1.Comparison of Spot Sign, Blend Sign and Black Hole Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage.
Peter B SPORNS ; Michael SCHWAKE ; André KEMMLING ; Jens MINNERUP ; Wolfram SCHWINDT ; Thomas NIEDERSTADT ; Rene SCHMIDT ; Uta HANNING
Journal of Stroke 2017;19(3):333-339
BACKGROUND AND PURPOSE: Blend sign (BS) and black hole sign (BHS) on non-contrast computed tomography (NCCT) and spot sign (SS) on CT-angiography (CTA) are indicators of early hematoma expansion in spontaneous intracerebral hemorrhage (ICH). However, their independent contributions to outcome have not been well explored. METHODS: In this retrospective study, inclusion criteria were: 1) spontaneous ICH and 2) NCCT and CTA performed on admission within 6 hours after onset of symptoms. Discharge outcome was dichotomized as good (modified Rankin Scale [mRS] 0-3) and poor (mRS 4-6) outcomes. The impacts of BHS, BS and SS on outcome were assessed in univariate and multivariable logistic regression models. RESULTS: Of 182 patients with spontaneous ICH, 26 (14.3%) presented with BHS, 37 (20.3%) with BS and 39 (21.4%) with SS. There was a substantial correlation between SS and BS (κ=0.701) and a moderate correlation between SS and BHS (κ=0.424). In univariable logistic regression, higher baseline hematoma volume (P < 0.001), intraventricular hemorrhage (P=0.002) and the presence of BHS/BS/SS (all P < 0.001) on admission CT scan were associated with poor outcome. Multivariable analysis identified intraventricular haemorrhage (odds ratio [OR] 2.22 per mL, P=0.022), baseline hematoma volume (OR 1.03 per mL, P < 0.001) and SS on CTA (OR 11.43, P < 0.001) as independent predictors of poor outcome, showing that SS compared to BS and BHS was more powerful to predict poor outcome. CONCLUSIONS: The NCCT BHS and BS are correlated with the CTA SS and are reliable predictors of poor outcome in patients with ICH. Of the CT variables indicating early hematoma expansion, SS on CTA was the most reliable outcome predictor. However, given their correlation with SS on CTA, BS and BHS on NCCT can be useful for predicting outcome if CTA is not obtainable.
Cerebral Hemorrhage*
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Hematoma
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Hemorrhage
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Humans
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Logistic Models
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Retrospective Studies
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Stroke
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Tomography, X-Ray Computed
2.Simplified Assessment of Lesion Water Uptake for Identification of Patients within 4.5 Hours of StrokeOnset: An Analysis of the MissPerfeCT Study
Peter B. SPORNS ; Marco HÖHNE ; Lennart MEYER ; Christos KROGIAS ; Volker PUETZ ; Kolja M. THIERFELDER ; Marco DUERING ; Daniel KAISER ; Sönke LANGNER ; Alex BREHM ; Lukas T. ROTKOPF ; Wolfgang G. KUNZ ; Jens FIEHLER ; Walter HEINDEL ; Peter SCHRAMM ; Heinz WIENDL ; Heike MINNERUP ; Marios Nikos PSYCHOGIOS ; André KEMMLING ; Jens MINNERUP
Journal of Stroke 2022;24(3):390-395
and Purpose Many patients with stroke cannot receive intravenous thrombolysis because the time of symptom onset is unknown. We tested whether a simple method of computed tomography (CT)-based quantification of water uptake in the ischemic tissue can identify patients with stroke onset within 4.5 hours. Methods This retrospective analysis of the MissPerfeCT study (August 2009 to November 2017) includes consecutive patients with known onset of symptoms from seven tertiary stroke centers. We developed a simplified algorithm based on region of interest (ROI) measurements to quantify water uptake of the ischemic lesion and thereby quantify time of symptom onset within and beyond 4.5 hours. Perfusion CT was used to identify ischemic brain tissue, and its density was measured in non-contrast CT and related to the density of the corresponding area of the contralateral hemisphere to quantify lesion water uptake. Results Of 263 patients, 204 (77.6%) had CT within 4.5 hours. Water uptake was significantly lower in patients with stroke onset within (6.7%; 95% confidence interval [CI], 6.0% to 7.4%) compared to beyond 4.5 hours (12.7%; 95% CI, 10.7% to 14.7%). The area under the curve for distinguishing these patient groups according to percentage water uptake was 0.744 with an optimal cut-off value of 9.5%. According to this cut-off the positive predictive value was 88.8%, sensitivity was 73.5%, specificity 67.8%, negative predictive value was 42.6%. Conclusions Ischemic stroke patients with unknown time of symptom onset can be identified as being within a timeframe of 4.5 hours using a ROI-based method to assess water uptake on admission non-contrast head CT.
3.Ischemic Lesion Water Uptake in Acute Stroke: Is Blood Glucose Related to Cause and Effect?
Gabriel BROOCKS ; Andre KEMMLING ; Jens ABERLE ; Helge KNIEP ; Matthias BECHSTEIN ; Fabian FLOTTMANN ; Hannes LEISCHNER ; Tobias D FAIZY ; Jawed NAWABI ; Gerhard SCHÖN ; Peter SPORNS ; Götz THOMALLA ; Jens FIEHLER ; Uta HANNING
Journal of Stroke 2019;21(3):347-349
No abstract available.
Blood Glucose
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Stroke
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Water
4.Venous Outflow Profiles Are Linked to Clinical Outcomes in Ischemic Stroke Patients with Extensive Baseline Infarct
Laurens WINKELMEIER ; Gabriel BROOCKS ; Helge KNIEP ; Vincent GEEST ; Jonathan REINWALD ; Lukas MEYER ; Noel VAN HORN ; Adrien GUENEGO ; Kamil ZELEŇÁK ; Gregory W. ALBERS ; Maarten LANSBERG ; Peter SPORNS ; Max WINTERMARK ; Jens FIEHLER ; Jeremy J. HEIT ; Tobias D. FAIZY
Journal of Stroke 2022;24(3):372-382
Background:
and Purpose The benefit of endovascular thrombectomy (EVT) treatment is still unclear in stroke patients presenting with extensive baseline infarct. The use of additional imaging biomarkers could improve clinical outcome prediction and individualized EVT selection in this vulnerable cohort. We hypothesized that cerebral venous outflow (VO) may be associated with functional outcomes in patients with low Alberta Stroke Program Early CT Score (ASPECTS).
Methods:
We conducted a retrospective multicenter cohort study of patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Extensive baseline infarct was defined by an ASPECTS of ≤5 on admission computed tomography (CT). VO profiles were assessed on admission CT angiography using the Cortical Vein Opacification Score (COVES). Favorable VO was defined as COVES ≥3. Multivariable logistic regression was used to determine the association between cerebral VO and good clinical outcomes (90-day modified Rankin Scale score of ≤3).
Results:
A total of 98 patients met the inclusion criteria. Patients with extensive baseline infarct and favorable VO achieved significantly more often good clinical outcomes compared to patients with unfavorable VO (45.5% vs. 10.5%, P<0.001). Higher COVES were strongly associated with good clinical outcomes (odds ratio, 2.17; 95% confidence interval, 1.15 to 4.57; P=0.024), independent of ASPECTS, National Institutes of Health Stroke Scale, and success of EVT.
Conclusions
Cerebral VO profiles are associated with good clinical outcomes in AIS-LVO patients with extensive baseline infarct. VO profiles could serve as a useful additional imaging biomarker for treatment selection and outcome prediction in low ASPECTS patients.
5.Cost-Effectiveness of Endovascular Thrombectomy in Childhood Stroke: An Analysis of the Save ChildS Study
Wolfgang G. KUNZ ; Peter B. SPORNS ; Marios N. PSYCHOGIOS ; Jens FIEHLER ; René CHAPOT ; Franziska DORN ; Astrid GRAMS ; Andrea MOROTTI ; Patricia MUSOLINO ; Sarah LEE ; André KEMMLING ; Hans HENKES ; Omid NIKOUBASHMAN ; Martin WIESMANN ; Ulf JENSEN-KONDERING ; Markus MÖHLENBRUCH ; Marc SCHLAMANN ; Wolfgang MARIK ; Stefan SCHOB ; Christina WENDL ; Bernd TUROWSKI ; Friedrich GÖTZ ; Daniel KAISER ; Konstantinos DIMITRIADIS ; Alexandra GERSING ; Thomas LIEBIG ; Jens RICKE ; Paul REIDLER ; Moritz WILDGRUBER ; Sebastian MÖNCH ;
Journal of Stroke 2022;24(1):138-147
Background:
and Purpose The Save ChildS Study demonstrated that endovascular thrombectomy (EVT) is a safe treatment option for pediatric stroke patients with large vessel occlusions (LVOs) with high recanalization rates. Our aim was to determine the long-term cost, health consequences and cost-effectiveness of EVT in this patient population.
Methods:
In this retrospective study, a decision-analytic Markov model estimated lifetime costs and quality-adjusted life years (QALYs). Early outcome parameters were based on the entire Save ChildS Study to model the EVT group. As no randomized data exist, the Save ChildS patient subgroup with unsuccessful recanalization was used to model the standard of care group. For modeling of lifetime estimates, pediatric and adult input parameters were obtained from the current literature. The analysis was conducted in a United States setting applying healthcare and societal perspectives. Probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set to $100,000 per QALY.
Results:
The model results yielded EVT as the dominant (cost-effective as well as cost-saving) strategy for pediatric stroke patients. The incremental effectiveness for the average age of 11.3 years at first stroke in the Save ChildS Study was determined as an additional 4.02 lifetime QALYs, with lifetime cost-savings that amounted to $169,982 from a healthcare perspective and $254,110 when applying a societal perspective. Acceptability rates for EVT were 96.60% and 96.66% for the healthcare and societal perspectives.
Conclusions
EVT for pediatric stroke patients with LVOs resulted in added QALY and reduced lifetime costs. Based on the available data in the Save ChildS Study, EVT is very likely to be a cost-effective treatment strategy for childhood stroke.
6.Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results from the INFINITY Registry
Johannes KAESMACHER ; Nuran ABDULLAYEV ; Basel MAAMARI ; Tomas DOBROCKY ; Jan VYNCKIER ; Eike I. PIECHOWIAK ; Raoul POP ; Daniel BEHME ; Peter B. SPORNS ; Hanna STYCZEN ; Pekka VIRTANEN ; Lukas MEYER ; Thomas R. MEINEL ; Daniel CANTRÉ ; Christoph KABBASCH ; Volker MAUS ; Johanna PEKKOLA ; Sebastian FISCHER ; Anca HASIU ; Alexander SCHWARZ ; Moritz WILDGRUBER ; David J. SEIFFGE ; Sönke LANGNER ; Nicolas MARTINEZ-MAJANDER ; Alexander RADBRUCH ; Marc SCHLAMANN ; Dan MIHOC ; Rémy BEAUJEUX ; Daniel STRBIAN ; Jens FIEHLER ; Pasquale MORDASINI ; Jan GRALLA ; Urs FISCHER
Journal of Stroke 2021;23(1):91-102
Background:
and Purpose Data on safety and efficacy of intra-arterial (IA) fibrinolytics as adjunct to mechanical thrombectomy (MT) are sparse.
Methods:
INtra-arterial FIbriNolytics In ThrombectomY (INFINITY) is a retrospective multi-center observational registry of consecutive patients with anterior circulation large-vessel occlusion ischemic stroke treated with MT and adjunctive administration of IA fibrinolytics (alteplase [tissue plasminogen activator, tPA] or urokinase [UK]) at 10 European centers. Primary outcome was the occurrence of symptomatic intracranial hemorrhage (sICH) according to the European Cooperative Acute Stroke Study II definition. Secondary outcomes were mortality and modified Rankin Scale (mRS) scores at 3 months.
Results:
Of 5,612 patients screened, 311 (median age, 74 years; 44.1% female) received additional IA after or during MT (194 MT+IA tPA, 117 MT+IA UK). IA fibrinolytics were mostly administered for rescue of thrombolysis in cerebral infarction (TICI) 0-2b after MT (80.4%, 250/311). sICH occurred in 27 of 308 patients (8.8%), with an increased risk in patients with initial TICI0/1 (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1 to 5.0 per TICI grade decrease) or in those with intracranial internal carotid artery occlusions (aOR, 3.7; 95% CI, 1.2 to 12.5). In patients with attempted rescue of TICI0-2b and available angiographic follow-up, 116 of 228 patients (50.9%) showed any angiographic reperfusion improvement after IA fibrinolytics, which was associated with mRS ≤2 (aOR, 3.1; 95% CI, 1.4 to 6.9).
Conclusions
Administration of IA fibrinolytics as adjunct to MT is performed rarely, but can improve reperfusion, which is associated with better outcomes. Despite a selection bias, an increased risk of sICH seems possible, which underlines the importance of careful patient selection.