Abstract WP91: Cerebral Small Vessel Disease Burden Predicts Poor Collateral Flow in Acute Ischemic Stroke Patients With Large Artery Atherosclerosis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Yueming Wang ◽  
Lumeng Yang ◽  
Lan Hong ◽  
Longting Lin ◽  
Mark Parsons ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Small Vessel Disease ◽  
Flow Coefficient ◽  
Collateral Flow ◽  
Large Artery ◽  
Stroke Patients ◽  
Vessel Disease

Aim: We sought to determine whether the extent of chronic white matter hyper-intensities (WMH) and white matter hypo-perfusion (WMHP), as markers of cerebral small vessel disease (CSVD), were associated with poor collateral flow in acute ischemic stroke as a potential cause of unfavorable functional outcome. Methods: Acute ischemic stroke patients within 12 hours of symptom onset with complete baseline and follow-up clinical data, who: (1) had large vessel occlusion in anterior circulation, (2) underwent baseline perfusion CT (CTP), (3) had 24-hour MRI were prospectively recruited. The volume of WMH was measured in the unaffected hemisphere on MRI semi-automatically. WMHP was measured as Delay Time (DT)>2s in white matter of unaffected hemisphere on CTP. Quality of Collateral flow was defined by the volume ratio of DT>3s/DT>6s on CTP. Unfavorable functional outcome was 90-day modified Rankin Scale (mRS)>2. The association between volumes of WMH, WMHP, and collateral flow were evaluated using univariate and multivariate generalized linear models. We also assessed the relationship between WMH, WHMP, and functional outcome with logistic regression. Results: There were 96 (66.6±12.81 years old, 35 female) ischemic stroke patients, and 51 were due to large artery atherosclerosis (LAA). In all patients, after multivariate adjustment, WMH volume (5.6±7.11ml) did not correlate with collateral flow (coefficient -0.01, 95% CI -0.03 to 0, P=0.09), although it was marginally associated with unfavorable outcome (Odds Ratio: 1.08, p=0.06, 95% CI 1 to 1.17). In all patients, WMHP volume (8.6±8.54ml) did not correlate with collateral flow (coefficient -0.01, 95% CI -0.01 to 0, P=0.29). However, in the LAA subgroup, WMH volume was strongly related to poorer collateral flow, i.e. lower DT>3s/DT>6s ratio(coefficient -0.03, 95% CI -0.04 to -0.01, P=0.01). WMHP volume was also correlated with poor collateral flow (coefficient -0.01, 95% CI -0.02 to 0, P=0.02). Conclusion: CSVD may contribute to poor collateral flow in acute stroke, especially in patients with LAA. This potentially explains the association between CSVD and poor acute stroke outcomes.

scholarly journals Imaging Markers of Brain Frailty and Outcome in Patients With Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Ning Bu ◽  
Mohamed Salah Khlif ◽  
Robin Lemmens ◽  
Anke Wouters ◽  
Jochen B. Fiebach ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Excellent Outcome ◽  
Vessel Disease ◽  
Brain Parenchymal Fraction ◽  
Imaging Markers ◽  
Brain Parenchymal

Background and Purpose: Functional outcome after stroke may be related to preexisting brain health. Several imaging markers of brain frailty have been described including brain atrophy and markers of small vessel disease. We investigated the association of these imaging markers with functional outcome after acute ischemic stroke. Methods: We retrospectively studied patients with acute ischemic stroke enrolled in the AXIS-2 trial (AX200 in Ischemic Stroke Trial), a randomized controlled clinical trial of granulocyte colony-stimulating factor versus placebo. We assessed the ratio of brain parenchymal volume to total intracerebral volumes (ie, the brain parenchymal fraction) and total brain volumes from routine baseline magnetic resonance imaging data obtained within 9 hours of symptom onset using the unified segmentation algorithm in SPM12. Enlarged perivascular spaces, white matter hyperintensities, lacunes, as well as a small vessel disease burden, were rated visually. Functional outcomes (modified Rankin Scale score) at day 90 were determined. Logistic regression was used to test associations between brain imaging features and functional outcomes. Results: We enrolled 259 patients with a mean age of 69±12 years and 46 % were female. Increased brain parenchymal fraction was associated with higher odds of excellent outcome (odds ratio per percent increase, 1.078 [95% CI, 1.008–1.153]). Total brain volumes and small vessel disease burden were not associated with functional outcome. An interaction between brain parenchymal fraction and large vessel occlusion on excellent outcome was not observed. Conclusions: Global brain health, as assessed by brain parenchymal fraction on magnetic resonance imaging, is associated with excellent functional outcome after ischemic stroke. REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00927836.

scholarly journals White Matter Lesion Severity in Mild Acute Ischemic Stroke Patients and Functional Outcome After 1 Year

Stroke ◽  
2012 ◽  
Vol 43 (11) ◽  
pp. 3046-3051 ◽  
Author(s):  
Christopher O. Leonards ◽  
Nils Ipsen ◽  
Uwe Malzahn ◽  
Jochen B. Fiebach ◽  
Matthias Endres ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
White Matter Lesion ◽  
Stroke Patients ◽  
Lesion Severity

scholarly journals Thyroid-Stimulating Hormone, White Matter Hyperintensities, and Functional Outcome in Acute Ischemic Stroke Patients

2014 ◽  
Vol 4 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Christopher O. Leonards ◽  
Harald J. Schneider ◽  
Thomas G. Liman ◽  
Jochen B. Fiebach ◽  
Matthias Endres ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
White Matter Hyperintensities ◽  
Thyroid Stimulating Hormone ◽  
Stroke Patients ◽  
Stimulating Hormone

Tissue Sodium Concentration within White Matter Correlates with the Extent of Small Vessel Disease

2021 ◽  
pp. 1-9
Author(s):  
Anne Adlung ◽  
Melina Samartzi ◽  
Lothar R. Schad ◽  
Eva Neumaier-Probst ◽  
Marc Fatar ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Small Vessel Disease ◽  
Sodium Concentration ◽  
Small Vessel ◽  
Vessel Disease ◽  
Significant Difference ◽  
Tissue Sodium ◽  
23Na Mri

Introduction: Sodium MRI (23Na MRI) derived biomarkers such as tissue sodium concentration (TSC) provide valuable information on cell function and brain tissue viability and has become a reliable tool for the assessment of brain tumors and ischemic stroke beyond pathoanatomical morphology. Patients with major stroke often suffer from different degrees of underlying white matter lesions (WMLs) attributed to chronic small vessel disease. This study aimed to evaluate the WM TSC in patients with an acute ischemic stroke and to correlate the TSC with the extent of small vessel disease. Furthermore, the reliability of relative TSC (rTSC) compared to absolute TSC in these patients was analyzed. Methodology: We prospectively examined 62 patients with acute ischemic stroke (73 ± 13 years) between November 2016 and August 2019 from which 18 patients were excluded and thus 44 patients were evaluated. A 3D 23Na MRI was acquired in addition to a T2-TIRM and a diffusion-weighted image. Coregistration and segmentation were performed with SPM 12 based on the T2-TIRM image. The extension of WM T2 hyperintense lesions in each patient was classified using the Fazekas scale of WMLs. The absolute TSC in the WM region was correlated to the Fazekas grades. The stroke region was manually segmented on the coregistered absolute diffusion coefficient image and absolute, and rTSC was calculated in the stroke region and compared to nonischemic WM region. Statistical significance was evaluated using the Student t-test. Results: For patients with Fazekas grade I (n = 25, age: 68.5 ± 15.1 years), mean TSC in WM was 55.57 ± 7.43 mM, and it was not statistically significant different from patients with Fazekas grade II (n = 7, age: 77.9 ± 6.4 years) with a mean TSC in WM of 53.9 ± 6.4 mM, p = 0.58. For patients with Fazekas grade III (n = 9, age: 81.4 ± 7.9 years), mean TSC in WM was 68.7 ± 10.5 mM, which is statistically significantly higher than the TSC in patients with Fazekas grade I and II (p < 0.001 and p = 0.05, respectively). There was a positive correlation between the TSC in WM and the Fazekas grade with r = 0.48 p < 0.001. The rTSC in the stroke region was statistically significant difference between low (0 and I) and high (2 and 3) Fazekas grades (p = 0.0353) whereas there was no statistically significant difference in absolute TSC in the stroke region between low (0 and I) and high (2 and 3) Fazekas grades. Conclusion: The significant difference in absolute TSC in WM in patients with severe small vessel disease; Fazekas grade 3 can lead to inaccuracies using rTSC quantification for evaluation of acute ischemic stroke using 23 Na MRI. The study, therefore, emphasizes the importance of absolute tissue sodium quantification.

Abstract TP207: Pre-stroke Dementia is Associated With Poor Functional Outcome After Acute Ischemic Stroke: The Fukuoka Stroke Registry

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Yoshinobu Wakisaka ◽  
Ryu Matsuo ◽  
Junya Hata ◽  
Junya Kuroda ◽  
Tetsuro Ago ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Stroke Severity ◽  
Large Artery ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Vessel Occlusion ◽  
Stroke Registry ◽  
Increased Risk

Introduction: With an aging population, an increased number of acute stroke patients with pre-stroke dementia is expected. Although both stroke and dementia are major cause of disability, the effect of pre-stroke dementia on functional outcome after stroke has been still on debate. Hypothesis: Pre-stroke dementia is associated with poor functional outcome after acute ischemic stroke. Methods: Of 9198 stroke patients registered in the Fukuoka Stroke Registry in Japan from June 2007 to May 2014, 3843 patients with first-ever ischemic stroke within 24h of onset, who had been functionally independent before the onset, were enrolled in this study (cardioembolism [n=926], large artery atherosclerosis [n=583], small vessel occlusion [n=1045], others [n=1289]). Pre-stroke dementia was defined as any type of dementia that was present prior to the stroke. For propensity score (PS)-matched analysis, 320 pairs of patients with and without pre-stroke dementia were also selected. Study outcome was poor functional outcome (modified Rankin Scale 3-6) at discharge. Results: In the total cohort, 330 (8.6%) had pre-stroke dementia. The age (80±8 vs 69±13, year, mean±SD, p<0.01), frequencies of female (46 vs 36, %, p<0.01) and cardioembolism (41 vs 23, %, p<0.01), and NIHSS score on admission (6 [3 - 12] vs 3 [1 - 6], median [interquartile], p<0.01) were higher in patients with pre-stroke dementia than those without the dementia. Poor functional outcome (62 vs 25, %, p<0.01) were more prevalent in patients with pre-stroke dementia than those without the dementia. Multivariable-adjusted analysis showed that pre-stroke dementia was significantly associated with increased risk for poor functional outcome (OR 2.3, 95% CI 1.7-3.2). There were no interactions between pre-stroke dementia and 4 variables (age, sex, stroke subtype, and initial stroke severity [NIHSS≤7 or NIHSS≥8]). In the PS-matched analysis, pre-stroke dementia was still associated with poor functional outcome (OR 4.3, 95%CI 2.1-8.8). Conclusions: Pre-stroke dementia was significantly associated with poor functional outcome at discharge in patients with acute ischemic stroke.

Abstract WP128: Stroke Subtype Predicts Neurological Deterioration After Intravenous Alteplase for Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alexander Allen ◽  
Katarina Dakay ◽  
Brittany Ricci ◽  
Andrew Chang ◽  
Brian Mac Grory ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Large Artery ◽  
Stroke Subtype ◽  
Vessel Disease ◽  
Stroke Subtypes ◽  
Intravenous Alteplase

Introduction: Intravenous alteplase improves functional outcome in patients with acute ischemic stroke. While patients often have better outcomes, other patients may experience recurrent or worsening symptoms. We sought to determine the association between stroke subtype and neurologic deterioration in this study cohort. Methods: Data were abstracted from a prospective quality improvement registry at a comprehensive stroke center. Patients with symptomatic intracranial hemorrhage, no follow-up imaging, code status change to comfort measures only in the first 24 hours, or stroke mimics were excluded. Recurrent cerebrovascular events (RCVE) were defined as any new or worsening symptoms due to cerebral ischemia in the absence of intracranial hemorrhage or an alternative etiology such as infection or seizure. We compared demographic factors, vascular comorbidities, admission blood pressure, medications, use and timing of antithrombotics during hospitalization, admission NIH stroke scale, endovascular intervention, stroke subtype [Cardioembolic, large artery atherosclerosis, small vessel disease, cryptogenic, and other defined (such as dissection, hypercoagulability, cancer related, illicit drug use)], and good 90-day outcome (mRS 0-1) between the two groups using Fisher’s exact test and t-test as indicated. We then performed multivariable logistic regression analyses to determine associations between stroke subtypes and RCVE. Results: We identified 705 patients treated with tPA, and 606 met the inclusion criteria. The rate of RCVE was 5.8% (35/606). In multivariable analyses, when compared to cardioembolic/cryptogenic stroke, RCVE was more common in small vessel disease (adjusted OR 9.51 p=0.029), large vessel disease (adjusted OR 5.60, p=0.033), and other stroke mechanisms (adjusted OR 11.29, p=0.019). RCVE was associated with more disability at 90 days when compared to non-RCVE (median mRS 4, IQR 3 vs. median mRS 3, IQR 2, p = 0.016). Conclusions: Non-cryptogenic/Non-cardioembolic stroke subtypes are associated with early RCVE, and RCVE is associated with long term disability. Studies are needed to confirm our findings and test interventions optimizing stroke prevention strategies in these subtypes.

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