Abstract TP47: Intracranial Intraplaque Hemorrhage in Acute Stroke: Interim Results of the Stroke Imaging Package Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Changyun Liu ◽  
Huisheng Chen ◽  
Yi Yang ◽  
Jun Xu ◽  
Meng Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Clinical Importance ◽  
Chinese Patients ◽  
Intraplaque Hemorrhage ◽  
Large Artery ◽  
Ischemic Event ◽  
Stroke Imaging ◽  
Medical Centers ◽  
Conventional Mri

Introdution: Intracranial artery atherosclerosis is an important cause of ischemic stroke, especially in people of Asian origin. Intraplaque hemorrhage is supposed to be a predictor of ischemic event. The goal of this study was to examine the occurrence of intraplaque hemorrhage in a large cohort of Chinese patients with acute ischemic stroke. Methods: Patients with first ever stroke within 72 hours from onset, confirmed by diffusion weighted imaging, were recruited from 16 medical centers. Conventional MRI, magnetic resonance angiography, HRMRI (including 3-dimentional T1 images and 2-dimentional T2 images), and SWI were performed. Intraplaque hemorrhage was identified if hyperintense signals on 3-dimentional T1 images of HRMRI were observed within intracranial plaques. Results: Six hundred and one patients (70% male, mean age 61±16 years old, mean NIHSS 6± 5) were enrolled. Median time from symptom onset to MRI was 44 ± 20 hours. Of them, 240(40%) were diagnosed with large artery atherosclerosis (LAA) stroke. Intracranial intraplaque hemorrhage was identified in 15 intracranial plaques of 13 patients with LAA stroke. Six plaques with intraplaque hemorrhage were asymptomatic and irrelevant to ischemic infarct lesions. In 2 patients, both symptomatic and asymptomatic intraplaque hemorrhage were observed. Conclusions: The prevalence of intracranial intraplaque hemorrhage was low (5.4%)in acute stroke patients. The clinical importance of asymptomatic intraplaque hemorrhage need further investigations.

scholarly journals Reclassification of Ischemic Stroke Etiological Subtypes on the Basis of High-Risk Nonstenosing Carotid Plaque

Stroke ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 504-510 ◽  
Author(s):  
Hooman Kamel ◽  
Babak B. Navi ◽  
Alexander E. Merkler ◽  
Hediyeh Baradaran ◽  
Iván Díaz ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Acute Stroke ◽  
Carotid Plaque ◽  
Brain Infarction ◽  
Intraplaque Hemorrhage ◽  
Large Artery ◽  
Stroke Subtypes

Background and Purpose— Carotid artery plaque with <50% luminal stenosis may be an underappreciated stroke mechanism. We assessed how many stroke causes might be reclassified after accounting for nonstenosing plaques with high-risk features. Methods— We included patients enrolled in the Cornell Acute Stroke Academic Registry from 2011 to 2015 who had anterior circulation infarction, magnetic resonance imaging of the brain, and magnetic resonance angiography of the neck. High-risk plaque was identified by intraplaque hemorrhage ascertained from routine neck magnetic resonance angiography studies using validated methods. Infarct location was determined from diffusion-weighted imaging. Intraplaque hemorrhage and infarct location were assessed separately in a blinded fashion by a neuroradiologist. We used the McNemar test for matched data to compare the prevalence of intraplaque hemorrhage ipsilateral versus contralateral to brain infarction. We reclassified stroke subtypes by including large-artery atherosclerosis as a cause if there was intraplaque hemorrhage ipsilateral to brain infarction, regardless of the degree of stenosis. Results— Among the 1721 acute ischemic stroke patients registered in the Cornell Acute Stroke Academic Registry from 2011 to 2015, 579 were eligible for this analysis. High-risk plaque was more common ipsilateral versus contralateral to brain infarction in large-artery atherosclerotic (risk ratio [RR], 3.7 [95% CI, 2.2–6.1]), cryptogenic (RR, 2.1 [95% CI, 1.4–3.1]), and cardioembolic strokes (RR, 1.7 [95% CI, 1.1–2.4]). There were nonsignificant ipsilateral-contralateral differences in high-risk plaque among lacunar strokes (RR, 1.2 [95% CI, 0.4–3.5]) and strokes of other determined cause (RR, 1.5 [95% CI, 0.7–3.3]). After accounting for ipsilateral high-risk plaque, 88 (15.2%) patients were reclassified: 38 (22.6%) cardioembolic to multiple potential etiologies, 6 (8.5%) lacunar to multiple, 3 (15.8%) other determined cause to multiple, and 41 (20.8%) cryptogenic to large-artery atherosclerosis. Conclusions— High-risk carotid plaque was more prevalent ipsilateral to brain infarction across several ischemic stroke subtypes. Accounting for such plaques may reclassify the etiologies of up to 15% of cases in our sample.

Abstract NS6: To Rest or Mobilize... When to Start Early Mobilization in Acute Stroke: a Systematic Review

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Michelle Whaley ◽  
Wendy Dusenbury ◽  
Andrei V Alexandrov ◽  
Georgios Tsivgoulis ◽  
Anne W Alexandrov
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Early Mobilization ◽  
Future Research ◽  
Cochrane Central Register ◽  
Large Artery ◽  
Stroke Subtype ◽  
Vascular Insufficiency ◽  
The Impact

Background: Recent nursing initiatives encourage early mobilization of neurocritical care patients, but whether this intervention can be safely generalized to acute stroke is debatable. We performed a systematic review of findings from recent studies to provide direction for patient management and future research. Methods: An exhaustive literature search was performed in Medline, SCOPUS and the Cochrane Central Register of Controlled Trials to identify published clinical trial research using a very early mobility intervention (within 24 hours) in acute ischemic stroke patients. The primary efficacy outcome supporting the search was neurologic disability reduction or improved functional outcomes, and the primary safety outcome was neurologic deterioration. Studies were critically reviewed for inclusion by 3 separate investigators, findings were synthesized, and an overall recommendation for very early mobilization use in acute stroke was assigned according to GRADE criteria. Results: We initially identified 12 papers focused on early mobilization in acute stroke; of these, 6 observational studies were excluded, 1 study was excluded due to an ambiguous population, and 3 studies were excluded due to first initial mobilization out of bed occurring greater than 24 hours after admission. Two prospective randomized outcome blinded evaluation (PROBE) studies were retained, consisting of a total 2160 patients; ischemic stroke subtype was not disclosed in either study, limiting an understanding of the impact of very early mobilization on small versus large artery occlusion. Slower mobilization occurring beyond the first 24 hours was associated with higher rates of favorable outcome (mRS 0-2) at 90 days, whereas very early mobilization within the first 24 hours was associated with a number needed to harm of 25. Conclusions: In acute stroke, evidence supports a rested approach to care within the first 24 hours of hospitalization (GRADE: Strong recommendation, high quality of evidence). Similar to acute myocardial infarction, vascular insufficiency experienced in stroke likely warrants a more guarded approach to mobility. Additional studies exploring timing beyond 24 hours and dose of mobility interventions are warranted in discreet populations.

scholarly journals The Predictive Value of the Boston Acute Stroke Imaging Scale (BASIS) in Acute Ischemic Stroke Patients among Chinese Population

PLoS ONE ◽  
2014 ◽  
Vol 9 (12) ◽  
pp. e113967
Author(s):  
Yuanqi Zhao ◽  
Min Zhao ◽  
Xiaomin Li ◽  
Xiancong Ma ◽  
Qinghao Zheng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Chinese Population ◽  
Stroke Patients ◽  
Stroke Imaging ◽  
Acute Stroke Imaging

scholarly journals Polymorphism of the complement 5 gene is associated with large artery atherosclerosis stroke in Chinese patients

2016 ◽  
Vol 74 (11) ◽  
pp. 881-886 ◽  
Author(s):  
Hui Wu ◽  
Yingfeng Weng ◽  
Lan Zheng ◽  
Huanyin Li ◽  
Qi Gong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Chinese Patients ◽  
Large Artery ◽  
Nucleotide Polymorphism ◽  
Term Outcome ◽  
Single Nucleotide ◽  
Long Term Outcome ◽  
Risk Predictors ◽  
The Complement System

ABSTRACT The complement system has been confirmed to play an increasingly important role in ischemic stroke (IS). This study aimed to determine whether the single-nucleotide polymorphism of the complement 5 (C5) gene independently influences the occurrence, severity, and long-term outcome of IS in Chinese patients. Methods C5 rs17611 genetic variants were investigated in 494 IS patients and 330 control individuals .Ischemic stroke was classified into subtypes and patients were assessed 90 days post-stroke with the modified Rankin Scale to determine stroke outcome. Results The presence of C5 polymorphism was associated with the incidence of large artery atherosclerosis (LAA)-subtype IS (n =2 00; p = 0.031), which even persisted after adjustment for covariates (OR = 1.518; 95%CI = 1.093–2.018; p = 0.013). However, no association was found between genotypes and the severity and outcome of stroke (p = 0.978; p = 0.296). Conclusions The C5 polymorphism might contribute to the risk of LAA-subtype IS independently of other known risk predictors.

Abstract 2223: Diagnoses and Outcomes of t-PA Treated Patients with No Imaging Evidence of Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Ilana Spokoyny ◽  
Rema Raman ◽  
Karin Ernstrom ◽  
Brett C Meyer ◽  
Thomas M Hemmen
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Diagnosis ◽  
Surrogate Marker ◽  
Stroke Patients ◽  
Correct Treatment ◽  
Stroke Mimics ◽  
Stroke Imaging ◽  
Significant Difference

Background/Purpose: Intravenous Alteplase (t-PA) improves outcome in patients with acute ischemic stroke. Of those who recover fully, some may not have had ischemia. We analyzed the frequency and post-treatment outcomes of patients with no imaging evidence of stroke and aimed to delineate the frequency of strokes with full recovery from that of stroke mimics treated with t-PA. Methods: We included all adult stroke patients treated with IV t-PA within 3 hours of stroke onset from the UCSD SPOTRIAS database. Group 1: Patients with neuroimaging evidence of acute stroke (IPS); Group 2: no neuroimaging evidence of acute stroke (INS). All diagnoses were established by an independent adjudicating body. We reviewed medical records, neuroimaging, and compared discharge diagnosis, 90-day mRS, and incidence of intracranial hemorrhage. We adjusted for age, admission NIHSS, and pre-stroke mRS in multivariable models. Results: We identified 61patients with IPS and 25 with INS, with similar baseline characteristics, except for baseline NIHSS (IPS 13.4±8.2, INS 8.4±5.9, p=0.007) and incidence of cardiac arrhythmias (IPS 36.1%, INS 4.0%, p=0.002). Adjusted for age and baseline NIHSS, we found no difference in outcome. ICH was found in 23% of the IPS patients and was symptomatic in 4.9%. None of the INS patients had ICH. Conclusions: Radiologic evidence of acute ischemic stroke was absent in 10.5% of the 86 patients in the UCSD SPOTRIAS database who were treated with t-PA and given a clinical diagnosis of acute ischemic stroke on adjudicating body review at discharge. The majority (64%) of imaging negative stroke patients in our study ultimately received the clinical diagnosis of acute stroke. No significant difference in outcomes (mRS) was found between imaging negative and imaging positive stroke code patients, aside from the increased ICH frequency in imaging positive patients. This lack of outcome difference emphasizes that while imaging plays an important role as a surrogate marker in determining the diagnosis, a detailed clinical evaluation is essential in the correct treatment of acute ischemic stroke. Imaging negative stroke patients are common and future larger scale prospective data is required to analyze the true frequency of stroke mimics versus imaging negative stroke.

THE HALIFAX ACUTE STROKE IMAGING STUDY (HASIS): DOES CT PERFUSION SCANNING IN ACUTE ISCHEMIC STROKE PREDICT FINAL INFARCT VOLUME?

2013 ◽  
Vol 84 (11) ◽  
pp. e2.196-e2 ◽  
Author(s):  
Gavin Langlands ◽  
Jai Shankar ◽  
Wendy Simpkin ◽  
Christine Christian ◽  
Stephen Phillips
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion ◽  
Infarct Volume ◽  
Imaging Study ◽  
Stroke Imaging ◽  
Acute Stroke Imaging

scholarly journals Correction: The Predictive Value of the Boston Acute Stroke Imaging Scale (BASIS) in Acute Ischemic Stroke Patients among Chinese Population

PLoS ONE ◽  
2015 ◽  
Vol 10 (5) ◽  
pp. e0126045
Author(s):  
Yuanqi Zhao ◽  
Min Zhao ◽  
Xiaomin Li ◽  
Xiancong Ma ◽  
Qinghao Zheng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Chinese Population ◽  
Stroke Patients ◽  
Stroke Imaging ◽  
Acute Stroke Imaging

Low HDL-C levels are associated with cervicocerebral atherosclerotic stenosis in Southern Chinese patients with large artery atherosclerotic ischemic stroke

2018 ◽  
Vol 171 ◽  
pp. 79-84
Author(s):  
Weihua Mai ◽  
Hanwei Liu ◽  
Xingwei Liu ◽  
Ling Chen ◽  
Wenying Zhou
Keyword(s):  
Ischemic Stroke ◽  
Chinese Patients ◽  
Large Artery ◽  
Southern Chinese ◽  
Atherosclerotic Stenosis ◽  
Low Hdl
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