scholarly journals Associations of Ischemic Lesion Volume With Functional Outcome in Patients With Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (5) ◽  
pp. 1233-1240 ◽  
Author(s):  
Amber Bucker ◽  
Anna M. Boers ◽  
Joseph C.J. Bot ◽  
Olvert A. Berkhemer ◽  
Hester F. Lingsma ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Lesion Volume ◽  
Ischemic Lesion

scholarly journals Posttreatment Ischemic Lesion Evolution Is Associated With Reduced Favorable Functional Outcome in Patients With Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Praneeta Konduri ◽  
Henk van Voorst ◽  
Amber Bucker ◽  
Katinka van Kranendonk ◽  
Anna Boers ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Odds Ratio ◽  
Interaction Analysis ◽  
Univariate Analysis ◽  
Arterial Occlusion ◽  
Lesion Volume ◽  
Ischemic Lesion ◽  
Favorable Functional Outcome

Background and Purpose: Ischemic lesion volume can increase even 24 hours after onset of an acute ischemic stroke. In this study, we investigated the association of lesion evolution with functional outcome and the influence of successful recanalization on this association. Methods: We included patients from the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) who received good quality noncontrast CT images 24 hours and 1 week after stroke onset. The ischemic lesion delineations included infarct, edema, and hemorrhagic transformation. Lesion evolution was defined as the difference between the volumes measured on the 1-week and 24-hour noncontrast CTs. The association of lesion evolution with functional outcome was evaluated using unadjusted and adjusted logistic regression. Adjustments were made for baseline, clinical, and imaging parameters that were associated P <0.10) in univariate analysis with favorable functional outcome, defined as modified Rankin Scale score of ≤2. Interaction analysis was performed to evaluate the influence of successful recanalization, defined as modified Arterial Occlusion Lesion score of 3 points, on this association. Results: Of the 226 patients who were included, 69 (31%) patients achieved the favorable functional outcome. Median lesion evolution was 22 (interquartile range, 10–45) mL. Lesion evolution was significantly inversely correlated with favourable functional outcome: unadjusted odds ratio, 0.76 (95% CI, 0.66–0.86; per 10 mL of lesion evolution; P <0.01) and adjusted odds ratio: 0.85 (95% CI, 0.72–0.97; per 10 mL of lesion evolution; P =0.03). There was no significant interaction of successful recanalization on the association of lesion evolution and favorable functional outcome (odds ratio, 1.01 [95% CI, 0.77–1.36]; P =0.94). Conclusions: In our population, subacute ischemic lesion evolution is associated with unfavorable functional outcome. This study suggests that even 24 hours after onset of stroke, deterioration of the brain continues, which has a negative effect on functional outcome. This finding may warrant additional treatment in the subacute phase.

scholarly journals The Role of Edema in Subacute Lesion Progression After Treatment of Acute Ischemic Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Praneeta Konduri ◽  
Katinka van Kranendonk ◽  
Anna Boers ◽  
Kilian Treurniet ◽  
Olvert Berkhemer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Water Uptake ◽  
Infarct Volume ◽  
Lesion Volume ◽  
Ischemic Lesion ◽  
Contrast Ct ◽  
Mr Clean

Background: Ischemic lesions commonly continue to progress even days after treatment, and this lesion growth is associated with unfavorable functional outcome in acute ischemic stroke patients. The aim of this study is to elucidate the role of edema in subacute lesion progression and its influence on unfavorable functional outcome by quantifying net water uptake.Methods: We included all 187 patients from the MR CLEAN trial who had high quality follow-up non-contrast CT at 24 h and 1 week. Using a CT densitometry-based method to calculate the net water uptake, we differentiated total ischemic lesion volume (TILV) into edema volume (EV) and edema-corrected infarct volume (ecIV). We calculated these volumes at 24 h and 1 week after stroke and determined their progression in the subacute period. We assessed the effect of 24-h lesion characteristics on EV and ecIV progression. We evaluated the influence of edema and edema-corrected infarct progression on favorable functional outcome after 90 days (modified Rankin Scale: 0–2) after correcting for potential confounders. Lastly, we compared these volumes between subgroups of patients with and without successful recanalization using the Mann–Whitney U-test.Results: Median TILV increased from 37 (IQR: 18–81) ml to 68 (IQR: 30–130) ml between 24 h and 1 week after stroke, while the net water uptake increased from 22 (IQR: 16–26)% to 27 (IQR: 22–32)%. The TILV progression of 20 (8.8–40) ml was mostly caused by ecIV with a median increase of 12 (2.4–21) ml vs. 6.5 (2.7–15) ml of EV progression. Larger TILV, EV, and ecIV volumes at 24 h were all associated with more edema and lesion progression. Edema progression was associated with unfavorable functional outcome [aOR: 0.53 (0.28–0.94) per 10 ml; p-value: 0.05], while edema-corrected infarct progression showed a similar, non-significant association [aOR: 0.80 (0.62–0.99); p-value: 0.06]. Lastly, edema progression was larger in patients without successful recanalization, whereas ecIV progression was comparable between the subgroups.Conclusion: EV increases in evolving ischemic lesions in the period between 1 day and 1 week after acute ischemic stroke. This progression is larger in patients without successful recanalization and is associated with unfavorable functional outcome. However, the extent of edema cannot explain the total expansion of ischemic lesions since edema-corrected infarct progression is larger than the edema progression.

Impact of Collateral Status on Neuroprotective Effect of Cyclosporine A in Acute Ischemic Stroke

2019 ◽  
Vol 16 (2) ◽  
pp. 173-177
Author(s):  
Norbert Nighoghossian ◽  
Lucie Cornut ◽  
Camille Amaz ◽  
Omer Eker ◽  
Nathan Mewton ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cyclosporine A ◽  
Neuroprotective Effect ◽  
Additional Benefit ◽  
Lesion Volume ◽  
Dynamic Susceptibility ◽  
Collateral Flow ◽  
Dynamic Susceptibility Contrast ◽  
Ischemic Lesion

Background: Neuroprotection for acute ischemic stroke remains an elusive goal. Intracranial collaterals may favor neuroprotective drugs delivery at the acute stage of ischemic stroke. A recent phase 2 study showed that cyclosporine A (CsA) reduced ischemic damage in patients with a proximal occlusion who experienced effective recanalization. Collateral flow may improve this benefit. Materials & Methods: Collateral supply was assessed using dynamic susceptibility contrast MRI in 47 patients among the 110 patients from the original study and were graded in two groups: good collaterals and poor collaterals. Patients with good collaterals had significantly smaller initial infarct in both CsA group (p = 0.003) and controls (p = 0.016). Similarly, the final lesion volume was significantly lower in patients with good collaterals in both groups. Results: In patients with either good or poor collaterals CsA showed no additional benefit on ischemic lesion progression and final infarct size at day 30. Conclusion: We failed to demonstrate any significant additional benefit of CsA in patients with good collateral circulation.

Abstract P317: White Matter Hyperintensity Lesion Burden Modulates Functional Outcome After Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Anna K Bonkhoff ◽  
Sungmin Hong ◽  
Markus Schirmer ◽  
Martin Bretzner ◽  
Anne-Katrin Giese ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
White Matter Hyperintensity ◽  
Study Cohort ◽  
Stroke Severity ◽  
Ischemic Lesion ◽  
Long Term Outcome ◽  
Index Stroke

Introduction: As a radiographic signature of end-stage small vessel disease, white matter hyperintensity (WMH) burden impacts recovery and outcomes after acute ischemic stroke (AIS). In this study, we sought to investigate the effect of WMH volume (WMHv) on stroke severity and functional outcomes independent of the infarct size and topography. Methods: We analyzed 503 AIS patients with MRI data obtained on admission for index stroke enrolled in the multi-center MRI-GENIE study (cohort 1), followed by validation of the findings in an independent single-site study of 555 AIS patients (cohort 2). Stroke severity (NIHSS score) at index stroke and the long-term outcome (3-6 months mRS score) were modeled via Bayesian linear regression. Models included WMHv, age, sex, a 10-dimensional spatial ischemic lesion representation, acute infarct (DWI) volume, and common vascular risk factors (hypertension, diabetes mellitus, atrial fibrillation, coronary artery disease). Results: Cohorts did not differ significantly in major clinical characteristics [cohort 1: age: 65.0±14.6, 41% female, NIHSS: 5.5±5.4, mRS: 1(iqr 2); cohort 2: age: 65.0±14.8, 38% female, NIHSS: 5.0±6.0, mRS: 1(iqr 3), p >0.05 for all comparisons]. WMHv did not substantially affect AIS severity ( Fig A ); in contrast, it emerged as an independent predictor of functional outcome in both datasets ( Fig B ). Conclusions: When accounted for AIS lesion topography and stroke volume, total WMH lesion burden did not appear to modulate initial stroke severity but was associated with worse functional post-stroke outcomes. Future studies are needed to explore potential origins of these detrimental effects of pre-existing WMH burden on recovery after AIS.

scholarly journals Radiological predictors of hemorrhagic transformation after acute ischemic stroke: An evidence-based analysis

2020 ◽  
Vol 33 (2) ◽  
pp. 118-133 ◽  
Author(s):  
Nada Elsaid ◽  
Wessam Mustafa ◽  
Ahmed Saied
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion ◽  
Treatment Plan ◽  
Hemorrhagic Transformation ◽  
Lesion Volume ◽  
Ischemic Lesion ◽  
Blood Brain Barrier Disruption

Hemorrhagic transformation (HT) is one of the most common adverse events related to acute ischemic stroke (AIS) that affects the treatment plan and clinical outcome. Identification of a sensitive radiological marker may influence the controversial thrombolytic decision in the setting of AIS and may at a minimum indicate more intensive monitoring or further prophylactic interventions. In this article we summarize possible radiological biomarkers and the role of different radiological modalities including computed tomography (CT), magnetic resonance imaging, angiography, and ultrasound in predicting HT. Different radiological indices of early ischemic changes, large ischemic lesion volume, severe blood flow restriction, blood-brain barrier disruption, poor collaterals and high blood flow velocities have been reported to be associated with higher risk of HT. The current levels of evidence of the available studies highlight the role of the different CT perfusion parameters in predicting HT. Further large standardized studies are recommended to compare the sensitivity and specificity of the different radiological markers combined and delineate the most reliable predictor.

scholarly journals Can Early Ischemic Lesion Recurrence on Diffusion-Weighted MRI Affect Functional Outcome after Acute Ischemic Stroke?

2010 ◽  
Vol 6 (1) ◽  
pp. 19 ◽  
Author(s):  
Wook-Joo Kim ◽  
Jae Hyoung Kim ◽  
Youngchai Ko ◽  
Jung Hyun Park ◽  
Mi Hwa Yang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Diffusion Weighted Mri ◽  
Ischemic Lesion ◽  
Diffusion Weighted

Motor Recovery as Assessed with Isometric Finger Movements and Perfusion Magnetic Resonance Imaging after Acute Ischemic Stroke

2006 ◽  
Vol 20 (3) ◽  
pp. 390-397 ◽  
Author(s):  
Patrick Weller ◽  
Hans-Jörg Wittsack ◽  
Mario Siebler ◽  
Volker Hömberg ◽  
Rüdiger J. Seitz
Keyword(s):  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Ischemic Stroke ◽  
Hand Function ◽  
Magnetic Resonance Images ◽  
Motor Recovery ◽  
Perfusion Magnetic Resonance Imaging ◽  
Lesion Volume ◽  
Ischemic Lesion ◽  
Hemiparetic Stroke

Objective. Recovery from hemiparetic stroke is variable. An important goal for clinicians and clinical researchers is to identify predictors of recovery. The initial phase after acute ischemic stroke is considered to be of major importance for neurological outcome. The authors sought to determine in patients with acute ischemic stroke whether early motor recovery, as measured by repetitive isometric index-thumb oppositions, is correlated with ischemic lesion volume. Methods. Thirty-six acute hemiparetic stroke patients with residual hand function were investigated. The European Stroke Scale (ESS) score was determined on admission and at discharge. Performance of repetitive index finger-thumb pinch movements was measured daily during the 1st 8 days after stroke onset. Brain ischemia volume was determined digitally in time-to-peak magnetic resonance images of per-fusion. Results. The recovery of patients with ( P = 0.002) and without ( P < 0.001) thrombolysis as assessed with the ESS was paralleled by an increase in isometric grip force and movement rate ( P < 0.05). Recovery was predicted by the area of moderately impaired perfusion indicated by the per-fusion mismatch volume ( r = 0.578, P < 0.001). Conclusions. In acute stroke, recovery of hand function is predicted by the volume of salvageable ischemic tissue, as determined by the perfusion mismatch.

scholarly journals Brain connectivity measures improve modeling of functional outcome after acute ischemic stroke

2019 ◽  
Author(s):  
Sofia Ira Ktena ◽  
Markus D. Schirmer ◽  
Mark R. Etherton ◽  
Anne-Katrin Giese ◽  
Carissa Tuozzo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Brain Function ◽  
Brain Connectivity ◽  
High Capacity ◽  
Lesion Volume ◽  
Characteristic Path Length ◽  
Post Stroke ◽  
The Impact

AbstractBackgroundThe ability to model long-term functional outcomes after acute ischemic stroke (AIS) represents a major clinical challenge. One approach to potentially improve prediction modeling involves the analysis of connectomics. The field of connectomics represents the brain’s connectivity as a graph, whose topological properties have helped uncover underlying mechanisms of brain function in health and disease. Specifically, we assessed the impact of stroke lesions on rich club (RC) organization, a high capacity backbone system of brain function.MethodsIn a hospital-based cohort of 41 AIS patients, we investigated the effect of acute infarcts on the brain’s pre-stroke RC backbone and post-stroke functional connectomes with respect to post-stroke outcome. Functional connectomes were created utilizing three anatomical atlases and characteristic path-length (L) was calculated for each connectome. The number of RC regions (NRC) affected were manually determined using each patient’s diffusion weighted image (DWI). We investigated differences inLwith respect to outcome (modified Rankin Scale score (mRS); 90-days; poor: mRS>2) and the National Institutes of Health Stroke Scale (NIHSS; early: 2-5 days; late: 90-day follow-up). Furthermore, we assessed the effect of including NRCandLin ‘outcome’ models, using linear regression and assessing the explained variance (R2).ResultsOf 41 patients (mean age (range): 70 (45-89) years), 61% were male. There were differences inLbetween patients with good and poor outcome (mRS). Including NRC in the backward selection models of outcome, R2increased between 1.3- and 2.6-fold beyond that of traditional markers (age and acute lesion volume) for NIHSS and mRS.ConclusionIn this proof-of-concept study, we showed that information on network topology can be leveraged to improve modeling of post-stroke functional outcome. Future studies are warranted to validate this approach in larger prospective studies of outcome prediction in stroke.

Abstract W P18: General Anesthesia is Associated With Reduced Likelihood of Good Functional Outcome After Endovascular Intervention for Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Michael Mlynash ◽  
Jeremy D Fields ◽  
Matus Straka ◽  
Roland Bammer ◽  
Stephanie Kemp ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
General Anesthesia ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Multivariable Analysis ◽  
Antiplatelet Agents ◽  
Endovascular Intervention ◽  
Lesion Volume ◽  
Glucose Levels ◽  
Good Functional Outcome

Background: Retrospective studies have suggested that the use of general anesthesia (GA) is associated with unfavorable outcomes in patients undergoing endovascular intervention for acute ischemic strokes. We aimed to assess this association in DEFUSE 2, a prospective cohort study of patients treated with endovascular therapy. Methods: In the DEFUSE 2 study, MRI was performed before, within 12 hours after, and 5 days after endovascular intervention. Good functional outcome was defined as mRS 0-2 at 90 days. All patients who underwent catheter angiography were included in the present analysis. Baseline characteristics and outcomes were compared between patients managed with general anesthesia (GA) vs. conscious sedation (CS). Variables that were associated with good functional outcome in univariate analyses (α<0.1) were entered into a multivariable analysis. Variables that were significant at α<0.05 after a backward elimination procedure were retained. Results: GA was utilized in 39/110 patients (35%) and CS in the remainder. Compared to the group managed with CS, those undergoing GA were older (70±13 vs. 63±17 years old), had higher SBP (156±29 vs. 144±21 mmHg), higher blood glucose levels (149±64 vs. 126±35 mg/dL), and higher NIHSS (median [IQR]: 18 [14-21] vs. 14 [9-19]). The GA group was more likely to have had a previous stroke or TIA (36% vs. 17%) and prior treatment with antiplatelet agents (46% vs. 26%). Rates of reperfusion were similar (49% vs. 65%, p=0.15) between patients managed with GA and CS. Patients managed with GA had a substantially lower rate of good functional outcome (21% vs. 55%, p=0.001). Age, DWI lesion volume, reperfusion status and GA were retained in the multivariable model as independent predictors of good functional outcome. The adjusted odds ratio for good functional outcome with GA was 0.21 (95% CI 0.07 - 0.66). Conclusion: In general, GA should be avoided in patients undergoing endovascular treatment for acute ischemic stroke as it is associated with worse clinical outcomes. The mechanisms underlying this association should be investigated.

scholarly journals Rich-Club organization: an important determinant of functional outcome after acute ischemic stroke

2019 ◽  
Author(s):  
Markus D. Schirmer ◽  
Sofia Ira Ktena ◽  
Marco J. Nardin ◽  
Kathleen L. Donahue ◽  
Anne-Katrin Giese ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Prediction Models ◽  
Brain Magnetic Resonance Imaging ◽  
Lesion Volume ◽  
Stroke Outcome ◽  
Rich Club ◽  
The Rich ◽  
Magnetic Resonance Imaging Mri

AbstractObjectiveTo determine whether the rich-club organization, essential for information transport in the human connectome, is an important biomarker of functional outcome after acute ischemic stroke (AIS).MethodsConsecutive AIS patients (N=344) with acute brain magnetic resonance imaging (MRI) (<48 hours) were eligible for this study. Each patient underwent a clinical MRI protocol, which included diffusion weighted imaging (DWI). All DWIs were registered to a template on which rich-club regions have been defined. Using manual outlines of stroke lesions, we automatically counted the number of affected rich-club regions and assessed its effect on the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS; obtained at 90 days post-stroke) scores through ordinal regression.ResultsOf 344 patients (median age 65, inter-quartile range 54-76 years) with a median DWI lesion volume (DWIv) of 3cc, 64% were male. We established that an increase in number of rich-club regions affected by a stroke increases the odds of poor stroke outcome, measured by NIHSS (OR: 1.77, 95%CI 1.41-2.21) and mRS (OR: 1.38, 95%CI 1.11-1.73). Additionally, we demonstrated that the OR exceeds traditional markers, such as DWIv (ORNIHSS 1.08, 95%CI 1.06-1.11; ORmRs 1.05, 95%CI 1.03-1.07) and age (ORNIHSS 1.03, 95%CI 1.01-1.05; ORmRs 1.05, 95%CI 1.03-1.07).ConclusionIn this proof-of-concept study, the number of rich-club nodes affected by a stroke lesion presents a translational biomarker of stroke outcome, which can be readily assessed using standard clinical AIS imaging protocols and considered in functional outcome prediction models beyond traditional factors.

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