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Guo T, Ma T, Bai X, Wang J, Wang Y. Intracranial hemorrhage risk in patients with cerebral microbleeds after mechanical thrombectomy for acute ischemic stroke: a systematic review and meta-analysis. Neurol Sci 2024; 45:3021-3029. [PMID: 38351360 DOI: 10.1007/s10072-024-07393-z] [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: 10/03/2023] [Accepted: 02/05/2024] [Indexed: 06/15/2024]
Abstract
Background and purpose intracranial hemorrhage risk in patients with cerebral microbleeds (CMBs) after mechanical thrombectomy for acute ischemic stroke (AIS) was investigated. We searched PubMed and Embase from inception to 29 August 2023 for relevant studies, calculated pooled odds ratio (ORs) of intracerebral hemorrhage (ICH) subtypes in AIS patients with CMB presence, 1-4 or ≥ 5 CMBs versus CMB absence, and with different CMB locations after mechanical thrombectomy. ICH subtypes included any ICH, symptomatic and asymptomatic ICH, hemorrhage outside infarct (including subarachnoid hemorrhage), hemorrhagic infarction, and parenchymal hemorrhage after mechanical thrombectomy. Five eligible studies enrolling 2051 patients were included. No significant association was shown between CMB locations (lobar, deep, infratentorial or mixed) and ICH risk. CMB presence or 1-4 CMBs did not significantly increase the risk of any ICH, symptomatic or asymptomatic ICH, ICH outside infarct, subarachnoid hemorrhage, hemorrhagic infarction, or parenchymal hemorrhage. CMBs ≥ 5 increased the risk of any ICH (OR 2.58, 95% CI 1.16-5.72), parenchymal hemorrhage (OR 3.38, 95% CI 1.43-7.97) and parenchymal hemorrhage-2 (OR 5.33, 2.05-13.86), without increasing hemorrhagic infarction or parenchymal haemorrhage-1 risk. After adjusted for possible confounding factors, increases in CMB burden were associated with hemorrhagic complications but not with symptomatic ICH. In AIS patients who received mechanical thrombectomy, no association was shown between CMB location and ICH risk. ICH risk was not significantly increased by CMB presence or 1-4 CMBs. ICH risk in patients with ≥ 5 CMBs requires further study.
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Affiliation(s)
- Tingting Guo
- Department of Neurology, People's Hospital of Liaoning Province, Shenhe District, 33 Wenyi Road, Shenyang, 110016, People's Republic of China
| | - Teng Ma
- Dalian Medical University, Dalian, People's Republic of China
| | - Xuan Bai
- Department of Neurology, People's Hospital of Liaoning Province, Shenhe District, 33 Wenyi Road, Shenyang, 110016, People's Republic of China
| | - Jian Wang
- Department of Neurology, People's Hospital of Liaoning Province, Shenhe District, 33 Wenyi Road, Shenyang, 110016, People's Republic of China
| | - Yujie Wang
- Department of Neurology, People's Hospital of Liaoning Province, Shenhe District, 33 Wenyi Road, Shenyang, 110016, People's Republic of China.
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2
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Agbonon R, Forestier G, Bricout N, Benhassen W, Turc G, Bretzner M, Pasi M, Benzakoun J, Seners P, Derraz I, Legrand L, Trystram D, Rodriguez-Regent C, Charidimou A, Rost NS, Bracard S, Cordonnier C, Eker OF, Oppenheim C, Naggara O, Henon H, Boulouis G. Cerebral microbleeds and risk of symptomatic hemorrhagic transformation following mechanical thrombectomy for large vessel ischemic stroke. J Neurol 2024; 271:2631-2638. [PMID: 38355868 DOI: 10.1007/s00415-024-12205-7] [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: 10/18/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND PURPOSE In patients with acute ischemic stroke (AIS) treated with endovascular therapy (EVT), the association of pre-existing cerebral small vessel disease (cSVD) with symptomatic intracerebral hemorrhage (sICH) remains controversial. We tested the hypothesis that the presence of cerebral microbleeds (CMBs) and their burden would be associated with sICH after EVT of AIS. METHODS We conducted a retrospective study combining cohorts of patients that underwent EVT between January 1st 2015 and January 1st 2020. CMB presence, burden, and other cSVD markers were assessed on a pre-treatment MRI, evaluated independently by two observers. Primary outcome was the occurrence of sICH. RESULTS 445 patients with pretreatment MRI were included, of which 70 (15.7%) demonstrated CMBs on baseline MRI. sICH occurred in 36 (7.6%) of all patients. Univariate analysis did not demonstrate an association between CMB and the occurrence of sICH (7.5% in CMB+ group vs 8.6% in CMB group, p = 0.805). In multivariable models, CMBs' presence was not significantly associated with increased odds for sICH (-aOR- 1.19; 95% CI [0.43-3.27], p = 0.73). Only ASPECTs (aOR 0.71 per point increase; 95% CI [0.60-0.85], p < 0.001) and collaterals status (aOR 0.22 for adequate versus poor collaterals; 95% CI [0.06-0.93], p 0.019) were independently associated with sICH. CONCLUSION CMB presence and burden is not associated with increased occurrence of sICH after EVT. This result incites not to exclude patients with CMBs from EVT. The risk of sICH after EVT in patients with more than10 CMBs will require further investigation. REGISTRATION Registration-URL: http://www. CLINICALTRIALS gov ; Unique identifier: NCT01062698.
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Affiliation(s)
- Rémi Agbonon
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Géraud Forestier
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France.
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France.
- Neuroradiology Department, Limoges University Hospital, 2 avenue Martin Luther-King, 87042, Limoges, France.
| | - Nicolas Bricout
- Neuroradiology Department, Univ. Lille, Inserm, CHU Lille, U1172-LilNCog (JPARC)-Lille Neurosciences & Cognition, 59000, Lille, France
| | - Wagih Benhassen
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Guillaume Turc
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Martin Bretzner
- Neuroradiology Department, Univ. Lille, Inserm, CHU Lille, U1172-LilNCog (JPARC)-Lille Neurosciences & Cognition, 59000, Lille, France
| | - Marco Pasi
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000, Lille, France
| | - Joseph Benzakoun
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Pierre Seners
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Laurence Legrand
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Denis Trystram
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Christine Rodriguez-Regent
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Andreas Charidimou
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Natalia S Rost
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Serge Bracard
- Neuroradiology Department, Lorraine University, INSERM U1254 CHRU Nancy, Nancy, France
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000, Lille, France
| | - Omer F Eker
- Department of Neuroradiology of Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon, France
| | - Catherine Oppenheim
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Olivier Naggara
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Hilde Henon
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Grégoire Boulouis
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neuroradiology Department, CHU de Tours, Centre Val de Loire Region, Tours, France
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Brugnara G, Engel A, Jesser J, Ringleb PA, Purrucker J, Möhlenbruch MA, Bendszus M, Neuberger U. Cortical atrophy on baseline computed tomography imaging predicts clinical outcome in patients undergoing endovascular treatment for acute ischemic stroke. Eur Radiol 2024; 34:1358-1366. [PMID: 37581657 PMCID: PMC10853300 DOI: 10.1007/s00330-023-10107-2] [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: 03/07/2023] [Revised: 06/05/2023] [Accepted: 07/01/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE Multiple variables beyond the extent of recanalization can impact the clinical outcome after acute ischemic stroke due to large vessel occlusions. Here, we assessed the influence of small vessel disease and cortical atrophy on clinical outcome using native cranial computed tomography (NCCT) in a large single-center cohort. METHODS A total of 1103 consecutive patients who underwent endovascular treatment (EVT) due to occlusion of the middle cerebral artery territory were included. NCCT data were visually assessed for established markers of age-related white matter changes (ARWMC) and brain atrophy. All images were evaluated separately by two readers to assess the inter-observer variability. Regression and machine learning models were built to determine the predictive relevance of ARWMC and atrophy in the presence of important baseline clinical and imaging metrics. RESULTS Patients with favorable outcome presented lower values for all measured metrics of pre-existing brain deterioration (p < 0.001). Both ARWMC (p < 0.05) and cortical atrophy (p < 0.001) were independent predictors of clinical outcome at 90 days when controlled for confounders in both regression analyses and led to a minor improvement of prediction accuracy in machine learning models (p < 0.001), with atrophy among the top-5 predictors. CONCLUSION NCCT-based cortical atrophy and ARWMC scores on NCCT were strong and independent predictors of clinical outcome after EVT. CLINICAL RELEVANCE STATEMENT Visual assessment of cortical atrophy and age-related white matter changes on CT could improve the prediction of clinical outcome after thrombectomy in machine learning models which may be integrated into existing clinical routines and facilitate patient selection. KEY POINTS • Cortical atrophy and age-related white matter changes were quantified using CT-based visual scores. • Atrophy and age-related white matter change scores independently predicted clinical outcome after mechanical thrombectomy and improved machine learning-based prediction models. • Both scores could easily be integrated into existing clinical routines and prediction models.
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Affiliation(s)
- Gianluca Brugnara
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Division of Computational Neuroimaging, Heidelberg University Hospital, Heidelberg, Germany
| | - Adrian Engel
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Department of Neurosurgery, Essen University Hospital, Essen, Germany
| | - Jessica Jesser
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | | | - Jan Purrucker
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ulf Neuberger
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
- Division of Computational Neuroimaging, Heidelberg University Hospital, Heidelberg, Germany.
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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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Tipirneni S, Stanwell P, Weissert R, Bhaskar SMM. Prevalence and Impact of Cerebral Microbleeds on Clinical and Safety Outcomes in Acute Ischaemic Stroke Patients Receiving Reperfusion Therapy: A Systematic Review and Meta-Analysis. Biomedicines 2023; 11:2865. [PMID: 37893237 PMCID: PMC10604359 DOI: 10.3390/biomedicines11102865] [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: 09/27/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Cerebral microbleeds (CMBs), a notable neuroimaging finding often associated with cerebral microangiopathy, demonstrate a heightened prevalence in patients diagnosed with acute ischemic stroke (AIS), which is in turn linked to less favourable clinical prognoses. Nevertheless, the exact prevalence of CMBs and their influence on post-reperfusion therapy outcomes remain inadequately elucidated. MATERIALS AND METHODS Through systematic searches of PubMed, Embase and Cochrane databases, studies were identified adhering to specific inclusion criteria: (a) AIS patients, (b) age ≥ 18 years, (c) CMBs at baseline, (d) availability of comparative data between CMB-positive and CMB-negative groups, along with relevant post-reperfusion therapy outcomes. The data extracted were analysed using forest plots of odds ratios, and random-effects modelling was applied to investigate the association between CMBs and symptomatic intracerebral haemorrhage (sICH), haemorrhagic transformation (HT), 90-day functional outcomes, and 90-day mortality post-reperfusion therapy. RESULTS In a total cohort of 9776 AIS patients who underwent reperfusion therapy, 1709 had CMBs, with a pooled prevalence of 19% (ES 0.19; 95% CI: 0.16, 0.23, p < 0.001). CMBs significantly increased the odds of sICH (OR 2.57; 95% CI: 1.72; 3.83; p < 0.0001), HT (OR 1.53; 95% CI: 1.25; 1.88; p < 0.0001), as well as poor functional outcomes at 90 days (OR 1.59; 95% CI: 1.34; 1.89; p < 0.0001) and 90-day mortality (OR 1.65; 95% CI: 1.27; 2.16; p < 0.0001), relative to those without CMBs, in AIS patients undergoing reperfusion therapy (encompassing intravenous thrombolysis [IVT], endovascular thrombectomy [EVT], either IVT or EVT, and bridging therapy). Variations in the level of association can be observed among different subgroups of reperfusion therapy. CONCLUSIONS This meta-analysis underscores a significant association between CMBs and adverse postprocedural safety outcomes encompassing sICH, HT, poor functional outcome, and increased mortality in AIS patients undergoing reperfusion therapy. The notable prevalence of CMBs in both the overall AIS population and those undergoing reperfusion therapy emphasizes their importance in post-stroke prognostication.
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Affiliation(s)
- Shraddha Tipirneni
- Global Health Neurology Lab, Sydney, NSW 2150, Australia
- UNSW Medicine and Health, South Western Sydney Clinical Campuses, University of New South Wales (UNSW), Sydney, NSW 2170, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW 2170, Australia
| | - Peter Stanwell
- School of Health Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Robert Weissert
- Department of Neurology, Regensburg University Hospital, University of Regensburg, 93053 Regensburg, Germany
| | - Sonu M. M. Bhaskar
- Global Health Neurology Lab, Sydney, NSW 2150, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital & South Western Sydney Local Health District (SWSLHD), Liverpool, NSW 2170, Australia
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Bani-Sadr A, Escande R, Mechtouff L, Pavie D, Hermier M, Derex L, Choc TH, Eker OF, Nighoghossian N, Berthezène Y. Vascular hyperintensities on baseline FLAIR images are associated with functional outcome in stroke patients with successful recanalization after mechanical thrombectomy. Diagn Interv Imaging 2023; 104:337-342. [PMID: 37355301 DOI: 10.1016/j.diii.2023.02.005] [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: 02/02/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The purpose of this study was to assess the prognostic value of vascular hyperintensities on FLAIR images (VHF) at admission MRI in patients with acute ischemic stroke (AIS) achieving successful recanalization after mechanical thrombectomy. MATERIALS AND METHODS Patients with AIS treated by mechanical thrombectomy following admission MRI from the single-center HIBISCUS-STROKE cohort were assessed for eligibility. VHF were categorized using a four-scale classification and were considered poor when grade < 3 (i.e., absence of distal VHF). Recanalization was considered successful when modified thrombolysis in cerebral infarction score was ≥ 2B Functional outcome was considered poor if modified Rankin scale (mRS) at three months was > 2. Univariable and multiple variable logistic regressions were performed to identify factors associated with poor functional outcome despite successful recanalization. RESULTS A total of 108 patients were included. There were 65 men and 43 women with a median age of 70.5 years (interquartile range: 55.0, 81.0; age range: 22.0-93.0 years). Among them, 39 subjects (36.1%) had poor functional outcome at three months. Univariable logistic regressions indicated that poorly extended VHF (VHF grade < 3) were associated with a poor functional outcome (P = 0.008) as well as age, hypertension and diabetes, baseline National Institute of Health Stroke Scale (NIHSS) score, pre-stroke mRS, lack of intravenous thrombolysis, cerebral microangiopathy and the presence of microbleeds. Multivariable analysis confirmed that poor VHF status was independently associated with a poor functional outcome (odds ratio [OR], 4.26; 95% confidence interval [CI]: 1.55-12.99; P = 0.007) in combination with hypertension (OR, 1.25; 95% CI: 0.87-1.85; P = 0.02), baseline NIHSS score (OR, 1.09; 95% CI: 1.04-1.20; P = 0.03), pre-stroke mRS (OR, 2.05; 95% CI: 1.07-4.61; P = 0.05) and lack of intravenous thrombolysis (OR, 0.23; 95% CI: 0.08-0.61; P = 0.004). CONCLUSION Poorly extended VHF (grade <3) at admission MRI are associated with a poor functional outcome at three months despite successful recanalization by mechanical thrombectomy.
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Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France.
| | - Raphaël Escande
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Laura Mechtouff
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Dylan Pavie
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Laurent Derex
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; Research on Healthcare Performance (RESHAPE), INSERM U 1290, Claude Bernard Lyon I University, 69373, Lyon Cedex 08, France
| | - Tae-Hee Choc
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Omer F Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France
| | - Norbert Nighoghossian
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Yves Berthezène
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France
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7
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Exploring the Impact of Cerebral Microbleeds on Stroke Management. Neurol Int 2023; 15:188-224. [PMID: 36810469 PMCID: PMC9944881 DOI: 10.3390/neurolint15010014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Stroke constitutes a major cause of functional disability and mortality, with increasing prevalence. Thus, the timely and accurate prognosis of stroke outcomes based on clinical or radiological markers is vital for both physicians and stroke survivors. Among radiological markers, cerebral microbleeds (CMBs) constitute markers of blood leakage from pathologically fragile small vessels. In the present review, we evaluated whether CMBs affect ischemic and hemorrhagic stroke outcomes and explored the fundamental question of whether CMBs may shift the risk-benefit balance away from reperfusion therapy or antithrombotic use in acute ischemic stroke patients. A literature review of two databases (MEDLINE and Scopus) was conducted to identify all the relevant studies published between 1 January 2012 and 9 November 2022. Only full-text articles published in the English language were included. Forty-one articles were traced and included in the present review. Our findings highlight the utility of CMB assessments, not only in the prognostication of hemorrhagic complications of reperfusion therapy, but also in forecasting hemorrhagic and ischemic stroke patients' functional outcomes, thus indicating that a biomarker-based approach may aid in the provision of counseling for patients and families, improve the selection of more appropriate medical therapies, and contribute to a more accurate choice of patients for reperfusion therapy.
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Derraz I, Abdelrady M, Ahmed R, Gaillard N, Morganti R, Cagnazzo F, Dargazanli C, Lefevre PH, Riquelme C, Corti L, Gascou G, Mourand I, Arquizan C, Costalat V. Impact of White Matter Hyperintensity Burden on Outcome in Large-Vessel Occlusion Stroke. Radiology 2022; 304:145-152. [PMID: 35348382 DOI: 10.1148/radiol.210419] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background White matter hyperintensity (WMH) has been linked to poor clinical outcomes after acute ischemic stroke. Purpose To assess whether the WMH burden on pretreatment MRI scans is associated with an increased risk for symptomatic intracranial hemorrhage (sICH) or poor functional outcome in patients with acute ischemic stroke treated with endovascular thrombectomy (EVT). Materials and Methods In this retrospective study, consecutive patients treated with EVT for anterior circulation acute ischemic stroke at a comprehensive stroke center (where MRI was the first-line pretreatment imaging strategy; January 2015 to December 2017) were included and analyzed. WMH volumes were assessed with semiautomated volumetric analysis at fluid-attenuated inversion recovery MRI by readers who were blinded to clinical data. The associations of WMH burden with sICH and 3-month functional outcome (modified Rankin Scale [mRS] score) were assessed. Results A total of 366 patients were included (mean age, 69 years ± 19 [SD]; 188 women [51%]). Median total WMH volume was 3.61 cm3 (IQR, 1.10-10.83 cm3). Patients demonstrated higher mRS scores with increasing WMH volumes (odds ratio [OR], 1.020 [95% CI: 1.003, 1.037] per 1.0-cm3 increase for each mRS point increase; P = .018) after adjustment for patient and clinical variables. There were no significant associations between WMH severity and 90-day mortality (OR, 1.007 [95% CI: 0.990, 1.024]; P = .40) or the occurrence of sICH (OR, 1.001 [95% CI: 0.978, 1.024]; P = .94). Conclusion Higher white matter hyperintensity burden was associated with increased risk for poor 3-month functional outcome after endovascular thrombectomy for large-vessel occlusive stroke. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Mossa-Basha and Zhu in this issue.
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Affiliation(s)
- Imad Derraz
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Mohamed Abdelrady
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Raed Ahmed
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Nicolas Gaillard
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Riccardo Morganti
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Federico Cagnazzo
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Cyril Dargazanli
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Pierre-Henri Lefevre
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Carlos Riquelme
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Lucas Corti
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Grégory Gascou
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Isabelle Mourand
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Caroline Arquizan
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Vincent Costalat
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
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Lee SJ, Hwang YH, Hong JM, Choi JW, Park JH, Park B, Kang DH, Kim YW, Kim YS, Hong JH, Yoo J, Kim CH, Sohn SI, Lee JS. Influence of cerebral microbleeds on mechanical thrombectomy outcomes. Sci Rep 2022; 12:3637. [PMID: 35256626 PMCID: PMC8901625 DOI: 10.1038/s41598-022-07432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 02/17/2022] [Indexed: 11/24/2022] Open
Abstract
In ischemic stroke patients undergoing endovascular treatment (EVT), we aimed to test the hypothesis that cerebral microbleeds (CMBs) are associated with clinical outcomes, while estimating the mediating effects of hemorrhagic transformation (HT), small-vessel disease burden (white matter hyperintensities, WMH), and procedural success. From a multicenter EVT registry, patients who underwent pretreatment MR imaging were analyzed. They were trichotomized according to presence of CMBs (none vs. 1–4 vs. ≥ 5). The association between CMB burden and 3-month mRS was evaluated using multivariable ordinal logistic regression, and mediation analyses were conducted to estimate percent mediation. Of 577 patients, CMBs were present in 91 (15.8%); 67 (11.6%) had 1–4 CMBs, and 24 (4.2%) had ≥ 5. Increases in CMBs were associated with hemorrhagic complications (β = 0.27 [0.06–0.047], p = 0.010) in multivariable analysis. The CMB effect on outcome was partially mediated by post-procedural HT degree (percent mediation, 14% [0–42]), WMH (23% [7–57]) and lower rates of successful reperfusion (6% [0–25]). In conclusion, the influence of CMBs on clinical outcomes is mediated by small-vessel disease burden, post-procedural HT, and lower reperfusion rates, listed in order of percent mediation size.
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Guo XJ, Wu M, Pei SF, Xie P, Wu MY. Influence of Carotid Intima-Media Thickness Levels at Bifurcation on Short-Term Functional Outcomes Among Non-Cardiogenic Ischemic Stroke Patients with and without Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:897-906. [PMID: 35356702 PMCID: PMC8958197 DOI: 10.2147/dmso.s351679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/10/2022] [Indexed: 04/13/2023] Open
Abstract
PURPOSE The intima-media thickness (IMT) is broadly reported to have relationships with non-cardiogenic ischemic stroke and with diabetes. But how does IMT affect the short-term prognosis of stroke seems unknown yet. We investigated the influence of the intima-media thickness at carotid bifurcation (IMTbif) on short-term functional outcomes among non-cardiogenic ischemic stroke patients with and without type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS A total of 314 patients with non-cardiogenic ischemic stroke (122 with T2DM and 192 without diabetes) were included in this retrospective study. Poor functional outcome was defined as a modified Rankin Scale (mRS) > 2 at 3 months after stroke onset. Group comparisons were done in favorable and poor outcome groups. Linear regression analysis was utilized to verify the associations between IMTbif and mRS in subgroups with and without diabetes, respectively. RESULTS The median IMTbif of total patients was 1.40mm. Patients with poor outcomes were significantly older, had higher National Institutes of Health Stroke Scale (NIHSS) scores, lower haemoglobin, higher fasting glucose and higher systolic blood pressure values. Their IMTbif levels were also markedly higher. Among 122 included stroke patients with T2DM, IMTbif levels and NIHSS were independently associated with functional outcomes at 3 months, whereas there was no significant association between IMTbif levels and short-term functional outcomes among patients without diabetes. CONCLUSION The IMTbif levels were significantly associated with 3-month functional outcomes in non-cardiogenic ischemic stroke patients with T2DM. The ultrasound detection of the IMTbif therefore suggests a prognostic value among patients with stroke and T2DM.
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Affiliation(s)
- Xiao-Jing Guo
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China
| | - Mian Wu
- Department of Endocrinology and Metabolism, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China
| | - Shao-Fang Pei
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China
| | - Ping Xie
- Department of Ultrasonography, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China
| | - Min-Ya Wu
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China
- Correspondence: Min-Ya Wu, Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, 242 Guangji Road, Suzhou, Jiangsu, People’s Republic of China, Tel +86 15151429862, Email
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11
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Schlemm L, Braemswig TB, Boutitie F, Vynckier J, Jensen M, Galinovic I, Simonsen CZ, Cheng B, Cho TH, Fiehler J, Puig J, Thijs V, Fiebach J, Muir K, Nighoghossian N, Ebinger M, Pedraza S, Thomalla G, Gerloff C, Endres M, Lemmens R, Nolte CH. Cerebral Microbleeds and Treatment Effect of Intravenous Thrombolysis in Acute Stroke: An Analysis of the WAKE-UP Randomized Clinical Trial. Neurology 2021; 98:e302-e314. [PMID: 34782419 PMCID: PMC8792812 DOI: 10.1212/wnl.0000000000013055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives Cerebral microbleeds (CMBs) are common in patients with acute ischemic stroke and are associated with increased risk of intracerebral hemorrhage (ICH) after intravenous thrombolysis. Whether CMBs modify the treatment effect of thrombolysis is unknown. Methods We performed a prespecified analysis of the prospective randomized controlled multicenter Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke (WAKE-UP) trial including patients with acute ischemic stroke with unknown time of symptom onset and diffusion-weighted imaging–fluid-attenuated inversion recovery mismatch on MRI receiving alteplase or placebo. Patients were screened and enrolled between September 2012 and June 2017 (with final follow-up in September 2017). Patients were randomized to treatment with IV thrombolysis with alteplase at 0.9 mg/kg body weight or placebo. CMB status (presence, number, and distribution) was assessed after study completion by 3 raters blinded to clinical information following a standardized protocol. Outcome measures were excellent functional outcome at 90 days, defined by modified Rankin Scale (mRS) score ≤1, and symptomatic ICH according to National Institutes of Neurological Disease and Stroke trial criteria 22 to 36 hours after treatment. Results Of 503 patients enrolled in the WAKE-UP trial, 459 (91.3%; 288 [63%] men) were available for analysis. Ninety-eight (21.4%) had at least 1 CMB on baseline imaging; 45 (9.8%) had exactly 1 CMB; 37 (8.1%) had 2 to 4 CMBs; and 16 (3.5%) had ≥5 CMBs. Presence of CMBs was associated with a nonsignificant increased risk of symptomatic ICH (11.2% vs 4.2%; adjusted odds ratio [OR] 2.32, 95% confidence interval [CI] 0.99–5.43, p = 0.052) but had no effect on functional outcome at 90 days (mRS score ≤1: 45.8% vs 50.7%; adjusted OR 0.99, 95% CI 0.59–1.64, p = 0.955). Patients receiving alteplase had better functional outcome (mRS score ≤1: 54.6% vs 44.6%, adjusted OR 1.61, 95% CI 1.07–2.43, p = 0.022) without evidence of heterogeneity in relation to CMB presence (p of the interactive term = 0.546). Results were similar for subpopulations with strictly lobar (presumed cerebral amyloid angiopathy related) or not strictly lobar CMB distribution. Discussion In the randomized-controlled WAKE-UP trial, we saw no evidence of reduced treatment effect of alteplase in patients with acute ischemic stroke with ≥1 CMBs. Additional studies are needed to determine the treatment effect of alteplase and its benefit-harm ratio in patients with a larger number of CMBs. Trial Registration Information ClinicalTrials.gov identifier NCT01525290; ClinicalTrialsRegister.EU identifier 2011-005906-32. Classification of Evidence This study provides Class II evidence that for patients with acute ischemic stroke with unknown time of onset and diffusion-weighted imaging–fluid-attenuated inversion recovery mismatch who received IV alteplase, CMBs are not significantly associated with functional outcome at 90 days.
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Affiliation(s)
- Ludwig Schlemm
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Tim Bastian Braemswig
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France.,Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Jan Vynckier
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ivana Galinovic
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon, Lyon, France
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josep Puig
- Department of Radiology, Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona, Spain
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Jochen Fiebach
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany
| | - Keith Muir
- Institute of Neuroscience and, University of Glasgow, Glasgow, United Kingdom
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon, Lyon, France
| | - Martin Ebinger
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Salvador Pedraza
- Department of Radiology, Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona, Spain
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Leuven, Belgium.,VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Christian H Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany .,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Berlin, Germany
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Rhim JK, Park JJ, Ahn JH, Kim HC, Na D, Chai CL, Jeon JP. Influence of renal impairment on neurologic outcomes following mechanical thrombectomy in acute vertebrobasilar stroke. Neuroradiology 2021; 64:807-815. [PMID: 34665269 DOI: 10.1007/s00234-021-02838-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Renal impairment (RI) has been regarded as a risk factor for unfavorable neurologic outcomes after mechanical thrombectomy (MT) in acute ischemic stroke. However, most of the previous studies were conducted on patients with anterior circulation stroke. Accordingly, the influence of RI on MT outcomes has not been well elucidated in detail in acute vertebrobasilar stroke. METHODS Consecutive stroke patients with MT due to acute vertebrobasilar artery occlusion between March 2015 and December 2020 at four institutions were included. Multivariable logistic regression analysis was conducted to assess the associations between RI and outcomes and mortality at 3 months, and the development of intracerebral hemorrhage (ICH) after the procedure. Additionally, the multivariable Cox proportional hazards model was performed to determine the influence of RI on survival probability after patient discharge. RESULTS A total of 110 patients were included in the final analysis. The presence of RI (OR = 0.268, 95% CI: 0.077-0.935), National Institute of Health Stroke Scale scores (OR = 0.849, 95% CI: 0.791-0.910), and puncture-to-recanalization time (OR = 0.981, 95% CI: 0.966-0.997) were related to outcomes. There was no significant association between RI and 3-month mortality or ICH. The cumulative survival probability after adjusting for relevant risk factors demonstrated that RI remained significantly associated with poorer survival after MT compared to patients without RI (HR = 2.111, 95% CI: 0.919-4.847). CONCLUSION RI was an independent risk factor for poor 3-month neurologic outcomes and survival probability after MT in patients with acute vertebrobasilar stroke.
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Affiliation(s)
- Jong Kook Rhim
- Department of Neurosurgery, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jun Hyong Ahn
- Department of Neurosurgery, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea
| | - Heung Cheol Kim
- Department of Radiology, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Doyoung Na
- Department of Neurosurgery, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea
| | - Chung Liang Chai
- Department of Neurosurgery, Yee Zen General Hospital, Taoyuan, Taiwan
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea.
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13
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Huang K, Zha M, Xiao L, Gao J, Du J, Wu M, Yang Q, Liu R, Liu X. Prognostic Value of Abnormal Liver Function Tests After Mechanical Thrombectomy for Acute Ischemic Stroke. Front Neurol 2021; 12:670387. [PMID: 34393970 PMCID: PMC8356900 DOI: 10.3389/fneur.2021.670387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: To determine the clinical significance of post-procedural abnormal liver function test (ALFT) on the functional outcomes at 90 days in acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT). Methods: In this retrospective observational study, patients with AIS undergoing MT were enrolled from the Nanjing Stroke Registry Program and the multicenter Captor trial. A favorable outcome was defined as a modified Rankin Scale score 0–2 at 90 days. Predictive models were established by multivariable logistic regression. Improved predictive value of models was assessed by continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). In addition, multivariable logistic regression and restricted cubic spline were used to analyze dose–response correlations between the severity of ALFT and prognosis. Results: Among 420 patients enrolled, 234 (55.7%) patients were diagnosed as post-procedural ALFT after MT. Patients with post-procedural ALFT had higher National Institute of Health Stroke Scale score on admission (median, 18 vs. 15, p < 0.001) and more pneumonia (65.4 vs. 38.2%, p < 0.001) than those without post-procedural ALFT. Post-procedural ALFT, rather than preprocedural ALFT, was independently associated with favorable outcome (adjusted odds ratio, 0.48; 95% CI 0.28–0.81; p = 0.006). The improvement of predictive model after adding post-procedural ALFT was significant [continuous NRI (value, 0.401; p < 0.001), IDI (value, 0.013; p < 0.001)]. However, the restricted cubic spline indicated no evidence of a dose–response relationship between the severity of post-procedural ALFT and prognosis. Conclusions: In AIS patients treated by MT, post-procedural ALFT was associated with more severe stroke and served as an independent predictor of worse prognosis at 90 days.
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Affiliation(s)
- Kangmo Huang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Mingming Zha
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Lulu Xiao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jie Gao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Juan Du
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Min Wu
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Qingwen Yang
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Rui Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
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14
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Xu T, Wang Y, Yuan J, Chen Y, Luo H. Small Vessel Disease Burden and Outcomes of Mechanical Thrombectomy in Ischemic Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:602037. [PMID: 33897580 PMCID: PMC8058474 DOI: 10.3389/fneur.2021.602037] [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: 09/02/2020] [Accepted: 03/01/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Cerebral small vessel disease (SVD) is prevalent in the population, especially among elderly individuals. Substantial uncertainties remain about the clinical relevance of SVD with outcomes of mechanical thrombectomy (MT) in acute ischemic stroke (AIS). Objectives: This systematic review and meta-analysis was performed to evaluate the association between SVD and clinical outcomes in patients with AIS undergoing MT. Methods: We systematically searched the Medline, Embase, and Cochrane databases for relevant clinical studies. The exposure of SVD mainly included leukoaraiosis, cerebral microbleeds (CMBs), and lacunes. The pooled OR was used to calculate the association between each subtype of SVD and outcomes of MT. The primary outcome was poor functional outcome, which was defined as a modified Rankin Scale score (mRS) ≥3 at 90 days after MT. The secondary outcomes included mortality at 90 days, in-hospital mortality, intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH), successful recanalization and futile recanalization (FR), early neurological improvement, and early neurological deterioration (END) after MT. Results: Overall, 20 studies with 5,189 patients with AIS undergoing MT were included. High leukoaraiosis burden (HLB) at baseline was associated with increased risks of poor functional outcome at 90 days (OR 2.70, 95% CI 2.01–3.63; p < 0.001; 10 studies; n = 2,004), in-hospital mortality (OR 4.06, 95% CI 1.48–11.13; p = 0.006; 2 studies; n = 314), FR (OR 5.00, 95% CI 2.86–8.73; p < 0.001; 3 studies; n = 493), and END (OR 2.65, 95% CI 1.09–6.45; 1 study; n = 273) after MT. HLB (VSS 3–4 or FS ≥ 2) at baseline was not associated with mortality at 90 days, ICH, or sICH after MT. CMBs at baseline were found to be associated with increased risks of poor functional outcome at 90 days (OR 1.84, 95% CI 1.17–2.90; p = 0.008; 2 studies; n = 1,924) after MT. We found no association between the presence of lacunes and poor functional outcome at 90 days after MT. Conclusions: In patients with AIS undergoing MT, HLB and CMBs were associated with increased risks of unfavorable outcomes after MT.
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Affiliation(s)
- Tao Xu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - You Wang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinxian Yuan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiyan Luo
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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15
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Derraz I, Cagnazzo F, Gaillard N, Morganti R, Dargazanli C, Ahmed R, Lefevre PH, Riquelme C, Mourand I, Gascou G, Bonafe A, Arquizan C, Costalat V. Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Endovascular Thrombectomy. Neurology 2021; 96:e1724-e1731. [PMID: 33495380 DOI: 10.1212/wnl.0000000000011566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 12/23/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether pretreatment cerebral microbleeds (CMBs) presence and burden are correlated with an increased risk of intracranial hemorrhage (ICH) or poor functional outcome following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). METHODS Consecutive patients treated by EVT for anterior circulation AIS were retrospectively analyzed. Experienced neuroradiologists blinded to functional outcomes rated CMBs on T2*-MRI using a validated scale. We investigated associations of CMB presence and burden with ICH and poor clinical outcome at 3 months (modified Rankin Scale score >2). RESULTS Among 513 patients, 281 (54.8%) had a poor outcome and 89 (17.3%) had ≥1 CMBs. A total of 190 (37%) patients experienced ICH; 66 (12.9%) were symptomatic. CMB burden was associated with poor outcome in a univariable analysis (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.03-1.36 per 1-CMB increase; p = 0.02), but significance was lost after adjustment for sex, age, stroke severity, hypertension, diabetes mellitus, atrial fibrillation, prior antithrombotic medication, IV thrombolysis, and reperfusion status (OR, 1.05; 95% CI, 0.92-1.20 per 1-CMB increase; p = 0.50). Results remained nonsignificant when taking into account CMB location or presumed underlying pathogenesis. CMB presence, burden, location, or presumed pathogenesis were not independently correlated with ICH. CONCLUSIONS Poor functional outcome or ICH were not correlated with CMB presence or burden on pre-EVT MRI after adjustment for confounding factors. Excluding such patients from reperfusion therapies is unwarranted. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with AIS undergoing EVT, after adjustment for confounding factors, the presence of CMBs is not significantly associated with clinical outcome or the risk of ICH.
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Affiliation(s)
- Imad Derraz
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy.
| | - Federico Cagnazzo
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Nicolas Gaillard
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Riccardo Morganti
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Cyril Dargazanli
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Raed Ahmed
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Pierre-Henri Lefevre
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Carlos Riquelme
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Isabelle Mourand
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Gregory Gascou
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Alain Bonafe
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Caroline Arquizan
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
| | - Vincent Costalat
- From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy
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16
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Venditti L, Chassin O, Ancelet C, Legris N, Sarov M, Lapergue B, Mihalea C, Ozanne A, Gallas S, Cortese J, Chalumeau V, Ikka L, Caroff J, Labreuche J, Spelle L, Denier C. Pre-procedural predictive factors of symptomatic intracranial hemorrhage after thrombectomy in stroke. J Neurol 2021; 268:1867-1875. [PMID: 33389028 DOI: 10.1007/s00415-020-10364-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Symptomatic intracerebral hemorrhage (sICH) is a common complication of acute ischemic stroke (AIS) associated with limited treatments and poor outcomes. We aimed to identify predictive factors of sICH in patients with AIS following mechanical thrombectomy (MT) in a real-world setting. METHODS Patients with large vessel occlusion of the anterior circulation treated with MT were consecutively included in a prospective monocentric cohort. Clinical, biological, and radiological parameters were collected to identify pre-procedural predictors for sICH. RESULTS 637 patients were included in our study. Magnetic resonance imaging was performed on most patients (86.7%). sICH occurred in 55 patients (8.6%). 428 patients (67.2%) were treated with intravenous thrombolysis. After multivariate analysis, prior use of antiplatelet therapies (odd ratio (OR) 1.84, 95% confidence interval (CI) 1.01-3.32), high C-reactive protein (OR per standard deviation (SD) increase 1.28, 95% 1.01-1.63), elevated mean arterial blood pressure (OR per 10 mmHg increase 1.22, 95% CI 1.03-1.44), hyperglycemia (OR per one SD-log increase 1.38, 95% CI 1.02-1.87), and low ASPECTS (OR per 1-point decrease 1.42, 95% CI 1.12-1.80) were found to be independent predictive factors of sICH. The pre-procedural predictors did not change when the absence of successful recanalization was considered as a covariate. Patients with strokes of unknown onset time were not especially vulnerable for sICH. CONCLUSION sICH after MT was associated with several pre-procedural risk factors: prior use of antiplatelet therapies, high C-reactive protein and hyperglycemia at baseline, elevated mean arterial blood pressure, and low ASPECTS.
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Affiliation(s)
- Laura Venditti
- Department of Neurology, Hôpital Bicêtre, Stroke Center, 78 rue du General Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Olivier Chassin
- Department of Neurology, Hôpital Bicêtre, Stroke Center, 78 rue du General Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Claire Ancelet
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Nicolas Legris
- Department of Neurology, Hôpital Bicêtre, Stroke Center, 78 rue du General Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Mariana Sarov
- Department of Neurology, Hôpital Bicêtre, Stroke Center, 78 rue du General Leclerc, 94270, Le Kremlin Bicêtre, France
| | | | - Cristian Mihalea
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Augustin Ozanne
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Sophie Gallas
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Jonathan Cortese
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Vanessa Chalumeau
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Leon Ikka
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Jildaz Caroff
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Julien Labreuche
- Épidémiologie et Qualité des Soins, CHU Lille, Université de Lille, EA2694, Santé Publique, Statistiques, Lille, France
| | - Laurent Spelle
- Neuroradiology, Faculté Paris-Saclay, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Christian Denier
- Department of Neurology, Hôpital Bicêtre, Stroke Center, 78 rue du General Leclerc, 94270, Le Kremlin Bicêtre, France.
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17
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Choi KH, Kim JH, Lee C, Kim JM, Kang KW, Kim JT, Choi SM, Park MS, Cho KH. Microbleeds and Outcome in Patients With Acute Ischemic Stroke and Atrial Fibrillation Taking Anticoagulants. Stroke 2020; 51:3514-3522. [DOI: 10.1161/strokeaha.120.030300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background and Purpose:
We investigated the impact of the presence, burden, and location of cerebral microbleeds (CMBs) on the risk of major adverse cerebrovascular and cardiovascular events (MACCE) in patients with acute ischemic stroke and atrial fibrillation treated with oral anticoagulants (OACs). We also examined whether the clinical effect of CMBs differs according to the type of OACs.
Methods:
A total of 1742 patients with acute ischemic stroke and atrial fibrillation treated with OACs were enrolled in this cohort study. The primary composite outcome was the occurrence of MACCE (a composite of stroke, acute myocardial infarction, or vascular death) over a 2-year period according to CMB status.
Results:
CMB presence was significantly associated with the risk of future MACCE (hazard ratio, 1.89 [95% CI, 1.23–2.88];
P
=0.003) after adjustment for confounders in patients with acute ischemic stroke and atrial fibrillation taking OACs. Patients with exactly 1 CMB had a similar rate of MACCE compared with those without CMBs (
P
=0.461). However, patients with multiple CMBs (≥2), particularly high burden CMBs (≥5), had a significantly higher proportion of MACCE. Both CMB-positive groups with lobar and deep CMB had more frequent MACCE than the CMB-negative group, and the rate of MACCE was not different according to CMB location. In patients treated with warfarin, CMB was significantly associated with a risk of MACCE (
P
=0.002), but not in patients treated with direct OACs (
P
=0.517).
Conclusions:
The study results indicate that the risk of future MACCE increased with increasing CMB burden in patients with AIS and atrial fibrillation taking OACs, while the anatomic location of CMBs did not influence the risk of future MACCE. This risk seemed to be more apparent in patients taking warfarin.
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Affiliation(s)
- Kang-Ho Choi
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
- Department of Neurology, Chonnam National University Hwasun Hospital, Korea (K.-H. Choi, J.-M.K., K.-W.K.)
| | - Ja-Hae Kim
- Department of Nuclear Medicine, Molecular Imaging Center (J.-H.K.), Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Changho Lee
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Korea (C.L.)
| | - Jae-Myung Kim
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
- Department of Neurology, Chonnam National University Hwasun Hospital, Korea (K.-H. Choi, J.-M.K., K.-W.K.)
| | - Kyung-Wook Kang
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
- Department of Neurology, Chonnam National University Hwasun Hospital, Korea (K.-H. Choi, J.-M.K., K.-W.K.)
| | - Joon-Tae Kim
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Seong-Min Choi
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Man-Seok Park
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Ki-Hyun Cho
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
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18
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Ryu WS, Jeong SW, Kim DE. Total small vessel disease burden and functional outcome in patients with ischemic stroke. PLoS One 2020; 15:e0242319. [PMID: 33180837 PMCID: PMC7660472 DOI: 10.1371/journal.pone.0242319] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/30/2020] [Indexed: 12/28/2022] Open
Abstract
Background Cerebral small vessel disease (SVD) is comprised of lacunes, cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and enlarged perivascular space (EPVS). We investigated the cumulative effect of SVD on 3-month functional outcome following ischemic stroke using the total SVD score. Methods The total SVD score of 477 acute ischemic stroke patients with adequate brain MRI was analyzed. We used multivariable ordinal logistic regression analysis to investigate the independent impact of total SVD score on ordinal modified Rankin Scale (mRS) score at 3-month after ischemic stroke. Results Mean age was 66±14 years, and 61% were men. The distribution of the total SVD score from 0 to 4 was 27%, 24%, 26%, 16%, and 7%, respectively. The proportion of mRS scores 2 or greater was 16% and 47% in total SVD score 0 and 4, respectively. Multivariable ordinal logistic regression analysis results showed that compared with the total SVD score of 0, total SVD scores of 2, 3, and 4 were independently associated with higher mRS scores with adjusted odds ratios (95% confidence intervals) of 1.68 (1.02–2.76), 2.24 (1.25–4.00), and 2.00 (1.02–4.29). Lacunes, CMBs, WMHs but not EPVS were associated with mRS scores at 3 months. However, the impact of each SVD marker on stroke outcome was smaller than that of the total SVD score. Conclusion We found an independent association between total SVD scores and functional outcome at 3 months following ischemic stroke. The total SVD score may be useful for stratification of patients who are at a high-risk of unfavorable outcomes.
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Affiliation(s)
- Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
- Korean Brain MRI Data Center, Goyang, Republic of Korea
- * E-mail:
| | - Sang-Wuk Jeong
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
- Korean Brain MRI Data Center, Goyang, Republic of Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
- Korean Brain MRI Data Center, Goyang, Republic of Korea
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19
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Wei Y, Pu Y, Pan Y, Nie X, Duan W, Liu D, Yan H, Lu Q, Zhang Z, Yang Z, Wen M, Gu W, Hou X, Ma N, Leng X, Miao Z, Liu L. Cortical Microinfarcts Associated With Worse Outcomes in Patients With Acute Ischemic Stroke Receiving Endovascular Treatment. Stroke 2020; 51:2742-2751. [PMID: 32811382 DOI: 10.1161/strokeaha.120.030895] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the impact of cortical microinfarcts (CMIs) on functional outcome after endovascular treatment in patients with acute ischemic stroke. METHODS In a multicenter registration study for RESCUE-RE (a registration study for Critical Care of Acute Ischemic Stroke After Recanalization), eligible patients with large vessel occlusion stroke receiving endovascular treatment, who had undergone 3T magnetic resonance imaging on admission or within 24 hours after endovascular treatment were analyzed. We evaluated the presence and numbers of CMIs with assessment of axial T1, T2-weighted images, and fluid-attenuated inversion recovery images. The primary outcome was functional dependence or death defined as modified Rankin Scale scores of 3 to 6 at 90 days. Secondary outcomes included early neurological improvement, any intracranial hemorrhage, symptomatic intracranial hemorrhage, and mortality. We investigated the independent associations of CMIs with the outcomes using multivariable logistic regression in overall patients and in subgroups. RESULTS Among 414 patients (enrolled from July 2018 to May 2019) included in the analyses, 96 (23.2%) patients had at least one CMI (maximum 6). Patients with CMI(s) were more likely to be functionally dependent or dead at 90 days, compared with those without (55.2% versus 37.4%; P<0.01). In multivariable logistic regression analyses, presence of CMI(s) (adjusted odds ratio, 1.78 [95% CI, 1.04-3.07]; P=0.04) and multiple CMIs (CMIs ≥2; adjusted odds ratio, 7.41 [95% CI, 2.48-22.17]; P<0.001) were independently, significantly associated with the primary outcome. There was no significant difference between subgroups in the associations between CMI presence and the primary outcome. CONCLUSIONS Acute large vessel occlusion stroke patients receiving endovascular treatment with CMI(s) were more likely to have a poor functional outcome at 90 days, independent of patients' characteristics. Such associations may be dose-dependent. Registration: URL: http://www.chictr.org.cn; Unique identifier: ChiCTR1900022154.
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Affiliation(s)
- Yufei Wei
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Yuehua Pu
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Yuesong Pan
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Ximing Nie
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Wanying Duan
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Dacheng Liu
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Hongyi Yan
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Qixuan Lu
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Zhe Zhang
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Zhonghua Yang
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Miao Wen
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Weibin Gu
- Department of Radiology (W.G., X.H.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xinyi Hou
- Department of Radiology (W.G., X.H.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Ning Ma
- Department of Interventional Neurology (N.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China (X.L.)
| | - Zhongrong Miao
- Department of Interventional Neurology (N.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Liping Liu
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
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20
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Smythe MA, Parker D, Garwood CL, Cuker A, Messé SR. Timing of Initiation of Oral Anticoagulation after Acute Ischemic Stroke in Patients with Atrial Fibrillation. Pharmacotherapy 2019; 40:55-71. [PMID: 31698510 DOI: 10.1002/phar.2345] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with atrial fibrillation (AF) who suffer an acute ischemic stroke are at risk for both hemorrhagic transformation and recurrent ischemic stroke in the acute post-stroke period. Oral anticoagulants are recommended for secondary stroke prevention in patients with AF. The optimal time to initiate anticoagulant therapy after acute ischemic stroke in patients with AF is uncertain. There is concern that early initiation increases the risk of hemorrhagic transformation, whereas delayed initiation leaves the patient at risk for recurrent ischemic stroke. In this article, we provide a review of the risk of hemorrhagic transformation of acute ischemic stroke as well as review the literature and major guidelines addressing the timing of anticoagulation initiation after an acute ischemic stroke in patients with AF. Relevant articles published from 1990 to the present were identified using the PubMed and Embase databases. The majority of available literature is observational data. Large ischemic lesions, cerebral microbleeds, thrombolytic therapy, and other clinical factors may increase the risk of hemorrhagic transformation of an acute ischemic stroke. Parenteral anticoagulation within 48 hours is associated with an increased risk of hemorrhagic transformation and is not recommended. Insufficient data exist to support the safety of routine oral anticoagulant (direct oral anticoagulants or warfarin) initiation within 48 hours of an acute ischemic stroke. Direct oral anticoagulant initiation within 2 days of an acute ischemic stroke is associated with a 5% rate of hemorrhagic transformation. Infarct size and presence of hemorrhage are important factors in identifying the optimal time to initiation and should guide decisions when available. A recommended framework for patient decision making is provided. Randomized controlled trials in this area are needed to identify the optimal timing of anticoagulation initiation, and such trials are under way.
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Affiliation(s)
- Maureen A Smythe
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan.,Department of Pharmacy Services, Beaumont Hospital, Royal Oak, Michigan
| | - Dennis Parker
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan.,Department of Pharmacy, Detroit Medical Center, Detroit Receiving Hospital, Detroit, Michigan
| | - Candice L Garwood
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan.,Department of Pharmacy, Detroit Medical Center, Harper University Hospital, Detroit, Michigan
| | - Adam Cuker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steve R Messé
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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21
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Mechtouff L, Nighoghossian N, Amaz C, Buisson M, Berthezène Y, Derex L, Ong E, Eker OF, Cho TH. White matter burden does not influence the outcome of mechanical thrombectomy. J Neurol 2019; 267:618-624. [DOI: 10.1007/s00415-019-09624-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/01/2019] [Accepted: 11/03/2019] [Indexed: 01/07/2023]
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