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Han N, Zhang X, Zhang Y, Liu Y, Ma H, Ge H, Wang Y, Li S, Yan X, Li T, Wu Y, Ma J, Shi W, Zhang G, Tian Y, Chang M. Endovascular thrombectomy versus medical management on outcomes with infarct volumes more than 70 mL. Ann Clin Transl Neurol 2024. [PMID: 38858521 DOI: 10.1002/acn3.52124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/06/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE Endovascular thrombectomy (EVT) in patients with large infarct volume remains controversial. The aim of this study is to compare clinical outcomes between EVT and medical management in acute large vessel occlusion with infarct volumes larger than 70 mL on diffusion-weighted magnetic resonance imaging (DWI). METHODS A prospective observational cohort study was conducted, including patients with anterior cerebral circulation occlusion due to ischemic stroke with infarct volumes larger than 70 mL within 24 h of onset between July 2018 and June 2023. Eligible patients were divided into two groups: the EVT group and the medical management (non-EVT) group. The main outcomes were functional independence and mortality at 90 days. To assess clinical endpoints, we selected variables including age, NIHSS score, infarct volume, and occlusion location for 1:1 propensity score (PS) matching and PS adjustment using inverse probability of treatment weighting (IPTW). RESULTS Among the 131 identified patients (mean [SD] age, 69.9 [13.7] years; 58 female), the median infarct volume was 123.6 mL. Of these patients, 75 (57.3%) underwent EVT. After PS adjustment, EVT was not associated with functional independence (10.9% vs. 10.9%; p = 1.000) or mortality (43.5% vs. 47.8%; p = 0.675). Additionally, after PS adjustment using IPTW, EVT was also not associated with a functional independence (15.8% vs. 13.7%; p = 0.767) or mortality (46.8% vs. 44.0%; p = 0.762). CONCLUSION This study provides real-world evidence regarding infarct volumes larger than 70 mL, indicating that EVT does not provide benefits compared to medical management alone when considering age, NIHSS score, infarct volume, and occlusion location.
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Affiliation(s)
- Nannan Han
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Xiaobo Zhang
- The College of Life Sciences, Northwest University, Xi'an, China
| | - Yu Zhang
- The College of Life Sciences, Northwest University, Xi'an, China
| | - Yu Liu
- School of Information Science and Technology, Northwest University, Xi'an, China
| | - Haojun Ma
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Hanming Ge
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Yanfei Wang
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Shilin Li
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Xudong Yan
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Tengfei Li
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Yulun Wu
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Juan Ma
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Wenzhen Shi
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, The Affiliated Hospital of Northwest University, Xi'an, China
- Clinical Medical Research Center, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Gejuan Zhang
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Ye Tian
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, The Affiliated Hospital of Northwest University, Xi'an, China
- Clinical Medical Research Center, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Mingze Chang
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
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TICI-RANKIN mismatch: Poor clinical outcome despite complete endovascular reperfusion in the ETIS Registry. Rev Neurol (Paris) 2023; 179:230-237. [PMID: 36804012 DOI: 10.1016/j.neurol.2022.10.003] [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: 01/12/2022] [Revised: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Endovascular treatment (EVT) is a well-established technic for acute ischemic stroke, but despite a high recanalization rate of near 80%, at 3 months roughly 50% of patients have a poor functional outcome with a modified Rankin score (mRS) ≥3. The aim of this study was to determine predictive factors of poor functional outcomes in patients with complete recanalization after EVT, defined as modified thrombolysis in cerebral infarction (mTICI) 3. PATIENTS AND METHODS This retrospective analysis based on the prospective multicenter ETIS registry (endovascular treatment in ischemic stroke) in France included 795 patients from January 2015 and November 2019 with acute ischemic stroke due to anterior circulation occlusion and prestroke mRS 0-1, treated with EVT and who achieved complete recanalization. Univariate and multivariate logistic regression models were used to identify predictive factors of poor functional outcome. RESULTS 365 patients (46%) showed a poor functional outcome (mRS>2). In backward-stepwise logistic regression analysis, poor functional outcome was independently associated with older age (OR per 10-year increase, 1.51; 95%CI, 1.30 to 1.75), higher admission NIHSS (OR per 1 point increase, 1.28; 95%CI, 1.21 to 1.34), absence of prior intravenous thrombolysis (OR, 0.59; 95%CI, 0.39 to 0.90), and an unfavorable 24-hour NIHSS change (24h-baseline) (OR, 0.82; 95%CI, 0.79 to 0.87). We calculated that patients whose 24h NIHSS decreased by less than 5 points are more at risk of a poor outcome, with a sensitivity and a specificity of 65.0%. CONCLUSION Despite complete reperfusion after EVT, half of patients had a poor clinical outcome. These patients, who were mainly older with a high initial NIHSS and an unfavorable post-EVT 24h NIHSS change, could represent a target population for early neurorepair and neurorestorative strategies.
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Maes M, Brinholi FF, Michelin AP, Matsumoto AK, de Oliveira Semeão L, Almulla AF, Supasitthumrong T, Tunvirachaisakul C, Barbosa DS. In Mild and Moderate Acute Ischemic Stroke, Increased Lipid Peroxidation and Lowered Antioxidant Defenses Are Strongly Associated with Disabilities and Final Stroke Core Volume. Antioxidants (Basel) 2023; 12:antiox12010188. [PMID: 36671047 PMCID: PMC9854933 DOI: 10.3390/antiox12010188] [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: 11/23/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
In acute ischemic stroke (AIS), there are no data on whether oxidative stress biomarkers have effects above and beyond known risk factors and measurements of stroke volume. This study was conducted in 122 mild-moderate AIS patients and 40 controls and assessed the modified ranking scale (mRS) at baseline, and 3 and 6 months later. We measured lipid hydroperoxides (LOOH), malondialdehyde (MDA), advanced oxidation protein products, paraoxonase 1 (PON1) activities and PON1 Q192R genotypes, high density lipoprotein cholesterol (HDL), sulfhydryl (-SH) groups), and diffusion-weighted imaging (DWI) stroke volume and fluid-attenuated inversion recovery (FLAIR) signal intensity. We found that (a) AIS is characterized by lower chloromethyl acetate CMPAase PON1 activity, HDL and -SH groups and increased LOOH and neurotoxicity (a composite of LOOH, inflammatory markers and glycated hemoglobin); (b) oxidative and antioxidant biomarkers strongly and independently predict mRS scores 3 and 6 months later, DWI stroke volume and FLAIR signal intensity; and (c) the PON1 Q192R variant has multiple effects on stroke outcomes that are mediated by its effects on antioxidant defenses and lipid peroxidation. Lipid peroxidation and lowered -SH and PON1-HDL activity are drug targets to prevent AIS and consequent neurodegenerative processes and increased oxidative reperfusion mediators due to ischemia-reperfusion injury.
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Affiliation(s)
- Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Rd., Phayathai Road, Pathumwan, Bangkok 10330, Thailand
- Cognitive Fitness and Technology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Psychiatry, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
- Research Institute, Medical University Plovdiv, 4000 Plovdiv, Bulgaria
- Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC 3220, Australia
- Correspondence:
| | - Francis F. Brinholi
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Ana Paula Michelin
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Andressa K. Matsumoto
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Laura de Oliveira Semeão
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Abbas F. Almulla
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf 54001, Iraq
| | - Thitiporn Supasitthumrong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Rd., Phayathai Road, Pathumwan, Bangkok 10330, Thailand
| | - Chavit Tunvirachaisakul
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Rd., Phayathai Road, Pathumwan, Bangkok 10330, Thailand
| | - Decio S. Barbosa
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
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Li Y, Liu Y, Hong Z, Wang Y, Lu X. Combining machine learning with radiomics features in predicting outcomes after mechanical thrombectomy in patients with acute ischemic stroke. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107093. [PMID: 36055039 DOI: 10.1016/j.cmpb.2022.107093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Some patients with mechanical thrombectomy will have a poor prognosis. This study establishes a model for predicting the prognosis after mechanical thrombectomy in acute stroke based on diffusion-weighted imaging (DWI) omics characteristics. METHODS A total of 260 stroke patients receiving mechanical thrombectomy in our hospital were randomly divided into a training set (n = 182) and a test set (n = 78) in a 7:3 ratio. The regions of interest (ROI) of the imaging features of the DWI infarct area were extracted, and the minimum absolute contraction and selection operator regression model were used to screen the best radiomics features. A support vector machine classifier established the prediction model of the prognosis after mechanical thrombectomy of acute stroke based on the selected features. The prediction efficiency of the model was evaluated by the receiver operating characteristic (ROC) curve. RESULTS A total of 1936 radiomic features were extracted, and six features highly correlated with prognosis were screened after dimensionality reduction. Based on the DWI model, the ROC analysis showed that the area under the curve (AUC) for correct prediction in the training and test sets was 0.945 and 0.920, respectively. CONCLUSION The model based on the characteristics of radiomics and machine learning has high predictive efficiency for the prognosis of acute stroke after mechanical thrombectomy, which can be used to guide personalized clinical treatment.
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Affiliation(s)
- Yan Li
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou Clinical Medical College of Hebei Medical University, Canzhou 061011, China.
| | - Yongchang Liu
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou Clinical Medical College of Hebei Medical University, Canzhou 061011, China
| | - Zhen Hong
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou Clinical Medical College of Hebei Medical University, Canzhou 061011, China
| | - Ying Wang
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou Clinical Medical College of Hebei Medical University, Canzhou 061011, China
| | - Xiuling Lu
- Cangzhou Infectious Disease Hospital, Canzhou 061011, China
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Grøan M, Ospel J, Ajmi S, Sandset EC, Kurz MW, Skjelland M, Advani R. Time-Based Decision Making for Reperfusion in Acute Ischemic Stroke. Front Neurol 2021; 12:728012. [PMID: 34790159 PMCID: PMC8591257 DOI: 10.3389/fneur.2021.728012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Decision making in the extended time windows for acute ischemic stroke can be a complex and time-consuming process. The process of making the clinical decision to treat has been compounded by the availability of different imaging modalities. In the setting of acute ischemic stroke, time is of the essence and chances of a good outcome diminish by each passing minute. Navigating the plethora of advanced imaging modalities means that treatment in some cases can be inefficaciously delayed. Time delays and individually based non-programmed decision making can prove challenging for clinicians. Visual aids can assist such decision making aimed at simplifying the use of advanced imaging. Flow charts are one such visual tool that can expedite treatment in this setting. A systematic review of existing literature around imaging modalities based on site of occlusion and time from onset can be used to aid decision making; a more program-based thought process. The use of an acute reperfusion flow chart helping navigate the myriad of imaging modalities can aid the effective treatment of patients.
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Affiliation(s)
- Mathias Grøan
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johanna Ospel
- Department of Radiology, Basel University Hospital, Basel, Switzerland.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Soffien Ajmi
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,University of Stavanger, Stavanger, Norway
| | - Else Charlotte Sandset
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.,Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Martin W Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Mona Skjelland
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Rajiv Advani
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.,Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway
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Kremers F, Venema E, Duvekot M, Yo L, Bokkers R, Lycklama À. Nijeholt G, van Es A, van der Lugt A, Majoie C, Burke J, Roozenbeek B, Lingsma H, Dippel D. Outcome Prediction Models for Endovascular Treatment of Ischemic Stroke: Systematic Review and External Validation. Stroke 2021; 53:825-836. [PMID: 34732070 PMCID: PMC8884132 DOI: 10.1161/strokeaha.120.033445] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Supplemental Digital Content is available in the text. Prediction models for outcome of patients with acute ischemic stroke who will undergo endovascular treatment have been developed to improve patient management. The aim of the current study is to provide an overview of preintervention models for functional outcome after endovascular treatment and to validate these models with data from daily clinical practice.
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Affiliation(s)
- Femke Kremers
- Neurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.)
| | - Esmee Venema
- Neurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.)
- Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (E.V., H.L.)
| | - Martijne Duvekot
- Neurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.)
- Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (M.D.)
| | - Lonneke Yo
- Radiology, Catharina Medical Center, Eindhoven, the Netherlands (L.Y.)
| | - Reinoud Bokkers
- Radiology, UMCG Groningen Medical Center, the Netherlands (R.B.)
| | | | - Adriaan van Es
- Radiology, Leiden Medical Center, the Netherlands (A.v.E.)
| | - Aad van der Lugt
- Radiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.v.d.L.)
| | - Charles Majoie
- Radiology, Amsterdam Medical Center, the Netherlands (C.M.)
| | - James Burke
- Neurology, University of Michigan, Ann Arbor (J.B.)
| | - Bob Roozenbeek
- Neurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.)
| | - Hester Lingsma
- Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (E.V., H.L.)
| | - Diederik Dippel
- Neurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.)
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Sarioglu O, Sarioglu FC, Capar AE, Sokmez DFB, Topkaya P, Belet U. The role of CT texture analysis in predicting the clinical outcomes of acute ischemic stroke patients undergoing mechanical thrombectomy. Eur Radiol 2021; 31:6105-6115. [PMID: 33559698 DOI: 10.1007/s00330-021-07720-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/19/2020] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the performance of CT-based texture analysis (TA) for predicting clinical outcomes of mechanical thrombectomy (MT) in acute ischemic stroke (AIS). METHODS This single-center, retrospective study contained 64 consecutive patients with AIS who underwent MT for large anterior circulation occlusion between December 2016 and January 2020. Patients were divided into 2 groups according to the modified Rankin scale (mRS) scores at 3 months as good outcome (mRS ≤ 2) and bad outcome (mRS > 2). Two observers examined the early ischemic changes for TA on baseline non-contrast CT images independently. Demographic, clinical, periprocedural, and texture variables were compared between the groups and ROC curves were made. Logistic regression analysis was used and a model was created to determine the independent predictors of a bad outcome. RESULTS Sixty-four patients (32 female, 32 male; mean age 63.03 ± 14.42) were included in the study. Fourteen texture parameters were significantly different between patients with good and bad outcomes. The long-run high gray-level emphasis (LRHGE), which is a gray-level run-length matrix (GLRLM) feature, showed the highest sensitivity (80%) and specificity (70%) rates to predict disability. The GLRLM_LRHGE value of > 4885.0 and the time from onset to puncture of > 237.5 mi were found as independent predictors of the bad outcome. The diagnostic rate was 80.0% when using the combination of the GLRLM_LRHGE and the time from onset to puncture cutoff values. CONCLUSION CT-based TA might be a promising modality to predict clinical outcome after MT in patients with AIS. KEY POINTS • The gray-level run-length matrix parameters displayed higher diagnostic performance among the texture features. • The long-run high gray-level emphasis showed the highest sensitivity and specificity rates for predicting a bad outcome in stroke patients undergoing mechanical thrombectomy. • The gray-level run-length matrix_long-run high gray-level emphasis value of > 4885.0 (OR = 11.06; 95% CI = 2.51 - 48.77; p = 0.001) and the time from onset to puncture of > 237.5 min (OR = 8.55; 95% CI = 1.96 - 37.21; p = 0.004) were found as independent predictors of the bad outcome.
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Affiliation(s)
- Orkun Sarioglu
- Department of Radiology, Health Sciences University, Tepecik Educational and Research Hospital, 35180 Yenisehir, Konak, Izmir, Turkey.
| | - Fatma Ceren Sarioglu
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ahmet Ergin Capar
- Department of Radiology, Health Sciences University, Tepecik Educational and Research Hospital, 35180 Yenisehir, Konak, Izmir, Turkey
| | - Demet Funda Bas Sokmez
- Department of Neurology, Health Sciences University, Tepecik Educational and Research Hospital, Izmir, Turkey
| | - Pelin Topkaya
- Department of Neurology, Health Sciences University, Tepecik Educational and Research Hospital, Izmir, Turkey
| | - Umit Belet
- Department of Radiology, Health Sciences University, Tepecik Educational and Research Hospital, 35180 Yenisehir, Konak, Izmir, Turkey
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