scholarly journals DWI Reversal Is Associated with Small Infarct Volume in Patients with TIA and Minor Stroke

2013 ◽  
Vol 35 (4) ◽  
pp. 660-666 ◽  
Author(s):  
N. Asdaghi ◽  
B. C. V. Campbell ◽  
K. S. Butcher ◽  
J. I. Coulter ◽  
J. Modi ◽  
...  
Keyword(s):  
Infarct Volume ◽  
Minor Stroke ◽  
Small Infarct

scholarly journals IV t-PA Influences Infarct Volume in Minor Stroke: A Pilot Study

PLoS ONE ◽  
2014 ◽  
Vol 9 (10) ◽  
pp. e110477 ◽  
Author(s):  
Kersten Villringer ◽  
Ulrike Grittner ◽  
Lars-Arne Schaafs ◽  
Christian H. Nolte ◽  
Heinrich Audebert ◽  
...  
Keyword(s):  
Pilot Study ◽  
Infarct Volume ◽  
Minor Stroke

Abstract T P292: Baseline Infarct Volume Predicts Disability in TIA and Minor Stroke Patients

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Negar Asdaghi ◽  
jonathan Coulter ◽  
Jayish Modi ◽  
Abdul Qazi ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
Tissue Injury ◽  
Infarct Volume ◽  
Recurrent Stroke ◽  
Multivariable Analysis ◽  
National Institutes Of Health ◽  
Minor Stroke ◽  
Predicting Outcome ◽  
Ischemic Attack ◽  
Symptom Progression ◽  
The Impact

BACKGROUND: Despite their mild presenting neurological deficit, over one third of patients with transient ischemic attack (TIA) and minor stroke are dead or disabled at the time of hospital discharge. This is predominantly related to either symptom progression or recurrent stroke, although predicting outcome can be difficult. We sought to determine whether baseline radiographic MR characteristics could predict disability at 3months in this population. METHODS: Consecutive TIA/minor stroke (National Institutes of Health Stroke Scale<4) that were not disabled at baseline and had an MRI within 24 hours of symptom onset were prospectively included. Disability was assessed at 90 days using the modified Rankin Scale (mRS). The impact of perfusion (PWI) and diffusion (DWI) variables on disability (mRS≥2) at 90 days was assessed. RESULTS: 418 patients were included; 55.5% had positive DWI lesions. 292 patients had PWI imaging of whom 35% had PWI deficit (Tmax≥2s) and 26.5% had mismatch (Tmax≥4s-DWI) at baseline. The median DWI, PWI and mismatch volumes were 1.14 ml (IQR=3.43), 9.8 ml (IQR=29.8) and 9 ml respectively. A total of 56/418 (13.4%) patients were disabled at 90days. In multivariable analysis we adjusted for baseline predictors of disability (age, DM, premorbid mRS 1, ongoing symptoms, baseline NIHSS, CT/CT angiography-positive metric and DWI or PWI volume). DWI volume (OR=1.05, p=0.007), and age (OR=1.03, p=0.003) remained independent predictors of disability. PWI or mismatch volume did not predict functional outcome. CONCLUSIONS: A substantial proportion of patients with TIA and minor stroke are disabled at 90days. The degree of tissue injury as measured by DWI volume is an independent predictor of disability regardless of the mechanism of disability.

scholarly journals Early Dabigatran Treatment After Transient Ischemic Attack and Minor Ischemic Stroke Does Not Result in Hemorrhagic Transformation

2020 ◽  
Vol 47 (5) ◽  
pp. 604-611
Author(s):  
Anas Alrohimi ◽  
Kelvin Ng ◽  
Dar Dowlatshahi ◽  
Brian Buck ◽  
Grant Stotts ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Infarct Volume ◽  
Hemorrhagic Transformation ◽  
Minor Stroke ◽  
Optimal Timing ◽  
Minor Ischemic Stroke ◽  
Pre Treatment ◽  
Ischemic Attack ◽  
Ischemic Events

ABSTRACT:Objectives:The optimal timing of anticoagulation after ischemic stroke in atrial fibrillation (AF) patients is unknown. Our aim was to demonstrate the feasibility and safety of initiating dabigatran therapy within 14 days of transient ischemic attack (TIA) or minor stroke in AF patients.Patients and Methods:A prospective, multi-center registry (NCT02415855) in patients with AF treated with dabigatran within 14 days of acute ischemic stroke/TIA (National Institutes of Health Stroke Scale (NIHSS) ≤ 3) onset. Baseline and follow-up computed tomography (CT) scans were assessed for hemorrhagic transformation (HT) and graded by using European Cooperative Acute Stroke Study criteria.Results:One hundred and one patients, with a mean age of 72.4 ± 11.5 years, were enrolled. Median infarct volume was 0 ml. Median time from index event onset to dabigatran initiation was 2 days, and median baseline NIHSS was 1. Pre-treatment HT was present in seven patients. No patients developed symptomatic HT. On the day 7 CT scan, HT was present in six patients (one progressing from baseline hemorrhagic infarction type 1). Infarct volume was a predictor of incident HT (odds ratio = 1.063 [1.020–1.107], p < 0.003). All six (100%) patients with new/progressive HT were functionally independent (modified Rankin Scale (mRS) = 0–2) at 30 days, which was similar to those without HT (90%, p = 0.422). Recurrent ischemic events occurred within 30 days in four patients, two of which were associated with severe disability and death (mRS 5 and 6, respectively).Conclusion:Early dabigatran treatment did not precipitate symptomatic HT after minor stroke. Asymptomatic HT was associated with larger baseline infarct volumes. Early recurrent ischemic events may be clinically more important.

Abstract 2674: DWI Reversal is associated with Small Infarct Volume and Early Reperfusion in Patients with TIA and Minor Stroke. Data from VISION and CATCH study groups

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Negar Asdaghi ◽  
Jonathan I Coulter ◽  
Jayish Modi ◽  
Abdul Qazi ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Infarct Volume ◽  
Linear Trend ◽  
Minor Stroke ◽  
Accurate Estimation ◽  
Lesion Volume ◽  
Early Reperfusion ◽  
Tissue Hypoperfusion ◽  
Minor Ischemic Stroke

Introduction: One-third of patients with TIA and minor ischemic stroke (MIS) have evidence of ischemic penumbra, defined as hypoperfused regions that have not been irreversibly damaged. Diffusion weighted Imaging (DWI) lesions are thought to represent irreversibly damaged tissue. DWI reversal therefore has implications in accurate estimation of penumbra. We aimed to determine the rate of DWI reversal in this population. Methods: Patients with TIA/MIS (NIH Stroke Scale ≤ 3) were prospectively enrolled and imaged within 24 hours of symptom onset as part of two prospective imaging cohorts. Patients were included if their baseline modified Rankin scale (mRS) score was ≤1. All patients were followed clinically for 3 months and had a repeat MRI either at day 30 or 90. Baseline diffusion and perfusion lesions and follow-up FLAIR final infarct volumes were measured. Results: 418 patients were included; 55.5% had DWI lesions and 37% had PWI (Tmax+2s delay) deficits at baseline. A total of 337 (81%) patients had follow-up imaging. DWI reversal occurred in 22/192 (11.5%) of patients who had a diffusion lesion at baseline. The median time from symptom onset to follow-up imaging was not significantly different between those with or without DWI reversal (78.6 days, IQR=33.3 vs. 79.7 days, IQR= 59.4, p=0.65). The median DWI lesion volume was significantly smaller in those with reversal (0.27ml, IQR=0.75 ml) compared to those who did not reverse (1.45 ml, IQR=3.8 ml, p<0.001). Patients with concurrent perfusion deficits (Tmax+2s) were significantly less likely to have DWI reversal (6%) compared to those without evidence of tissue hypoperfusion (20%; p=0.003). DWI reversal occurred in 4% of patients with penumbral patterns ((Tmax+2s)-DWI) and 18% of those without penumbra (p=0.003).Severity of hypoperfusion defined as greater prolongation of Tmax (+2,+4, +6, +8s) did not affect the likelihood of DWI reversal (linear trend p=0.147). No patient with DWI reversal had a mRS of ≥2 at 90 day, compared to 19% of those with evidence of infarction on follow-up imaging (p= 0.02). Conclusion: DWI reversal is common in patients with TIA/MIS and is more likely to occur in those with smaller baseline lesions without concurrent tissue hypoperfusion. DWI reversal therefore should not have a significant effect on the accuracy of penumbra definition. These data suggest early reperfusion is correlated with DWI reversal and better clinical outcome as measured by mRS.

Abstract WP44: NIHSS Score Components Predict Infarct Volume in Minor Ischemic Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Charlotte Herber ◽  
Amelia K Boehme ◽  
Howard Andrews ◽  
Joshua Z Willey ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Language Disorder ◽  
Infarct Volume ◽  
Final Diagnosis ◽  
Minor Stroke ◽  
Lesion Volume ◽  
Nihss Score ◽  
Therapeutic Implications ◽  
Significant Relationships ◽  
Minor Ischemic Stroke

Background: Prior studies have shown a correlation between the National Institutes of Health Stroke Scale (NIHSS) score and infarct volume on diffusion weighted imaging (DWI); however data are limited in patients with minor stroke whose treatment is controversial. Our aim is to determine the association between DWI lesion(s) volume and the (1) total NIHSS score and (2) NIHSS components in a population of patients with minor ischemic stroke. Methods: We included all patients with minor stroke (NIHSS 0-5) who were enrolled in the prospective Stroke Warning Information and Faster Treatment (SWIFT) study. All patients were admitted to the hospital with a final diagnosis of stroke. We calculated lesion(s) volume (cm 3 ) on DWI sequence using Medical Image Processing, Analysis, and Visualization (MIPAV, NIH, Version 7.1.1). Based on the distribution of lesion volume, we summarized the explanatory value into median cm 3 . We used non-parametric tests to study the association between the primary outcome, DWI lesion(s) volume, and the predictors (NIHSS score and its components). Results: 894 patients had a discharge diagnosis of ischemic stroke; 709 underwent MRI and 510 were DWI positive. There was a weak graded relationship between NIHSS score and median DWI lesion volume in cm 3 : (NIHSS 0: 7.1, NIHSS 1: 8.0, NIHSS 2: 17.1, NIHSS 3: 11.6, NIHSS 4: 19.0, NIHSS 5: 23.6). We also noted highly significant relationships between lesion volume and certain NIHSS components. Compared to patients without the deficit, the median lesion volume was significantly higher in patients with neglect (105.6 vs. 12.5,p=0.025), language disorder (34.6 vs. 11.9,p<0.001), and visual field deficits (185.6 vs. 11.6,p<0.001). Other components of the NIHSS were not associated with lesion volume. Conclusion: In patients with minor stroke, the nature of the neurological deficit improves prediction of infarct volume when added to the total NIHSS score. This may lead to clinical and therapeutic implications.

Surgical management of extracranial carotid artery aneurysms

VASA ◽  
2016 ◽  
Vol 45 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Jan Paweł Skóra ◽  
Jacek Kurcz ◽  
Krzysztof Korta ◽  
Przemysław Szyber ◽  
Tadeusz Andrzej Dorobisz ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Surgical Management ◽  
Minor Stroke ◽  
Stroke Rate ◽  
Extracranial Carotid Artery ◽  
Long Term Follow Up ◽  
End To End ◽  
Dacron Patch ◽  
Major Stroke

Abstract. Background: We present the methods and results of the surgical management of extracranial carotid artery aneurysms (ECCA). Postoperative complications including early and late neurological events were analysed. Correlation between reconstruction techniques and morphology of ECCA was assessed in this retrospective study. Patients and methods: In total, 32 reconstructions of ECCA were performed in 31 symptomatic patients with a mean age of 59.2 (range 33 - 84) years. The causes of ECCA were divided among atherosclerosis (n = 25; 78.1 %), previous carotid endarterectomy with Dacron patch (n = 4; 12.5 %), iatrogenic injury (n = 2; 6.3 %) and infection (n = 1; 3.1 %). In 23 cases, intervention consisted of carotid bypass. Aneurysmectomy with end-to-end suture was performed in 4 cases. Aneurysmal resection with patching was done in 2 cases and aneurysmorrhaphy without patching in another 2 cases. In 1 case, ligature of the internal carotid artery (ICA) was required. Results: Technical success defined as the preservation of ICA patency was achieved in 31 cases (96.9 %). There was one perioperative death due to major stroke (3.1 %). Two cases of minor stroke occurred in the 30-day observation period (6.3 %). Three patients had a transient hypoglossal nerve palsy that subsided spontaneously (9.4 %). At a mean long-term follow-up of 68 months, there were no major or minor ipsilateral strokes or surgery-related deaths reported. In all 30 surviving patients (96.9 %), long-term clinical outcomes were free from ipsilateral neurological symptoms. Conclusions: Open surgery is a relatively safe method in the therapy of ECCA. Surgical repair of ECCAs can be associated with an acceptable major stroke rate and moderate minor stroke rate. Complication-free long-term outcomes can be achieved in as many as 96.9 % of patients. Aneurysmectomy with end-to-end anastomosis or bypass surgery can be implemented during open repair of ECCA.

Acute treatment by a PPAR-α agonist decreases cerebral infarct volume and prevents post-ischemic endothelium and Kir 2.1 impairment

2005 ◽  
Vol 25 (1_suppl) ◽  
pp. S56-S56 ◽  
Author(s):  
Thavarak Ouk ◽  
Olivier Pétrault ◽  
Sophie Gautier ◽  
Patrick Gelé ◽  
Maud Laprais ◽  
...  
Keyword(s):  
Acute Treatment ◽  
Infarct Volume ◽  
Cerebral Infarct

Minor Stroke – wann ist ein Schlaganfall zu harmlos für eine Thrombolyse?

2009 ◽  
Vol 36 (S 02) ◽  
Author(s):  
M Köhrmann ◽  
T Nowe ◽  
HB Huttner ◽  
T Engelhorn ◽  
A Dörfler ◽  
...  
Keyword(s):  
Minor Stroke
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