scholarly journals Relation of Pre‐stroke Aspirin Use With Cerebral Infarct Volume and Functional Outcomes

2021 ◽  
Author(s):  
Wi‐Sun Ryu ◽  
Dawid Schellingerhout ◽  
Keun‐Sik Hong ◽  
Sang‐Wuk Jeong ◽  
Beom Joon Kim ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Infarct Volume ◽  
Cerebral Infarct

Acute treatment by a PPAR-α agonist decreases cerebral infarct volume and prevents post-ischemic endothelium and Kir 2.1 impairment

2005 ◽  
Vol 25 (1_suppl) ◽  
pp. S56-S56 ◽  
Author(s):  
Thavarak Ouk ◽  
Olivier Pétrault ◽  
Sophie Gautier ◽  
Patrick Gelé ◽  
Maud Laprais ◽  
...  
Keyword(s):  
Acute Treatment ◽  
Infarct Volume ◽  
Cerebral Infarct

Combined Ischemic Preconditioning and Resveratrol Improved Bloodbrain Barrier Breakdown via Hippo/YAP/TAZ Signaling Pathway

2020 ◽  
Vol 18 (9) ◽  
pp. 713-722 ◽  
Author(s):  
Ganji Hong ◽  
Ying Yan ◽  
Yali Zhong ◽  
Jianer Chen ◽  
Fei Tong ◽  
...  
Keyword(s):  
Signaling Pathway ◽  
Blood Brain Barrier ◽  
Ischemic Preconditioning ◽  
Infarct Volume ◽  
Ischemia Reperfusion ◽  
Cerebral Infarct ◽  
Brain Barrier ◽  
Binding Motif ◽  
Blood Brain ◽  
Barrier Breakdown

Background: Transient Ischemia/Reperfusion (I/R) is the main reason for brain injury and results in disruption of the Blood-Brain Barrier (BBB). It had been reported that BBB injury is one of the main risk factors for early death in patients with cerebral ischemia. Numerous investigations focus on the study of BBB injury which have been carried out. Objective: The objective of this study was to investigate the treatment function of the activation of the Hippo/Yes-Associated Protein (YAP) signaling pathway by combined Ischemic Preconditioning (IPC) and resveratrol (RES) before brain Ischemia/Reperfusion (BI/R) improves Blood-Brain Barrier (BBB) disruption in rats. Methods: Sprague-Dawley (SD) rats were pretreated with 20 mg/kg RES and IPC and then subjected to 2 h of ischemia and 22 h of reperfusion. The cerebral tissues were collected; the cerebral infarct volume was determined; the Evans Blue (EB) level, the brain Water Content (BWC), and apoptosis were assessed; and the expressions of YAP and TAZ were investigated in cerebral tissues. Results: Both IPC and RES preconditioning reduced the cerebral infarct size, improved BBB permeability, lessened apoptosis, and upregulated expressions of YAP and transcriptional co-activator with PDZ-binding motif (TAZ) compared to the Ischemia/Reperfusion (I/R) group, while combined IPC and RES significantly enhanced this action. Conclusion: combined ischemic preconditioning and resveratrol improved blood-brain barrier breakdown via Hippo/YAP/TAZ signaling pathway.

Eloquence-based reperfusion scoring and its ability to predict post-thrombectomy disability and functional status

2021 ◽  
pp. 159101992110464
Author(s):  
Elliot Pressman ◽  
Victoria Sands ◽  
Gabriel Flores ◽  
Liwei Chen ◽  
Rahul Mhaskar ◽  
...  
Keyword(s):  
Frontal Lobe ◽  
Functional Outcomes ◽  
Visual Fields ◽  
Predictive Ability ◽  
Occipital Lobe ◽  
Cerebral Infarct ◽  
Modified Rankin Scale ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy ◽  
Post Procedure

Background Angiographic reperfusion after endovascular thrombectomy in acute ischemic stroke is commonly graded using volume-based reperfusion scores such as the modified thrombolysis in cerebral infarct score. The location of non-reperfused regions is not included in modified thrombolysis in cerebral infarct score. We studied the predictive ability of an eloquence-based reperfusion score. Methods Consecutive cases of endovascular thrombectomy for anterior circulation strokes performed between January 2018 and April 2020 were included. Digital subtraction angiograms were reviewed by two blinded neurointerventionalist operators. Incomplete reperfusion was further classified by lobar regions lacking reperfusion to create various cohorts. Outcomes were graded four to seven days post-procedure with the National Institute of Health Stroke Scale (NIHSS) and 90 days post-procedure with the modified Rankin Scale. Results One hundred patients were identified. Via multivariate analysis, we found that frontal lobe non-reperfusion (mean difference (MD) = −1.60, p = 0.002) and occipital lobe non-reperfusion (MD = −1.68, p = 0.001) were associated with worse mental status improvement while left-sided stroke (MD = 2.02, p < 0.001) featured better improvement post-thrombectomy. Occipital lobe non-reperfusion (MD = −0.734, p = 0.009) was associated with the worse improvement of visual fields. The non-reperfusion of the frontal lobe was associated with a 1.732-worse NIHSS hemibody strength score (95% confidence interval (95%CI) = −3.39 to −0.072, p = 0.041). Worse improvement in NIHSS scores was found to be associated with frontal lobe non-reperfusion (MD = −5.34, 95%CI = −9.52 to −1.18, p = 0.013) and occipital lobe non-reperfusion (MD = −6.35, 95%CI = −10.4 to −2.31, p = 0.002). Odds of achieving modified Rankin Scale of 0–2 at 90 days were decreased with frontal lobe non-reperfusion (odds ratio (OR) = 0.279, 95%CI = 0.090–0.869, p = 0.028) and left laterality (OR = 0.376, 95%CI = 0.153–0.922, p = 0.033). Conclusions Eloquence-based reperfusion assessment is an important predictor for functional outcomes after thrombectomy.

Abstract W P218: Interleukin 21 receptor: A Major Modulator of Infarct Volume

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Han Kyu Lee ◽  
Sehoon Keum ◽  
Donald C Lo ◽  
Douglas A Marchuk
Keyword(s):  
Infarct Volume ◽  
Brain Slices ◽  
Oxygen Deprivation ◽  
Cerebral Infarct ◽  
Adult Brain ◽  
Chromosome 7 ◽  
Mouse Strains ◽  
Circulatory Effects ◽  
A Genome ◽  
Interleukin 21

Using the permanent middle cerebral artery occlusion (MCAO) model of stroke, we have demonstrated that different inbred mouse strains show profound differences in infarct volume, indicating that infarction is under strong genetic control. To identify natural genetic determinants modulating infarction, we employed quantitative trait locus (QTL) linkage analysis and a genome-wide association study of cerebral infarct volume. We identified a locus on distal chromosome 7 that contributes over 50% of the variation in infarct volume, as well as other loci of smaller effect. Using interval-specific ancestral haplotype analysis, we fine-mapped the chromosome 7 locus to only 12 candidate genes. To identify the gene(s) underlying this locus, we determined the strain-specific transcript levels of all 12 genes in relevant tissues that included P1 and adult brain cortex, and embryonic macrophages, the latter due to their importance in the development of the cerebrovascular system. One gene, interleukin 21 receptor (Il21r), showed a 7-fold expression difference between strains and harbors a coding SNP difference that segregates with infarct volume. To determine whether Il21r is a major modulator of infarction, we examined Il21r in mice for their cerebrovascular anatomy as well as the cerebral infarct volume after MCAO. While Il21r-/- mice show a moderate reduction in collateral vessel connections compared to wild-type littermate mice cerebral infarct volume in Il21r-/- mice is increased 3-fold. This suggests that Il21r has effects on both cerebrovascular anatomy and innate neuroprotection. To examine the latter, we performed an ex vivo study of brain slices under in vitro oxygen deprivation. In this system devoid of any potential circulatory effects, but retaining appropriate tissue architecture, Il21r-/- brain slices showed an increase in oxygen-deprivation induced cell death, showing that Il21r is also involved in cerebrovascular-independent neuroprotection. Biochemical studies of the brain slices show that Il21R regulates ischemia-induced apoptosis. The identification of Il21R as a cerebrovascular-independent modulator of infarct volume provides a fundamental advance in the understanding of genetic modulation of ischemic stroke.

Abstract TP20: Longer Procedural Times Are Independently Associated with Symptomatic Intracranial Hemorrhage in Large Vessels Occlusion Stroke Patients Undergoing Thrombectomy

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Omar Kass-Hout ◽  
Tareq Kass-Hout ◽  
Michael R. Frankel ◽  
Fadi Nahab ◽  
Samir R. Belagaje ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Infarct Volume ◽  
P Value ◽  
Procedure Time ◽  
Entire Cohort ◽  
Radiographic Outcomes ◽  
Academic Center ◽  
Procedural Time ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose: Time to reperfusion is an essential factor in determination of outcomes in (AIS). We sought to establish the effect of the procedural time on the clinical and radiographic outcomes of AIS patients undergoing intra-arterial therapy. Methods: Retrospective review of a prospectively collected database of endovascularly treated large vessel AIS in a large academic center. Data from all consecutive patients who underwent mechanical thrombectomy from September 2010 to July 2012 were analyzed. The variable of interest was procedural time (defined as time from groin puncture to end of procedure). Outcome measures included the rates of symptomatic intracebral hemorrhage (sICH, defined as any parenchymal hematoma e.g. PH-1/PH-2), final infarct volume, 90-day mortality, and independent functional outcomes (modified Rankin Scale, mRS 0-2) at 90 days. Results: The entire cohort included 242 patients with a mean age of 65.5+/- 14.2 and median baseline NIHSS 20. Of the patients 49.38% were females. The median ASPECTS score was 8. The mean procedure time was significantly shorter in patients with good outcome (86.73 vs. 73.13 respectively, P-value: 0.0228). However, after controlling for ASPECTS score, type of retrieval device, TICI score, volume of infarct, interval from symptoms onset to puncture, and co-morbidities, this association did not prove to be significant (P-value = 0.7101). Patients with SICH had significantly higher mean procedure time than patients without SICH (79.65 vs. 104.5 respectively; P-value: 0.0319) which remained significant when controlling to the previous factors (OR = 0.974 with a 95 % CI of (0.957, 0.991). There was no correlation between the volume of infarction and the procedure time (r = 0.10996, P-value: 0.0984). There was no association between procedure time and 90-day mortality (77.8 vs. 88.2 minutes in survivals vs. deaths respectively; P-value: 0.0958). Conclusion: Our data support an association between the risk of SICH and a longer procedure time while no definite association between procedural times and the final infarction volume or long-term functional outcomes was found after adjustment for multiple imbalances.

Abstract P481: Time to Reperfusion Determines Clinical Outcomes Independent of Post Thrombectomy Infarct Volume

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shashvat Desai ◽  
Amin N Aghaebrahim ◽  
James E Siegler ◽  
Andre Monteiro ◽  
Ashutosh P Jadhav ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Functional Outcomes ◽  
Time Window ◽  
Infarct Volume ◽  
Late Time ◽  
Inclusion Criteria ◽  
Ischemic Time ◽  
The Impact

Introduction: Late time window thrombectomy trials demonstrated that good functional outcomes can be achieved up to 24 hours from stroke onset in Slow Progressors (small infarct volume and large penumbral volume). In this study, we aim to investigate whether early (<6 hours) recanalization leads to superior functional outcomes compared to delayed recanalization (>6 hours) amongst patients with similar 24-hour infarct volumes post thrombectomy. Methods: We performed a retrospective analysis of a prospectively maintained LVO stroke thrombectomy database across 3 comprehensive stroke centers. Demographic, clinical, radiological, and outcomes data were analyzed. Inclusion criteria were witnessed onset anterior circulation LVO [internal carotid or middle cerebral artery M1] strokes with a good baseline mRS score (0-1) having achieved success recanalization [mTICI 2b-3] and 24-hour infarct volume of ≤10 ml on CT head or MRI. Univariate and multivariate analysis of the impact of time to recanalization on clinical outcomes was performed. Results: Of the 499 LVO strokes undergoing thrombectomy, 30% (148) met inclusion criteria. Mean age was 70 ±14 and median NIHSS score was 17 (14-21). Early recanalization (<6h) was achieved in 65% (96) of patients. Baseline demographic (age: 73 vs 74, p=0.80) and clinical characteristics (NIHSS:16.5 vs 17, p=0.52; 24-h infarct volume: 4.4 vs 4.2 ml, p=0.60) were comparable between early versus late recanalization patients. Rates of early clinical improvement (24-h NIHSS <6) (71% vs 39%, p=0.0007) and mRS 0-2 at 90 days (68% vs 48%, p=0.019) were higher in early recanalizers compared to late recanalizers. Multivariate analysis including age, NIHSS, time to recanalization, and 24-hour infarct volume identified early recanalization as an independent predictor of mRS 0-2 at 90 days (OR-2.41 95% CI 1.89-4.50). Every 1-hour increase in time to recanalization decreased the odds of 90-day mRS 0-2 by 2.2%. Conclusion: Among patients with similar 24-hour infarct volume post thrombectomy (≤10 ml), shorter time to successful recanalization is associated with significantly higher rates of early clinical improvement and mRS 0-2 at 90 days. Increased penumbral ischemic time may have an impact on outcomes post stroke thrombectomy.

scholarly journals GPVI-Fc-PEG improves cerebral infarct volume and cerebral thrombosis in mouse model with cerebral thrombosis

2017 ◽  
Vol 16 (5) ◽  
pp. 7561-7568 ◽  
Author(s):  
Yimae Wufuer ◽  
Xuefeng Shan ◽  
Magaoweiya Sailike ◽  
Kamile Adilaimu ◽  
Songfeng Ma ◽  
...  
Keyword(s):  
Mouse Model ◽  
Infarct Volume ◽  
Cerebral Infarct ◽  
Cerebral Thrombosis

scholarly journals KADAR FIBRIN MONOMER DAN UKURAN INFARK DI STROK ISKEMIK AKUT

2016 ◽  
Vol 20 (3) ◽  
pp. 171
Author(s):  
Ani Kartini ◽  
Mansyur Arif ◽  
Hardjoeno Hardjoeno
Keyword(s):  
Ischemic Stroke ◽  
Infarct Size ◽  
Acute Ischemic Stroke ◽  
Thrombus Formation ◽  
Infarct Volume ◽  
Cross Sectional Study ◽  
Cerebral Infarct ◽  
Cross Sectional ◽  
Fibrin Monomer ◽  
Significant Difference

Coagulation activation and thrombosis frequently exist in ischemic stroke, thrombus formation can be detected early by the presence of fibrin monomer. The purpose of this study was to know the correlation of fibrin monomer level with cerebral infarct size in acute ischemic stroke patients. This was a cross sectional study with a total of 39 samples. The fibrin monomer level was determined by immunoturbidimetry method using STA-Compact and the measurement of the infarct size was done by CT scan of the head using Broderick formula. The results of this study showed that the median level of fibrin monomer in acute ischemic stroke with nonlacunar infarct type and lacunar infarct type were 14.46 μg/mL and 4.29 μg/mL, respectively. Mann-Whitney test showed there was a significant difference of fibrin monomer levels between nonlacunar infarct type and the lacunar type, p=0.000. The cut-off point analysis result of the fibrin monomer level was 5.96 μg/mL with a sensitivity of 88.9% and specificity of 76.4%, respectively. Spearman correlation test showed that fibrin monomer level was positively correlated with cerebral infarct volume in acute ischemic stroke (r=0.56, p=0.000). Based on this study, it can be concluded that fibrin monomer level can be used as a marker to predict the type of cerebral infarct and volume of acute ischemic stroke as well.

Early Effects of Acid-Base Management during Hypothermia on Cerebral Infarct Volume, Edema, and Cerebral Blood Flow in Acute Focal Cerebral Ischemia in Rats

2002 ◽  
Vol 97 (4) ◽  
pp. 868-874 ◽  
Author(s):  
Rainer Kollmar ◽  
Thomas Frietsch ◽  
Dimitrios Georgiadis ◽  
Wolf-Rüdiger Schäbitz ◽  
Klaus F. Waschke ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Edema ◽  
Focal Cerebral Ischemia ◽  
Infarct Volume ◽  
Cerebral Infarct ◽  
Moderate Hypothermia ◽  
Acid Base ◽  
Base Management ◽  
Ph Stat

Background Although the frequency for the use of moderate hypothermia in acute ischemic stroke is increasing, the optimal acid-base management during hypothermia remains unclear. This study investigates the effect of pH- and alpha-stat acid-base management on cerebral blood flow (CBF), infarct volume, and cerebral edema in a model of transient focal cerebral ischemia in rats. Methods Twenty Sprague-Dawley rats were subjected to transient middle cerebral artery occlusion (MCAO) for 2 h during normothermic conditions followed by 5 h of reperfusion during hypothermia (33 degrees C). Animals were artificially ventilated with either alpha- (n = 10) or pH-stat management (n = 10). CBF was analyzed 7 h after induction of MCAO by iodo[(14)C]antipyrine autoradiography. Cerebral infarct volume and cerebral edema were measured by high-contrast silver infarct staining (SIS). Results Compared with the alpha-stat regimen, pH-stat management reduced cerebral infarct volume (98.3 +/- 33.2 mm(3) vs. 53.6 +/- 21.6 mm(3); P &gt; or = 0.05 mean +/- SD) and cerebral edema (10.6 +/- 4.0% vs. 3.1 +/- 2.4%; P &gt; or = 0.05). Global CBF during pH-stat management exceeded that of alpha-stat animals (69.5 +/- 12.3 ml x 100 g(-1) x min(-1) vs. 54.7 +/- 13.3 ml x 100 g(-1) x min; P &gt; or = 0.05). The regional CBF of the ischemic hemisphere was 62.1 +/- 11.2 ml x 100 g(-1) x min(-1) in the pH-stat group versus 48.2 +/- 7.2 ml x 100 g(-1) x min(-1) in the alpha-stat group ( P&gt; or = 0.05). Conclusions In the very early reperfusion period (5 h), pH-stat management significantly decreases cerebral infarct volume and edema as compared with alpha-stat during moderate hypothermia, probably by increasing CBF.

Abstract WP106: Redefined Measure of Early Neurological Improvement Shows Treatment Benefit of Intravenous Tissue Plasminogen Activator Treatment in NINDS Rt-PA Acute Stroke Trial at 24 Hours

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shashank Agarwal ◽  
Erica Scher ◽  
Aaron Lord ◽  
Jennifer Frontera ◽  
Koto Ishida ◽  
...  
Keyword(s):  
Roc Curve ◽  
Functional Outcomes ◽  
Infarct Volume ◽  
Surrogate Marker ◽  
Percentage Change ◽  
Treatment Benefit ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Percent Change ◽  
Stroke Study

Background and Purpose: The first of the 2 NINDS Stroke Study trials did not show a significant increase in early neurological improvement (ENI), defined as NIHSS improvement by ≥ 4, with alteplase treatment. We hypothesized that ENI defined as a percentage change in NIHSS (percent change NIHSS) at 24 hours is superior to other definitions in predicting 3-month functional outcomes and using this definition there would be treatment benefit of alteplase over placebo at 24 hours. Methods: We analyzed the NINDS rt-PA Stroke Study (Parts 1 and 2) trial data. Percent change NIHSS was defined as [(admission NIHSS score–24-hour NIHSS score)x100/admission NIHSS score] and delta NIHSS as (admission NIHSS score–24-hour NIHSS score). We compared ENI using these definitions between alteplase vs. placebo patients. We also used receiver operating characteristic (ROC) curve to determine the predictive association of ENI with excellent 3-month functional outcomes [Barthel Index (BI) score 95 – 100 and modified Rankin scale (mRS) 0-1], good 3-month functional outcome (mRS 0-2) and 3-month infarct volume. Results: There was a significantly greater improvement in the 24-hour median percent change NIHSS among patients treated with alteplase compared to the placebo group (28% vs. 15%, p = 0.045) but not median delta NIHSS (3 vs. 2, p = 0.471). ROC curve comparison showed that percent change NIHSS (ROC percent ) was better than delta NIHSS (ROC delta ) and admission NIHSS (ROC admission ) with regards to excellent 3-month BI (ROC percent 0.83, ROC delta 0.76, ROS admission 0.75), excellent 3-month mRS (ROC percent 0.83, ROC delta 0.74, ROS admission 0.78), and good 3-month mRS (ROC percent 0.83, ROC delta 0.76, ROS admission 0.78). Percentage change had a stronger association with 90-day infarct volume than delta NIHSS score and both delta NIHSS and percent change in NIHSS were more pronounced with faster treatment times. Conclusion: In the NINDS rt-PA trial, alteplase was associated with a significant percent change improvement in NIHSS at 24 hours. Percent change in NIHSS may be a better surrogate marker of thrombolytic activity and 3-month outcomes.

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