scholarly journals Improving the Evaluation of Collateral Circulation by Multiphase Computed Tomography Angiography in Acute Stroke Patients Treated with Endovascular Reperfusion Therapies

2016 ◽  
Vol 5 (3-4) ◽  
pp. 209-217 ◽  
Author(s):  
Alvaro García-Tornel ◽  
Vanessa Carvalho ◽  
Sandra Boned ◽  
Alan Flores ◽  
David Rodríguez-Luna ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Stroke ◽  
Computed Tomography Angiography ◽  
Collateral Circulation ◽  
Infarct Volume ◽  
National Institutes Of Health ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
The Mean ◽  
Mean Time

Good collateral circulation (CC) is associated with favorable outcomes in acute stroke, but the best technique to evaluate collaterals is controversial. Single-phase computed tomography angiography (sCTA) is widely used but lacks temporal resolution. We aim to compare CC evaluation by sCTA and multiphase CTA (mCTA) as predictors of outcome in endovascular treated patients. Methods: Consecutive endovascular treated patients with M1 middle cerebral artery (MCA) or terminal intracranial carotid artery (TICA) occlusion confirmed by sCTA were included. Two more CTA acquisitions with 8- and 16-second delays were performed for mCTA. Endovascular thrombectomy was performed independently of the CC status according to a local protocol [Alberta Stroke Program Early CT score (ASPECTS) >6, modified Rankin scale (mRS) score <3]. CC on sCTA and mCTA were compared. Results: 108 patients were included. Their mean age was 69.6 ± 13 years and their median National Institutes of Health Stroke Scale (NIHSS) score was 17 (interquartile range 8). 79 (73.1%) had M1 MCA and 29 (26.9%) TICA occlusions. The mean time from symptom onset to CTA was 146.8 ± 96.5 min. On sCTA, 50.9% patients presented good CC vs. 57.5% on mCTA. Good CC status in both sCTA and mCTA had a lower 24-hour infarct volume (27.4 vs. 74.8 cm3 on sCTA, p = 0.04; 17.2 vs. 97.8 cm3 on mCTA, p < 0.01). However, only good CC on mCTA was associated with lower 24-hour (5 vs. 8.5, p = 0.04) and median discharge NIHSS (2 vs. 4.5, p = 0.04) scores and functional independency (mRS score <3) at 3 months (76.9 vs. 23.1%, p < 0.01). In a logistic regression model including age, NIHSS, ASPECTS and recanalization, only age (OR 0.96, 95% CI 0.93-0.99, p = 0.02) and good CC on mCTA (OR 5, 95% CI 1.99-12.6, p < 0.01) were independent predictors of functional outcome at 3 months. Conclusion: CC evaluation by mCTA is a better prognostic marker than CC evaluation by sCTA for clinical and functional endpoints in acute stroke patients treated with endovascular thrombectomy.

Abstract WP40: Quick CT Perfusion Evaluation of Leptomeningeal Collateral Circulation: Single Cortical CBV-ROI

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Marta Rubiera ◽  
Alvaro Garcia-Tornell ◽  
Sandra Boned ◽  
Nicolas Romero ◽  
Pilar Coscojuela ◽  
...  
Keyword(s):  
Collateral Circulation ◽  
Ct Perfusion ◽  
Infarct Volume ◽  
Accurate Information ◽  
Outcome Predictor ◽  
Stroke Patients ◽  
Quick Method ◽  
Accurate Evaluation ◽  
The Mean ◽  
Contrast Ct

Good collateral circulation (CC) is a strong outcome predictor in acute stroke patients. CT angiography (CTA) is wide-world available but does not provide accurate information about parenchymal status. CT perfusion (CTP) is frequently used to determine ischemic core and tissue at risk. Our aim was to identify an easy and quick method to evaluate CC status by CTP. Methods: Consecutive ischemic stroke patients <8h from symptoms onset evaluated for reperfusion therapies were studied. Non-contrast CT, CTP and multiphase CTA were performed. Patients with confirmed M1-MCA or TICA occlusion on CTA were included. CC evaluation was determined by multiphase CTA (mCTA) according to the Calgary CC Scale and classified as poor (grades 0-2) or good (grades 3-5). In CTP maps, one single ipsi- and contralateral regions of interest (ROI) were defined in the MCA cortical territory (M4, M5, M6). We studied the association of absolute and relative to contralateral ROI-CTP values with CC degree determined by mCTA. Results: 33 patients were included, median NIHSS 17.5 (2-22). Twenty-five patients (75.8%) presented a M1 and 8 (24.2%) a TICA occlusion. On mCTA, 27 (81.8%) patients presented with a favourable CC status and 6 (18.2%) with poor CC. Mean ROI values in the ischemic MCA territory were: CBV 3.5±1.5 ml/100mg, CBF 46.9±29.3 ml/100mg/min, MTT 8.1±3.1 s, Tmax 23.2±4.4 s. In the contralateral non-ischemic MCA, the mean ROI values were: CBV 3.48±1.4, CBF 66.5±32.7, MTT 5.6±2.3, Tmax 20.4±4.8. Absolute and relative CBV-ROI data (relCBV= ischemic CBV value / contralateral CBV value) were the only values significantly associated with CC status on mCTA (good CC mean CBV: 3.8 ml/100g VS poor CC mean CBV: 1.9, p=0.006; good CC mean relCBV 1.1 vs poor CC mean relCBV 0.6, p=0.019). A ROC curve defined 2.5 ml/100mg as the better cut-off point of ROI-CBV that identified patients with good CC status (sensitivity 96%, specificity 84%, VPP 0.96, VPN 0.83). Patients with a ROI-CBV >2.5 presented lower median NIHSS after 24 hours (4 vs 18, p= 0.012) and smaller mean infarct volume on control CT (27.9 vs 88.3, p=0.021). Conclusion: A single cortical ROI-CBV allows an easy and quick accurate evaluation of collateral circulation in CTP. ROI-CBV>2.5 ml/100mg is related to good clinical and radiological outcomes.

scholarly journals Mobile Stroke Unit Computed Tomography Angiography Substantially Shortens Door-to-Puncture Time

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1613-1615 ◽  
Author(s):  
Alexandra L. Czap ◽  
Noopur Singh ◽  
Ritvij Bowry ◽  
Amanda Jagolino-Cole ◽  
Stephanie A. Parker ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Stroke Unit ◽  
Interquartile Range ◽  
National Institutes Of Health ◽  
Unique Identifier ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Unit Management ◽  
Mobile Stroke Unit

Background and Purpose— Endovascular thrombectomy (ET) door-to-puncture time (DTPT) is a modifiable metric. One of the most important, yet time-consuming steps, is documentation of large vessel occlusion by computed tomography angiography (CTA). We hypothesized that obtaining CTA on board a Mobile Stroke Unit and direct alert of the ET team shortens DTPT by over 30 minutes. Methods— We compared DTPT between patients having CTA onboard the Mobile Stroke Unit then subsequent ET from September 2018 to November 2019 and patients in Mobile Stroke Unit from August 2014 to August 2018, when onboard CTA was not yet being used. We also correlated DTPT with change in National Institutes of Health Stroke Scale between baseline and 24 hours. Results— Median DTPT was 53.5 (95% CI, 35–67) minutes shorter with onboard CTA and direct ET team notification: 41 minutes (interquartile range, 30.0–63.5) versus 94.5 minutes (interquartile range, 69.8–117.3; P <0.001). Median on-scene time was 31.5 minutes (interquartile range, 28.8–35.5) versus 27.0 minutes (interquartile range, 23.0–31.0) ( P <0.001). Shorter DTPT correlated with greater improvement of National Institutes of Health Stroke Scale (correlation=−0.2, P =0.07). Conclusions— Prehospital Mobile Stroke Unit management including on-board CTA and ET team alert substantially shortens DTPT. Registration— URL: https://clinicaltrials.gov ; Unique identifier: NCT02190500.

Spatial Analysis of Geographic Distribution and Accessibility of Suspected Acute Stroke Patients Transferred to Acute Stroke Centers by Emergency Medical Services in Tehran, Iran: A Cross-Sectional Study

2020 ◽  
Vol 22 (7) ◽  
Author(s):  
Pir-Hossein Kolivand ◽  
Hassanali Faraji Sabokbar ◽  
Peyman Saberian ◽  
Mahdi Bahmanabadi ◽  
Parisa Hasani-Sharamin ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Cross Sectional Study ◽  
Time Of Arrival ◽  
Sectional Study ◽  
Stroke Patients ◽  
The West ◽  
Cross Sectional ◽  
The Mean ◽  
Stroke Center ◽  
Mean Time

Objectives: We intended to map the geographical distribution of patients with acute stroke who called the Tehran EMS center based on the geographic information of the incident location on a map. The distributions of these centers and patients’ access within a standard period were evaluated. Methods: A cross-sectional study based on the registered data was conducted on suspected acute stroke patients > 18 years of age that were transferred by EMS. The analysis was performed based on pointing the patients’ locations and locating the hospitals in ArcGIS software plus a review of the polygons and focal points. Results: Totally, 1,606 patients suspected to stroke with a mean age of 64.89 ± 17.48 years were evaluated, of whom 947 (58.6%) were male. The mean time of arrival of an ambulance in the patient’s location from the EMS station was 11.94 ± 6.67 minutes, and the longest time was 69.32 minutes. The mean time from the patient’s location to the stroke center was 17.79 ± 11.42 minutes (range 2.4 - 83.70 minutes). Stroke centers in Tehran are not distributed in a balanced manner, and they are concentrated on the central and northern parts of Tehran, limiting access to hospital services. Conclusions: The multiplicity of hospitals in the west and center of Tehran led to an increase in access times in eastern Tehran. It emphasizes the necessity of revision of service locating, especially because the east of Tehran has a denser texture than the west.

Abstract WP338: A Prospective Study of Post-thrombolysis related coagulopathy in Acute Ischemic Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nicholas Osteraas ◽  
Shawna Cutting ◽  
Laurel Cherian ◽  
James Conners ◽  
Sarah Song ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Degradation Products ◽  
International Normalized Ratio ◽  
National Institutes Of Health ◽  
Mean Deviation ◽  
Stroke Patients ◽  
Patient Demographics ◽  
Intravenous Tissue Plasminogen Activator ◽  
A Prospective Study ◽  
Mean Time

Introduction: Although alterations in fibrinogen and fibrinogen degradation products are well-established after intravenous tissue plasminogen activator (IVtPA) in acute stroke, IVtPA is not recognized to cause markedly abnormal international normalized ratio (INR). Methods: With IRB approval, we prospectively screened 99 consecutive acute stroke patients who received IVtPA admitted from November 1, 2015 to July 1, 2016. Laboratory tests including INR, activated partial thromboplastin time (aPTT), fibrinogen, and d-Dimer were drawn at intervals of 6, 12, 24, and 48 hours. Data was collected on patient demographics, last known normal (LKN), IVtpA dose and timing, and National Institutes of Health Stroke Scale (NIHSS). Post-IVtPA coagulopathy was defined as INR ≥ 1.5. Reference range for fibrinogen was 190 - 395 mg/dL. Results: Among 44 patients prospectively enrolled, the mean age was 66.5 years (range, 32 to 91). Mean time from LKN to IVtPA administration was 2.6 hours (range 0.07 to 10.8). Initial pre-IVTPA mean NIHSS was 14 (range, 3 to 26) and 24 hour mean NIHSS was 7.4, (range 0 to 30). Mean pre-IVtPA INR was 1.05 (range, 0.9 to 1.4). Mean peak post-IVtPA INR was 1.28 (range 1.01 to 3.08). Mean deviation of actual to ideal IVtPA dose was 1.02 mg (range, 22.9 to 14.4). Post IVtPA coagulopathy occurred in 6 patients (14%), with peak INR noted at a mean of 13 hours after IVtPA administration (range, 5.6 to 18.6). Five patients of the six (83%) with post IVtPA coagulopathy had low fibrinogen, and mean fibrinogen nadir was 97 mg/dL (range, 37 to 242). Post-IVtPA coagulopathy was not significantly associated with initial NIHSS, 24 hour NIHSS, LKN to IVtPA time, or deviation of actual IVtPA dose from ideal dose. Conclusion: Post-IVtpA coagulopathy occurs in 14% of patients when studied prospectively and is associated with hypofibrinogenemia, but does not appear to correlate with severity of stroke or IVtPA dosing/timing.

scholarly journals Validation of a Dysphagia Screening Tool in Acute Stroke Patients

2010 ◽  
Vol 19 (4) ◽  
pp. 357-364 ◽  
Author(s):  
Jeff Edmiaston ◽  
Lisa Tabor Connor ◽  
Lynda Loehr ◽  
Abdullah Nassief
Keyword(s):  
Acute Stroke ◽  
Health Care Professionals ◽  
Screening Tool ◽  
Tertiary Care ◽  
Screening Tools ◽  
Care Hospital ◽  
Stroke Patients ◽  
Aspiration Risk ◽  
The Mean ◽  
Mean Time

Background Although many dysphagia screening tools exist, none has high sensitivity and reliability or can be administered quickly with minimal training. Objective To design and validate a swallowing screening tool to be used by health care professionals who are not speech language pathologists to identify dysphagia and aspiration risk in acute stroke patients. Methods In a prospective study of 300 patients admitted to the stroke service at an urban tertiary care hospital, interrater and test-retest reliabilities of a new tool (the Acute Stroke Dysphagia Screen) were established. The tool was administered by nursing staff when patients were admitted to the stroke unit. A speech language pathologist blinded to the results with the new tool administered the Mann Assessment of Swallowing Ability, a clinical bedside evaluation, with dysphagia operationally defined by a score less than 178. Results The mean time from admission to screening with the new tool was 8 hours. The mean time between administration of the new tool and the clinical bedside evaluation was 32 hours. For the new tool, interrater reliability was 93.6% and test-retest reliability was 92.5%. The new tool had a sensitivity of 91% and a specificity of 74% for detecting dysphagia and a sensitivity of 95% and a specificity of 68% for detecting aspiration risk. Conclusions The Acute Stroke Dysphagia Screen is an easily administered and reliable tool that has sufficient sensitivity to detect both dysphagia and aspiration risk in acute stroke patients.

scholarly journals Impact of COVID-19 on Acute Stroke Presentation in a Designated COVID-19 Hospital

2021 ◽  
Vol 12 ◽  
Author(s):  
Qing Tan ◽  
Qing-Jun Liu ◽  
Wen-Hui Fan ◽  
Xiao-Yan Du ◽  
Lin Wu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Hemorrhagic Stroke ◽  
Surgical Operation ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Patient Arrival ◽  
The Mean ◽  
Set Up ◽  
Mean Time

Objectives: Thousands of designated COVID-19 hospitals have been set up in China to fight the ongoing COVID-19 pandemic. Anecdotal reports indicate a falling rate of acute stroke diagnoses in these hospitals during the COVID-19 period. We conducted an exploratory single-center analysis to estimate the change in acute stroke presentation at the designated COVID-19 hospitals.Methods: This retrospective observational study included all patients admitted to Yongchuan Hospital Affiliated to Chongqing Medical University with acute stroke between January 24 and March 10, 2020. Patient demographics, characteristics of the stroke, treatment details, and clinical outcomes were compared with those of patients admitted in the corresponding period in the year before (2019, “the pre-COVID-19 period”). Subgroup analysis was performed in the ischemic and hemorrhagic stroke groups.Results: A total of 110 patients presented with acute stroke symptoms during the COVID-19 pandemic, compared with 173 patients in the pre-COVID-19 period. A higher proportion of stroke patients presented to the hospital via emergency medical services during the pandemic (48.2 vs. 31.8%, p = 0.006). There was a lower proportion of ischemic stroke patients (50.9 vs. 65.3%, p = 0.016) than in the preceding year. There were significantly fewer patients with 90-day modified Rankin Scale score ≥3 in the COVID-19 period compared with the pre-COVID-19 period (17.3 vs. 30.6%, p = 0.012). Among patients with ischemic stroke, the mean time from patient arrival to vessel puncture for emergency endovascular therapy in the COVID-19 period was shorter than that in the pre-COVID-19 period (109.18 ± 71.39 vs. 270.50 ± 161.51 min, p = 0.002). Among patients with hemorrhagic stroke, the rate of emergency surgical operation in the COVID-19 period was higher than that in the pre-COVID-19 period (48.1 vs. 30.0%, p = 0.047). The mean time from patient arrival to emergency surgical operation (15.31 ± 22.89 vs. 51.72 ± 40.47 min, p = 0.002) was shorter in the COVID-19 period than in the pre-COVID-19 period.Conclusions: Although fewer acute stroke patients sought medical care in this designated COVID-19 hospital during the COVID-19 pandemic, this type of hospital was more efficient for timely treatment of acute stroke. Recognizing how acute strokes presented in designated COVID-19 hospitals will contribute to appropriate adjustments in strategy for dealing with acute stroke during COVID-19 and future pandemics.

Mid-aortic syndrome: computed tomography angiography depicting extensive collateral circulation in an 11-year-old patient with thoracoabdominal aortic coarctation

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 132-135 ◽  
Author(s):  
Krohn ◽  
Gebauer ◽  
Hübler ◽  
Beck
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Collateral Circulation ◽  
Intestinal Ischemia ◽  
Clinical Presentation ◽  
Lower Limbs ◽  
Upper Body ◽  
Descending Aorta ◽  
Before And After ◽  
Blood Pressures

The mid-aortic syndrome is an uncommon clinical condition characterized by severe narrowing of the descending aorta, usually with involvement of its renal and visceral branches, presenting with uncontrollably elevated blood pressures of the upper body, renal and cardiac failure, intestinal ischemia, encephalopathy symptoms and claudication of the lower limbs, although clinical presentation is variable. In this article we report the case of an eleven-year-old patient with the initial diagnosis of a mid-aortic syndrome and present the computed tomography angiography pictures and reconstructions before and after surgical therapy.

Do methods of hospital pre-alerts influence the on-scene times for acute pre-hospital stroke patients? A retrospective observational study

2021 ◽  
Vol 6 (2) ◽  
pp. 19-25
Author(s):  
Jacob Gunn
Keyword(s):  
Standard Deviation ◽  
Observational Study ◽  
Acute Stroke ◽  
Ambulance Service ◽  
Time Saving ◽  
North East ◽  
Admission Policies ◽  
The Mean ◽  
Time Critical ◽  
Mean Time

Introduction: Stroke is one of the leading causes of death and disability worldwide. The ambulance service is often the first medical service to reach an acute stroke patient, and due to the time-critical nature of stroke, a time-critical assessment and rapid transport to a hyper acute stroke unit are essential. As stroke services have been centralised, different hospitals have implemented different pre-alert admission policies that may affect the on-scene time of the attending ambulance crew. The aim of this study is to investigate if the different pre-alert admission policies affect time on scene.Method: The current study is a retrospective quantitative observational study using data routinely collected by North East Ambulance Service NHS Foundation Trust. The time on scene was divided into two variables; group one was a telephone pre-alert in which a telephone discussion with the receiving hospital is required before they accept admission of the patient. Group two was a radio-style pre-alert in which the attending clinician makes an autonomous decision on the receiving hospital and alerts them via a short radio message of the incoming patient. These times were then compared to identify if there was any difference between them.Results: Data on 927 patients over a three-month period, from October to December 2019, who had received the full stroke bundle of care, were within the thrombolysis window and recorded as a stroke by the attending clinician, were split into the variable groups and reported on. The mean time on scene for a telephone call pre-alert was 33 minutes and 19 seconds, with a standard deviation of 13 minutes and 8 seconds. The mean on-scene time for a radio pre-alert was 28 minutes and 24 seconds, with a standard deviation of 11 minutes and 51 seconds.Conclusion: A pre-alert given via radio instead of via telephone is shown to have a mean time saving of 4 minutes and 55 seconds, representing an important decrease in time which could be beneficial to patients.

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