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  • Online Resource  (13)
  • Dzialowski, Imanuel  (13)
  • 2010-2014  (13)
  • 1
    Online Resource
    Online Resource
    Does the Application of X-Ray Contrast Agents Impair the Clinical Effect of Intravenous Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients?
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. 6 ( 2012-06), p. 1567-1571
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. 6 ( 2012-06), p. 1567-1571
    Abstract: Experimental data suggest a negative interaction between x-ray contrast agents and fibrinolytic efficacy of recombinant tissue-type plasminogen activator (rtPA). We hypothesized that the application of a contrast agent before intravenous thrombolysis with rtPA reduces its clinical efficacy in acute ischemic stroke. Methods— We retrospectively studied consecutive ischemic stroke patients receiving contrast agents for computed tomography angiography before intravenous treatment with rtPA. We compared functional outcomes with an historical control group from the Canadian Alteplase for Stroke Effectiveness Study who did not receive contrast agents before thrombolysis with rtPA. Primary end point was favorable functional outcome at 90 days defined as modified Rankin Scale scores 0 to 2. We performed logistic regression analysis and a propensity score matching analysis to estimate the effect size of contrast agent use as a negative predictor of outcome. Results— We identified 111 patients for the computed tomography angiography and 1119 patients for the control group. Proportions of favorable functional outcome were 47.7% (53/111 patients) for the computed tomography angiography group and 49.5% (542/1094 patients) for the control group ( P =0.77). Adjusted probabilities for favorable outcome were 0.48 (95% CI, 0.37–0.58) and 0.51 (95% CI, 0.47–0.54), respectively. Contrast use was associated with reduced odds of favorable outcome (OR, 0.62 ; 95% CI, 0.38–0.99). Propensity score matching suggested a larger effect size (OR, 10.0%; 95% CI, 0.5%–19.3%). Conclusions— Our study did not show a significant negative clinical effect of x-ray contrast agents applied before intravenous thrombolysis with rtPA. However, to confirm a possible small negative interaction between contrast agents and rtPA, additional experimental and prospective clinical studies are needed.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.112.651737
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 2
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    Tissue Window in Stroke Thrombolysis Study (TWIST): A Safety Study
    Cambridge University Press (CUP) ; 2013
    In:  Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques Vol. 40, No. 1 ( 2013-01), p. 17-20
    Details
    In: Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, Cambridge University Press (CUP), Vol. 40, No. 1 ( 2013-01), p. 17-20
    Abstract: Stroke thrombolysis is limited by the “last-seen well” principle, which defines stroke onset time. A significant minority of stroke patients (~15%) awake with their symptoms and are by definition ineligible for thrombolysis because they were “last-seen well” at the time they went to bed implying an interval that is most often greater than three hours. Methods: A single-centre prospective, safety study was designed to thrombolyse 20 subjects with stroke-on-awakening. Patients were eligible for inclusion if they were last seen well less than 12 hours previously, specifically including those who awoke from sleep with their stroke deficits. They had a baseline computed tomogram (CT) scan with an ASPECTS score greater than 5, no evidence of well-evolved infarction and a CT angiogram / Trans-cranial Doppler ultrasound study demonstrating an intracranial arterial occlusion. Patients fulfilled all other standard criteria for stroke thrombolysis. The primary outcome was safety defined by symptomatic ICH or death. Results: Among 89 screened patients, 20 were treated with thrombolysis. Two patients (10%) died due to massive carotid territory stroke and two patients (10%) died of stroke complications. Two patients (10%) showed asymptomatic intracerebral hemorrhage (ICH) (petechial hemorrhage) and none symptomatic ICH. Reasons for exclusion were: (a) ASPECTS ≤ 5 (29); (b) well-evolved infarcts on CT (19); (c) historical mRS 〉 2 (17); (d) no demonstrable arterial occlusion or were too mild to warrant treatment (10). Conclusions: Patients who awake with their deficits can be safely treated with thrombolysis based upon a tissue window defined by NCCT and CTA/TCD.
    Type of Medium: Online Resource
    ISSN: 0317-1671 , 2057-0155
    URL: Article
    DOI: 10.1017/S0317167100012890
    RVK:
    XA 10000
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2013
    detail.hit.zdb_id: 2577275-2
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  • 3
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    Extent of Hypoattenuation on CT Angiography Source Images in Basilar Artery Occlusion : Prognostic Value in the Basilar Artery International Cooperation Study
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Stroke Vol. 42, No. 12 ( 2011-12), p. 3454-3459
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 12 ( 2011-12), p. 3454-3459
    Abstract: The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) quantifies the extent of early ischemic changes in the posterior circulation with a 10-point grading system. We hypothesized that pc-ASPECTS applied to CT angiography source images predicts functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). Methods— BASICS was a prospective, observational registry of consecutive patients with acute symptomatic basilar artery occlusion. Functional outcome was assessed at 1 month. We applied pc-ASPECTS to CT angiography source images of patients with CT angiography for confirmation of basilar artery occlusion. We calculated unadjusted and adjusted risk ratios (RRs) of pc-ASPECTS dichotomized at ≥8 versus 〈 8. Primary outcome measure was favorable outcome (modified Rankin Scale scores 0–3). Secondary outcome measures were mortality and functional independence (modified Rankin Scale scores 0–2). Results— Of 158 patients included, 78 patients had a CT angiography source images pc-ASPECTS ≥8. Patients with a pc-ASPECTS ≥8 more often had a favorable outcome than patients with a pc-ASPECTS 〈 8 (crude RR, 1.7; 95% CI, 0.98–3.0). After adjustment for age, baseline National Institutes of Health Stroke Scale score, and thrombolysis, pc-ASPECTS ≥8 was not related to favorable outcome (RR, 1.3; 95% CI, 0.8–2.2), but it was related to reduced mortality (RR, 0.7; 95% CI, 0.5–0.98) and functional independence (RR, 2.0; 95% CI, 1.1–3.8). In post hoc analysis, pc-ASPECTS dichotomized at ≥6 versus 〈 6 predicted a favorable outcome (adjusted RR, 3.1; 95% CI, 1.2–7.5). Conclusions— pc-ASPECTS on CT angiography source images independently predicted death and functional independence at 1 month in the CT angiography subgroup of patients in the BASICS registry.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.111.622175
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
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  • 4
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    Malignant Profile Detected by CT Angiographic Information Predicts Poor Prognosis despite Thrombolysis within Three Hours from Symptom Onset
    S. Karger AG ; 2010
    In:  Cerebrovascular Diseases Vol. 29, No. 6 ( 2010), p. 584-591
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 29, No. 6 ( 2010), p. 584-591
    Abstract: 〈 i 〉 Objective: 〈 /i 〉 A malignant profile of early brain ischemia has been demonstrated in the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) trial. Patients with a malignant profile had a low chance for an independent functional outcome despite thrombolysis within 3–6 h. We sought to determine whether CT angiography (CTA) could identify a malignant imaging profile within 3 h from symptom onset. 〈 i 〉 Methods: 〈 /i 〉 We studied consecutive patients (04/02–09/07) with anterior circulation stroke who received CTA before intravenous thrombolysis within 3 h. We assessed the Alberta Stroke Program Early CT Score (ASPECTS) on CTA source images (CTASI). Intracranial thrombus burden on CTA was assessed with a novel 10-point clot burden score (CBS). We analyzed percentages independent (modified Rankin Scale score ≤2) and fatal outcome at 3 months and parenchymal hematoma rates across categorized combined CTASI-ASPECTS + CBS score groups where 20 is best and 0 is worst. 〈 i 〉 Results: 〈 /i 〉 We identified 114 patients (median age 73 years [interquartile range 61–80], onset-to-tPA time 129 min [95–152] ). Among 24 patients (21%) with extensive hypoattenuation on CTASI and extensive thrombus burden (combined score ≤10), only 4% (1/24) were functionally independent whereas mortality was 50% (12/24). In contrast, 57% (51/90) of patients with less affected scores (combined score 11–20) were functionally independent and mortality was 10% (9/90; p 〈 0.001). Parenchymal hematoma rates were 30% (7/23) vs. 8% (7/88), respectively (p = 0.008). 〈 i 〉 Conclusion: 〈 /i 〉 CTA identifies a large hyperacute stroke population with high mortality and low likelihood for independent functional outcome despite early thrombolysis.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000311079
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2010
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  • 5
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    Abstract 115: Venous Phase Acquisition Is the Best Bolus Timing to Increase Spot Sign Detection in ICH, But Frequency and Extent of Hematoma Expansion Are Greater in Spot Signs Detected in the Arterial Phase of CTA
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background: Although the PREDICT study validated the spot sign for predicting significant hematoma expansion (HE) in acute intracerebral hemorrhage (ICH), the sensitivity was 51% and PPV 61%. Recent studies suggest that second pass imaging can increase the yield of contrast extravasation. The present analysis aimed to determine the frequency of spot sign depending on the phase of image acquisition, and whether an early phase spot sign has greater HE compared to later phases. Methods: The PREDICT study was a multicentric, prospective, observational cohort study of ICH patients presented 〈 6 hours. A blinded neurologist measured the Hounsfield units of an arterial and venous structure at three levels on CTA source images. The nearest structure to ICH was chosen to classify each study into the phase of acquisition. CTA were classified in 10 phases from early triggering to steady state, including arterial peak (5), arterial-venous equilibrium (6), and venous peak (7). Significant HE was defined as ICH enlargement 〉 33% or 〉 6mL at 24 hours. Results: Overall (n=378), 77.5% of CTA were acquired in arterial phases. The spot sign occurred in 29.6%, and there was a trend to more frequent detection in the venous phases (37.6% vs. 27.3%, p=0.066) and in later image acquisition phases (p=0.141; Fig). HE analysis was limited to 318 patients: 26.7% presented spot sign and 32.4% experienced significant HE. In spot-sign positive group, there was a trend that HE occurred more frequently in earlier image acquisition phases (p=0.193, Fig). Similarly, median total hematoma enlargement (ICH+IVH) was greater in earlier phases (p=0.041; Fig). Conclusions: This analysis highlights improved spot sign detection with later image acquisition in venous phase of CTA. However spot signs identified in the arterial phase are associated with more frequent hematoma expansion and greater extent. A two phase CTA is optimal in ICH patients and should include image acquisition in the arterial and venous phases.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.A115
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 6
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    Abstract 2972: Perfusion CT in Patients with Basilar Artery Occlusion: Diagnostic and Prognostic Value in the Basilar Artery International Cooperation Study
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background: The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) applied to CT angiography source images (CTA-SI) predicts the functional outcome of patients with basilar artery occlusion (BAO). Compared with CTA-SI, perfusion CT (CTP) may provide added information. We assessed the diagnostic and prognostic impact of CTP compared with CTA-SI among patients in the Basilar Artery International Cooperation Study (BASICS) Methods: BASICS was a prospective observational registry of consecutive patients with acute symptomatic BAO. We applied pc-ASPECTS to CTA-SI and cerebral blood volume (CBV), cerebral blood flow (CBF), time-to-peak (TTP) and mean-transit-time (MTT) parameter maps in a 3-reader-consensus with readers blinded to clinical data. Hypoattenuation on CTA-SI, a relative reduction in CBV or CBF, or relative increase in MTT or TTP was rated as abnormal. Clinical outcome was measured with the modified Rankin Scale (mRS) score at 1 month. Results: Among 592 patients in the BASICS registry, 27 patients (4.6%) had CTP studies performed. Median (interquartile-range) pc-ASPECTS values on TTP/MTT, CTA-SI, CBF and CBV were 6 (5-8), 7 (5-9), 8 (6-9) and 10 (8.75-10), respectively (p 〈 0.001). The proportion of patients with any perfusion abnormalities in the posterior circulation was highest for TTP/MTT (93%; CI 95% 74% to 99%), compared with 78% (CI 95% 57% to 91%) for both CTA-SI and CBF and 46% (CI 95% 27% to 66%) for CBV (p 〈 0.001). At 1 month, 9 patients (33%) had a favourable outcome (mRS scores 0-3), 8 patients (30%) had an unfavourable outcome (mRS scores 4-5) and 10 patients (37%) were deceased. In univariate analysis, pc-ASPECTS scores did not correlate with outcome mRS scores for all imaging modalities (Spearman’s Rho, p 〉 0.1 for all). All three patients (100%) with a CBV pc-ASPECTS 〈 8 compared to 6 of 23 patients (26%) with a CBV pc-ASPECTS 〉 8 died (p=0.03). Conclusion: CTP was performed in a minority of patients in the BASICS registry population. Perfusion disturbances in the posterior circulation were most frequent and most pronounced on TTP and MTT parameter maps. Extensive reduction of CBV, defined as a pc-ASPECTS 〈 8, may indicate patients with a high case fatality.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A2972
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 7
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    Abstract 3046: Co-registration and 3D Comparison Reveal a Variable Trajectory of Intracerebral Hemorrhage Expansion in Relation to Spot Sign Location: Analysis from the PREDICT Study
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background: Intracerebral hemorrhage (ICH) expansion can have devastating effects for patients. The spot sign, a form of contrast extravasation, has been shown to predict hemorrhage expansion. However, the relationship between the location of the spot sign within the ICH and the direction of hemorrhage expansion has not been defined. We hypothesized that the spot sign can predict the trajectory of ICH expansion. Methods: Data from PREDICT, a prospective, observational cohort study coordinated at the University of Calgary, were used to conduct this case series. Non-contrast computed tomography (CT) and CT-angiography data were obtained for each subject. We used segmentation software to outline ICH volume on baseline and follow-up CTs. We then co-registered the scans and volumes in the same space to allow for three-dimensional voxel-to-voxel comparison along the x-, y-, and z-axes. This comparison yielded three points in three-dimensional space: the spot sign center of mass, the baseline ICH center of mass, and the follow-up ICH center of mass. Distances and angles between these points were used to classify four groups of ICH expansion: 1) perpendicular to the spot sign and baseline ICH center of mass; 2) away from the spot sign; 3) toward the spot sign; and, 4) circumferential. Results: Eighty-two PREDICT study subjects exhibited spot signs. Forty were multiple spot signs and 42 were single spot signs eligible for this analysis. Seven subjects were excluded because of surgery or incomplete imaging. Sixteen subjects were not co-registered because of head motion or insufficient image quality. Nineteen single spot subjects were successfully co-registered. The radius of these 19 hemorrhages was 1.6±0.4 cm (assuming a sphere). The spot sign was located 1.4±0.6 times the length of the radius away from the baseline ICH center of mass. We classified nine co-registered subjects into the four groups because they showed significant hemorrhage expansion defined as ≥6 mL or ≥33% from baseline to follow-up. Four subjects exhibited hemorrhage expansion away from the spot sign, three exhibited circumferential hemorrhage expansion, and two exhibited hemorrhage expansion toward the spot sign. No hemorrhages expanded perpendicular to the spot sign. Conclusion: The spot sign is generally located in the periphery of the ICH. Hemorrhages do not consistently expand in one specific trajectory from the spot sign. This study suggests that the spot sign location may not be useful to predict the direction of hemorrhage expansion.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A3046
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 8
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    Venous Phase of Computed Tomography Angiography Increases Spot Sign Detection, but Intracerebral Hemorrhage Expansion Is Greater in Spot Signs Detected in Arterial Phase
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 3 ( 2014-03), p. 734-739
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 3 ( 2014-03), p. 734-739
    Abstract: Variability in computed tomography angiography (CTA) acquisitions may be one explanation for the modest accuracy of the spot sign for predicting intracerebral hemorrhage expansion detected in the multicenter Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study. This study aimed to determine the frequency of the spot sign in intracerebral hemorrhage and its relationship with hematoma expansion depending on the phase of image acquisition. Methods— PREDICT study was a prospective observational cohort study of patients with intracerebral hemorrhage presenting within 6 hours from onset. A post hoc analysis of the Hounsfield units of an artery and venous structure were measured on CTA source images of the entire PREDICT cohort in a core laboratory. Each CTA study was classified into arterial or venous phase and into 1 of 5 specific image acquisition phases. Significant hematoma expansion and total hematoma enlargement were recorded at 24 hours. Results— Overall (n=371), 77.9% of CTA were acquired in arterial phase. The spot sign, present in 29.9% of patients, was more frequently seen in venous phase as compared with arterial phase (39% versus 27.3%; P =0.041) and the later the phase of image acquisition ( P =0.095). Significant hematoma expansion ( P =0.253) and higher total hematoma enlargement ( P =0.019) were observed more frequently among spot sign–positive patients with earlier phases of image acquisition. Conclusions— Later image acquisition of CTA improves the frequency of spot sign detection. However, spot signs identified in earlier phases may be associated with greater absolute enlargement. A multiphase CTA including arterial and venous acquisitions could be optimal in patients with intracerebral hemorrhage.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.003007
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 9
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    Abstract WP293: Baseline Perihematomal Edema is Greater in the Presence of a CTA Spot Sign but Does Not Predict Hematoma Expansion Independent of ICH Volume
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background: Similarly to intracerebral hemorrhage (ICH), perihematomal edema (PHE) increases with time from onset. A small degree of PHE relative to ICH may suggest a very early timepoint from onset or actively bleeding ICH and therefore predict a higher likelihood of hematoma expansion (HE). The relationship between PHE, ICH and HE has not however been established. Therefore, we aimed to investigate the link between PHE and ICH by time and their relationship with the CTA spot sign and HE. Methods: The PREDICT study was a multicentric, prospective, observational cohort study of ICH patients 〈 6 hours. All study cohort subjects with available baseline CT scan images (n=377) were included in this analysis. Volumes and diameters of total lesion, ICH and PHE were measured systematically by two blinded investigators, respectively. Diameter measurements were taken in the axial CT slice with the largest ICH area. Significant HE was defined as ICH enlargement 〉 33% or 〉 6mL at 24 hours. Results: Correlation between volume and diameter measurements was strong for total lesion (r=0.9; p 〈 0.001) and ICH (r=0.88; p 〈 0.001), but moderate for PHE (r=0.43; p 〈 0.001). PHE represented a half of the total lesion volume at baseline (Table). PHE volume and diameter were not related to time from onset to baseline CT, although PHE/ICH diameter (p=0.017) and volume (p=0.061) ratios were higher the later the baseline CT scan was performed. Spot-sign patients (29.7%) had more baseline PHE, ICH and total lesion than spot-negative patients (Table). HE analysis was limited to 322 patients with follow-up CT before rFVIIa or surgical intervention. HE patients (32%) presented with higher PHE, ICH and total lesion volumes (Table). Baseline PHE diameter and volume ratios however did not predict subsequent HE. Conclusion: Edema represents about half of total lesion volume in acute ICH. Edema and ICH are larger in the presence of a CTA spot sign. Edema alone does not predict subsequent hematoma expansion.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.AWP293
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 10
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    Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study
    Elsevier BV ; 2012
    In:  The Lancet Neurology Vol. 11, No. 4 ( 2012-04), p. 307-314
    Details
    In: The Lancet Neurology, Elsevier BV, Vol. 11, No. 4 ( 2012-04), p. 307-314
    Type of Medium: Online Resource
    ISSN: 1474-4422
    URL: Article
    DOI: 10.1016/S1474-4422(12)70038-8
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2012
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