scholarly journals Clinical and radiological factors predict unexplained early neurological deterioration after intravenous thrombolysis in patients with acute middle cerebral artery stroke

2019 ◽  
Author(s):  
Yiping Ding ◽  
Tong Sun ◽  
Yue Lu ◽  
Shuangjiao Huang ◽  
Shanshan Diao ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Middle Cerebral Artery Stroke ◽  
Proximal Occlusion ◽  
Multimodal Ct

Abstract Background Some patients with acute middle cerebral artery stroke (MCA-stroke) cannot benefit from thrombolysis and develop early neurological deterioration (END) within 24 hours. Except for several defenitive causes such as symptomatic intracerebral hemorrhage, malignant edema, and early recurrent stroke, no definitive mechanism (unexplained END) account for majority of END cases deserving our attention. Methods We retrospectively collected 142 MCA-stroke patients who had pretreatment multimodal CT including non-contrast CT (NCCT), CT angiography (CTA) and CT perfusion (CTP) and received intravenous thrombolytic therapy within 4.5h of onset and. Unexplained END was denited as NIHSS scores increased from baseline within 24 hours after thrombolysis ≥ 4 points or death without definite causes. The clinical and imaging data based on multimodal CT were compared between unexplained END and no END through univariate and multivariate regression analyses. Results The prevalence of unexplained END (24 patients, 16.9%) outnumbered the prevalence of END due to other causes. Univariate analysis showed that higher admission glucose (P= 0.039), lower initial NIHSS score (P=0.026), lower r-LMC score (P= 0.003), proximal occlusion (P=0.003) and large penumbra volume(P<0.001) were more frequently observed in patients with unexplained END; In multivariate analysis, lower NIHSS score (OR=1.19; 95% CI, 1.07-1.32; P=0.001), proximal occlusion (OR=0.32; 95% CI, 0.06-0.92; P=0.038), lower r-LMC score (OR=1.17; 95% CI, 1.02-1.35; P=0.028) and larger penumbra volume (OR=0.98; 95% CI, 0.96-0.99; P=0.003) were associated with unexplained END. Conclusion Lower NIHSS score, proximal occlusion, lower r-LMC score and larger penumbra volume can predict unexplained END in the hyperacute phase of MCA-stroke and contribute to develop treatment strategies.

Hypoperfusion in lenticulostriate arteries territory related to unexplained early neurological deterioration after intravenous thrombolysis

2019 ◽  
Vol 14 (3) ◽  
pp. 306-309 ◽  
Author(s):  
Ying Zhou ◽  
Wansi Zhong ◽  
Anli Wang ◽  
Wanyun Huang ◽  
Shenqiang Yan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Terminal Branch ◽  
Stroke Patients ◽  
Lenticulostriate Arteries ◽  
Early Neurological Deterioration

Background Early neurological deterioration occurs in approximately 10% acute ischemic stroke patients after thrombolysis. Over half of the early neurological deterioration occurred without known causes and is called unexplained early neurological deterioration. Aims We aimed to explore the development of early neurological deterioration at 24 h after thrombolysis, and whether it could be predicted by the presence of baseline hypoperfusion in lenticulostriate arteries territory in acute ischemic stroke patients. Methods We retrospectively reviewed our prospectively collected database of acute ischemic stroke patients in the unilateral middle cerebral artery territory who had baseline perfusion image and received thrombolysis. Unexplained early neurological deterioration was defined as ≥ 2 points increase of National Institutes of Health Stroke Scale (NIHSS) from baseline to 24 h, without known causes. Hypoperfusion lesions in different territories were identified on perfusion maps. Results A total of 306 patients were included in analysis. Patients with pure lenticulostriate arteries hypoperfusion (defined as the presence of hypoperfusion in lenticulostriate artery territory, but not in middle cerebral artery terminal branch territory) were more likely to have unexplained early neurological deterioration than others (27.6% vs. 6.1%; OR, 5.974; p = 0.001), after adjusting for age, baseline NIHSS and onset to treatment time. Conclusions Patients presenting hypoperfusion in pure lenticulostriate arteries territory were easier to experience unexplained early neurological deterioration.

scholarly journals Compressed Sensing Algorithm-Based Magnetic Resonance Imaging Guided for Prognosis of Early Neurological Deterioration after Intravenous Thrombolysis in Ischemic Stroke Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yiwei Huang ◽  
Xiaoyun Sun ◽  
Yinping Yao ◽  
Yejun Chen ◽  
Yan Chen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Resonance Imaging ◽  
Blood Cell Count ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Watershed Infarction

This work was aimed to study the risk factors and prognostic treatment for acute ischemic stroke (AIS) patients with early neurological deterioration (END) after intravenous thrombolytic therapy via compressed sensing algorithm-based magnetic resonance imaging (CS-MRI). 231 patients who were diagnosed with AIS were selected, and the final involved number of patients was 182. Patients with AIS were treated with intravenous thrombolysis with alteplase within 4.5 hours of onset. After treatment, patients with early neurological deterioration were defined as the deteriorating group and those without early neurological impairment were defined as the nondeteriorating group. In univariate analysis, hypertension, white blood cell count, and National Institutes of Health Stroke Scale (NIHSS) score were correlated with the occurrence of END. Under the CS-MRI theory, the two groups of patients were evaluated for middle cerebral artery basal ganglia infarction and internal watershed infarction. After univariate analysis, the P < 0.1 variables were taken as the independent variable, and the binary logistic regression model was adopted for multivariate regression analysis. It was disclosed that NIHSS score was not correlated with the occurrence of early neurological function deterioration, while homocysteine was. Hypertension, white blood cell count, homocysteine, and NIHSS score were risk factors for END. The image analysis revealed that the incidence of deteriorating basal ganglia infarction group was lower relative to the nondeteriorating group, and the incidence of watershed infarction was higher in the deteriorating group versus the nondeteriorating group. The image analysis suggested that predicting the occurrence of END through risk factors can actively provide endovascular treatment for patients with AIS.

Impact of Brain Atrophy on Early Neurological Deterioration and Outcome in Severe Ischemic Stroke Treated by Intravenous Thrombolysis

2018 ◽  
Vol 79 (5-6) ◽  
pp. 240-246 ◽  
Author(s):  
Olivier Tschirret ◽  
Gabriela Moreno Legast ◽  
Adeline Mansuy ◽  
Nathan Mewton ◽  
Marielle Buisson ◽  
...  
Keyword(s):  
Brain Atrophy ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
National Institutes Of Health ◽  
Neurological Deterioration ◽  
Good Outcome ◽  
Early Neurological Deterioration ◽  
Backward Procedure ◽  
Proximal Occlusion

Background: Brain atrophy has shown a protective effect on the risk of early neurological deterioration (END) related to malignant edema in patients with hemispheric infarction but could be deleterious on the outcome. Aims: We aimed to assess whether brain atrophy has an impact on the risk of END and on the outcome in severe ischemic strokes after intravenous (IV) thrombolysis. Methods: From a prospective thrombolysis registry, 137 patients who had a National Institutes of Health Stroke Scale (NIHSS) ≥15, MRI at admission, and IV thrombolysis were included. Relative cerebral volume was calculated. END was defined as a ≥2-points deterioration 72-h NIHSS and a good outcome as a modified Rankin Scale (mRS) ≤2 at 3 months. A multiple logistic regression analysis with a stepwise backward procedure was performed. Results: END and a good outcome were observed, respectively, in 20 (14.6%) and 48 (37.5%) patients. In univariate analysis, predictors of END included age (p = 0.049), diabetes (p = 0.041), and parenchymal hemorrhage (p = 0.039). In multivariate analysis, age (p = 0.018) was significantly associated with END. Brain atrophy was not associated with END even in subgroup analysis according to the baseline infarct size. In univariate analysis, age (p = 0.003), prestroke mRS (p = 0.002), hypertension (p = 0.006), baseline NIHSS (p = 0.002), END (p = 0.002), proximal occlusion (p = 0.006), and recanalization at 24 h (p < 0.001) were associated with a good outcome. Only baseline NIHSS (p = 0.006) was associated with a good outcome after adjustment. Conclusions: We did not find any impact of brain atrophy on the risk of END and the outcome at 3 months in severe ischemic strokes after IV thrombolysis.

Abstract 101: Predictors of Early Neurological Deterioration in Minor Strokes With Large Vessel Occlusion Treated With Intravenous Thrombolysis. A French Multicentric Observational Study (MINOR-STROKE)

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Pierre Seners ◽  
Claire Perrin ◽  
Guillaume Turc
Keyword(s):  
Basilar Artery ◽  
Multivariable Analysis ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Large Vessel ◽  
Minor Stroke ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Early Neurological Deterioration ◽  
Proximal Occlusion

Introduction: Whether thrombectomy added on intravenous thrombolysis (IVT), as compared to IVT alone, is beneficial in minor strokes with large vessel occlusion (LVO) is unknown. To identify predictors of early neurological deterioration (END) following IVT alone may help to select the best candidates for additional thrombectomy. Methods: MINOR-STROKE was a multicentric retrospective registry collecting data of IVT-treated minor strokes (NIHSS≤5) with LVO (internal carotid artery [ICA], M1, M2 or basilar artery; with central reading) treated with or without additional thrombectomy in 45 French stroke units. The patients initially intended for IVT alone, including those who eventually received thrombectomy due to END, were included in the present analysis. END was defined as a ≥4 points on NIHSS within 24hrs following admission. Thrombus length was measured centrally either on T2*-MRI, CT (hyperdense middle cerebral artery) or CT-angiography. Results: Overall, 799 patients were included: mean age 69 years, median NIHSS 3, occlusion located in ICA±M1/M2, proximal M1, distal M1, M2, or basilar artery in 20%, 7%, 19%, 50% and 4% of patients, respectively. Thrombus was visible in 78% of patients (median length 9mm, IQR 6-12mm). END occurred in 15% of patients and was associated with poor 3-month functional outcome (mRS>2: 55% vs. 12% of patients with and without END, respectively). Only 15% of ENDs were due to intracranial haemorrhage. In multivariable analysis, a more proximal occlusion site (M2 [reference], distal M1: OR 2.1 [IC95% 1.1-4.1], proximal M1: OR 3.8 [1.6-9.1], ICA±M1/M2: OR 5.0 [2.6-9.6], basilar artery: OR 4.9 [1.1-4.1]; P <0.001) and a longer thrombus (<6mm [reference], [6-9mm[: OR 1.3 [IC95% 0.6-2.9], [9-12mm[: OR 1.8 [0.8-3.9] and ≥12mm: OR 2.7 [1.3-5.6]; P =0.036) were independently associated with END. END occurred in 33%, 19%, 14%, 7% and 27% of patients with ICA±M1/M2, M1 proximal, M1 distal, M2 and basilar artery, respectively, and in 8%, 10%, 14% et 23% of patients with thrombus length of <6, [6-9[, [9-12[ and ≥12mm, respectively. Conclusion: Our study suggests that thrombus location and length are strong predictors of END in minor strokes with LVO. This may help to select the best candidates for additional endovascular therapy.

scholarly journals Length of Occlusion Predicts Recanalization and Outcome After Intravenous Thrombolysis in Middle Cerebral Artery Stroke

Stroke ◽  
2014 ◽  
Vol 45 (7) ◽  
pp. 2010-2017 ◽  
Author(s):  
Vladimir Rohan ◽  
Jan Baxa ◽  
Radek Tupy ◽  
Lenka Cerna ◽  
Petr Sevcik ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intravenous Thrombolysis ◽  
Middle Cerebral Artery Stroke

Multimodal CT: Favorable Outcome Factors in Acute Middle Cerebral Artery Stroke with Large Artery Occlusion

2013 ◽  
Vol 69 (6) ◽  
pp. 366-374 ◽  
Author(s):  
Joon Hwa Lee ◽  
Young Jin Kim ◽  
Jin Woo Choi ◽  
Hong Gee Roh ◽  
Young Il Chun ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Large Artery ◽  
Middle Cerebral Artery Stroke ◽  
Multimodal Ct

scholarly journals Does the side of middle cerebral artery compromise matters in the mortality after thrombolysis in ischemic stroke?

2015 ◽  
Vol 73 (8) ◽  
pp. 644-647 ◽  
Author(s):  
Renata Dal-Prá Ducci ◽  
Marcos Christiano Lange ◽  
Carla Heloísa Moro ◽  
Rodrigo Harger ◽  
Alexandre Luiz Longo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
Left Middle Cerebral Artery ◽  
Affected Side ◽  
The Impact ◽  
Left Middle

The impact of the side in middle cerebral artery (MCA) ischemic stroke is not well established. Our aim was to analyze the differences between right (RMCA) and left middle cerebral artery (LMCA) stroke in patients submitted to intravenous thrombolysis and the influence of the affected side in the patient’s mortality after 3 months. Method Patients with MCA ischemic stroke submitted to intravenous thrombolysis from March 2010 to December 2011 at two Brazilian Stroke Centers were included. Differences between patients with RMCA and LMCA stroke were identified by univariate analysis. Results Forty-five patients with RMCA stroke and 67 with LMCA stroke were analyzed. Patients with LMCA had a higher incidence of atrial fibrillation (p = 0.031), although patients with RMCA more often had a previous ischemic stroke (p = 0.034). The mortality over 3 months was similar for either side (OR = 1.20 ;0.37 - 4.29, p = 0.772). Conclusion The side of the MCA ischemic stroke did not influence the patients mortality.

scholarly journals Risk Assessment of Hemorrhagic Transformation of Acute Middle Cerebral Artery Stroke Using Multimodal CT

2010 ◽  
Vol 22 (2) ◽  
pp. 160-166 ◽  
Author(s):  
Ke Lin ◽  
Walter E. Zink ◽  
A. John Tsiouris ◽  
Majnu John ◽  
Leena Tekchandani ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Hemorrhagic Transformation ◽  
Middle Cerebral Artery Stroke ◽  
Multimodal Ct

scholarly journals Pathophysiology of acute middle cerebral artery infarct by multimodal computed tomography: A pilot study in Thai patients

2015 ◽  
Vol 6 (01) ◽  
pp. 059-064 ◽  
Author(s):  
Pornpatr A. Dharmasaroja ◽  
Arvemas Watcharakorn ◽  
Utairat Chaumrattanakul
Keyword(s):  
Computed Tomography ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Anterior Circulation ◽  
Severe Stroke ◽  
Middle Cerebral Artery Infarct ◽  
Multimodal Ct

ABSTRACTMultimodal computed tomography, including non-contrast computed tomography (CT), computed tomography perfusion (CTP) and computed tomography angiography (CTA), has been increasingly used. Aims: The purpose of this study was to study pathophysiology of acute middle cerebral artery infarct using multimodal CT and to evaluate the safety and feasibility of this method in our center. Materials and Methods: Patients who had moderate to severe stroke (NIHSS score > 10), suspected of anterior circulation infarct and presented within 4 hours after stroke onset were prospectively included. Multimodal CTs, using low-osmolar contrast agents, were performed in all patients. Results: Twenty-two patients were included. Mean NIHSS was 16. All patients received intravenous thrombolysis. Favorable outcome was found in nine patients (41%). CTP was unable to identify ischemic lesions in three patients with small subcortical infarct. Most patients (82%) with large middle cerebral artery infarct still had some salvageable brain (penumbra) which partly recovered in a follow-up imaging. Eleven patients (50%) had major artery occlusion. Two patients had creatinine rising within 72 hours. Conclusions: Multimodal CT does provide information about status of major artery and the volume of salvageable/infarct brain tissue and is safely and easily applicable in our center.

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