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  • Kim, Doojin  (6)
  • Sharma, Latisha  (6)
  • 1
    Online-Ressource
    Online-Ressource
    Abstract WP174: Frequency, Predicators, and Outcomes of Pre-Intervention Thrombus Migration in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Kurzfassung: Background: In patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion (LVO), between initial CTA/MRA and catheter angiography performed for intervention, the occlusive thrombus may persist unchanged, fragment and migrate distally, or resolve completely, with or without bridging intravenous fibrinolytic treatment. The frequency, predictors, and outcomes of pre-intervention thrombus migration not been well delineated. Methods: We analyzed a prospectively maintained registry of AIS-LVO patients at an academic medical center over a 2.8 year period (Dec 2014-Oct 2017). Comparing occlusion sites on arrival CTA/MRA with immediately following interventional angiogram, patients were classified as having: 1) thrombus persistence (TP), 2) thrombus migration (TM), or 3) thrombus resolution (TR). Results: In the 220 patients, mean age was 70.7, 42.7% were female, NIHSS was 13.8, onset to first imaging was 156 minutes, and initial occlusion sites on MRA/CTA were: ICA-20.5%; MCA-67.3%; VA/BA-12.3%. Frequencies of thrombus evolution patterns were: TP-59.5%; TM-30.5%; TR-10.0%. On multivariate analysis, independent predictors of TM were: higher NIHSS (OR 1.06 per 1 pt), cardioembolic mechanism (OR 2.40), and longer time from last known well to first CTA/MRA imaging (OR 1.08 per 60 min). While rates of substantial reperfusion (TICI 2b-3) were similar (85.2% vs 83.7%), patients with TM rather than TP had lower rates of excellent reperfusion (TICI 2C-3), 24.1% vs 44.2%, p = 0.02. Symptomatic intracranial hemorrhage occurred more often in TM than TP, 17.9% vs 8.4%, p = 0.05. In multivariate analysis, TM was independently associated with reduced rates of good functional outcome (mRS 0-2), both at discharge (OR 0.41, 95% CI 0.19 to 0.90; p=0.03) and at 3 months (OR 0.43, 95% CI 0.19 to 0.94; p=0.03). Conclusions: Early TM between initial noninvasive imaging and interventional angiography occurs in nearly one-third of patients, is paradoxically associated with poorer outcomes, including more symptomatic hemorrhage and reduced final functional independence. Better understanding of dynamic clot changes early after arrival and their effects on outcome may aid further development of reperfusion therapeutics.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.WP174
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2019
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 2
    Online-Ressource
    Online-Ressource
    Abstract 170: Impact of Eloquent Motor Cortex-Tissue Reperfusion Beyond the Traditional TICI Scoring After Thrombectomy
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. Suppl_1 ( 2020-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
    Kurzfassung: Background: Targeted eloquence-based tissue reperfusion within the primary motor cortex may have differential effect on disability as compared to the traditional volume-based (TICI) reperfusion after endovascular thrombectomy (EVT) in setting of acute ischemic stroke (AIS). Methods: We explored the impact of eloquent reperfusion (ER) within primary motor cortex (PMC) on clinical outcome (mRS) in AIS patients undergoing EVT. ER was defined as presence of flow on final digital subtraction angiography (DSA) within four main cortical branches, supplying the PMC (MCA - precentral, central, anterior parietal; ACA- pericallosal) and graded as absent (0), partial (1), and complete (2). Prospectively collected data from two centers were analyzed. Multivariable analysis was conducted to assess the impact of ER on 90-day disability (mRS) among patients with anterior circulation occlusion who achieved partial reperfusion (TICI 2 a and b). Results: Among the 125 patients who met study criteria, median age was 73, median NIHSS was 16, median ASPECTS was 7, 48% (60/125) were female, and 36.8% achieved functional independence (mRS 0-2) at 90 days. ER distribution was: Absent (0) in 19/125 (15.2%); Partial (1) in 52/125 (41.6%), and Complete (2) in 54/125 (43.2%). TICI 2b was achieved in 102/125 (81.6%) and ER was substantially higher in those patients (p 〈 0.001). In multivariate analysis, in addition to age and sICH, ER had a profound independent impact on 90-day disability (OR 6.10, p=0.001 for ER 1 vs 0; and OR 9.87, p 〈 0.001 for ER 2 vs 0). In contrast, extent of total partial reperfusion (TICI 2b vs 2a) was not related to 90-day disability. Conclusions: Our findings support that eloquent PMC-tissue reperfusion is a major determinant of functional outcome, more impactful than volume-based degree of partial reperfusion. More aggressive, PMC-targeted revascularization among patients with non-eloquent partial reperfusion may further improve post-stroke disability after EVT.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.51.suppl_1.170
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2020
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
    Online-Ressource
  • 3
    Online-Ressource
    Online-Ressource
    Abstract WP59: Cerebral Blood Flow Increase After Endovascular Thrombectomy on Perfusion Weighted Image is Associated With Hemorrhagic Transformation
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. Suppl_1 ( 2020-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
    Kurzfassung: Introduction: The role of increased CBF after endovascular thrombectomy in post-ischemic hyperperfusion has not been studied in detail. We aimed to investigate the timing of CBF increases on PWI after thrombectomy in association with hemorrhagic transformation. Methods: We analyzed prospectively collected data in consecutive patients treated with endovascular thrombectomy. Inclusion criteria were: (1) patients with ICA or M1 occlusion, and (2) PWI and GRE obtained within 12 hours and 12-48 hours after thrombectomy. We compared each rCBF with early hemorrhage (within 12 hours after thrombectomy), late hemorrhage (12-48 hour) and non-hemorrhage in basal ganglia (BG) and MCA cortical or subcortical (CS) region. In each PWI dataset, ROIs were placed in two slice levels of the BG and three slice levels of the CS region. Results: Fifty-three patients met inclusion criteria. Early BG hemorrhages were noted in 13 patients, with 4 late BG hemorrhage, 8 early CS hemorrhage and 3 late CS hemorrhage. There were no significant differences on rCBF in PWI within 12 hours after thrombectomy between early hemorrhage, late hemorrhage and non-hemorrhage groups. In contrast, rCBF on 12-48 hours PWI in the BG region was significantly higher in the early BG hemorrhage than non-BG hemorrhage (lower BG slice 1.36 vs 1.01, p 〈 0.001, upper BG slice 1.33 vs 0.96, p 〈 0.001) and rCBF in CS region were significantly higher in early CS hemorrhage than non-CS hemorrhage (lower CS slice 1.55 vs 0.98, p=0.001, middle CS slice 1.31 vs 0.92, p=0.018). There were no significant differences in rCBF on 12-48 hours PWI between the late hemorrhage and non-hemorrhage group. Conclusions: Most intracerebral hemorrhages after thrombectomy were seen within 12 hours after intervention. A rCBF increase in hemorrhage cases was not seen on PWI within 12 hours after thrombectomy. rCBF increases on PWI 12-48 hours after thrombectomy, however, was associated with post-thrombectomy hemorrhage within 12 hours.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.51.suppl_1.WP59
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2020
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
    Online-Ressource
  • 4
    Online-Ressource
    Online-Ressource
    Abstract TP73: Perfusion Values in Ischemic Core Depend on Time from Onset in Acute Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Kurzfassung: Introduction: Infarct core in perfusion imaging is defined by rCBF regardless of time from onset. Hypothesis: Perfusion values and optimal perfusion thresholds for ischemic core depend on onset-to-imaging time. Methods: Prospectively collected date for consecutive patients treated with IV t-PA and/or endovascular thrombectomy was analyzed retrospectively. Inclusion criteria were (1) patients with ICA or M1 occlusion (2) underwent both DWI and PWI (3) onset time was clear. Ten places of ROI were set in the same place of ADC and PWI images. These ROI were separated into two groups; low ADC (ADC 〈 620) and normal ADC area (ADC 〉 620). In each area we investigated relationship between time to imaging from onset and each PWI values (rCBF, rCBV, MTT and Tmax). ROC curve analysis for ADC 〈 620 was also performed and compared AUC of early (time from onset to imaging 〈 180 min) and late group ( 〉 180 min). Results: Sixty-six patients meet inclusion criteria and 660 ROI was analyzed. 164 ROI were low ADC and 496 ROI were normal ADC. There were statistically significant relationships between time from onset to imaging and rCBF (p=0.0051), rCBV (p 〈 0.0001), MTT (p=0.0001) and Tmax (p 〈 0.0001) in low ADC area. In contrast, no relationship was found in normal ADC area between time and each MRP values. ROC analysis for ADC 〈 620 showed rCBF had the highest AUC. However, AUC in late group was significantly higher than early group (0.927 vs 0.850, p=0.0055) and optimal thresholds was different between early and late group. Conclusions: Perfusion values on PWI depend on time only in low ADC area. The accuracy and optimal thresholds for ischemic core in perfusion image depend on time.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.TP73
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2019
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
    Online-Ressource
  • 5
    Online-Ressource
    Online-Ressource
    Efficient Multimodal MRI Evaluation for Endovascular Thrombectomy of Anterior Circulation Large Vessel Occlusion
    Elsevier BV ; 2020
    In:  Journal of Stroke and Cerebrovascular Diseases Vol. 29, No. 12 ( 2020-12), p. 105271-
    Details
    In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, Vol. 29, No. 12 ( 2020-12), p. 105271-
    Materialart: Online-Ressource
    ISSN: 1052-3057
    URL: Article
    DOI: 10.1016/j.jstrokecerebrovasdis.2020.105271
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2020
    ZDB Id: 2052957-0
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 6
    Online-Ressource
    Online-Ressource
    Abstract TP287: Efficient Multimodal-MRI versus CT Selection for Anterior Circulation Large Vessel
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Kurzfassung: Background: Prompt diagnosis and revascularization of large vessel occlusion ischemic stroke is associated with better functional outcome. While both MRI and CT modalities are current standard of care options for initial imaging, and MR imaging provides greater lesion conspicuity and spatial resolution to inform management, few series have yet demonstrated that multimodal MR may be performed speedily and efficiently in AIS-LVO patients. Methods: In a prospectively maintained Comprehensive Stroke Center Registry, we analyzed all anterior circulation LVO thrombectomy patients: 1) arriving directly by EMS transport from the field, 2) with initial NIHSS ≥6, between 2012-2017. Throughout this period, imaging policy was multimodal MRI (including DWI/GRE/MRA w/wo PWI) as the initial evaluation in all patients without contraindications, and multimodal CT (including CT with CTA, w/wo CTP) in the remainder. Achieved process times were compared with national recommendations for door-to-needle (45m, AHA/ASA Target Stroke) and door-to-puncture (90m, SVIN). Results: Among 106 LVO thrombectomy patients, MRI was used in 62.3% and CT in 37.7%. MRI and CT patients were similar in age, 72.5 v 71.3y; severity (NIHSS) 16.4 v 18.2); and IV tPA door-to-needle times, median 45 vs 46 mins. However, MRI patients had longer onset-to-door times, median 100 vs 50 mins. From Jan 2012-Dec2014, in MRI vs CT groups, median door-to-imaging times were 20 min vs 18 min, p=0.88 and door-to-puncture times 102 vs 93 min, p=0.39. From Jan 2015-Dec2017, after the publication of the positive thrombectomy trials and endorsement of endovascular stroke treatment in US guidelines, in MRI vs CT groups, median door-to-imaging times were 17 min vs 17 min (p=0.93) and door-to-groin puncture 86 vs 71 min (p=0.02). There was no difference in functional outcome (mRS 0-2) between groups. Conclusions: Optimized imaging processes enable acute AIS-LVO patients to be evaluated by multimodal MR with care speeds faster than national recommendations for door-to-needle and door-to-puncture times. While some patients have absolute contraindications to high magnetic fields, MRI, with its greater pathophysiologic insight, remains a highly viable primary imaging strategy in acute ischemic stroke patients.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.TP287
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2019
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
    Online-Ressource
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