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Deliktas Y, Derraz I, Finitsis S, Caroff J, Bourcier R, Soize S, Moulin S, Richard S, Marnat G, Hoferica M, Cognard C, Desilles JP, Anadani M, Olivot JM, Casolla B, Consoli A, Lapergue B, Gory B. Clinical and safety outcomes of acute stenting plus thrombectomy for carotid tandem lesions with large ischemic core. J Neurointerv Surg 2024:jnis-2024-021517. [PMID: 38839283 DOI: 10.1136/jnis-2024-021517] [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: 02/24/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND We evaluated the clinical and safety outcomes of emergent carotid artery stenting (eCAS) plus endovascular thrombectomy (EVT) among patients with anterior tandem lesion (TL) and large ischemic core (LIC). METHODS This retrospective study included consecutive stroke patients enrolled in the Endovascular Treatment in Ischemic Stroke Registry in France between January 2015 and June 2023. We compared the outcomes of carotid stenting vs no stenting in tandem lesion with pre-treatment LIC (Alberta Stroke Program Early CT Score (ASPECTS) 3-5) and stenting in tandem lesion vs thrombectomy alone for isolated intracranial occlusions with pre-treatment LIC. Primary outcome was a score of 0 to 3 on the modified Rankin scale (mRS) at 90 days. Multivariable mixed-effects logistic regression was performed. RESULTS Among 218 tandem patients with LIC, 55 were treated with eCAS plus EVT. The eCAS group had higher odds of 90-day mRS 0-3 (adjusted Odds Ratio (aOR) 2.40, 95% confidence interval (CI) 1.10 to 5.21; p=0.027). There were no differences in the risk of any intracerebral hemorrhage (OR 1.41, 95% CI 0.69 to 2.86; p=0.346), parenchymal hematoma (aOR 1.216, 95% CI 0.49 to 3.02; p=0.675), symptomatic intracerebral hemorrhage (aOR 1.45, 95% CI 0.60 to 3.48; p=0.409), or 90-day mortality (aOR 0.74, 95% CI 0.33 to 1.68; p=0.472). eCAS was associated with a higher rate of carotid patency at day 1 (aOR 3.54, 95% CI 1.14 to 11.01; p=0.028). Safety outcomes were similar between EVT+eCAS group in TL-LIC and EVT alone group in isolated intracranial occlusions with LIC. CONCLUSION eCAS appears to be a safe and effective strategy in patients with TL and LIC volume.
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Affiliation(s)
- Yakub Deliktas
- Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, Nancy, France
| | - Imad Derraz
- Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Stephanos Finitsis
- Neuroradiology, Aristotle University of Thessaloniki, Ahepa Hospital, Thessaloniki, Greece
| | - Jildaz Caroff
- Interventional Neuroradiology - NEURI Brain Vascular Center, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | | | | | | | | | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Matúš Hoferica
- Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Mohammad Anadani
- Department of Neurosciences, Intent Medical Group, NorthShore University HealthSystem, Arlington Heights, Illinois, USA
| | | | | | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
| | | | - Benjamin Gory
- Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, Nancy, France
- Université de Lorraine, INSERM U1254, IADI, Nancy, France
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2
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Yang Y, Yang L, Shi X, Ni X, Fan S, Xu X, Ma J, Yang S, Wang Z, Zi W, Yang D, Hao Y. Blood glucose to predict symptomatic intracranial hemorrhage after endovascular treatment of acute ischemic stroke with large infarct core: a prospective observational study. Front Neurol 2024; 15:1367177. [PMID: 38751885 PMCID: PMC11094206 DOI: 10.3389/fneur.2024.1367177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Symptomatic intracranial hemorrhage (sICH) is a serious complication of acute ischemic stroke (AIS) after endovascular treatment (EVT). Limited data exist regarding predictors and clinical implications of sICH after EVT, underscoring the significance of identifying risk factors to enhance prevention strategies. Therefore, the main objective of this study was to evaluate the incidence of sICH and identify its predictors after EVT in patients with large infarct core-AIS in the pre-circulation stage. Methods Using data from the EVT for the Pre-circulation Large Infarct Core-AIS Study, we enrolled patients who were treated with EVT from the Prospective Multicenter Cohort Study of Early Treatment in Acute Stroke (MAGIC) registry. Baseline demographics, medical history, vascular risk factors, blood pressure, stroke severity, radiographic features, and EVT details were collected. The patients were classified into three groups: without intracranial hemorrhage (ICH), with asymptomatic intracranial hemorrhage (aICH), and sICH, based upon the occurrence of sICH. The main outcomes were the occurrence of sICH according to the Heidelberg Bleeding Classification and functional condition at 90 days. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curves were used to identify independent predictors of sICH after EVT. Results The study recruited a total of 490 patients, of whom 13.3% (n = 65) developed sICH. Patients with sICH had less favorable outcomes than those without intracranial hemorrhage (ICH) and those with aICH (13.8% vs. 43.5% vs. 32.2%, respectively; p < 0.001). The overall mortality was 41.8% (n = 205) at 90 days post-EVT. The univariate analysis revealed significant differences among the three groups in terms of blood glucose levels at admission, probability of favorable outcomes, incidence of brain herniation, and 90-day mortality. The multifactorial logistic regression analysis revealed that the blood glucose level at admission [odds ratio (OR) 1.169, p < 0.001, confidence interval (CI) 1.076-1.269] was an independent predictor of sICH. A blood glucose level of 6.95 mmol/L at admission was the best predictor of sICH, with an area under the ROC curve (AUC) of 0.685 (95% CI: 0.616-0.754). Discussion The study findings demonstrated that the probability of sICH after EVT was 13.3% in patients with pre-circulation large infarct core-AIS, and sICH increased the risk of an unfavorable prognosis. Higher blood glucose levels at admission were associated with sICH after EVT in patients with pre-circulation large infarct core AIS. These findings underscore the importance of early management strategies to mitigate this risk.
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Affiliation(s)
- Yujie Yang
- Department of Neurology, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
| | - Lihui Yang
- Department of Neurology, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaolei Shi
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xuan Ni
- Department of Pharmacy, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
| | - Shitao Fan
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xu Xu
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jinfu Ma
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shihai Yang
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhixi Wang
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Dahong Yang
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yonggang Hao
- Department of Neurology, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
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3
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Koneru M, Hoseinyazdi M, Wang R, Ozkara BB, Hyson NZ, Marsh EB, Llinas RH, Urrutia VC, Leigh R, Gonzalez LF, Xu R, Caplan JM, Huang J, Lu H, Luna L, Wintermark M, Dmytriw AA, Guenego A, Albers GW, Heit JJ, Nael K, Hillis AE, Yedavalli VS. Pretreatment parameters associated with hemorrhagic transformation among successfully recanalized medium vessel occlusions. J Neurol 2024; 271:1901-1909. [PMID: 38099953 DOI: 10.1007/s00415-023-12149-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/26/2023] [Accepted: 12/03/2023] [Indexed: 03/28/2024]
Abstract
Although pretreatment radiographic biomarkers are well established for hemorrhagic transformation (HT) following successful mechanical thrombectomy (MT) in large vessel occlusion (LVO) strokes, they are yet to be explored for medium vessel occlusion (MeVO) acute ischemic strokes. We aim to investigate pretreatment imaging biomarkers representative of collateral status, namely the hypoperfusion intensity ratio (HIR) and cerebral blood volume (CBV) index, and their association with HT in successfully recanalized MeVOs. A prospectively collected registry of acute ischemic stroke patients with MeVOs successfully recanalized with MT between 2019 and 2023 was retrospectively reviewed. A multivariate logistic regression for HT of any subtype was derived by combining significant univariate predictors into a forward stepwise regression with minimization of Akaike information criterion. Of 60 MeVO patients successfully recanalized with MT, HT occurred in 28.3% of patients. Independent factors for HT included: diabetes mellitus history (p = 0.0005), CBV index (p = 0.0071), and proximal versus distal occlusion location (p = 0.0062). A multivariate model with these factors had strong diagnostic performance for predicting HT (area under curve [AUC] 0.93, p < 0.001). Lower CBV indexes, distal occlusion location, and diabetes history are significantly associated with HT in MeVOs successfully recanalized with MT. Of note, HIR was not found to be significantly associated with HT.
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Affiliation(s)
- Manisha Koneru
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Meisam Hoseinyazdi
- Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA
| | - Richard Wang
- Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA
| | | | - Nathan Z Hyson
- Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA
| | | | - Rafael H Llinas
- Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA
| | - Victor C Urrutia
- Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA
| | - Richard Leigh
- Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA
| | | | - Risheng Xu
- Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA
| | - Justin M Caplan
- Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA
| | - Judy Huang
- Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA
| | - Hanzhang Lu
- Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA
| | - Licia Luna
- Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA
| | | | | | - Adrien Guenego
- Universite Libre De Bruxelles Hospital Erasme, Anderlecht, Belgium
| | | | - Jeremy J Heit
- Stanford University School of Medicine, Stanford, CA, USA
| | - Kambiz Nael
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Argye E Hillis
- Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA
| | - Vivek S Yedavalli
- Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD, 21287, USA.
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4
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Chen M, Joshi KC, Kolb B, Sitton CW, Pujara DK, Abraham MG, Ortega-Gutierrez S, Kasner SE, Hussain SM, Churilov L, Blackburn S, Sundararajan S, Hu YC, Herial N, Arenillas JF, Tsai JP, Budzik RF, Hicks W, Kozak O, Yan B, Cordato D, Manning NW, Parsons M, Hanel RA, Aghaebrahim A, Wu T, Cardona Portela P, Gandhi CD, Al-Mufti F, Perez de la Ossa N, Schaafsma J, Blasco J, Sangha N, Warach S, Kleinig TJ, Johns H, Shaker F, Abdulrazzak MA, Ray A, Sunshine J, Opaskar A, Duncan KR, Xiong W, Al-Shaibi FK, Samaniego EA, Nguyen TN, Fifi JT, Tjoumakaris SI, Jabbour P, Mendes Pereira V, Lansberg MG, Sila C, Bambakidis NC, Davis S, Wechsler L, Albers GW, Grotta JC, Ribo M, Hassan AE, Campbell B, Hill MD, Sarraj A. Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial. J Neurointerv Surg 2024:jnis-2023-021219. [PMID: 38471760 DOI: 10.1136/jnis-2023-021219] [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: 11/02/2023] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized. METHODS SELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was examined. RESULTS Of 351 included patients, 194 (55%) and 189 (54%) demonstrated intracranial and intracerebral hemorrhage, respectively, with a higher incidence in EVT (134 (75%) and 130 (73%)) versus medical management (MM) (60 (35%) and 59 (34%), both P<0.001). Hemorrhagic infarction type 1 (HBC=1a) and type 2 (HBC=1b) accounted for 93% of all hemorrhages. Parenchymal hematoma (PH) type 1 (HBC=1c) and type 2 (HBC=2) were observed in 1 (0.6%) EVT-treated and 4 (2.2%) MM patients. Symptomatic ICH (sICH) (SITS-MOST definition) was seen in 0.6% EVT patients and 1.2% MM patients. No trend for ICH with core volumes (P=0.10) or Alberta Stroke Program Early CT Score (ASPECTS) (P=0.74) was observed. Among EVT patients, the presence of any ICH did not worsen clinical outcome (modified Rankin Scale (mRS) at 90 days: 4 (3-6) vs 4 (3-6); adjusted generalized OR 1.00, 95% CI 0.68 to 1.47, P>0.99) or modify EVT treatment effect (Pinteraction=0.77). CONCLUSIONS ICH was present in 75% of the EVT population, but PH or sICH were infrequent. The presence of any ICH did not worsen functional outcomes or modify EVT treatment effect at 90-day follow-up. The high rate of hemorrhages overall still represents an opportunity for adjunctive therapies in EVT patients with a large ischemic core.
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Affiliation(s)
- Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Krishna C Joshi
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bradley Kolb
- Rush University Medical Center, Chicago, Illinois, USA
| | - Clark W Sitton
- Diagnostic & Interventional Imaging, UT Houston, Houston, Texas, USA
| | | | - Michael G Abraham
- Neurology and Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Santiago Ortega-Gutierrez
- Neuroloy, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Scott E Kasner
- Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shazam M Hussain
- Cleveland Clinic Stroke Program, Cleveland Clinic, Cleveland Heights, Ohio, USA
| | | | - Spiros Blackburn
- Neurosurgery, University of Texas Medical School at Houston Vivian L Smith Department of Neurosurgery, Houston, Texas, USA
| | | | - Yin C Hu
- Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Nabeel Herial
- Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Juan F Arenillas
- Stroke Unit, Neurology Department, Stroke Unit. Neurology Department. Universitary Hospital, Valladolid (Spain), Valladolid, Spain
| | - Jenny P Tsai
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - William Hicks
- OhioHealth Neurological Physicians, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Osman Kozak
- Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Abington Memorial Hospital, Abington, Pennsylvania, USA
| | - Bernard Yan
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Dennis Cordato
- Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Nathan W Manning
- Institute of Neurosciences, UNSW Prince of Wales Clinical School, Sydney, New South Wales, Australia
- Advanced Endovascular Therapy, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Mark Parsons
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | - Amin Aghaebrahim
- Neurological Institute, Lyerley Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Teddy Wu
- Neurology, Christchurch Hospital, Christchurch, Canterbury, New Zealand
| | | | - Chirag D Gandhi
- Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Fawaz Al-Mufti
- Neurology and Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | | | - Joanna Schaafsma
- Medicine - Div. Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jordi Blasco
- Neurointerventional Department C.D.I, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Navdeep Sangha
- Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Steven Warach
- University of Texas at Austin Dell Seton Medical Center, Austin, Texas, USA
| | - Timothy J Kleinig
- Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hannah Johns
- University of Melbourne, Parkville, Victoria, Australia
| | - Faris Shaker
- Neurology, University of Texas McGovern Medical School, Houston, Texas, USA
| | | | - Abhishek Ray
- Neurological Surgery, University Hospitals, Cleveland, Ohio, USA
| | - Jeffery Sunshine
- Radiology, University Hospitals-Case Medical Center, Cleveland, Ohio, USA
| | - Amanda Opaskar
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kelsey R Duncan
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Wei Xiong
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Edgar A Samaniego
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Thanh N Nguyen
- Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Pascal Jabbour
- Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Maarten G Lansberg
- Department of Neurology, Stanford Stroke Center, Stanford University, Stanford, California, USA
| | - Cathy Sila
- Neurological Institute, University Hospitals- Case Medical Center, Cleveland, Ohio, USA
- Neurology, Case Western Reserve University School of Medicine
| | - Nicholas C Bambakidis
- Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Stephen Davis
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Lawrence Wechsler
- University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Gregory W Albers
- Neurology & Neurological Sciences, Stanford University, Stanford, California, USA
| | - James C Grotta
- Neurology, Memorial Hermann Hospital/UT Houston, Houston, Texas, USA
| | - Marc Ribo
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Spain
- Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Bruce Campbell
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael D Hill
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Amrou Sarraj
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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5
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Seners P, Baron JC, Olivot JM, Albers GW. Does imaging of the ischemic penumbra have value in acute ischemic stroke with large vessel occlusion? Curr Opin Neurol 2024; 37:1-7. [PMID: 38038427 DOI: 10.1097/wco.0000000000001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW In this review, we summarize current evidence regarding potential benefits and limitations of using perfusion imaging to estimate presence and extent of irreversibly injured ischemic brain tissue ('core') and severely ischemic yet salvageable tissue ('penumbra') in acute stroke patients with large vessel occlusion (LVO). RECENT FINDINGS Core and penumbra volumes are strong prognostic biomarkers in LVO patients. Greater benefits of both intravenous thrombolysis and endovascular therapy (EVT) are observed in patients with small core and large penumbra volumes. However, some current definitions of clinically relevant penumbra may be too restrictive and exclude patients who may benefit from reperfusion therapies. Alongside other clinical and radiological factors, penumbral imaging may enhance the discussion regarding the benefit/risk ratio of EVT in common clinical situations, such as patients with large core - for whom EVT's benefit is established but associated with a high rate of severe disability -, or patients with mild symptoms or medium vessel occlusions - for whom EVT's benefit is currently unknown. Beyond penumbral evaluation, perfusion imaging is clinically relevant for optimizing patient's selection for neuroprotection trials. SUMMARY In an emerging era of precision medicine, perfusion imaging is a valuable tool in LVO-related acute stroke.
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Affiliation(s)
- Pierre Seners
- Neurology Department, A. de Rothschild Foundation Hospital
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266
| | - Jean-Claude Baron
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Paris
| | - Jean-Marc Olivot
- Acute Stroke Unit, Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, Toulouse, France
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6
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Toscano‐Prat C, Martínez‐González JP, Guasch‐Jiménez M, Ramos‐Pachón A, Martí‐Fàbregas J, Blanco‐Sanroman N, Coronel‐Coronel MF, Domine MC, Martínez‐Domeño A, Prats‐Sánchez L, Marín‐Bueno R, Aguilera‐Simón A, Lambea‐Gil Á, Ezcurra‐Díaz G, Camps‐Renom P. Asymptomatic parenchymal haemorrhage following endovascular treatment: Impact on functional outcome in patients with acute ischaemic stroke. Eur J Neurol 2024; 31:e16112. [PMID: 37909802 PMCID: PMC11235616 DOI: 10.1111/ene.16112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND PURPOSE In patients with acute ischaemic stroke (AIS), haemorrhagic transformation (HT) following endovascular treatment (EVT) is associated with poor functional outcome. However, the impact of asymptomatic HT, not linked to neurological deterioration in the acute phase, is unknown. We aimed to investigate the impact of asymptomatic PH1 (aPH1) and PH2 (aPH2) subtypes of HT on the functional outcome of patients treated with EVT. METHODS We conducted a retrospective study of patients with AIS who were consecutively admitted to our comprehensive stroke centre between January 2019 and December 2022, and who underwent EVT. We collected clinical, radiological, and procedural data. HTs were categorized according to the Heidelberg classification. The primary outcome was the shift on the modified Rankin Scale (mRS) at 3 months of follow-up. We performed bivariate and multivariable ordinal regression analyses to test the association between aPH1/aPH2 and the primary outcome. RESULTS We included 314 patients (mean age = 72.5 years [SD = 13.6], 171 [54.5%] women). We detected 54 (17.2%) patients with HT; 23 (7.3%) were classified as PH2 (11 asymptomatic) and 17 (5.4%) as PH1 (16 asymptomatic). The adjusted common odds ratio for aPH2 of worsening 1 point on the 3-month mRS was 3.32 (95% confidence interval = 1.16-9.57, p = 0.026). No association was observed for aPH1. aPH2 was also independently associated with lower odds of achieving a favourable outcome (mRS = 0-2). Neither aPH1 nor aPH2 was associated with mortality. CONCLUSIONS In patients with AIS treated with EVT, aPH2 is independently associated with unfavourable functional outcome.
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Affiliation(s)
- Clara Toscano‐Prat
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - José Pablo Martínez‐González
- Department of Radiology, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - Marina Guasch‐Jiménez
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - Anna Ramos‐Pachón
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - Joan Martí‐Fàbregas
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - Nerea Blanco‐Sanroman
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - Melissa Fabiola Coronel‐Coronel
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - María Constanza Domine
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - Alejandro Martínez‐Domeño
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - Luis Prats‐Sánchez
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - Rebeca Marín‐Bueno
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - Ana Aguilera‐Simón
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - Álvaro Lambea‐Gil
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - Garbiñe Ezcurra‐Díaz
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
| | - Pol Camps‐Renom
- Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de Barcelona (Department of Medicine)BarcelonaSpain
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Wang Q, Jiang T, Li R, Zheng T, Han Q, Wang M. Whether serum leptin and insulin-like growth factor-1 are predictive biomarkers for post-stroke depression: A meta-analysis and systematic review. J Psychiatr Res 2024; 169:347-354. [PMID: 38091723 DOI: 10.1016/j.jpsychires.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 01/15/2024]
Abstract
Leptin and insulin-like growth factor-1 (IGF-1) may play a role in clinical identification of post-stroke depression (PSD). Here, eight databases (including CNKI, Wanfang, SinoMed, VIP, PubMed, the Cochrane Library, Embase, and the Web of Science) were employed to search for studies on serum leptin and insulin-like growth factor-1 expression levels in patients with PSD. In total, 13 articles were included, of which 6 studies investigated the expression level of serum leptin in patients with PSD, 7 studies explored the serum IGF-1 in PSD patients. Then, the RevMan 5.4 software was used for meta-analysis. The results showed that serum leptin levels were significantly higher in PSD patients than in patients without PSD (SMD = 1.54, 95% CI: 0.84, 2.23; P = 0.006). The result of subgroup analysis showed that the serum leptin levels in PSD patients were significantly higher than those without PSD in acute phase (SMD = 1.38, 95% CI: 0.04, 2.71; P = 0.04), subacute phase (SMD = 2.31, 95% CI: 0.88, 3.73; P = 0.001), and chronic phase (SMD = 1.02, 95% CI: 0.43, 1.60; P = 0.0007); There was no significant difference in serum IGF-1 level between PSD patients and patients without PSD (SMD = 0.49, 95% CI: -0.55, 1.52; P = 0.36). Moreover, the subgroup analysis also showed that there was no statistical difference in acute stage (SMD = 0.36, 95% CI: 0.89, 1.60; P = 0.57). Our study provides evidence to prove that serum leptin level has potential clinical application value as biomarkers for identifying PSD.
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Affiliation(s)
- Qi Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Taotao Jiang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Rundong Li
- Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Ting Zheng
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Qian Han
- School of Public Health, Lanzhou University, Lanzhou, 730030, China
| | - Manxia Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, 730030, China.
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