Journal of Clinical Medicine

Editorial

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3 pages, 190 KiB

Open AccessEditorial

Advance of Thrombolysis and Thrombectomy in Acute Ischemic Stroke

by Hyo Suk Nam and Byung Moon Kim

J. Clin. Med. 2023, 12(2), 720; https://doi.org/10.3390/jcm12020720 - 16 Jan 2023

Cited by 3 | Viewed by 1977

Abstract

Globally, stroke remains the second leading cause of death, and the third-leading cause of death and disability, in the world [...] Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

Research

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11 pages, 272 KiB

Open AccessArticle

Reperfusion Therapies for Acute Ischemic Stroke in COVID-19 Patients: A Nationwide Multi-Center Study

by Justina Jurkevičienė, Mantas Vaišvilas, Rytis Masiliūnas, Vaidas Matijošaitis, Antanas Vaitkus, Dovilė Geštautaitė, Saulius Taroza, Paulius Puzinas, Erika Galvanauskaitė, Dalius Jatužis and Aleksandras Vilionskis

J. Clin. Med. 2022, 11(11), 3004; https://doi.org/10.3390/jcm11113004 - 26 May 2022

Cited by 6 | Viewed by 1983

Abstract

(1) Background: Acute ischemic stroke (AIS) is a possible complication of the coronavirus disease 2019 (COVID-19). Safety and efficacy data on reperfusion therapies (RT)—intravenous thrombolysis and endovascular treatment (EVT)—in stroke patients with COVID-19 is lacking. (2) Methods: We performed a retrospective nationwide multi-center [...] Read more.

(1) Background: Acute ischemic stroke (AIS) is a possible complication of the coronavirus disease 2019 (COVID-19). Safety and efficacy data on reperfusion therapies (RT)—intravenous thrombolysis and endovascular treatment (EVT)—in stroke patients with COVID-19 is lacking. (2) Methods: We performed a retrospective nationwide multi-center pair-matched analysis of COVID-19 patients with AIS who underwent RT. We included adult COVID-19 patients with AIS who were treated with RT between 16 March 2020 and 30 June 2021. All subjects were paired with non-infected controls, matched for age, sex, stroke arterial vascular territory, and RT modality. The primary outcome measure was a favorable functional outcome defined by the modified Rankin scale (mRS 0–2). (3) Results: Thirty-one subjects and thirty-one matched controls were included. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was higher in the COVID-19 group (16 vs. 12, p = 0.028). Rates of ischemic changes and symptomatic intracerebral hemorrhages did not differ significantly between the two groups at 24 h after RT. The median NIHSS 24 h after reperfusion remained significantly higher in the COVID-19 group (16 vs. 5, p = 0.003). MRS 0–2 at discharge was significantly less common in COVID-19 patients (22.6% vs. 51.8%, p = 0.018). Three-month mortality was 54.8% in the COVID-19 group versus 12.9% in controls (p = 0.001). (4) Conclusion: Reperfusion therapies on AIS in COVID-19 patients appear to be safe; however, functional outcomes are significantly worse, and 3-month mortality is higher. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

13 pages, 790 KiB

Open AccessArticle

Association between CHADS₂, CHA₂DS₂-VASc, ATRIA, and Essen Stroke Risk Scores and Unsuccessful Recanalization after Endovascular Thrombectomy in Acute Ischemic Stroke Patients

by Hyung Jun Kim, Moo-Seok Park, Joonsang Yoo, Young Dae Kim, Hyungjong Park, Byung Moon Kim, Oh Young Bang, Hyeon Chang Kim, Euna Han, Dong Joon Kim, JoonNyung Heo, Jin Kyo Choi, Kyung-Yul Lee, Hye Sun Lee, Dong Hoon Shin, Hye-Yeon Choi, Sung-Il Sohn, Jeong-Ho Hong, Jong Yun Lee, Jang-Hyun Baek, Gyu Sik Kim, Woo-Keun Seo, Jong-Won Chung, Seo Hyun Kim, Sang Won Han, Joong Hyun Park, Jinkwon Kim, Yo Han Jung, Han-Jin Cho, Seong Hwan Ahn, Sung Ik Lee, Kwon-Duk Seo, Yoonkyung Chang, Tae-Jin Song, Hyo Suk Nam and on behalf of the SECRET Study Investigators Show full author list Hide full author list

J. Clin. Med. 2022, 11(1), 274; https://doi.org/10.3390/jcm11010274 - 5 Jan 2022

Cited by 6 | Viewed by 3215

Abstract

Background: The CHADS₂, CHA₂DS₂-VASc, ATRIA, and Essen scores have been developed for predicting vascular outcomes in stroke patients. We investigated the association between these stroke risk scores and unsuccessful recanalization after endovascular thrombectomy (EVT). Methods: From the [...] Read more.

Background: The CHADS₂, CHA₂DS₂-VASc, ATRIA, and Essen scores have been developed for predicting vascular outcomes in stroke patients. We investigated the association between these stroke risk scores and unsuccessful recanalization after endovascular thrombectomy (EVT). Methods: From the nationwide multicenter registry (Selection Criteria in Endovascular Thrombectomy and Thrombolytic therapy (SECRET)) (Clinicaltrials.gov NCT02964052), we consecutively included 501 patients who underwent EVT. We identified pre-admission stroke risk scores in each included patient. Results: Among 501 patients who underwent EVT, 410 (81.8%) patients achieved successful recanalization (mTICI ≥ 2b). Adjusting for body mass index and p < 0.1 in univariable analysis revealed the association between all stroke risk scores and unsuccessful recanalization (CHADS₂ score: odds ratio (OR) 1.551, 95% confidence interval (CI) 1.198–2.009, p = 0.001; CHA₂DS₂VASc score: OR 1.269, 95% CI 1.080–1.492, p = 0.004; ATRIA score: OR 1.089, 95% CI 1.011–1.174, p = 0.024; and Essen score: OR 1.469, 95% CI 1.167–1.849, p = 0.001). The CHADS₂ score had the highest AUC value and differed significantly only from the Essen score (AUC of CHADS₂ score; 0.618, 95% CI 0.554–0.681). Conclusion: All stroke risk scores were associated with unsuccessful recanalization after EVT. Our study suggests that these stroke risk scores could be used to predict recanalization in stroke patients undergoing EVT. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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12 pages, 295 KiB

Open AccessArticle

Acute Recanalization of Large Vessel Occlusion in the Anterior Circulation Stroke: Is Mechanical Thrombectomy Alone Better in Patients over 80 Years of Age? Findings from a Retrospective Observational Study

by Dagmar Krajíčková, Antonín Krajina, Roman Herzig, Oldřich Vyšata, Libor Šimůnek and Martin Vališ

J. Clin. Med. 2021, 10(18), 4266; https://doi.org/10.3390/jcm10184266 - 20 Sep 2021

Cited by 5 | Viewed by 2417

Abstract

Real-world data report worse 3-month clinical outcomes in elderly patients with acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT). The aim was to identify factors influencing clinical outcome in elderly patients with anterior circulation AIS treated with MT (±intravenous thrombolysis (IVT)). In [...] Read more.

Real-world data report worse 3-month clinical outcomes in elderly patients with acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT). The aim was to identify factors influencing clinical outcome in elderly patients with anterior circulation AIS treated with MT (±intravenous thrombolysis (IVT)). In a retrospective, monocentric study, analysis of prospectively collected data of 138 patients (≥80 years) was performed. IVT was an independent negative predictor (OR 0.356; 95% CI: 0.134–0.942) and female sex an independent positive predictor (OR 4.179, 95% CI: 1.300–13.438) of 3-month good clinical outcome (modified Rankin scale 0–2). Female sex was also an independent negative predictor of 3-month mortality (OR 0.244, 95% CI: 0.100–0.599). Other independent negative predictors of 3-month good clinical outcome were older age, lower pre-stroke self-sufficiency, more severe neurological deficit and longer procedural intervals. Mortality was also independently predicted by longer procedural interval and by the occurrence of symptomatic intracerebral hemorrhage (p < 0.05 in all cases). Our results demonstrated, that in patients aged ≥80 years with anterior circulation AIS undergoing MT (±IVT), IVT reduced the chance of 3-month good clinical outcome and female sex was associated with a greater likelihood of 3-month good clinical outcome and lower probability of 3-month mortality. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

19 pages, 7551 KiB

Open AccessArticle

RP11-362K2.2:RP11-767I20.1 Genetic Variation Is Associated with Post-Reperfusion Therapy Parenchymal Hematoma. A GWAS Meta-Analysis

by Elena Muiño, Jara Cárcel-Márquez, Caty Carrera, Laia Llucià-Carol, Cristina Gallego-Fabrega, Natalia Cullell, Miquel Lledós, José Castillo, Tomás Sobrino, Francisco Campos, Emilio Rodríguez-Castro, Mònica Millán, Lucía Muñoz-Narbona, Alejandro Bustamante, Elena López-Cancio, Marc Ribó, José Álvarez-Sabín, Jordi Jiménez-Conde, Jaume Roquer, Eva Giralt-Steinhauer, Carolina Soriano-Tárraga, Cristófol Vives-Bauza, Rosa Díaz-Navarro, Silvia Tur, Victor Obach, Juan F. Arenillas, Tomás Segura, Gemma Serrano-Heras, Joan Martí-Fàbregas, Raquel Delgado-Mederos, Pol Camps-Renom, Luis Prats-Sánchez, Daniel Guisado, Marina Guasch, Rebeca Marin, Alejandro Martínez-Domeño, Maria del Mar Freijo-Guerrero, Francisco Moniche, Juan Antonio Cabezas, Mar Castellanos, Jerzy Krupinsky, Daniel Strbian, Turgut Tatlisumak, Vincent Thijs, Robin Lemmens, Agnieszka Slowik, Joanna Pera, Laura Heitsch, Laura Ibañez, Carlos Cruchaga, Rajat Dhar, Jin-Moo Lee, Joan Montaner, Israel Fernández-Cadenas, on behalf of International Stroke Genetic Consortium and the Spanish Stroke Genetic Consortium Show full author list Hide full author list

J. Clin. Med. 2021, 10(14), 3137; https://doi.org/10.3390/jcm10143137 - 16 Jul 2021

Cited by 9 | Viewed by 3956

Abstract

Stroke is one of the most common causes of death and disability. Reperfusion therapies are the only treatment available during the acute phase of stroke. Due to recent clinical trials, these therapies may increase their frequency of use by extending the time-window administration, [...] Read more.

Stroke is one of the most common causes of death and disability. Reperfusion therapies are the only treatment available during the acute phase of stroke. Due to recent clinical trials, these therapies may increase their frequency of use by extending the time-window administration, which may lead to an increase in complications such as hemorrhagic transformation, with parenchymal hematoma (PH) being the more severe subtype, associated with higher mortality and disability rates. Our aim was to find genetic risk factors associated with PH, as that could provide molecular targets/pathways for their prevention/treatment and study its genetic correlations to find traits sharing genetic background. We performed a GWAS and meta-analysis, following standard quality controls and association analysis (fastGWAS), adjusting age, NIHSS, and principal components. FUMA was used to annotate, prioritize, visualize, and interpret the meta-analysis results. The total number of patients in the meta-analysis was 2034 (216 cases and 1818 controls). We found rs79770152 having a genome-wide significant association (beta 0.09, p-value 3.90 × 10⁻⁸) located in the RP11-362K2.2:RP11-767I20.1 gene and a suggestive variant (rs13297983: beta 0.07, p-value 6.10 × 10⁻⁸) located in PCSK5 associated with PH occurrence. The genetic correlation showed a shared genetic background of PH with Alzheimer’s disease and white matter hyperintensities. In addition, genes containing the ten most significant associations have been related to aggregated amyloid-β, tau protein, white matter microstructure, inflammation, and matrix metalloproteinases. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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13 pages, 614 KiB

Open AccessArticle

Fasting Normoglycemia after Intravenous Thrombolysis Predicts Favorable Long-Term Outcome in Non-Diabetic Patients with Acute Ischemic Stroke

by Marcin Wnuk, Justyna Derbisz, Leszek Drabik, Maciej Malecki and Agnieszka Slowik

J. Clin. Med. 2021, 10(14), 3005; https://doi.org/10.3390/jcm10143005 - 6 Jul 2021

Cited by 3 | Viewed by 2042

Abstract

Background: Only a few studies evaluated the role of fasting glucose levels after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS). Importantly, formal analysis concerning the prognostic role of fasting glucose levels in these patients with and without diabetes mellitus (DM) [...] Read more.

Background: Only a few studies evaluated the role of fasting glucose levels after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS). Importantly, formal analysis concerning the prognostic role of fasting glucose levels in these patients with and without diabetes mellitus (DM) was not performed. Therefore, we assessed whether fasting normoglycemia (FNG) next morning after AIS treated with IVT was associated with 90-day functional outcome in diabetic and non-diabetic patients. Methods: We retrospectively analyzed 362 AIS patients treated with IVT at The University Hospital in Krakow. FNG was defined as glucose below 5.5 mmol/L. A favorable outcome was defined as modified Rankin score (mRS) of 0–2 at day 90 after AIS onset. Results: At 3-month follow-up, FNG was associated with favorable outcome (87.5% vs. 60.8%, p < 0.001) and decreased risk of death (3.1% vs. 18.1%, p = 0.002). Independent predictors of a favorable outcome for the whole group were: younger age (HR 0.92, 95%CI 0.89–0.95), lower NIHSS score after IVT (HR 0.70, 95%CI 0.65–0.76), lower maximal systolic blood pressure within 24 h after IVT (HR 0.92, 95%CI 0.89–0.95) and FNG (HR 4.12, 95%CI 1.38–12.35). Association between FNG and mortality was found in univariable (HR 1.47, 95%CI 0.04–0.62) but not in multivariable analysis (HR 0.23, 95%CI 0.03–1.81). In subgroup analyses, FNG was an independent predictor of favorable outcome (HR 5.96, 95%CI 1.42–25.1) only in patients without DM. Conclusions: FNG next morning after IVT is an independent protective factor for a favorable long-term outcome in non-diabetic AIS patients. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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11 pages, 977 KiB

Open AccessArticle

Advanced Neuroimaging Preceding Intravenous Thrombolysis in Acute Ischemic Stroke Patients Is Safe and Effective

by Klearchos Psychogios, Apostolos Safouris, Odysseas Kargiotis, Georgios Magoufis, Athina Andrikopoulou, Ermioni Papageorgiou, Maria Chondrogianni, Georgios Papadimitropoulos, Eftihia Polyzogopoulou, Stavros Spiliopoulos, Elias Brountzos, Elefterios Stamboulis, Sotirios Giannopoulos and Georgios Tsivgoulis

J. Clin. Med. 2021, 10(13), 2819; https://doi.org/10.3390/jcm10132819 - 26 Jun 2021

Cited by 9 | Viewed by 2584

Abstract

Advanced neuroimaging is one of the most important means that we have in the attempt to overcome time constraints and expand the use of intravenous thrombolysis (IVT). We assessed whether, and how, the prior use of advanced neuroimaging (AN), and more specifically CT/MR [...] Read more.

Advanced neuroimaging is one of the most important means that we have in the attempt to overcome time constraints and expand the use of intravenous thrombolysis (IVT). We assessed whether, and how, the prior use of advanced neuroimaging (AN), and more specifically CT/MR perfusion post-processed with RAPID software, regardless of time from symptoms onset, affected the outcomes of acute ischemic stroke (AIS) patients who received IVT. Methods. We retrospectively evaluated consecutive AIS patients who received intravenous thrombolysis monotherapy (without endovascular reperfusion) during a six-year period. The study population was divided into two groups according to the neuroimaging protocol used prior to IVT administration in AIS patients (AN+ vs. AN−). Safety outcomes included any intracranial hemorrhage (ICH) and 3-month mortality. Effectiveness outcomes included door-to-needle time, neurological status (NIHSS-score) on discharge, and functional status at three months assessed by the modified Rankin Scale (mRS). Results. The rate of IVT monotherapy increased from ten patients per year (n = 29) in the AN− to fifteen patients per year (n = 47) in the AN+ group. Although the onset-to-treatment time was longer in the AN+ cohort, the two groups did not differ in door-to-needle time, discharge NIHSS-score, symptomatic ICH, any ICH, 3-month favorable functional outcome (mRS-scores of 0–1), 3-month functional independence (mRS-scores of 0–2), distribution of 3-month mRS-scores, or 3-month mortality. Conclusion. Our pilot observational study showed that the incorporation of advanced neuroimaging in the acute stroke chain pathway in AIS patients increases the yield of IVT administration without affecting the effectiveness and safety of the treatment. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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11 pages, 893 KiB

Open AccessArticle

Analysis of Frailty in Geriatric Patients as a Prognostic Factor in Endovascular Treated Patients with Large Vessel Occlusion Strokes

by Marlena Schnieder, Mathias Bähr, Mareike Kirsch, Ilko Maier, Daniel Behme, Christian Heiner Riedel, Marios-Nikos Psychogios, Alex Brehm, Jan Liman and Christine A. F. von Arnim

J. Clin. Med. 2021, 10(10), 2171; https://doi.org/10.3390/jcm10102171 - 18 May 2021

Cited by 23 | Viewed by 2954

Abstract

Frailty is associated with an increased risk of adverse health-care outcomes in elderly patients. The Hospital Frailty Risk Score (HFRS) has been developed and proven to be capable of identifying patients which are at high risk of adverse outcomes. We aimed to investigate [...] Read more.

Frailty is associated with an increased risk of adverse health-care outcomes in elderly patients. The Hospital Frailty Risk Score (HFRS) has been developed and proven to be capable of identifying patients which are at high risk of adverse outcomes. We aimed to investigate whether frail patients also face adverse outcomes after experiencing an endovascular treated large vessel occlusion stroke (LVOS). In this retrospective observational cohort study, we analyzed patients ≥ 65 years that were admitted during 2015–2019 with LVOS and endovascular treatment. Primary outcomes were mortality and the modified Rankin Scale (mRS) after three months. Regression models were used to determine the impact of frailty. A total of 318 patients were included in the cohort. The median HFRS was 1.6 (IQR 4.8). A total of 238 (75.1%) patients fulfilled the criteria for a low-frailty risk with a HFRS < 5.72 (22.7%) for moderate-frailty risk with an HFRS from 5–15 and 7 (2.2%) patients for a high-frailty risk. Multivariate regression analyses revealed that the HFRS was associated with an increased mortality after 90 days (CI (95%) 1.001 to 1.236; OR 1.112) and a worse mRS (CI (95%) 1.004 to 1.270; OR 1.129). We identified frailty as an impact factor on functional outcome and mortality in patients undergoing thrombectomy in LVOS. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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11 pages, 2352 KiB

Open AccessArticle

Low Hypoperfusion Intensity Ratio Is Associated with a Favorable Outcome Even in Large Ischemic Core and Delayed Recanalization Time

by Jang-Hyun Baek, Young Dae Kim, Ki Jeong Lee, Jin Kyo Choi, Minyoul Baik, Byung Moon Kim, Dong Joon Kim, Ji Hoe Heo and Hyo Suk Nam

J. Clin. Med. 2021, 10(9), 1869; https://doi.org/10.3390/jcm10091869 - 26 Apr 2021

Cited by 10 | Viewed by 3826

Abstract

In ischemic brain tissue, hypoperfusion severity can be assessed using the hypoperfusion intensity ratio (HIR). We evaluated the link between HIR and clinical outcomes after successful recanalization by endovascular treatment. We retrospectively reviewed 162 consecutive patients who underwent endovascular treatment for intracranial large [...] Read more.

In ischemic brain tissue, hypoperfusion severity can be assessed using the hypoperfusion intensity ratio (HIR). We evaluated the link between HIR and clinical outcomes after successful recanalization by endovascular treatment. We retrospectively reviewed 162 consecutive patients who underwent endovascular treatment for intracranial large vessel occlusion. The HIR was calculated using an automated software program, with initial computed tomography perfusion images. The HIR was compared between patients with and without favorable outcomes. To observe the modifying effect of the HIR on the well-known major outcome determinants, regression analyses were performed in the low and high HIR groups. The median HIR value was significantly lower in patients with a favorable outcome, with an optimal cut-off point of 0.54. The HIR was an independent factor for a favorable outcome in a specific multivariable model and was significantly correlated with the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). In contrast to the high HIR group, the low HIR group showed that ASPECTS and onset-to-recanalization time were not independently associated with a favorable outcome. Finally, the low HIR group had a more favorable outcome even in cases with an unfavorable ASPECTS and onset-to-recanalization time. The HIR could be useful in predicting outcomes after successful recanalization. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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11 pages, 530 KiB

Open AccessArticle

C-Reactive Protein and White Blood Cell Count in Non-Infective Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

by Marcin Wnuk, Justyna Derbisz, Leszek Drabik and Agnieszka Slowik

J. Clin. Med. 2021, 10(8), 1610; https://doi.org/10.3390/jcm10081610 - 10 Apr 2021

Cited by 6 | Viewed by 2834

Abstract

Background: Previous studies on inflammatory biomarkers in acute ischemic stroke (AIS) produced divergent results. We evaluated whether C-reactive protein (CRP) and white blood cell count (WBC) measured fasting 12–24 h after intravenous thrombolysis (IVT) were associated with outcome in AIS patients without concomitant [...] Read more.

Background: Previous studies on inflammatory biomarkers in acute ischemic stroke (AIS) produced divergent results. We evaluated whether C-reactive protein (CRP) and white blood cell count (WBC) measured fasting 12–24 h after intravenous thrombolysis (IVT) were associated with outcome in AIS patients without concomitant infection. Methods: The study included 352 AIS patients treated with IVT. Excluded were patients with community-acquired or nosocomial infection. Outcome was measured on discharge and 90 days after stroke onset with the modified Rankin scale (mRS) and defined as poor outcome (mRS 3–6) or death (mRS = 6). Results: Final analysis included 158 patients (median age 72 years (interquartile range 63-82), 53.2% (n = 84) women). Poor outcome on discharge and at day 90 was 3.8-fold and 5.8-fold higher for patients with CRP ≥ 8.65 mg/L (fifth quintile of CRP), respectively, compared with first quintile (<1.71 mg/L). These results remained significant after adjustment for potential confounders (odds ratio (OR) on discharge = 10.68, 95% CI: 2.54–44.83, OR at day 90 after stroke = 7.21, 95% CI: 1.44–36.00). In-hospital death was 6.3-fold higher for patients with fifth quintile of CRP as compared with first quintile and remained independent from other variables (OR = 4.79, 95% CI: 1.29–17.88). Independent predictors of 90-day mortality were WBC < 6.4 × 10⁹ /L (OR = 5.00, 95% CI: 1.49–16.78), baseline National Institute of Health Stroke Scale (NIHSS) score (OR = 1.13 per point, 95% CI: 1.01–1.25) and bleeding brain complications (OR = 5.53, 95% CI: 1.59–19.25) but not CRP ≥ 8.65 mg/L. Conclusions: Non-infective CRP levels are an independent risk factor for poor short- and long-term outcomes and in-hospital mortality in AIS patients treated with IVT. Decreased WBC but not CRP is a predictor for 90-day mortality. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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10 pages, 1389 KiB

Open AccessArticle

Hypoperfusion Index Ratio as a Surrogate of Collateral Scoring on CT Angiogram in Large Vessel Stroke

by Chun-Min Wang, Yu-Ming Chang, Pi-Shan Sung and Chih-Hung Chen

J. Clin. Med. 2021, 10(6), 1296; https://doi.org/10.3390/jcm10061296 - 21 Mar 2021

Cited by 27 | Viewed by 3484

Abstract

Background: This study was to evaluate the correlation of the hypoperfusion intensity ratio (HIR) with the collateral score from multiphase computed tomography angiography (mCTA) among patients with large vessel stroke. Method: From February 2019 to May 2020, we retrospectively reviewed the patients with [...] Read more.

Background: This study was to evaluate the correlation of the hypoperfusion intensity ratio (HIR) with the collateral score from multiphase computed tomography angiography (mCTA) among patients with large vessel stroke. Method: From February 2019 to May 2020, we retrospectively reviewed the patients with large vessel strokes (intracranial carotid artery or proximal middle cerebral artery occlusion). HIR was defined as a Tmax > 10 s lesion volume divided by a Tmax > 6 s lesion volume, which was calculated by automatic software (Syngo.via, Siemens). The correlation between the HIR and mCTA score was evaluated by Pearson’s correlation. The cutoff value predicting the mCTA score was evaluated by receiver operating characteristic analysis. Result: Ninety-four patients were enrolled in the final analysis. The patients with good collaterals had a smaller core volume (37.3 ± 24.7 vs. 116.5 ± 70 mL, p < 0.001) and lower HIR (0.51 ± 0.2 vs. 0.73 ± 0.13, p < 0.001) than those with poor collaterals. A higher HIR was correlated with a poorer collateral score by Pearson’s correlation. (r = −0.64, p < 0.001). The receiver operating characteristic (ROC) analysis suggested that the best HIR value for predicting a good collateral score was 0.68 (area under curve: 0.82). Conclusion: HIR is a good surrogate of collateral circulation in patients with acute large artery occlusion. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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13 pages, 483 KiB

Open AccessArticle

Acute Management Should Be Optimized in Patients with Less Specific Stroke Symptoms: Findings from a Retrospective Observational Study

by Simona Halúsková, Roman Herzig, Dagmar Krajíčková, Abduljabar Hamza, Antonín Krajina, Vendelín Chovanec, Miroslav Lojík, Jan Raupach, Ondřej Renc, Libor Šimůnek, Eva Vítková, Lukáš Sobíšek and Martin Vališ

J. Clin. Med. 2021, 10(5), 1143; https://doi.org/10.3390/jcm10051143 - 9 Mar 2021

Cited by 7 | Viewed by 2619

Abstract

Anterior circulation stroke (ACS) is associated with typical symptoms, while posterior circulation stroke (PCS) may cause a wide spectrum of less specific symptoms. We aim to assess the correlation between the initial presentation of acute ischemic stroke (AIS) symptoms and the treatment timeline. [...] Read more.

Anterior circulation stroke (ACS) is associated with typical symptoms, while posterior circulation stroke (PCS) may cause a wide spectrum of less specific symptoms. We aim to assess the correlation between the initial presentation of acute ischemic stroke (AIS) symptoms and the treatment timeline. Using a retrospective, observational, single-center study, the set consists of 809 AIS patients treated with intravenous thrombolysis (IVT) and/or endovascular treatment (EVT). We investigate the impact of baseline clinical AIS symptoms and the affected vascular territory on recanalization times in patients treated with IVT only and EVT (±IVT). Regarding the IVT-only group, increasing the National Institutes of Health Stroke Scale (NIHSS) score on admission and speech difficulties are associated with shorter (by 1.59 ± 0.76 min per every one-point increase; p = 0.036, and by 24.56 ± 8.42 min; p = 0.004, respectively) and nausea/vomiting with longer (by 43.72 ± 13.13 min; p = 0.001) onset-to-needle times, and vertigo with longer (by 8.58 ± 3.84 min; p = 0.026) door-to-needle times (DNT). Regarding the EVT (±IVT) group, coma is associated with longer (by 22.68 ± 6.05 min; p = 0.0002) DNT, anterior circulation stroke with shorter (by 47.32 ± 16.89 min; p = 0.005) onset-to-groin time, and drooping of the mouth corner with shorter (by 20.79 ± 6.02 min; p = 0.0006) door-to-groin time. Our results demonstrate that treatment is initiated later in strokes with less specific symptoms than in strokes with typical symptoms. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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13 pages, 1490 KiB

Open AccessArticle

Prediction of Infarct Growth and Neurological Deterioration in Patients with Vertebrobasilar Artery Occlusions

by Seungyon Koh, Ji Hyun Park, Bumhee Park, Mun Hee Choi, Sung Eun Lee, Jin Soo Lee, Ji Man Hong and Seong-Joon Lee

J. Clin. Med. 2020, 9(11), 3759; https://doi.org/10.3390/jcm9113759 - 22 Nov 2020

Cited by 5 | Viewed by 2799

Abstract

We aimed to identify predictors of infarct growth and neurological deterioration (ND) in vertebrobasilar occlusions (VBOs) with a focus on clinical-core mismatch. From 2010 to 2018, VBO patients were selected from a university hospital registry. In total, 138 VBO patients were included. In [...] Read more.

We aimed to identify predictors of infarct growth and neurological deterioration (ND) in vertebrobasilar occlusions (VBOs) with a focus on clinical-core mismatch. From 2010 to 2018, VBO patients were selected from a university hospital registry. In total, 138 VBO patients were included. In these patients, a posterior circulation Alberta Stroke Program Early CT score (PC-ASPECTS) less than 6 was associated with futile outcome. Within patients with feasible cores, a decrease in PC-ASPECTS score of 2 or more on follow-up imaging was classified as infarct growth and could be predicted by a National Institutes of Health Stroke Scale (NIHSS) mental status subset of 1 or higher (odds ratio (OR): 3.34, 95% confidence interval (CI) (1.19–9.38), p = 0.022). Among the 73 patients who did not undergo reperfusion therapy, 13 patients experienced ND (increase in discharge NIHSS score of 4 or more compared to the initial presentation). Incomplete occlusion (vs. complete occlusion, OR 6.17, 95% CI (1.11–34.25), p = 0.037), poorer collateral status (BATMAN score, OR: 1.91, 95% CI (1.17–3.48), p = 0.009), and larger infarct cores (PC-ASPECTS, OR: 1.96, 95% CI (1.11–3.48), p = 0.021) were predictive of ND. In patients with VBO, an initial PC-ASPECTS of 6 or more, but with a decrease in the mental status subset of 1 or more can predict infarct growth, and may be used as a criterion for clinical-core mismatch. ND in VBO patients presenting with milder symptoms can be predicted by incomplete occlusion, poor collaterals, and larger infarct cores. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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8 pages, 500 KiB

Open AccessArticle

Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients

by Moritz Kielkopf, Thomas Meinel, Johannes Kaesmacher, Urs Fischer, Marcel Arnold, Mirjam Heldner, David Seiffge, Pasquale Mordasini, Tomas Dobrocky, Eike Piechowiak, Jan Gralla and Simon Jung

J. Clin. Med. 2020, 9(8), 2376; https://doi.org/10.3390/jcm9082376 - 25 Jul 2020

Cited by 6 | Viewed by 2993

Abstract

(1) Background: The benefit of acute ischemic stroke (AIS) treatment declines with any time delay until treatment. Hence, factors influencing the time from symptom onset to admission (TTA) are of utmost importance. This study aimed to assess temporal trends and risk factors for [...] Read more.

(1) Background: The benefit of acute ischemic stroke (AIS) treatment declines with any time delay until treatment. Hence, factors influencing the time from symptom onset to admission (TTA) are of utmost importance. This study aimed to assess temporal trends and risk factors for delays in TTA. (2) Methods: We included 1244 consecutive patients from 2015 to 2018 with suspected stroke presenting within 24 h after symptom onset registered in our prospective, pre-specified hospital database. Temporal trends were assessed by comparing with a cohort of a previous study in 2006. Factors associated with TTA were assessed by univariable and multivariable regression analysis. (3) Results: In 1244 patients (median [IQR] age 73 [60–82] years; 44% women), the median TTA was 96 min (IQR 66–164). The prehospital time delay reduced by 27% in the last 12 years and the rate of patients referred by Emergency medical services (EMS) increased from 17% to 51% and the TTA for admissions by General Practitioner (GP) declined from 244 to 207 min. Factors associated with a delay in TTA were stroke severity (beta−1.9; 95% CI–3.6 to −0.2 min per point NIHSS score), referral by General Practitioner (GP, beta +140 min, 95% CI 100–179), self-admission (+92 min, 95% CI 57–128) as compared to admission by emergency medical services (EMS) and symptom onset during nighttime (+57 min, 95% CI 30–85). Conclusions: Although TTA improved markedly since 2006, our data indicates that continuous efforts are mandatory to raise public awareness on the importance of fast hospital referral in patients with suspected stroke by directly informing EMS, avoiding contact of a GP, and maintaining high effort for fast transportation also in patients with milder symptoms. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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12 pages, 763 KiB

Open AccessArticle

Temperature-Induced Changes in Reperfused Stroke: Inflammatory and Thrombolytic Biomarkers

by Paulo Ávila-Gómez, Pablo Hervella, Andrés Da Silva-Candal, María Pérez-Mato, Manuel Rodríguez-Yáñez, Iria López-Dequidt, José M. Pumar, José Castillo, Tomás Sobrino, Ramón Iglesias-Rey and Francisco Campos

J. Clin. Med. 2020, 9(7), 2108; https://doi.org/10.3390/jcm9072108 - 4 Jul 2020

Cited by 6 | Viewed by 2583

Abstract

Although hyperthermia is associated with poor outcomes in ischaemic stroke (IS), some studies indicate that high body temperature may benefit reperfusion therapies. We assessed the association of temperature with effective reperfusion (defined as a reduction of ≥8 points in the National Institute of [...] Read more.

Although hyperthermia is associated with poor outcomes in ischaemic stroke (IS), some studies indicate that high body temperature may benefit reperfusion therapies. We assessed the association of temperature with effective reperfusion (defined as a reduction of ≥8 points in the National Institute of Health Stroke Scale (NIHSS) within the first 24 h) and poor outcome (modified Rankin Scale (mRS) > 2) in 875 retrospectively-included IS patients. We also studied the influence of temperature on thrombolytic (cellular fibronectin (cFn); matrix metalloproteinase 9 (MMP-9)) and inflammatory biomarkers (tumour necrosis factor-alpha (TNF-α), interleukin 6 (IL-6)) and their relationship with effective reperfusion. Our results showed that a higher temperature at 24 but not 6 h after stroke was associated with failed reperfusion (OR: 0.373, p = 0.001), poor outcome (OR: 2.190, p = 0.005) and higher IL-6 levels (OR: 0.958, p < 0.0001). Temperature at 6 h was associated with higher MMP-9 levels (R = 0.697; p < 0.0001) and effective reperfusion, although this last association disappeared after adjusting for confounding factors (OR: 1.178, p = 0.166). Our results suggest that body temperature > 37.5 °C at 24 h, but not at 6 h after stroke, is correlated with reperfusion failure, poor clinical outcome, and infarct size. Mild hyperthermia (36.5–37.5 °C) in the first 6 h window might benefit drug reperfusion therapies by promoting clot lysis. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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14 pages, 2687 KiB

Open AccessArticle

Novel Estimation of Penumbra Zone Based on Infarct Growth Using Machine Learning Techniques in Acute Ischemic Stroke

by Yoon-Chul Kim, Hyung Jun Kim, Jong-Won Chung, In Gyeong Kim, Min Jung Seong, Keon Ha Kim, Pyoung Jeon, Hyo Suk Nam, Woo-Keun Seo, Gyeong-Moon Kim and Oh Young Bang

J. Clin. Med. 2020, 9(6), 1977; https://doi.org/10.3390/jcm9061977 - 24 Jun 2020

Cited by 7 | Viewed by 5048

Abstract

While the penumbra zone is traditionally assessed based on perfusion–diffusion mismatch, it can be assessed based on machine learning (ML) prediction of infarct growth. The purpose of this work was to develop and validate an ML method for the prediction of infarct growth [...] Read more.

While the penumbra zone is traditionally assessed based on perfusion–diffusion mismatch, it can be assessed based on machine learning (ML) prediction of infarct growth. The purpose of this work was to develop and validate an ML method for the prediction of infarct growth distribution and volume, in cases of successful (SR) and unsuccessful recanalization (UR). Pre-treatment perfusion-weighted, diffusion-weighted imaging (DWI) data, and final infarct lesions annotated from day-7 DWI from patients with middle cerebral artery occlusion were utilized to develop and validate two ML models for prediction of tissue fate. SR and UR models were developed from data in patients with modified treatment in cerebral infarction (mTICI) scores of 2b–3 and 0–2a, respectively. When compared to manual infarct annotation, ML-based infarct volume predictions resulted in an intraclass correlation coefficient (ICC) of 0.73 (95% CI = 0.31–0.91, p < 0.01) for UR, and an ICC of 0.87 (95% CI = 0.73–0.94, p < 0.001) for SR. Favorable outcomes for mismatch presence and absence in SR were 50% and 36%, respectively, while they were 61%, 56%, and 25%, respectively, for the low, intermediate, and high infarct growth groups. The presented method can offer novel and alternative insights into selecting patients for recanalization therapy and predicting functional outcome. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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13 pages, 412 KiB

Open AccessArticle

Dynamic Hyperglycemic Patterns Predict Adverse Outcomes in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

by Giovanni Merlino, Carmelo Smeralda, Massimo Sponza, Gian Luigi Gigli, Simone Lorenzut, Alessandro Marini, Andrea Surcinelli, Sara Pez, Alessandro Vit, Vladimir Gavrilovic and Mariarosaria Valente

J. Clin. Med. 2020, 9(6), 1932; https://doi.org/10.3390/jcm9061932 - 20 Jun 2020

Cited by 18 | Viewed by 2912

Abstract

Background: Admission hyperglycemia impairs outcome in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). Since hyperglycemia in AIS represents a dynamic condition, we tested whether the dynamic patterns of hyperglycemia, defined as blood glucose levels > 140 mg/dl, affect outcomes in these [...] Read more.

Background: Admission hyperglycemia impairs outcome in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). Since hyperglycemia in AIS represents a dynamic condition, we tested whether the dynamic patterns of hyperglycemia, defined as blood glucose levels > 140 mg/dl, affect outcomes in these patients. Methods: We retrospectively analyzed data of 200 consecutive patients with prospective follow-up. Based on blood glucose level, patients were distinguished into 4 groups: (1) persistent normoglycemia; (2) hyperglycemia at baseline only; (3) hyperglycemia at 24-h only; and (4) persistent (at baseline plus at 24-h following MT) hyperglycemia. Results: AIS patients with persistent hyperglycemia have a significantly increased risk of poor functional outcome (OR 6.89, 95% CI 1.98–23.94, p = 0.002, for three-month poor outcome; OR 11.15, 95% CI 2.99–41.52, p = 0.001, for no major neurological improvement), mortality (OR 5.37, 95% CI 1.61–17.96, p = 0.006, for in-hospital mortality; OR 4.43, 95% CI 1.40–13.97, p = 0.01, for three-month mortality), and hemorrhagic transformation (OR 6.89, 95% CI 2.35–20.21, p = 0.001, for intracranial hemorrhage; OR 5.42, 95% CI 1.54–19.15, p = 0.009, for symptomatic intracranial hemorrhage) after endovascular treatment. These detrimental effects were partially confirmed after also excluding diabetic patients. The AUC-ROC showed a very good performance for predicting three-month poor outcome (0.76) in-hospital mortality (0.79) and three-month mortality (0.79). Conclusions: Our study suggests that it is useful to perform the prolonged monitoring of glucose levels lasting 24-h after MT. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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11 pages, 663 KiB

Open AccessArticle

Acute Kidney Injury after Endovascular Treatment in Patients with Acute Ischemic Stroke

by Joonsang Yoo, Jeong-Ho Hong, Seong-Joon Lee, Yong-Won Kim, Ji Man Hong, Chang-Hyun Kim, Jin Wook Choi, Dong-Hun Kang, Yong-Sun Kim, Yang-Ha Hwang, Jin Soo Lee and Sung-Il Sohn

J. Clin. Med. 2020, 9(5), 1471; https://doi.org/10.3390/jcm9051471 - 14 May 2020

Cited by 16 | Viewed by 3061

Abstract

Acute kidney injury (AKI) is often associated with the use of contrast agents. We evaluated the frequency of AKI, factors associated with AKI after endovascular treatment (EVT), and associations with AKI and clinical outcomes. We retrospectively analyzed consecutively enrolled patients with acute ischemic [...] Read more.

Acute kidney injury (AKI) is often associated with the use of contrast agents. We evaluated the frequency of AKI, factors associated with AKI after endovascular treatment (EVT), and associations with AKI and clinical outcomes. We retrospectively analyzed consecutively enrolled patients with acute ischemic stroke who underwent EVT at three stroke centers in Korea. We compared the characteristics of patients with and without AKI and independent factors associated with AKI after EVT. We also investigated the effects of AKI on functional outcomes and mortality at 3 months. Of the 601 patients analyzed, 59 patients (9.8%) developed AKI and five patients (0.8%) started renal replacement therapy after EVT. In the multivariate analysis, diabetes mellitus (odds ratio (OR), 2.341; 95% CI, 1.283–4.269; p = 0.005), the contrast agent dose (OR, 1.107 per 10 mL; 95% CI, 1.032–1.187; p = 0.004), and unsuccessful reperfusion (OR, 1.909; 95% CI, 1.019–3.520; p = 0.040) were independently associated with AKI. The presence of AKI was associated with a poor functional outcome (OR, 5.145; 95% CI, 2.177–13.850; p < 0.001) and mortality (OR, 8.164; 95% CI, 4.046–16.709; p < 0.001) at 3 months. AKI may also affect the outcomes of ischemic stroke patients undergoing EVT. When implementing EVT, practitioners should be aware of these risk factors. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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9 pages, 2359 KiB

Open AccessCase Report

Acute Middle Cerebral Artery Occlusion Detection Using Mobile Non-Imaging Brain Perfusion Ultrasound—First Case

by Mustafa Kilic, Christina Wendl, Sibylle Wilfling, David Olmes, Ralf Andreas Linker and Felix Schlachetzki

J. Clin. Med. 2022, 11(12), 3384; https://doi.org/10.3390/jcm11123384 - 13 Jun 2022

Cited by 3 | Viewed by 2544

Abstract

Mobile brain perfusion ultrasound (BPU) is a novel non-imaging technique creating only hemispheric perfusion curves following ultrasound contrast injection and has been specifically designed for early prehospital large vessel occlusion (LVO) stroke identification. We report on the first patient investigated with the SONAS [...] Read more.

Mobile brain perfusion ultrasound (BPU) is a novel non-imaging technique creating only hemispheric perfusion curves following ultrasound contrast injection and has been specifically designed for early prehospital large vessel occlusion (LVO) stroke identification. We report on the first patient investigated with the SONAS^® system, a portable point-of-care ultrasound system for BPU. This patient was admitted into our stroke unit about 12 h following onset of a fluctuating motor aphasia, dysarthria and facial weakness resulting in an NIHSS of 3 to 8. Occlusion of the left middle cerebral artery occlusion was diagnosed by computed tomography angiography. BPU was performed in conjunction with injection of echo-contrast agent to generate hemispheric perfusion curves and in parallel, conventional color-coded sonography (TCCS) assessing MCAO. Both assessments confirmed the results of angiography. Emergency mechanical thrombectomy (MT) achieved complete recanalization (TICI 3) and post-interventional NIHSS of 2 the next day. Telephone follow-up after 2 years found the patient fully active in professional life. Point-of-care BPU is a non-invasive technique especially suitable for prehospital stroke diagnosis for LVO. BPU in conjunction with prehospital stroke scales may enable goal-directed stroke patient placement, i.e., directly to comprehensive stroke centers aiming for MT. Further results of the ongoing phase II study are needed to confirm this finding. Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

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