scholarly journals MR Imaging for Differentiating Contrast Staining from Hemorrhagic Transformation after Endovascular Thrombectomy in Acute Ischemic Stroke: Phantom and Patient Study

2018 ◽  
Vol 39 (12) ◽  
pp. 2313-2319 ◽  
Author(s):  
S.-H. You ◽  
B. Kim ◽  
B.K. Kim ◽  
S.-i. Suh
Keyword(s):  
Ischemic Stroke ◽  
Mr Imaging ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Transformation ◽  
Endovascular Thrombectomy ◽  
Patient Study

Endovascular thrombectomy for acute ischemic stroke in patients with cancer: a propensity-matched analysis

2021 ◽  
pp. neurintsurg-2021-018211
Author(s):  
Krishna C Joshi ◽  
Parneet Grewal ◽  
André Beer-Furlan ◽  
Alejandro Vargas ◽  
Nicholas Osteraas ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Group Versus ◽  
Hemorrhagic Transformation ◽  
National Institutes Of Health ◽  
Endovascular Thrombectomy ◽  
Patients With Cancer ◽  
Cancer Group ◽  
Significant Difference ◽  
Active Cancer

BackgroundThere is a paucity of data and a belief that endovascular thrombectomy (EVT) has low efficacy for acute ischemic stroke (AIS) in patients with cancer. We aimed to critically compare the clinical outcomes of EVT for AIS in patients with and without cancer.MethodsRecords of all patients undergoing EVT for AIS between January 2015 and 2020 were screened for cancer at the time of EVT. Active cancer was defined as patients who were diagnosed with cancer and were undergoing or refused treatment for that cancer. Baseline modified Rankin Scale (mRS), age and sex were used in a 1:5 propensity score matching ratio. After matching we evaluated for any change in the National Institutes of Health Stroke Scale (NIHSS) from baseline to discharge, hemorrhagic transformation (HT), and 90-day mRS and mortality.ResultsThere were 19 patients with cancer and 95 matched controls. The mean±SD age was 70.89±11.16 years, and 17 (89.47%) were female. The baseline NIHSS was 22±7.5 and baseline mRS was 1 (IQR 1). There was no significant difference in change in baseline to discharge NIHSS, 90-day mRS or mortality; 90-day mRS 0–2 was 45.2% in the non-cancer group versus 46.7% in cancer group (p=0.54). HT was significantly higher in patients with cancer (57.89% vs 6.49%, p<0.001).ConclusionsIn propensity matched analysis of patients undergoing EVT for AIS with and without cancer, 90-day functional outcomes and mortality were similar. However, there was a significantly higher rate of HT in cancer patients.

Abstract WP38: MR Imaging Based Paradigm for Early Anticoagulation After Acute Ischemic Stroke: A Pilot Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Marie Luby ◽  
Nidhi Gupta ◽  
Richard T Benson ◽  
Tina M Burton ◽  
Amie W Hsia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Pilot Study ◽  
Mr Imaging ◽  
Acute Ischemic Stroke ◽  
Diffusion Weighted Imaging ◽  
Hemorrhagic Transformation ◽  
Limited Data ◽  
Stroke Patients ◽  
Acute Hospitalization ◽  
Low Incidence

Background and objectives: There is limited data on the optimal times to start anticoagulation (AC) in patients with a recent ischemic stroke. The objective of this pilot study was to investigate the safety of our institutional MR imaging based paradigm (MR-IBP, Figure) regarding initiation of AC in acute ischemic stroke patients, with and without large ischemic stroke. Methods: Patients admitted with acute ischemic stroke between July 1, 2014 and December 31, 2015 and consented to our natural history protocol were included in this study. Eligible patients had a discharge diagnosis of ischemic stroke and were started on AC during their acute hospitalization. We rated all incidences of hemorrhagic transformation (HT) using ECASS-II criteria during their acute hospitalization with the HT ratings performed at the time of discharge. We retrospectively evaluated all cases for large stroke based on baseline diffusion-weighted imaging (DWI) lesion diameter > 5 cm measurements. Results: Fifty-seven patients were included with 44% (25/57) started on AC according to the MR-IBP, Figure. For the patients started on AC, 8% (2/25) had HT (1 had HI-1; 1 had PH-2) after AC was started while 8% (2/25) were started on AC 1 day after HT (both were HI-2). Both patients started on AC after HT had baseline DWI lesion volumes < 1/3 MCA. Overall 16% (4/25) had HT pre- or post-AC versus patients who were not started on AC who had HT 19% (6/32) (p=0.77). There were 14 patients (25%) with large ischemic stroke. Of these large stroke patients, 8 (57%) had no HT, 4 (67%) were not started on AC but had HT post stroke (3 had HI-2; 1 had PH-1) and 2 (33%) were started on AC within MR-IBP but had HT (1 had HI-1; 1 had PH-2). Conclusion: Based on our pilot study, starting AC in patients with acute ischemic stroke including those with large stroke per our institutional MR-IBP is safe based on the low incidence of HT, with a 4% incidence of PH-2 HT during the acute hospitalization.

scholarly journals Flat Panel CT Scanning Is Helpful in Predicting Hemorrhagic Transformation in Acute Ischemic Stroke Patients Undergoing Endovascular Thrombectomy

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Liuwei Chen ◽  
Yi Xu ◽  
Rui Shen ◽  
Jiping Sun ◽  
Xiang Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Area Under The Curve ◽  
Hemorrhagic Transformation ◽  
Flat Panel ◽  
Contrast Extravasation ◽  
Predictive Values ◽  
Endovascular Thrombectomy ◽  
Flat Panel Ct ◽  
Noncontrast Ct

Purpose. Hyperdense lesions are frequently revealed on flat panel CT (FP-CT) immediately after endovascular thrombectomy in patients with acute ischemic stroke. This study is aimed at discriminating hyperdense lesions caused by extravasation plus hemorrhage from those caused by contrast extravasation alone. Methods. We retrospectively analyzed clinical and radiological data of patients who underwent an immediate postprocedure FP-CT scan and a follow-up noncontrast CT 24 hours after thrombectomy. We especially focused on the Maximum Hounsfield Units (HUmax) of each hyperdense lesion. A hyperdense lesion was judged to be hemorrhagic when it persisted on noncontrast CT and/or developed a mass effect. Results. Of 81 patients included in this study, 32 (39.5%) patients presented 41 hyperdense lesions on FP-CT. The chance of hemorrhagic transformation is higher in patients with hyperdense lesions on FP-CT than that in patients without hyperdense lesions (23/32 vs. 1/49, p < 0.001 ). The HUmax of hyperdensity on FP-CT can predict hemorrhagic transformation with an area under the curve of 0.805 (95% CI: 0.67-0.94, p = 0.02 ). The sensitivity, specificity, positive, and negative predictive values of hyperdensity on FP-CT for hemorrhagic transformation were 96%, 84%, 72%, and 98%, respectively. A HUmax of >600 predicted hemorrhagic transformation with a sensitivity of 50% and a specificity of 100%. Conclusions. The presence of hyperdensity on FP-CT can predict hemorrhagic transformation with a high sensitivity and negative predictive value. The measurement of HUmax of hyperdense lesion on FP-CT can be applied to the management of patients undergoing endovascular recanalization.

scholarly journals Stress hyperglycemia as a prognostic factor in acute ischemic stroke patients: a prospective observational cohort study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Hanaa A. El-Gendy ◽  
Mahmoud A. Mohamed ◽  
Amr E. Abd-Elhamid ◽  
Mohammed A. Nosseir
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prognostic Value ◽  
Area Under The Curve ◽  
Hemorrhagic Transformation ◽  
Diabetic Patients ◽  
Stroke Patients ◽  
Stress Hyperglycemia ◽  
Discrimination Power ◽  
Observational Cohort

Abstract Background Hyperglycemia is a risk factor for infarct expansion and poor outcome for both diabetic and non-diabetic patients. We aimed to study the prognostic value of stress hyperglycemia on the outcome of acute ischemic stroke patients as regards National Institutes of Health Stroke Scale (NIHSS) as a primary outcome. Results Patients with high random blood sugar (RBS) on admission showed significantly higher values of both median NIHSS score and median duration of hospital stay. There were significant associations between stress hyperglycemia and the risk of 30-day mortality (p < 0.001), the need for mechanical ventilation (p < 0.001) and vasopressors (p < 0.001), and the occurrence of hemorrhagic transformation (p = 0.001). The 24-h RBS levels at a cut off > 145 mg/dl showed a significantly good discrimination power for 30-day mortality (area under the curve = 0.809). Conclusions Stress hyperglycemia had a prognostic value and was associated with less-favorable outcomes of acute stroke patients. Therefore, early glycemic control is recommended for those patients.

Endovascular Thrombectomy for Acute Ischemic Stroke

2019 ◽  
Vol 21 (10) ◽  
Author(s):  
Tasneem F. Hasan ◽  
Nathaniel Todnem ◽  
Neethu Gopal ◽  
David A. Miller ◽  
Sukhwinder S. Sandhu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Thrombectomy

Differences in Acute Ischemic Stroke Management and Prognosis between Multiple Large-Vessel Occlusion and Single Large-Vessel Occlusion: Subanalysis of the RESCUE-Japan Registry 2

2021 ◽  
Vol 50 (4) ◽  
pp. 397-404
Author(s):  
Kotaro Tatebayashi ◽  
Kazutaka Uchida ◽  
Hiroto Kageyama ◽  
Hirotoshi Imamura ◽  
Nobuyuki Ohara ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Characteristics ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Tandem Occlusion ◽  
The Mean ◽  
Patient Prognosis

<b><i>Introduction:</i></b> The management and prognosis of acute ischemic stroke due to multiple large-vessel occlusion (LVO) (MLVO) are not well scrutinized. We therefore aimed to elucidate the differences in patient characteristics and prognosis of MLVO and single LVO (SLVO). <b><i>Methods:</i></b> The Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism Japan Registry 2 (RESCUE-Japan Registry 2) enrolled 2,420 consecutive patients with acute LVO who were admitted within 24 h of onset. We compared patient prognosis between MLVO and SLVO in the favorable outcome, defined as a modified Rankin Scale (mRS) score ≤2, and in mortality at 90 days by adjusting for confounders. Additionally, we stratified MLVO patients into tandem occlusion and different territories, according to the occlusion site information and also examined their characteristics. <b><i>Results:</i></b> Among the 2,399 patients registered, 124 (5.2%) had MLVO. Although there was no difference between the 2 groups in terms of hypertension as a risk factor, the mean arterial pressure on admission was significantly higher in MLVO (115 vs. 107 mm Hg, <i>p</i> = 0.004). MLVO in different territories was more likely to be cardioembolic (42.1 vs. 10.4%, <i>p</i> = 0.0002), while MLVO in tandem occlusion was more likely to be atherothrombotic (39.5 vs. 81.3%, <i>p</i> &#x3c; 0.0001). Among MLVO, tandem occlusion had a significantly longer onset-to-door time than different territories (200 vs. 95 min, <i>p</i> = 0.02); accordingly, the tissue plasminogen activator administration was significantly less in tandem occlusion (22.4 vs. 47.9%, <i>p</i> = 0.003). However, interestingly, the endovascular thrombectomy (EVT) was performed significantly more in tandem occlusion (63.2 vs. 41.7%; adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1–5.0). The type of MLVO was the only and significant factor associated with EVT performance in multivariate analysis. The favorable outcomes were obtained less in MLVO than in SLVO (28.2 vs. 37.1%; aOR, 0.48; 95% CI, 0.30–0.76). The mortality rate was not significantly different between MLVO and SLVO (8.9 vs. 11.1%, <i>p</i> = 0.42). <b><i>Discussion/Conclusion:</i></b> The prognosis of MLVO was significantly worse than that of SLVO. In different territories, we might be able to consider more aggressive EVT interventions.

Sign in / Sign up

Export Citation Format

Share Document