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  • 1
    Online Resource
    Online Resource
    Multiparametric Neuroimaging and Its Association with Non-Contrast Computed Tomography in Late-Window Large Vessel Occlusion Acute Stroke
    S. Karger AG ; 2023
    In:  Cerebrovascular Diseases Vol. 52, No. 3 ( 2023), p. 344-352
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 52, No. 3 ( 2023), p. 344-352
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Endovascular treatment (EVT) for acute ischemic stroke (AIS) between 6 and 24 h is established as a standard of care among patients selected by multiparametric neuroimaging. We aimed to explore neuroimaging parameters in late-window large vessel occlusion (LVO) patients and its association with non-contrast computed tomography (NCCT) findings. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We included consecutive AIS patients within 6–24 h from the symptoms onset with LVO. We described multiparametric imaging findings, the rate of patients who fulfilled imaging perfusion criteria according to the DAWN and DEFUSE-3 trials that define the computed tomography perfusion mismatch (CTP-MM) group and its association with NCCT focused on Alberta Stroke Program Early CT Score (ASPECTS). We also analyzed the association between neuroimaging parameters and the clinical outcome determined by the 90-day modified Rankin scale (mRS). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 We included 206 patients, of them, 176 (85.4%) presented CTP-MM and 184 (89.3%) presented an ASPECTS ≥6 on admission. The rate of CTP-MM was 90.8% in patients with ASPECTS ≥6, compared with 40.9% in those with low ASPECTS. ASPECTS was moderately correlated with ischemic core determined by cerebral blood flow & #x3c;30% volume (rS = −0.557, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). In EVT-treated patients (185, 89.8%), after adjusting for identifiable confounders, the presence of CTP-MM was a predictor of 90-day functional independence (OR: 3.38; 95% CI: 1.01–11.29; 〈 i 〉 p 〈 /i 〉 = 0.048). We did not find an association between CTP-MM and 90-day functional disability (ordinal mRS shift, aOR: 1.39; 95% CI: 0.58–3.34; 〈 i 〉 p 〈 /i 〉 = 0.459). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 A great majority of patients who presented a LVO in the late window fulfilled guidelines imaging criteria to undergo EVT, especially those with high ASPECTS (≥6). Our data suggest that NCCT with CT angiography could be a reasonable approach for AIS treatment selection also in the late window.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000526477
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
    detail.hit.zdb_id: 1482069-9
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  • 2
    Online Resource
    Online Resource
    Intracranial Artery Calcifications Profile as a Predictor of Recanalization Failure in Endovascular Stroke Treatment
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. 2 ( 2023-02), p. 430-438
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. 2 ( 2023-02), p. 430-438
    Abstract: Acute ischemic stroke with large or medium-vessel occlusion associated with intracranial artery calcification (IAC) is an infrequent phenomenon presumably associated with intracranial atherosclerotic disease. We aimed to characterize IAC and its impact on endovascular treatment outcomes. Methods: We performed a retrospective cross-sectional study of consecutive patients with stroke treated with thrombectomy from January 2020 to July 2021 in our institution. We described IAC findings (length, density, and location pattern) on baseline noncontrast computed tomography. Patients were divided into 3 groups: IAC related to the occlusion location (symptomatic-IAC group), unrelated to the occlusion (asymptomatic-IAC group), and absence of any IAC (non-IAC group). We analyzed the association between the IAC profile and outcomes using logistic regression models. Intracranial angioplasty and stenting were considered rescue treatments. Results: Of the 393 patients included, 26 (6.6%) patients presented a symptomatic-IAC, 77 (19.6%) patients an asymptomatic-IAC, and in 290 (73.8%) patients no IAC was observed. The rate of failed recanalization (expanded Thrombolysis in Cerebral Infarction 0-2a) before rescue treatment was higher in symptomatic-IAC (65.4%) than in asymptomatic-IAC (15.6%; P 〈 0.001) or non-IAC (13.4%; P 〈 0.001). Rescue procedures were more frequently performed in symptomatic-IAC (26.9%) than in asymptomatic-IAC (1.3%; P 〈 0.001) and non-IAC (4.1%; P 〈 0.001). After adjusting for identifiable clinical and radiological confounders, symptomatic-IAC emerged as an independent predictor of failed recanalization (odds ratio, 11.89 [95% CI, 3.94–35.91]; P 〈 0.001), adoption of rescue procedures (odds ratio, 12.38 [95% CI, 2.22–69.09]; P =0.004), and poor functional outcome (90-day modified Rankin Scale score ≥3; odds ratio, 3.51 [95% CI, 1.02–12.00]; P =0.046). Conclusions: The presence of IAC related to the occlusion location is associated with worse angiographic and functional outcomes. Therefore, identification of symptomatic-IAC on baseline imaging may guide optimal endovascular treatment strategy, predicting the need for intracranial stenting and angioplasty.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.122.041257
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    Abstract WP115: Patient Reported Outcomes to Improve the Accuracy of Disability Evaluation After Endovascular Treatment-Successful Recanalization
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Background: Complete recanalization is a well-known predictor of functional outcome among patients who undergo MT. However, trying to improve recanalization from successful (eTICI ≥ 2b) to complete (eTICI2c-3) with more passes is under debate. PROMS allow an accurate assessment of patients status in different domains after AIS. Hypothesis: In AIS patients undergoing MT, PROMS may allow a more precise characterization of the long-term outcome than the usual mRS according to different degrees of recanalization. Methods: Patients with anterior circulation AIS, treated with MT who achieved a successful recanalization (eTICI ≥ 2b) were included. Patients were classified in two groups according to the degree of recanalization: eTICI 2b (successful) vs eTICI 2c-3 (complete). The collected study variables were baseline, procedural characteristics, and 90 days outcome measures including: assessment of disability by a certified clinician blinded to recanalization status (mRS) and PROMS (PROMIS 10- Physical and Mental, HAD depression and Anxiety, visual EQ-5D scale) Results: From Jan 2020 to Dec 2022, 96 patients with PROMS collection at 90 days were identified: 21 had a final eTICI 2b and 75 a final eTICI2c-3. No differences in terms of age, sex and other baseline and procedural characteristic were observed between groups. Median 90-days mRS was similar in both groups (2 [IQR 1-3]; p= 0.517). At 90 days patients achieving TICI 2c-3 had significantly lower HAD depression score: 7 [3-10] vs 10 [7-15] (p=0.02). All other median PROMS values were numerically favourable for patients who achieved TICI 2c-3: visual EQ-5D scale: 64 [10-80] vs 50 [42-65] (p= 0.1), PROMIS 10-Physical and Mental (eTICI 2b: 12 [10-14] and 12 [9-15] versus eTICI 2c-3: 9[7-12] and 9 [7-12]; p=0.8 and p=0.6 respectively), except for HAD-anxiety score (eTICI 2b: 6 [3-9] versus eTICI 2c-3: 7 [4-9]), p=0.520). More than 250 patients will complete the 90 days follow-up in the next 6 months, analyses will be updated for presentation at the conference Conclusion: The differences observed between patients achieving successful versus complete recanalization indicate that PROMs may be more adequate tool than the usual mRS for a fine-tune characterization of long-term outcome in different quality of life domains
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.WP115
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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  • 4
    Online Resource
    Online Resource
    Abstract WMP66: Multiparametric Neuroimaging And Its Association With Non-Contrast Computed Tomography In Late Window Large Vessel Occlusion Acute Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Background: Endovascular treatment (EVT) for acute ischemic stroke (AIS) between 6 to 24 hours is established as a standard of care among patients selected by multiparametric neuroimaging. Therefore, we aimed to explore neuroimaging parameters in late window AIS large vessel occlusion (LVO) patients and the association between findings in non-contrast computed tomography (NCCT) and multiparametric CT. Methods: We included consecutive AIS patients within 6-24 hours from symptoms onset with CTA-LVO. We studied potential associations between computed tomography mismatch defined by DAWN and/or DEFUSE-3 neuroimaging criteria (CTP-MM), infarct volume on CTP, and ASPECTS on NCCT. We also analyzed the association between neuroimaging parameters and outcome determined by 90-day mRS. Results: We included 206 patients, of which 176 (85.4%) presented CTP-MM and 184 (89.3%) presented with an ASPECTS ≥ 6 on admission. The rate of CTP-MM was 90.8% in patients with ASPECTS ≥ 6, as compared with 40.9% in those with low ASPECTS [Figure 1A] . The ASPECTS correlated with infarct core, determined by Cerebral Blood Flow 〈 30% volume (rP=-0.575, P 〈 0.001). In EVT-treated patients (185, 89.8%), after adjusting for identifiable confounders, the presence of CTP-MM was a predictor of 90-day functional independence (OR 3.38; 95%CI 1.01-11.29; P=0.048). We did not find an association between CTP-MM and 90-day functional disability (ordinal mRS shift, aOR 1.39; 95% CI 0.58-3.34; P=0.459) [Figure 1B] . Conclusions: A great majority of patients who presented a LVO in late window fulfilled guidelines imaging criteria to undergo EVT, especially those with high ASPECTS (≥ 6). Our data suggest that NCCT with CT angiography is a reasonable approach for acute ischemic stroke treatment selection also in the late window.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.WMP66
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
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