Determining factors of better leptomeningeal collaterals: a study of 857 consecutive acute ischemic stroke patients

Nannoni, Stefania; Gaia, Silvia; Cereda, Carlo; Lambrou, Dimitris; Strambo, Davide; Eskandari, Ashraf; Mosimann, Pascal J.; Wintermark, Max; Michel, Patrik

doi:10.1007/s00415-018-09170-3

Cited by 34 publications

(44 citation statements)

References 23 publications

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“…This cannot be substantiated in this study because infarct volume size was not available for analysis in this dataset. 28,29 Also, only 66.4% patients at 08:00-10:15 were hypertensive compared to a frequency of 74.7% for all groups. While concomitant hypertension in AIS is associated with poorer outcome and therefore could in part explain better outcome in the morning cohorts, we do not observe a statistically poorer outcome in cohorts with higher frequency hypertension.…”

Section: Discussionmentioning

confidence: 92%

Association of Time of Day When Endovascular Therapy for Stroke Starts and Functional Outcome

et al. 2021

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Objective:To investigate the association between EVT start time in acute ischemic stroke (AIS) and mid-term functional outcome.Methods:This retrospective cohort study included all AIS cases treated with EVT from two stroke center registries from January 2012 to December 2018. The primary outcome was the score on the modified Rankin Scale (mRS) and the utility-weighted mRS (uw-mRS) at 90 days. A proportional odds model was used to calculate the common odds ratio as a measure of the likelihood that the intervention at a given EVT start time would lead to lower scores on the mRS (shift analysis).Results:One thousand five hundred fifty-eight cases were equally allotted into twelve EVT-start-time periods. The primary outcome favored EVT start times in the morning at 08:00-10:20 and 10:20-11:34 (common odds ratio (OR), 0.53; 95% confidence interval (CI), 0.38 to 0.75; P<0.001; OR, 0.62; 95% CI, 0.44 to 0.87; P=0.006, respectively), while it disfavored EVT start times at the end of the working day at 15:55-17:15 and 18:55-20:55 (OR, 1.47; 95% CI, 1.03 to 2.09; P=0.034; OR, 1.49; 95% CI, 1.03 to 2.15; P=0.033). Symptom onset-to-EVT start time was significantly higher and use of IV t-PA significantly lower between 10:20-11:34 (P<0.004 and P=0.012, respectively).Conslusion:EVT for AIS in the morning leads to better mid-term functional outcome, while EVT at the end of the work day leads to poorer mid-term functional outcome. Neither difference in baseline factors, standard workflow and technical efficacy metrics could be identified as potential mediators of this effect.

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Section: Discussionmentioning

confidence: 92%

Association of Time of Day When Endovascular Therapy for Stroke Starts and Functional Outcome

et al. 2021

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“…However, there are great differences in collateral blood flow among patients with ischemic stroke. Nannoni et al [ 17 ] found that age, dyslipidemia, and creatinine levels had a greater impact on collateral blood flow through general data analysis of patients with ischemic stroke. This study also found that blood glucose (95% CI = 0.943, P =0.028) and history of ischemic stroke (95% CI = 0.855, P =0.003) were independent factors affecting the collateral blood flow status of stroke patients.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of CT Perfusion Imaging on the Basis of Automatic Segmentation Algorithm to Evaluate the Collateral Blood Flow Status on the Outcome of Reperfusion Therapy for Ischemic Stroke

Qingsong

Wang

et al. 2021

Journal of Healthcare Engineering

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Our objective was to study the predictive value of CT perfusion imaging based on automatic segmentation algorithm for evaluating collateral blood flow status in the outcome of reperfusion therapy for ischemic stroke. All data of 30 patients with ischemic stroke reperfusion in our hospital were collected and examined by CT perfusion imaging. Convolutional neural network (CNN) algorithm was used to segment perfusion imaging map and evaluate the results. The patients were grouped by regional leptomeningeal collateral score (rLMCs). Binary logistic regression was used to analyze the independent influencing factors of collateral blood flow on brain CT perfusion. The modified Scandinavian Stroke Scale was used to evaluate the prognosis of patients, and the effects of different collateral flow conditions on prognosis were obtained. The accuracy of CNN segmentation image is 62.61%, the sensitivity is 87.42%, the similarity coefficient is 93.76%, and the segmentation result quality is higher. Blood glucose (95% CI = 0.943, P = 0.028 ) and ischemic stroke history (95% CI = 0.855, P = 0.003 ) were independent factors affecting the collateral blood flow status of stroke patients. CBF (95% CI = 0.818, P = 0.008 ) and CBV (95% CI = 0.796, P = 0.016 ) were independent influencing factors of CT perfusion parameters. After 3 weeks of onset, the prognostic function defect score of the good collateral flow group (11.11%) was lower than that of the poor group (41.67%) ( P < 0.05 ). The automatic segmentation algorithm has more accurate segmentation ability for stroke CT perfusion imaging and plays a good auxiliary role in the diagnosis of clinical stroke reperfusion therapy. The collateral blood flow state based on CT perfusion imaging is helpful to predict the treatment outcome of patients with ischemic stroke and further predict the prognosis of patients.

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“…Similarly, in a study involving 857 patients, younger age, lower creatinine levels and dyslipidaemia were significantly associated with good collateral circulation. 38 Older age is known to be associated with insufficiency of the collateral circulation in multiple tissues, resulting in more severe ischemic injury. 39 This evidence also supports our hypothesis, that aging and impaired renal function as a complication of diabetes or other vascular disease may be an important pathogenetic factor in the development of poor collateral circulation.…”

Section: Discussionmentioning

confidence: 99%

Risk analysis of post-procedural intracranial hemorrhage based on STAY ALIVE Acute Stroke Registry

Csécsei

Tarkanyi

Bosnyák

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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Background: Intracranial hemorrhages (ICH) are classified as symptomatic or asymptomatic according to the presence of clinical deterioration. Here, we aimed to find predictive factors of symptomatic intracranial bleeding in a registry-based stroke research. Methods: Data of consecutive patients with acute ischemic stroke (AIS) were extracted from the prospective STAY ALIVE stroke registry. Analysis of the total population and treatment sugroups such as endovascular thrombectomy (EVT), intravenous thrombolysis (IVT), or their combination (IVT+EVT) were also done. Outcome measures were ICH, 30-and 90-day clinical outcome based on the modified Rankin Scale (mRS:0À2 as favorable outcome). The hemorrhage was captured by a non-enhanced CT of the skull within 24 h after procedure. Results: A total of 355 patients (mean age: 68 §11; female N=177 (49.9%); EVT n=131 (36.9%); IVT n=157 (44.2%); IVT+EVT n=67 (18.9%) were included in the analysis. The total number of ICH was 47 (13%), symptomatic (sICH) 12 (3.4%) and asymptomatic (aICH) 35 (9.9%) in the whole population. NIHSS 15.5 at 24 post stroke hours predicted sICH with a sensitivity of 100% and a specificity of 92% (p<0.001). Furthermore, lower age, good collateral circulation on initial CT angiography and lower NIHSS score measured at 24 h independently associated with a favorable 90-day outcome, whereas baseline NIHSS and ASPECT score were not. Conclusion: Although partial recanalization, ASPECT< 6, and poor collaterals were significantly associated with sICH, the only independent predictor was NIHSS 15.5 at 24 post stroke hours. This suggests a careful evaluation of patients with worsening NIHSS despite an adequate therapy.

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Determining factors of better leptomeningeal collaterals: a study of 857 consecutive acute ischemic stroke patients

Cited by 34 publications

References 23 publications

Association of Time of Day When Endovascular Therapy for Stroke Starts and Functional Outcome

Association of Time of Day When Endovascular Therapy for Stroke Starts and Functional Outcome

Predictive Value of CT Perfusion Imaging on the Basis of Automatic Segmentation Algorithm to Evaluate the Collateral Blood Flow Status on the Outcome of Reperfusion Therapy for Ischemic Stroke

Risk analysis of post-procedural intracranial hemorrhage based on STAY ALIVE Acute Stroke Registry

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