1.Impact of Multiphase Computed Tomography Angiography for Endovascular Treatment Decision-Making on Outcomes in Patients with Acute Ischemic Stroke
Johanna M. OSPEL ; Ondrej VOLNY ; Wu QIU ; Mohamed NAJM ; Moiz HAFEEZ ; Sarah ABDALRAHMAN ; Enrico FAINARDI ; Marta RUBIERA ; Alexander KHAW ; Jai J. SHANKAR ; Michael D. HILL ; Mohammed A. ALMEKHLAFI ; Andrew M. DEMCHUK ; Mayank GOYAL ; Bijoy K. MENON
Journal of Stroke 2021;23(3):377-387
Background:
and Purpose Various imaging paradigms are used for endovascular treatment (EVT) decision-making and outcome estimation in acute ischemic stroke (AIS). We aim to compare how these imaging paradigms perform for EVT patient selection and outcome estimation.
Methods:
Prospective multi-center cohort study of patients with AIS symptoms with multi-phase computed tomography angiography (mCTA) and computed tomography perfusion (CTP) baseline imaging. mCTA-based EVT-eligibility was defined as presence of large vessel occlusion (LVO) and moderate-to-good collaterals on mCTA. CTP-based eligibility was defined as presence of LVO, ischemic core (defined on relative cerebral blood flow, absolute cerebral blood flow, and cerebral blood volume maps) <70 mL, mismatch-ratio >1.8, absolute mismatch >15 mL. EVT-eligibility and adjusted rates of good outcome (modified Rankin Scale 0–2) based on these imaging paradigms were compared.
Results:
Of 289/464 patients with LVO, 263 (91%) were EVT-eligible by mCTA-criteria versus 63 (22%), 19 (7%) and 103 (36%) by rCBF, aCBF, and CBV-CTP-criteria. CTP and mCTA-criteria were discordant in 40% to 53%. Estimated outcomes were best in patients who met both mCTA and CTP eligibility-criteria and were treated with EVT (62% to 87% good outcome). Patients eligible for EVT by mCTA-criteria and not by CTP-criteria receiving EVT achieved good outcome rates of 53% to 57%. Few patients met CTP-criteria and not mCTA-criteria for EVT.
Conclusions
Simpler imaging selection criteria that rely on little else than detection of the occluded blood vessel may be more sensitive and less specific, thus resulting in more patients being offered EVT and arguably benefiting from it.
2.Impact of Multiphase Computed Tomography Angiography for Endovascular Treatment Decision-Making on Outcomes in Patients with Acute Ischemic Stroke
Johanna M. OSPEL ; Ondrej VOLNY ; Wu QIU ; Mohamed NAJM ; Moiz HAFEEZ ; Sarah ABDALRAHMAN ; Enrico FAINARDI ; Marta RUBIERA ; Alexander KHAW ; Jai J. SHANKAR ; Michael D. HILL ; Mohammed A. ALMEKHLAFI ; Andrew M. DEMCHUK ; Mayank GOYAL ; Bijoy K. MENON
Journal of Stroke 2021;23(3):377-387
Background:
and Purpose Various imaging paradigms are used for endovascular treatment (EVT) decision-making and outcome estimation in acute ischemic stroke (AIS). We aim to compare how these imaging paradigms perform for EVT patient selection and outcome estimation.
Methods:
Prospective multi-center cohort study of patients with AIS symptoms with multi-phase computed tomography angiography (mCTA) and computed tomography perfusion (CTP) baseline imaging. mCTA-based EVT-eligibility was defined as presence of large vessel occlusion (LVO) and moderate-to-good collaterals on mCTA. CTP-based eligibility was defined as presence of LVO, ischemic core (defined on relative cerebral blood flow, absolute cerebral blood flow, and cerebral blood volume maps) <70 mL, mismatch-ratio >1.8, absolute mismatch >15 mL. EVT-eligibility and adjusted rates of good outcome (modified Rankin Scale 0–2) based on these imaging paradigms were compared.
Results:
Of 289/464 patients with LVO, 263 (91%) were EVT-eligible by mCTA-criteria versus 63 (22%), 19 (7%) and 103 (36%) by rCBF, aCBF, and CBV-CTP-criteria. CTP and mCTA-criteria were discordant in 40% to 53%. Estimated outcomes were best in patients who met both mCTA and CTP eligibility-criteria and were treated with EVT (62% to 87% good outcome). Patients eligible for EVT by mCTA-criteria and not by CTP-criteria receiving EVT achieved good outcome rates of 53% to 57%. Few patients met CTP-criteria and not mCTA-criteria for EVT.
Conclusions
Simpler imaging selection criteria that rely on little else than detection of the occluded blood vessel may be more sensitive and less specific, thus resulting in more patients being offered EVT and arguably benefiting from it.
3.Characteristics of Early Presenters after Intracerebral Hemorrhage
Andrea MOROTTI ; Jawed NAWABI ; Frieder SCHLUNK ; Loris POLI ; Paolo COSTA ; Federico MAZZACANE ; Giorgio BUSTO ; Elisa SCOLA ; Francesco ARBA ; Laura BRANCALEONI ; Sebastiano GIACOMOZZI ; Luigi SIMONETTI ; Michele LAUDISI ; Anna CAVALLINI ; Massimo GAMBA ; Mauro MAGONI ; Roberto GASPAROTTI ; Alessandro PADOVANI ; Alessandro PEZZINI ; Andrea ZINI ; Enrico FAINARDI ; Ilaria CASETTA
Journal of Stroke 2022;24(3):425-428
4.History of Migraine and Volume of Brain Infarcts: The Italian Project on Stroke at Young Age (IPSYS)
Valeria De GIULI ; Michele BESANA ; Mario GRASSI ; Marialuisa ZEDDE ; Andrea ZINI ; Corrado LODIGIANI ; Simona MARCHESELLI ; Anna CAVALLINI ; Giuseppe MICIELI ; Maurizia RASURA ; Maria Luisa DELODOVICI ; Giampaolo TOMELLERI ; Nicoletta CHECCARELLI ; Alberto CHITI ; Elisa GIORLI ; Massimo Del SETTE ; Lucia TANCREDI ; Antonella TORIELLO ; Massimiliano BRAGA ; Andrea MOROTTI ; Loris POLI ; Filomena CARIA ; Massimo GAMBA ; Rosalba PATELLA ; Alessandra SPALLONI ; Anna Maria SIMONE ; Rosario PASCARELLA ; Sandro BERETTA ; Enrico FAINARDI ; Alessandro PADOVANI ; Roberto GASPAROTTI ; Alessandro PEZZINI ;
Journal of Stroke 2019;21(3):324-331
BACKGROUND AND PURPOSE: Migraine has been shown to increase cerebral excitability, promote rapid infarct expansion into tissue with perfusion deficits, and result in larger infarcts in animal models of focal cerebral ischemia. Whether these effects occur in humans has never been properly investigated. METHODS: In a series of consecutive patients with acute ischemic stroke, enrolled in the setting of the Italian Project on Stroke at Young Age, we assessed acute as well as chronic infarct volumes by volumetric magnetic resonance imaging, and compared these among different subgroups identified by migraine status. RESULTS: A cohort of 591 patients (male, 53.8%; mean age, 37.5±6.4 years) qualified for the analysis. Migraineurs had larger acute infarcts than non-migraineurs (median, 5.9 cm³ [interquartile range (IQR), 1.4 to 15.5] vs. 2.6 cm³ [IQR, 0.8 to 10.1], P<0.001), and the largest volumes were observed in patients with migraine with aura (median, 9.0 cm³ [IQR, 3.4 to 16.6]). In a linear regression model, migraine was an independent predictor of increased log (acute infarct volumes) (median ratio [MR], 1.64; 95% confidence interval [CI], 1.22 to 2.20), an effect that was more prominent for migraine with aura (MR, 2.92; 95% CI, 1.88 to 4.54). CONCLUSIONS: These findings reinforce the experimental observation of larger acute cerebral infarcts in migraineurs, extend animal data to human disease, and support the hypothesis of increased vulnerability to ischemic brain injury in people suffering migraine.
Animals
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Brain Injuries
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Brain Ischemia
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Brain
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Cohort Studies
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Cortical Spreading Depression
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Humans
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Linear Models
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Magnetic Resonance Imaging
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Migraine Disorders
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Migraine with Aura
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Models, Animal
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Perfusion
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Risk Factors
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Stroke