scholarly journals Agreement of novel hemodynamic imaging parameters for the acute and chronic stages of ischemic stroke: a matched-pair cohort study

2021 ◽  
Vol 51 (1) ◽  
pp. E12
Author(s):  
Martina Sebök ◽  
Christiaan Hendrik Bas van Niftrik ◽  
Susanne Wegener ◽  
Andreas Luft ◽  
Luca Regli ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Flow Velocity ◽  
Cerebral Artery ◽  
Blood Oxygenation ◽  
Matched Pair ◽  
Imaging Parameters ◽  
Study Results ◽  
Significant Difference ◽  
Ischemic Events

OBJECTIVE In symptomatic patients with cerebrovascular steno-occlusive disease, impaired blood oxygenation level–dependent cerebrovascular reactivity (BOLD-CVR) and increased flow velocity of the P2 segment of the posterior cerebral artery (PCA-P2) on transcranial Doppler (TCD) ultrasonography have been introduced as emerging clinical imaging parameters to identify patients at high risk for recurrent ischemic events. Since hemodynamic physiology differs between the acute and chronic stages of ischemic stroke, the authors sought to investigate whether those parameters have merit for both the acute and chronic stages of ischemic stroke. METHODS From a prospective database, patients who underwent BOLD-CVR and TCD examinations in the acute stroke stage (< 10 days) were matched to patients in the chronic stroke stage (> 3 months). A linear regression analysis for both groups was performed between ipsilateral PCA-P2 systolic flow velocity and BOLD-CVR of the ipsilateral (affected) hemisphere, the ipsilateral middle cerebral artery (MCA) territory, and the ipsilateral steal volume (i.e., paradoxical BOLD-CVR response). The resulting slopes and intercepts were statistically compared to evaluate differences between groups. RESULTS Forty matched patient pairs were included. Regression analysis showed no significant difference for either the intercept (p = 0.84) or the slope (p = 0.85) between PCA-P2 flow velocity and BOLD-CVR as measured for the ipsilateral (affected) hemisphere. Similarly, no significant difference was seen between PCA-P2 flow velocity and BOLD-CVR of the ipsilateral MCA territory (intercept, p = 0.72; slope, p = 0.36) or between PCA-P2 flow velocity and steal volume (intercept, p = 0.59; slope, p = 0.34). CONCLUSIONS The study results indicated that the relationship between ipsilateral PCA-P2 systolic flow velocity and BOLD-CVR remains the same during the acute and chronic stages of ischemic stroke. This provides further support that these novel hemodynamic imaging parameters may have merit to assess the risk for recurrent ischemic events for a wide ischemic stroke population. PCA-P2 systolic flow velocity, in particular, may be a highly practical screening tool, independent of ischemic stroke stage.

Risk Factors of Recurrent Ischemic Events after Acute Noncardiogenic Ischemic Stroke

2020 ◽  
Vol 25 (45) ◽  
pp. 4827-4834 ◽  
Author(s):  
Limin Zhang ◽  
Xingang Li ◽  
Dongzhi Wang ◽  
Hong Lv ◽  
Xuezhong Si ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Operating Characteristic ◽  
Control Group ◽  
Case Group ◽  
Stroke Patients ◽  
Clopidogrel Therapy ◽  
Ischemic Events

Background: A considerable proportion of acute noncardiogenic ischemic stroke patients continue to experience recurrent ischemic events after standard therapy. Aim: We aimed to identify risk factors for recurrent ischemic event prediction at an early stage. Methods : 286 non-cardioembolic ischemic stroke patients with the onset of symptoms within 24 hours were enrolled. Vascular risk factors, routine laboratory data on admission, thromboelastography test seven days after clopidogrel therapy and any recurrent events within one year were assessed. Patients were divided into case group (patients with clinical adverse events, including ischemic stokes, transient ischemic attack, myocardial infarction and vascular related mortality) and control group (events-free patients). The risk of the recurrent ischemic events was determined by the receiver operating characteristic curve and multivariable logistic regression analysis. Results: Clinical adverse events were observed in 43 patients (case group). The mean levels of Mean Platelet Volume (MPV), Platelet/Lymphocyte Ratio (PLR), Lymphocyte Count (LY) and Fibrinogen (Fib) on admission were significantly higher in the case group as compared to the control group (P<0.001). Seven days after clopidogrel therapy, the ADP-induced platelet inhibition rate (ADP%) level was lower in the case group, while the Maximum Amplitude (MA) level was higher in the case group as compared to the control group (P<0.01). The Area Under the Curve (AUC) of receiver operating characteristic(ROC) curve of LY, PLR, , Fib, MA, ADP% and MPV were 0.602, 0.614, 0.629, 0.770, 0.800 and 0.808, respectively. The logistic regression analysis showed that MPV, ADP% and MA were indeed predictive factors. Conclusion: MPV, ADP% and MA were risk factors of recurrent ischemic events after acute noncardiogenic ischemic stroke. Urgent assessment and individual drug therapy should be offered to these patients as soon as possible.

scholarly journals Doppler Flow Velocity Indices (RI, PI, S/D & PSV) of Fetal Middle Cerebral Artery in Normal Pregnancies: Correlation with Gestational Age of 20 to 40 Weeks

2012 ◽  
Vol 2 (2) ◽  
pp. 77-80
Author(s):  
Md Abu Taher ◽  
Nuzhat Tasmin ◽  
AS Mohiuddin ◽  
Md Mohit Ul Alam ◽  
Md Mofazzal Sharif ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Cerebral Artery ◽  
Gestational Age ◽  
Resistance Index ◽  
Peak Systolic Velocity ◽  
Doppler Flow ◽  
Significant Difference ◽  
Before And After ◽  
Doppler Indices

This observational type of descriptive study was carried out in the Department of Radiology and Imaging, BIRDEM selecting 70 Bangladeshi pregnant babies with the aim to find out the normogram of foetal middle cerebral artery Doppler flow velocity indices and correlation between Doppler flow velocity indices [Resistance Index (RI), Pulsatility Index (PI), Systolic/Diastolic ratio (S/D) & Peak Systolic Velocity (PSV)] of foetal middle cerebral artery and gestational age in normal pregnancies of 20 to 40 weeks. It was observed that RI, PI and S/D were decreased with the advance of gestational age but PSV was increases with the advance of gestational age. Statistical analyses showed there were significant difference between mean PSV, RI and PI before and after 25 weeks of gestation. No significant difference was found between mean S/D before and after 25 weeks of gestation. It was observed from Correlation analysis between Doppler indices with independent gestational age that all the Doppler indices of foetal middle cerebra artery was positively correlated with the whole gestation period. The statistical analysis showed only PSV and RI were significantly correlated with the gestational age. Simple regression analysis between dependent Doppler index with independent gestational age before and after 25 weeks revealed that all the Doppler indices had positive relationship with the corresponding gestational age but relationship between PSV and PI (before 25 weeks) with their corresponding gestational ages were only statistically significant.DOI: http://dx.doi.org/10.3329/birdem.v2i2.12306 Birdem Med J 2012; 2(2) 77-80

Abstract WP1: Thrombectomy Outcomes in Acute Ischemic Stroke due to Middle Cerebral Artery M2 Occlusion with Stent-Retriever, Aspiration, MERCI: Multi-Center Experience

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kunakorn Atchaneeyasakul ◽  
Amer M Malik ◽  
Dileep R Yavagal ◽  
Mehdi Bouslama ◽  
Diogo C Haussen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Tertiary Care ◽  
Stent Retriever ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference

Introduction: Recent trials demonstrated that mechanical thrombectomy improve functional outcome in anterior circulation acute ischemic stroke (AIS) due to emergent large vessel occlusion (ELVO) of the middle cerebral artery (MCA) M1 segment. However, such data regarding AIS due to MCA M2 segment ELVO is limited. Analysis of the STAR, SWIFT, and SWIFT-PRIME trials found thrombectomy in MCA M2 occlusion to be feasible in achieving successful reperfusion. The most optimal technique and/or device used for such reperfusion is not clearly defined. We aim to compare the outcome for the contemporary techniques and devices used for thrombectomy of AIS patients due to MCA M2 ELVO. Methods: A retrospective review of AIS patients with MCA M2 ELVO receiving thrombectomy from three tertiary care academic medical centers was conducted. Thrombectomy technique and thrombectomy device utilized were recorded. Outcomes were successful angiographic reperfusion (TICI ≥2b), favorable modified Rankin Scale (mRS≤2) at discharge and at 90 days, and rate of symptomatic intracerebral hemorrhage (sICH). Results: From October 1999 through June 2016, 253 AIS patients underwent thrombectomy for MCA M2 ELVO. Thrombectomy methods utilized were Stent-retriever (n=118), Aspiration only [manual or Penumbra device] (n=83), and MERCI retriever (n=52). Table 1 shows rate of outcomes measured. There was no difference in baseline NIHSS or in stroke onset to groin puncture time. Stent-retriever group showed a significantly higher recanalization rate, lower sICH rate, and favorable 90-day mRS versus Aspiration group or MERCI group, respectively. No significant difference was seen in discharge mRS between the groups. Conclusions: Thrombectomy for AIS patients with MCA M2 ELVO with Stent-retriever appears to be feasible with a significantly higher rate of recanalization, lower sICH rate, and favorable 90-day mRS when compared to Aspiration and MERCI.

scholarly journals Current data about localization of acute ischemic stroke and prognostic factors in diabetic and non-diabetic patients

2021 ◽  
Vol 16 (2) ◽  
pp. 215-224
Author(s):  
Nicolae Ovidiu POP ◽  
◽  
Petru Aurel BABEȘ ◽  
Larisa Bianca HOLHOȘ ◽  
Eugenia GAVRILUȚ ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Current Data ◽  
Diabetic Patients ◽  
Established Risk Factor ◽  
Significant Difference ◽  
Elevated Cholesterol ◽  
Prospective Longitudinal

Introduction. Ischemic stroke accounts for approximately 85% of all vascular accidents and has a high number of identified risk factors, including transient ischemic attack, smoking, metabolic syndrome, alcohol consumption, elevated cholesterol levels and artery stenosis carotid. Diabetes mellitus (DM) is a well-established risk factor for ischemic stroke. Material and method. This prospective longitudinal observational study highlights the importance of localization of ischemic stroke, including 340 patients with acute ischemic stroke with / without diabetes mellitus. The database was collected in a Microsoft Excel document. The correlation analysis was processed in the MedCalc 14.1 program where correlation tests included in the program were used. Results. The predominant localization of ischemic stroke in diabetic patients was the middle cerebral artery followed by the posterior cerebral artery and the double localization compared to the group witness where the same trend is maintained (p = 0.22). The correlation between the localization of the acute ischemic stroke with the age 64.5 for MCA, 64.6 for PCA, and 73.57 for DL (CI 95%, p= 0.02). The correlation of the NIHSS severity score with the location of ischemic strokes was also obtained: average NIHSS score 18.9 points for MCA, 18.5 for PCA, 24 for DL (CI 95, p < 0.0001). The data obtained from the Kaplan-Meier analysis on the survival rate of the patients (divided by the vascular territory involved), provided an expected result difference (statistically significant, p < 0.0001). Conclusions. There is no statistically significant difference between diabetic vs. non-diabetic patients regarding the localization correlated with DM, the double location being statistically insignificant between the two batches. The double location having a higher frequency in elderly patients.

Abstract W P217: The Impaired Leptomeningeal Collateral Flow Recruitment in the Type II Diabetic Mice is Independent of Hyperglycemia

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Yosuke Akamatsu ◽  
Chih Cheng Lee ◽  
Jialing Liu
Keyword(s):  
Flow Velocity ◽  
Cerebral Artery ◽  
Flow Direction ◽  
Vessel Diameter ◽  
Vascular Pathology ◽  
Collateral Flow ◽  
Type Ii ◽  
Diabetic Mice ◽  
Vascular Networks ◽  
Significant Difference

Introduction: Previously we found that type II diabetic mice db/db strain exhibited impaired collateral flow recruitment between the middle cerebral artery (MCA) and anterior cerebral artery (ACA) vascular networks during MCA occlusion (MCAO)contributed to the worse stroke outcome when compared to their normoglycemic strain. However, it is unclear whether the underlying etiology in the diabetic stroke mice is attributed to hyperglycemia or other vascular pathology. Methods: Adult male db/+ received intraperitoneal injection of dextrose (HG) or normal saline (NG) (n=5-6/group), respectively, 60 minutes prior to distal MCAO. Doppler optical coherence tomography (DOCT) was used to quantify the MCA flow direction and velocity at baseline and 30 min after MCAO. The chosen regions of interest of MCA network were classified according to branching order as segment 1 (seg1), seg2 and seg3, with seg1 most proximal to ACA while most distal to MCA. 5-10 points corresponding to the same location of each segment were selected for quantification. Results: Blood glucose level was maintained at approximately 382± 83.8 mg/dl in the HG group during blood flow imaging, compared to 166± 60.1 mg/ml in the NG group. It fell to 141± 36.3 mg/dl and 142± 46.3 mg/dl at 24h after stroke in both groups. Hyperglycemia didn't change baseline flow velocity (NG: 6.8±0.8/9.2±0.7/12.5±0.5mm in seg1/seg2/seg3; HG: 5.7±0.7/8.2±0.5/12.6±0.9 mm/s, NS in all segments). At 30 min after MCAO, collateral flow was induced in both groups and there was no significant difference in flow velocity between groups (NG: -3.8±0.3/-2.7±0.1/-2.7±0.3mm/s; HG: -4.1±0.2/-3.1±0.3/2.2±0.4mm/s, NS in all segments). There was also no significant difference in vessel diameter between the groups both at baseline (NG: 48.9±3.5/55.1±1.6/61.5±2.7μm; HG: 45.6±1.7/48.8±2.7/59.2±2.7μm, NS in all segments) and 30 min after MCAO (NG: 48.4±2.0/50.8±2.6/55.5±2.6μm, HG: 42.6±2.3/49.9±2.0/52.5±2.6 μm in HG, NS in all segments). Conclusions: Temporary induction of hyperglycemia doesn't affect collateral flow in normoglycemic mice during acute stroke, suggesting that the observed impairment of collateral flow recruitment in the type II diabetic mice is likely attributed to chronic vascular pathology.

Mechanical thrombectomy for acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: a meta-analysis

2017 ◽  
Vol 10 (7) ◽  
pp. 620-624 ◽  
Author(s):  
Hamidreza Saber ◽  
Sandra Narayanan ◽  
Mohan Palla ◽  
Jeffrey L Saver ◽  
Raul G Nogueira ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Functional Independence ◽  
Vessel Occlusion ◽  
Increased Risk ◽  
Significant Difference

BackgroundEndovascular thrombectomy has demonstrated benefit for patients with acute ischemic stroke from proximal large vessel occlusion. However, limited evidence is available from recent randomized trials on the role of thrombectomy for M2 segment occlusions of the middle cerebral artery (MCA).MethodsWe conducted a systematic review and meta-analysis to investigate clinical and radiographic outcomes, rates of hemorrhagic complications, and mortality after M2 occlusion thrombectomy using modern devices, and compared these outcomes against patients with M1 occlusions. Recanalization was defined as Thrombolysis in Cerebral Infarction (TICI) 2b/3 or modified TICI 2b/3.ResultsA total of 12 studies with 1080 patients with M2 thrombectomy were included in our analysis. Functional independence (modified Rankin Scale 0–2) rate was 59% (95% CI 54% to 64%). Mortality and symptomatic intracranial hemorrhage rates were 16% (95% CI 11% to 23%) and 10% (95% CI 6% to 16%), respectively. Recanalization rates were 81% (95% CI 79% to 84%), and were equally comparable for stent-retriever versus aspiration (OR 1.05; 95% CI 0.91 to 1.21). Successful M2 recanalization was associated with greater rates of favorable outcome (OR 4.22; 95% CI 1.96 to 9.1) compared with poor M2 recanalization (TICI 0–2a). There was no significant difference in recanalization rates for M2 versus M1 thrombectomy (OR 1.05; 95% CI 0.77 to 1.42).ConclusionsThis meta-analysis suggests that mechanical thrombectomy for M2 occlusions that can be safely accessed is associated with high functional independence and recanalization rates, but may be associated with an increased risk of hemorrhage.

scholarly journals Analysis of Clinical and Demographic Variables in the Treatment of Carotid Stenosis by Endarterectomy and Stent Angioplasty

2018 ◽  
Vol 26 (4) ◽  
pp. 269-273
Author(s):  
André Stavitski Costa De Oliveira ◽  
André Giacomelli Leal ◽  
Murilo Sousa De Meneses ◽  
Emanuel Cassou Dos Santos ◽  
Guilherme Santos Piedade
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Carotid Stenosis ◽  
Medical Records ◽  
Demographic Variables ◽  
Stent Angioplasty ◽  
Significant Difference ◽  
Cerebral Ischemic ◽  
Ischemic Events ◽  
Clinical Worsening

Introduction: Carotid stenosis plays a major role in the etiology of cerebral ischemic events. We evaluated the variables that impact the evolution of these patients. Methods: Data were retrospectively checked from the medical records of patients treated in the period between 2008 and 2015. Different variables were evaluated to determine the factors that influence the patients clinically. Results: The analysis was conducted based on a sample of 63 patients with carotid stenosis who underwent surgery. Regarding the factors that influenced the outcome, there was significant association with age ≥70 years, smoking and previous ischemic stroke. Although hypertension was the most prevalent comorbidity, no significant association as clinical worsening factor was found, as well as the isolated analysis of each surgery showed no significant difference. Conclusions: The clinical profile and lifestyle habits associated with certain comorbidities are variables that influence the clinical outcome of patients with carotid stenosis.

Abstract W P400: Headache at the Onset of Anterior versus Posterior Circulation Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Caroline Cahill ◽  
Kiersten Espaillat ◽  
Emily Gilchrist ◽  
Michael Froehler
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Artery ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Posterior Circulation ◽  
Anterior Circulation ◽  
Pain Pathways ◽  
Significant Difference ◽  
Chi Squared ◽  
The Rich

Background: Past evidence suggests that there is a higher incidence of onset headache with posterior rather than anterior circulation stroke. We sought to further explore this connection in order to better understand the mechanisms underlying onset headache and to examine this symptom in relation to ischemic stroke. Methods: A retrospective chart review was conducted of 253 patients who presented to Vanderbilt University Medical Center in 2013 with ischemic stroke in either the anterior or posterior circulation. The significant difference between the incidence of onset headache in the anterior and posterior circulation territories was analyzed using a chi-squared test of independence. The frequency of onset headache was compared between the two groups, as well as between more specific locations within the posterior circulation and the middle cerebral artery (MCA). Results: A total of 48 (19%) of patients reported experiencing onset headache. Of those, 12 (25%) suffered a stroke in the anterior circulation, while 28 (58%) suffered a stroke in the posterior circulation (The remaining 8 were excluded due to multiple infarcts or poorly defined territories). Analysis was done comparing the MCA, the posterior cerebral artery (PCA), and the vertebrobasilar territories. The frequency of onset headache was 21% for vertebrobasilar stroke, 6.1% for MCA stroke, and 33% for PCA stroke. Compared to the other areas, PCA stroke showed a significantly higher rate of headache as a symptom at onset (χ 2 = 18.60, p < 0.001, ϕc = 0.312). Furthermore, 20 (42%) of the 48 patients in this study who had reported onset headache were found to have suffered ischemia of the thalamus. Conclusions: Patients who suffered a stroke in the PCA territory were more likely to have experienced a headache at stroke onset. Given the rich blood supply to the thalamus from the posterior circulation, an additional mechanism linking ischemic stroke in the PCA to thalamic pain pathways should be further scrutinized as a possible cause for onset headache.

Sign in / Sign up

Export Citation Format

Share Document