scholarly journals Susceptibility vessel sign predicts poor clinical outcome for acute stroke patients untreated by thrombolysis

2017 ◽  
Author(s):  
Huiqin Liu ◽  
Wenli Mei ◽  
Yue Huang ◽  
Yongli Li ◽  
Zuzhi Chen ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Stroke Patients ◽  
Poor Clinical Outcome

scholarly journals In-Hospital Intravenous Thrombolysis Offers No Benefit in Mechanical Thrombectomy in Optimized Tertiary Stroke Center Setting

2020 ◽  
Author(s):  
Juha-Pekka Pienimäki ◽  
Jyrki Ollikainen ◽  
Niko Sillanpää ◽  
Sara Protto
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
Clinical Laboratory ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Ordinal Logistic Regression Analysis ◽  
Stroke Center

Abstract Purpose Mechanical thrombectomy (MT) is the first-line treatment in acute stroke patients presenting with large vessel occlusion (LVO). The efficacy of intravenous thrombolysis (IVT) prior to MT is being contested. The objective of this study was to evaluate the efficacy of MT without IVT in patients with no contraindications to IVT presenting directly to a tertiary stroke center with acute anterior circulation LVO. Materials and Methods We collected the data of 106 acute stroke patients who underwent MT in a single high-volume stroke center. Patients with anterior circulation LVO eligible for IVT and directly admitted to our institution who subsequently underwent MT were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of intravenous thrombolysis on 3-month clinical outcome (mRS) was analyzed with univariate tests and binary and ordinal logistic regression analysis. Results Fifty-eight out of the 106 patients received IVT + MT. These patients had 2.6-fold higher odds of poorer clinical outcome in mRS shift analysis (p = 0.01) compared to MT-only patients who had excellent 3-month clinical outcome (mRS 0–1) three times more often (p = 0.009). There were no significant differences between the groups in process times, mTICI, or number of hemorrhagic complications. A trend of less distal embolization and higher number of device passes was observed among the MT-only patients. Conclusions MT without prior IVT was associated with an improved overall three-month clinical outcome in acute anterior circulation LVO patients.

Abstract W P48: Flair Vessel Hyper-intensities Could Predict Target Mismatch Signs in Acute Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Manabu Inoue ◽  
Michael Mlynash ◽  
Carlo W Cerada ◽  
Nishant K Mishra ◽  
Soren Christensen ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Clinical Outcomes ◽  
Pooled Analysis ◽  
Stroke Patients ◽  
Good Clinical Outcome ◽  
Kappa Score ◽  
Early Reperfusion ◽  
Diffusion Weighted Images ◽  
Fluid Attenuated Inversion Recovery

Background and purpose: Fluid-attenuated inversion recovery (FLAIR) vessel hyper-intensities (FVH) have been hypothesized to have a positive correlation with good collaterals and more favorable clinical outcomes in acute stroke patients. We assessed if FVH predict the Target mismatch profile (TMM) and clinical outcomes in the DEFUSE studies. Methods: Patients with technically adequate baseline diffusion weighted images (DWI), perfusion images (PWI), and FLAIR images were included in this pooled analysis of the DEFUSE 1 and 2 studies. The FVH sign was defined as visible hyper-intense vessels on FLAIR images and assessed at basal ganglia levels by two independent raters. Clinical outcomes were assessed using modified Rankin Scale (mRS) at 90 days. The Target mismatch profile was based on baseline DWI and PWI volumes using automated software (RAPID). Results: Seventy seven patients met the inclusion criteria. Median time (IQR) from symptom onset to baseline MRI was 4.6 hours (3.9 - 5.4) and median (IQR) DWI lesion was 13.1 (5.0 - 32.0) ml. Of these, 66 patients (86%) had the FVH sign. Kappa score for inter-rater agreement was 0.621 (95CI: 0.33 - 0.91). Seventy (74%) cases with FVH had TMM profile vs. 33% of No FVH patients (p=0.023). Good clinical outcome (mRS 0-2) did not differ (50% with FVH vs. 73% without FVH, p=0.203). Only 38% of the patients with FVH had good angiographic collaterals and the rate of early reperfusion did not differ (45% with FVH vs. 25% without FVH, p=0.45). Conclusions: FVH is common in acute stroke patients (86%) and is associated with the Target Mismatch profile. However, FVH was not associated with favorable angiographic collaterals, good clinical outcome or early reperfusion in the DEFUSE 1 and 2 cohorts.

Abstract WP148: Functional Independence Score of Acute Stroke Patients Can Predict Favorable Clinical Outcome at 3 Months After Stroke Onset

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Takashi Johno ◽  
Hiroyuki Kawano ◽  
Masataka Torii ◽  
Hiroshi Kamiyama ◽  
Tatsuo Amano ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Functional Independence ◽  
Stroke Onset ◽  
Stroke Patients ◽  
Favorable Clinical Outcome

Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization – When “tissue clock” and “time clock” are desynchronized

2019 ◽  
pp. 174749301988452 ◽  
Author(s):  
Jawed Nawabi ◽  
Fabian Flottmann ◽  
Andre Kemmling ◽  
Helge Kniep ◽  
Hannes Leischner ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Water Uptake ◽  
Quantitative Imaging ◽  
Receiver Operating Curve ◽  
Imaging Biomarker ◽  
Poor Clinical Outcome ◽  
Similar Time ◽  
Poor Outcome ◽  
Malignant Infarction

Background Ischemic water uptake in acute stroke is a reliable indicator of lesion age. Nevertheless, inter-individually varying edema progression has been observed and elevated water uptake has recently been described as predictor of malignant infarction. Aims We hypothesized that early-elevated lesion water uptake indicates accelerated “tissue clock” desynchronized with “time clock” and therefore predicts poor clinical outcome despite successful recanalization. Methods Acute middle cerebral artery stroke patients with multimodal admission-CT who received successful thrombectomy (TICI 2b/3) were analyzed. Net water uptake (NWU), a quantitative imaging biomarker of ischemic edema, was determined in admission-CT and tested as predictor of clinical outcome using modified Rankin Scale (mRS) after 90 days. A binary outcome was defined for mRS 0–4 and mRS 5–6. Results Seventy-two patients were included. The mean NWU (SD) in patients with mRS 0–4 was lower compared to patients with mRS 5–6 (5.0% vs. 12.1%; p < 0.001) with similar time from symptom onset to imaging (2.6 h vs. 2.4 h; p = 0.7). Based on receiver operating curve analysis, NWU above 10% identified patients with very poor outcome with high discriminative power (AUC 0.85), followed by Alberta Stroke Program Early CT Score (ASPECTS) (AUC: 0.72) and National Institutes of Health Stroke Scale (NIHSS) (AUC: 0.72). Conclusions Quantitative NWU may serve as an indicator of “tissue clock” and pronounced early brain edema with elevated NWU might suggest a desynchronized “tissue clock” with real “time clock” and therefore predict futile recanalization with poor clinical outcome.

Carotid Artery Stenosis Is Associated with Better Intracranial Collateral Circulation in Stroke Patients

2020 ◽  
Vol 49 (2) ◽  
pp. 200-205
Author(s):  
Juha-Pekka Pienimäki ◽  
Niko Sillanpää ◽  
Pasi Jolma ◽  
Sara Protto
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Clinical Outcome ◽  
Acute Stroke ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Collateral Circulation ◽  
Artery Stenosis ◽  
Stroke Patients ◽  
Significant Difference

Background: Adequate collateral circulation improves the clinical outcome of ischemic stroke patients. We evaluated the influence of ipsilateral carotid stenosis on intracranial collateral circulation in acute stroke patients. Methods: We collected the data of 385 consecutive acute stroke patients who underwent mechanical thrombectomy after multimodal computed tomography (CT) imaging in a single high-volume stroke center. Patients with occlusion of the first segment (M1) segment of the middle cerebral artery were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of carotid stenosis on intracranial collateral circulation was studied with appropriate statistical tests and ordinal regression analysis. Results: Fifty out of the 247 patients eligible for analysis had severe ipsilateral carotid stenosis (≥75%). These patients were 4-times more likely to have very good intracranial collaterals (Collateral Score 3–4, p = 0.001) than the nonstenotic and slightly stenotic (<75%) patients. The severely stenotic patients had a longer mean operation time (41 vs. 29 min to reperfusion, respectively, p = 0.001). Nevertheless, 54% of severely stenotic patients had good 3-month clinical outcome (modified Rankin Scale ≤2) with no significant difference between the 2 groups. Conclusions: Carotid artery stenosis of over 75% of vessel diameter was associated with better intracranial collateral circulation of patients with acute ischemic stroke. This did not significantly change the 3-month clinical outcome.

Renal Impairment Is Associated with Intracerebral Hemorrhage after Mechanical Thrombectomy in Vertebrobasilar Stroke

2019 ◽  
Vol 47 (1-2) ◽  
pp. 48-56 ◽  
Author(s):  
Mona Laible ◽  
Ekkehart Jenetzky ◽  
Markus A. Möhlenbruch ◽  
Ulf Neuberger ◽  
Martin Bendszus ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Intracerebral Hemorrhage ◽  
Mechanical Thrombectomy ◽  
Posterior Circulation ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Poor Clinical Outcome ◽  
Treatment Results ◽  
Risk Of Mortality ◽  
Vertebrobasilar Stroke

Background and Purpose: Renal dysfunction (RD) is overall associated with unfavorable functional outcome and higher risk of mortality after acute ischemic stroke. Associations between RD and outcome in patients with acute vertebrobasilar stroke treated with thrombectomy have not been evaluated so far. Materials and Methods: Consecutive patients with vertebrobasilar stroke treated with mechanical thrombectomy between October 2010 and July 2017 at our center were analyzed. RD was defined as glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 at admission. Endpoints were (I) poor clinical outcome (modified Rankin Scale > 2) at 3 months, (II) 3-month mortality, and (III) intracerebral hemorrhage (ICH) after treatment. Results: Overall, 106 patients were included. Median age was 73.0 years (interquartile range 62.0–80.0), and RD was present in 20.8%. Multivariate analysis revealed that RD was associated with a higher risk for any ICH (OR 3.54; 95% CI 1.09–11.49; p = 0.035). Stroke severity at onset predicted poor clinical outcome (OR 1.08; 95% CI 1.03–1.14; p = 0.003). Neither low GFR nor any ICH, but stroke severity (OR 1.08; 95% CI 1.03–1.14; p = 0.002) and poor recanalization results (OR 11.38; 95% CI 2.01–64.41; p = 0.006) were associated with a higher risk for mortality. Conclusions: Patients with RD and acute vertebrobasilar stroke should be thoroughly monitored to prevent ICH after thrombectomy. Our results support performing mechanical thrombectomy in acute stroke patients with large vessel occlusions of the posterior circulation, irrespective of their renal function.

Serum S-100 Protein, Relationship to Clinical Outcome in Acute Stroke

1997 ◽  
Vol 34 (5) ◽  
pp. 546-550 ◽  
Author(s):  
Hagosa D Abraha ◽  
Richard J Butterworth ◽  
Philip M W Bath ◽  
Wassif S Wassif ◽  
John Garthwaite ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Acute Stroke ◽  
Barthel Index ◽  
Protein Concentration ◽  
Protein A ◽  
Haemorrhagic Stroke ◽  
Poor Clinical Outcome ◽  
Anterior Circulation ◽  
S 100

The clinical significance of serum S-100 protein, a protein released by damaged brain tissue, was assessed in patients with acute ischaemic or haemorrhagic stroke and matched controls. Serum S-100 protein concentration was significantly elevated in patients with ischaemic stroke [median (SQR): 0·27 (0·09)μg/L, n = 68] and haemorrhagic stroke [0·43 (0·23)μg/L, n=13] compared to controls [0·11 (0·03)μg/L, n = 51, P<0·0001]. Although patients with haemorrhagic stroke had higher serum S-100 concentrations compared to patients with ischaemic stroke, this was not quite statistically significant. Serum S-100 concentrations were related to infarct size, large (total anterior circulation) infarcts concentrations having the highest [0·40 (0·22) μg/L], and small vessel (‘lacunar’) infarcts concentrations having the lowest [0·20 (0·06)μg/L, P<0·0005] concentrations. S-100 protein concentration was also significantly related to clinical outcome at three months measured using three disability and handicap scales ( n = 81): modified Barthel index ( rs=–0·285, P = 0·01), modified Rankin score ( rs = 0·313, P = 0·004) and Lindley score ( rs = 0·262, P = 0·018) with high values associated with poor clinical outcome. Similarly high values of serum S-100 protein were observed in patients who died or were discharged to an institution [median (SQR): 0·63 (0·29)μg/L and 0·37 (0·13)μg/L, respectively] compared to those who were discharged home [0·26 (0·11)μg/L, P = 0·13]. The present study suggests measurement of serum S-100 protein could be a useful prognostic marker of clinical outcome in acute stroke. Whether S-100 concentrations can be altered by therapeutic intervention in acute stroke remains to be elucidated. Indexing terms: acute stroke/serum S-100/Barthel index/Rankin scale.

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