Abstract TP66: Single Slice Maximal Lesion Diameter Predicts Malignant Pattern of Diffusion Lesions in Acute Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Anke Wouters ◽  
Patrick Dupont ◽  
Anna Kufner ◽  
Robin Lemmens ◽  
Vincent Thijs
Keyword(s):  
Clinical Outcome ◽  
Intravenous Thrombolysis ◽  
Volumetric Analysis ◽  
Maximum Diameter ◽  
Lesion Volume ◽  
Imaging Data ◽  
Poor Clinical Outcome ◽  
Lesion Diameter ◽  
Single Slice ◽  
Lesion Extension

Introduction: Recent endovascular trials excluded patients with large ischemic cores on diffusion-weighted imaging (DWI) or perfusion CT using automated volumetric analysis. Hypothesis: We investigated whether the largest diameter of the DWI lesion measured on a single slice could accurately predict large ischemic cores, as defined by automated volumetric analysis; such findings could result in a simple tool for predicting clinical outcome. Methods: Magnetic resonance imaging data from the multicenter AXIS 2-trial were used. Patients were included within 9h of symptom onset and received intravenous thrombolysis if eligible. The maximum diameter of the diffusion lesion was measured on the slice with the largest lesion extension. Maximum diameters on a single slice were compared with the volumes of > 50 ml, >70ml and >100ml determined by standard volumetric analysis. We also assessed whether and for which threshold, largest lesion diameter was a predictor of poor clinical outcome defined as modified ranking scale (mRS) 5 or 6. Results: A total of 304 patients were included of which 50 (16%) presented with a carotid occlusion. 96 (32%) patients had a DWI-volume of more than 50 ml, 63 (21%) more than 70ml and 46 (15%) more than 100ml. A diameter of respectively 5.5, 6.5 and 7 cm on a single slice with the largest lesion extension was the best predictor of a DWI lesion volume of more than 50 (sensitivity (sens) 97%, specificity (spec) 80%), 70 (sens 95%, spec 83%) and 100ml (sens 100%, spec 85%). The maximum diameter was a reasonable predictor of poor clinical outcome with an AUC of 0.76 (95%CI: 0.68-0.83). The optimal cut off point was found to be 5.5 cm (sens 71%, spec 67%). Conclusion: Measuring the maximum lesion diameter on a single slice on DWI identifies patients with large ischemic cores with a high sensitivity and specificity. This finding can be useful in clinical practice and for future clinical trials where rapid and uniform decision making to exclude patients with a malignant profile from endovascular therapy is essential.

Abstract P338: Incidence, Predictors and Impact of Infarct in New Territory in Escape Na1 Trial

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nishita Singh ◽  
Martha Marko ◽  
Petra Cimflova ◽  
Johanna Ospel ◽  
Nima Kashani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Endovascular Therapy ◽  
Randomized Study ◽  
Maximum Diameter ◽  
Vascular Territory ◽  
Poor Clinical Outcome ◽  
Guide Catheter ◽  
Ct And Mri

Introduction: Infarct in new territory (INT) is a known complication of endovascular therapy. We assessed the prevalence, predictors and clinical relevance of INT Methods: We included patients from the ESCAPE-NA1: a multicenter, international randomized study that assessed the efficacy of intravenous nerinetide in patients with acute ischemic stroke who underwent EVT within 12 hours from onset. All imaging was re-evaluated, and INT was defined by presence of infarct in new vascular territory, outside the baseline target occlusion(s) on follow up CT and MRI. INT’s were classified by maximum diameter (<2mm, 2-20mm and >20mm) and location. Results: Of 1099 analyzed patients in ESCAPE NA1, 107 had INT (9.7%, mean age 67 years, 51.4% females). There were no differences at baseline in those with vs without INT. Most INTs (75.7%) were angiographically occult and 41(38.3%) were > 20mm. The most common INT territory was the ACA alone or in combination with MCA/PCA (30.3%). The presence of emboli in new territory angiographically was significantly associated with INT (OR 16.39, 95%CI 8.14-33.09). Alteplase use, balloon guide catheter use, nerinetide and initial occlusion site did not predict INT. INT patients had higher final median infarct volumes compared to non-INT (44.5cc vs 23.3cc, P<0.001). Large INT (diameter of >20mm) were associated with poor clinical outcome compared to INT (<2mm) OR (mRS 0-2) 0.17, 95%CI 0.05-0.55). Conclusion: Infarcts in new territory are common and are associated with poor outcome.

Abstract TP26: The Outcome of Patients With Tandem Occlusion Remains Poor Despite Mechanical Thrombectomy

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Robert Fahed ◽  
Hocine Redjem ◽  
Raphaël Blanc ◽  
Julien Labreuche ◽  
Stanislas Smajda ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Intravenous Thrombolysis ◽  
Poor Clinical Outcome ◽  
Good Clinical Outcome ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tandem Occlusion ◽  
Treatment Data ◽  
Research Gap

Introduction: Ischemic strokes with tandem occlusions are associated with a poor prognosis. Recent studies demonstrating the effectiveness of endovascular treatment for large vessel occlusions have shown less impressive results in patients with tandem occlusions than in those with isolated intracranial occlusions. Besides, the indications and effects of ICA stenting remain unclear. Hypothesis: To determine the factors associated with favorable outcome at 3-month in this subtype of AIS. Methods: From a prospectively gathered registry, we analyzed the data of 70 consecutive patients who underwent mechanical endovascular treatment for acute stroke with tandem occlusions from November 2011 to August 2014. Clinical (including demographics, NIHSS, and stroke etiology), imaging (including DWI-ASPECTS), and endovascular treatment data were assessed and reviewed in consensus by two observers. Good clinical outcome was defined as a modified Rankin Scale (mRS) of ≤2 at 3-month follow-up. The mRS at 3 months follow-up was available in 67 patients. Results: At 3-month follow-up, 33 of 67 (49.3%) patients had a good clinical outcome and 34 (50.8%) had a poor clinical outcome, including 9 deaths (13.4%). Lower NIHSS (initial, at day 1, and at discharge) and successful recanalization (TICI 2b-3) were associated with a good clinical outcome (P<0.05). There were no statistically significant differences between patients with a good or poor clinical outcome in terms of intravenous tissue plasminogen activator use, delay between symptom onset and recanalization, and endovascular technique, including the ICA stenting. Conclusions: Despite the recent randomized control trials demonstrating the effectiveness of thrombectomy, there is still a research gap about tandem occlusions. This subtype of stroke, which usually responds poorly to intravenous thrombolysis, is also difficult to treat by endovascular means.

Different risk factors for poor outcome between patients with positive and negative susceptibility vessel sign

2015 ◽  
Vol 8 (10) ◽  
pp. 1001-1005 ◽  
Author(s):  
Shenqiang Yan ◽  
Keqin Liu ◽  
Lusha Tong ◽  
Yannan Yu ◽  
Sheng Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Intravenous Thrombolysis ◽  
Multivariate Regression Analysis ◽  
Artery Occlusion ◽  
National Institutes Of Health ◽  
Imaging Data ◽  
Poor Outcome ◽  
The Difference ◽  
Cerebral Artery Occlusion

PurposeThe absence of the susceptibility vessel sign (negative SVS) on gradient-recalled echo or susceptibility-weighted imaging (SWI) in thrombolytic therapy has not been well studied. Since positive and negative SVS may have different components, we aimed to investigate the difference in risk factors for clinical outcome between patients with positive and negative SVS.MethodsWe retrospectively examined clinical and imaging data from 85 consecutive patients with acute ischemic stroke with middle cerebral artery occlusion who underwent SWI before intravenous thrombolysis (IVT). We then examined the predictors of negative SVS and the risk factors for a poor outcome (defined as modified Rankin Scale score ≥3) 3 months after IVT in subgroup analysis.ResultsMultivariate regression analysis indicated that previous antiplatelet use (OR 0.076; 95% CI 0.007 to 0.847; p=0.036) and shorter time from onset to treatment (OR 1.051; 95% CI 1.003 to 1.102; p=0.037) were inversely associated with poor outcome in patients with negative SVS, while higher baseline National Institutes of Health Stroke Scale (NIHSS) score was associated with poor outcome in patients with positive SVS (OR 1.222; 95% CI 1.084 to 1.377; p=0.001).ConclusionsThe risk factors for clinical outcome after IVT in patients with negative SVS may differ from those with positive SVS.

scholarly journals Thrombolysis implementation intervention and clinical outcome: A Secondary analysis of a cluster randomized trial.

2020 ◽  
Author(s):  
Md Golam Hasnain ◽  
Christine L Paul ◽  
John R Attia ◽  
Annika Ryan ◽  
Erin Kerr ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Post Treatment ◽  
Control Group ◽  
Intervention Period ◽  
Poor Clinical Outcome ◽  
Post Intervention ◽  
Individual Level ◽  
Post Intervention Period

Abstract BackgroundMultiple studies have attempted to increase the rate of intravenous thrombolysis for ischemic stroke using interventions to promote adherence to guidelines. Still, many of them did not measure individual-level impact. This study aimed to make a posthoc comparison of the clinical outcomes of patients in the “Thrombolysis ImPlementation in Stroke (TIPS)” study, which aimed to improve rates of intravenous thrombolysis in Australia.MethodsA posthoc analysis was conducted using individual-level patient data. Excellent (Three-month post treatment modified Rankin Score 0-2) and poor clinical outcome (Three-month post treatment modified Rankin Score 5-6) and post treatment parenchymal haematoma were the three main outcomes, and a mixed logistic regression model was used to assess the difference between the intervention and control groups.ResultsThere was a non-significant higher odds of having an excellent clinical outcome of 57% (odds ratio: 1.57; 95% CI: 0.73-3.39) and 33% (odds ratio: 1.33; 95% CI: 0.73-2.44) during the active-and post-intervention period respectively, for the intervention compared to the control group. A non-significant lower odds of having a poor clinical outcome was also found in the intervention, relative to control group of 4% (odds ratio: 0.96; 95% CI: 0.56-2.07) and higher odds of having poor outcome of 44% (odds ratio: 1.44 95% CI: 0.61-3.41) during both active and post-intervention period respectively. Similarly, a non-significant lower odds of parenchymal haematoma was also found for the intervention group during the both active- (odds ratio: 0.53; 95% CI: 0.21-1.32) and post-intervention period (odds ratio: 0.96; 95% CI: 0.36-2.52).ConclusionThe TIPS multi-component implementation approach was not effective in reducing the odds of post-treatment severe disability at 90 days, or post-thrombolysis hemorrhage.Trial registrationClinical Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN12613000939796.

scholarly journals Susceptibility vessel sign as a predictor for recanalization and clinical outcome in acute ischaemic stroke: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Si Zhao Tang ◽  
Jon Sen
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Qualitative Synthesis ◽  
Poor Clinical Outcome ◽  
Significant Difference ◽  
Quantitative Synthesis

AbstractT2*-weighted MRI using GRE and SWI sequences can potentially prognosticate the recanalization rate and clinical outcomes in patients with acute ischaemic stroke, using susceptibility vessel sign (SVS) and prominent hypointense vessel sign (PHVS).A literature search on PubMed, EMBASE databases and other sources from inception up to 01 February 2020 was conducted. 15 studies which reported SVS and PHVS were included in qualitative synthesis. 9 studies on SVS were included in quantitative synthesis i.e. meta-analysis.Meta-analysis did not show any significant difference in the recanalization rate between SVS (+) group and SVS (-) group (RR = 0.95, 95% CI = 0.87–1.05, p = 0.33). Treatment subgroup analysis (intravenous thrombolysis, IVT- or mechanical thrombectomy, MT-only) does not show significant association between the SVS and IVT-only (RR = 0.73, 95% CI = 0.51-1.05, P=0.09); or MT-only groups (RR = 0.99, 95% CI = 0.90-1.09, P=0.90). No significant association between poor clinical outcome at 3 months and presence of SVS (RR = 1.42, 95% CI = 0.79–2.57, p = 0.24). Treatment subgroup analysis revealed significant association of the SVS and poor clinical outcome at 3 months in the MT-only (RR = 0.67, 95% CI = 0.55–0.82, p = 0.0001) or no thrombolytic treatment (RR = 2.83, 95% CI = 1.69-4.75, p < 0.0001).In conclusion, there is a significant association between the presence of SVS and poor clinical outcome in patients who underwent MT or without treatment, and no definitive association between the presence of SVS and recanalization rate for acute ischemic stroke.

scholarly journals Thrombolysis Implementation Intervention and Clinical Outcome: A Secondary Analysis of a Cluster Randomized Trial.

2020 ◽  
Author(s):  
Md Golam Hasnain ◽  
Christine L Paul ◽  
John R Attia ◽  
Annika Ryan ◽  
Erin Kerr ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Control Group ◽  
Intervention Period ◽  
Poor Clinical Outcome ◽  
Post Intervention ◽  
Lower Odds ◽  
Individual Level ◽  
Post Intervention Period

Abstract Background Multiple studies have attempted to increase the rate of intravenous thrombolysis for ischemic stroke using interventions to promote adherence to guidelines. Still, many of them did not measure individual-level impact. This study aimed to make a posthoc comparison of the clinical outcomes of patients in the “Thrombolysis ImPlementation in Stroke (TIPS)” study, which aimed to improve rates of intravenous thrombolysis in Australia.Methods A posthoc analysis was conducted using individual-level patient data. Excellent and poor clinical outcome and parenchymal haematoma were the three main outcomes, and a mixed logistic regression model was used to assess the difference between the intervention and control groups.Results There was a non-significantly higher odds of having an excellent clinical outcome of 57% (odds ratio: 1.57; 95% CI: 0.73–3.39) and 33% (odds ratio: 1.33; 95% CI: 0.73–2.44) during the active-and post-intervention period respectively, for the intervention compared to the control group. A non-significantly lower odds of having a poor clinical outcome was also found in the intervention, relative to control group of 4% (odds ratio: 0.96; 95% CI: 0.56–2.07) and higher odds of having poor outcome of 44% (odds ratio: 1.44 95% CI: 0.61–3.41) during both active and post-intervention period respectively. Similarly, a non-significant lower odds of parenchymal haematoma was also found for the intervention group during the both active- (odds ratio: 0.53; 95% CI: 0.21–1.32) and post-intervention period (odds ratio: 0.96; 95% CI: 0.36–2.52).Conclusion The TIPS multi-component implementation approach was not effective in reducing the odds of post-treatment severe disability at 90 days, or post-thrombolysis hemorrhage.Trial registration Clinical Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN12613000939796.

Extensive cerebral microbleeds predict parenchymal haemorrhage and poor outcome after intravenous thrombolysis

2015 ◽  
Vol 86 (11) ◽  
pp. 1267-1272 ◽  
Author(s):  
Shenqiang Yan ◽  
Xinchun Jin ◽  
Xuting Zhang ◽  
Sheng Zhang ◽  
David S Liebeskind ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Clinical Outcome ◽  
Logistic Regression Analysis ◽  
Intravenous Thrombolysis ◽  
Cerebral Microbleeds ◽  
Poor Clinical Outcome ◽  
Radiological Data ◽  
Prognostic Implications ◽  
The Impact

PurposeThrombolysis-related haemorrhagic transformation (HT) subtypes may have different prognostic implications. We aimed to analyse the impact of cerebral microbleeds (CMBs) burden on HT subtypes and outcome after intravenous thrombolysis.MethodsWe retrospectively examined clinical and radiological data from 333 consecutive patients with acute ischaemic stroke who underwent susceptibility-weighted imaging before intravenous thrombolysis. Logistic regression analysis was used to determine the impact of CMBs on HT subtypes and neurological outcome.ResultsWe observed 596 CMBs in 119 (39.7%) patients on initial gradient-recalled echo scans. HT occurred in 88 (29.3%) patients, among which 62 were haemorrhagic infarction and 26 were parenchymal haemorrhage (PH). Logistic regression analysis indicated that the presence of extensive (≥3) CMBs was independently associated with PH (OR 6.704; 95% CI 2.054 to 21.883; p=0.002) and poor clinical outcome (OR 2.281; 95% CI 1.022 to 5.093; p=0.044).ConclusionsThe presence of extensive (≥3) CMBs increased the risk of PH 24 h after intravenous thrombolysis, and predicted poor clinical outcome independently.

Abstract TP82: High Rate of Recanalization and Attenuated Poor Outcome After Intravenous Thrombolysis in “Top-of-the-basilar” Syndrome

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Shenqiang Yan ◽  
Xiaocheng Zhang ◽  
Quan Han ◽  
Min Lou
Keyword(s):  
Clinical Outcome ◽  
Cerebral Artery ◽  
Basilar Artery ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Artery Occlusion ◽  
High Rate ◽  
Basilar Artery Occlusion ◽  
Imaging Data ◽  
Tof Mra

Objective: The safety and efficacy of intravenous thrombolysis (IVT) in patients with “top-of-the-basilar” syndrome (TOBS) was not systematically investigated. We thus aim to evaluate the rate of recanalization, hemorrhagic transformation and long-term prognosis after IVT in TOBS in our consecutively collected thrombolytic patients. Methods: We retrospectively examined clinical and imaging data from consecutive acute ischemic stroke patients with basilar artery occlusion (BAO) who underwent multimodal CT or MRI before and 24 hours after IVT at our center. The presence of Hyperdense artery sign (HAS) on noncontrast CT or Susceptibility vessel sign (SVS) on susceptibility-weighted imaging were recorded. Recanalization, hemorrhagic transformation (HT), and clinical outcome were assessed by Arterial Occlusive Lesion (AOL) scale, ECASS II definition and modified Rankin Scale (mRS), respectively. Results: Among all 43 BAO patients with pre- and post-treatment angiongraphy, 24 (55.8%) were considered as TOBS based on either CTA (n = 18) or TOF-MRA (n = 6) before IVT. Follow-up imaging revealed recanalization (AOL ≥ 2) in 19 (79.2%) and HT in 6 (25%) of TOBS patients. This recanalization rate of TOBS was much higher than other LAO (56.2% for M1, 68.0% for M2, 12.8% for internal carotid artery, 50.0% for anterior cerebral artery, 58.3% for posterior cerebral artery, and 21.1% for other type of BAO). Cardioembolic stroke were considered in 18 (75%) of TOBS. The presence of HAS or SVS in TOBS with recanalization was higher than those without (89.5% verse 40%, p=0.042). The rate of poor clinical outcome (mRS ≥ 3) was lower in patients with recanalization than those without recanalization (36.8% verse 100%, p=0.037). 3-month mortality were also lower in patients with recanalization (15.8% verse 80.0%, p=0.014). Conclusions: Most (about 80%) of TOBS patients can achieve recanalization after IVT, leading to a dramatic recovery in Chinese population. The presence of HAS or SVS of basilar artery might indicate high rate of recanalization.

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