scholarly journals Inflammatory Factors as Potential Markers of Early Neurological Deterioration in Acute Ischemic Stroke Patients Receiving Endovascular Therapy – The AISRNA Study

2021 ◽  
Vol Volume 14 ◽  
pp. 4399-4407
Author(s):  
Qi-Wen Deng ◽  
Shi Huang ◽  
Shuo Li ◽  
Qian Zhai ◽  
Qing Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Neurological Deterioration ◽  
Inflammatory Factors ◽  
Stroke Patients ◽  
Early Neurological Deterioration

scholarly journals Inflammatory factors are associated with early neurological deterioration in acute ischemic stroke patients receiving endovascular therapy-The AISRNA study

2020 ◽  
Author(s):  
Qi-Wen Deng ◽  
Shi Huang ◽  
Shuo Li ◽  
Qian Zhai ◽  
Qing Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Time Course ◽  
Molecular Mechanisms ◽  
Interleukin 2 ◽  
Neurological Deterioration ◽  
Inflammatory Factors ◽  
Large Artery ◽  
Early Neurological Deterioration

Abstract Background: This study aimed to explore several peripheral blood-based markers related to inflammatory response in a total of 85 patients with acute ischemic stroke (AIS) caused by large artery occlusion in the anterior circulation receiving endovascular therapy (EVT) from the AISRNA study regarding the association between inflammatory factors and early neurological deterioration (END), and investigated whether their time course correlated with END after EVT.Methods: We collected baseline characteristics of 85 AIS patients participating in an observational acute stroke cohort: the AISRNA study. The following inflammatory factors were measured in these participants: interleukin-2 [IL-2], IL-4, IL-6, IL-10, tumor necrosis factor-α [TNF-α], and interferon-γ [IFN-γ]. The National Institute of Health Stroke Scale score increase of ≥4 within 24 hours after EVT defined as END.Results: IL-6 and IL-10 were higher in patients with END compared to those with non-END (P<0.01), and they were also associated with risk factors of END after EVT. Furthermore, we found that the area under curves (AUCs) of IL-6 and IL-10 for predicting END were 0.791 (0.689-0.871), and 0.564 (0.452-0.671), respectively. Adjusting for age, sex, and atrial fibrillation, the odds ratios (ORs; 95% confidence interval) for incident END for IL-6 and IL-10 were 1.83 (1.08-6.36) and 1.15 (1.02-1.30), respectively. Additionally, we found significant changes over time in the expression levels of IL-4, IL-6, and IL-10 in patients undergoing END compared with non-END (P<0.05).Conclusions: IL-6 and IL-10 levels on admission are significantly associated with END after EVT, and time course of IL-4, IL-6, and IL-10 is correlated with stroke progression. Further study of molecular mechanisms on peripheral immunomodulation in AIS would be helpful.Trial registration: ClinicalTrials.gov NCT04175691. Registered November 21, 2019.

Hypoperfusion in lenticulostriate arteries territory related to unexplained early neurological deterioration after intravenous thrombolysis

2019 ◽  
Vol 14 (3) ◽  
pp. 306-309 ◽  
Author(s):  
Ying Zhou ◽  
Wansi Zhong ◽  
Anli Wang ◽  
Wanyun Huang ◽  
Shenqiang Yan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Terminal Branch ◽  
Stroke Patients ◽  
Lenticulostriate Arteries ◽  
Early Neurological Deterioration

Background Early neurological deterioration occurs in approximately 10% acute ischemic stroke patients after thrombolysis. Over half of the early neurological deterioration occurred without known causes and is called unexplained early neurological deterioration. Aims We aimed to explore the development of early neurological deterioration at 24 h after thrombolysis, and whether it could be predicted by the presence of baseline hypoperfusion in lenticulostriate arteries territory in acute ischemic stroke patients. Methods We retrospectively reviewed our prospectively collected database of acute ischemic stroke patients in the unilateral middle cerebral artery territory who had baseline perfusion image and received thrombolysis. Unexplained early neurological deterioration was defined as ≥ 2 points increase of National Institutes of Health Stroke Scale (NIHSS) from baseline to 24 h, without known causes. Hypoperfusion lesions in different territories were identified on perfusion maps. Results A total of 306 patients were included in analysis. Patients with pure lenticulostriate arteries hypoperfusion (defined as the presence of hypoperfusion in lenticulostriate artery territory, but not in middle cerebral artery terminal branch territory) were more likely to have unexplained early neurological deterioration than others (27.6% vs. 6.1%; OR, 5.974; p = 0.001), after adjusting for age, baseline NIHSS and onset to treatment time. Conclusions Patients presenting hypoperfusion in pure lenticulostriate arteries territory were easier to experience unexplained early neurological deterioration.

Outcomes after Early Neurological Deterioration and Transitory Deterioration in Acute Ischemic Stroke Patients

2016 ◽  
Vol 42 (5-6) ◽  
pp. 378-386 ◽  
Author(s):  
Bernt Harald Helleberg ◽  
Hanne Ellekjaer ◽  
Bent Indredavik
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Strong Association ◽  
Neurological Deterioration ◽  
Stroke Patients ◽  
Repeated Observations ◽  
The Poor ◽  
Early Neurological Deterioration ◽  
Clinically Significant ◽  
Td Methods

Background and Purpose: Early neurological deterioration (END) occurs in 10-40% of acute ischemic stroke (AIS) patients and has been associated with worse outcome. Recent improvements in treatment may have reduced the prevalence of END. A single early control or repeated observations have been applied to detect END close to occurrence, in order to improve the poor outcome associated with END, as clinical interventions may still be effective. Deterioration detected through repeated observations may be transitory or lead to END. Our aim was to study outcome after END and transitory deterioration (TD). Methods: In acute ischemic stroke patients, key Scandinavian Stroke Scale (SSS) items were scored 12 times from admission to 72 h. END was defined as ≥2 point decrease in any key SSS item from admission to 72 h. Early deterioration episode was defined as similar worsening between two consecutive assessments within 72 h, and TD as early deterioration episode in patients without END. Main outcome measures were odds ratios (OR) for worse functional outcome (including death) measured by modified Rankin scale at 90 days for END and TD compared with stable patients. Results: 368 patients were included. 13.9% had END and 28.3% had TD. Both deterioration groups were associated with worse outcome at 12 weeks compared with stable patients, with ORs of 35.1 (95% CI 8.8-140) for death/dependency and 5.8 (95% CI 1.8-19.4) for death in END patients and ORs of 2.3 (95% CI 1.1-4.8) for death/dependency and 1.9 (95% CI 0.5-6.3) for death in patients with TD. LOS increased by 6.4 days for END (p < 0.001) and 1.1 days for TD (p = 0.014) compared with stable patients. Conclusion: We found a strong association between END and worse outcome, and even TD doubled the OR for death/dependency compared to stable patients. Early deterioration episodes identified through frequent observations are therefore clinically significant and such frequent observations may detect worsening sufficiently close to occurrence for potentially effective treatment to be applied.

scholarly journals Asymmetrical cortical vein sign predicts early neurological deterioration in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wei Li ◽  
Wei-Min Xiao ◽  
Gen-Pei Luo ◽  
Yong-Lin Liu ◽  
Jian-Feng Qu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Neurological Deterioration ◽  
Arterial Stenosis ◽  
Signal Loss ◽  
Intracranial Arterial Stenosis ◽  
Stroke Patients ◽  
Cortical Vein ◽  
Early Neurological Deterioration

Abstract Background Susceptibility weighted imaging (SWI) provides an approximate assessment of tissue perfusion and shows prominent hypointense cortical veins in the ischemic territory because of the increased concentration of deoxyhemoglobin. We aimed to evaluate whether asymmetrical prominent cortical vein sign (APCVS) on SWI can predict early neurological deterioration (END) in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion (SIASO). Methods One hundred and nine acute ischemic stroke patients with SIASO who underwent SWI were retrospectively recruited. END was defined as an increase in the National Institutes of Health Stroke Scale score ≧2 points despite standard treatment in the first 72 h after admission. The APCVS was defined as more and/or large vessels with greater signal loss than those in the opposite hemisphere on SWI. Results Thirty out of the 109 (27.5%) patients developed END. Sixty (55.0%) patients presented with APCVS on SWI. APCVS occurred in 24 (80%) patients with END, whereas it only occurred in 36 (45.6%) patients without END (P = 0.001). Patients with APCVS were more likely to have END (40.0%, vs. 12.2%, P = 0.001) than those without END. Multivariate logistic regression indicated that APCVS (OR = 4.349, 95% C.I. = 1.580–11.970, P = 0.004) was a significant predictor of END in acute ischemic stroke patients with SIASO, adjusted for previous stroke history and acute infarct volume. Conclusions In acute ischemic stroke patients with SIASO, the APCVS might be a useful neuroimaging marker for predicting END, which suggests the importance of evaluation of perfusion status.

scholarly journals Asymmetrical Cortical Vein Sign Predicts Early Neurological Deterioration in Acute Ischemic Stroke Patients with Severe Intracranial Arterial Stenosis or Occlusion

2020 ◽  
Author(s):  
Wei Li ◽  
Wei-Min Xiao ◽  
Gen-Pei Luo ◽  
Yong-Lin Liu ◽  
Jian-feng Qu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Neurological Deterioration ◽  
Arterial Stenosis ◽  
Signal Loss ◽  
Intracranial Arterial Stenosis ◽  
Stroke Patients ◽  
Cortical Vein ◽  
Early Neurological Deterioration

Abstract Background: Susceptibility weighted imaging (SWI) provides a rough assessment of tissue perfusion with the prominent hypointense cortical veins in the ischemic territory due to increased concentration of deoxyhemoglobin. We aimed to evaluate whether asymmetrical prominent cortical vein sign (APCVS) on SWI can predict early neurological deterioration (END) in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion (SIASO).Results: One hundred and nine acute ischemic stroke patients with SIASO who underwent SWI were retrospectively recruited. END was defined as a National Institutes of Health Stroke Scale (NIHSS) increasement≧2 points despite standard treatment in the first 72h after admission. APCVS was defined as more and/or large vessels with greater signal loss than those in the opposite hemisphere on SWI. Thirty out of the 109 (27.5%) patients developed END. Sixty (55.0%) patients presented with APCVS on SWI. APCVS occurred in 24 (80%) patients with END, whereas it only occurred in 36 (45.6%) patients without END (P=0.001). Patient with APCVS were more likely to have END (40.0%, vs. 12.2%, P=0.001), in comparation with those without END. Multivariate logistic regression indicated that APCVS (OR=4.349, 95% C.I.=1.580-11.970, P=0.004) was a significant predictor of END in acute ischemic stroke patients with SIASO, adjusted for previous stroke history and acute infarct volume.Conclusions: In acute ischemic stroke patients with SIASO, APCVS might be a useful neuroimaging marker for predicting END, suggesting the importance of evaluation of perfusion status.

scholarly journals Metabolic Syndrome Augments the Risk of Early Neurological Deterioration in Acute Ischemic Stroke Patients Independent of Inflammatory Mediators: A Hospital-Based Prospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Xiaohao Zhang ◽  
Zhiguang Sun ◽  
Caixia Ding ◽  
Yinyan Tang ◽  
Xuemei Jiang ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Inflammatory Mediators ◽  
High Sensitivity ◽  
Neurological Deterioration ◽  
Stroke Patients ◽  
Reactive Protein ◽  
Increased Risk ◽  
Early Neurological Deterioration

Background and Aims. Metabolic syndrome (MetS) has been associated with occurrence and prognosis of ischemic stroke. This study aimed to evaluate whether an association exists between MetS and early neurological deterioration (END) following acute ischemic stroke and the possible role inflammatory biomarkers play.Methods and Results. We conducted a prospective cohort investigation that involved 208 stroke patients within 48 hours from symptom onset. MetS was determined by the modified National Cholesterol Education Program/Adult Treatment Panel III criteria. END was defined as an increase of⩾1 point in motor power or⩾2 points in the total National Institutes of Health Stroke Scale (NIHSS) score within 7 days. Univariate logistic regression analysis showed that patients with MetS had a 125% increased risk of END (OR 2.25; 95% CI 1.71–4.86,P=0.005). After adjustment for fibrinogen and high-sensitivity C-reactive protein, MetS remained significantly correlated to END (OR 2.20; 95% CI 1.10–4.04,P=0.026) with a 77% elevated risk per additional MetS trait (OR 1.77; 95% CI 1.23–2.58,P=0.002).Conclusions. This study demonstrated that MetS may be a potential predictor for END after ischemic stroke, which was independent of raised inflammatory mediators.

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