scholarly journals Letter by Broocks et al Regarding Article, “Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging”

Stroke ◽  
2021 ◽  
Vol 52 (2) ◽  
Author(s):  
Gabriel Broocks ◽  
Jens Minnerup ◽  
Rosalie McDonough ◽  
Fabian Flottmann ◽  
Andre Kemmling
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Core Concept ◽  
Stroke Imaging ◽  
Ischemic Core

scholarly journals Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 3147-3155 ◽  
Author(s):  
Mayank Goyal ◽  
Johanna M. Ospel ◽  
Bijoy Menon ◽  
Mohammed Almekhlafi ◽  
Mahesh Jayaraman ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Neuronal Loss ◽  
Treatment Decision ◽  
Stroke Care ◽  
Core Concept ◽  
Vessel Occlusion ◽  
Ischemic Core

Endovascular treatment is a highly effective therapy for acute ischemic stroke due to large vessel occlusion and has recently revolutionized stroke care. Oftentimes, ischemic core extent on baseline imaging is used to determine endovascular treatment-eligibility. There are, however, 3 fundamental issues with the core concept: First, computed tomography and magnetic resonance imaging, which are mostly used in the acute stroke setting, are not able to precisely determine whether and to what extent brain tissue is infarcted (core) or still viable, due to variability in tissue vulnerability, the phenomenon of selective neuronal loss and lack of a reliable gold standard. Second, treatment decision-making in acute stroke is multifactorial, and as such, the relative importance of single variables, including imaging factors, is reduced. Third, there are often discrepancies between core volume and clinical outcome. This review will address the uncertainty in terminology and proposes a direction towards more clarity. This theoretical exercise needs empirical data that clarify the definitions further and prove its value.

scholarly journals The Predictive Value of the Boston Acute Stroke Imaging Scale (BASIS) in Acute Ischemic Stroke Patients among Chinese Population

PLoS ONE ◽  
2014 ◽  
Vol 9 (12) ◽  
pp. e113967
Author(s):  
Yuanqi Zhao ◽  
Min Zhao ◽  
Xiaomin Li ◽  
Xiancong Ma ◽  
Qinghao Zheng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Chinese Population ◽  
Stroke Patients ◽  
Stroke Imaging ◽  
Acute Stroke Imaging

Association of collateral status and ischemic core growth in patients with acute ischemic stroke

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011258
Author(s):  
Longting Lin ◽  
Jianhong Yang ◽  
Chushuang Chen ◽  
Huiqiao Tian ◽  
Andrew Bivard ◽  
...  
Keyword(s):  
Growth Rate ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion ◽  
Study Cohort ◽  
Vessel Occlusion ◽  
Ischemic Core ◽  
Relationship Of ◽  
The Relationship ◽  
Linear Regressions

ObjectiveTo test the hypothesis that acute ischemic patients with poorer collaterals would have faster ischemic core growth, we included 2 cohorts in the study, cohort 1 of 342 patients for derivation and cohort 2 of 414 patients for validation purpose.MethodsAcute ischemic stroke patients with large vessel occlusion were included. Core growth rate was calculated by the following equation: Core growth rate = Acute core volume on CTP/Time from stroke onset to CTP. Collateral status was assessed by the ratio of severe hypoperfusion volume within the hypoperfusion region of CTP. The CTP collateral index was categorized in tertiles; for each tertile, core growth rate was summarized as median and inter-quartile range. Simple linear regressions were then performed to measure the predictive power of CTP collateral index in core growth rate.ResultsFor patients allocated to good collateral on CT perfusion (tertile 1 of collateral index), moderate collateral (tertile 2), and poor collateral (tertile 3), the median core growth rate was 2.93 mL/h (1.10–7.94), 8.65 mL/h (4.53–18.13), and 25.41 mL/h (12.83–45.07) respectively. Increments in the collateral index by 1% resulted in an increase of core growth by 0.57 mL/h (coefficient = 0.57, 95% confidence interval = [0.46, 0.68], p < 0.001). The relationship of core growth and CTP collateral index was validated in cohort 2. An increment in collateral index by 1% resulted in an increase of core growth by 0.59 mL/h (coefficient = 0.59 [0.48–0.71], p < 0.001) in cohort 2.ConclusionCollateral status is a major determinant of ischemic core growth.

scholarly journals Hemorrhage/Contrast Staining Areas after Mechanical Intra-Arterial Thrombectomy in Acute Ischemic Stroke: Imaging Findings and Clinical Significance

2012 ◽  
Vol 33 (9) ◽  
pp. 1791-1796 ◽  
Author(s):  
G. Parrilla ◽  
B. García-Villalba ◽  
M. Espinosa de Rueda ◽  
J. Zamarro ◽  
E. Carrión ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Significance ◽  
Imaging Findings ◽  
Stroke Imaging

Abstract 2223: Diagnoses and Outcomes of t-PA Treated Patients with No Imaging Evidence of Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Ilana Spokoyny ◽  
Rema Raman ◽  
Karin Ernstrom ◽  
Brett C Meyer ◽  
Thomas M Hemmen
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Diagnosis ◽  
Surrogate Marker ◽  
Stroke Patients ◽  
Correct Treatment ◽  
Stroke Mimics ◽  
Stroke Imaging ◽  
Significant Difference

Background/Purpose: Intravenous Alteplase (t-PA) improves outcome in patients with acute ischemic stroke. Of those who recover fully, some may not have had ischemia. We analyzed the frequency and post-treatment outcomes of patients with no imaging evidence of stroke and aimed to delineate the frequency of strokes with full recovery from that of stroke mimics treated with t-PA. Methods: We included all adult stroke patients treated with IV t-PA within 3 hours of stroke onset from the UCSD SPOTRIAS database. Group 1: Patients with neuroimaging evidence of acute stroke (IPS); Group 2: no neuroimaging evidence of acute stroke (INS). All diagnoses were established by an independent adjudicating body. We reviewed medical records, neuroimaging, and compared discharge diagnosis, 90-day mRS, and incidence of intracranial hemorrhage. We adjusted for age, admission NIHSS, and pre-stroke mRS in multivariable models. Results: We identified 61patients with IPS and 25 with INS, with similar baseline characteristics, except for baseline NIHSS (IPS 13.4±8.2, INS 8.4±5.9, p=0.007) and incidence of cardiac arrhythmias (IPS 36.1%, INS 4.0%, p=0.002). Adjusted for age and baseline NIHSS, we found no difference in outcome. ICH was found in 23% of the IPS patients and was symptomatic in 4.9%. None of the INS patients had ICH. Conclusions: Radiologic evidence of acute ischemic stroke was absent in 10.5% of the 86 patients in the UCSD SPOTRIAS database who were treated with t-PA and given a clinical diagnosis of acute ischemic stroke on adjudicating body review at discharge. The majority (64%) of imaging negative stroke patients in our study ultimately received the clinical diagnosis of acute stroke. No significant difference in outcomes (mRS) was found between imaging negative and imaging positive stroke code patients, aside from the increased ICH frequency in imaging positive patients. This lack of outcome difference emphasizes that while imaging plays an important role as a surrogate marker in determining the diagnosis, a detailed clinical evaluation is essential in the correct treatment of acute ischemic stroke. Imaging negative stroke patients are common and future larger scale prospective data is required to analyze the true frequency of stroke mimics versus imaging negative stroke.

Abstract WP102: Increased Blood Pressure Variability After Acute Ischemic Stroke Correlates With Ischemic Core Growth and Poor Neurological Outcome

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Eva Mistry ◽  
Mohammad Anadani ◽  
Shadi Yaghi ◽  
Farhaan Vahidy ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Blood Pressure Variability ◽  
Secondary Analysis ◽  
Unfavorable Outcome ◽  
Stroke Recovery ◽  
Secondary Outcome ◽  
Mediation Effects ◽  
Ischemic Core

Background: Research has shown that increased blood pressure variability (BPV) correlates with worse outcome after stroke. However, the mechanism is unknown. Methods: In this secondary analysis of the Albumin in Acute Ischemic Stroke (ALIAS) trial, we calculated BPV for SBP over the first 120 hours. The primary outcome was 90-day modified Rankin Scale of 2-6 (unfavorable outcome). The secondary outcome was difference between the CT ASPECTS at baseline and 24 hours. We fit regression models to the outcomes and used the Baron and Kenny method to estimate causal mediation effects. Results: We included 508 patients with a mean (SD) age of 64.3 (12.3) years, 56.1% male, median NIHSS of 11, and mean SBP measurements of 19.8. Unfavorable outcome was seen in 309 (60.8%). BPV was significantly higher in patients with unfavorable outcome (Table 1). In adjusted models, increased BPV was independently associated with unfavorable outcome (Table 2) and ASPECTS decline (Table 3). Mediation analysis revealed that ASPECTS decline accounted for 23.5% of the effect of BPV on outcome, with 16.4% as direct effect. Conclusion: We found that increased BPV was associated with both unfavorable outcome and growth of the ischemic core. Future prospective studies are needed to establish causality and confirm BPV’s effect on stroke recovery.

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