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  • 1
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    Online Resource
    Machine Learning–Based Model for Prediction of Outcomes in Acute Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. 5 ( 2019-05), p. 1263-1265
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 5 ( 2019-05), p. 1263-1265
    Abstract: The prediction of long-term outcomes in ischemic stroke patients may be useful in treatment decisions. Machine learning techniques are being increasingly adapted for use in the medical field because of their high accuracy. This study investigated the applicability of machine learning techniques to predict long-term outcomes in ischemic stroke patients. Methods— This was a retrospective study using a prospective cohort that enrolled patients with acute ischemic stroke. Favorable outcome was defined as modified Rankin Scale score 0, 1, or 2 at 3 months. We developed 3 machine learning models (deep neural network, random forest, and logistic regression) and compared their predictability. To evaluate the accuracy of the machine learning models, we also compared them to the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) score. Results— A total of 2604 patients were included in this study, and 2043 (78%) of them had favorable outcomes. The area under the curve for the deep neural network model was significantly higher than that of the ASTRAL score (0.888 versus 0.839; P 〈 0.001), while the areas under the curves of the random forest (0.857; P =0.136) and logistic regression (0.849; P =0.413) models were not significantly higher than that of the ASTRAL score. Using only the 6 variables that are used for the ASTRAL score, the performance of the machine learning models did not significantly differ from that of the ASTRAL score. Conclusions— Machine learning algorithms, particularly the deep neural network, can improve the prediction of long-term outcomes in ischemic stroke patients.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.118.024293
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Immediate and Long-Term Outcomes of Reperfusion Therapy in Patients With Cancer
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 6 ( 2021-06), p. 2026-2034
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 6 ( 2021-06), p. 2026-2034
    Abstract: Patients with acute stroke are often accompanied by comorbidities, such as active cancer. However, adequate treatment guidelines are not available for these patients. The purpose of this study was to evaluate the association between cancer and the outcomes of reperfusion therapy in patients with stroke. Methods: We compared treatment outcomes in patients who underwent reperfusion therapy, using a nationwide reperfusion therapy registry. We divided the patients into 3 groups according to cancer activity: active cancer, nonactive cancer, and without a history of cancer. We investigated reperfusion processes, 24-hour neurological improvement, adverse events, 3-month functional outcome, and 6-month survival and related factors after reperfusion therapy. Results: Among 1338 patients who underwent reperfusion therapy, 62 patients (4.6%) had active cancer, 78 patients (5.8%) had nonactive cancer, and 1198 patients (89.5%) had no history of cancer. Of the enrolled patients, 969 patients received intravenous thrombolysis and 685 patients underwent endovascular treatment (316 patients received combined therapy). Patients with active cancer had more comorbidities and experienced more severe strokes; however, they showed similar 24-hour neurological improvement and adverse events, including cerebral hemorrhage, compared with the other groups. Although the functional outcome at 3 months was poorer than the other groups, 36.4% of patients with active cancer showed functional independence. Additionally, 52.9% of the patients with determined stroke etiology showed functional independence despite active cancer. During the 6-month follow-up, 46.6% of patients with active cancer died, and active cancer was independently associated with poor survival (hazard ratio, 3.973 [95% CI, 2.528–6.245]). Conclusions: In patients with active cancer, reperfusion therapy showed similar adverse events and short-term outcomes to that of other groups. While long-term prognosis was worse in the active cancer group than the nonactive cancer groups, not negligible number of patients had good functional outcomes, especially those with determined stroke mechanisms.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.032380
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Risks and Benefits of Early Rhythm Control in Patients With Acute Strokes and Atrial Fibrillation: A Multicenter, Prospective, Randomized Study (the RAFAS Trial)
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of the American Heart Association Vol. 11, No. 3 ( 2022-02)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 11, No. 3 ( 2022-02)
    Abstract: The purpose of the RAFAS (Risk and Benefits of Urgent Rhythm Control of Atrial Fibrillation in Patients With Acute Stroke) trial was to explore the risks and benefits of early rhythm control in patients with newly documented atrial fibrillation (AF) during an acute ischemic stroke (IS). Method and Results An open‐label, randomized, multicenter trial design was used. If AF was diagnosed, the patients in the early rhythm control group started rhythm control within 2 months after the occurrence of an IS, unlikely the usual care. The primary end points were recurrent IS within 3 and 12 months. The secondary end points were a composite of all deaths, unplanned hospitalizations from any cause, and adverse arrhythmia events. Patients (n=300) with AF and an acute IS (63.0% men, aged 69.6±8.5 years; 51.2% with paroxysmal AF) were randomized 2:1 to early rhythm control (n=194) or usual care (n=106). A total of 273 patients excluding those lost to follow‐up (n=27) were analyzed. The IS recurrences did not differ between the groups within 3 months of the index stroke (2 [1.1%] versus 4 [4.2%] ; hazard ratio [HR], 0.257 [log‐rank P =0.091]) but were significantly lower in the early rhythm control group at 12 months (3 [1.7%] versus 6 [6.3%]; HR, 0.251 [log‐rank P =0.034]). Although the rates of overall mortality, any cause of hospitalizations (25 [14.0%] versus 16 [16.8%]; HR, 0.808 [log‐rank P =0.504]), and arrhythmia‐related adverse events (5 [2.8%] versus 1 [1.1%]; HR, 2.565 [log‐rank P =0.372]) did not differ, the proportion of sustained AF was lower in the early rhythm control group than the usual care group (60 [34.1%] versus 59 [62.8%], P 〈 0.001) in 12 months. Conclusions The early rhythm control strategy of an acute IS decreased the sustained AF and recurrent IS within 12 months without an increase in the composite adverse outcomes. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT 02285387.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.121.023391
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2653953-6
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  • 4
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    Online Resource
    Development of Smartphone Application That Aids Stroke Screening and Identifying Nearby Acute Stroke Care Hospitals
    XMLink ; 2014
    In:  Yonsei Medical Journal Vol. 55, No. 1 ( 2014), p. 25-
    Details
    In: Yonsei Medical Journal, XMLink, Vol. 55, No. 1 ( 2014), p. 25-
    Type of Medium: Online Resource
    ISSN: 0513-5796 , 1976-2437
    URL: Article
    DOI: 10.3349/ymj.2014.55.1.25
    Language: English
    Publisher: XMLink
    Publication Date: 2014
    detail.hit.zdb_id: 2084860-2
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  • 5
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    Abstract 194: Machine Learning-Based Model Can Predict Stroke Outcome
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Introduction: Prediction of outcome in stroke patients can help both physicians and patients in making treatment decisions and managing prognostic expectations. Machine learning techniques are being increasingly used in the field of medical research. Hypothesis: We hypothesized that models developed with machine learning techniques are useful for predicting long-term functional outcomes in patients with acute ischemic stroke. Methods: The model was developed with a prospective cohort of acute ischemic stroke patients. This cohort registers stroke patients who were admitted within 7 days from the onset of symptoms. For this study, we included all patients admitted between January 1, 2010, and December 31, 2014. We excluded patients with pre-stroke modified Rankin Scale (mRS) score 〉 2 or missing 3-month mRS score. Univariate analysis was performed to guide in variable selection for machine learning models. Machine learning models were trained to classify patients likely to have unfavorable outcome, defined as 3-month mRS score 〉 2. Developed models included artificial neural network, random forest, support vector machine, and logistic regression models. Area under the receiver-operated characteristic curve (AUC) was used to compare effectiveness of each model. Google’s TensorFlow and scikit-learn toolkit were used for training of machine learning models. Results: Total of 3,524 patients were admitted during the study period. After excluding 454 patients with unavailable 3-month mRS scores, 60 patients with pre-stroke mRS score 〉 2, and 87 patients with missing laboratory tests or clinical data, 2,923 patients were finally enrolled. Of the 2,923 patients, 695 (24%) patients had unfavorable outcome (mRS 〉 2) at 3 months. The AUC was 0.888 for Artificial neural network model, 0.810 for random forest model, 0.836 for support vector machine model, and 0.842 for logistic regression model. We calculated the AUC of ASTRAL score for reference, which showed 0.839 in our study group. Conclusion: Machine learning models, particularly the artificial neural network model, achieved high accuracy of prediction for functional outcome in stroke. This study showed the feasibility of machine learning approach for predicting outcomes in stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.194
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 6
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    Intensive vs Conventional Blood Pressure Lowering After Endovascular Thrombectomy in Acute Ischemic Stroke : The OPTIMAL-BP Randomized Clinical Trial
    American Medical Association (AMA) ; 2023
    In:  JAMA Vol. 330, No. 9 ( 2023-09-05), p. 832-
    Details
    In: JAMA, American Medical Association (AMA), Vol. 330, No. 9 ( 2023-09-05), p. 832-
    Abstract: Optimal blood pressure (BP) control after successful reperfusion with endovascular thrombectomy (EVT) for patients with acute ischemic stroke is unclear. Objective To determine whether intensive BP management during the first 24 hours after successful reperfusion leads to better clinical outcomes than conventional BP management in patients who underwent EVT. Design, Setting, and Participants Multicenter, randomized, open-label trial with a blinded end-point evaluation, conducted across 19 stroke centers in South Korea from June 2020 to November 2022 (final follow-up, March 8, 2023). It included 306 patients with large vessel occlusion acute ischemic stroke treated with EVT and with a modified Thrombolysis in Cerebral Infarction score of 2b or greater (partial or complete reperfusion). Interventions Participants were randomly assigned to receive intensive BP management (systolic BP target & amp;lt;140 mm Hg; n = 155) or conventional management (systolic BP target 140-180 mm Hg; n = 150) for 24 hours after enrollment. Main Outcomes and Measures The primary outcome was functional independence at 3 months (modified Rankin Scale score of 0-2). The primary safety outcomes were symptomatic intracerebral hemorrhage within 36 hours and death related to the index stroke within 3 months. Results The trial was terminated early based on the recommendation of the data and safety monitoring board, which noted safety concerns. Among 306 randomized patients, 305 were confirmed eligible and 302 (99.0%) completed the trial (mean age, 73.0 years; 122 women [40.4%]). The intensive management group had a lower proportion achieving functional independence (39.4%) than the conventional management group (54.4%), with a significant risk difference (−15.1% [95% CI, −26.2% to −3.9%] ) and adjusted odds ratio (0.56 [95% CI, 0.33-0.96]; P  = .03). Rates of symptomatic intracerebral hemorrhage were 9.0% in the intensive group and 8.1% in the conventional group (risk difference, 1.0% [95% CI, −5.3% to 7.3%]; adjusted odds ratio, 1.10 [95% CI, 0.48-2.53] ; P  = .82). Death related to the index stroke within 3 months occurred in 7.7% of the intensive group and 5.4% of the conventional group (risk difference, 2.3% [95% CI, −3.3% to 7.9%]; adjusted odds ratio, 1.73 [95% CI, 0.61-4.92] ; P  = .31). Conclusions and Relevance Among patients who achieved successful reperfusion with EVT for acute ischemic stroke with large vessel occlusion, intensive BP management for 24 hours led to a lower likelihood of functional independence at 3 months compared with conventional BP management. These results suggest that intensive BP management should be avoided after successful EVT in acute ischemic stroke. Trial Registration ClinicalTrials.gov Identifier: NCT04205305
    Type of Medium: Online Resource
    ISSN: 0098-7484
    URL: Article
    DOI: 10.1001/jama.2023.14590
    RVK:
    XA 10000
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2023
    detail.hit.zdb_id: 2958-0
    detail.hit.zdb_id: 2018410-4
    SSG: 5,21
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  • 7
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    Care Process of Recanalization Therapy for Acute Stroke during the COVID-19 Outbreak in South Korea
    XMLink ; 2021
    In:  Journal of Clinical Neurology Vol. 17, No. 1 ( 2021), p. 63-
    Details
    In: Journal of Clinical Neurology, XMLink, Vol. 17, No. 1 ( 2021), p. 63-
    Type of Medium: Online Resource
    ISSN: 1738-6586 , 2005-5013
    URL: Article
    DOI: 10.3988/jcn.2021.17.1.63
    Language: English
    Publisher: XMLink
    Publication Date: 2021
    detail.hit.zdb_id: 2500489-X
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  • 8
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    Improving the Clinical Outcome in Stroke Patients Receiving Thrombolytic or Endovascular Treatment in Korea: from the SECRET Study
    MDPI AG ; 2020
    In:  Journal of Clinical Medicine Vol. 9, No. 3 ( 2020-03-06), p. 717-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 9, No. 3 ( 2020-03-06), p. 717-
    Abstract: We investigated whether there was an annual change in outcomes in patients who received the thrombolytic therapy or endovascular treatment (EVT) in Korea. This analysis was performed using data from a nationwide multicenter registry for exploring the selection criteria of patients who would benefit from reperfusion therapies in Korea. We compared the annual changes in the modified Rankin scale (mRS) at discharge and after 90 days and the achievement of successful recanalization from 2012 to 2017. We also investigated the determinants of favorable functional outcomes. Among 1230 included patients, the improvement of functional outcome at discharge after reperfusion therapy was noted as the calendar year increased (p 〈 0.001). The proportion of patients who were discharged to home significantly increased (from 45.6% in 2012 to 58.5% in 2017) (p 〈 0.001). The successful recanalization rate increased over time from 78.6% in 2012 to 85.1% in 2017 (p = 0.006). Time from door to initiation of reperfusion therapy decreased over the years (p 〈 0.05). These secular trends of improvements were also observed in 1203 patients with available mRS data at 90 days (p 〈 0.05). Functional outcome was associated with the calendar year, age, initial stroke severity, diabetes, preadmission disability, intervals from door to reperfusion therapy, and achievement of successful recanalization. This study demonstrated the secular trends of improvement in functional outcome and successful recanalization rate in patients who received reperfusion therapy in Korea.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm9030717
    Language: English
    Publisher: MDPI AG
    Publication Date: 2020
    detail.hit.zdb_id: 2662592-1
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  • 9
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    Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion
    Korean Stroke Society ; 2021
    In:  Journal of Stroke Vol. 23, No. 2 ( 2021-05-31), p. 244-252
    Details
    In: Journal of Stroke, Korean Stroke Society, Vol. 23, No. 2 ( 2021-05-31), p. 244-252
    Abstract: Background and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion.Methods Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization.Results Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI] , 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032).Conclusions The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.
    Type of Medium: Online Resource
    ISSN: 2287-6391 , 2287-6405
    URL: Article
    DOI: 10.5853/jos.2020.03622
    Language: English
    Publisher: Korean Stroke Society
    Publication Date: 2021
    detail.hit.zdb_id: 2814366-8
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  • 10
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    Abstract WP183: Spontaneous Echo Contrast is Associated With Larger Cerebral Infarction Volume in Stroke Patients With Atrial Fibrillation
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Introduction: The presence of spontaneous echo contrast (SEC) on transesophageal echocardiography (TEE) is associated with increased thrombogenecity and a risk factor of thromboembolism. The increased thrombogenecity in SEC may produce larger intracardiac thrombi, which result in larger cerebral infarctions and severe stroke. Hypothesis: We hypothesized that infarction volume will be larger in stroke patients with SEC than in those without SEC. Methods: This was a post-hoc analysis using a prospective cohort of acute ischemic stroke. This study included patients with nonvalvular atrial fibrillation (NVAF) who underwent TEE and diffusion weighted imaging (DWI) from Jan. 2008 to Dec. 2014. The volume of cerebral infarction on DWI was measured semi-automatically using 3-dimensional software by an investigator who was blinded to clinical information. The infarction volume was compared between patients with SEC and those without. Results: Of 4252 considered patients, 889 patients had NVAF. After excluding 449 patients without TEE and 39 patients without DWI, 401 patients were included for analysis. Of them, SEC was found in 181 patients (45.1%, 82 mild, 35 moderate, and 64 severe SEC). Infarction volume was larger for the patients with SEC than those without SEC (median [interquartile range], 7226.8 mm 3 [1218.1-28804.6] vs. 4756.8 mm 3 [672.8-14887.8], p=0.015). Infarction volume also increased with SEC severity (p=0.006). Initial National Institute of Health Stroke Scale scores were higher for the patients with SEC than those without SEC (median [interquartile range] , 5.0 [2.0-12.0] vs. 3.0 [1.0-8.0] . p=0.008). On multivariate analysis, infarction volume was independently associated with the presence of SEC (p=0.014). Conclusion: Among stroke patients with NVAF, those with co-existing SEC had larger cerebral infarction, which may account for severe stroke. This may be related with increased thrombogenecity in patients with SEC.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.wp183
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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