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Marnat G, Gerschenfeld G, Olindo S, Sibon I, Seners P, Clarençon F, Smadja D, Chausson N, Ben Hassen W, Piotin M, Caroff J, Alamowitch S, Turc G. Incidence and predictors of intracranial hemorrhage after intravenous thrombolysis with tenecteplase. Eur Stroke J 2024:23969873241253660. [PMID: 38757712 DOI: 10.1177/23969873241253660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Despite its increasing use, there are limited data on the risk of intracranial hemorrhage (ICH) after intravenous thrombolysis with tenecteplase in the setting of acute ischemic stroke. Our aim was to investigate the incidence and predictors of ICH after tenecteplase administration. METHODS We reviewed data from the prospective ongoing multicenter TETRIS (Tenecteplase Treatment in Ischemic Stroke) registry. Patients with available day-1 imaging were included in this study. Clinical, imaging and biological variables were collected. Follow-up imaging performed 24 h after IVT was locally reviewed by senior neuroradiologists and neurologists. The incidence of parenchymal hematoma (PH) and any ICH were investigated. Potential predictors of PH and any ICH were assessed in multivariable logistic regressions. Subgroup analyses focusing on patients intended for endovascular treatment were performed. RESULTS PH and any ICH occurred in 126/1321 (incidence rate: 9.5%, 95% CI 8.1-11.2) and 521/1321 (39.4%, 95% CI 36.8-42.1) patients, respectively. Symptomatic ICH was observed in 77/1321 (5.8%; 95% CI 4.7-7.2). PH occurrence was significantly associated with poorer functional outcomes (p < 0.0001) and death (p < 0.0001) after 3 months. Older age (aOR = 1.03; 95% CI 1.01-1.05), male gender (aOR = 2.07; 95% CI 1.28-3.36), a history of hypertension (aOR = 2.08; 95% CI 1.19-3.62), a higher baseline NIHSS (aOR = 1.07; 95% CI 1.03-1.10) and higher admission blood glucose level (aOR = 1.12; 95% CI 1.05-1.19) were independently associated with PH occurrence. Similar associations were observed in the subgroup of patients intended for endovascular treatment. CONCLUSION We quantified the incidence of ICH after IVT with tenecteplase in a real-life prospective registry and determined independent predictors of ICH. These findings allow to identify patients at high risk of ICH.
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Affiliation(s)
- Gaultier Marnat
- Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Gaspard Gerschenfeld
- Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France; STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | | | - Igor Sibon
- Neurology, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Seners
- Neurology, Fondation Rothschild, Paris, Île-de-France, France
| | | | - Didier Smadja
- Unité Neuro-vasculaire, Hôpital Sud Francilien, Corbeil-Essonnes, France
| | - Nicolas Chausson
- Unité Neuro-vasculaire, Hôpital Sud Francilien, Corbeil-Essonnes, France
| | | | | | - Jildaz Caroff
- Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Sonia Alamowitch
- Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France; STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Guillaume Turc
- Neurology, GHU Paris Psychiatrie et Neurosciences, INSERM U1266, Université Paris Cité, FHU NeuroVasc, Paris, France
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Qiao X, Zheng F, Wei M, Zhao Z. The ratio of the maximum density values: a new method for predicting hemorrhagic transformation in acute ischemic stroke patients undergoing mechanical thrombectomy. Front Neurol 2024; 15:1357689. [PMID: 38585350 PMCID: PMC10996850 DOI: 10.3389/fneur.2024.1357689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/13/2024] [Indexed: 04/09/2024] Open
Abstract
Background It is challenging yet critical to differentiate between hemorrhagic transformation (HT) and contrast extravasation on non-contrast-enhanced computed tomography (NCCT) scans following mechanical thrombectomy (MT) in patients with acute ischemic stroke. We propose a new method called the ratio of maximum density values (RMDV) to minimize the confusion of contrast extravasation and to evaluate the diagnostic significance of RMDV in predicting HT on immediate post-interventional NCCT scans. Methods We conducted a retrospective analysis of the prospective patients' database who received MT for acute ischemic stroke caused by occlusion of the intracranial large artery and showed postinterventional cerebral hyperdensities (PCHDs) on NCCT scans immediately after MT. Based on the subsequent NCCT scans, we divided patients with PCHDs into the HT and the non-HT groups. The clinical characters and radiological details were collected and compared to the two groups. We assessed the ability of RMDV >1 to predict HT by analyzing the receiver operating characteristic curve. Results One hundred and three patients showed PCHDs; 58 (56.31%) were classified as HT, while 45 (43.69%) were classified as non-HT. The only notable distinction between the two groups was the proportion of RMDV >1 in the HT group. The correlation between HT and RMDV >1 with an area under the curve of 0.826 (95% confidence interval, 0.739 to 0.894). The sensitivity, specificity, positive, and negative predictive values of RMDV >1 on NCCT for predicting HT were 89.66, 75.56, 82.54, and 85.00%, respectively. Conclusion The utilization of RMDV >1 on immediate NCCT scans after MT can predict early HT with good sensitivity and specificity.
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Affiliation(s)
- Xiaohong Qiao
- Department of Neurology, Weihai Central Hospital Affiliated to Qingdao University, Weihai, China
| | - Fuhao Zheng
- Department of Neurointervention, Weihai Central Hospital Affiliated to Qingdao University, Weihai, China
| | - Manman Wei
- Department of Neurology, Weihai Central Hospital Affiliated to Qingdao University, Weihai, China
| | - Zhenming Zhao
- Department of Neurointervention, Weihai Central Hospital Affiliated to Qingdao University, Weihai, China
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Hu H, Zhao Y, Liu X, Sun X, Nguyen TN, Chen H. Benefit of endovascular treatment for primary versus secondary medium vessel occlusion: A multi-center experience. CNS Neurosci Ther 2024; 30:e14687. [PMID: 38497517 PMCID: PMC10945881 DOI: 10.1111/cns.14687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
AIMS This study aimed to compare the clinical outcomes and safety of endovascular treatment (EVT) in patients with primary versus secondary medium vessel occlusion (MeVO). METHODS From the endovascular treatment for acute ischemic stroke in the China registry, we collected consecutive patients with MeVO who received EVT. The primary endpoint was a good outcome, defined as a modified Rankin Scale (mRS) 0 to 2 at 90 days. RESULTS 154 patients were enrolled in the final analysis, including 74 primary MeVO and 80 secondary MeVO. A good outcome at 90 days was achieved in 42 (56.8%) patients with primary MeVO and 33 (41.3%) patients with secondary MeVO. There was a higher probability of good outcomes in patients with the primary vs secondary MeVO (adjusted odds ratio, 2.16; 95% confidence interval, 1.04 to 4.46; p = 0.04). There were no significant differences in secondary and safety outcomes between MeVO groups. In the multivariable analysis, baseline ASPECTS (p = 0.001), final modified thrombolysis in cerebral infarction score (p = 0.01), and any ICH (p = 0.03) were significantly associated with good outcomes in primary MeVO patients, while baseline National Institutes of Health Stroke Scale (p = 0.002), groin puncture to recanalization time (p = 0.02), and early neurological improvement (p < 0.001) were factors associated with good outcome in secondary MeVO patients. CONCLUSION In MeVO patients who received EVT, there was a higher likelihood of poor outcomes in patients with secondary versus primary MeVO.
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Affiliation(s)
- Hai‐Zhou Hu
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
- Department of Graduate SchoolChina Medical UniversityShenyangChina
| | - Yong‐Gang Zhao
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
| | - Xin Liu
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
| | - Xian‐Hui Sun
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
| | - Thanh N. Nguyen
- Neurology, RadiologyBoston Medical CenterBostonMassachusettsUSA
| | - Hui‐Sheng Chen
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
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4
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Radu RA, Costalat V, Fahed R, Ghozy S, Siegler JE, Shaikh H, Khalife J, Abdalkader M, Klein P, Nguyen TN, Heit JJ, Sweid A, El Naamani K, Regenhardt RW, Diestro JDB, Cancelliere NM, Amllay A, Meyer L, Dusart A, Bellante F, Forestier G, Rouchaud A, Saleme S, Mounayer C, Fiehler J, Kühn AL, Puri AS, Dyzmann C, Kan PT, Colasurdo M, Marnat G, Berge J, Barreau X, Sibon I, Nedelcu S, Henninger N, Kyheng M, Marotta TR, Stapleton CJ, Rabinov JD, Ota T, Dofuku S, Yeo LLL, Tan BYQ, Martinez-Gutierrez JC, Salazar-Marioni S, Sheth S, Renieri L, Capirossi C, Mowla A, Tjoumakaris SI, Jabbour P, Khandelwal P, Biswas A, Clarençon F, Elhorany M, Premat K, Valente I, Pedicelli A, Pedro Filipe J, Varela R, Quintero-Consuegra M, Gonzalez NR, Möhlenbruch MA, Jesser J, Tancredi I, ter Schiphorst A, Yedavalli V, Harker P, Chervak LM, Aziz Y, Gory B, Paul Stracke C, Hecker C, Killer-Oberpfalzer M, Griessenauer CJ, Thomas AJ, Hsieh CY, Liebeskind DS, Alexandre AM, Faizy TD, Weyland C, Patel AB, Pereira VM, Lubicz B, Dmytriw AA, Guenego A. First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study. Eur Stroke J 2024; 9:114-123. [PMID: 37885243 PMCID: PMC10916815 DOI: 10.1177/23969873231208276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. PATIENTS AND METHODS We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0-2 at 3 months. RESULTS Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10-2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93-0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59-3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25-0.72) and 0.55 (95% CI, 0.39-0.77), respectively. CONCLUSION Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.
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Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Robert Fahed
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Hamza Shaikh
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Jane Khalife
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Mohamad Abdalkader
- Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
| | - Piers Klein
- Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
| | - Thanh N Nguyen
- Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
| | - Jeremy J Heit
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA
| | - Ahmad Sweid
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Jose Danilo Bengzon Diestro
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
| | - Nicole M Cancelliere
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
| | - Abdelaziz Amllay
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Géraud Forestier
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Aymeric Rouchaud
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Suzana Saleme
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Charbel Mounayer
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Luisa Kühn
- Department of Radiology, University of Massachusetts Memorial Hospital, Worcester, MA, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Memorial Hospital, Worcester, MA, USA
| | - Christian Dyzmann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Sana Klinik Lübeck, Lübeck, Germany
| | - Peter T Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Marco Colasurdo
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Gaultier Marnat
- Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Jérôme Berge
- Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Barreau
- Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Igor Sibon
- Neurology Department, Bordeaux University Hospital, Bordeaux, France
| | - Simona Nedelcu
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Maéva Kyheng
- Department of Biostatistics, CHU Lille, Lille, France
| | - Thomas R Marotta
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Shogo Dofuku
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Leonard LL Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin YQ Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | | | | | - Sunil Sheth
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Carolina Capirossi
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Priyank Khandelwal
- Department of Endovascular Neurosurgery and Neuroradiology, NJMS, Newark, NJ, USA
| | - Arundhati Biswas
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital. Paris. France; GRC BioFast, Sorbonne University, Paris VI, France
| | - Mahmoud Elhorany
- Department of Neuroradiology, Pitié-Salpêtrière Hospital. Paris. France; GRC BioFast, Sorbonne University, Paris VI, France
- Neurology Department, Faculty of Medicine, Tanta University, Egypt
| | - Kevin Premat
- Department of Neuroradiology, Pitié-Salpêtrière Hospital. Paris. France; GRC BioFast, Sorbonne University, Paris VI, France
| | - Iacopo Valente
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy
| | - Alessandro Pedicelli
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy
| | - João Pedro Filipe
- Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ricardo Varela
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Nestor R Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Markus A Möhlenbruch
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jessica Jesser
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Illario Tancredi
- Department of Radiology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Adrien ter Schiphorst
- Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Vivek Yedavalli
- Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Pablo Harker
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Lina M Chervak
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Yasmin Aziz
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Benjamin Gory
- Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France
| | - Christian Paul Stracke
- Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany
| | - Constantin Hecker
- Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Monika Killer-Oberpfalzer
- Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Christoph J Griessenauer
- Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Ajith J Thomas
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - David S Liebeskind
- UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, CA, USA
| | - Andrea M Alexandre
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy
| | - Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Weyland
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Vitor Mendes Pereira
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
| | - Boris Lubicz
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
| | - Adrien Guenego
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
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5
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Harker P, Aziz YN, Vranic J, Chulluncuy-Rivas R, Previtera M, Yaghi S, DeHavenon AH, Tsivgoulis GK, Khatri V, Mistry AM, Khatri P, Mistry EA. Asymptomatic Intracerebral Hemorrhage Following Endovascular Stroke Therapy Is Not Benign: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2024; 13:e031749. [PMID: 38348800 PMCID: PMC11010099 DOI: 10.1161/jaha.123.031749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Asymptomatic intracerebral hemorrhage (aICH) occurs in approximately 35% of patients with acute ischemic stroke after endovascular thrombectomy. Unlike symptomatic ICH, studies evaluating the effect of aICH on outcomes have been inconclusive. We performed a systematic review and meta-analysis to evaluate the long-term effects of postendovascular thrombectomy aICH. METHODS AND RESULTS The meta-analysis protocol was submitted to the International Prospective Register of Systematic Reviews a priori. PubMed, Scopus, and Web of Science were searched from inception through September 2023, yielding 312 studies. Two authors independently reviewed all abstracts. Included studies contained adult patients with ischemic stroke undergoing endovascular thrombectomy with follow-up imaging assessment of ICH reporting comparative outcomes according to aICH versus no ICH. After screening, 60 papers were fully reviewed, and 10 studies fulfilled inclusion criteria (n=5723 patients total, 1932 with aICH). Meta-analysis was performed using Cochrane RevMan v5.4. Effects were estimated by a random-effects model to estimate summary odds ratio (OR) of the effect of aICH versus no ICH on primary outcomes of 90-day modified Rankin Scale 3 to 6 and mortality. The presence of aICH was associated with a higher odds of 90-day mRS 3 to 6 (OR, 2.17 [95% CI, 1.81-2.60], P<0.0001, I2 46% Q 19.15) and mortality (OR, 1.72 [95% CI, 1.17-2.53], P:0.005, I2 79% Q 27.59) compared with no ICH. This difference was maintained following subgroup analysis according to hemorrhage classification and recanalization status. CONCLUSIONS The presence of aICH is associated with worse 90-day functional outcomes and higher mortality. Further studies to evaluate the factors predicting aICH and treatments aimed at reducing its occurrence are warranted.
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Affiliation(s)
- Pablo Harker
- Department of Neurology and Rehabilitation Medicine University of Cincinnati Cincinnati OH
| | - Yasmin N Aziz
- Department of Neurology and Rehabilitation Medicine University of Cincinnati Cincinnati OH
| | - Justin Vranic
- Department of Neurosurgery Massachusetts General Hospital Boston MA
| | | | - Melissa Previtera
- Department of Neurology and Rehabilitation Medicine University of Cincinnati Cincinnati OH
| | - Shadi Yaghi
- Department of Neurology Brown University Providence RI
| | | | - Georgios K Tsivgoulis
- Second Department of Neurology National & Kapodistrian University of Athens Athens Greece
| | | | | | - Pooja Khatri
- Department of Neurology and Rehabilitation Medicine University of Cincinnati Cincinnati OH
| | - Eva A Mistry
- Department of Neurology and Rehabilitation Medicine University of Cincinnati Cincinnati OH
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6
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Toscano-Prat C, Martínez-González JP, Guasch-Jiménez M, Ramos-Pachón A, Martí-Fàbregas J, Blanco-Sanroman N, Coronel-Coronel MF, Domine MC, Martínez-Domeño A, Prats-Sánchez L, Marín-Bueno R, Aguilera-Simón A, Lambea-Gil Á, Ezcurra-Díaz G, Camps-Renom P. Asymptomatic parenchymal haemorrhage following endovascular treatment: Impact on functional outcome in patients with acute ischaemic stroke. Eur J Neurol 2024; 31:e16112. [PMID: 37909802 DOI: 10.1111/ene.16112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND PURPOSE In patients with acute ischaemic stroke (AIS), haemorrhagic transformation (HT) following endovascular treatment (EVT) is associated with poor functional outcome. However, the impact of asymptomatic HT, not linked to neurological deterioration in the acute phase, is unknown. We aimed to investigate the impact of asymptomatic PH1 (aPH1) and PH2 (aPH2) subtypes of HT on the functional outcome of patients treated with EVT. METHODS We conducted a retrospective study of patients with AIS who were consecutively admitted to our comprehensive stroke centre between January 2019 and December 2022, and who underwent EVT. We collected clinical, radiological, and procedural data. HTs were categorized according to the Heidelberg classification. The primary outcome was the shift on the modified Rankin Scale (mRS) at 3 months of follow-up. We performed bivariate and multivariable ordinal regression analyses to test the association between aPH1/aPH2 and the primary outcome. RESULTS We included 314 patients (mean age = 72.5 years [SD = 13.6], 171 [54.5%] women). We detected 54 (17.2%) patients with HT; 23 (7.3%) were classified as PH2 (11 asymptomatic) and 17 (5.4%) as PH1 (16 asymptomatic). The adjusted common odds ratio for aPH2 of worsening 1 point on the 3-month mRS was 3.32 (95% confidence interval = 1.16-9.57, p = 0.026). No association was observed for aPH1. aPH2 was also independently associated with lower odds of achieving a favourable outcome (mRS = 0-2). Neither aPH1 nor aPH2 was associated with mortality. CONCLUSIONS In patients with AIS treated with EVT, aPH2 is independently associated with unfavourable functional outcome.
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Affiliation(s)
- Clara Toscano-Prat
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - José Pablo Martínez-González
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Marina Guasch-Jiménez
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Anna Ramos-Pachón
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Nerea Blanco-Sanroman
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Melissa Fabiola Coronel-Coronel
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - María Constanza Domine
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Alejandro Martínez-Domeño
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Luis Prats-Sánchez
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Rebeca Marín-Bueno
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Ana Aguilera-Simón
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Álvaro Lambea-Gil
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Garbiñe Ezcurra-Díaz
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Pol Camps-Renom
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
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7
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Li M, Liu H, Xu M, Yu B, Guo M, Wang X, Shi G, Zhou R. Glial Fibrillary Acidic Protein as a Potential Indicator for Symptomatic Intracranial Hemorrhage in Acute Ischemic Patients Undergoing Endovascular Thrombectomy. Clin Interv Aging 2024; 19:123-132. [PMID: 38283765 PMCID: PMC10813222 DOI: 10.2147/cia.s448180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024] Open
Abstract
Background The correlation between glial fibrillary acidic protein (GFAP) and symptomatic intracranial hemorrhage (sICH) in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT) treatment remains uncertain. We aimed to assess the association between levels of GFAP in the bloodstream and the occurrence of sICH. Methods Between June 2019 and May 2023, 142 consecutive AIS patients undergoing EVT at Stroke Center and 35 controls from the Physical Examination Center were retrospectively included. The levels of GFAP in the bloodstream were quantified using enzyme-linked immunosorbent assay prior to endovascular treatment (T1) and 24 h after the procedure (T2). The identification of sICH was based on the Heidelberg Bleeding Classification. Results Serum GFAP levels at T1 in AIS patients were significantly higher than those in the controls (0.249 [0.150-0.576] versus 0.065 [0.041-0.110] ng/mL, p = 0.001), and there was a notably elevation in GFAP levels at T2 compared to T1 (3.813 [1.474, 5.876] versus 0.249 [0.150-0.576] ng/mL, p = 0.001). Of the 142 AIS patients, 18 (14.5%) had sICH after EVT. Serum GFAP levels at T2 showed significant associations with sICH in both the unadjusted model (OR 1.513, 95% CI 1.269-1.805, p = 0.001) and multivariable adjusted model (OR 1.518, 95% CI 1.153-2.000, p = 0.003). Furthermore, the addition of GFAP at T2 to conventional model resulted in a significant enhancement of risk reclassification for sICH (integrated discrimination improvement [IDI] 0.183, 95% CI 0.070-0.295, p = 0.001). Conclusion Serum GFAP levels were notably increased in AIS patients 24 h after EVT. Elevated GFAP levels were correlated to an elevated risk of sICH. GFAP could potentially serve as a dependable indicator for sICH in AIS individuals who treated with EVT.
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Affiliation(s)
- Minghao Li
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Vascular Surgery, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Hua Liu
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Mingyang Xu
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Baiyang Yu
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing Clinical College of Bengbu Medical College, Bengbu, Anhui, People’s Republic of China
| | - Minwang Guo
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Xiaorong Wang
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Guomei Shi
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Rujuan Zhou
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
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Hoche C, Henderson A, Ifergan H, Gaudron M, Magni C, Maldonado I, Cottier JP, Pasi M, Boulouis G, Cohen C. Determinants and Clinical Relevance of Iodine Contrast Extravasation after Endovascular Thrombectomy: A Dual-Energy CT Study. AJNR Am J Neuroradiol 2023; 45:30-36. [PMID: 38323978 PMCID: PMC10756568 DOI: 10.3174/ajnr.a8081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/29/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND AND PURPOSE Iodine contrast extravasation (ICE) is common in patients with acute ischemic stroke (AIS) after endovascular-thrombectomy (EVT). The aim of our study was to evaluate the incidence of ICE assessed by dual-energy CT (DECT), its determinants, and associations with clinical outcome. MATERIALS AND METHODS We retrospectively examined imaging parameters and clinical factors from consecutive patients with AIS treated with EVT who had a DECT 24 hours thereafter, identified at a single academic center. Associations between ICE, clinical, imaging, and procedural parameters, as well as clinical outcome were explored by using univariable and multivariable models. RESULTS A total of 197 consecutive patients were included (period 2019-2020), of which 53 (27%) demonstrated ICE that was pure ICE in 30/53 (57%) and mixed with intracranial hemorrhage (ICH) in 23/53 (43%). Low initial-ASPECTS, high per-procedural-contrast volume injected, and high admission-glycemia were independently associated with ICE (respectively, OR = 0.43, 95% CI, 0.16-1.13, P = .047; OR = 1.02, 95% CI, 1.00-1.04, P = .003; OR = 8.92, 95% CI, 0.63-125.77, P = .043). ICE was independently associated with ICH (P = .047), but not with poorer clinical outcome (6-month mRS >2, P = .223). Univariate analysis demonstrated that low ADC, higher ischemic volume, ICA occlusion, mass effect, longer procedure duration, combined thrombectomy technique, higher number of device passes, and lower recanalization rate were associated with ICE (respectively, P = .002; <.001; .002; <.001; .002; 0.011; <0.001; 0.015). CONCLUSIONS ICE evaluated with DECT is a relatively frequent finding after EVT, present in almost one-third of patients. Lower admission ASPECTS, higher glycemia, and high contrast volume injected per procedure were associated with ICE. We also found an association between ICE and ICH, confirming blood-brain barrier alteration as a major determinant of ICH.
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Affiliation(s)
- Clémence Hoche
- Neurology (C.H., M.G., M.P.), University Hospital of Tours, Tours, France
| | - Alba Henderson
- Department of Diagnostic Neuroradiology (A.H., C.M., C.C.), University Regional Hospital of Orleans, Orléans, France
| | - Héloïse Ifergan
- From the Departments of Diagnostic and Interventional Neuroradiology (H.I., J.-P.C.,G.B.), University Hospital of Tours, Tours, France
| | - Marie Gaudron
- Neurology (C.H., M.G., M.P.), University Hospital of Tours, Tours, France
| | - Christophe Magni
- Department of Diagnostic Neuroradiology (A.H., C.M., C.C.), University Regional Hospital of Orleans, Orléans, France
| | | | - Jean-Philippe Cottier
- From the Departments of Diagnostic and Interventional Neuroradiology (H.I., J.-P.C.,G.B.), University Hospital of Tours, Tours, France
| | - Marco Pasi
- Neurology (C.H., M.G., M.P.), University Hospital of Tours, Tours, France
| | - Grégoire Boulouis
- From the Departments of Diagnostic and Interventional Neuroradiology (H.I., J.-P.C.,G.B.), University Hospital of Tours, Tours, France
| | - Clara Cohen
- Department of Diagnostic Neuroradiology (A.H., C.M., C.C.), University Regional Hospital of Orleans, Orléans, France
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Kang Z, Liu G, Fan R, Sun D, Zhou G, Wu X, Nie C, Qiu H, Mei B, Zhang J. Prognosis and Prediction of Asymptomatic Intracranial Hemorrhage After Endovascular Thrombectomy: A Multi-Center Study. J Endovasc Ther 2023:15266028231219990. [PMID: 38149437 DOI: 10.1177/15266028231219990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
PURPOSE The impact of asymptomatic intracranial hemorrhage (aICH) on functional outcomes after endovascular thrombectomy (EVT) remains unclear, and tools for forecasting this complication are lacking. We aim to evaluate the clinical relevance of aICH and establish a prediction model. METHODS Data of patients who received EVT for acute anterior-circulation large vessel occlusion in 3 comprehensive hospitals were retrospectively analyzed. Asymptomatic intracranial hemorrhage was defined as any hemorrhage detected after EVT that did not fulfill the definition of symptomatic intracranial hemorrhage in the European Cooperative Acute Stroke Study. Logistic regression models were performed to assess the impact of aICH on 90-day functional outcomes and identify the predictors of aICH, which were then used to establish a prediction model. The discrimination, calibration, and clinical utility of the model were evaluated. RESULTS This study included 460 patients, among whom 152 (33.0%) developed aICH after EVT. Asymptomatic intracranial hemorrhage was negatively associated with 90-day excellent outcomes (adjusted odds ratio [OR]: 0.414, 95% confidence interval [CI]: 0.230-0.745, p=0.003) and good outcome (adjusted OR: 0.603, 95% CI: 0.374-0.971, p=0.037), but not with mortality (adjusted OR: 1.110, 95% CI: 0.611-2.017, p=0.732) after adjusted for other predictors of functional outcome. Pre-stroke anticoagulant therapy (OR: 2.233, 95% CI: 1.073-4.647, p=0.032), Alberta stroke program early CT score (OR: 0.842, 95% CI: 0.754-0.939, p=0.002), site of occlusion (internal carotid artery occlusion as the reference; M1 segment of middle cerebral artery occlusion, OR: 2.827, 95% CI: 1.409-5.674, p=0.003; tandem occlusion, OR: 3.928, 95% CI: 1.752-8.806, p=0.001), intravenous thrombolysis (OR: 2.091, 95% CI: 1.362-3.209, p=0.001), and successful recanalization (OR: 0.383, 95% CI: 0.213-0.689, p=0.001) were identified as the predictors of aICH, which were incorporated into a nomogram model. The area under the receiver operating characteristic curve of the model was 0.707 (95% CI: 0.657-0.757), and the calibration plot demonstrated good consistency between actual observed and predicted probability of aICH. Decision curve analysis showed that patients might benefit from the model. CONCLUSION Asymptomatic intracranial hemorrhage was negatively associated with favorable functional outcome after EVT. We established a nomogram model for predicting aICH, which requires external clinical validation. CLINICAL IMPACT The impact of asymptomatic intracranial hemorrhage after endovascular thrombectomy on mid-term functional outcome has been controversial. We found that asymptomatic intracranial hemorrhage may also decreased the likelihood of 90-day favourable functional outcome after endovascular thrombectomy, supporting the notion that asymptomatic intracranial hemorrhage at the acute stage may not be benign. Moreover, we established a prediction model for this complication, which may improve clinical evaluation and management of patients who would receive endovascular thrombectomy for large vessel occlusion.
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Affiliation(s)
- Zhiming Kang
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
- Hubei Province Clinical Research Center for Dementia and Cognitive Impairment, Wuhan, China
| | - Guangzhi Liu
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
- Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Ruixue Fan
- Postgraduate Union Training Base of Jinzhou Medical University, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Dong Sun
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
- Hubei Province Clinical Research Center for Dementia and Cognitive Impairment, Wuhan, China
| | - Gang Zhou
- Department of Neurology, Huanggang Central Hospital, Huanggang, China
| | - Xiangbo Wu
- Department of Neurology, Huanggang Central Hospital, Huanggang, China
| | - Chuang Nie
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Han Qiu
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
- Hubei Province Clinical Research Center for Dementia and Cognitive Impairment, Wuhan, China
| | - Bin Mei
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
- Hubei Province Clinical Research Center for Dementia and Cognitive Impairment, Wuhan, China
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
- Hubei Province Clinical Research Center for Dementia and Cognitive Impairment, Wuhan, China
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Marnat G, Kaesmacher J, Buetikofer L, Sibon I, Saleme S, Pop R, Henon H, Michel P, Mazighi M, Kulcsar Z, Janot K, Machi P, Pikula A, Gentric JC, Hernández-Pérez M, Krause LU, Turc G, Liebeskind DS, Gralla J, Fischer U. Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial. J Neurointerv Surg 2023; 16:45-52. [PMID: 37055063 DOI: 10.1136/jnis-2023-020113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/30/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND In proximal occlusions, the effect of reperfusion therapies may differ between slow or fast progressors. We investigated the effect of intravenous thrombolysis (IVT) (with alteplase) plus mechanical thrombectomy (MT) versus thrombectomy alone among slow versus fast stroke progressors. METHODS The SWIFT-DIRECT trial data were analyzed: 408 patients randomized to IVT+MT or MT alone. Infarct growth speed was defined by the number of points of decay in the initial Alberta Stroke Program Early CT Score (ASPECTS) divided by the onset-to-imaging time. The primary endpoint was 3-month functional independence (modified Rankin scale 0-2). In the primary analysis, the study population was dichotomized into slow and fast progressors using median infarct growth velocity. Secondary analysis was also conducted using quartiles of ASPECTS decay. RESULTS We included 376 patients: 191 IVT+MT, 185 MT alone; median age 73 years (IQR 65-81); median initial National Institutes of Health Stroke Scale (NIHSS) 17 (IQR 13-20). The median infarct growth velocity was 1.2 points/hour. Overall, we did not observe a significant interaction between the infarct growth speed and the allocation to either randomization group on the odds of favourable outcome (P=0.68). In the IVT+MT group, odds of any intracranial hemorrhage (ICH) were significantly lower in slow progressors (22.8% vs 36.4%; OR 0.52, 95% CI 0.27 to 0.98) and higher among fast progressors (49.4% vs 26.8%; OR 2.62, 95% CI 1.42 to 4.82) (P value for interaction <0.001). Similar results were observed in secondary analyses. CONCLUSION In this SWIFT-DIRECT subanalysis, we did not find evidence for a significant interaction of the velocity of infarct growth on the odds of favourable outcome according to treatment by MT alone or combined IVT+MT. However, prior IVT was associated with significantly reduced occurrence of any ICH among slow progressors whereas this was increased in fast progressors.
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Affiliation(s)
- Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, University Hospital Centre Bordeaux, Bordeaux, Aquitaine, France
| | | | - Lukas Buetikofer
- CTU Bern, University of Bern, Bern, Switzerland, Bern, Switzerland
| | | | - Suzana Saleme
- Interventional Neuroradiology, CHU Limoges, Limoges, France
| | - Raoul Pop
- Department of Neuroradiolology, CHU Strasbourg, Strasbourg, France
| | - Hilde Henon
- Department of Vascular Neurology, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Patrik Michel
- Neurology Servcie, University of Lausanne, Lausanne, Switzerland
| | - Mikaël Mazighi
- Departement of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
- Neurology, GH Lariboisiere Fernand-Widal, Paris, France
| | | | - Kevin Janot
- Neuroradiology, University Hospital of Tours, Tours, France
| | - Paolo Machi
- Neuroradiology, Geneva University Hospitals, Geneve, Switzerland
| | | | | | | | - Lars Udo Krause
- Neurology, Osnabruck Hospital, Osnabruck, Niedersachsen, Germany
| | - Guillaume Turc
- Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris Cité, Paris, France
- INSERM U1266, Paris, France
- FHU Neurovasc, Paris, France
| | - David S Liebeskind
- Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - Jan Gralla
- Department for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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11
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Luijten SPR, van der Ende NAM, Cornelissen SAP, Kluijtmans L, van Hattem A, Lycklama A Nijeholt G, Postma AA, Bokkers RPH, Thomassen L, Waje-Andreassen U, Logallo N, Bracard S, Gory B, Roozenbeek B, Dippel DWJ, van der Lugt A. Comparison of diffusion weighted imaging b0 with T2*-weighted gradient echo or susceptibility weighted imaging for intracranial hemorrhage detection after reperfusion therapy for ischemic stroke. Neuroradiology 2023; 65:1649-1655. [PMID: 37380891 PMCID: PMC10567825 DOI: 10.1007/s00234-023-03180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Diffusion-weighted imaging (DWI) b0 may be able to substitute T2*-weighted gradient echo (GRE) or susceptibility-weighted imaging (SWI) in case of comparable detection of intracranial hemorrhage (ICH), thereby reducing MRI examination time. We evaluated the diagnostic accuracy of DWI b0 compared to T2*GRE or SWI for detection of ICH after reperfusion therapy for ischemic stroke. METHODS We pooled 300 follow-up MRI scans acquired within 1 week after reperfusion therapy. Six neuroradiologists each rated DWI images (b0 and b1000; b0 as index test) of 100 patients and, after a minimum of 4 weeks, T2*GRE or SWI images (reference standard) paired with DWI images of the same patients. Readers assessed the presence of ICH (yes/no) and type of ICH according to the Heidelberg Bleeding Classification. We determined the sensitivity and specificity of DWI b0 for detection of any ICH, and the sensitivity for detection of hemorrhagic infarction (HI1 & HI2) and parenchymal hematoma (PH1 & PH2). RESULTS We analyzed 277 scans of ischemic stroke patients with complete image series and sufficient image quality (median age 65 years [interquartile range, 54-75], 158 [57%] men). For detection of any ICH on DWI b0, the sensitivity was 62% (95% CI: 50-76) and specificity 96% (95% CI: 93-99). The sensitivity of DWI b0 was 52% (95% CI: 28-68) for detection of hemorrhagic infarction and 84% (95% CI: 70-92) for parenchymal hematoma. CONCLUSION DWI b0 is inferior for detection of ICH compared to T2*GRE/SWI, especially for smaller and more subtle hemorrhages. Follow-up MRI protocols should include T2*GRE/SWI for detection of ICH after reperfusion therapy.
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Affiliation(s)
- Sven P R Luijten
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Nadinda A M van der Ende
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sandra A P Cornelissen
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Leo Kluijtmans
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Antonius van Hattem
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Alida A Postma
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lars Thomassen
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Nicola Logallo
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Bob Roozenbeek
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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12
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Rong B, Guo Z, Gao L, Yang Y, Zi W, Qiu Z, Li F, Lv Z, Luo Y, Meng R, Xie Y, Long T, Zhang S, Jiang J, Tian J, Zhao J, Zeng H, Yuan Z. Association of tirofiban treatment with outcomes following endovascular therapy in cardioembolic stroke: insights from the RESCUE BT randomized trial. Eur J Med Res 2023; 28:473. [PMID: 37915101 PMCID: PMC10621173 DOI: 10.1186/s40001-023-01406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND AND PURPOSE The efficacy and safety of tirofiban in endovascular therapy for cardioembolic ischemic stroke patients remain controversial. This study aimed to evaluate the role of intravenous tirofiban before endovascular therapy in cardioembolic stroke. METHODS This post hoc analysis utilized data from the RESCUE BT (Endovascular Treatment With versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke) trial, which was an investigator-initiated, randomized, double-blind, placebo-controlled trial. Participants were randomized to receive either tirofiban or a placebo in a 1:1 ratio before undergoing endovascular therapy. The study included patients aged 18 years or older, presenting with occlusion of the internal carotid artery or middle cerebral artery (MCA) M1/M2 within 24 h of the last known well time, and with a stroke etiology of cardioembolism. The primary efficacy outcome was global disability at 90 days, assessed using the modified Rankin Scale (mRS). The safety outcome included symptomatic intracranial hemorrhage (sICH) within 48 h and mortality within 90 days. RESULTS A total of 406 cardioembolic stroke patients were included in this study, with 212 assigned to the tirofiban group and 194 assigned to the placebo group. Tirofiban treatment did not correlate with a favorable shift towards a lower 90-day mRS score (adjusted common odds ratio [OR], 0.91; 95% CI 0.64-1.3; p = 0.617). However, the tirofiban group had a significantly higher risk of symptomatic intracranial hemorrhage (sICH) within 48 h (adjusted OR, 3.26; 95% CI 1.4-7.57; p = 0.006) compared to the placebo group. The adjusted odds ratio (aOR) for mortality within 90 days was 1.48 (95% CI 0.88-2.52; p = 0.143). CONCLUSIONS Tirofiban treatment was not associated with a lower level of disability and increased the incidence of sICH after endovascular therapy in cardioembolic stroke patients.
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Affiliation(s)
- Benbing Rong
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhangbao Guo
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China
| | - Lijie Gao
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuan Yang
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhongming Qiu
- Department of Neurology, The 903Rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhiyu Lv
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ying Luo
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Renliang Meng
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yang Xie
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ting Long
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shujiang Zhang
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jinshan Jiang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Jinfeng Tian
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Jingling Zhao
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Hongliang Zeng
- Department of Neurology, Ganzhou People's Hospital, Zhanggong District, 17 Hongqi Avenue, Ganzhou, China.
| | - Zhengzhou Yuan
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Kang Z, Wu L, Sun D, Zhou G, Wu X, Qiu H, Mei B, Zhang J. Proximal hyperdense middle cerebral artery sign is associated with increased risk of asymptomatic hemorrhagic transformation after endovascular thrombectomy: a multicenter retrospective study. J Neurol 2023; 270:1587-1599. [PMID: 36446912 PMCID: PMC9971136 DOI: 10.1007/s00415-022-11500-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether hyperdense middle cerebral artery sign (HMCAS) on pretreatment no-contrast CT (NCCT) is associated with hemorrhagic transformation (HT) after endovascular thrombectomy (EVT). METHODS Patients with acute middle cerebral artery (MCA) occlusion who received EVT in three comprehensive hospitals were retrospectively evaluated. They were divided into four groups based on the presence or absence of HMCAS and corresponding CTA findings, among whom differences were compared. Univariate and multivariate logistic regression analyses were performed to investigate the association between HMCAS and HT and its subtypes. RESULTS 318 patients were included, among whom 149 (46.9%) had HMCAS. Patients in the proximal positive HMCAS group had higher National Institute of Health Stroke Scale scores and lower Alberta Stroke Program Early CT Scores (ASPECTS) than those in the proximal negative HMCAS group. The rate of HT was higher in the proximal positive HMCAS group than that in the proximal negative HMCAS group. In multivariate logistic regression analysis, the proximal HMCAS were independently associated with HT (adjusted OR = 2.073, 95% CI 1.211-3.551, p = 0.008) and aHT (adjusted OR = 2.271, 95% CI 1.294-3.986, p = 0.004), but not with sHT. Patients who developed HT, including aHT and sHT, had a lower rate of good outcome. CONCLUSION Proximal HMCAS on initial NCCT was independently associated with aHT in patients who received EVT for acute MCA occlusion. Both aHT and sHT had a detrimental effect on clinical outcome.
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Affiliation(s)
- Zhiming Kang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lishuo Wu
- Department of Neurology, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, 530022, China
| | - Dong Sun
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Gang Zhou
- Department of Neurology, Huanggang Central Hospital, Huanggang, 438000, China
| | - Xiangbo Wu
- Department of Neurology, Huanggang Central Hospital, Huanggang, 438000, China
| | - Han Qiu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Bin Mei
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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