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  • 1
    Online Resource
    Online Resource
    Comparison Between Perfusion- and Collateral-Based Triage for Endovascular Thrombectomy in a Late Time Window
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. 12 ( 2019-12), p. 3465-3470
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 12 ( 2019-12), p. 3465-3470
    Abstract: Perfusion-based triage has proven to be effective and safe for selecting patients who are likely to benefit from endovascular thrombectomy (EVT) in a late time window. We investigated collateral-based triage for EVT in patients presenting beyond 6 hours, in terms of interrater reliability and efficacy in predicting clinical outcome, in comparison to perfusion-based triage. Methods— One hundred and thirty-two patients who underwent both computed tomographic angiography and computed tomography perfusion for anterior circulation large artery occlusion 6 to 24 hours after last seen well were enrolled. Patients were classified into EVT-eligible and EVT-ineligible groups according to perfusion- and collateral-based triages. We evaluated the interrater reliability of collateral-based triage and differences in good outcome rates of patients who received EVT in the EVT-eligible groups based on perfusion- and collateral-based triages. Results— Both computed tomographic angiography and computed tomography perfusion were assessable in 93 patients. Seventy-six patients were eligible for EVT according to perfusion-based triage. Among them, EVT was performed in 58, of whom 32 (55.1%) had good outcome. Sixty-nine patients were eligible for EVT based on collateral-based triage. Among them, EVT was performed in 50 patients, of whom 31 (62.0%) had good outcome. Interrater reliability of collateral-based triage was good (generalized κ=0.73 [95% CI, 0.59–0.84]). Agreement on EVT eligibility between perfusion- and collateral-based triages was moderate (κ=0.41 [95% CI, 0.16–0.61] ). There was no difference in good outcome rates of patients who underwent EVT in the EVT-eligible groups based on perfusion- and collateral-based triages (55.1% versus 62.0%; P =0.0675). Conclusions— Collateral-based triage showed good interrater reliability and comparable efficacy to that of perfusion-based triage in predicting clinical outcome after EVT in patients presenting beyond 6 hours. Collateral-based triage is a reliable approach for selecting patients for EVT in the extended therapeutic time window.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.119.027216
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Combination of Rescue Stenting and Antiplatelet Infusion Improved Outcomes for Acute Intracranial Atherosclerosis-Related Large-Vessel Occlusion
    Frontiers Media SA ; 2021
    In:  Frontiers in Neurology Vol. 12 ( 2021-7-5)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 12 ( 2021-7-5)
    Abstract: Background and Purpose: Intracranial atherosclerosis-related large-vessel occlusion caused by in situ thrombo-occlusion (ICAS-LVO) has been regarded an important reason for refractoriness to mechanical thrombectomy (MT). To achieve better outcomes for ICAS-LVO, different endovascular strategies should be explored. We aimed to investigate an optimal endovascular strategy for ICAS-LVO. Methods: We retrospectively reviewed three prospective registries of acute stroke underwent endovascular treatment. Among them, patients with ICAS-LVO were assigned to four groups based on their endovascular strategy: (1) MT alone , (2) rescue intracranial stenting after MT failure ( MT-RS ), (3) glycoprotein IIb/IIIa inhibitor infusion after MT failure ( MT-GPI ), and (4) a combination of MT-RS and MT-GPI ( MT-RS + GPI ). Baseline characteristics and outcomes were compared among the groups. To evaluate whether the endovascular strategy resulted in favorable outcome, multivariable analysis was also performed. Results: A total of 184 patients with ICAS-LVO were included. Twenty-four patients (13.0%) were treated with MT alone, 25 (13.6%) with MT-RS, 84 (45.7%) with MT-GPI, and 51 (27.7%) with MT-RS+GPI. The MT-RS+GPI group showed the highest recanalization efficiency (98.0%). Frequency of patent arteries on follow-up (98.0%, p & lt; 0.001) and favorable outcome (84.3%, p & lt; 0.001) were higher in the MT-RS+GPI group than other groups. The MT-RS+GPI strategy remained an independent factor for favorable outcome (odds ratio, 20.4; 95% confidence interval, 1.97–211.4; p = 0.012). Conclusion: Endovascular strategy was significantly associated with procedural and clinical outcomes in acute stroke by ICAS-LVO. A combination of RS and GPI infusion might be an optimal rescue modality when frontline MT fails.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    DOI: 10.3389/fneur.2021.608270
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2564214-5
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  • 3
    Online Resource
    Online Resource
    Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of the American Heart Association Vol. 7, No. 14 ( 2018-07-17)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 14 ( 2018-07-17)
    Abstract: Despite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke, the benefits of thrombectomy remain uncertain for patients with acute basilar artery occlusion ( BAO ). This study aimed to evaluate the effectiveness and safety of thrombectomy and to identify predictors of outcomes in a large cohort of patients with acute BAO . Methods and Results This study included 212 consecutive patients with acute BAO who underwent either stent‐retriever or contact aspiration thrombectomy as the first‐line approach between January 2011 and August 2017 at 3 stroke centers. Clinical and radiologic data were prospectively collected and stored in a database at each center. Multivariable ordinal logistic regression was performed to assess the association between each characteristic and 90‐day modified Rankin scale scores. Reperfusion was successful in 91.5% (194/212) of patients; 44.8% (95/212) of patients achieved 90‐day modified Rankin scale 0 to 2. The symptomatic hemorrhage rate was 1.9% (4/212) and mortality was 16% (34/212). In a multivariable ordinal regression, younger age, lower National Institute of Health stroke scale on admission, and absence of diabetes mellitus and parenchymal hematoma were significantly associated with a favorable shift in the overall distribution of 90‐day modified Rankin scale scores. Treatment outcomes were similar between patients who received stent‐retriever thrombectomy and contact aspiration thrombectomy as the first‐line technique. Conclusions Endovascular thrombectomy was effective and safe for treating patients with acute BAO . Age, the baseline National Institute of Health stroke scale, diabetes mellitus, and parenchymal hematoma were associated with better outcomes. This study showed no superiority of the stent‐retriever over the aspiration thrombectomy for treating acute BAO .
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.118.009419
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2653953-6
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  • 4
    Online Resource
    Online Resource
    Prognostication of cardiac arrest survivors using low apparent diffusion coefficient cluster volume
    Elsevier BV ; 2016
    In:  Resuscitation Vol. 100 ( 2016-03), p. 18-24
    Details
    In: Resuscitation, Elsevier BV, Vol. 100 ( 2016-03), p. 18-24
    Type of Medium: Online Resource
    ISSN: 0300-9572
    URL: Article
    DOI: 10.1016/j.resuscitation.2015.12.013
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2016
    detail.hit.zdb_id: 2010733-X
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  • 5
    Online Resource
    Online Resource
    Valence band structures of the phase change material Ge2Sb2Te5
    AIP Publishing ; 2007
    In:  Applied Physics Letters Vol. 91, No. 25 ( 2007-12-17)
    Details
    In: Applied Physics Letters, AIP Publishing, Vol. 91, No. 25 ( 2007-12-17)
    Abstract: We report the experimental evidence of significant change of the valence band structure during crystallization of Ge2Sb2Te5 (GST). Amorphous GST, prepared by sputter deposition at room temperature (RT), transforms successively into face-centered-cubic (fcc) and a hexagonal-close-packed (hcp) structures at around 150 and 300°C, respectively, during a stepwise temperature increase from RT to 350°C. During temperature increase, ultraviolet photoemission spectra were in vacuo obtained using synchrotron radiation. The measurement of the amorphous and fcc GST shows that the difference between the maximum valence band edge and the Fermi level reduces by 0.35eV during crystallization. For the fcc to hcp phase transformation, no band gap reduction was observed.
    Type of Medium: Online Resource
    ISSN: 0003-6951 , 1077-3118
    URL: Article
    DOI: 10.1063/1.2825573
    RVK:
    UA 1000
    Language: English
    Publisher: AIP Publishing
    Publication Date: 2007
    detail.hit.zdb_id: 211245-0
    detail.hit.zdb_id: 1469436-0
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  • 6
    Online Resource
    Online Resource
    Abstract TMP62: High Levels Of Ldl Cholesterol And Hb A1c Hindering Mitigation Of Intracranial Arterial Diseases After Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. Suppl_1 ( 2023-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. Suppl_1 ( 2023-02)
    Abstract: Introduction: Intracranial arterial disease (ICAD) may have dynamic temporal changes which high-resolution MR (HR-MR) images can visualize. Until now, there is only limited evidence on the risk factor for the evolution of ICAD after ischemic stroke. Method: We have collected acute ischemic stroke patients admitted to a single referral stroke center between 01/2015 and 06/2019 with baseline and follow-up HR-MR images on their ICAD lesions. A total of 246 patients were identified, and for the current pilot study, HR-MR images from 93 patients were used. Degree of stenosis on T1/gadolinium-enhanced (Gd) T1 sequences, remodeling index on proton-density sequence, and enhancement signal on Gd-T1 sequence were measured. Temporal changes were defined as (1-([parameters at the initial]/[parameters at the follow-up] )*100. The temporal changes of image parameters were compared by bivariate baseline blood risk factors, such as LDLC ( ≥ 100 vs. 〈 100 mg/dL) and HbA1c ( ≥ 6.5 vs. 〈 6.5%). Result: A total of 93 patients were analyzed for the pilot study. Temporal changes in the degree of stenosis, remodeling index, and enhancement signal of ICAD lesion were -19.6 ± 50.3%, 2.9 ± 45.6%, and -15.0 ± 31.6%, respectively. ICAD parameters were further mitigated in lower levels of selected markers, such as the degree of stenosis (-24.9±37.6% from lower vs. -16.0±57.5% from higher LDLC, P =0.37; -23.0±54.9% from lower Hb A1c vs. -9.3±32.3% from higher Hb A1c, P =0.16) and the enhancement signal (-18.0±29.1% from lower vs. -12.9±33.2% from higher LDLC, P=0.45; -17.1±32.2% from lower Hb A1c vs. -6.5±28.4% from higher Hb A1c, P=0.17). Linear associations between change in the enhancement signal and LDLC in higher LDLC (B=0.38, P=0.01) and degree of stenosis and Hb A1c in higher Hb A1c (B=0.49, P=0.02) were observed. Conclusion: ICAD lesions in acute ischemic stroke patients may have temporal appearance changes. Baseline LDLC and Hb A1c levels may be used as a marker for the evolution of ICAD.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.54.suppl_1.TMP62
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
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  • 7
    Online Resource
    Online Resource
    Clinical outcomes of rescue stenting for failed endovascular thrombectomy: a multicenter prospective registry
    BMJ ; 2022
    In:  Journal of NeuroInterventional Surgery Vol. 14, No. 12 ( 2022-12), p. 1166-1172
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 14, No. 12 ( 2022-12), p. 1166-1172
    Abstract: Mechanical thrombectomy (MT) is a primary endovascular modality for acute intracranial large vessel occlusion. However, further treatment, such as rescue stenting, is occasionally necessary for refractory cases. We aimed to investigate the efficacy and safety of rescue stenting in first-line MT failure and to identify the clinical factors affecting its clinical outcome. Methods A multicenter prospective registry was designed for this study. We enrolled consecutive patients who underwent rescue stenting for first-line MT failure. Endovascular details and outcomes, follow-up patency of the stented artery, and clinical outcomes were summarized and compared between the favorable and unfavorable outcome groups. Results A total of 78 patients were included. Intracranial atherosclerotic stenosis was the most common etiology for rescue stenting (97.4%). Seventy-seven patients (98.7%) were successfully recanalized by rescue stenting. A favorable outcome was observed in 66.7% of patients. Symptomatic intracranial hemorrhage and mortality were observed in 5.1% and 4.0% of patients, respectively. The stented artery was patent in 82.1% of patients on follow-up angiography. In a multivariable analysis, a patent stent on follow-up angiography was an independent factor for a favorable outcome (OR 87.6; 95% CI 4.77 to 1608.9; p=0.003). Postprocedural intravenous maintenance of glycoprotein IIb/IIIa inhibitor was significantly associated with the follow-up patency of the stented artery (OR 5.72; 95% CI 1.45 to 22.6; p=0.013). Conclusions In this multicenter prospective registry, rescue stenting for first-line MT failure was effective and safe. For a favorable outcome, follow-up patency of the stented artery was important, which was significantly associated with postprocedural maintenance of glycoprotein IIb/IIIa inhibitors.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2021-018308
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2506028-4
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  • 8
    Online Resource
    Online Resource
    Abstract WMP81: Dynamic Changes In Intracranial Atherosclerotic Stenosis In Serial Follow-up Of High-resolution Magnetic Resonance Imaging
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. Suppl_1 ( 2023-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. Suppl_1 ( 2023-02)
    Abstract: Background: Pathophysiology of intracranial atherosclerotic stenosis (ICAS) development and subsequent stroke occurrence is diverse, including cholesterol deposition, arterial dissection, and intrinsic vasculopathies. To differentiate these specific etiologies, performing high-resolution MRI (HR-MRI) has increased. However, the information on serial change of ICAS on HR-MRI was limited. Methods: Patients hospitalized at a tertiary university hospital for AIS and who took HR-MRI more than twice between 2015 and 2019 were collected. Two specialists manually segmented the contour of the culprit and reference vessel's inner lumen, outer wall, and plaque. The stenotic degree, remodeling index, and enhancement signal were measured for the culprit lesion at each examination. Results: A total of 202 HR-MRI examinations from 93 patients were analyzed. The Median follow-up was 270 days (118-390). The ranges of the serial change in stenotic degree (-86% to 41%), remodeling index (-83% to 266%), and enhancement signal (-85% to 71%) were very diverse. Changes in stenotic degree and enhancement according to the initial stenotic degree were insignificant. On the other hand, the change in enhancement signal was greater in the initially more enhanced lesions (0.1±23.0; mild vs. -23.1±22.6; moderate vs. -35.5±28; severe, p difference 〈 .001) and in the other determined etiology (-14.6±22.8; large atherosclerosis vs. -30.7±30.8; other determined vs. -0.8±30.2; etc., p difference =.005). Conclusions: ICAS showed very dynamic changes in the follow-up HR-MRIs. To identify the underlying etiology, such as arterial dissection and Moyamoya disease, serial HR-MRI will be helpful.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.54.suppl_1.WMP81
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
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  • 9
    Online Resource
    Online Resource
    Abstract 38: Temporal Changes in Intracranial Arterial Diseases: A Longitudinal High-Resolution Vessel Wall Imaging Analysis
    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: Introduction: Temporal changes of intracranial arterial disease (ICAD) in patients with ischemic stroke in high-resolution vessel wall imaging (HR-VWI) have not been elucidated. Methods: We recruited consecutive ICAD-related ischemic stroke patients admitted between June 2016 and June 2019 and had subsequent HR-VWI follow-ups. On HR-VWI, we manually segmented the lumen area (LA), total vessel area (TVA), and enhancing area (EA) of the culprit lesion's most stenotic part in the perpendicular section on T1-weighted, proton density, and post-contrast T1-weighted sequences. We defined the area stenosis as [1-LA/TVA]х100 (%) and the enhancing proportion as EA/TVAх100 (%). Enhancement ratio of the enhancing lesion was also quantified. Three raters independently quantified the imaging using ITK-SNAP with acceptable inter-rater reliability. Results: A total of 208 patients (age 57±14, male 58%) with 469 HR-VWIs (2-6 scans per patient) were included. The causes of ICAD were atherosclerosis (69%), dissection (24%), vasculitis (3%), moyamoya disease (1%), and other causes (2%). The median follow-up duration was 9.0 months (interquartile range: 3.9-13.2 months), and the maximum follow-up duration was 41.3 months. Among patients with atherosclerosis, area stenosis aggravated, stable, and improved in 7%, 77%, and 16%, respectively, with an overall rate of 0.23 ± 0.07% improvement per month. Among patients with dissection, area stenosis aggravated, stable, and improved in 2%, 49%, and 49%, respectively, with an overall rate of 2.11 ± 0.26% improvement per month (Figure, P -for-difference 〈 0.01). The temporal changes of the enhancing proportion and enhancement ratio were different between atherosclerosis and dissection (Figure, P 〈 0.01). Conclusions: ICAD lesions had dynamic changes over time; the temporal changes of atherosclerosis and dissection are distinct. Serial HR-VWI can offer insights for a more accurate diagnosis of the underlying pathologies of ICADs.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.38
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 1467823-8
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  • 10
    Online Resource
    Online Resource
    Deep Learning-Based Computer-Aided Detection System for Automated Treatment Response Assessment of Brain Metastases on 3D MRI
    Frontiers Media SA ; 2021
    In:  Frontiers in Oncology Vol. 11 ( 2021-10-27)
    Details
    In: Frontiers in Oncology, Frontiers Media SA, Vol. 11 ( 2021-10-27)
    Abstract: Although accurate treatment response assessment for brain metastases (BMs) is crucial, it is highly labor intensive. This retrospective study aimed to develop a computer-aided detection (CAD) system for automated BM detection and treatment response evaluation using deep learning. Methods We included 214 consecutive MRI examinations of 147 patients with BM obtained between January 2015 and August 2016. These were divided into the training (174 MR images from 127 patients) and test datasets according to temporal separation (temporal test set #1; 40 MR images from 20 patients). For external validation, 24 patients with BM and 11 patients without BM from other institutions were included (geographic test set). In addition, we included 12 MRIs from BM patients obtained between August 2017 and March 2020 (temporal test set #2). Detection sensitivity, dice similarity coefficient (DSC) for segmentation, and agreements in one-dimensional and volumetric Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria between CAD and radiologists were assessed. Results In the temporal test set #1, the sensitivity was 75.1% (95% confidence interval [CI]: 69.6%, 79.9%), mean DSC was 0.69 ± 0.22, and false-positive (FP) rate per scan was 0.8 for BM ≥ 5 mm. Agreements in the RANO-BM criteria were moderate ( κ , 0.52) and substantial ( κ , 0.68) for one-dimensional and volumetric, respectively. In the geographic test set, sensitivity was 87.7% (95% CI: 77.2%, 94.5%), mean DSC was 0.68 ± 0.20, and FP rate per scan was 1.9 for BM ≥ 5 mm. In the temporal test set #2, sensitivity was 94.7% (95% CI: 74.0%, 99.9%), mean DSC was 0.82 ± 0.20, and FP per scan was 0.5 (6/12) for BM ≥ 5 mm. Conclusions Our CAD showed potential for automated treatment response assessment of BM ≥ 5 mm.
    Type of Medium: Online Resource
    ISSN: 2234-943X
    URL: Article
    DOI: 10.3389/fonc.2021.739639
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2649216-7
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