scholarly journals Predicting hemorrhagic transformation and its timing from maximum cerebral lesion diameter in nonlacunar ischemic strokes

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Antonio Muscari ◽  
Luca Faccioli ◽  
Maria Vittoria Lega ◽  
Andrea Lorusso ◽  
Marco Masetti ◽  
...  
Keyword(s):  
Hemorrhagic Transformation ◽  
Cerebral Lesion ◽  
Lesion Diameter

scholarly journals MRI Characteristics in Acute Ischemic Stroke Patients with Preceding Direct Oral Anticoagulant Therapy as compared to Vitamin K Antagonists

2020 ◽  
Author(s):  
Thomas Meinel ◽  
Johannes Kaesmacher ◽  
Jan Gralla ◽  
David Julian Seiffge ◽  
Elias Auer ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Hemorrhagic Transformation ◽  
Ischemic Lesion ◽  
Lesion Diameter ◽  
Imaging Characteristics ◽  
Therapeutic Anticoagulation

Abstract Background : Despite the utility of neuroimaging in the diagnostic and therapeutic management of patients with acute ischemic stroke (AIS), imaging characteristics in patients with preceding direct oral anticoagulants (DOAC) compared to vitamin K antagonists (VKA) have hardly been described. We aimed to determine presence of large vessel occlusion (LVO), thrombus length, infarction diameter, and occurrence of hemorrhagic transformation in AIS patients with preceding DOAC as compared to VKA therapy. Methods : Using a prospectively collected cohort of AIS patients, we performed univariate and multivariable regression analyses regarding imaging outcomes. Additionally, we provide a sensitivity analysis for the subgroup of patients with confirmed therapeutic anticoagulation. Results : We included AIS in patients with preceding DOAC (N=75) and VKA (N=61) therapy, median age 79 (IQR 70 – 83), 39% female. Presence of any LVO between DOAC and VKA patients (29.3% versus 37.7%, P=0.361), and target LVO for endovascular therapy (26.7% versus 27.9%, P=1.0) was equal with a similar occlusion pattern. DOAC as compared to VKA were associated with a similar rate of target LVO for EVT (aOR 0.835, 95% CI 0.368 – 1.898). The presence of multiple lesions and characteristics of the thrombus were similar in DOAC and VKA patients. Acute ischemic lesion diameter in real world patients was equal in patients taking DOAC as compared to VKA. Lesion diameter in VKA patients (median 13 mm, IQR 6 – 26 versus median 20 mm, IQR 7 – 36, P=0.001), but not DOAC patients was smaller in the setting of confirmed therapeutic VKA. The frequency of radiological hemorrhagic transformation and symptomatic intracranial hemorrhage in OAC patients was low. Sensitivity analysis considering only patients with confirmed therapeutic anticoagulation did not change any of the results. Conclusion : Preceding DOAC treatment showed equal rates of LVO and infarct size as compared to VKA in AIS patients. This study adds to the knowledge of imaging findings in AIS patients with preceding anticoagulation.

scholarly journals MRI Characteristics in Acute Ischemic Stroke Patients with Preceding Direct Oral Anticoagulant Therapy as compared to Vitamin K Antagonists

2019 ◽  
Author(s):  
Thomas Meinel ◽  
Johannes Kaesmacher ◽  
Jan Gralla ◽  
David Julian Seiffge ◽  
Elias Auer ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Hemorrhagic Transformation ◽  
Ischemic Lesion ◽  
Lesion Diameter ◽  
Imaging Characteristics ◽  
Therapeutic Anticoagulation

Abstract Background: Despite the utility of neuroimaging in the diagnostic and therapeutic management of patients with acute ischemic stroke (AIS), imaging characteristics in patients with preceding direct oral anticoagulants (DOAC) compared to vitamin K antagonists (VKA) have hardly been described. We aimed to determine presence of large vessel occlusion (LVO), thrombus length, infarction diameter, and occurrence of hemorrhagic transformation in AIS patients with preceding DOAC as compared to VKA therapy. Methods: Using a prospectively collected cohort of AIS patients, we performed univariate and multivariable regression analyses regarding imaging outcomes. Additionally, we provide a sensitivity analysis for the subgroup of patients with confirmed therapeutic anticoagulation. Results: We included AIS in patients with preceding DOAC (N=75) and VKA (N=61) therapy, median age 79 (IQR 70 – 83), 39% female. Presence of any LVO between DOAC and VKA patients (29.3% versus 37.7%, P=0.361), and target LVO for endovascular therapy (26.7% versus 27.9%, P=1.0) was equal with a similar occlusion pattern. DOAC as compared to VKA were associated with a similar rate of target LVO for EVT (aOR 0.835, 95% CI 0.368 – 1.898). The presence of multiple lesions and characteristics of the thrombus were similar in DOAC and VKA patients. Acute ischemic lesion diameter in real world patients was equal in patients taking DOAC as compared to VKA. Lesion diameter in VKA patients (median 13 mm, IQR 6 – 26 versus median 20 mm, IQR 7 – 36, P=0.001), but not DOAC patients was smaller in the setting of confirmed therapeutic VKA. The frequency of radiological hemorrhagic transformation and symptomatic intracranial hemorrhage in OAC patients was low. Sensitivity analysis considering only patients with confirmed therapeutic anticoagulation did not change any of the results. Conclusion: Preceding DOAC treatment showed equal rates of LVO and infarct size as compared to VKA in AIS patients. This study adds to the knowledge of imaging findings in AIS patients with preceding anticoagulation.

Cerebral Lesion Topography in Spasticity following ischemic Stroke

2010 ◽  
Vol 41 (01) ◽  
Author(s):  
P Urban ◽  
T Wolf ◽  
M Uebele ◽  
J Marx ◽  
P Stoeter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Lesion ◽  
Lesion Topography

Vergleich von Blutfluß und Benzodiazepin-Rezeptorverteilung bei fokaler Epilepsie: Vorläufige Ergebnisse einer SPECT-Studie

1989 ◽  
Vol 28 (05) ◽  
pp. 181-186
Author(s):  
A. Ludolph ◽  
O. Schober ◽  
G. Lottes ◽  
I. Böttger ◽  
H.-F. Beer ◽  
...  
Keyword(s):  
Human Brain ◽  
Receptor Binding ◽  
Brain Area ◽  
Brain Perfusion ◽  
Partial Epilepsy ◽  
Cerebral Lesion ◽  
Receptor Ligand ◽  
Receptor Mapping ◽  
Hmpao Spect ◽  
99Mtc Hmpao

99mTc-HMPAO-SPECT and SPECT with the 123I-labelled benzodiazepine (Bz) receptor ligand Ro 16-0154 were performed in 10 patients suffering from partial epilepsy, without cerebral lesion in MRT or CT. 2 h p.i. of Ro 16-0154 the distribution of activity correlated with the known distribution of Bz- receptors in the human brain. Perfusion and receptor-binding were found decreased in 7 patients of each study in the suspicious brain-area. 123l-labelled Ro 16-0154 is suitable for Bz-receptor mapping by SPECT. The decrease of Bz-receptor binding in epileptic foci, as described in PET-studies, was also detected by SPECT in 7 of 10 patients.

scholarly journals Combined Perfusion and Permeability Imaging Reveals Different Pathophysiologic Tissue Responses After Successful Thrombectomy

2021 ◽  
Author(s):  
Arne Potreck ◽  
Matthias A. Mutke ◽  
Charlotte S. Weyland ◽  
Johannes A. R. Pfaff ◽  
Peter A. Ringleb ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Blood Brain Barrier ◽  
Hemorrhagic Transformation ◽  
Brain Barrier ◽  
Dynamic Susceptibility ◽  
Blood Brain Barrier Disruption ◽  
Flow Maps ◽  
Blood Brain ◽  
Patients At Risk ◽  
Brain Barrier Disruption

AbstractDespite successful recanalization of large-vessel occlusions in acute ischemic stroke, individual patients profit to a varying degree. Dynamic susceptibility-weighted perfusion and dynamic T1-weighted contrast-enhanced blood-brain barrier permeability imaging may help to determine secondary stroke injury and predict clinical outcome. We prospectively performed perfusion and permeability imaging in 38 patients within 24 h after successful mechanical thrombectomy of an occlusion of the middle cerebral artery M1 segment. Perfusion alterations were evaluated on cerebral blood flow maps, blood-brain barrier disruption (BBBD) visually and quantitatively on ktrans maps and hemorrhagic transformation on susceptibility-weighted images. Visual BBBD within the DWI lesion corresponded to a median ktrans elevation (IQR) of 0.77 (0.41–1.4) min−1 and was found in all 7 cases of hypoperfusion (100%), in 10 of 16 cases of hyperperfusion (63%), and in only three of 13 cases with unaffected perfusion (23%). BBBD was significantly associated with hemorrhagic transformation (p < 0.001). While BBBD alone was not a predictor of clinical outcome at 3 months (positive predictive value (PPV) = 0.8 [0.56–0.94]), hypoperfusion occurred more often in patients with unfavorable clinical outcome (PPV = 0.43 [0.10–0.82]) compared to hyperperfusion (PPV = 0.93 [0.68–1.0]) or unaffected perfusion (PPV = 1.0 [0.75–1.0]). We show that combined perfusion and permeability imaging reveals distinct infarct signatures after recanalization, indicating the severity of prior ischemic damage. It assists in predicting clinical outcome and may identify patients at risk of stroke progression.

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