1
|
Huo X, Raynald, Jin H, Yin Y, Yang G, Miao Z. Performance of automated CT ASPECTS in comparison to physicians at different levels on evaluating acute ischemic stroke at a single institution in China. Chin Neurosurg J 2021; 7:40. [PMID: 34593050 PMCID: PMC8485462 DOI: 10.1186/s41016-021-00257-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background Our aim was to evaluate the sensitivity and specificity of the automated computer-based Alberta Stroke Program Early CT Score (e-ASPECTS) for acute stroke patients and compare the result with physicians at different levels. Methods In our center, e-ASPECTS and 9 physicians at different levels retrospectively and blindly assessed baseline computed tomography (CT) images of 55 patients. Sensitivity, specificity, receiver-operating characteristic curves, Bland–Altman plots with mean score error, and Matthews correlation coefficients were calculated. Comparisons were made between the scores by physicians and e-ASPECTS with diffusion-weighted imaging (DWI) being the ground truth. Two methods for clustered data were used to estimate sensitivity and specificity in the region-based analysis. Results In total, 1100 (55 patients × 20 regions per patient) ASPECTS regions were scored. In the region-based analysis, sensitivity of e-ASPECTS was better than junior doctors and residents (0.576 vs 0.165 and 0.111, p < 0.05) but inferior to senior doctors (0.576 vs 0.617). Specificity was lower than junior doctors and residents (0.883 vs 0.971 and 0.914) but higher than senior doctors (0.883 vs 0.809, p < 0.05). E-ASPECTS had the best Matthews correlation coefficient of 0.529, compared to senior doctors, junior doctors, and residents (0.463, 0.251, and 0.087, respectively). Conclusions e-ASPECTS showed a similar performance to that of senior physicians in the assessment of brain CT of acute ischemic stroke patients with the Alberta Stroke Program Early CT score method.
Collapse
Affiliation(s)
- Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Raynald
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Hailan Jin
- Department of R&D, UnionStrong (Beijing) Technology Co. Ltd, Beijing, China
| | - Yin Yin
- Department of R&D, UnionStrong (Beijing) Technology Co. Ltd, Beijing, China
| | - Guangming Yang
- Department of R&D, UnionStrong (Beijing) Technology Co. Ltd, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
| |
Collapse
|
2
|
Zhongxing Y, Zhiqiang L, Jiangjie W, Qing C, Jinfeng Z, Chaoqun W, Feng L. Efficacy and Safety of Endovascular Treatment for Acute Large-Vessel Ischemic Stroke Beyond 6 h After Symptom Onset: A Meta-Analysis. Front Neurol 2021; 12:654816. [PMID: 34122303 PMCID: PMC8195613 DOI: 10.3389/fneur.2021.654816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background: There is considerable evidence on the benefits of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) within 6 h after symptom onset. However, uncertainties remain regarding EVT efficacy beyond 6 h after symptom onset. We undertook a meta-analysis to assess the efficacy and safety of EVT in patients with AIS >6 h after symptom onset. Methods: We searched PubMed, EMBASE, and Chinese Biomedical through July 2019. We included studies involving early (≤6 h) vs. delayed (>6 h) EVT in selected patients with AIS, based on radiological evaluation criteria. Functional independence, successful recanalization, mortality, and symptomatic intracranial hemorrhage (sICH) rates were assessed. Results: Eight articles, with 3,265 patients who had undergone early EVT and 1,078 patients who had received delayed EVT, were included in the meta-analysis. Patients treated with early EVT showed a similar proportion of functional independence at 90 days [odds ratio (OR) = 1.14, 95% confidence interval (CI) = 0.926–1.397, P = 0.219; I2 = 36.2%, P = 0.128] as those treated with delayed EVT. Delayed EVT was also associated with no significant difference in mortality (OR = 1.015, 95% CI = 0.852–1.209; P = 0.871; I2 = 0.0%, P = 0.527), successful recanalization (OR = 1.255, 95% CI = 0.923–1.705; P = 0.147; I2 = 60.5%, P = 0.009), and sICH (OR = 0.976, 95% CI = 0.737–1.293; P = 0.871; I2 = 0.0%, P = 0.742) rates compared with early EVT. Conclusions: Among selected patients with AIS, delayed EVT showed comparable outcomes in functional independence, recanalization, mortality, and sICH rates compared with early EVT.
Collapse
Affiliation(s)
- Ye Zhongxing
- Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou, China
| | - Liu Zhiqiang
- Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou, China
| | - Wang Jiangjie
- Department of Neurosurgery, Linyi Central Hospital, Linyi, China
| | - Chen Qing
- Department of Pathology, Linyi Central Hospital, Linyi, China
| | - Zhang Jinfeng
- Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou, China
| | - Weng Chaoqun
- Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou, China
| | - Li Feng
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| |
Collapse
|
4
|
Dorado L, Ahmed N, Thomalla G, Lozano M, Malojcic B, Wani M, Millán M, Tomek A, Dávalos A. Intravenous Thrombolysis in Unknown-Onset Stroke: Results From the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Registry. Stroke 2017; 48:720-725. [PMID: 28174326 DOI: 10.1161/strokeaha.116.014889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke patients with unknown onset (UKO) are excluded from thrombolytic therapy. We aim to study the safety and efficacy of intravenous alteplase in ischemic stroke patients with UKO of symptoms compared with those treated within 4.5 hours in a large cohort. METHODS Data were analyzed from 47 237 patients with acute ischemic stroke receiving intravenous tissue-type plasminogen activator in hospitals participating in the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Registry between 2010 and 2014. Two groups were defined: (1) patients with UKO (n=502) and (2) patients treated within 4.5 hours of stroke onset (n=44 875). Outcome measures were symptomatic intracerebral hemorrhage per Safe Implementation of Treatment in Stroke on the 22 to 36 hours post-treatment neuroimaging and mortality and functional outcome assessed by the modified Rankin Scale at 3 months. RESULTS Patients in UKO group were significantly older, had more severe stroke at baseline, and longer door-to-needle times than patients in the ≤4.5 hours group. Logistic regression showed similar risk of symptomatic intracerebral hemorrhage (adjusted odds ratio, 1.09; 95% confidence interval, 0.44-2.67) and no significant differences in functional independency (modified Rankin Scale score of 0-2; adjusted odds ratio, 0.79; 95% confidence interval, 0.56-1.10), but higher mortality (adjusted odds ratio, 1.58; 95% confidence interval, 1.04-2.41) in the UKO group compared with the ≤4.5 hours group. Patients treated within 4.5 hours showed reduced disability over the entire range of modified Rankin Scale compared with the UKO group (common adjusted odds ratio, 1.29; 95% confidence interval, 1.01-1.65). CONCLUSIONS Our data suggest no excess risk of symptomatic intracerebral hemorrhage but increased mortality and reduced favorable outcome in patients with UKO stroke compared with patients treated within the approved time window.
Collapse
Affiliation(s)
- Laura Dorado
- From the Department of Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain (L.D., M.L., M.M., A.D.); Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A.); Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Germany (G.T.); Department of Neurology, University Hospital Center Zagreb, Croatia (B.M.); Department of Stroke Medicine, Morriston Hospital, Swansea, United Kingdom (M.W.); and Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic (A.T.).
| | - Niaz Ahmed
- From the Department of Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain (L.D., M.L., M.M., A.D.); Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A.); Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Germany (G.T.); Department of Neurology, University Hospital Center Zagreb, Croatia (B.M.); Department of Stroke Medicine, Morriston Hospital, Swansea, United Kingdom (M.W.); and Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic (A.T.)
| | - Götz Thomalla
- From the Department of Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain (L.D., M.L., M.M., A.D.); Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A.); Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Germany (G.T.); Department of Neurology, University Hospital Center Zagreb, Croatia (B.M.); Department of Stroke Medicine, Morriston Hospital, Swansea, United Kingdom (M.W.); and Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic (A.T.)
| | - Manuel Lozano
- From the Department of Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain (L.D., M.L., M.M., A.D.); Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A.); Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Germany (G.T.); Department of Neurology, University Hospital Center Zagreb, Croatia (B.M.); Department of Stroke Medicine, Morriston Hospital, Swansea, United Kingdom (M.W.); and Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic (A.T.)
| | - Branko Malojcic
- From the Department of Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain (L.D., M.L., M.M., A.D.); Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A.); Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Germany (G.T.); Department of Neurology, University Hospital Center Zagreb, Croatia (B.M.); Department of Stroke Medicine, Morriston Hospital, Swansea, United Kingdom (M.W.); and Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic (A.T.)
| | - Mushtaq Wani
- From the Department of Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain (L.D., M.L., M.M., A.D.); Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A.); Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Germany (G.T.); Department of Neurology, University Hospital Center Zagreb, Croatia (B.M.); Department of Stroke Medicine, Morriston Hospital, Swansea, United Kingdom (M.W.); and Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic (A.T.)
| | - Mònica Millán
- From the Department of Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain (L.D., M.L., M.M., A.D.); Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A.); Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Germany (G.T.); Department of Neurology, University Hospital Center Zagreb, Croatia (B.M.); Department of Stroke Medicine, Morriston Hospital, Swansea, United Kingdom (M.W.); and Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic (A.T.)
| | - Ales Tomek
- From the Department of Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain (L.D., M.L., M.M., A.D.); Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A.); Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Germany (G.T.); Department of Neurology, University Hospital Center Zagreb, Croatia (B.M.); Department of Stroke Medicine, Morriston Hospital, Swansea, United Kingdom (M.W.); and Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic (A.T.)
| | - Antoni Dávalos
- From the Department of Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain (L.D., M.L., M.M., A.D.); Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A.); Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Germany (G.T.); Department of Neurology, University Hospital Center Zagreb, Croatia (B.M.); Department of Stroke Medicine, Morriston Hospital, Swansea, United Kingdom (M.W.); and Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic (A.T.)
| |
Collapse
|
5
|
A Stroke Registry Data on the Use of Intravenous Recombinant Tissue Plasminogen Activator in Stroke of Unknown Time of Onset. J Stroke Cerebrovasc Dis 2016; 25:1843-50. [PMID: 27132489 DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/19/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Stroke of unknown time of onset (SUTO) constitutes one fifth of all ischemic stroke admissions, and routine use of intravenous recombinant tissue plasminogen activator (IV rtPA) is recommended only in patients with a symptom onset time of less than 4.5 hours. There are limited data on clinical outcome in patients with SUTO versus patients with symptoms onset less than 4.5 hours from onset time. We hypothesized that efficacy and safety outcomes of IV rtPA therapy in selected SUTO patients are comparable to those with known onset time. METHODS We compared 90 days' modified Rankin Scale (mRS), rates of symptomatic intracerebral hemorrhage (sICH), in-hospital mortality, and death due to sICH between 3 groups treated with IV rtPA: SUTO, 3 hours or less, and 3.0-4.5 hours from prospective patient admissions between April 1, 2012, and July 31, 2013. RESULTS There were 65 participants in the SUTO group, 186 in the 3 hours or less group, and 51 in the 3.0-4.5 hours group. In-hospital mortality rates were 14.5%, 13.5%, and 11.8%, respectively. sICH risks were 1.5%, 1.6%, and 5.8%, and death rates due to sICH were 0%, 1.1%, and 1.9%, respectively. Ninety days' odds of excellent clinical outcome (mRS score 0-1) were not different between the SUTO group (odds ratio [OR] 1.14, 95% confidence interval [CI]: .63-2.10), the 3 hours or less group (OR .87, 95% CI: .48-1.60), and the 3.0-4.5 hours group (OR .79, 95% CI: .48-1.60) (P = .82). CONCLUSION Thrombolytic therapy outcome in SUTO is not different from in-license use in our patient population. There is an urgent need to include this patient group in ongoing randomized multicenter trials.
Collapse
|
6
|
He AH, Churilov L, Mitchell PJ, Dowling RJ, Yan B. Every 15-Min Delay in Recanalization by Intra-Arterial Therapy in Acute Ischemic Stroke Increases Risk of Poor Outcome. Int J Stroke 2015; 10:1062-7. [DOI: 10.1111/ijs.12495] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 01/06/2015] [Indexed: 12/30/2022]
Abstract
Background Intra-arterial therapy has improved recanalization rates compared with intravenous thrombolysis for acute ischemic stroke; however, superior clinical efficacy has not been convincingly demonstrated. Time to recanalization is postulated as a mechanism hindering the efficacy of intra-arterial therapy. Aim To investigate the effects of time to recanalization on clinical outcome postintra-arterial therapy for acute ischemic stroke. Methods Clinical data were collected prospectively for consecutive patients undergoing intra-arterial therapy for acute ischemic stroke at a single center between 2009 and 2013. Ninety-day functional outcome was assessed by the modified Rankin scale. Univariate analyses identified candidate clinical variables for inclusion in the multivariable model; multivariable logistic regression analyses identified variables independently associated with good outcome, defined as modified Rankin scale 0–2. Results One hundred and seven patients were included in the analysis. Median (interquartile range) age was 67 (54–77) years, 41 (38%) were female, and median (interquartile range) baseline National Institute of Health Stroke Severity score was 18 (13–22). Median time from symptom onset to recanalization was 330 min (interquartile range 277–397). Fifty-four (50%) patients achieved a favorable modified Rankin scale at 90 days. Age, successful recanalization, and time to recanalization were independently associated with good outcome at 90 days in multivariable logistic regression analysis. For every 15 min delay in recanalization, the odds of good outcome decreased by 10%. Conclusions Longer time to recanalization was associated with poorer functional outcome post intra-arterial therapy. We recommend that a systematic approach to minimize time delay to treatment is warranted in intra-arterial therapy for acute ischemic stroke.
Collapse
Affiliation(s)
- Anna H. He
- Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health, Melbourne, Vic., Australia
| | - Peter J. Mitchell
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Richard J. Dowling
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Bernard Yan
- Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Vic., Australia
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| |
Collapse
|