Early Neurological Deterioration and Hypoperfusion Volume Ratio on Arterial Spin Labeling in Patients with Acute Ischemic Stroke

Zhang, Min; Zhu, Wusheng; Ma, Yi; Huang, Kuankuan; Huang, Shanying; Chen, Qian; Yun, Wenwei; Xu, Gelin

doi:10.1016/j.jstrokecerebrovasdis.2021.105885

Cited by 8 publications

(5 citation statements)

References 20 publications

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“…Reduction in the proximal and distal segments of the LSAs could cause decreased blood supply, which might explain why patients with culprit plaques of large parent arteries are vulnerable to END. In line with our study, a previous study also found that cerebral hypoperfusion could predict END in patients with acute ischemic stroke [26].…”

Section: Discussionsupporting

confidence: 92%

Culprit Plaques of Large Parent Arteries, Rather than Cerebral Small Vessel Disease, Contribute to Early Neurological Deterioration in Stroke Patients with Intracranial Branch Atheromatous Disease

Men¹,

Hu²,

Guo³

et al. 2023

Cerebrovasc Dis

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Introduction: Intracranial branch atheromatous disease (BAD) has been applied to occlusions that occur at the origin of large caliber penetrating arteries due to the microatheromas or large parent artery plaques. This study aimed to explore the association between culprit plaques of large parent arteries, neuroimaging markers of cerebral small vessel disease (CSVD), and the risk of early neurological deterioration (END) in stroke patients with BAD. Methods: A total of 97 stroke patients with BAD in the vascular territories of the lenticulostriate arteries or paramedian pontine arteries, diagnosed using high-resolution magnetic resonance imaging (HRMRI), were prospectively recruited in this observational study. A culprit plaque in the middle cerebral artery was defined as the only arterial plaque on the ipsilateral side of an infarction visible on diffusion-weighted imaging. A culprit plaque in the basilar artery (BA) was identified when it was observed within the same axial slices of an infarction or on the adjacent upper or lower slice, whereas a plaque within the BA located in the ventral region was considered non-culprit. If more than one plaque was present in the same vascular territory, the most stenotic plaque was chosen for the analysis. Four CSVD neuroimaging markers, including white matter hyperintensity (WMH), lacunes, microbleeds, and enlarged perivascular spaces (EPVS), were evaluated in accordance with the total CSVD score. The associations between neuroimaging features of lesions within large parent arteries, neuroimaging markers of CSVD, and the risk of END in stroke patients with BAD were investigated using logistic regression analysis. Results: END occurred in 41 stroke patients (42.27%) with BAD. The degree of large parent artery stenosis (P<0.001), culprit plaques of large parent arteries (P<0.001), and plaque burden (P<0.001) were significantly different between the END and non-END groups in stroke patients with BAD. In logistic regression analysis, culprit plaques of large parent arteries (OR, 32.258; 95% CI, 4.140-251.346) were independently associated with the risk of END in stroke patients with BAD. Conclusions: Culprit plaques of large parent arteries could predict the risk of END in stroke patients with BAD. These results suggest that lesions in the large parent arteries, rather than damage to the cerebral small vessels, contribute to END in stroke patients with BAD.

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Section: Discussionsupporting

confidence: 92%

Culprit Plaques of Large Parent Arteries, Rather than Cerebral Small Vessel Disease, Contribute to Early Neurological Deterioration in Stroke Patients with Intracranial Branch Atheromatous Disease

Men¹,

Hu²,

Guo³

et al. 2023

Cerebrovasc Dis

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“…Early neurological deterioration (END) occurs in 19% to 24% of patients within 72 h after the onset of cerebral infarction and is characterized by progressive worsening of neurological deficits [ 3 , 4 ]. The occurrence of END often leads to increased length of stay, in-hospital mortality, disability, and a further decline in quality of life, which seriously affects the prognosis of patients [ 5 ]. Therefore, early determination of the risk of END occurrence and prediction of its development in ACI patients is beneficial for the identification of high-risk groups and the development of individualized treatment plans such as thrombolysis/anticoagulation to prevent a recurrence, reduce the incidence of END, and promote later recovery.…”

Section: Prefacementioning

confidence: 99%

Study on the Predictive Value of Thromboelastography in Early Neurological Deterioration in Patients with Primary Acute Cerebral Infarction

Zhang

Jia

Chen

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To investigate the predictive value of thromboelastography for the occurrence of early neurological deterioration (END) in patients with primary acute cerebral infarction (ACI). Methods. 150 patients who were hospitalized in the department of neurology of our hospital from September 2020 to September 2021 and were clearly diagnosed with primary ACI by head CT and head magnetic resonance imaging (MRI) were selected and divided into END and non-END groups according to the change in National Institute of Health Stroke Scale (NIHSS) score within 72 h of admission. The general baseline data and laboratory indexes of the first examination at admission were compared between the two groups, and the factors that may affect the occurrence of END were determined by univariate analysis and multivariate logistic regression analysis, and the predictive value of thromboelastography on the occurrence of END after ACI was analyzed by applying the receiver operating characteristic (ROC) curve. Results. Time to onset, baseline NIHSS score, percentage of diabetes, white blood cell (WBC) levels, C-reactive protein (CRP), and apolipoprotein B (Apo B) levels were higher in the END group than in the non-END group ( P < 0.05 ); coagulation reaction time (RT) (3.97 ± 1.16 vs. 5.49 ± 1.03) and kinetic time (KT) (1.32 ± 0.67 vs. 1.82 ± 0.58) were lower in the END group than in the non-END group ( P < 0.05 ). Inthe END group ( P < 0.05 ) diabetes, baseline NHISS score, CRP level, Apo B level, and RT were independent risk factors for the development of END in patients with ACI ( P < 0.05 ). The AUC of RT to predict the occurrence of END in patients with ACI was 0.855 (95% CI: 0784 to 0925, P = 0.001 ), with a sensitivity of 81.70% and specificity of 78.00% when the optimal cut-off value was 0.597. Conclusion. NIHSS score at admission, CRP, apolipoprotein B, RT shortening, and diabetes mellitus were independent risk factors for the development of END in ACI patients; RT shortening in TEG was predictive of END in ACI patients.

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“…Early neurological deterioration is usually defined as clinical deterioration or recurrence within 72 h after an ischemic stroke ( 16 ). For this study, END was defined as a National Institutes of Health Stroke Scale (NIHSS) score of more than 2 points recorded within 72 h after admission ( 17 , 18 ). Previous studies have demonstrated that the occurrence of END is related to multiple factors such as blood pressure at admission, blood glucose level, NIHSS score, atrial fibrillation, and the presence of intracranial large vessel lesions ( 12 , 13 , 19 ).…”

Section: Methodsmentioning

confidence: 99%

The role of asymmetrical prominent veins sign in early neurological deterioration of acute ischemic stroke patients

Huang¹,

Liu

Yun

et al. 2022

Front. Neurol.

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Background and purposeAsymmetrical prominent veins sign (APVS) often appears on susceptibility-weighted angiography (SWAN) images in patients with acute stroke. Early neurological deterioration (END) is highly correlated with survival prognosis in patients with ischemic stroke. This study sought to explore the relationship between APVS and END in patients with acute stroke.MethodsThe subjects retrospectively enrolled in this study were patients with acute ischemic stroke in the middle cerebral artery supply area. All patients underwent head MRI, including the SWAN sequence, within 7 days of stroke symptom onset. END was defined as clinical deterioration or recurrence within 72 h after ischemic stroke. The volume of infarction on diffusion-weighted imaging was measured. Univariate and multivariate analyses were used to analyze the relationship between APVS and END. Spearman correlation between APVS grades and infarct volume, white matter hyperintensity (WMH) volume, and offending vessel were also analyzed.ResultsA total of 157 patients with middle cerebral artery infarct between September 2018 and April 2020 were included in the study. APVS appeared on MRI in 84 of 157 patients, and 34 of 157 patients were diagnosed with END. In patients with END, the proportion of severe APVS was higher than in patients without END (P = 0.001, x2 = 14.659). Patients with END were older and had a larger volume of infarct and WMH than patients without END (all P < 0.05). After adjustments were made for related risk factors of END, the severity of APVS was still related to END (OR = 2.56, 95% CI, 1.38–4.75; P for trend = 0.003). Spearman correlation showed that APVS grades were positively related to infarct volume (r = 0.289, P < 0.001) and 3-month modified Rankin Scale score (r = 0.203, P = 0.011) and negatively related to offending vessels (r = −0.170, P = 0.034).ConclusionAPVS may be an important predictor of END in patients with acute ischemic stroke.

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Early Neurological Deterioration and Hypoperfusion Volume Ratio on Arterial Spin Labeling in Patients with Acute Ischemic Stroke

Cited by 8 publications

References 20 publications

Culprit Plaques of Large Parent Arteries, Rather than Cerebral Small Vessel Disease, Contribute to Early Neurological Deterioration in Stroke Patients with Intracranial Branch Atheromatous Disease

Culprit Plaques of Large Parent Arteries, Rather than Cerebral Small Vessel Disease, Contribute to Early Neurological Deterioration in Stroke Patients with Intracranial Branch Atheromatous Disease

Study on the Predictive Value of Thromboelastography in Early Neurological Deterioration in Patients with Primary Acute Cerebral Infarction

The role of asymmetrical prominent veins sign in early neurological deterioration of acute ischemic stroke patients

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