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  • 11
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    Respective effects of early cerebral and abdominal magnetic resonance imaging on clinical decisions in infective endocarditis (2012)
    Oxford University Press
    Details
    Publication Date: 2012-07-11
    Description: Aims Extracardiac complications of endocarditis influence diagnosis, therapeutic plans, and prognosis. The aim of this study was to assess how early combined cerebral and abdominal magnetic resonance imaging (MRI) affects the diagnosis and management of adults with endocarditis. Methods and results In a single-centre prospective study, 58 patients with endocarditis underwent systematic cerebral and abdominal MRI within 7 days following admission. Diagnostic classification (Duke's modified criteria) and therapeutic plans were established by two experts just before and after MRI and then compared. Endocarditis was initially classified as definite in 29 patients, possible in 27, and excluded in 2. MRI detected cerebral lesions in 47 patients (81%) (ischaemic lesions in 25, microbleeds in 32, and silent aneurysms in 6), and abdominal lesions in 20 patients (34%). Based solely on MRI results without taking microbleeds into account, experts upgraded endocarditis diagnostic classification in 8 out of 29 (28%) non-definite endocarditis cases either to definite in 6 or to possible in 2. This upgrading was exclusively due to cerebral MRI in four patients and to cerebral and/or abdominal MRI in four patients. Experts modified endocarditis therapeutic plans in 11 (19%) out of the 58 patients, based solely on cerebral MRI, including modification of surgical plans in six (10%) patients. Overall, early MRI led experts to modify classification and/or therapeutic plans in 16 (28%) patients. Conclusion MRI identified cerebral and/or abdominal asymptomatic lesions in many patients with endocarditis, but more frequently cerebral. Both cerebral and abdominal MRI findings affected diagnosis, but only cerebral MRI affected clinical management plans. ClinicalTrials.gov identification number NCT 00144885 IRB authorization number 0511114 (Comité Protection des Personnes Paris-Ile de France 1)
    Print ISSN: 1525-2167
    Electronic ISSN: 1532-2114
    Topics: Medicine
    Published by Oxford University Press
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    Is Intracerebral Hemorrhage a Time-Dependent Phenomenon After Successful Combined Intravenous and Intra-Arterial Therapy? [Brief Reports] (2013)
    American Heart Association (AHA)
    In: Stroke
    Details
    Publication Date: 2013-02-26
    Description: Background and Purpose— Onset-to-reperfusion time (ORT) has recently emerged as an essential prognostic factor in acute ischemic stroke therapy. Although favorable outcome is associated with reduced ORT, it remains unclear whether intracranial bleeding depends on ORT. We therefore sought to determine whether ORT influenced the risk and volume of intracerebral hemorrhage (ICH) after combined intravenous and intra-arterial therapy. Methods— Based on our prospective registry, we included 157 consecutive acute ischemic stroke patients successfully recanalized with combined intravenous and intra-arterial therapy between April 2007 and October 2011. Primary outcome was any ICH within 24 hours posttreatment. Secondary outcomes included occurrence of symptomatic ICH (sICH) and ICH volume measured with the ABC/2. Results— Any ICH occurred in 26% of the study sample (n=33). sICH occurred in 5.5% (n=7). Median ICH volume was 0.8 mL. ORT was increased in patients with ICH (median=260 minutes; interquartile range=230–306) compared with patients without ICH (median=226 minutes; interquartile range=200–281; P =0.008). In the setting of sICH, ORT reached a median of 300 minutes (interquartile range=276–401; P =0.004). The difference remained significant after adjustment for potential confounding factors (adjusted P =0.045 for ICH; adjusted P =0.002 for sICH). There was no correlation between ICH volume and ORT ( r =0.16; P =0.33). Conclusions— ORT influences the rate but not the volume of ICH and appears to be a critical predictor of symptomatic hemorrhage after successful combined intravenous and intra-arterial therapy. To minimize the risk of bleeding, revascularization should be achieved within 4.5 hours of stroke onset.
    Keywords: Acute Stroke Syndromes, Thrombolysis, Other Stroke Treatment - Surgical
    Print ISSN: 0039-2499
    Electronic ISSN: 1524-4628
    Topics: Medicine
    Published by American Heart Association (AHA)
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