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  • 1
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    Combining Spot Sign and Intracerebral Hemorrhage Score to Estimate Functional Outcome : Analysis From the PREDICT Cohort
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. 6 ( 2018-06), p. 1511-1514
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 6 ( 2018-06), p. 1511-1514
    Abstract: The intracerebral hemorrhage (ICH) score is the most commonly used grading scale for stratifying functional outcome in patients with acute ICH. We sought to determine whether a combination of the ICH score and the computed tomographic angiography spot sign may improve outcome prediction in the cohort of a prospective multicenter hemorrhage trial. Methods— Prospectively collected data from 241 patients from the observational PREDICT study (Prediction of Hematoma Growth and Outcome in Patients With Intracerebral Hemorrhage Using the CT-Angiography Spot Sign) were analyzed. Functional outcome at 3 months was dichotomized using the modified Rankin Scale (0–3 versus 4–6). Performance of (1) the ICH score and (2) the spot sign ICH score—a scoring scale combining ICH score and spot sign number—was tested. Results— Multivariable analysis demonstrated that ICH score (odds ratio, 3.2; 95% confidence interval, 2.2–4.8) and spot sign number (n=1: odds ratio, 2.7; 95% confidence interval, 1.1–7.4; n 〉 1: odds ratio, 3.8; 95% confidence interval, 1.2–17.1) were independently predictive of functional outcome at 3 months with similar odds ratios. Prediction of functional outcome was not significantly different using the spot sign ICH score compared with the ICH score alone (spot sign ICH score area under curve versus ICH score area under curve: P =0.14). Conclusions— In the PREDICT cohort, a prognostic score adding the computed tomographic angiography–based spot sign to the established ICH score did not improve functional outcome prediction compared with the ICH score.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.118.020679
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 2
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    Response by Dowlatshahi et al to Letter Regarding Article, “Predicting Intracerebral Hemorrhage Expansion With Noncontrast Computed Tomography: The BAT Score”
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. 8 ( 2018-08)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 8 ( 2018-08)
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.118.022306
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 3
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    Tenecteplase–Tissue-Type Plasminogen Activator Evaluation for Minor Ischemic Stroke With Proven Occlusion
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. 3 ( 2015-03), p. 769-774
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. 3 ( 2015-03), p. 769-774
    Abstract: Minor stroke and transient ischemic attack with an intracranial occlusion are associated with neurological deterioration and disability. Tenecteplase (TNK–tissue-type plasminogen activator) compared with alteplase is easier to administer, has a longer half-life, higher fibrin specificity, possibly a lower rate of intracranial hemorrhage, and may be an ideal thrombolytic agent in this population. Methods— TNK–Tissue-Type Plasminogen Activator Evaluation for Minor Ischemic Stroke With Proven Occlusion (TEMPO-1) was a multicenter, prospective, uncontrolled, TNK–tissue-type plasminogen activator dose-escalation, safety, and feasibility trial. Patients with a National Institutes of Health Stroke Scale ≤5 within 12 hours of symptom onset, intracranial arterial occlusion on computed tomographic angiography and absence of well-evolved infarction were eligible. Fifty patients were enrolled; 25 patients at a dose of 0.1 mg/kg, and 25 patients at 0.25 mg/kg. Primary outcome was the rate of drug-related serious adverse events. Secondary outcomes included recanalization and 90-day neurological outcome (modified Rankin Scale, 0–1). Results— Median baseline National Institutes of Health Stroke Scale was 2.5 (interquartile range, 1), and median age was 71 (interquartile range, 22) years. There were no drug-related serious adverse events in tier 1. In tier 2, there was 1 symptomatic intracranial hemorrhage (4%; 95% confidence interval, 0.01–20.0). Stroke progression occurred in 6% of cases. Overall, 66% had excellent functional outcome (modified Rankin Scale, 0–1) at 90 days. Recanalization rates were high; 0.1 mg/kg (39% complete and 17% partial), 0.25 mg/kg (52% complete and 9% partial). Complete recanalization was significantly related to excellent functional outcome (modified Rankin Scale, 0–1) at 90 days (relative risk, 1.65; 95% confidence interval, 1.09–2.5; P =0.026). Conclusions— Administration of TNK–tissue-type plasminogen activator in minor stroke with intracranial occlusion is both feasible and safe. A larger randomized controlled trial is needed to prove that this treatment is efficacious. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01654445.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.114.008504
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 4
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    Perihematomal Edema Is Greater in the Presence of a Spot Sign but Does Not Predict Intracerebral Hematoma Expansion
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. 2 ( 2016-02), p. 350-355
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 2 ( 2016-02), p. 350-355
    Abstract: Perihematomal edema volume may be related to intracerebral hemorrhage (ICH) volume at baseline and, consequently, with hematoma expansion. However, the relationship between perihematomal edema and hematoma expansion has not been well established. We aimed to investigate the relationship among baseline perihematomal edema, the computed tomographic angiography spot sign, hematoma expansion, and clinical outcome in patients with acute ICH. Methods— Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) was a prospective observational cohort study of ICH patients presenting within 6 hours from onset. Patients underwent computed tomography and computed tomographic angiography scans at baseline and 24-hour computed tomography scan. A post hoc analysis of absolute perihematomal edema and relative perihematomal edema (absolute perihematomal edema divided by ICH) volumes was performed on baseline computed tomography scans (n=353). Primary outcome was significant hematoma expansion ( 〉 6 mL or 〉 33%). Secondary outcomes were early neurological deterioration, 90-day mortality, and poor outcome. Results— Absolute perihematomal edema volume was higher in spot sign patients (24.5 [11.5–41.8] versus 12.6 [6.9–22] mL; P 〈 0.001), but it was strongly correlated with ICH volume ( ρ =0.905; P 〈 0.001). Patients who experienced significant hematoma expansion had higher absolute perihematomal edema volume (18.4 [10–34.6] versus 11.8 [6.5–22] mL; P 〈 0.001) but similar relative perihematomal edema volume (1.09 [0.89–1.37] versus 1.12 [0.88–1.54] ; P =0.400). Absolute perihematomal edema volume and poorer outcomes were higher by tertiles of ICH volume, and perihematomal edema volume did not independently predict significant hematoma expansion. Conclusions— Perihematomal edema volume is greater at baseline in the presence of a spot sign. However, it is strongly correlated with ICH volume and does not independently predict hematoma expansion.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.115.011295
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 5
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    Computed Tomographic Perfusion Predicts Poor Outcomes in a Randomized Trial of Endovascular Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. 6 ( 2018-06), p. 1426-1433
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 6 ( 2018-06), p. 1426-1433
    Abstract: In the ESCAPE trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times), patients with large vessel occlusions and small infarct cores identified with computed tomography (CT)/CT angiography were randomized to endovascular therapy or standard of care. CT perfusion (CTP) was obtained in some cases but was not used to select patients. We tested the hypothesis that patients with penumbral CTP patterns have higher rates of good clinical outcome. Methods— All CTP data acquired in ESCAPE patients were analyzed centrally using a semiautomated perfusion threshold-based approach. A penumbral pattern was defined as an infarct core 〈 70 mL, penumbral volume 〉 15 mL, and a total hypoperfused volume:core volume ratio of 〉 1.8. The primary outcome was good functional outcome at 90 days (modified Rankin Scale score, 0–2). Results— CTP was acquired in 138 of 316 ESCAPE patients. Penumbral patterns were present in 116 of 128 (90.6%) of patients with interpretable CTP data. The rate of good functional outcome in penumbral pattern patients (53 of 114; 46%) was higher than that in nonpenumbral patients (2 of 12; 17%; P =0.041). In penumbral patients, endovascular therapy increased the likelihood of a good clinical outcome (34 of 58; 57%) compared with those in the control group (19 of 58; 33%; odds ratio, 2.68; 95% confidence interval, 1.25–5.76; P =0.011). Only 3 of 12 nonpenumbral patients were randomized to the endovascular group, preventing an analysis of treatment effect. Conclusions— The majority of patients with CTP imaging in the ESCAPE trial had penumbral patterns, which were associated with better outcomes overall. Patients with penumbra treated with endovascular therapy had the greatest odds of good functional outcome. Nonpenumbral patients were much less likely to achieve good outcomes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.117.019806
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 6
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    Computed Tomography Identifies Patients at High Risk for Stroke After Transient Ischemic Attack/Nondisabling Stroke : Prospective, Multicenter Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. 1 ( 2015-01), p. 114-119
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. 1 ( 2015-01), p. 114-119
    Abstract: Ischemia on computed tomography (CT) is associated with subsequent stroke after transient ischemic attack. This study assessed CT findings of acute ischemia, chronic ischemia, or microangiopathy for predicting subsequent stroke after transient ischemic attack. Methods— This prospective cohort study enrolled patients with transient ischemic attack or nondisabling stroke that had CT scanning within 24 hours. Primary outcome was subsequent stroke within 90 days. Secondary outcomes were stroke at ≤2 or 〉 2 days. CT findings were classified as ischemia present or absent and acute or chronic or microangiopathy. Analysis used Fisher exact test and multivariate logistic regression. Results— A total of 2028 patients were included; 814 had ischemic changes on CT. Subsequent stroke rate was 3.4% at 90 days and 1.5% at ≤2 days. Stroke risk was greater if baseline CT showed acute ischemia alone (10.6%; P =0.002), acute+chronic ischemia (17.4%; P =0.007), acute ischemia+microangiopathy (17.6%; P =0.019), or acute+chronic ischemia+microangiopathy (25.0%; P =0.029). Logistic regression found acute ischemia alone (odds ratio [OR], 2.61; 95% confidence interval [CI[, 1.22–5.57), acute+chronic ischemia (OR, 5.35; 95% CI, 1.71–16.70), acute ischemia+microangiopathy (OR, 4.90; 95% CI, 1.33–18.07), or acute+chronic ischemia+microangiopathy (OR, 8.04; 95% CI, 1.52–42.63) was associated with a greater risk at 90 days, whereas acute+chronic ischemia (OR, 10.78; 95% CI, 2.93–36.68), acute ischemia+microangiopathy (OR, 8.90; 95% CI, 1.90–41.60), and acute+chronic ischemia+microangiopathy (OR, 23.66; 95% CI, 4.34–129.03) had greater risk at ≤2 days. Only acute ischemia (OR, 2.70; 95% CI, 1.01–7.18; P =0.047) was associated with a greater risk at 〉 2 days. Conclusions— In patients with transient ischemic attack/nondisabling stroke, CT evidence of acute ischemia alone or acute ischemia with chronic ischemia or microangiopathy was associated with increased subsequent stroke risk within 90 days.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.114.006768
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 7
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    Early Trajectory of Stroke Severity Predicts Long-Term Functional Outcomes in Ischemic Stroke Subjects : Results From the ESCAPE Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times)
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 1 ( 2017-01), p. 105-110
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 1 ( 2017-01), p. 105-110
    Abstract: The trajectory of neurological improvement after stroke treatment is clinically likely to be an important prognostic signal. We compared the accuracy of early longitudinal National Institutes of Health Stroke Scale (NIHSS) measurement versus other early markers of stroke severity post treatment in predicting subjects’ 90-day stroke outcome. Methods— Data are from the Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with ESCAPE trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times). Stroke severity was assessed at baseline, 1, 2, 5, 30, and 90 days. Subjects’ functional outcome was assessed using the modified Rankin Scale at baseline, 30 days, and 90 days. Group-based trajectory model was used to identify distinct subgroups of longitudinal trajectories of NIHSS measured over the first 2, 5, and 30 days. The accuracy of baseline NIHSS, infarct volume, 24-hour change in NIHSS, infarct volume, and disease severity trajectory subgroups in predicting 90-day stroke outcome were assessed using logistic regression analysis. Results— Group-based trajectory model of the 2-day longitudinal NIHSS data revealed 3 distinct subgroups of NIHSS trajectories—large improvement (41.6%), minimal improvement (31.1%), and no improvement (27.3%) subgroups. Individuals in the large improvement group were more likely were more likely to exhibit good outcomes after 90 days than those in the minimal improvement or no improvement subgroup. Among candidate predictors, the 2-day trajectory subgroup variable was the most accurate in predicting 90-day modified Rankin Scale at 84.5%. Conclusions— Early trajectory of neurological improvement defined by 2-day longitudinal NIHSS data predicts functional outcomes with greater accuracy than other common variables. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01778335.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.014456
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 8
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    Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke
    Massachusetts Medical Society ; 2015
    In:  New England Journal of Medicine Vol. 372, No. 11 ( 2015-03-12), p. 1019-1030
    Details
    In: New England Journal of Medicine, Massachusetts Medical Society, Vol. 372, No. 11 ( 2015-03-12), p. 1019-1030
    Type of Medium: Online Resource
    ISSN: 0028-4793 , 1533-4406
    URL: Article
    DOI: 10.1056/NEJMoa1414905
    RVK:
    XA 10000
    Language: English
    Publisher: Massachusetts Medical Society
    Publication Date: 2015
    detail.hit.zdb_id: 1468837-2
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  • 9
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    Survival Analysis of Risk Factors for Major Recurrence of Intracranial Aneurysms after Coiling
    Cambridge University Press (CUP) ; 2015
    In:  Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques Vol. 42, No. 1 ( 2015-01), p. 40-47
    Details
    In: Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, Cambridge University Press (CUP), Vol. 42, No. 1 ( 2015-01), p. 40-47
    Abstract: Analyse de survie des facteurs de risque de récidive majeure après occlusion endovasculaire d’anévrismes intracrâniens . Contexte: Une récidive après l’occlusion endovasculaire d’un anévrisme survient fréquemment, sans qu’on ne s’explique pourquoi. Nous avons examiné les facteurs cliniques, radiologiques et procéduraux associés à la récidive majeure d’anévrismes intracrâniens après occlusion endovasculaire. Méthode: Nous avons analysé rétrospectivement les données prospectives concernant les patients traités par occlusion endovasculaire entre 2003 et 2012. Nous avons recueilli les caractéristiques des anévrismes, des patients et les techniques opératoires utilisées, avant le congé hospitalier ainsi que le suivi angiographique après l’occlusion. La classification Raymond-Roy a été utilisée: une récidive majeure était définie comme un changement de la classe I ou II à la classe III, une augmentation résiduelle de classe III et une récidive nécessitant tout type de réintervention. Les facteurs de risque associés à une récidive majeure ont été identifiés au moyen du modèle des risques proportionnels de Cox suivi d’une analyse de régression multivariée des covariables, p 〈 0,01. Résultats: Au total, 467 anévrismes ont été traités chez 435 patients: 283 patients (65%) présentaient une rupture aiguë de l’anévrisme, 44 patients (10,1%) sont décédés avant le congé hospitalier et 33 (7,6%) ont été perdus au suivi. En tout, 1367 études angiographiques de suivi (écart de 1 à 108 mois ; médiane 37 ; écarts interquartiles de 14 à 62 mois) ont été effectuées pour 384 anévrismes (82,2%). Le taux de récidive majeure a été de 21% (98) après 6 mois (3,5 à 22,5 mois). L’analyse multivariée (358 patients porteurs de 384 anévrismes) a montré que les facteurs de risque d’une récidive majeure étaient: l’âge 〉 65 ans (risque relatif (RR): 1,61 ; p=0,04), le sexe masculin (RR: 2,13 ; p 〈 0,01), l’hypercholestérolémie (RR: 1,65; p=0,03), la taille du collet de l’anévrisme≥4mm (RR: 1,79 ; p=0,01), la taille de l’anévrisme≥7mm (RR: 2,44 ; p 〈 0,01), l’endoembolisation assistée par stent (RR: 2,87 ; p=0,01) et une classe III initiale (RR: 2,18 ; p 〈 0,01). Conclusion: Environ un anévrisme intracrânien sur cinq a donné lieu à une récidive majeure. Les facteurs modifiables d’une récidive majeure étaient le choix d’une technique assistée par stent et la confirmation d’une occlusion initiale adéquate (classe I/II) lors de la première embolisation endovasculaire.
    Type of Medium: Online Resource
    ISSN: 0317-1671 , 2057-0155
    URL: Article
    DOI: 10.1017/cjn.2014.126
    RVK:
    XA 10000
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2015
    detail.hit.zdb_id: 2577275-2
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  • 10
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    Abstract TP37: Predictors of Hemorrhage After Endovascular Therapy: Findings From the Interrsect Study
    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: Background: While recent endovascular therapy trials have had a minimal number of adverse events, intracerebral hemorrhage (ICH) still occurs. The predictors of ICH with endovascular therapy remain unclear. We assessed predictors of hemorrhage following endovascular thrombectomy using data from the prospectively collected, multicenter INTERRSeCT study. Methods: Patients undergoing endovascular therapy +/- intravenous alteplase (tPA) were enrolled and received baseline CT/CTA, follow-up CTA/Angiogram and 24-hr CT or MRI images. Primary outcome was any ICH as per the ECASS classification of hemorrhage. Secondary outcome was PH1/PH2 hemorrhages. We assessed the relations between ICH and baseline ASPECTS scoring, thrombus location, residual flow, collateralization, tPA use, and final recanalization state. Multivariable regression with stepwise selection was used to adjust for relevant covariates. Results: Of 242 patients who met inclusion criteria, 58 (24%) had an ICH at 24 hours (HI1 53%, HI2 19%, PH1 7%, PH2 21%). Post-procedure hemorrhage was associated with lower ASPECTS scores (p 〈 0.001), ICA (p=0.004), proximal M1 (p=0.008), and mid-M1 (p=0.002) thrombus locations, and serum glucose (7.6 vs. 6.7; p=0.027). When adjusted for covariates, lower ASPECTS score (OR: 1.41 per point lost; 95% CI: 0.57-0.88; p=0.002), mid-M1 thrombus location (OR: 2.03; 95% CI: 1.03-4.01; p=0.041), and serum glucose (OR:1.15, 95% CI: 1.01-1.35, p=0.033) independently predicted the presence of post-procedure ICH. PH1/PH2 hemorrhages were associated with ICA thrombus (OR:2.96, 95% CI:1.05-8.33, p=0.04) after adjusting for relevant covariates. Conclusion: Early ischemia defined by imaging, mid-M1 thrombus location, and increased serum glucose are associated with increased risk of hemorrhage in patients undergoing combination tPA and endovascular therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.TP37
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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