Abstract P73: Imaging Markers of Brain Frailty and Outcome in Patients With Acute Ischemic Stroke

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, an international, multicenter, randomized controlled clinical trial of Granulocyte Colony Stimulating Factor versus placebo. We assessed the ratio of brain parenchymal volume to total intracerebral volumes (i.e., the brain parenchymal fraction [BPF]) and total brain volumes from routine baseline MRI data obtained within 9 hours of symptom onset using the unified segmentation algorithm in SPM12. Enlarged perivascular spaces (EPVS), white matter hyperintensities (WMH), lacunes as well as a small vessel disease (SVD) burden were rated visually. Functional outcomes (modified Rankin Scale [mRS] score) at day 90 were determined. Logistic regression was used to test associations between brain imaging features and functional outcomes. As there was no significant effect of G-CSF on any outcomes in AXIS-2, placebo and active groups were combined for these analyses. Results: We enrolled 259 patients with a mean age of 69±12 years and 46 % were female. Increased BPF was associated with higher odds of excellent outcome (OR per percent increase: 1.081, 95%CI: 1.012-1.155). Total brain volumes and SVD burden were not associated with functional outcome. An interaction between BPF 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. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00927836.

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

Stroke ◽

10.1161/strokeaha.120.029841 ◽

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.

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Total Small Vessel Disease Burden Predicts Functional Outcome in Patients With Acute Ischemic Stroke

Frontiers in Neurology ◽

10.3389/fneur.2019.00808 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 3

Author(s):

Ying-chao Huo ◽

Qi Li ◽

Wen-yu Zhang ◽

Ning Zou ◽

Rui Li ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Disease Burden ◽

Small Vessel Disease ◽

Small Vessel ◽

Vessel Disease

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Women and Stroke: Different, yet Similar

Cerebrovascular Diseases Extra ◽

10.1159/000519540 ◽

2021 ◽

pp. 106-111

Author(s):

Nandini Mitta ◽

Sapna Erat Sreedharan ◽

Sankara P. Sarma ◽

Padmavathy N. Sylaja

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

South India ◽

Stroke Severity ◽

Sree Chitra Tirunal Institute ◽

Large Artery ◽

Stroke Subtype ◽

Excellent Outcome ◽

The Impact

Background: The impact of gender on acute ischemic stroke, in terms of presentation, severity, etiology, and outcome, is increasingly getting recognized. Here, we analyzed the gender-related differences in etiology and outcome of ischemic stroke in South India. Methods: Patients with first ever ischemic stroke within 1 week of onset presenting to the Comprehensive Stroke Care Centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India, were included in our study. Clinical and risk factor profile was documented. The stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at onset, and stroke subtype classification was done using Trial of Org 10172 in Acute Ischemic Stroke criteria. The 3-month functional outcome was assessed using the modified Rankin Scale (mRS) with excellent outcome defined as an mRS ≤2. Results: Of the 742 patients, 250 (33.7%) were females. The age, clinical profile, and rate of reperfusion therapies did not differ between the genders. Women suffered more severe strokes (mean NIHSS 9.5 vs. 8.4, p = 0.03). While large artery atherosclerosis was more common in men (21.3% vs. 14.8%, p = 0.03), cardioembolic strokes secondary to rheumatic heart disease were more common in women (27.2% vs. 19.7%, p = 0.02). Men had a better 3-month functional outcome compared to women (68.6% vs. 61.2%, p = 0.04), but was not statistically significant after adjusting for confounders. Conclusion: Our data, from a single comprehensive stroke unit from South India, suggest that stroke in women are different, yet similar in many ways to men. Guideline-based treatment can result in comparable short-term outcomes, irrespective of admission stroke severity.

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

Stroke ◽

10.1161/str.51.suppl_1.wp91 ◽

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.

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Study of Short Latency Somatosensory and Brain Stem Auditory Evoked Potentials Patients with Acute Ischemic Stroke Involving Middle Cerebral Artery Territory

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1727558 ◽

2021 ◽

Author(s):

Abhishek Miryala ◽

Mahendra Javali ◽

Anish Mehta ◽

Pradeep R. ◽

Purushottam Acharya ◽

...

Keyword(s):

Ischemic Stroke ◽

Evoked Potentials ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Brain Stem ◽

Functional Outcome ◽

Cerebral Artery ◽

Negative Correlation ◽

Auditory Evoked Potentials ◽

Positive Correlation

Abstract Background The precise timings of evoked potentials in evaluating the functional outcome of stroke have remained indistinct. Few studies in the Indian context have studied the outcome of early prognosis of stroke utilizing evoked potentials. Objective The aim of this study was to determine somatosensory evoked potentials (SSEPs) and brain stem auditory evoked potentials (BAEPs), their timing and abnormalities in acute ischemic stroke involving the middle cerebral artery (MCA) territory and to correlate SSEP and BAEP with the functional outcome (National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS) and Barthel’s index) at 3 months. Methods MCA territory involved acute ischemic stroke patients (n = 30) presenting consecutively to the hospital within 3 days of symptoms onset were included. Details about clinical symptoms, neurological examination, treatment, NIHSS score, mRS scores were collected at the time of admission. All patients underwent imaging of the brain and were subjected to SSEP and BAEP on two occasions, first at 1 to 3 days and second at 4 to 7 days from the onset of stroke. At 3 months of follow-up, NIHSS, mRS, and Barthel’s index were recorded. Results P37 and N20 amplitude had a strong negative correlation (at 1–3 and 4–7 days) with NIHSS at admission, NIHSS at 3 months, mRS at admission, and mRS at 3 months and a significant positive correlation with Barthel’s index (p < 0.0001). BAEP wave V had a negative correlation (at 1–3 and 4–7 days) with NIHSS at admission, NIHSS at 3 months, mRS at admission, and mRS at 3 months and a positive correlation with Barthel’s index (p < 0.0001). Conclusion SSEP abnormalities recorded on days 4 to 7 from onset of stroke are more significant than those recorded within 1 to 3 days of onset of stroke; hence, the timing of 4 to 7 days after stroke onset can be considered as better for predicting functional outcome.

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Eosinophil-to-monocyte ratio is a potential biomarker in the prediction of functional outcome among patients with acute ischemic stroke

BMC Neuroscience ◽

10.1186/s12868-021-00610-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Shuhong Yu ◽

Yi Luo ◽

Tan Zhang ◽

Chenrong Huang ◽

Yu Fu ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Odds Ratio ◽

Poor Outcome ◽

Net Reclassification Improvement ◽

Potential Biomarker ◽

The Impact ◽

The Relationship ◽

Integrated Discrimination Improvement

Abstract Background It has been shown that eosinophils are decreased and monocytes are elevated in patients with acute ischemic stroke (AIS), but the impact of eosinophil-to-monocyte ratio (EMR) on clinical outcomes among AIS patients remains unclear. We aimed to determine the relationship between EMR on admission and 3-month poor functional outcome in AIS patients. Methods A total of 521 consecutive patients admitted to our hospital within 24 h after onset of AIS were prospectively enrolled and categorized in terms of quartiles of EMR on admission between August 2016 and September 2018. The endpoint was the poor outcome defined as modified Rankin Scale score of 3 to 6 at month 3 after admission. Results As EMR decreased, the risk of poor outcome increased (p < 0.001). Logistic regression analysis revealed that EMR was independently associated with poor outcome after adjusting potential confounders (odds ratio, 0.09; 95% CI 0.03–0.34; p = 0.0003), which is consistent with the result of EMR (quartile) as a categorical variable (odds ratio, 0.23; 95% CI 0.10–0.52; ptrend < 0.0001). A non-linear relationship was detected between EMR and poor outcome, whose point was 0.28. Subgroup analyses further confirmed these associations. The addition of EMR to conventional risk factors improved the predictive power for poor outcome (net reclassification improvement: 2.61%, p = 0.382; integrated discrimination improvement: 2.41%, p < 0.001). Conclusions EMR on admission was independently correlated with poor outcome in AIS patients, suggesting that EMR may be a potential prognostic biomarker for AIS.

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Neopterin as a Predictor of Functional Outcome and Mortality in Chinese Patients with Acute Ischemic Stroke

Molecular Neurobiology ◽

10.1007/s12035-015-9310-3 ◽

2015 ◽

Vol 53 (6) ◽

pp. 3939-3947 ◽

Cited By ~ 10

Author(s):

Xianwei Zeng ◽

Guoqing Zhang ◽

Bin Yang ◽

Bo Zhang ◽

Linpeng Zhang ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Chinese Patients

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Pre-Stroke Cholinesterase Inhibitor Treatment Is Beneficially Associated with Functional Outcome in Patients with Acute Ischemic Stroke and Pre-Stroke Dementia: The Fukuoka Stroke Registry

Cerebrovascular Diseases ◽

10.1159/000514368 ◽

2021 ◽

pp. 1-7

Author(s):

Yoshinobu Wakisaka ◽

Ryu Matsuo ◽

Kuniyuki Nakamura ◽

Tetsuro Ago ◽

Masahiro Kamouchi ◽

...

Keyword(s):

Cohort Study ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Neurological Deterioration ◽

Stroke Outcome ◽

Matched Cohort ◽

Poor Functional Outcome ◽

Stroke Registry ◽

Chei Treatment

Introduction: Pre-stroke dementia is significantly associated with poor stroke outcome. Cholinesterase inhibitors (ChEIs) might reduce the risk of stroke in patients with dementia. However, the association between pre-stroke ChEI treatment and stroke outcome remains unresolved. Therefore, we aimed to determine this association in patients with acute ischemic stroke and pre-stroke dementia. Methods: We enrolled 805 patients with pre-stroke dementia among 13,167 with ischemic stroke within 7 days of onset who were registered in the Fukuoka Stroke Registry between June 2007 and May 2019 and were independent in basic activities of daily living (ADLs) before admission. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale [mRS] score: 3–6) at 3 months after stroke onset and neurological deterioration (≥2-point increase in the NIH Stroke Scale [NIHSS] during hospitalization), respectively. Logistic regression analysis was used to evaluate associations between pre-stroke ChEI treatment and study outcomes. To improve covariate imbalance, we further conducted a propensity score (PS)-matched cohort study. Results: Among the participants, 212 (26.3%) had pre-stroke ChEI treatment. Treatment was negatively associated with poor functional outcome (odds ratio: 0.68 [95% confidence interval: 0.46–0.99]) and neurological deterioration (0.52 [0.31–0.88]) after adjusting for potential confounding factors. In the PS-matched cohort study, the same trends were observed between pre-stroke ChEI treatment and poor functional outcome (0.61 [0.40–0.92]) and between the treatment and neurological deterioration (0.47 [0.25–0.86]). Conclusions: Our findings suggest that pre-stroke ChEI treatment is associated with reduced risks for poor functional outcome and neurological deterioration after acute ischemic stroke in patients with pre-stroke dementia who are independent in basic ADLs before the onset of stroke.

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Efficacy and Safety of Intravenous rtPA in Ischemic Strokes Due to Small-Vessel Occlusion: Systematic Review and Meta-Analysis

Translational Stroke Research ◽

10.1007/s12975-021-00890-9 ◽

2021 ◽

Author(s):

Bartosz Karaszewski ◽

Adam Wyszomirski ◽

Bartosz Jabłoński ◽

David J. Werring ◽

Dominika Tomaka

Keyword(s):

Clinical Trials ◽

Ischemic Stroke ◽

Randomized Clinical Trials ◽

Small Vessel Disease ◽

Small Vessel ◽

Efficacy And Safety ◽

Eligibility Criteria ◽

Vessel Occlusion ◽

Excellent Outcome ◽

Symptomatic Intracerebral Hemorrhage

AbstractIntravenous recombinant tissue plasminogen activator (iv-rtPA) has been routinely used to treat ischemic stroke for 25 years, following large clinical trials. However, there are few prospective studies on the efficacy and safety of this therapy in strokes attributed to cerebral small vessel disease (SVD). We evaluated functional outcome (modified Rankin scale, mRS) and symptomatic intracerebral hemorrhage (sICH) using all available data on the effects of iv-rtPA in SVD-related ischemic stroke (defined either using neuroimaging, clinical features, or both). Using fixed-effect and random-effects models, we calculated the pooled effect estimates with regard to excellent and favorable outcomes (mRS=0–1 and 0–2 respectively, at 3 months), and the rate of sICH. Twenty-three studies fulfilled the eligibility criteria, 11 of which were comparative, and there were only 3 randomized clinical trials. In adjusted analyses, there was an increased odds of excellent outcome (adjusted OR=1.53, 95% CI: 1.29–1.82, I2: 0%) or favorable outcome (adjusted OR=1.68, 95% CI: 1.31–2.15,I2: 0%) in patients who received iv-rtPA compared with placebo. Across the six studies which reported it, the incidence of sICH was higher in the treatment group (M-H RR = 8.83, 95% CI: 2.76–28.27). The pooled rate of sICH in patients with SVD administered iv-rtPA was only 0.72% (95% CI: 0.12%–1.64%). We conclude that when ischemic stroke attributed to SVD is considered separately, available data on the effects of iv-rtPA therapy are insufficient for the highest level of recommendation, but it seems to be safe. Although further therapeutic trials in SVD-related ischemic stroke appear to be justified, our findings should not prevent its continued use for this group of patients in clinical practice.

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