Abstract T P59: Brain Atrophy Rates Not Affected By Stroke Thrombolysis

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Amy Brodtmann
Keyword(s):  
Brain Atrophy ◽  
Brain Volume ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Volume Changes ◽  
Significant Difference ◽  
Siemens Trio ◽  
Healthy Control ◽  
Stroke Thrombolysis ◽  
Global Brain

Introduction: Despite clear outcome benefits, some physicians remain concerned about theoretical deleterious effects of intravenous thrombolysis. In the CANVAS study (Cognition and Neocortical Volume After Stroke) we have reported brain volume changes in patients following stroke. We sought here to compare brain atrophy rates of 3 groups of patients presenting with MCA stroke, versus a group of healthy control participants. Hypothesis: We hypothesized that IV thrombolysis would not affect brain atrophy rates following stroke. Methods: Three groups of patients with acute ischemic MCA stroke were included, 2 of whom received thrombolysis: 10 patients were imaged at 2 hours and at 3 months (Copenhagen cohort) and 9 patients imaged within 30 days of symptom onset and at 3 months (Melbourne CANVAS cohort). We compared regional and global brain volume and atrophy rates with 10 patients who did not receive thrombolysis and a group of 10 healthy control participants were also imaged at these timepoints. 3D MPRAGE images were acquired on a Siemens Trio 3T MRI scanner. Images were processed using Freesurfer V 5.1 with default settings. We compared baseline and 3 month average regional cortical thickness. Ipsilesional and contralesional results were analyzed separately. Paired sample t-tests were used to assess significant change. Results: There was no significant difference in brain volume between the 2 timepoints in our control participants. Ipsilesional white matter (WM) and gray matter (GM) volume declined over the 3 month period in all 3 stroke groups. There was no significant difference in brain atrophy rates between stroke patients who received IV thrombolysis and those who didn’t. Conclusions: In this pilot study, we found that thrombolysis did not affect brain atrophy rates in the stroke patients studied.

Abstract P12: Alteplase Reduces Mortality in Patients With Ischemic Stroke and Atrial Fibrillation: Analysis of the IAC Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Eva Mistry ◽  
Adam H De Havenon ◽  
Christopher Leon Guerrero ◽  
Amre Nouh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Intravenous Thrombolysis ◽  
The United States ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Increased Risk ◽  
Significant Difference

Background and Purpose: Multiple studies have established that intravenous thrombolysis with alteplase improves outcome after acute ischemic stroke. However, assessment of thrombolysis’ efficacy in stroke patients with atrial fibrillation (AF) has yielded mixed results. We sought to determine the association of alteplase with mortality, hemorrhagic transformation (HT), infarct volume, and mortality in patients with AF and acute ischemic stroke. Methods: We retrospectively analyzed consecutive acute ischemic stroke patients with AF included in the Initiation of Anticoagulation after Cardioembolic stroke (IAC) study, which pooled data from 8 comprehensive stroke centers in the United States. 1889 (90.6%) had available 90-day follow up data and were included. For our primary analysis we used a cohort of 1367/1889 (72.4%) patients who did not undergo mechanical thrombectomy (MT). Secondary analyses were repeated in the patients that underwent MT (n=522). Binary logistic regression was used to determine whether alteplase use was independently associated with risk of HT, final infarct volume, and 90-day mortality, respectively, adjusting for potential confounders. Results: In our primary analyses we found that alteplase use was independently associated with an increased risk for HT (adjusted OR 2.14, 95% CI 1.49 - 3.07, p <0.001) but overall reduced risk of 90-day mortality (adjusted OR 0.58, 95% CI 0.39 - 0.87, p = 0.009). Among patients undergoing MT, alteplase use was associated with a trend towards a reduction in 90-day mortality (adjusted OR 0.68 95% CI 0.45 - 1.04, p = 0.077). In the subgroup of patients prescribed DOAC treatment (n = 327; 24 received alteplase), alteplase treatment was associated with a trend towards smaller infarct size (< 10 mL), (adjusted OR 0.40, 95% CI 0.15 - 1.12, p = 0.082) without a significant difference in the odds of 90-day mortality (adjusted OR 0.51, 95% CI 0.12 - 2.13, p = 0.357) or hemorrhagic transformation (adjusted OR 0.27, 95% CI 0.03 - 2.07, p = 0.206). Conclusion: Thrombolysis with intravenous alteplase was associated with reduced 90-day mortality in AF patients with acute ischemic stroke not undergoing MT. Further study is required to assess the safety and efficacy of alteplase in AF patients undergoing MT and those on DOACs.

scholarly journals PREDIKTOR SYMPTOMATIC INTRACEREBRAL HEMORRHAGE PASCATROMBOLISIS INTRAVENA PADA STROKE ISKEMIK AKUT

2018 ◽  
Vol 35 (3) ◽  
Author(s):  
Al Rasyid ◽  
Salim Harris ◽  
Mohammad Kurniawan ◽  
Rakhmad Hidayat ◽  
Taufik Mesiano
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Intravenous Thrombolysis ◽  
Definitive Treatment ◽  
Stroke Patients ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stroke Thrombolysis ◽  
Withholding Therapy ◽  
Diabetes Melitus

PREDICTORS OF SYMPTOMATIC INTRACEREBRAL HEMORRHAGE FOLLOWING INTRAVENOUS THROMBOLYSIS IN ACUTE ISCHEMIC STROKEABSTRACTDespite its effectiveness, the percentage of ischemic stroke patients who received definitive treatment, thrombolysis, never went above 10%, due to one of the reason is the occurrence of severe, post-therapeutic complications, such as symptomatic intracerebral hemorrhage (sICH). Several factors contribute to sICH occurrence are age, severity of stroke, early changes of ischemic sign, hyperglycemia, blood pressure, antiplatelet use and its interval. Patients with highest risk of sICH has been shown to have the greatest benefits from thrombolysis among other subgroup patients, therefore withholding therapy is not a choice. Compliance to the stroke’s guidelines could reduce the risk of complications as well as boost effectiveness of treatment.Keywords: Safety predictors, acute ischemic stroke, thrombolysis, sICH ABSTRAK Walau terbukti efektif, persentase pasien yang dapat dilakukan tindakan definitif stroke iskemik akut berupa trombolisis  tidak  pernah  mencapai  angka  10%,  salah  satunya  disebabkan  pertimbangan  terhadap  komplikasi  berat, seperti symptomatic intracerebral hemorrhage (sICH). Beberapa faktor yang berpengaruh terhadap kejadian sICH antara lain usia, derajat stroke, perubahan tanda iskemik dini, hiperglikemia dan diabetes melitus, tekanan darah, penggunaan antiplatelet, serta waktu pemberian. Pasien dengan risiko sICH tertinggi memiliki keuntungan terbesar dari trombolisis sehingga menunda tindakan bukanlah suatu opsi. Kepatuhan terhadap panduan tindakan dapat mengurangi angka kejadian komplikasi berat.Kata kunci: Prediktor keamanan, stroke iskemik akut, trombolisis, sICH

Measuring Global Brain Atrophy with the Brain Volume/Cerebrospinal Fluid Index: Normative Values, Cut-Offs and Clinical Associations

2015 ◽  
Vol 16 (1-2) ◽  
pp. 77-86 ◽  
Author(s):  
Camila Orellana ◽  
Daniel Ferreira ◽  
J.-Sebastian Muehlboeck ◽  
Patrizia Mecocci ◽  
Bruno Vellas ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Brain Atrophy ◽  
Brain Volume ◽  
Normative Values ◽  
Clinical Associations ◽  
Global Brain ◽  
The Brain

Abstract TMP23: Intravenous Thrombolysis in Unknown-onset Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Laura Dorado ◽  
Niaz Ahmed ◽  
Götz Thomalla ◽  
Manuel Lozano ◽  
Branko Malojcic ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Similar Rate ◽  
Stroke Patients ◽  
Severe Stroke ◽  
Safety And Efficacy ◽  
Tissue Plasminogen ◽  
Stroke Thrombolysis ◽  
Iv Tpa ◽  
Symptomatic Intracerebral Haemorrhage

Background and Purpose: Unknown onset (UKO) stroke patients are at present excluded from thrombolytic therapy thrombolysis according to approval criteria and guideline recommendations. However, a number of them might benefit from the treatment. We aim to study the safety and efficacy of intravenous (IV) tissue plasminogen activator (tPA) in ischemic stroke patients with UKO of symptoms compared to those treated within 4.5 hours in a large cohort. Methods: Data were analyzed from 47,237 patients with acute ischemic stroke receiving IV-tPA in hospitals participating in the SITS International Stroke Thrombolysis Registry between 2010 and 2014. Two groups were defined: 1) patients with UKO, (n=502) and 2) patients treated within 4.5 hours of stroke onset, (n=44,875). Outcome measures were symptomatic intracerebral haemorrhage (SICH)-SITS, mortality at 3 months and functional independency as a score in the modified Rankin Scale (mRS) of 0-2 at 3 months. Results: Patients in UKO group were older (74 [65-82] vs. 72 [62-79] years, p<0.001), and had more severe stroke at baseline as measured by NIH Stroke Scale (12 [7-18] vs. 11 [6-17], p<0.001) than ≤4.5h. SICH-SITS occurred in 2.7% vs. 1.6% (p=0.052). At 3 months, mortality was higher (22%vs.16.9%, p=0.01) and functional independency was lower (46.8% vs. 56.2%, p<0.001) in the UKO group than ≤4.5h. In the multivariate analysis, these differences disappeared after adjustment baseline imbalances; SICH-SITS (OR0.98; 95% CI [0.43-2.21], p=0.962), mortality (OR0.88; 95% CI [0.64-1.20], p=0.435) and functional independency (OR 0.71; 95% CI [0.48-1.04], p=0.083). Conclusions: Our data suggest no excess risk of SICH in patients with UKO stroke treated with tPA and similar rate of functional independency and mortality than patients treated within 4.5 hours.

Abstract P27: Safety and Efficacy of Alteplase in Ischemic Stroke Patients > 80 Years of Age in the Extended Time Window

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Christoph Stretz ◽  
Brian C Mac Grory ◽  
Nasir Fakhri ◽  
Anusha Boyanpally ◽  
Syed Daniyal Asad ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Primary Outcome ◽  
Intravenous Thrombolysis ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Safety And Efficacy ◽  
Good Functional Outcome ◽  
Significant Difference ◽  
Intravenous Alteplase

Background: While patients > 80 years of age were originally excluded from the ECASS 3 trial showing benefit in the 3 – 4.5-hour window, recent studies have shown that intravenous alteplase is safe and benefits this population. We aimed to assess safety and efficacy of intravenous thrombolysis in stroke patients above 80 presenting both in the 3 and 3 – 4.5-hour windows. Methods: We analyzed data from 3 comprehensive stroke centers in the US of consecutive patients > 80 years of age presenting with acute ischemic stroke who received intravenous alteplase in both the 3 and 4.5-hour time windows over a 3-year period. We collected baseline demographic data, stroke severity as assessed by NIHSS scores, and use of mechanical thrombectomy (MT). Primary outcome was symptomatic intracerebral hemorrhage, as defined by ECASS 2 criteria (hemorrhagic transformation post thrombolysis with worsening of NIHSS score by ≥ 4 points). Secondary outcomes included assessment of efficacy, evaluated by good functional outcome (mRS 0 – 2) at time of discharge. Results: We identified 418 patients with ischemic stroke above 80 years (64.8% women) who received alteplase: 344 (82.3%) within 3 hour and 74 (17.7%) in the 3 to 4.5-hour window, with similar stroke severity by NIHSS scores (median [IQR] 13 [12-32] vs. 12 [6-20], p = 0.87). In addition, 147 patients received MT, 128 (37.2%) versus 19 (25.7%), (p= 0.059) in the 3 and 3-4.5-hour groups. The overall rate of sICH was 6.1% and 4.0% (p = 0.49), in the 3 and 3-4.5-hour groups, respectively. Good functional outcome was achieved in 16.7% at time of discharge, for 17.7% in the 3-hour group and for 12.2% in the 3 – 4.5-hour group (p= 0.24). Conclusions: In our multi-center cohort, the use of alteplase in patients above 80 was safe, with low sICH rates similar to the literature, irrespective of age. Given the rare occurrence of our primary outcome in a selected cohort of acute stroke patients, our study was not powered to detect a possible significant difference in sICH.

Can resistance training impact MRI outcomes in relapsing-remitting multiple sclerosis?

2017 ◽  
Vol 24 (10) ◽  
pp. 1356-1365 ◽  
Author(s):  
Tue Kjølhede ◽  
Susanne Siemonsen ◽  
Damian Wenzel ◽  
Jan-Patrick Stellmann ◽  
Steffen Ringgaard ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Resistance Training ◽  
Disease Progression ◽  
Cortical Thickness ◽  
Brain Atrophy ◽  
Brain Volume ◽  
Lesion Load ◽  
Volume Percentage ◽  
Relapsing Remitting ◽  
Global Brain

Background: Multiple sclerosis (MS) is characterised by accelerated brain atrophy, which relates to disease progression. Previous research shows that progressive resistance training (PRT) can counteract brain atrophy in other populations. Objective: To evaluate the effects of PRT by magnetic resonance imaging (MRI) and clinical measures of disease progression in people with MS. Methods: This study was a 24-week randomised controlled cross-over trial, including a Training ( n = 18, 24 weeks of PRT followed by self-guided physical activity) and Waitlist group ( n = 17, 24 weeks of habitual lifestyle followed by PRT). Assessments included disability measures and MRI (lesion load, global brain volume, percentage brain volume change (PBVC) and cortical thickness). Results: While the MS Functional Composite score improved, Expanded Disability Status Scale, lesion load and global brain volumes did not differ between groups. PBVC tended to differ between groups and higher absolute cortical thickness values were observed in 19 of 74 investigated cortical regions after PRT. Observed changes were confirmed and reproduced when comparing relative cortical thickness changes between groups for four areas: anterior cingulate gyrus, temporal pole, orbital sulcus and inferior temporal sulcus. Conclusion: PRT seem to induce an increase in cortical thickness, indicating that PRT have a neuroprotective or even neuroregenerative effect in relapsing-remitting MS.

scholarly journals Assessment of Tau Pathology as Measured by 18F-THK5317 and 18F-Flortaucipir PET and Their Relation to Brain Atrophy and Cognition in Alzheimer’s Disease

2021 ◽  
pp. 1-15
Author(s):  
Elisa Colato ◽  
Konstantinos Chiotis ◽  
Daniel Ferreira ◽  
Mariam S. Mazrina ◽  
Laetitia Lemoine ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Brain Atrophy ◽  
Brain Volume ◽  
Volume Index ◽  
Discriminative Ability ◽  
Therapeutic Trials ◽  
Prodromal Ad ◽  
Global Brain

Background: In Alzheimer’s disease (AD), the abnormal aggregation of hyperphosphorylated tau leads to synaptic dysfunction and neurodegeneration. Recently developed tau PET imaging tracers are candidate biomarkers for diagnosis and staging of AD. Objective: We aimed to investigate the discriminative ability of 18F-THK5317 and 18F-flortaucipir tracers and brain atrophy at different stages of AD, and their respective associations with cognition. Methods: Two cohorts, each including 29 participants (healthy controls [HC], prodromal AD, and AD dementia patients), underwent 18F-THK5317 or 18F-flortaucipir PET, T1-weighted MRI, and neuropsychological assessment. For each subject, we quantified regional 18F-THK5317 and 18F-flortaucipir uptake within six bilateral and two composite regions of interest. We assessed global brain atrophy for each individual by quantifying the brain volume index, a measure of brain volume-to-cerebrospinal fluid ratio. We then quantified the discriminative ability of regional 18F-THK5317, 18F-flortaucipir, and brain volume index between diagnostic groups, and their associations with cognition in patients. Results: Both 18F-THK5317 and 18F-flortaucipir outperformed global brain atrophy in discriminating between HC and both prodromal AD and AD dementia groups. 18F-THK5317 provided the highest discriminative ability between HC and prodromal AD groups. 18F-flortaucipir performed best at discriminating between prodromal and dementia stages of AD. Across all patients, both tau tracers were predictive of RAVL learning, but only 18F-flortaucipir predicted MMSE. Conclusion: Our results warrant further in vivo head-to-head and antemortem-postmortem evaluations. These validation studies are needed to select tracers with high clinical validity as biomarkers for early diagnosis, prognosis, and disease staging, which will facilitate their incorporation in clinical practice and therapeutic trials.

The START nomogram for individualized prediction of the probability of unfavorable outcome after intravenous thrombolysis for stroke

2018 ◽  
Vol 13 (7) ◽  
pp. 700-706 ◽  
Author(s):  
Manuel Cappellari ◽  
Gianni Turcato ◽  
Stefano Forlivesi ◽  
Fabio Bagante ◽  
Gianfranco Cervellin ◽  
...  
Keyword(s):  
Scale Score ◽  
Operating Characteristic ◽  
Treatment Time ◽  
Characteristic Curve ◽  
Intravenous Thrombolysis ◽  
Unfavorable Outcome ◽  
Stroke Patients ◽  
Operating Characteristic Curve ◽  
Stroke Thrombolysis ◽  
Individualized Prediction

Background and purpose The nomogram is an important component of modern medical decision-making, which calculates the probability of an event entirely based on individual characteristics. We aimed to develop and validate a nomogram for individualized prediction of the probability of unfavorable outcome in intravenous thrombolysis-treated stroke patients included in the large multicenter Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register. Methods All patients registered in the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register by 179 Italian centers between May 2001 and March 2016 were originally included. The main outcome measure was three-month unfavorable outcome (modified Rankin Scale 3–6). Four non-categorical predictors of unfavorable outcome (baseline National Institutes of Health (NIH) Stroke Scale score: 0–25, age ≥18 years, pre-stroke modified Rankin Scale score: 0–2, and onset-to-treatment time: 0–270 min) were identified a-priori by three neurologists with expertise in the management of stroke. To generate the NIHSS STroke Scale score, Age, pre-stroke mRS score, onset-to-treatment Time (START), the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed using the area under the receiver operating characteristic curve. Results A total of 15,862 patients with complete data for generating the START was randomly dichotomized into training (2/3, n = 10,574) and test (1/3, n = 5288) sets. The area under the receiver operating characteristic curve of START was 0.800 (95% confidence interval: 0.792–0.809) in the training set and 0.815 (95% confidence interval: 0.804–0.822) in the test set. Conclusions By using a limited number of non-categorical predictors, the START is the first nomogram developed and validated in a large Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register cohort, which reliably calculates the probability of unfavorable outcome in intravenous thrombolysis-treated stroke patients.

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