scholarly journals Hemorrhagic Transformation (HT) and Symptomatic Intracerebral Hemorrhage (sICH) Risk Prediction Models for Postthrombolytic Hemorrhage in the Stroke Belt

ISRN Stroke ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
James E. Siegler ◽  
Muhammad Alvi ◽  
Amelia K. Boehme ◽  
Michael J. Lyerly ◽  
Karen C. Albright ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Prediction Models ◽  
Hemorrhagic Transformation ◽  
Small Sample ◽  
Entire Cohort ◽  
Intravenous Tissue Plasminogen Activator ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stroke Belt ◽  
Iv Tpa

Background. Symptomatic intracerebral hemorrhage (sICH) remains the most feared complication of intravenous tissue plasminogen activator (IV tPA) treatment. We aimed to investigate how previously validated scoring methodologies would perform in treated patients in two US Stroke Belt states. Methods and Results. We retrospectively reviewed consecutive patients from two centers in two Stroke Belt states who received IV tPA (2008–2011). We assessed the ability of three models to predict sICH. sICH was defined as a type 2 parenchymal hemorrhage with deterioration in National Institutes of Health Stroke Scale (NIHSS) score of ≥4 points or death. Among 457 IV tPA-treated patients, 19 (4.2%) had sICH (mean age 68, 26.3% Black, 63.2% female). The Cucchiara model was most predictive of sICH in the entire cohort (AUC: 0.6528) and most predictive of sICH among Blacks (OR = 6.03, 95% CI 1.07–34.1, P=0.0422) when patients were dichotomized by score. Conclusions. In our small sample from the racially heterogeneous US Stroke Belt, the Cucchiara model outperformed the other models at predicting sICH. While predictive models should not be used to justify nontreatment with thrombolytics, those interested in understanding contributors to sICH may choose to use the Cucchiara model until a Stroke Belt model is developed for this region.

Abstract TP138: SITS Symptomatic Intracerebral Hemorrhage Risk Score in the Stroke Belt

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Muhammad Alvi ◽  
Amelia K Boehme ◽  
Michael J Lyerly ◽  
James E Siegler ◽  
Karen C Albright ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Risk Score ◽  
Predictive Ability ◽  
Clinical Score ◽  
Symptomatic Intracerebral Hemorrhage ◽  
The Us ◽  
Hemorrhage Risk ◽  
Stroke Belt ◽  
Iv Tpa

Background: sICH remains the most feared complication of IV tPA treatment. SITS investigators developed a clinical score to predict sICH in European stroke patients. We aimed to investigate the how this score would perform in IV tPA treated patients at two centers in the US Stroke Belt. Methods: We retrospectively reviewed IV tPA treated consecutive patients from two centers in the Stroke Belt (2008-2011). The SITS Symptomatic Intracerebral Hemorrhage Risk Score was calculated using published criteria . sICH was defined as a type 2 parenchymal hemorrhage with deterioration in NIHSS score of 4 points or death. Only patients with all 9 variables needed to calculate the SITS sICH scores were included. Logistic regression was used to investigate the predictive ability of the score. Results: During the study period, 457 patients were treated with IV tPA (sICH 4.2%). Among the 220 patients with all 9 variables, 19 (8.6%) had sICH. The SITS sICH scores and other variables are shown in the Table. SITS score was not a predictor of sICH in overall patient sample (OR=1.16, 95% CI 0.856-1.57, p=0.3387). The score performed poorly in Blacks (OR 1.18, 95% CI 0.79-1.77, p=0.417) as compared to Whites (OR 1.19, 95% CI 0.77-1.82, p=0.438) for prediction of sICH, Figure. However, SITS score was predictive of mRS 4-6 at discharge (OR=1.34, 95% CI 1.16-1.55, p<0.001). Conclusions: SITS sICH score was not predictive of sICH in Stroke Belt patients, particularly among Blacks. The specific components of the 9 variable score needs to be re-evaluated individually for point estimates specific for the Stroke Belt population.

Abstract WMP78: Investigating the Utility of Previously Developed Prediction Scores in AIS patients in the Stroke Belt

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Pawan V Rawal ◽  
Amelia K Boehme ◽  
Reza Bavarsad Shahripour ◽  
Paola Palazzo ◽  
Karen C Albright ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Scoring Systems ◽  
Roc Curves ◽  
Stroke Patients ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Baseline Characteristics ◽  
Stroke Belt ◽  
Iv Tpa

Background: A number of scoring systems have been developed in different geographic and treatment populations, however, it remains unknown how these scores perform in the Stroke Belt population. We sought to validate and assess the utility of the SEDAN, THRIVE, HIAT and HIAT2 scoring systems among patients receiving systemic (IV tPA) and endovascular (IAT) reperfusion. Methods: We retrospectively reviewed all IV tPA and IAT patients presenting to our tertiary care center from 2009-2011. The scores were assessed in IV tPA only patients, IAT only patients and in patients who received both therapies (IV-IA). We tested THRIVE for predicting mRS 3-6, HIAT and HIAT2 for mRS 4-6, and SEDAN for symptomatic intracerebral hemorrhage (sICH). sICH was defined as a Type 2 parenchymal hemorrhage with deterioration in NIHSS score of 4 points or death. ROC curves were used to evaluate each score within the three groups. Result: Of the 366 patients who were included in this study, 89 had IAT only, 243 had IV tPA only and 34 had IV-IA. Figure 1a shows their demographic and baseline characteristics. Figure 1b shows the performance of SEDAN, THRIVE, HIAT and HIAT2 scores in our population (ROC range from 0.512-0.818). Conclusion: The two scores developed in the Stroke Belt, HIAT and HIAT2, performed well in the patient group for which they were developed (IAT). Additionally, they are also good predictors in other groups (IV and IV-IA). THRIVE performed well for predicting mRS 3-6 in all three groups. SEDAN was only moderately useful in predicting sICH after IV tPA. SEDAN had poor predictive value in IAT and IV-IA. These results highlight the need for validating clinical scores in different patient populations to determine their generalizability to all stroke patients.

scholarly journals Artificial neural network based prediction of postthrombolysis intracerebral hemorrhage and death

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Chen-Chih Chung ◽  
Lung Chan ◽  
Oluwaseun Adebayo Bamodu ◽  
Chien-Tai Hong ◽  
Hung-Wen Chiu
Keyword(s):  
Neural Network ◽  
Artificial Neural Network ◽  
Intracerebral Hemorrhage ◽  
Predictive Model ◽  
Sensitivity And Specificity ◽  
Characteristic Curve ◽  
Intravenous Tissue Plasminogen Activator ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Ann Models ◽  
Artificial Neural

AbstractDespite the salient benefits of the intravenous tissue plasminogen activator (tPA), symptomatic intracerebral hemorrhage (sICH) remains a frequent complication and constitutes a major concern when treating acute ischemic stroke (AIS). This study explored the use of artificial neural network (ANN)-based models to predict sICH and 3-month mortality for patients with AIS receiving tPA. We developed ANN models based on evaluation of the predictive value of pre-treatment parameters associated with sICH and mortality in a cohort of 331 patients between 2009 and 2018. The ANN models were generated using eight clinical inputs and two outputs. The generalizability of the model was validated using fivefold cross-validation. The performance of each model was assessed according to the accuracy, precision, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). After adequate training, the ANN predictive model AUC for sICH was 0.941, with accuracy, sensitivity, and specificity of 91.0%, 85.7%, and 92.5%, respectively. The predictive model AUC for 3-month mortality was 0.976, with accuracy, sensitivity, and specificity of 95.2%, 94.4%, and 95.5%, respectively. The generated ANN-based models exhibited high predictive performance and reliability for predicting sICH and 3-month mortality after thrombolysis; thus, its clinical application to assist decision-making when administering tPA is envisaged.

Abstract WP84: Thrombolysis is Safe in the Nonagenarians With Acute Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Tapan Abrol ◽  
Zeeshan Hussain ◽  
Varun Chaubal ◽  
Gaurav Dighe ◽  
Muhammad F Bilal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Multiple Logistic Regression Analysis ◽  
Discharge Disposition ◽  
Intravenous Tissue Plasminogen Activator ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Tissue Plasminogen ◽  
History Of ◽  
Symptomatic Intracranial Hemorrhage ◽  
Iv Tpa

Introduction: People aged 90 years or older are the fastest growing group in North America. This group was excluded from traditional clinical trials of intravenous tissue plasminogen activator (iv tPA) thrombolysis. IV tPA is the most beneficial emergent therapy in acute ischemic stroke (AIS). We have compassionately treated AIS patients in this age group with iv tPA in recent years. Hypothesis: Our aim is to evaluate the safety and outcome of iv tPA use in nonagenarian patients with AIS Methods: Consecutively iv tPA-treated AIS patients who were older than 90 years and were admitted at our institution from January 2004-June 2015 were included. The administration of iv tPA was within 3 hours after the stroke onset. We reviewed the clinical features of the patients at presentation, complications, and outcomes. Outcome measures at discharge included improvement of NIHSS, mRS, symptomatic intracranial hemorrhage (sICH), and discharge disposition. We also assessed the rate of complications of iv tPA. Multiple logistic regression analysis was used to evaluate association between the outcome versus the severity of stroke, or versus pre-stroke dependence. Results: A total of 35 AIS patients who were 90 years or older (female 80%; and median age 93 years old) were treated with iv tPA. At baseline twenty-two patients (62.9%) had a history of atrial fibrillation without anticoagulation, and more than half (20/35) patients needed assistance for gait instability, but they were otherwise functional. Median NIHSS on admission was 16 (IQR 9-22). Two patients (5.7%) had symptomatic intracerebral hemorrhage. At discharge the median NIHSS was 10 (IQR 1-19). Ten patients (28.6%) had favorable outcome (mRS ≤ 2) while sixteen patients (45.7%) had good outcome (mRS ≤ 3). Four patients were discharged home and 16 patients went to rehabilitation facility. Fifteen patients (42.9%) succumbed to cardio-pulmonary failure or were discharged to hospice. Mild AIS patients (NIHSS <7) had better outcomes (p < 0.05). The pre-existing dependence (mRS ≥3) did not predict poor outcome. Conclusion: It is safe to administer iv tPA to AIS patients who are 90 years or older although the benefits are less robust compared to younger patients. Patients with milder deficits had more favorable outcomes.

scholarly journals Intravenous Tissue Plasminogen Activator in Combination With Mechanical Thrombectomy: Clot Migration, Intracranial Bleeding, and the Impact of “Drip and Ship” on Effectiveness and Outcomes

2020 ◽  
Vol 11 ◽  
Author(s):  
Adam Chang ◽  
Elham Beheshtian ◽  
Edward J. Llinas ◽  
Oluwatoyin R. Idowu ◽  
Elisabeth B. Marsh
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Mechanical Thrombectomy ◽  
Hemorrhagic Transformation ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
The Impact ◽  
Iv Tpa

Purpose: Intravenous tissue plasminogen activator (tPA) is indicated prior to mechanical thrombectomy (MT) to treat large vessel occlusion (LVO). However, administration takes time, and rates of clot migration complicating successful retrieval and hemorrhagic transformation may be higher. Given time-to-effectiveness, the benefit of tPA may vary significantly based on whether administration occurs at a thrombectomy-capable center or transferring hospital.Methods: We prospectively evaluated 170 individuals with LVO involving the anterior circulation who underwent MT at our Comprehensive Stroke Center over a 3.5 year period. Two thirds (n = 114) of patients were admitted through our Emergency Department (ED). The other 33% were transferred from outside hospitals (OSH). Patients meeting criteria were bridged with IV tPA; the others were treated with MT alone. Clot migration, recanalization times, TICI scores, and hemorrhage rates were compared for those bridged vs. treated with MT alone, along with modified Rankin scores (mRS) at discharge and 90-day follow-up. Multivariable regression was used to determine the relationship between site of presentation and effect of tPA on outcomes.Results: Patients presenting to an OSH had longer mean discovery to puncture/recanalization times, but were actually more likely to receive IV tPA prior to MT (70 vs. 42%). The rate of clot migration was low (11%) and similar between groups, though slightly higher for those receiving IV tPA. There was no difference in symptomatic ICH rate after tPA. TICI scores were also not significantly different; however, more patients achieved TICI 2b or higher reperfusion (83 vs. 67%, p = 0.027) after tPA, and TICI 0 reperfusion was seen almost exclusively in patients who were not treated with tPA. Those bridged at an OSH required fewer passes before successful recanalization (2.4 vs. 1.6, p = 0.037). Overall, mean mRS scores on discharge and at 90 days were significantly better for those receiving IV tPA (3.9 vs. 4.6, 3.4 vs. 4.4 respectively, p ~ 0.01) and differences persisted when comparing only patients recanalized in under 6 h.Conclusion: Independent of site of presentation, IV tPA before MT appears to lead to better radiographic outcomes, without increased rates of clot migration or higher intracranial hemorrhage risk, and overall better functional outcomes.

scholarly journals Hypointense Transcerebral Veins at T2∗-Weighted MRI: A Marker of Hemorrhagic Transformation Risk in Patients Treated with Intravenous Tissue Plasminogen Activator

2003 ◽  
Vol 23 (11) ◽  
pp. 1362-1370 ◽  
Author(s):  
Marc Hermier ◽  
Norbert Nighoghossian ◽  
Laurent Derex ◽  
Patrice Adeleine ◽  
Marlène Wiart ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Cerebral Blood Volume ◽  
Volume Ratio ◽  
Hemorrhagic Transformation ◽  
Tissue Type ◽  
Cerebral Veins ◽  
Mri Findings ◽  
Intravenous Tissue Plasminogen Activator ◽  
Magnetic Resonance Imaging Mri

Prediction of hemorrhagic transformation (HT) in patients treated by intravenous recombinant tissue-type plasminogen activator (rt-PA) is a challenging issue in acute stroke management. HT may be correlated with severe hypoperfusion. Signal changes may be observed at susceptibility-weighted magnetic resonance imaging (MRI) within large perfusion defects. A signal drop within cerebral veins at T2∗-weighted gradient-echo MRI may be expected in severe ischemia, and may indicate subsequent risk of HT. The authors prospectively searched for an abnormal visibility of transcerebral veins (AVV) within the ischemic area in patients with hemispheric ischemic stroke, before they were treated with intravenous rt-PA therapy. Any correlation between AVV and baseline clinical or MRI findings, or further HT, was noted. An AVV was present in 23 of 49 patients (obvious, n = 8; moderate, n = 15), and was supported by severe hemodynamic changes at baseline MRI. The AVV was correlated with the occurrence of parenchymal hematoma type 2 at computed tomography during the first week ( r = 0.44, P = 0.002). Five of six type 2 parenchymal hematomas occurred in association with obvious AVV. At multiple regression analysis, two baseline MRI factors had an independent predictive value for HT risk during the first week: the AVV and the cerebral blood volume ratio (Nagelkerke R2 = 0.48).

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