Abstract TMP45: Usefulness of Susceptibility Vessel Sign With Bright Vessel Appearance in Acute Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Han-Gil Jeong ◽  
Beom-Joon Kim ◽  
Chi Kyung Kim ◽  
Jun Yup Kim ◽  
Dong-Wan Kang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Arterial Occlusion ◽  
University Hospital ◽  
Large Artery ◽  
Peripheral Arteries ◽  
Inclusion Criteria ◽  
Arterial Segment ◽  
Susceptibility Effect ◽  
National University ◽  
Seoul National University

Background: Red thrombi, composed of fibrin and trapped erythrocytes, have magnetic susceptibility effect. Susceptibility vessel sign (SVS) is visualized more sensitively using susceptibility weighted imaging (SWI) than T2*-weighted imaging. Bright vessel appearance (BVA) on arterial spin labeling (ASL) imaging can visualize occluded arterial segment by arterial transit artifact, more sensitively in small and peripheral branches. We investigated the usefulness of SWI-SVS with BVA to visualize different thrombus and predict stroke mechanisms. Methods: From a total of 564 stroke cases who admitted to Seoul National University Hospital in 2014, the authors collected eligible cases with the following inclusion criteria; (1) Lesion-documented ischemic stroke (N=425); (2) SWI and ASL MRI performed (N=407); (3) Symptomatic arterial occlusion with BVA (N=141). All images were analyzed for the presence and location of SWI-SVS and BVA. The location of SWI-SVS and BVA were classified into (1) proximal, large arteries; distal ICA, M1/2, A1, P1, basilar artery, V4 and (2) peripheral, small arteries; M3/4, P2/3, A2/3, lenticulostriate arteries, three cerebellar arteries. The relationships between SWI-SVS in the presence of BVA and stroke etiologies are explored. Results: Male was 58.2% (n=82) and mean age was 65.7±14.3. Thirty-four percent (n=48/141) of BVA and 30.3% (n=30/99) of SVS was located within small, peripheral arteries. SWI-SVS was more commonly associated with other determined etiology (20.2% vs. 4.8%) and cardioembolism (39.4% vs. 14.3%), but less with large artery atherosclerosis (26.3% vs. 69.0%, P <0.01) compared to the patients without SWI-SVS. Cancer-related hypercoagulability (60%, n=12/20) was most common in other determined cases with SWI-SVS. Multivariate analysis showed that SWI-SVS was an independent predictor of other determined etiology (adjusted OR, 7.20; 95% CI, 1.48-34.99) and cardioembolism (adjusted OR, 5.76; 95% CI, 1.27-26.02) Conclusions: SWI-SVS with BVA may predict ischemic stroke of cardioembolism and other determined etiology. Occlusions of small, peripheral arteries are well visualized with BVA and composition of thrombus can be identified by SWI-SVS.

scholarly journals Association of Carotid Artery Endothelial Signal Intensity Gradient with Unilateral Large Artery Ischemic Stroke

2021 ◽  
Vol 50 (3) ◽  
pp. 270-278
Author(s):  
Chan-Hyuk Lee ◽  
Sang Hyuk Lee ◽  
Young I. Cho ◽  
Seul-Ki Jeong
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Signal Intensity ◽  
Internal Carotid ◽  
University Hospital ◽  
Large Artery ◽  
Intensity Gradient ◽  
National University ◽  
Endothelial Shear Stress ◽  
Stroke Center

<b><i>Background:</i></b> Common carotid artery (CCA) and internal carotid artery (ICA) are aligned linearly, but their hemodynamic role in ischemic stroke has not been studied in depth. <b><i>Objectives:</i></b> We aimed to investigate whether CCA and ICA endothelial shear stress (ESS) could be associated with the ischemic stroke of large artery atherosclerosis (LAA). <b><i>Methods:</i></b> We enrolled consecutive patients with unilateral ischemic stroke of LAA and healthy controls aged &#x3e;60 years in the stroke center of Jeonbuk National University Hospital. All patients and controls were examined with carotid artery time-of-flight magnetic resonance angiography, and their endothelial signal intensity gradients (SIGs) were determined, as a measure of ESS. The effect of right or left unilateral stroke on the association between carotid artery endothelial SIG and ischemic stroke of LAA was assessed. <b><i>Results:</i></b> In total, the results from 132 patients with ischemic stroke of LAA and 121 controls were analyzed. ICA endothelial SIG showed significant and independent associations with the same-sided unilateral ischemic stroke of LAA, even after adjusting for the potential confounders including carotid stenosis, whereas CCA endothelial SIG showed a significant association with the presence of the ischemic stroke of LAA. <b><i>Conclusion:</i></b> Although CCA and ICA are located with continuity, the hemodynamics and their roles in large artery ischemic stroke should be considered separately. Further studies are needed to delineate the pathophysiologic roles of ESS in CCA and ICA for large artery ischemic stroke.

Abstract 66: Dynamics of Statin Use and Outcomes After Recanalization Treatment for Acute Ischemic Stroke: When, How Much and for Whom?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Han-Gil Jeong ◽  
Beom Joon Kim ◽  
Mi-Hwa Yang ◽  
Moon-Ku Han ◽  
Hee-Joon Bae
Keyword(s):  
Ischemic Stroke ◽  
High Intensity ◽  
Medication Administration ◽  
Moderate Intensity ◽  
Large Artery ◽  
Bar Code ◽  
National University ◽  
Seoul National University ◽  
Improved Outcome ◽  
Statin Use

Introduction: Statin has the potential to be effective in the early phase of recanalization. However it is largely unknown in which group, when, and at what doses statin use is beneficial after recanalization. Methods: From a total of 7663 stroke cases of Seoul National University Bundang Hospital between July 2007 and Dec 2015, we collected eligible cases with the following inclusion criteria; (1) Lesion-documented ischemic stroke (N=6151); (2) received recanalization treatment (N=908). We excluded cases with missing in (1) the time information (N=26) and (2) modified Rankin Score (mRS) at 3 months (N=1). We gathered the exact timing, type, dose of statin use from a database of electronic bar-code medication administration system. Multivariable ordinal logistic regression was performed for mRS at 3 months (improved outcome). Results: Of the 881 analyzable cases (male, 58%; mean age, 68.9; median initial NIHSS score, 12), recanalization treatment consisted of 33% of IV-only, 33% of IA-only and 34% of combined IV-IA strategies. Stroke mechanisms were 26% of large artery atherosclerosis (LAA), 49% of cardioembolism (CE) and 25% of non-LAA/CE. Statins were administered in the acute phase (within 7 days) in 68% (n=598) patients (<24 hours in 35% [n=307] and 24-72 hours in 43% [n=170]). High intensity statins (atorvastatin 40-80 mg or rosuvastatin 20 mg) were used in 72% (n=429) and low-to-moderate intensity statins in 28% (n=169). Multivariable analyses revealed acute statin (within 7 days) was associated with improved outcome, especially in patients with IA treatment or when used within 24 hours. Low-to-moderate intensity statin was associated with improved outcome, but high intensity statin was not. Conclusions: Acute statin use after recanalization treatment may positively influence functional outcome, more in patients with IA treatment or when used within 24 hours. Low-to-moderate intensity statin may be as beneficial as high intensity statin after recanalization.

Abstract P523: Mechanical Thrombectomy for in Hospital Stroke: A Single Center Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jeonghoon Bae ◽  
Eung-joon Lee ◽  
Byung-woo Yoon
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Multivariable Analysis ◽  
Functional Independence ◽  
Underlying Disease ◽  
University Hospital ◽  
Single Center Study ◽  
National University ◽  
Baseline Characteristics ◽  
Seoul National University

Purpose: There are many differences between in hospital ischemic stroke(IHS) and community onset ischemic stroke(COS), and there are several comparative studies. Although the importance of mechanical thrombectomy(MT) in the treatment of acute ischemic stroke is becoming increasingly important, there are not many studies on the effectiveness of MT in IHS. We aimed to compare the clinical features and outcomes between IHS and COS patients who received MT. Methods: We analyzed cases of mechanical thrombectomy performed at Seoul National University Hospital from January 2012 to June 2020. We selected patients with previous mRS(modified Rankin Scale) 0-1 and then divided them into two groups: IHS and COS, and compared successful recanalization, discharge mRS, 3month mRS, and 3month functional independence (mRS 0-2). Results: A total of 41 patients with IHS and 213 patients with COS were included. The baseline characteristics(age, sex, underlying disease, occlusion site) of the two groups were similar, but malignancy tended to be more common in IHS than COS(19.5% vs 7.5%). The median/mean LNT(last normal time)-to-puncture time was 341min/399min in IHS and 370min/461min in COS. The percentages of successful recanalization (92% vs 89%), discharge mRS (mean, 2.19 vs 2.97), 3 month mRS (mean, 2.05 vs 2.56), 3 month functional independence (61% vs 49%) were comparable between the two groups. In the multivariable analysis of the 3 month functional independence, initial NIHSS and successful recanalization were the most important predictors. In addition, a multivariable analysis was performed on successful recanalization, and LNT to puncture time was the most important predictor. Conclusions: The importance of MT is still high even in the in hospital stroke. In addition, IHS has more factors that can reduce the onset to puncture time compared to COS such as well designed on-call system and patient transfer system, well arrangement of nursing manpower. Therefore, more attention is needed for MT in IHS.

scholarly journals Screening for early detection of lung cancer: results from Seoul National University Hospital.

1991 ◽  
Vol 38 (2) ◽  
pp. 119-127
Author(s):  
Yong Chol Han ◽  
Chul Gyu Yoo ◽  
Young Whan Kim ◽  
Sung Koo Han ◽  
Young Soo Shim ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Detection ◽  
University Hospital ◽  
National University ◽  
Seoul National University

scholarly journals Predictors of the functional outcome after thrombolysis in an Egyptian patients’ sample

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
H. M. Eldeeb ◽  
D. H. Elsalamawy ◽  
A. M. Elabd ◽  
H. S. Abdelraheem
Keyword(s):  
Ischemic Stroke ◽  
Hospital Stay ◽  
Functional Outcome ◽  
Arterial Occlusion ◽  
University Hospital ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Predicting Factors ◽  
Egyptian Patients ◽  
Cerebrovascular Stroke

Abstract Background About 6.2 million individuals worldwide and approximately 200 Egyptians/100,000 citizens have cerebrovascular stroke annually, and only less than 1% of stroke patients received intravenous (IV) thrombolysis in 2014. Outcome of the ischemic stroke after IV thrombolysis varies, and there is lack of data about the predicting factors that contributes to the outcome of ischemic strokes after IV thrombolysis in Egypt. Objective The aim of this work is to study the predictors of the functional outcome of ischemic cerebrovascular stroke after IV thrombolysis in Egyptian patients. Patients and methods This is a prospective study that includes acute ischemic stroke patients who received IV thrombolysis at the Alexandria University Hospital during the year from February 2017 to February 2018, and they were evaluated initially by Rapid Arterial Occlusion Evaluation (RACE) scale and followed-up serially for 6 months after thrombolysis using the National Institutes of Health Stroke Scale (NIHSS) and modified ranking score (mRS). Results Forty-five patients are included; 56% had favorable functional outcome (mRS 0–2) after 6 months, 68% had ≥ 4 points improvement in NIHSS after 6 months, and 13% had hemorrhagic conversion with 18% mortality rate. High initial RACE scale and long hospital stay are associated with poor functional outcome 6 months after thrombolysis. Conclusion Stroke severity demonstrated by high initial RACE and the duration of hospital stay are the two most significant predictors with an impact on the functional outcome of ischemic cerebrovascular stroke after thrombolysis.

Analysis of microRNA signatures in ischemic stroke thrombus

2021 ◽  
pp. neurintsurg-2021-017597
Author(s):  
Jeong-Min Kim ◽  
Jun-Soo Byun ◽  
Jiah Kim ◽  
Moo-Seok Park ◽  
Soon Auck Hong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Expression Pattern ◽  
Microarray Analysis ◽  
Laboratory Data ◽  
Microrna Expression ◽  
University Hospital ◽  
Large Artery ◽  
Stroke Patients ◽  
Qrt Pcr ◽  
Functional Relevance

BackgroundWe investigated the microRNA expression pattern from thrombus retrieved by mechanical thrombectomy in acute stroke patients to understand the stroke mechanism.MethodsThis study included acute ischemic stroke patients who had undergone intra-arterial thrombectomy at Chung-Ang University Hospital in Seoul, Korea between February 2016 and March 2019. The thrombus was retrieved and stored at −70℃ after obtaining informed consent. MicroRNA microarray analysis was performed for the patients with identified stroke mechanisms including (1) large artery atherosclerosis, (2) cardioembolism with atrial fibrillation, and (3) cardioembolism with valvular heart disease. The microRNAs derived from microarray analysis were validated by quantitative real-time polymerase chain reaction (qRT-PCR) from different patient populations. The correlation analysis was performed between microRNA levels and laboratory data to understand the functional relevance of the altered microRNA.ResultsIn total, 55 thrombi were obtained from 74 patients, and the microRNAs were analyzed in 45 samples. Microarray analysis of 2578 microRNAs revealed that 50 microRNAs were significantly altered among the three groups. Validation using qRT-PCR showed that miR-378f and miR-450b-5p were significantly elevated among the cardioembolic thrombi; both microRNAs were inversely correlated with the ejection fraction from echocardiography. Thrombi from patients with early neurological deterioration exhibited higher levels of miR-93-5p and lower levels of miR-629-5p than those from neurologically stable patients.ConclusionsThe microRNA expression pattern can provide information regarding the mechanism of stroke by reflecting the underlying pathological status of the organ from which the thrombus was derived.

scholarly journals Optimizing Patient Selection for Interhospital Transfer and Endovascular Therapy in Acute Ischemic Stroke: Real-World Data From a Supraregional, Hub-and-Spoke Neurovascular Network in Germany

2020 ◽  
Vol 11 ◽  
Author(s):  
Maria-Ioanna Stefanou ◽  
Vera Stadler ◽  
Dominik Baku ◽  
Florian Hennersdorf ◽  
Ulrike Ernemann ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Selection ◽  
Real World ◽  
University Hospital ◽  
Large Artery ◽  
Hub And Spoke ◽  
Interhospital Transfer ◽  
Selection For ◽  
Transferred Patients

Background: Interhospital transfer for endovascular treatment (EVT) within neurovascular networks might result in transfer of patients who will not undergo EVT (futile transfer). Limited evidence exists on factors associated with the primary patient selection for interhospital transfer from primary stroke centers (PSCs) to comprehensive stroke centers (CSCs), or EVT-workflow parameters that may render a transfer futile.Methods: A prospective, registry-based study was performed between July 1, 2017 and June 30, 2018, at a hub-and-spoke neurovascular network in southwest Germany, comprising 12 referring PSCs and one designated CSC providing round-the-clock EVT at the University Hospital Tübingen. Patients with acute ischemic stroke due to suspected large artery occlusion (LAO) were included upon emergency interhospital transfer inquiry (ITI).Results: ITI was made for 154 patients, 91 (59%) of whom were transferred to the CSC. Non-transferred patients (41%) had significantly higher premorbid modified Rankin scale scores (mRS) compared to transferred patients [median (IQR): 2 (1–3) vs. 0 (0–1), p &lt; 0.001]. Interhospital transfer was denied due to: distal vessel occlusion (44.4%), or non-verifiable LAO (33.3%) in computed tomography angiography (CTA) upon teleconsultation by CSC neuroradiologists; limited Stroke-Unit or ventilation capacity (9.5%), or limited neuroradiological capacity at the CSC (12.7%). The CT-to-ITI interval was significantly longer in patients denied interhospital transfer [median (IQR): 43 (29–56) min] compared to transferred patients [29 (15–55), p = 0.029]. No further differences in EVT-workflow, and no differences in the 3-month mRS outcomes were noted between non-transferred and transferred patients [median (IQR): 2 (0–5) vs. 3 (1–4), p = 0.189]. After transfer to the CSC, 44 (48%) patients underwent EVT. The Alberta stroke program early CT score [ORadj (95% CI): 1.786 (1.573–2.028), p &lt; 0.001] and the CT-to-ITI interval [0.994 (0.991–0.998), p = 0.001] were significant predictors of the likelihood of EVT performance.Conclusion: Our findings show that hub-and-spoke neurovascular network infrastructures efficiently enable access to EVT to patients with AIS due to LAO, who are primarily admitted to PSCs without on-site EVT availability. As in real-world settings optimal allocation of EVT resources is warranted, teleconsultation by experienced endovascular interventionists and prompt interhospital-transfer-inquiries are crucial to reduce the futile transfer rates and optimize patient selection for EVT within neurovascular networks.

Pancreatoduodenectomy in Seoul National University Hospital

1997 ◽  
pp. 447-463
Author(s):  
Kuhn Uk Lee ◽  
Eui Gon Youk ◽  
Keon-Young Lee
Keyword(s):  
University Hospital ◽  
National University ◽  
Seoul National University
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