateral Spatial Neglect ◽  
Left Limb

Background and Purpose: Unilateral spatial neglect (USN) is often observed in ischemic stroke patients suffered their right parietal lobe. USN is an obstacle to undergo rehabilitation smoothly, then might influence the recovery of activities of daily living (ADL) after stroke. We aimed to clarify the association between the presence of USN after ischemic stroke and the ADL improvement. Methods: Consecutive patients with first-ever ischemic stroke and left limb paralysis who admitted to within 7 days from onset during February 2011 and March 2019 were included. Patients met the following criteria were excluded: mRS ≥3 before onset, NIHSS >15 on admission, without left limb paralysis, and missing NIHSS or functional independence measure (FIM) score on admission. Multiple regression analysis was performed to investigate the association between FIM efficiency score of acute phase and following factors: age, sex, acute reperfusion therapy (using an intravenous infusion of recombinant tissue plasminogen activator and/or endovascular therapy), FIM score on admission, and other clinical characteristics. All data were collected retrospectively using our electrical health record. Results: 721 ischemic stroke patients with left limb paralysis (320 women, median age 76) were included. Median FIM efficiency score was significantly lower in patients with USN than without USN (n=240, 481; 0.83 vs 1.63, respectively). Multiple regression analysis showed that USN, age, and acute reperfusion therapy were significant prognostic factors of FIM efficiency (coefficient and 95% confidence interval [CI]: -0.135 [-0.771 to -0.153], -0.106 [-0.022 to -0.002], and 0.224 [0.136 to 0.305], respectively). Conclusions: USN significantly influence the recovery of ADL after ischemic stroke. Clinicians should adequately evaluate USN after stroke and undergo USN-specific rehabilitation for them to optimize the effect of post-stroke rehabilitation. USN-specific rehabilitation might lead to better FIM efficiency.

scholarly journals The Relationship of Serum S100B Levels with Infarction Size and Clinical Outcome in Acute Ischemic Stroke Patients

2014 ◽  
Vol 51 (4) ◽  
pp. 395-400 ◽  
Author(s):  
Ozlem Selcuk ◽  
Vildan Yayla ◽  
Murat Cabalar ◽  
Vildan Guzel ◽  
Samiye Uysal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Serum S100b ◽  
Infarction Size ◽  
Relationship Of ◽  
The Relationship

Predictors of favorable outcome after endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion in young patients

2021 ◽  
pp. 028418512110564
Author(s):  
Maciej Szmygin ◽  
Michał Sojka ◽  
Piotr Tarkowski ◽  
Krzysztof Pyra ◽  
Piotr Luchowski ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mortality Rate ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Young Patients ◽  
High Rate ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Favorable Clinical Outcome

Background Mechanical thrombectomy (MT) became a standard of care for patients with acute ischemic stroke (AIS) with its efficacy demonstrated by meta-analysis and randomized studies. Although ischemic stroke is associated more with older patients, it may also have devastating neurological effects on young patients. Purpose To present our experience with stroke patients aged <50 years treated with endovascular means and to evaluate clinical and procedural factors associated with outcome and mortality. Material and Methods This study was conducted on 34 young stroke patients treated with MT. Clinical features including baseline results, radiological imaging, procedural details, and outcome results were documented and evaluated. Recanalization was assessed according to the TICI score. The clinical condition was evaluated after three months using mRS. Mortality rate was calculated. Results The rate of successful recanalization (TICI ≥2c) was 79% (27/34). Symptomatic intracranial hemorrhage (sICH) was observed in 5 (15%) patients. After 90 days, the mortality rate was 12%. Favorable clinical outcome (mRs 0–2) was regained in 65% of the patients whereas satisfactory clinical outcome was seen in 85%. Poor clinical outcome (mRs >2) was observed in 9 (23.7%) patients. Conclusion In conclusion, the results of this study demonstrate that MT for AIS in young patients is feasible and provides an excellent rate of arterial recanalization and high rate of favorable outcomes. Statistical analysis showed that shorter time from onset to arrival and reperfusion, successful recanalization and absence of hemorrhagic transformation are the predictors of favorable clinical outcome and overall survival rate.

scholarly journals Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

2016 ◽  
Vol 6 (9) ◽  
pp. e00513 ◽  
Author(s):  
Johannes C. Gerber ◽  
Marketa Petrova ◽  
Pawel Krukowski ◽  
Matthias Kuhn ◽  
Andrij Abramyuk ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Reperfusion Therapy ◽  
Stroke Patients
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