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  • 1
    Online Resource
    Online Resource
    Acute Stroke Imaging Research Roadmap II
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 9 ( 2013-09), p. 2628-2639
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 9 ( 2013-09), p. 2628-2639
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.002015
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Acute Stroke Imaging Research Roadmap III Imaging Selection and Outcomes in Acute Stroke Reperfusion Clinical Trials : Consensus Recommendations and Further Research Priorities
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. 5 ( 2016-05), p. 1389-1398
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 5 ( 2016-05), p. 1389-1398
    Abstract: The Stroke Imaging Research (STIR) group, the Imaging Working Group of StrokeNet, the American Society of Neuroradiology, and the Foundation of the American Society of Neuroradiology sponsored an imaging session and workshop during the Stroke Treatment Academy Industry Roundtable (STAIR) IX on October 5 to 6, 2015 in Washington, DC. The purpose of this roadmap was to focus on the role of imaging in future research and clinical trials. Methods— This forum brought together stroke neurologists, neuroradiologists, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (NINDS), industry representatives, and members of the US Food and Drug Administration to discuss STIR priorities in the light of an unprecedented series of positive acute stroke endovascular therapy clinical trials. Results— The imaging session summarized and compared the imaging components of the recent positive endovascular trials and proposed opportunities for pooled analyses. The imaging workshop developed consensus recommendations for optimal imaging methods for the acquisition and analysis of core, mismatch, and collaterals across multiple modalities, and also a standardized approach for measuring the final infarct volume in prospective clinical trials. Conclusions— Recent positive acute stroke endovascular clinical trials have demonstrated the added value of neurovascular imaging. The optimal imaging profile for endovascular treatment includes large vessel occlusion, smaller core, good collaterals, and large penumbra. However, equivalent definitions for the imaging profile parameters across modalities are needed, and a standardization effort is warranted, potentially leveraging the pooled data resulting from the recent positive endovascular trials.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.115.012364
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    Image_1.TIFF
    Frontiers Media SA ; 2021
    In:  Frontiers in Neurology Vol. 11 ( 2021-1-6)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 11 ( 2021-1-6)
    Abstract: Objectives: Baseline-core-infarct volume is a critical factor in patient selection and outcome in acute ischemic stroke (AIS) before mechanical thrombectomy (MT). We determined whether oxygen extraction efficiency and arterial collaterals, two different physiologic components of the cerebral ischemic cascade, interacted to modulate baseline-core-infarct volume in patients with AIS-LVO undergoing MT triage. Methods: Between January 2015 and March 2018, consecutive patients with an AIS and M1 occlusion considered for MT with a baseline MRI and perfusion-imaging were included. Variables such as baseline-core-infarct volume [mL], arterial collaterals (HIR: TMax & gt; 10 s volume/TMax & gt; 6 s), high oxygen extraction (HOE, presence of the brush-sign on T2 * ) were assessed. A linear-regression was used to test the interaction of HOE and HIR with baseline-core-infarct volume, after including potential confounding variables. Results: We included 103 patients. Median age was 70 (58–78), and 63% were female. Median baseline-core-infarct volume was 32 ml (IQR 8–74.5). Seventy six patients (74%) had HOE. In a multivariate analysis both favorable HIR collaterals ( p = 0.02) and HOE ( p = 0.038) were associated with lower baseline-core-infarct volume. However, HOE significantly interacted with HIR ( p = 0.01) to predict baseline-core-infarct volume, favorable collaterals (low HIR) with HOE was associated with small baseline-core-infarct whereas patients with poor collaterals (high HIR) and HOE had large baseline-core-infarct. Conclusion: While HOE under effective collateral blood-flow has the lowest baseline-core-infarct volume of all patients, the protective effect of HOE reverses under poor collateral blood-flow and may be a maladaptive response to ischemic stroke as measured by core infarctions in AIS-LVO patients undergoing MT triage.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    URL: Article
    DOI: 10.3389/fneur.2020.618765
    DOI: 10.3389/fneur.2020.618765.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2564214-5
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  • 4
    Online Resource
    Online Resource
    Collateral blood flow measurement with intravoxel incoherent motion perfusion imaging in hyperacute brain stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Neurology Vol. 92, No. 21 ( 2019-05-21)
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 92, No. 21 ( 2019-05-21)
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000007538
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1491874-2
    detail.hit.zdb_id: 207147-2
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  • 5
    Online Resource
    Online Resource
    Table_1.DOC
    Frontiers Media SA ; 2021
    In:  Frontiers in Neurology Vol. 12 ( 2021-2-1)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 12 ( 2021-2-1)
    Abstract: Objectives: The susceptibility-vessel-sign (SVS) allows thrombus visualization, length estimation and composition, and it may impact reperfusion during mechanical thrombectomy (MT). SVS can also describe thrombus shape in the occluded artery: in the straight M1-segment (S-shaped), or in an angulated/traversing a bifurcation segment (A-shaped). We determined whether SVS clot shape influenced reperfusion and outcomes after MT for proximal middle-cerebral-artery (M1) occlusions. Methods: Between May 2015 and March 2018, consecutive patients who underwent MT at one comprehensive stroke center and who had a baseline MRI with a T2 * sequence were included. Clinical, procedural and radiographic data, including clot shape on SVS [angulated/bifurcation (A-SVS) vs. straight (S-SVS)] and length were assessed. Primary outcome was successful reperfusion (TICI 2b-3). Secondary outcome were MT complication rates, MT reperfusion time, and clinical outcome at 90-days. Predictors of outcome were assessed with univariate and multivariate analyses. Results: A total of 62 patients were included. 56% (35/62) had an A-SVS. Clots were significantly longer in the A-SVS group (19 mm vs. 8 mm p = 0.0002). Groups were otherwise well-matched with regard to baseline characteristics. There was a significantly lower rate of successful reperfusion in the A-SVS cohort (83%) compared to the S-SVS cohort (96%) in multivariable analysis [OR 0.04 (95% CI, 0.002–0.58), p = 0.02]. There was no significant difference in long term clinical outcome between groups. Conclusion: Clot shape as determined on T2 * imaging, in patients presenting with M1 occlusion appears to be a predictor of successful reperfusion after MT. Angulated and bifurcating clots are associated with poorer rates of successful reperfusion.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    URL: Article
    DOI: 10.3389/fneur.2021.642877
    DOI: 10.3389/fneur.2021.642877.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
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  • 6
    Online Resource
    Online Resource
    Hypoperfusion Intensity Ratio Is Correlated With Patient Eligibility for Thrombectomy
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. 4 ( 2019-04), p. 917-922
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 4 ( 2019-04), p. 917-922
    Abstract: Hypoperfusion intensity ratio (HIR) is associated with collateral status in acute ischemic stroke patients with anterior circulation large vessel occlusion. We assessed whether HIR was correlated to patient eligibility for mechanical thrombectomy (MT). Methods— We performed a retrospective cohort study of consecutive acute ischemic stroke patients with a proximal middle cerebral artery or internal carotid artery occlusion who underwent MT triage with computed tomography or magnetic resonance perfusion imaging. Clinical data, ischemic core (mL), HIR (defined as time-to-maximum [TMax] 〉 10 seconds/TMax 〉 6 seconds), mismatch volume between core and penumbra, and MT details were assessed. Primary outcome was favorable HIR collateral score (HIR 〈 0.4) between patients who underwent MT (MT+) and those who did not (MT−) according to American Heart Association guidelines both in the 〈 6 hours and 6 to 24 hours windows. Secondary outcomes were favorable HIR score in MT− subgroups (National Institutes of Health Stroke Scale 〈 6 versus core 〉 70 mL) and core-penumbra mismatch volumes. Patients who did not meet guidelines were not included. Results— We included 197 patients (145 MT+ and 52 MT−). MT+ patients had a significantly lower median HIR compared with MT− patients (0.4 [interquartile range, 0.2–0.5] versus 0.6 [interquartile range, 0.5–0.8] ; P 〈 0.001) and a higher mismatch volume (96 versus 27 mL, P 〈 0.001). Among MT− patients, 43 had a core 〉 70 mL, and 9 had a National Institutes of Health Stroke Scale 〈 6. MT− patients with National Institutes of Health Stroke Scale 〈 6 had a lower HIR than MT− patients with core 〉 70 mL (0.2 [interquartile range, 0.2–0.3] versus 0.7 [interquartile range, 0.6–0.8] , P 〈 0.001) but their HIR was not significantly different that MT+ patients. Conclusions— Patients who meet American Heart Association guidelines for thrombectomy are more likely to have favorable collaterals (low HIR). HIR may be used as a marker of eligibility for MT triage.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.118.024134
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 80381-9
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  • 7
    Online Resource
    Online Resource
    Endovascular versus medical therapy for large-vessel anterior occlusive stroke presenting with mild symptoms
    SAGE Publications ; 2020
    In:  International Journal of Stroke Vol. 15, No. 3 ( 2020-04), p. 324-331
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 15, No. 3 ( 2020-04), p. 324-331
    Abstract: Acute ischemic stroke patients with a large-vessel occlusion but mild symptoms (NIHSS ≤ 6) pose a treatment dilemma between medical management and endovascular thrombectomy. Aims To evaluate the differences in clinical outcomes of endovascular thrombectomy-eligible patients with target-mismatch perfusion profiles who undergo either medical management or endovascular thrombectomy. Methods Forty-seven patients with acute ischemic stroke due to large-vessel occlusion, NIHSS ≤ 6, and a target-mismatch perfusion imaging profile were included. Patients underwent medical management or endovascular thrombectomy following treating neurointerventionalist and neurologist consensus. The primary outcome measure was NIHSS shift. Secondary outcome measures were symptomatic intracranial hemorrhage, in-hospital mortality, and 90-day mRS scores. The primary intention-to-treat and as-treated analyses were compared to determine the impact of crossover patient allocation on study outcome measures. Results Forty-seven patients were included. Thirty underwent medical management (64%) and 17 underwent endovascular thrombectomy (36%). Three medical management patients underwent endovascular thrombectomy due to early clinical deterioration. Presentation NIHSS ( P = 0.82), NIHSS shift ( P = 0.62), and 90-day functional independence (mRS 0–2; P = 0.25) were similar between groups. Endovascular thrombectomy patients demonstrated an increased overall rate of intracranial hemorrhage (35.3% vs. 10.0%; P = 0.04), but symptomatic intracranial hemorrhage was similar between groups ( P = 0.25). In-hospital mortality was similar between groups ( P = 0.46), though all two deaths in the medical management group occurred among crossover patients. Endovascular thrombectomy patients demonstrated a longer length of stay (7.6 ± 7.2 vs. 4.3 ± 3.9 days; P = 0.04) and a higher frequency of unfavorable discharge to a skilled-nursing facility ( P = 0.03) rather than home ( P = 0.05). Conclusions Endovascular thrombectomy may pose an unfavorable risk-benefit profile over medical management for endovascular thrombectomy-eligible acute ischemic stroke patients with mild symptoms, which warrants a randomized trial in this subpopulation.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/1747493019873510
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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    detail.hit.zdb_id: 2211666-7
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  • 8
    Online Resource
    Online Resource
    Reduced Intravoxel Incoherent Motion Microvascular Perfusion Predicts Delayed Cerebral Ischemia and Vasospasm After Aneurysm Rupture
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. 3 ( 2018-03), p. 741-745
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 3 ( 2018-03), p. 741-745
    Abstract: Proximal artery vasospasm and delayed cerebral ischemia (DCI) after cerebral aneurysm rupture result in reduced cerebral perfusion and microperfusion and significant morbidity and mortality. Intravoxel incoherent motion (IVIM) magnetic resonance imaging extracts microvascular perfusion information from a multi-b value diffusion-weighted sequence. We determined whether decreased IVIM perfusion may identify patients with proximal artery vasospasm and DCI. Methods— We performed a pilot retrospective cohort study of patients with ruptured cerebral aneurysms. Consecutive patients who underwent a brain magnetic resonance imaging with IVIM after ruptured aneurysm treatment were included. Patient demographic, treatment, imaging, and outcome data were determined by electronic medical record review. Primary outcome was DCI development with proximal artery vasospasm that required endovascular treatment. Secondary outcomes included mortality and clinical outcomes at 6 months. Results— Sixteen patients (11 females, 69%; P =0.9) were included. There were no differences in age, neurological status, or comorbidities between patients who subsequently underwent endovascular treatment of DCI (10 patients; DCI+ group) and those who did not (6 patients; DCI− group). Compared with DCI− patients, DCI+ patients had decreased IVIM perfusion fraction f (0.09±0.03 versus 0.13±0.01; P =0.03), reduced diffusion coefficient D (0.82±0.05 versus 0.92±0.07×10 −3 mm 2 /s; P =0.003), and reduced blood flow–related parameter fD * (1.18±0.40 versus 1.83±0.40×10 −3 mm 2 /s; P =0.009). IVIM pseudodiffusion coefficient D * did not differ between DCI− (0.011±0.002) and DCI+ (0.013±0.005 mm 2 /s; P =0.4) patients. No differences in mortality or clinical outcome were identified. Conclusions— Decreased IVIM perfusion fraction f and blood flow–related parameter fD * correlate with DCI and proximal artery vasospasm development after cerebral aneurysm rupture.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.117.020395
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 80381-9
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  • 9
    Online Resource
    Online Resource
    Abstract TP213: Arcadia CSI (Cognition And Silent Infarcts): Update
    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: Introduction: Cognitive decline and dementia after stroke is a major public healthcare problem, with dementia risk doubling over time, affecting more than 2M people in the US, with no current treatment. Silent brain infarction has been associated with cognitive decline, especially among those at risk for cardio-embolism. The therapeutic challenge is to prevent the occurrence of silent infarction to mitigate proactively the loss of cognitive function. Methods: The NINDS-funded ARCADIA-CSI is an ancillary study to ARCADIA, a randomized trial comparing apixaban vs aspirin to prevent recurrent clinical stroke in patients with cryptogenic stroke and left atrial cardiopathy. The aim of ARCADIA-CSI is to address whether apixaban might also reduce the incidence of silent infarction and be associated with better cognitive function over time compared to aspirin. Five hundred patients will be enrolled at least 90 days after the ARCADIA index stroke and undergo cognitive assessments at baseline and yearly thereafter using a telephone-based cognitive battery. We are testing the hypothesis that the slope of change in cognitive function is less steep during the follow-up period in patients on apixaban compared to patients on aspirin therapy. We will also collect an initial MRI around the time of the qualifying stroke and a follow-up MRI at the time that the subject completes participation in the ARCADIA parent study to assess the occurrence of new silent infarction. Results: As of August 12, 2021, the study has enrolled 188 subjects from 78 ARCADIA sites which have been green-lighted for enrollment in ARCADIA-CSI. A total of 61 sites have enrolled at least one subject. To date, there is a 95% completion of baseline cognitive exams and 98% completion at the 1-yr follow-up. We have obtained 91% of the clinical scans of the index stroke of which 95% have undergone central reading and interpretation. Conclusion: ARCADIA-CSI is designed to identify the most favorable medical approach to prevent the occurrence of silent infarction and cognitive decline in the setting of secondary stroke prevention. An update will be provided regarding the number of patients enrolled, centers green-lighted, and the completion rates of cognitive assessments, and MRIs obtained and interpreted.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.TP213
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 80381-9
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  • 10
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    Online Resource
    A Clinical and Imaging Fused Deep Learning Model Matches Expert Clinician Prediction of 90-Day Stroke Outcomes
    American Society of Neuroradiology (ASNR) ; 2024
    In:  American Journal of Neuroradiology Vol. 45, No. 4 ( 2024-04), p. 406-411
    Details
    In: American Journal of Neuroradiology, American Society of Neuroradiology (ASNR), Vol. 45, No. 4 ( 2024-04), p. 406-411
    Type of Medium: Online Resource
    ISSN: 0195-6108 , 1936-959X
    URL: Article
    DOI: 10.3174/ajnr.A8140
    RVK:
    XA 10000
    RVK:
    XA 19280
    Language: English
    Publisher: American Society of Neuroradiology (ASNR)
    Publication Date: 2024
    detail.hit.zdb_id: 603808-6
    detail.hit.zdb_id: 2025541-X
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