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Large ischemic core defined by visually assessed ASPECTS predicts functional outcomes comparably accurate to automated CT perfusion in the 6-24 h window. 通过目测 ASPECTS 界定的大面积缺血核心在 6-24 小时窗口期预测功能预后的准确性可与自动 CT 灌注相媲美。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-07 DOI: 10.1177/23969873241286691
Tolga D Dittrich, Anh Nguyen, Peter B Sporns, Anna M Toebak, Lilian F Kriemler, Salome Rudin, Annaelle Zietz, Benjamin Wagner, Filip Barinka, Martin Hänsel, Henrik Gensicke, Raoul Sutter, Christian H Nickel, Mira Katan, Nils Peters, Lars Michels, Zsolt Kulcsár, Grzegorz M Karwacki, Marco Pileggi, Carlo Cereda, Susanne Wegener, Leo H Bonati, Marios Psychogios, Gian Marco De Marchis

Introduction: Automated CT perfusion (aCTP) is commonly used to select patients with anterior circulation large vessel occlusion (aLVO) for endovascular treatment (EVT). The equivalence of visually assessed Non-contrast CT Alberta Stroke Program Early CT Scores (ASPECTS) and aCTP based selection in predicting favorable functional outcomes remains uncertain.

Patients and methods: Retrospective multicenter study of adult aLVO patients from the Swiss Stroke Registry (2014-2021) treated with EVT or best medical treatment 6-24 h after stroke onset. We assessed ASPECTS on non-contrast CT visually and ischemic core volumes on aCTP, defining ASPECTS 0-5 and aCTP CBF < 30% volumes ⩾50 mL as large ischemic cores. We used logistic regression to explore the association between CT modalities and favorable functional outcomes (modified Rankin Scale [mRS] score shift toward lower categories) at 3 months. Receiver operating characteristic (ROC) curve analysis compared the predictive accuracy of visually assessed ASPECTS and aCTP ischemic core for favorable outcomes (mRS 0-2) at 3 months.

Results: Of 210 patients, 11.4% had ASPECTS 0-5, and 12.9% aCTP core volumes ⩾50 mL. Within the same model, ASPECTS but not aCTP core volumes were associated with favorable outcomes (ASPECTS: acOR 1.85, 95%CI 1.27-2.70, p = 0.001). The ROC curve analyses showed comparable diagnostic accuracy in predicting favorable functional outcomes (mRS 0-2) at 3 months (ROC areas: ASPECTS 0.80 [95%CI 0.74-0.86] vs aCTP core 0.79 [95%CI 0.72-0.85]).

Discussion and conclusion: In patients with aLVO, visually assessed ASPECTS showed at least comparable accuracy to automatically generated CTP core volumes in predicting functional outcomes at 3 months.

简介:自动 CT 灌注(aCTP)通常用于选择前循环大血管闭塞(aLVO)患者进行血管内治疗(EVT)。目测评估的非对比 CT 阿尔伯塔卒中计划早期 CT 评分(ASPECTS)和基于 CTP 的选择在预测良好功能预后方面的等效性仍不确定:对瑞士卒中登记处(2014-2021 年)的成人 aLVO 患者进行回顾性多中心研究,这些患者在卒中发生 6-24 小时后接受了 EVT 或最佳药物治疗。我们在非对比 CT 上直观评估了 ASPECTS,在 aCTP 上评估了缺血核心体积,定义了 ASPECTS 0-5 和 aCTP CBF 结果:在 210 名患者中,11.4% 的患者 ASPECTS 为 0-5,12.9% 的患者 aCTP 核心容积⩾50 mL。在同一模型中,ASPECTS 而非 aCTP 核心体积与良好的预后相关(ASPECTS:acOR 1.85,95%CI 1.27-2.70,p = 0.001)。ROC 曲线分析表明,在预测 3 个月后的良好功能预后(mRS 0-2)方面,诊断准确性相当(ROC 区域:ASPECTS 0.80 [95%CI 1.27-2.70,P = 0.001):讨论与结论:讨论与结论:在aLVO患者中,目测ASPECTS与自动生成的CTP核心体积在预测3个月后功能预后方面的准确性至少相当。
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引用次数: 0
Home and workforce reintegration one year after thrombectomy in acute stroke patients. 急性中风患者血栓切除术一年后重返家庭和工作岗位。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-03 DOI: 10.1177/23969873241282875
Felix J Bode, Nina A Zadon, Hannah Asperger, Niklas M Beckonert, Taraneh Ebrahimi, Louisa Nitsch, Julia Nordsiek, Julius N Meissner, Omid Shirvani, Sebastian Stösser, Christian Thielscher, Franziska Dorn, Nils C Lehnen, Gabor C Petzold, Johannes M Weller

Introduction: Endovascular thrombectomy (EVT) combined with intravenous thrombolysis is the current standard treatment for acute large-vessel occlusion stroke. Beyond clear clinical benefits in the acute and post-acute phases, comprehensive evaluations of long-term outcomes, including home and workforce reintegration, remain limited. This study aimed to assess home and workforce reintegration 1 year post-EVT in a cohort of acute stroke patients and explore their association with health-related quality of life (HRQoL).

Patients and methods: We conducted a prospective observational study of 404 patients undergoing EVT at a tertiary university medical center between October 2019 and December 2021. Patients' functional outcomes were evaluated using the modified Rankin Scale (mRS), and HRQoL was assessed via the European Quality of Life Five Dimension Scale (EQ-5D). Data on occupational and living status were collected through standardized telephone interviews at 3- and 12-months post-treatment.

Results: Of 357 patients with 12-month follow-up data, 33.6% had a favorable outcome (mRS 0-2). Among stroke survivors, the rate of home reintegration without nursing care was 42.1%, and workforce reintegration among previously employed patients was 43.3% at 12 months. Both outcomes were significantly associated with improved HRQoL. Lower neurological deficits and younger age were predictive of successful home and workforce reintegration.

Discussion and conclusion: One year post-EVT, approximately 40%-50% of acute stroke patients successfully reintegrate into home and work settings. These findings underscore the need for ongoing support tailored to improving long-term reintegration and quality of life for stroke survivors.

Data access statement: The data supporting the findings of the study are available from the corresponding author upon reasonable request and in accordance to European data privacy obligations.

简介血管内血栓切除术(EVT)联合静脉溶栓是目前治疗急性大血管闭塞性卒中的标准方法。除了急性期和急性期后的明显临床疗效外,对长期疗效(包括重返家庭和工作岗位)的全面评估仍然有限。本研究旨在评估一组急性中风患者在 EVT 术后 1 年重返家庭和工作岗位的情况,并探讨其与健康相关生活质量(HRQoL)的关系:我们对2019年10月至2021年12月期间在一所三级大学医疗中心接受EVT治疗的404名患者进行了前瞻性观察研究。患者的功能结果采用改良Rankin量表(mRS)进行评估,HRQoL采用欧洲生活质量五维量表(EQ-5D)进行评估。在治疗后3个月和12个月,通过标准化电话访谈收集有关职业和生活状况的数据:结果:在 357 名有 12 个月随访数据的患者中,33.6% 的患者预后良好(mRS 0-2)。在脑卒中幸存者中,12 个月后无需护理即可重返家庭的比例为 42.1%,之前有工作的患者重返工作岗位的比例为 43.3%。这两项结果都与 HRQoL 的改善密切相关。较低的神经功能缺损和较年轻的年龄是成功重返家庭和劳动力市场的预兆:EVT术后一年,约有40%-50%的急性卒中患者成功重返家庭和工作环境。这些发现强调了为改善中风幸存者的长期重返社会和生活质量而提供持续支持的必要性:支持该研究结果的数据可在合理要求下从通讯作者处获得,并符合欧洲数据隐私义务。
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引用次数: 0
Adjunctive intra-arterial tenecteplase after successful endovascular thrombectomy in patients with large vessel occlusion stroke (POST-TNK): Study rationale and design. 大血管闭塞性卒中患者血管内血栓切除术成功后辅助动脉内替尼采普酶(POST-TNK):研究原理与设计。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-30 DOI: 10.1177/23969873241286983
Jiacheng Huang, Changwei Guo, Jie Yang, Xiaolei Shi, Chang Liu, Jiaxing Song, Fengli Li, Weilin Kong, Shitao Fan, Zhouzhou Peng, Shihai Yang, Jinfu Ma, Xu Xu, Linyu Li, Zhixi Wang, Nizhen Yu, Wenzhe Sun, Chengsong Yue, Xiang Liu, Dahong Yang, Cheng Huang, Duolao Wang, Raul G Nogueira, Thanh N Nguyen, Jeffrey L Saver, Yangmei Chen, Wenjie Zi

Rationale: Adjunct intra-arterial alteplase has been shown to potentially improve clinical outcomes in patients with large vessel occlusion (LVO) stroke who have undergone successful endovascular thrombectomy. Tenecteplase, known for its enhanced fibrin specificity and extended activity duration, could potentially enhance outcomes in stroke patients after successful reperfusion when used as an adjunct intra-arterial therapy.

Aim: To explore the safety and efficacy of intra-arterial tenecteplase after successful endovascular thrombectomy in patients with LVO stroke.

Sample size: To randomize 498 participants 1:1 to receive intra-arterial tenecteplase or no intra-arterial adjunctive thrombolysis therapy.

Methods and design: An investigator-initiated, prospective, randomized, open-label, blind-endpoint multicenter clinical trial. Eligible patients with anterior circulation LVO stroke presenting within 24 h from symptom onset (time last known well) and excellent to complete reperfusion (expanded Thrombolysis In Cerebral Infarction (eTICI) scale 2c-3) at endovascular thrombectomy are planned to be randomized.

Outcomes: The primary outcome is freedom from disability (modified Rankin Scale, mRS, of 0-1) at 90 days. The primary safety outcomes are mortality through 90 days and symptomatic intracranial hemorrhage within 48 h.

Discussion: The POST-TNK trial will evaluate the efficacy and safety of intra-arterial tenecteplase in patients with LVO stroke and excellent to complete reperfusion.

理由:辅助动脉内阿替普酶已被证明可改善成功接受血管内血栓切除术的大血管闭塞(LVO)卒中患者的临床预后。特奈替普酶以其增强的纤维蛋白特异性和延长的活性持续时间而著称,如果作为动脉内辅助疗法使用,有可能改善再灌注成功后中风患者的预后。目的:探讨在 LVO 中风患者血管内血栓切除术成功后使用动脉内特奈替普酶的安全性和有效性:方法与设计:由研究者发起的一项前瞻性研究:一项由研究者发起的前瞻性、随机、开放标签、盲端点多中心临床试验。符合条件的前循环低密度脂蛋白血栓性脑卒中患者在症状发生后24小时内(最后一次已知良好的时间)出现症状,且血管内溶栓治疗的再灌注效果极佳(扩大的脑梗死溶栓治疗(eTICI)评分2c-3),计划对其进行随机分组:主要结果是90天后无残疾(改良Rankin量表,mRS为0-1)。主要安全性结果为90天内的死亡率和48小时内的无症状颅内出血:POST-TNK试验将评估动脉内替尼采普酶对低密度脂蛋白血症卒中患者的疗效和安全性,以及完全再灌注的效果。
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引用次数: 0
Prehospital computed tomography in a rural district for rapid diagnosis and treatment of stroke. 在农村地区进行院前计算机断层扫描,以快速诊断和治疗中风。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-28 DOI: 10.1177/23969873241267084
Jørgen Ibsen, Maren Ranhoff Hov, Gunn Eli Tokerud, Julia Fuglum, Marianne Linnerud Krogstad, Marie Stugaard, Hege Ihle-Hansen, Christian Georg Lund, Christian Hall

Background: Early diagnosis and triage of patients with ischemic stroke is essential for rapid reperfusion therapy. The prehospital delay may be substantial and patients from rural districts often arrive at their local hospital too late for disability-preventing thrombolytic therapy due to prolonged transport times.

Methods: Hallingdal District Medical Centre (HDMC) is located in a rural area of Norway and is equipped with a computed tomography (CT) scanner. We established emergency pathways of CT imaging and thrombolytic treatment of patients with acute ischemic stroke at HDMC. During office hours these pathways were managed by a radiographer and a general physician supported by videoconference from the Primary Stroke Centre. Outside office hours we remotely controlled the CT exam and supported telestroke guided paramedics handling and examining the patients. With a primary aim of demonstrating the feasibility of this de novo concept we enrolled patients in the period 2017-2021 into a comparative cohort observational study. We compared patients treated at HDMC (the Rural CT group) to patients from two other rural regions in Norway with similar distances to their local hospital but without access to a rural CT scanner (the Reference group).

Results: A total of 86 patients were included in the Rural CT group (mean age 74, 52% male, 43% stroke mimics), and 69 patients were included in the Reference group (mean age 70, 42% male, 28% stroke mimics). Median time from onset of symptoms to completed CT examination was 93 min in the Rural CT group as compared to 240 min in the Reference group (p < 0.05). In patients receiving intravenous thrombolysis time from onset of symptoms to treatment was median 124 min in the Rural CT group and 213 min in the Reference group, p < 0.05. The frequency of thrombolysis for ischemic stroke did not significantly differ between the two groups.

Conclusion: Combining prehospital rural CT examination with telestroke guided diagnosis and thrombolytic treatment by paramedics may facilitate earlier initiation of thrombolysis for patients with ischemic stroke.

背景:缺血性脑卒中患者的早期诊断和分流对于快速再灌注治疗至关重要。院前延误的时间可能很长,来自农村地区的患者由于转运时间过长,往往来不及到当地医院接受预防残疾的溶栓治疗。我们在 HDMC 建立了对急性缺血性中风患者进行 CT 成像和溶栓治疗的紧急路径。在上班时间,这些路径由一名放射技师和一名全科医生通过视频会议从初级卒中中心提供支持。非办公时间,我们远程控制 CT 检查,并支持远程卒中指导护理人员处理和检查患者。为了证明这一全新理念的可行性,我们在 2017-2021 年期间招募患者参与一项队列比较观察研究。我们将在HDMC接受治疗的患者(农村CT组)与挪威另外两个农村地区的患者(参照组)进行了比较,这两个地区距离当地医院的距离相似,但没有农村CT扫描仪:农村 CT 组共有 86 名患者(平均年龄 74 岁,52% 为男性,43% 为中风模拟患者),参照组共有 69 名患者(平均年龄 70 岁,42% 为男性,28% 为中风模拟患者)。农村 CT 组患者从症状出现到完成 CT 检查的中位时间为 93 分钟,而参照组患者为 240 分钟(P P 结论:将院前农村 CT 检查与远程卒中指导诊断和辅助医务人员溶栓治疗相结合,有助于缺血性卒中患者更早地开始溶栓治疗。
{"title":"Prehospital computed tomography in a rural district for rapid diagnosis and treatment of stroke.","authors":"Jørgen Ibsen, Maren Ranhoff Hov, Gunn Eli Tokerud, Julia Fuglum, Marianne Linnerud Krogstad, Marie Stugaard, Hege Ihle-Hansen, Christian Georg Lund, Christian Hall","doi":"10.1177/23969873241267084","DOIUrl":"10.1177/23969873241267084","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis and triage of patients with ischemic stroke is essential for rapid reperfusion therapy. The prehospital delay may be substantial and patients from rural districts often arrive at their local hospital too late for disability-preventing thrombolytic therapy due to prolonged transport times.</p><p><strong>Methods: </strong>Hallingdal District Medical Centre (HDMC) is located in a rural area of Norway and is equipped with a computed tomography (CT) scanner. We established emergency pathways of CT imaging and thrombolytic treatment of patients with acute ischemic stroke at HDMC. During office hours these pathways were managed by a radiographer and a general physician supported by videoconference from the Primary Stroke Centre. Outside office hours we remotely controlled the CT exam and supported telestroke guided paramedics handling and examining the patients. With a primary aim of demonstrating the feasibility of this de novo concept we enrolled patients in the period 2017-2021 into a comparative cohort observational study. We compared patients treated at HDMC (the Rural CT group) to patients from two other rural regions in Norway with similar distances to their local hospital but without access to a rural CT scanner (the Reference group).</p><p><strong>Results: </strong>A total of 86 patients were included in the Rural CT group (mean age 74, 52% male, 43% stroke mimics), and 69 patients were included in the Reference group (mean age 70, 42% male, 28% stroke mimics). Median time from onset of symptoms to completed CT examination was 93 min in the Rural CT group as compared to 240 min in the Reference group (<i>p</i> < 0.05). In patients receiving intravenous thrombolysis time from onset of symptoms to treatment was median 124 min in the Rural CT group and 213 min in the Reference group, <i>p</i> < 0.05. The frequency of thrombolysis for ischemic stroke did not significantly differ between the two groups.</p><p><strong>Conclusion: </strong>Combining prehospital rural CT examination with telestroke guided diagnosis and thrombolytic treatment by paramedics may facilitate earlier initiation of thrombolysis for patients with ischemic stroke.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241267084"},"PeriodicalIF":5.8,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Response to Xu et al: Time-to-event analysis, data variability, and consideration of model selection: Considerations in relation to stroke-heart syndrome. 对 Xu 等人的回应:从时间到事件的分析、数据的可变性以及对模型选择的考虑:与中风-心脏综合征有关的考虑因素。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-28 DOI: 10.1177/23969873241287131
Benjamin Jr Buckley, Gregory Yh Lip
{"title":"Response to Xu et al: Time-to-event analysis, data variability, and consideration of model selection: Considerations in relation to stroke-heart syndrome.","authors":"Benjamin Jr Buckley, Gregory Yh Lip","doi":"10.1177/23969873241287131","DOIUrl":"10.1177/23969873241287131","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241287131"},"PeriodicalIF":5.8,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Depressive symptoms profile and dementia risk after spontaneous intracerebral haemorrhage. 自发性脑出血后的抑郁症状概况和痴呆症风险。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-26 DOI: 10.1177/23969873241284725
Giuseppe Scopelliti, Maéva Kyheng, Barbara Casolla, Grégory Kuchcinski, Grégoire Boulouis, Solène Moulin, Julien Labreuche, Hilde Hénon, Marco Pasi, Charlotte Cordonnier

Introduction: Depressive symptoms are commonly reported after spontaneous intracerebral haemorrhage (ICH) and frequently associated with cognitive decline. Using hierarchical clustering analysis (HCA), we aimed to identify different post-ICH depressive symptoms profiles and to evaluate their association with dementia risk.

Methods: We included consecutive patients from the prospective Prognosis of Intracerebral Haemorrhage (PITCH) study who survived 6 months after the ICH. We performed HCA using depressive symptoms severity (assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS)), along with the presence of apathy and anxiety (screened using Neuropsychiatric Inventory questionnaire). Baseline clinical/neuroimaging characteristics and risk of incident dementia were compared between different profiles using univariate and multivariable models.

Results: Of 265 six-month ICH survivors, 221 (83%) underwent neuropsychiatric screening (mean age 65.5 years; 57% male). Using HCA, 3 profiles were identified: (1) without significant depressive symptoms (n = 152; median MADRS score = 2 [IQR 0-4]); (2) depressive symptoms with predominant apathy (n = 41; median MADRS score = 15 [IQR 5-20], 68% with apathy); (3) depressive symptoms profile with predominant anxiety (n = 28; median MADRS score = 17 [IQR 9-25]; 100% with anxiety). Compared to patients without depressive symptoms, patients with depressive symptoms and predominant apathy (but not those with predominant anxiety) were more likely to have cerebral atrophy (OR = 2.4, 95% CI = 1.4-4.2) and had significantly higher long-term new-onset dementia risk (adjusted hazard ratio = 2.2, 95% CI = 1.3-3.8).

Conclusion: Screening for apathy and anxiety on top of depressive symptoms might help identifying patients at risk for dementia. Future studies on treatment should account for different post-ICH depressive symptoms profiles that may impact on cognitive function.

简介:抑郁症状是自发性脑出血(ICH)后的常见症状,通常与认知能力下降有关。我们采用分层聚类分析(HCA),旨在确定不同的 ICH 后抑郁症状特征,并评估它们与痴呆风险的关系:我们纳入了前瞻性脑出血预后(PITCH)研究中在 ICH 后存活 6 个月的连续患者。我们使用抑郁症状严重程度(使用蒙哥马利-奥斯伯格抑郁评定量表(MADRS)进行评估)以及是否存在冷漠和焦虑(使用神经精神量表问卷进行筛查)进行了 HCA 评估。采用单变量和多变量模型比较了不同类型患者的基线临床/神经影像学特征和痴呆症发病风险:在 265 名存活六个月的 ICH 患者中,221 人(83%)接受了神经精神病学筛查(平均年龄 65.5 岁;57% 为男性)。通过 HCA 筛选,确定了 3 种情况:(1)无明显抑郁症状(152 人;MADRS 中位数评分 = 2 [IQR0-4]);(2)抑郁症状以冷漠为主(41 人;MADRS 中位数评分 = 15 [IQR5-20],68% 患有冷漠);(3)抑郁症状以焦虑为主(28 人;MADRS 中位数评分 = 17 [IQR9-25];100% 患有焦虑)。与无抑郁症状的患者相比,有抑郁症状且以冷漠为主的患者(但不包括以焦虑为主的患者)更有可能出现脑萎缩(OR = 2.4,95% CI = 1.4-4.2),且长期新发痴呆症的风险明显更高(调整后危险比 = 2.2,95% CI = 1.3-3.8):结论:在抑郁症状的基础上筛查冷漠和焦虑可能有助于识别痴呆症高危患者。未来的治疗研究应考虑到ICH后不同抑郁症状对认知功能的影响。
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引用次数: 0
Addressing biases: Evaluating the Cox proportional hazards model and alternative approaches for major adverse cardiovascular events research. 消除偏见:评估主要心血管不良事件研究中的 Cox 比例危险模型和替代方法。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-19 DOI: 10.1177/23969873241286984
Lingyu Xu, Bin Zhou, Yan Xu
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引用次数: 0
Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy. 机械取栓术治疗大脑中动脉 M2 段血管闭塞中风随访梗死体积对功能预后的预测价值。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-13 DOI: 10.1177/23969873241275531
Vivek Yedavalli, Hamza Adel Salim, Basel Musmar, Nimer Adeeb, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Benjamin Yq Tan, Robert W Regenhardt, Jeremy J Heit, Nicole M Cancelliere, Joshua D Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Xavier Barreau, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas R Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, Muhammed Amir Essibayi, David Altschul, Nestor R Gonzalez, Markus A Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Mohammad Ali Aziz-Sultan, Constantin Hecker, Hamza Shaikh, David S Liebeskind, Alessandro Pedicelli, Andrea M Alexandre, Illario Tancredi, Tobias D Faizy, Erwah Kalsoum, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Adrien Guenego, Adam A Dmytriw

Background: Medium vessel occlusion (MeVO) strokes, particularly affecting the M2 segment of the middle cerebral artery, represent a critical proportion of acute ischemic strokes, posing significant challenges in management and outcome prediction. The efficacy of mechanical thrombectomy (MT) in MeVO stroke may warrant reliable predictors of functional outcomes. This study aimed to investigate the prognostic value of follow-up infarct volume (FIV) for predicting 90-day functional outcomes in MeVO stroke patients undergoing MT.

Methods: This multicenter, retrospective cohort study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, covering patients with acute ischemic stroke due to M2 segment occlusion treated with MT. We examined the relationship between 90-day functional outcomes, measured by the modified Rankin Scale (mRS), and follow-up infarct volume (FIV), assessed through CT or MRI within 12-36 h post-MT.

Results: Among 130 participants, specific FIV thresholds were identified with high specificity and sensitivity for predicting outcomes. A FIV ⩽5 ml was highly specific for predicting favorable and excellent outcomes. The optimal cut-off for both prognostications was identified at ⩽15 ml by the Youden Index, with significant reductions in the likelihood of favorable outcomes observed above a 40 ml threshold. Receiver Operator Curve (ROC) analyses confirmed FIV as a superior predictor of functional outcomes compared to traditional recanalization scores, such as final modified thrombolysis in cerebral infarction score (mTICI). Multivariable analysis further highlighted the inverse relationship between FIV and positive functional outcomes.

Conclusions: FIV within 36 h post-MT serves as a potent predictor of 90-day functional outcomes in patients with M2 segment MeVO strokes. Establishing FIV thresholds may aid in the prognostication of stroke outcomes, suggesting a role for FIV in guiding post intervention treatment decisions and informing clinical practice. Future research should focus on validating these findings across diverse patient populations and exploring the integration of FIV measurements with other clinical and imaging markers to enhance outcome prediction accuracy.

背景:中血管闭塞(MeVO)脑卒中,尤其是影响大脑中动脉 M2 段的中血管闭塞,在急性缺血性脑卒中中占有重要比例,给管理和预后带来了巨大挑战。机械性血栓切除术(MT)在MeVO脑卒中中的疗效可能需要可靠的功能预后预测指标。本研究旨在探讨随访梗死体积(FIV)对预测接受MT治疗的MeVO卒中患者90天功能预后的预后价值:这项多中心、回顾性队列研究分析了 "原发性远端中血管闭塞多中心分析:机械取栓术(MAD-MT)的影响 "登记处的数据,涵盖了接受 MT 治疗的 M2 段闭塞所致急性缺血性卒中患者。我们研究了以改良兰金量表(mRS)衡量的 90 天功能预后与后续梗死体积(FIV)之间的关系,FIV 是在 MAD-MT 术后 12-36 小时内通过 CT 或 MRI 评估的:结果:在130名参与者中,确定了特定的FIV阈值,其特异性和灵敏度都很高,可预测结果。FIV ⩽5 毫升对预测良好和卓越预后具有高度特异性。根据尤登指数(Youden Index),两种预后的最佳临界值均为⩽15 毫升,超过 40 毫升临界值后,预后良好的可能性显著降低。受体运算曲线(ROC)分析证实,与传统的再通化评分(如最终的改良脑梗塞溶栓评分(mTICI))相比,FIV能更好地预测功能预后。多变量分析进一步强调了FIV与积极功能预后之间的反向关系:结论:MT后36小时内的FIV是M2段MeVO脑卒中患者90天功能预后的有力预测指标。建立 FIV 阈值可帮助预测脑卒中的预后,表明 FIV 在指导干预后治疗决策和临床实践中的作用。未来的研究应侧重于在不同的患者群体中验证这些发现,并探索将 FIV 测量与其他临床和影像学标记物相结合,以提高预后预测的准确性。
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引用次数: 0
Association between angiographic and clinical outcomes after STA-MCA bypass in adult moyamoya disease. 成人 moyamoya 病 STA-MCA 分流术后血管造影与临床结果之间的关联。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-11 DOI: 10.1177/23969873241278193
Guicheng Kuang, Hang Ji, Jixuan Zheng, Xinchen Li, Kejin Luo, Yajun Hu, Zheyuan Zhang, Haogeng Sun

Background and purpose: As an angiographic outcome, postoperative collateral formation (PCF) is commonly used to evaluate the effect of STA-MCA bypass in moyamoya disease (MMD), but whether it can reliably reflect clinical outcomes is still unclear. We investigated the association between PCF and clinical outcomes in adult MMD.

Methods: All STA-MCA bypass procedures performed from January 2013 to December 2019 were screened in this prospective cohort study. Patients who acquired presurgical and follow-up catheter angiography were included. The clinical outcomes consisted of symptom improvement and recurrent cerebrovascular events. Logistic and Cox regression and Kaplan-Meier analyses were performed to explore the association between PCF and clinical outcomes.

Results: Of 165 included symptomatic hemispheres of 154 patients, 104 (63.0%) and 61 (37.0%) had good and poor PCF, respectively. The hemispheres with good PCF were younger (p = 0.004) and had a higher incidence of hemodynamic dysfunction on admission (p < 0.001) than those with poor PCF. Multivariate logistic regression analysis showed that the good PCF (odd ratio, 28.96; 95% confidence interval (CI), 9.12-91.98; p < 0.001) was associated with a higher incidence of symptom improvement. Multivariate Cox regression analysis showed that the poor PCF (hazard ratio, 3.77; 95% CI, 1.31-10.84; p = 0.014) was associated with a higher incidence of recurrent cerebrovascular events. In the hemorrhagic-onset hemispheres, good PCF group had a higher incidence of symptom improvement (p < 0.001) and a longer hemorrhage-free time (p = 0.031). In the ischemic-onset hemispheres, good PCF group also had a higher incidence of symptom improvement (p < 0.001) and a longer ischemia-free time (p = 0.028).

Conclusions: As a angiographic outcome, collateral formation is a qualified surrogate measure for clinical outcomes after STA-MCA bypass in adult MMD.

背景和目的:作为一种血管造影结果,术后侧支形成(PCF)通常用于评估STA-MCA搭桥术在moyamoya病(MMD)中的效果,但它是否能可靠地反映临床结果仍不清楚。我们研究了 PCF 与成人 MMD 临床预后之间的关系:这项前瞻性队列研究筛选了 2013 年 1 月至 2019 年 12 月期间实施的所有 STA-MCA 搭桥术。纳入获得术前和随访导管血管造影的患者。临床结果包括症状改善和复发性脑血管事件。研究人员进行了逻辑回归、Cox回归和Kaplan-Meier分析,以探讨PCF与临床结局之间的关联:在154名患者的165个有症状半球中,分别有104个(63.0%)和61个(37.0%)半球的PCF良好和不良。PCF良好的半球更年轻(p = 0.004),入院时血流动力学功能障碍的发生率更高(p p = 0.014),这与复发性脑血管事件的发生率较高有关。在出血性发病的半球中,PCF良好组症状改善的发生率更高(P P = 0.031)。在缺血发作的半球中,PCF良好组症状改善的发生率也更高(P = 0.028):作为血管造影结果,侧支形成是衡量成人多发性硬化症患者 STA-MCA 搭桥术后临床结果的合格替代指标。
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引用次数: 0
Early statin use is associated with improved survival and cardiovascular outcomes in patients with atrial fibrillation and recent ischaemic stroke: A propensity-matched analysis of a global federated health database. 早期使用他汀类药物与改善心房颤动和近期缺血性中风患者的生存率和心血管预后有关:对全球联合健康数据库的倾向匹配分析。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-10 DOI: 10.1177/23969873241274213
Sylvia E Choi, Tommaso Bucci, Jia-Yi Huang, Kai-Hang Yiu, Christopher Tw Tsang, Kui Kai Lau, Andrew Hill, Greg Irving, Gregory Yh Lip, Azmil H Abdul-Rahim

Introduction: Statins reduce recurrent stroke and cardiovascular events in patients with non-cardioembolic stroke. The benefits of statins in patients with AF and recent IS remain unclear. We aimed to investigate the benefits of statins in patients with AF and recent IS.

Patients and methods: This retrospective, cohort study was conducted using deidentified electronic medical records within TriNetX platform. Patients with AF and recent IS, who received statins within 28 days of their index stroke were propensity score-matched with those who did not. Patients were followed up for up to 2 years. Primary outcomes were the 2-year risk of recurrent IS, all-cause mortality and the composite outcome of all-cause mortality, recurrent IS, transient ischaemic attack (TIA), and acute myocardial infarction (MI). Secondary outcomes were the 2-year risk of TIA, intracranial haemorrhage (ICH), acute MI, and hospital readmission. Cox regression analyses were used to calculate hazard ratios (HRs) with 95% confidence intervals (95%CI).

Results: Of 20,902 patients with AF and recent IS, 7500 (35.9%) received statins within 28 days of their stroke and 13,402 (64.1%) did not. 11,182 patients (mean age 73.7 ± 11.5; 5277 (47.2%) female) remained after propensity score matching. Patients who received early statins had significantly lower risk of recurrent IS (HR: 0.45, 95%CI: 0.41-0.48, p < 0.001), mortality (HR: 0.75, 95%CI: 0.66-0.84, p < 0.001), the composite outcome (HR: 0.48, 95%CI: 0.45-0.52, p < 0.001), TIA (HR: 0.37, 95%CI: 0.30-0.44, p < 0.001), ICH (HR: 0.59, 95%CI: 0.47-0.72, p < 0.001 ), acute MI (HR: 0.35, 95%CI: 0.30-0.42, p < 0.001) and hospital readmission (HR: 0.46, 95%CI: 0.42-0.50, <0.001). Beneficial effects of early statins were evident in the elderly, different ethnic groups, statin dose intensity, and AF subtypes, large vessel occlusion and embolic strokes and within the context of statin lipophilicity, optimal LDL-cholesterol levels, various cardiovascular comorbidities, treatment with intravenous thrombolysis or endovascular thrombectomy, and NIHSS 0-5 and NIHSS > 5 subgroups.

Discussion and conclusion: Patients with AF and recent IS, who received early statins, had a lower risk of recurrent stroke, death, and other cardiovascular outcomes including ICH, compared to those who did not.

简介:他汀类药物可减少非心血管栓塞性中风患者的复发性中风和心血管事件。他汀类药物对房颤和近期发生过 IS 的患者的益处尚不清楚。我们旨在研究他汀类药物对房颤和近期发生 IS 的患者的益处:这项回顾性队列研究使用 TriNetX 平台中的去身份化电子病历。心房颤动和近期IS患者在中风发生后28天内接受了他汀类药物治疗,并与未接受他汀类药物治疗的患者进行了倾向评分匹配。对患者进行了长达 2 年的随访。主要结果是两年内IS复发风险、全因死亡率以及全因死亡率、IS复发、短暂性脑缺血发作(TIA)和急性心肌梗死(MI)的综合结果。次要结果是 TIA、颅内出血 (ICH)、急性心肌梗死和再次入院的 2 年风险。采用 Cox 回归分析计算危险比(HRs)和 95% 置信区间(95%CI):在 20902 名房颤且近期发生过 IS 的患者中,7500 人(35.9%)在中风后 28 天内服用了他汀类药物,13402 人(64.1%)未服用。经过倾向得分匹配后,仍有 11182 名患者(平均年龄为 73.7 ± 11.5;5277 人(47.2%)为女性)接受了他汀类药物治疗。早期接受他汀类药物治疗的患者复发IS的风险明显降低(HR:0.45,95%CI:0.41-0.48,p p p p p p 5个亚组):讨论与结论:与未接受他汀类药物治疗的患者相比,接受早期他汀类药物治疗的房颤和近期IS患者发生卒中复发、死亡和其他心血管后果(包括ICH)的风险较低。
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引用次数: 0
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European Stroke Journal
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