Abstract TP63: Detection of Perfusion Deficits Using FLAIR and GRE Based Vessel Signs

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Dennys Reyes ◽  
Emi Hitomi ◽  
Alexis Simpkins ◽  
John Lynch ◽  
Amie Hsia ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Roc Analysis ◽  
Area Under The Curve ◽  
Arterial Blood Flow ◽  
Lesion Volume ◽  
Perfusion Deficit ◽  
Stroke Patients ◽  
Time To Peak ◽  
Arterial Blood ◽  
Perfusion Deficits

Background: The presence of a perfusion deficit in an acute stroke patient can play an important role in their clinical management. However, many patients are unable to have perfusion-weighted imaging (PWI) due to renal disease. Perfusion deficits are often accompanied by FLAIR hyperintense vessels (FHV), presumably due to slow arterial blood flow, and GRE hypointense vessels (GHV), presumably due to venous congestion. Purpose: To determine how well FHV and GHV perform at identifying PWI lesions. Methods: One rater, blinded to the PWI MR sequences, retrospectively reviewed the DWI, FLAIR and GRE scans of acute stroke patients enrolled in the NIH Natural History of Stroke study during 2013-2014 who had an MRI with PWI prior to being treated with IV tPA. DWI images were used to guide evaluation of the FLAIR and GRE images for FHV and GHV and in each case were classified as definitively present, possibly present or absent. PWI lesion volumes were calculated by thresholding the time-to-peak (TTP) maps at 4 seconds beyond normal tissue. ROC analysis was used to assess the performance of FHV and GHV at various PWI lesion volume thresholds. Results: 102 patients were included in the analysis; their mean PWI lesion volume was 52 mL with a standard deviation of +/- 66 mL. 22% of patients had no perfusion deficit. The ROC analysis found the presence of any FHV performed the best with an area under the curve (AUC) of 0.925 displayed in the figure. Any GHV performed modestly with an AUC of 0.776. Combining FHV with GHV did not improve the performance over FHV alone (AUC=0.876). The sensitivity and specificity for identifying any perfusion deficit with FHV was 95% and 67% respectively with 87% being correctly classified. For detecting a PWI lesion greater than 10 mL, FHV had an 80% sensitivity and 93% specificity classifying 83% correctly. Conclusions: FHV is highly sensitive for identifying a perfusion deficit in stroke patients, and for patients with a lesion volume greater than 10 mL it is highly specific.

scholarly journals Quantitative Evaluation of Peripheral Arterial Blood Flow Using Peri-Interventional Fluoroscopic Parameters: An In Vivo Study Evaluating Feasibility and Clinical Utility

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Patrick Ghibes ◽  
Gerald Hefferman ◽  
Konstantin Nikolaou ◽  
Roland Syha ◽  
Christoph Artzner ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Arterial Disease ◽  
Arterial Blood Flow ◽  
Time Resolved ◽  
Complementary Method ◽  
Time To Peak ◽  
Arterial Blood ◽  
Fluoroscopic Imaging ◽  
Peripheral Arterial

Purpose. The purpose of this study was to evaluate various objective, quantitative, time-resolved fluoroscopic imaging parameters for use in the peri-interventional evaluation of stenotic peripheral arterial disease lesions. Material and Methods. Ten patients (median age, 64; age range, 52 to 79; 8 males, 2 females) with high-grade stenoses of either the superficial femoral or popliteal arteries who underwent endovascular treatment were included. During each intervention, two series of intraprocedural fluoroscopic images were collected, one preintervention and one postintervention. For each imaging series, four regions of interest (ROIs) were defined within the vessel lumen, with two ROIs being proximal (ROIs 1 and 2) and two being distal (ROIs 3 and 4) to the stenosis. The time-density curve (TDC) at each ROI was measured, and the resulting area under the curve (AUC), full width at half maximum (FWHM), and time-to-peak (TTP) were then calculated. Results. The analysis of the TDC-derived parameters demonstrated significant differences between pre- and postinterventional flow rates in the ROI placed most distal to the stenosis, ROI 4. The AUC at ROI 4 (reported as a relative percentage of the AUC measured at ROI 1 proximal to the lesion) demonstrated a significant increase in the total flow (mean 67.84% vs. 128.68%, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s, p=0.015) was observed. A significant reduction in TTP at ROI 4 (2.43 s to 1.45 s, p=0.009) was also observed. A positive change in at least 1 of the 3 calculated parameters was seen in all patients after a successful intervention, with 7 of 10 patients showing improvement in all 3 parameters, 2 of 10 showing improvement in 2 parameters, and 1 patient showing improvement in 1 parameter. Conclusion. AUC, FWHM, and TTP are objective, reproducible, quantifiable tools for the peri-interventional fluoroscopic evaluation of vessel stenoses. When compared to the standard subjective interpretation of fluoroscopic imagery, AUC, FWHM, and TTP offer interventionalists the advantage of having an objective, complementary method of evaluating the success of a procedure, potentially allowing for more precisely targeted and quantitatively determined treatment goals and improved patient outcomes. This retrospective study was approved by the local ethics committee under the Number 372/2018BO2. The trial was registered at the German clinical trials register under the number DRKS00017813.

Is Perfusion MRI without Deconvolution Reliable for Mismatch Detection in Acute Stroke? Validation with 15O-Positron Emission Tomography

2018 ◽  
Vol 46 (1-2) ◽  
pp. 16-23 ◽  
Author(s):  
Johanna Reimer ◽  
Cornelia Montag ◽  
Alexander Schuster ◽  
Walter Moeller-Hartmann ◽  
Jan Sobesky ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
At Risk ◽  
Acute Stroke ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Treatment Decisions ◽  
Emission Tomography ◽  
Time To Peak ◽  
Positron Emission ◽  
First Moment

Background: In acute stroke, the magnetic resonance (MR) imaging-based mismatch concept is used to select patients with tissue at risk of infarction for reperfusion therapies. There is however a controversy if non-deconvolved or deconvolved perfusion weighted (PW) parameter maps perform better in tissue at risk prediction and which parameters and thresholds should be used to guide treatment decisions. Methods: In a group of 22 acute stroke patients with consecutive MR and quantitative positron emission tomography (PET) imaging, non-deconvolved parameters were validated with the gold standard for penumbral-flow (PF) detection 15O-water PET. Performance of PW parameters was assessed by a receiver operating characteristic curve analysis to identify the accuracy of each PWI map to detect the ­upper PF threshold as defined by PET cerebral blood flow <20 mL/100 g/min. Results: Among normalized non-deconvolved parameters, PW-first moment without delay correction (FM without DC) > 3.6 s (area under the curve [AUC] = 0.89, interquartile range [IQR] 0.85–0.94), PW-maximum of the concentration curve (Cmax) < 0.66 (AUC = 0.92, IQR 0.84–0.96) and PW-time to peak (TTP) > 4.0 s (AUC = 0.92, IQR 0.87–0.94) perform significantly better than other non-deconvolved parameters to detect the PF threshold as defined by PET. Conclusions: Non-deconvolved parameters FM without DC, Cmax and TTP are an observer-independent alternative to established deconvolved parameters (e.g., Tmax) to guide treatment decisions in acute stroke.

P1315PREDICTABILITY OF SONOGRAPHICALLY DETERMINED IMMEDIATE POST-OPERATIVE BLOODFLOW AND VEIN DIAMETER ON PRIMARY RADIOCEPHALIC FISTULA SHORT AND LONGTERM OUTCOMES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Claude Renaud ◽  
Desmond Ooi ◽  
Chuo Ren Leong
Keyword(s):  
Predictive Value ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Primary Patency ◽  
Arterial Blood Flow ◽  
Secondary Patency ◽  
Arterial Blood ◽  
Linear Probe ◽  
Significant Difference ◽  
Esrd Patients

Abstract Background and Aims Vascular access (VA) guidelines recommend radio-cephalic (RC) over upper arm autogenous arteriovenous fistulas (AVF) as first line VA for hemodialysis in end stage renal disease (ESRD) patients. RCAVFs generally have inferior maturation and patency rates predicated on a lower feeding arterial blood flow (BF) and outflow vein calibre (VC). However studies on postoperative BF and VC as predictors of AVF outcomes, so far are confounded by their focus on early outcomes only, heterogeneity of AVFs studied, variable timing of assessment and use of non-standardised outcome definitions. Our aim was therefore to assess the accuracy and influence of immediate post-operative BF and VC on both early and longterm outcomes in a homogenous cohort of primary RCAVFs using standardised definitions and outcome measures as mandated by VA guidelines. Method This was a prospective study conducted in multi-ethnic Asian ESRD patients who had their primary RCAVFs created between October 2013 and October 2014 under regional anesthesia at Khoo Teck Puat hospital Singapore. All AVFs were assessed immediately after surgery for brachial artery BF and outflow VC using doppler ultrasound. A 10MHz linear probe and GE Logic e R7 machine were used exclusively by a single operator. Receiver operating characteristic (ROC) curves were generated to determine the optimal BF and VC cut-off for AVF maturation. Maturation was defined as BF&gt;600mL/min, VC&gt;6mm and vein depth &lt;6mm at 6 weeks post-op. An area under the curve (AUC)&gt; 0.7 was considered clinically significant. Kaplan–Meier analysis was used to evaluate the AVF primary and secondary patency based on best BF and VC cut-offs. Cox regression statistics was used to determine AVF hazard factors. Results Fifty-seven primary RCAVFs were created and included in the study. The baseline characteristics are shown in Table 1. Sonography- based non-assisted maturation at 6 weeks was 56%. ROC identified 410 mL/min and 42mm as the best BF and VC cut-off respectively to most accurately predict 6-week maturation. The sensitivity, specificity, positive predictive value and negative predictive value were 75%, 61%, 44% and 86% for BF at 410 mL/min and 69%, 61%, 41% and 83% for VC at 42mm respectively. Survival analysis (Fig. 1 and 2) showed that AVFs with VC≥42 mm compared to &lt;42mm had significantly greater 6 months, 1-year, 2-year and 4-year primary and secondary patency rates. There was no significant difference in patency rates between AVFs with BF≥410 and &lt;410mL/min. Cox proportional regression hazard analysis showed that diabetes (HR 2.26, CI 1.02-4.99, p= 0.04) and maturation (HR 0.47, 95% CJ 0.24-0.89, p=0.02) as significant contributed to the variability of primary patency. Only VC (HR 0.28, 95% CI 0.13-0.063, p=0.002) impacted significantly towards secondary patency. Conclusion An immediate post-op BF≥410mL/min and VC≥42mm can predict early RCAVF outcome in the form of nonassisted maturation, but only VC accurately impact on longterm AVF survival. VA surveillance efforts should therefore target RCAVFs with post-op VC &lt;42mm for timely intervention and maintenance of longterm patency.

Abstract WP83: Validation of a Relative Non-Contrast CT Map to Detect Early Ischemic Changes in Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Margy E McCullough-Hicks ◽  
Soren Christensen ◽  
Aditya Srivatsan ◽  
Gregory W Albers ◽  
Maarten Lansberg
Keyword(s):  
Acute Stroke ◽  
Brain Regions ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Infarct Core ◽  
Test Characteristics ◽  
Contrast Ct ◽  
Sensitivity Specificity ◽  
Early Infarction

Background: Discerning signs of early infarct on the non-contrast CT (NCCT) can be difficult. To facilitate interpretation of the NCCT we previously developed a technique to generate symmetry ratio maps of the NCCT (rNCCT maps) on which subtle (≥5%) differences in density between symmetric brain regions are enhanced. We sought to validate the rNCCT map against other measures of early infarction in a large cohort. Methods: rNCCT maps were generated for 146 ischemic stroke patients. We assessed how often a neurologist’s interpretation of the NCCT was changed when provided with the rNCCT map. The neurologist was blinded to CTP and DWI but was given the infarct hemisphere. In addition, using the 24-hour DWI as the gold standard, we assessed the sensitivity, specificity and volumetric accuracy of the rNCCT-defined infarct core and compared this to the test characteristics of CTP-defined infarct core (CBF<38% threshold). Results: Addition of rNCCT overlay map changed clinician’s initial read 64.4% of the time (95% CI 56-72%); the rNCCT identified new areas of ischemia not appreciated on blinded review 86.2% of the time (95% CI 78-92%) and in 35.1% helped rule out early ischemia where the reader was unsure of its presence (95% CI 26-45%). In the 53 patients with reperfusion and follow-up MRI, specificity of rNCCT for final lesion volume was 99.5% for rNCCT [98.5-99.8%] vs. 99.8% [IQR 98.8-99.9%] for CTP (P=0.08). Sensitivity for rNCCT was 19.9% [7.1-28.1%] vs. 17.5% [4.7-32.2%] for CTP (P=0.56). Conclusions: This study validates the rNCCT map for detection of early ischemic changes. It is more quantitative and objective than a clinician’s read of the NCCT alone. The sensitivity and specificity for detecting early ischemic changes on rNCCT were comparable to those achieved with CTP. This indicates that the rNCCT could be a valuable tool in the evaluation of acute stroke patients.

scholarly journals Spatial Distribution of Perfusion Abnormality in Acute MCA Occlusion is Associated with Likelihood of Later Recanalization

2014 ◽  
Vol 34 (5) ◽  
pp. 813-819 ◽  
Author(s):  
Susanne Siemonsen ◽  
Nils Daniel Forkert ◽  
Anne Hansen ◽  
Andre Kemmling ◽  
Götz Thomalla ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Three Dimensional ◽  
Area Under The Curve ◽  
Fibrinolytic Therapy ◽  
Data Sets ◽  
Infarct Core ◽  
Compensatory Mechanisms ◽  
Time To Peak

The aim of this study is to investigate whether different spatial perfusion-deficit patterns, which indicate differing compensatory mechanisms, can be recognized and used to predict recanalization success of intravenous fibrinolytic therapy in acute stroke patients. Twenty-seven acute stroke data sets acquired within 6 hours from symptom onset including diffusion- (DWI) and perfusion-weighted magnetic resonance (MR) imaging (PWI) were analyzed and dichotomized regarding recanalization outcome using time-of-flight follow-up data sets. The DWI data sets were used for calculation of apparent diffusion coefficient (ADC) maps and subsequent infarct core segmentation. A patient-individual three-dimensional (3D) shell model was generated based on the segmentation and used for spatial analysis of the ADC as well as cerebral blood volume (CBV), cerebral blood flow, time to peak (TTP), and mean transit time (MTT) parameters derived from PWI. Skewness, kurtosis, area under the curve, and slope were calculated for each parameter curve and used for classification (recanalized/nonrecanalized) using a LogitBoost Alternating Decision Tree (LAD Tree). The LAD tree optimization revealed that only ADC skewness, CBV kurtosis, and MTT kurtosis are required for best possible prediction of recanalization success with a precision of 85%. Our results suggest that the propensity for macrovascular recanalization after intravenous fibrinolytic therapy depends not only on clot properties but also on distal microvascular bed perfusion. The 3D approach for characterization of perfusion parameters seems promising for further research.

Abstract 2511: Reperfusion Measured by Mean Transit Time Predicts Clinical Improvement in Hyperacute Ischemic Stroke Patients Better Than Time-to-Peak and Tmax

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Andria L Ford ◽  
Hongyu An ◽  
Katie D Vo ◽  
William J Powers ◽  
Weili Lin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Linear Regression ◽  
Acute Ischemic Stroke ◽  
Clinical Improvement ◽  
Independent Predictor ◽  
Mean Transit Time ◽  
Perfusion Deficit ◽  
Perfusion Parameter ◽  
Stroke Patients ◽  
Time To Peak

Background: Early reperfusion is associated with improved clinical outcome in acute ischemic stroke; however, there is no consensus regarding which perfusion parameter may best serve as a marker of clinical improvement. We compared three commonly used MRI perfusion parameters, mean transit time (MTT), time-to-peak (TTP), and Tmax, to identify which method of measuring reperfusion best predicted clinical improvement. Methods: Acute ischemic stroke patients underwent two MR scans: within 4.5 hours (tp1) and at 6 hours (tp2) after stroke onset. Co-registered MTT, TTP, and Tmax maps were generated to measure regions of perfusion deficit at tp1 and tp2. Perfusion deficit was defined as prolongation of MTT, TTP, or Tmax beyond four pre-specified thresholds for each parameter (4 thresholds were chosen to ensure results were not spuriously based on one threshold). Commonly-used thresholds (relative to contralateral median) were selected for each parameter: for MTT: >3, 4, 5, or 6 seconds (s), for TTP: >2, 4, 6, or 8s, and for Tmax: >2, 4, 6, and 8s. The volume of reperfusion (Vreperf) was defined as the volume of tissue with perfusion deficit at tp1 and no perfusion deficit at tp2. Clinical improvement was defined as: Admission NIH Stroke Scale (NIHSS) - 1 month NIHSS (ΔNIHSS). A multivariable linear regression model identified if Vreperf as measured by MTT, TTP, or Tmax was an independent predictor of clinical improvement after adjusting for patient age, admission NIHSS, tPA treatment, and volume of tp1 perfusion deficit. Results: Thirty-nine acute ischemic stroke patients were prospectively scanned at 2.8±.8hr (tp1) and 6.4±.4hr (tp2) after stroke onset (mean age=64, 44% female, 36% Black, mean NIHSS=14, 74% received IV tPA). Across the four thresholds, mean volume of perfusion deficit ranged from 58-96ml for MTT, 56-116ml for TTP, and 51-113ml for Tmax. Mean Vreperf ranged from 15-22ml for MTT, 15-23ml for TTP, and 14-21ml for Tmax. In the multivariable linear regression analysis, after adjusting for age, admission NIHSS, tPA treatment, and volume of tp1 perfusion deficit, Vreperf predicted ΔNIHSS for MTT=4s (p=0.007), MTT=5s (p=0.005), and MTT=6s (p=0.010), whereas Vreperf did not predict ΔNIHSS for any TTP or Tmax threshold ( Table ). Conclusion: Reperfusion, defined by MTT, was an independent predictor of clinical improvement, while reperfusion defined by TTP and Tmax were not. Therefore, MTT may be the best time-based perfusion parameter to define clinically-relevant reperfusion after stroke.

Evaluation of Contrast-enhanced Transcranial Color-coded Duplex Sonography (CE-TCCD) Applied in Stroke Patients with Intracranial Collateral Circulation

2020 ◽  
Vol 16 (7) ◽  
pp. 887-891
Author(s):  
Jin Xing ◽  
Bin Xu ◽  
Lin Zhai ◽  
Yan Men ◽  
Dan Zhang ◽  
...  
Keyword(s):  
Collateral Circulation ◽  
Duplex Sonography ◽  
Arterial Blood Flow ◽  
Anterior Communicating Artery ◽  
Stroke Patients ◽  
Diagnostic Efficacy ◽  
Arterial Blood ◽  
Contrast Enhanced ◽  
Temporal Bones ◽  
Color Coded Duplex Sonography

Background and Introduction: Collateral circulation is very crucial for the prognosis of stroke patients. Transcranial color-coded duplexsonography (TCCD) is used widely to evaluate the intracranial arterial blood flow. However, approximately 20% - 30% of the patients with cerebral infarction cannot be detected via TCCD due to the interruption of thickened temporal bones. We assessed the diagnostic efficacy of contrast-enhanced transcranial color-coded duplexsonography (CE-TCCD) in stroke patients with limited bone windows. Methods: CE-TCCD was applied to 70 patients (51 males and 19 females) who presented with ischemic symptoms, to detect the openness of the anterior communicating artery (ACoA) and posterior communicating artery (PCoA) of the Willis ring before Computed Tomography angiography (CTA) or Magnetic Resonance Angiography (MRA) examination. The results from CETCCD is used to compare with CTA/MRA result to verify the diagnostic efficacy. Results: Forty-one communicating artery openings were detected by CE-TCCD, among which 37 were PCoA and 4 were ACoA. Among the 70 patients, 23 of 70 patients indicated severe stenosis within intracranial and/or extracranial arteries. Eighteen out of the 23 patients showed collateral circulation, accounting for 78.3% (18/23). Moderate stenosis were 23 cases in total, in which 7 cases showed collateral circulation, accounting for 30.4% (7/23). Slight stenosis were 24 cases in total, none of which showed collateral circulation. Conclusion : In the stroke patients with limited bone windows, CE-TCCD can evaluate intracranial collateral circulation.

Elevated Circulating Endothelial Microparticles in Acute Stroke Patients: A Correlation with Brain Lesion Volume and Outcome.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3504-3504 ◽  
Author(s):  
Jan Simak ◽  
Monique P. Gelderman ◽  
Hua Yu ◽  
Violet Wright ◽  
Noah Alberts-Grill ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Hospital Discharge ◽  
Vascular Injury ◽  
Brain Lesion ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Disability Score ◽  
Ischemic Lesion ◽  
Blood Samples

Abstract Elevated endothelial cell membrane microparticles (EC MP) in blood have been demonstrated in various diseases with a vascular injury component. The aim of this study was to investigate if circulating EC MP show a relationship with outcome after acute stroke and with the ischemic brain lesion volume measured by magnetic resonance diffusion-weighted imaging (DWI). We analyzed EC MP in the blood of 42 acute stroke patients (AS): 20 patients with National Institutes of Health Stroke Scale (NIHSS) scores < 5 were classified as mild stroke (MS) (median NIHSS= 2; 25th–75th%: 0–2), while the other 22 patients with NIHSS ≥5 (NIHSS=12; 6–21) were classified as moderate to severe stroke (SS). Peripheral venous blood samples were collected at a median time of 36 hours (18–52) after the onset of clinical symptoms. The patients outcome was based on the Rankin disability score at the time of hospital discharge. Blood samples of 23 age matched control volunteers (CTRL) were used for comparison. EC MP analysis used a three-color flow cytometry assay (Simak et al, British J Haematol125, 804–813, 2004). EC MP were identified by antibodies to EC antigen CD105 (endoglin) and the highly specific CD144 (VE-cadherin). Platelet, white, and red blood cell MP were identified using cell specific antibodies to CD41, CD45, and CD235a, respectively. Plasma counts of CD105+CD41−CD45- EC MP were elevated in SS (median: 840/μL; 25th–75th%: 565–1079/μL) as compared to CTRL (415/μL; 201–624/μL; p=0.014). Moreover, CD105+CD144+ EC MP were elevated in SS (261/μL; 137–433/μL) when compared to MS (154/μL; 99–182/μL; p=0.031) or CTRL group (140/μL; 79–247/μL; p=0.031). Interestingly, CD105+CD41−CD45- EC MP, but not CD105+CD144+ EC MP, exhibited a significant correlation (p=0.005; r=0.45) with DWI brain lesion volume in AS group. However, CD105+CD144+ EC MP in the admission samples highly correlated (p=0.0007; r=0.54) with the Rankin disability score in the AS group at hospital discharge, while correlation of CD105+CD41−CD45- EC MP with the Rankin score was not as significant (p=0.007; r=0.44). We further analyzed 12 MS and 12 SS follow-up samples collected at a median period of 10 days (7–14) after the first sampling. Surprisingly, in SS follow-up samples, CD105+ EC MP populations decreased, while CD144+CD105−CD41- EC MP significantly increased, as compared to the samples at admission. In conclusion, the SS patient group had elevated different phenotypes of EC MP in the plasma samples at admission when compared to MS or CTRL groups. This is likely a reflection of the severity of ischemic-reperfusion injury of the brain vasculature. Elevated endoglin-positive EC MP were associated with brain ischemic lesion volume, whereas EC MP positive for both endoglin and VE-cadherin in the admission samples showed highly significant correlation with the patients disability outcome. The increased VE-cadherin-positive EC MP in follow-up samples may reflect a continuing endothelial injury in SS patients. Analysis of different phenotypes of EC MP in peripheral blood of stroke patients may be indicative of volume, character and severity of brain vascular injury and could be of diagnostic and prognostic use.

Reperfusion after Severe Local Perfusion Deficit Precedes Hemorrhagic Transformation: An MRI Study in Acute Stroke Patients

2005 ◽  
Vol 19 (2) ◽  
pp. 117-124 ◽  
Author(s):  
Jens Fiehler ◽  
Christian Remmele ◽  
Thomas Kucinski ◽  
Michael Rosenkranz ◽  
Götz Thomalla ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Hemorrhagic Transformation ◽  
Perfusion Deficit ◽  
Stroke Patients ◽  
Mri Study

Abstract T MP86: A Prospective Study of the Effect of Dehydration on Stroke Severity and Short Term Outcome

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Mona N Bahouth ◽  
Argye Hillis ◽  
Rebecca Gottesman
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Urine Specific Gravity ◽  
Stroke Severity ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Short Term ◽  
Term Outcome ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Many ischemic stroke patients present to the hospital in a state of dehydration. We hypothesized that patients who were dehydrated at the time of acute stroke would have more severe stroke and worse short term outcomes. Methods: We enrolled consecutive ischemic stroke patients within 12 hours from their last normal neurological exam at a single academic health system. Patients with renal failure or who were unable to undergo MRI were excluded. Surrogate markers for dehydration were defined as BUN/Creatinine ratio >15 and urine specific gravity >1.010. Stroke severity was determined based on clinical examination (NIHSS score) and lesion volume measured on diffusion weighted MRI. The primary outcome of interest was change in NIHSS from admission to discharge. Results: We surveyed 383 ischemic stroke admissions to our comprehensive stroke center. Of these, 168 met inclusion criteria with 126/168 (75%) having complete laboratory and MRI data. 44% of our patients were dehydrated at the time of admission, with no difference in demographics between the dehydrated and hydrated groups. Baseline NIHSS (6.7 vs 7.3; p=0.63) and lesion volumes (12 vs 16; p=0.48) were similar in the two groups. 42% of dehydrated patients were in the worst short term quartile of NIHSS change, as compared with 17% of the hydrated group (p=0.02). Dehydration remained a significant predictor of having the worst NIHSS change, after adjustment for age, initial NIHSS, lesion volume, and admission glucose (OR=4.34, 95% CI 1.75-10.76). Conclusions: Nearly half of acute stroke patients admitted to the hospital are dehydrated by surrogate laboratory markers. Acute stroke patients with markers of dehydration demonstrate greater worsening in NIHSS scores as compared with hydrated patients, independent of infarct size. Results suggest an opportunity for an inexpensive and globally available treatment to optimize functional outcomes of the stroke patient.

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