Abstract TP219: Hyperintense Vessels on FLAIR MRI Suggest Dissection and Large-Artery Atherosclerosis but Do Not Predict Outcome in Acute Posterior Circulation Infarct

Background and Purpose: Hyperintense vessel sign on FLAIR (HVS) has been described in hyperacute stroke patients with arterial occlusion. It’s a surrogate marker for stroke severity in patients with acute ischemic stroke of the anterior circulation. We aimed to reveal the clinical significance of HVS in patients with acute posterior circulation infarction. Methods: This observational study is based on a single-center prospective registry study. Inclusion criteria were: symptomatic ischemic stroke patients who have lesions only in posterior circulation; and taken initial MRI within 14 days from onset.An unfavorable outcome was defined as mRS score of 2 to 6 at 3 months from the onset. First investigation is to estimate whether HVS could be related to the subtype of acute ischemic stroke (cohort A). Second, the correlation between HVS and mRS at 3 months was evaluated (cohort B). Results: From October 2012 to May 2019, consecutive 1,079 ischemic stroke subjects were screened, including 277 in cohort A (191 male, median age 64 years) and 240 in cohort B (165 male, median age 66 years, Figure A). In cohort A, HVS was independently associated with intracranial artery dissection (OR 5.228; 95% CI 2.270-12.039; p = 0.001) and large-artery atherosclerosis (OR 3.582; 95% CI 1.244-10.317; p = 0.018, Figure B). In cohort B, HVS was not a factor independently associated with unfavorable outcome (OR 2.925; 95% CI 0.881-9.714; p = 0.080). Conclusions: HVS in patients with posterior circulation infarct suggests intracranial artery dissection or large-artery atherosclerosis, but does not have impact on their clinical courses.

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Intravenous thrombolysis in acute ischemic stroke due to intracranial artery dissection: a single-center case series and a review of literature

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-019-01918-6 ◽

2019 ◽

Vol 48 (4) ◽

pp. 679-684 ◽

Cited By ~ 2

Author(s):

Francisco Bernardo ◽

Stefania Nannoni ◽

Davide Strambo ◽

Bruno Bartolini ◽

Patrik Michel ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Case Series ◽

Intravenous Thrombolysis ◽

Artery Dissection ◽

Intracranial Artery ◽

Review Of Literature ◽

Single Center ◽

Intracranial Artery Dissection

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Thrombolytic therapy for acute ischemic stroke following intracranial artery dissection: Fukuoka stroke registry

Journal of the Neurological Sciences ◽

10.1016/j.jns.2017.08.3329 ◽

2017 ◽

Vol 381 ◽

pp. 394-395 ◽

Cited By ~ 2

Author(s):

S. Arakawa ◽

Y. Furuta ◽

M. Osaki ◽

S. Sakai ◽

S. Kimura ◽

...

Keyword(s):

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Acute Ischemic Stroke ◽

Artery Dissection ◽

Intracranial Artery ◽

Stroke Registry ◽

Intracranial Artery Dissection

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Abstract 74: Early Arterial Recanalization After Intra-venous Tissue-Plasminogen-Activator Treatment in the Interventional Management of Stroke-3 Study

Stroke ◽

10.1161/str.45.suppl_1.74 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Ruediger Von Kummer ◽

Andrew M Demchuk ◽

Lydia D Foster ◽

Bernard Yan ◽

Wouter J Schonewille ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Internal Carotid ◽

Arterial Occlusion ◽

Posterior Circulation ◽

Stroke Patients ◽

Vessel Occlusion ◽

Tissue Plasminogen ◽

Arterial Recanalization

Background: Data on arterial recanalization after IV t-PA treatment are rare. IMS-3 allows the study of variables affecting arterial recanalization after IV t-PA in acute ischemic stroke patients with CTA-proved major artery occlusions. Methods: Of 656 acute ischemic stroke patients in IMS-3, 306 were examined with baseline CTA and randomized either to IV t-PA (N=95) or to IV t-PA followed by digital subtraction angiography (DSA) and endovascular therapy (EVT) (N=211). Comparison of baseline CTA to DSA within 5 hours of stroke onset assessed early arterial recanalization after IV t-PA. A central core lab categorized DSA vessel occlusion as “no, partial, or complete”. We studied the association between arterial occlusion sites on baseline CTA with early recanalization for the endovascular group and analyzed its impact on clinical outcome at 90 days. Results: In the EVT group, 22 patients (10.4%) had no CTA intracranial occlusions, but 1 extracranial occlusion; 42 patients (19.9%) had occlusions of intracranial internal carotid artery (ic-ICA); 10 patients (4.7%) had tandem occlusions of the cervical ICA and middle cerebral artery (MCA); 95 patients (45.0%) had MCA-trunk (M1) occlusions, 33 patients (15.6%) had M2 occlusions, 3 patients (1.4%) had M3/4 occlusions, and 6 patients (2.8%) occlusions within posterior circulation. Partial or complete recanalization occurred in 28.6% of patients before DSA and was marginally associated with occlusion site (p=0.0525) (8 patients (19.0%) with ic-ICA occlusion, 0 patients with tandem ICA/MCA occlusions, 34 patients (35.8%) with M1 occlusions, 11 patients (33.3%) with M2 occlusions, 0 patients with M3/4 occlusions, and 1 patient (16.7%) with occlusion within posterior circulation). Three CTA negative patients had intracranial occlusions on DSA. Thirty-two patients (59.3%) with early recanalization achieved mRS of 0-2 at 90 days compared to 51 patients (38.4%) without early recanalization (p=0.0099). There was no relationship between early recanalization and time to IV t-PA or mean t-PA dose. Conclusion: Before EVT, IV rt-PA may facilitate arterial recanalization and better clinical outcome in about one third of patients.

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Plasma Levels of Apolipoprotein E and Risk of Intracranial Artery Stenosis in Acute Ischemic Stroke Patients

Annals of Nutrition and Metabolism ◽

10.1159/000343789 ◽

2013 ◽

Vol 62 (1) ◽

pp. 26-31 ◽

Cited By ~ 6

Author(s):

Yong-Jae Kim ◽

Seung-Min Lee ◽

Hyun-Ji Cho ◽

Hyun Ju Do ◽

Chang Hyung Hong ◽

...

Keyword(s):

Ischemic Stroke ◽

Apolipoprotein E ◽

Acute Ischemic Stroke ◽

Plasma Levels ◽

Artery Stenosis ◽

Intracranial Artery ◽

Stroke Patients ◽

Intracranial Artery Stenosis

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A COACHS Nomogram to Predict the Probability of Three-Month Unfavorable Outcome after Acute Ischemic Stroke in Chinese Patients

Cerebrovascular Diseases ◽

10.1159/000497243 ◽

2019 ◽

Vol 47 (1-2) ◽

pp. 80-87 ◽

Cited By ~ 2

Author(s):

BaiLi Song ◽

YuKai Liu ◽

Linda Nyame ◽

XiangLiang Chen ◽

Teng Jiang ◽

...

Keyword(s):

Logistic Regression ◽

Heart Disease ◽

Ischemic Stroke ◽

Blood Glucose ◽

Acute Ischemic Stroke ◽

Valvular Heart Disease ◽

Cerebral Hemorrhage ◽

Unfavorable Outcome ◽

Stroke Patients ◽

Lemeshow Test

Background: Accurate prognostication of unfavorable outcome made at the early onset of stroke is important to both the clinician and the patient management. This study was aimed to develop a nomogram based on the integration of parameters to predict the probability of 3-month unfavorable functional outcome in Chinese acute ischemic stroke patients. Methods: We retrospectively collected patients who underwent acute ischemic stroke at Stroke Center of the Nanjing First Hospital (China) between May 2013 and May 2018. After exclusion, the study population includes 1,025 patients for nomogram development. The main outcome measure was 3-month unfavorable outcome (modified Rankin Scale > 2). Multivariable logistic regression analysis was used to develop the predicting model, and stepwise logistic regression with the Akaike information criterion was utilized to find best-fit nomogram model. We incorporated the creatinine, fast blood glucose, age, previous cerebral hemorrhage, previous valvular heart disease, and NHISS score (COACHS), and these factors were presented with a nomogram. We assessed the discriminative performance by using the area under curve (AUC) of receiver-operating characteristic (ROC) and calibration of risk prediction model by using the Hosmer-Lemeshow test. Results: Multivariate analysis of the 1,025 patients for logistic regression helped identify the independent factors as National Institutes of Health Stroke Scale score on admission, age, previous valvular heart disease, fasting blood glucose, creatinine, and previous cerebral hemorrhage, which were included in the COACHS nomogram. The AUC-ROC of nomogram was 0.799. Calibration was good (p = 0.1376 for the Hosmer-Lemeshow test). Conclusions: The COACHS nomogram may be used to predict unfavorable outcome at 3 months after acute ischemic stroke in Chinese population. It may be also a reliable tool that is effective in its clinical utilization to risk-stratify acute stroke patients.

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