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  • 1
    Online Resource
    Online Resource
    Setting a gold standard for quantification of leukoaraiosis burden in patients with ischemic stroke: The Atherosclerosis Risk in Communities Study
    Elsevier BV ; 2014
    In:  Journal of Neuroscience Methods Vol. 221 ( 2014-01), p. 196-201
    Details
    In: Journal of Neuroscience Methods, Elsevier BV, Vol. 221 ( 2014-01), p. 196-201
    Type of Medium: Online Resource
    ISSN: 0165-0270
    URL: Article
    DOI: 10.1016/j.jneumeth.2013.10.009
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
    detail.hit.zdb_id: 1500499-5
    SSG: 12
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  • 2
    Online Resource
    Online Resource
    Abstract T P48: Neuroimaging Markers of Swelling Predict Outcome After Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. suppl_1 ( 2015-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. suppl_1 ( 2015-02)
    Abstract: Introduction: In malignant infarction, brain edema leads to secondary neurological deterioration and poor outcome. We investigated whether swelling is associated with outcome in a broader range of stroke severity. Methods: Two research cohorts (NBO and EPITHET) comprising 98 acute stroke subjects with prospective serial brain magnetic resonance imaging (MRI) were analyzed. The categorical presence of swelling and/or infarct growth (IG) was assessed on diffusion weighted MRI (DWI) by comparing baseline and 3-5 day follow-up scans. IG was defined using the ASPECTS system (small IG = decrease in ASPECTS ≥ 1; large IG = decrease in ASPECTS ≥ 2). The increase in lesion volume (ΔDWI) was then subdivided into swelling and IG volumes using region-of-interest analysis. The relationship of these imaging markers with outcome was evaluated using univariate and multivariate regression, with poor outcome defined as a 90 day modified Rankin Scale score of 3-6. Receiver operating characteristic (ROC) curve analysis was undertaken to define a threshold for prediction of poor outcome. Results: The presence of swelling independently predicted poor outcome after adjustment for age, admission NIH stroke scale score, admission glucose, and baseline DWI volume (OR4.55, 95%CI 1.21-18.9, p 〈 0.02). Volumetric analysis confirmed ΔDWI was associated with outcome (OR4.29, 95%CI 2.00-11.5, p 〈 0.001). After separating ΔDWI into swelling and IG volumes, swelling remained an independent predictor of poor outcome (OR1.15, 95%CI 1.02-1.43, p 〈 0.02). While large IG was associated with poor outcome (OR7.05, 95%CI 1.04-143, p=0.045), small IG was not. ROC curve analysis identified a swelling volume of ≥11mL as the threshold with greatest sensitivity (77%) and specificity (75%) for predicting poor outcome (AUC=0.798). Conclusions: Both swelling and IG contribute to total lesion growth in the days following stroke. Swelling is an independent predictor of poor outcome in moderate to severe stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.tp48
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Online Resource
    Abstract T P30: Logarithmic Growth of Ischemic Lesions in Major Anterior Circulation Ischemic Strokes
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. suppl_1 ( 2015-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. suppl_1 ( 2015-02)
    Abstract: Purpose: To analyze the dynamics of diffusion lesion volumes within the first 48 hours after stroke onset in patients with major anterior circulation occlusions (ACOs). Methods: Diffusion ischemic lesion volumes were serially measured in 50 patients that had MRI performed at baseline (~4 hours post ictus) and 2 or 3 additional MRI exams (~12, ~24, ~48 hours post ictus). Thirty eight of these patients had documented major ACOs (terminal internal carotid or proximal middle cerebral artery). Average rate of lesion growth was calculated at each time interval. Functional outcomes (3-month modified Rankin Scale) were correlated to admission NIHSS, DWI volumes and initial lesion growth rates. Results: DWI lesion growth in ACOs was nonlinear over 48 hours and exhibited a logarithmic pattern. The lesion growth rates were highest during earliest period (11.4 ml/hr) and declined during at the 5-12 (0.8 ml/hr ), 12-24 (1.9 ml/hr) and 24-48 hour (0.9 ml/hr) periods. In 23/38 patients there was little or no growth during 5-12 hours period despite continued presence of occlusion in over half of these patients. However, 12/38 experienced 〉 30% growth of lesion during this period, with nearly all patients having persistent occlusions. Functional outcomes correlated with baseline NIHSS and DWI lesion size, as well as initial average growth rate, but only the latter was an independent predictor Conclusions: The growth of ischemic DWI lesions caused by occlusion of major anterior circulation arteries is nonlinear and typically logarithmic. The rate of growth at the earliest time period is a strong predictor of functional outcomes. There is high variability in growth rates due to site of occlusion and most likely the quality of collateral flow. Our results have implications for "Time is Brain."
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.tp30
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Brain Edema Predicts Outcome After Nonlacunar Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 12 ( 2014-12), p. 3643-3648
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 12 ( 2014-12), p. 3643-3648
    Abstract: In malignant infarction, brain edema leads to secondary neurological deterioration and poor outcome. We sought to determine whether swelling is associated with outcome in smaller volume strokes. Methods— Two research cohorts of acute stroke subjects with serial brain MRI were analyzed. The categorical presence of swelling and infarct growth was assessed on diffusion-weighted imaging (DWI) by comparing baseline and follow-up scans. The increase in stroke volume (ΔDWI) was then subdivided into swelling and infarct growth volumes using region-of-interest analysis. The relationship of these imaging markers with outcome was evaluated in univariable and multivariable regression. Results— The presence of swelling independently predicted worse outcome after adjustment for age, National Institutes of Health Stroke Scale, admission glucose, and baseline DWI volume (odds ratio, 4.55; 95% confidence interval, 1.21–18.9; P 〈 0.02). Volumetric analysis confirmed that ΔDWI was associated with outcome (odds ratio, 4.29; 95% confidence interval, 2.00–11.5; P 〈 0.001). After partitioning ΔDWI into swelling and infarct growth volumetrically, swelling remained an independent predictor of poor outcome (odds ratio, 1.09; 95% confidence interval, 1.03–1.17; P 〈 0.005). Larger infarct growth was also associated with poor outcome (odds ratio, 7.05; 95% confidence interval, 1.04–143; P 〈 0.045), although small infarct growth was not. The severity of cytotoxic injury measured on apparent diffusion coefficient maps was associated with swelling, whereas the perfusion deficit volume was associated with infarct growth. Conclusions— Swelling and infarct growth each contribute to total stroke lesion growth in the days after stroke. Swelling is an independent predictor of poor outcome, with a brain swelling volume of ≥11 mL identified as the threshold with greatest sensitivity and specificity for predicting poor outcome.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.114.006884
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 5
    Online Resource
    Online Resource
    Identifying Severe Stroke Patients Likely to Benefit From Thrombectomy Despite Delays of up to a Day
    Springer Science and Business Media LLC ; 2020
    In:  Scientific Reports Vol. 10, No. 1 ( 2020-03-04)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 10, No. 1 ( 2020-03-04)
    Abstract: Selected patients with large vessel occlusions (LVO) can benefit from thrombectomy up to 24 hours after onset. Identifying patients who might benefit from late intervention after transfer from community hospitals to thrombectomy-capable centers would be valuable. We searched for presentation biomarkers to identify such patients. Frequent MR imaging over 2 days of 38 untreated LVO patients revealed logarithmic growth of the ischemic infarct core. In 24 patients with terminal internal carotid artery or the proximal middle cerebral artery occlusions we found that an infarct core growth rate (IGR) 〈 4.1 ml/hr and initial infarct core volumes (ICV) 〈 19.9 ml had accuracies 〉 89% for identifying patients who would still have a core of 〈 50 ml 24 hours after stroke onset, a core size that should predict favorable outcomes with thrombectomy. Published reports indicate that up to half of all LVO stroke patients have an IGR 〈 4.1 ml/hr. Other potentially useful biomarkers include the NIHSS and the perfusion measurements MTT and Tmax. We conclude that many LVO patients have a stroke physiology that is favorable for late intervention, and that there are biomarkers that can accurately identify them at early time points as suitable for transfer for intervention.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-020-60933-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2615211-3
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