Prestroke statin use enhances collateralization in acute ischemic stroke patients

2020 ◽  
Vol 38 (4) ◽  
pp. 311-321
Author(s):  
Jiaying Zhu ◽  
Mengmeng Ma ◽  
Jinghuan Fang ◽  
Jiajia Bao ◽  
Shuju Dong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Statin Therapy ◽  
Cerebral Artery ◽  
Functional Outcomes ◽  
Collateral Circulation ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Statin Use

Background: Statin therapy has been shown to be effective in the prevention of ischemic stroke. In addition, recent studies have suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcomes in the event of stroke. It was speculated that prestroke statin use may enhance collateral circulation and result in favorable functional outcomes. Objective: The aim of the study was to investigate the association of prestroke statin use with leptomeningeal collaterals and to determine the association of prestroke statin use with stroke severity and functional outcome in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 h in the neurology department of West China Hospital from May 2011 to April 2017. Computed tomographic angiography (CTA) imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; the National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission; the modified Rankin scale (mRS) was used to measure outcome at 90 days; and premorbid medications were recorded. Univariate and multivariate analyses were performed. Results: Overall, 239 patients met the inclusion criteria. Fifty-four patients used statins, and 185 did not use statins before stroke onset. Prestroke statin use was independently associated with good collateral circulation (rLMCS > 10) (odds ratio [OR], 4.786; 95% confidence interval [CI], 1.195–19.171; P = 0.027). Prestroke statin use was not independently associated with lower stroke severity (NIHSS score≤14) (OR, 1.955; 95% CI, 0.657–5.816; p = 0.228), but prestroke statin use was independently associated with favorable outcome (mRS score≤2) (OR, 3.868; 95% CI, 1.325–11.289; P = 0.013). Conclusions: Our findings suggest that prestroke statin use was associated with good leptomeningeal collaterals and clinical outcomes in acute ischemic stroke (AIS) patients presenting with occlusion of the middle cerebral artery. However, clinical studies should be conducted to verify this claim.

Abstract WMP120: Pre-stroke Statin Enhancement of Collateralization in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mengmeng Ma ◽  
Jiaying Zhu ◽  
Li He
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Cerebral Artery ◽  
Collateral Circulation ◽  
Stroke Onset ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Statin Use

Background: Recent studies suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcome in case of stroke onset. It was speculated that pre-stroke statin may enhance collateral circulation and result in favorable functional outcome. This study aimed to investigate the association of pre-stroke statin use with leptomeningeal collaterals in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 hours from May 2011 to April 2017. CTA imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; admission NIHSS was used to measure stroke severity; modified Rankin scale (mRS) at 90 day was used to measure outcome. Univariate and multivariate analyses were performed. Results: 239 patients met inclusion criteria. 54 patients use statin before stroke onset. Pre-stroke statin use was independently associated with good collateral circulations (rLMCS>10) (OR, 4.786; 95% CI, 1.195 - 19.171; P = 0.027). Pre-stroke statin use was not independently associated with lower stroke severity (NIHSS≤14) (OR, 1.955; 95%CI, 0.657- 5.816; P = 0.228), but pre-stroke statin use was independently associated with good outcome (mRS≤2) (OR, 3.868; 95%CI, 1.325 - 11.289; P = 0.013). Conclusion: Pre-stroke statin use seems enhance collateralization and improve clinical outcomes in patients with acute stroke. However, clinical controlled studies should be used to verify this claim.

scholarly journals The anesthetic approach for endovascular recanalization therapy depends on the lesion site in acute ischemic stroke

2021 ◽  
Author(s):  
Kilian Fröhlich ◽  
Gabriela Siedler ◽  
Svenja Stoll ◽  
Kosmas Macha ◽  
Thomas M. Kinfe ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Posterior Circulation ◽  
Neurological Deficits ◽  
Stroke Severity ◽  
Lesion Volume ◽  
Middle Cerebral Artery Territory ◽  
Cerebral Lesion

Abstract Purpose Endovascular therapy (EVT) of large-vessel occlusion in acute ischemic stroke (AIS) may be performed in general anesthesia (GA) or conscious sedation (CS). We intended to determine the contribution of ischemic cerebral lesion sites on the physician’s decision between GA and CS using voxel-based lesion symptom mapping (VLSM). Methods In a prospective local database, we sought patients with documented AIS and EVT. Age, stroke severity, lesion volume, vigilance, and aphasia scores were compared between EVT patients with GA and CS. The ischemic lesions were analyzed on CT or MRI scans and transformed into stereotaxic space. We determined the lesion overlap and assessed whether GA or CS is associated with specific cerebral lesion sites using the voxel-wise Liebermeister test. Results One hundred seventy-nine patients with AIS and EVT were included in the analysis. The VLSM analysis yielded associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas. Stroke severity and lesion volume were significantly higher in the GA group. The prevalence of aphasia and aphasia severity was significantly higher and parameters of vigilance lower in the GA group. Conclusions The VLSM analysis showed associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas including the thalamus that are known to cause neurologic deficits, such as aphasia or compromised vigilance, in AIS-patients with EVT. Our data suggest that higher disability, clinical impairment due to neurological deficits like aphasia, or reduced alertness of affected patients may influence the physician’s decision on using GA in EVT.

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 Prevalence, Comorbid Associations and Prognostic Value of the Hyperdense Middle Cerebral Artery Sign

ISRN Stroke ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Patrick Aouad ◽  
Andrew Hughes ◽  
Nishant Valecha ◽  
Yash Gawarikar ◽  
Kate Ahmad ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Interobserver Variability ◽  
Kappa Statistic ◽  
Stroke Severity ◽  
Ischemic Attack ◽  
Sensitivity Specificity ◽  
Hyperdense Middle Cerebral Artery

Background. The significance of the Hyperdense Middle Cerebral Artery Sign (HMCAS) is uncertain. Aims. This prospective study investigated the sensitivity, specificity, prevalence, prognosis, interobserver variability, and associated clinical features of HMCAS in acute ischemic stroke. Methods. Initial CT scans of 117 patients with acute ischemic stroke or transient ischemic attack (TIA) and 65 age-matched controls were reported independently by two neuroradiologists blinded to diagnosis. Details of initial stroke severity and comorbidities were collected, and outcome on the modified Rankin scale (mRS) was assessed at 3–6 months. Results. HMCAS was seen in 15% of all ischemic strokes and 25% of all middle cerebral artery (MCA) strokes; specificity was 100%. HMCAS was associated with more severe initial deficit and atrial fibrillation. Only 21% of patients with a first-ever MCA stroke and HMCAS had a good outcome (mRS≤2) compared to 55% of those without the sign (P<0.001). Interobserver agreement was only 0.747 (Kappa statistic). Conclusion. The prevalence, specificity, sensitivity, and clinical associations of HMCAS were similar to previous reports. This study confirmed prospectively that HMCAS was associated with a poorer outcome at 3 to 6 months and demonstrated interobserver variability in detection of the sign.

scholarly journals Plasma Translocator Protein Levels and Outcomes of Acute Ischemic Stroke: A Pilot Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Wen-Hung Chen ◽  
Hsu-Ling Yeh ◽  
Chiung-Wen Tsao ◽  
Li-Ming Lien ◽  
Arthur Chiwaya ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Neurological Diseases ◽  
Severe Disability ◽  
National Institutes Of Health ◽  
Translocator Protein ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Protein Levels

Translocator protein 18 kDa (TSPO) has been used as a biomarker of brain injury and inflammation in various neurological diseases. In this study, we measured the level of TSPO in acute ischemic stroke patients and determined its association with the degree of stroke severity and its ability to predict stroke functional outcomes. In total, 38 patients with moderate to severe acute ischemic stroke were enrolled. Demographic information, cerebral risk factors, and stroke severity were examined at the baseline. The National Institutes of Health Stroke Scale, modified Rankin Scale, and Barthal Index were assessed at discharge as measures of poor functional outcomes and severe disability. The baseline fasting plasma TSPO level was assessed within 24 h after the incident stroke and during hospitalization (on days 8–10). The proportion of patients with poor functional outcomes was significantly higher in the higher-TSPO group (compared to the lower group) in terms of clinical worsening (odds ratio (OR) = 11.69, 95% confidence interval (CI) = 2.08–65.6), poor functional outcomes (OR = 10.5, 95% CI = 1.14–96.57), and severe disability (OR = 4.8, 95% CI = 1.20–19.13). Plasma TSPO may be intimately linked with disease progression and worse functional outcomes in acute ischemic stroke patients.

Abstract 210: Is Endovascular Treatment Beneficial in Acute Ischemic Stroke Patients With M2 Segment Middle Cerebral Artery Occlusion?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Muhammad A Saleem
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Functional Independence ◽  
Neurological Deterioration ◽  
Stroke Patients

Background: The benefit of endovascular treatment in acute ischemic stroke patients with occlusion of distal middle cerebral artery (M2 segment) is unclear. Methods: We analyzed data from subjects with occlusion of M2 segment of middle cerebral artery confirmed with computed tomographic (CT) angiogram who were randomized to either intravenous (IV) recombinant tissue plasminogen activator (rt-PA) alone or in combination with endovascular treatment. We compared the rates of neurological deterioration within 24 hours; symptomatic intracranial hemorrhage (ICH) within 30 hours; good quality of life (defined by EQ-5D index score of ≥0.6) and functional independence (defined by modified Rankin scale of 0-2) at 3 months among subjects who underwent endovascular treatment with subjects who received IV rt-PA alone. Results: Of these 51 subjects (mean age ±SD; 68.3±11.8 years) with M2 segment occlusion, 34 and 17 subjects received IV rt-PA followed by endovascular treatment and IV rt-PA alone, respectively. There was a non-significantly lower rate of neurological deterioration (14.7% versus 25.0%) and symptomatic intracranial hemorrhages (5.9% versus 17.6%) among subjects who received IV rt-PA followed by endovascular treatment. At 3 months, the rates of independent functional outcome (52.9% versus 41.2%, odds ratio [OR] 1.6; 95 % confidence interval [CI] 0.5-5.2; P = 0.46) and good quality of life (50.0% vs 35.3% OR 1.9; 95% CI 0.5-7.2; p=0.37) were non-significantly higher among subjects with M2 segment occlusion who received IV rt-PA followed by endovascular treatment. The rate of death within 3 months was significantly lower among those who received IV rt-PA followed by endovascular treatment (5.9% vs 35.3%; OR 0.2; 95% CI 0.1-0.9; p=0.048). Conclusions: A randomized clinical trial should be considered based on the significant reduction in mortality and non-significant increase in functional independence and good quality of life following endovascular treatment in among acute ischemic stroke patients with M2 segment occlusion.

Middle Cerebral Artery Residual Contrast Stagnation on Noncontrast CT Scan Following Endovascular Treatment in Acute Ischemic Stroke Patients

2015 ◽  
Vol 25 (6) ◽  
pp. 946-951 ◽  
Author(s):  
Seyedmehdi Payabvash ◽  
Mushtaq H. Qureshi ◽  
Shayandokht Taleb ◽  
Swaroop Pawar ◽  
Adnan I. Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Ct Scan ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Stroke Patients ◽  
Noncontrast Ct

Abstract W P38: Collateral Circulation Status Correlates With Aspects Decay During Inter-facility Transfer After Anterior Acute Ischemic Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Carla Abdelnour ◽  
Srikant Rangaraju ◽  
Christopher Streib ◽  
Nima Aghaebrahim ◽  
William Delfyett ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Collateral Circulation ◽  
Infarct Volume ◽  
Relative Rate ◽  
Stroke Patients ◽  
Transferred Patients ◽  
Comprehensive Stroke Center

Introduction: The collateral circulation plays an important role in the dynamic process of cerebral ischemia. The aim of this study is to determine if collateral status correlates with the early ischemic changes measured by the rate of Alberta Stroke Program Early CT Scores (ASPECTS) decay in emergently transferred acute ischemic stroke patients with anterior large vessel conclusions. Material and methods: We retrospectively analyzed the data of patients referred to our comprehensive stroke center from 7 outside hospitals between January 15, 2006 and January 15, 2014. Collateral status was assessed using an initial CT angiography obtained before treatment, and graded as "Good" (the entire medial cerebral artery reconstitutes with contrast) or "Poor" (partial or no reconstitution of the distal medial cerebral artery), by two independent reviewers (CA and WD). ASPECTS decay was calculated in the following ways: 1. Absolute ASPECTS decay: (A1-A2)/T, 2. Relative ASPECTS decay: [(A1-A2)/A1]/T 3. Net ASPECTS difference: (A1-A2) and 4. Relative ASPECTS difference: (A1-A2)/A1; where A1= ASPECTS 1st CT, A2= ASPECTS 2nd CT, T= hours between 2 CT scans. Results: After reviewing 701 medical records from transferred patients, 51 patients with mean age 65±3 yrs and median initial NIHSS of 17 (IQR 14-21) were selected. In the multivariate analysis, good collateral status was independently associated with lower rates of ASPECTS decay measured by the relative rate of ASPECTS decay (0.04+/-0.01 score/h; p<0.05), the net ASPECTS difference (1.10+/-0.17 score/h, p<0.05) and the relative ASPECTS difference (0.12+/-0.02 score, p<0.05). The relative ASPECTS difference was most strongly associated with collateral status, and an independent predictor of good outcome (p=0.047) and final infarct volume (p=0.001) after controlling for age and NIHSS in a multivariate analysis. Conclusions: Good collateral circulation status is associated with lower rates of ASPECTS decay in transferred patients, which also tend to have smaller final infarct volumes and better clinical outcome after 3 months. The analysis of the collateral circulation gives us a better understanding of the pathophysiology in acute ischemic stroke.

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