Predicting functional outcomes of posterior circulation acute ischemic stroke in first 36 h of stroke onset

Lin, Sheng Feng; Chen, Chin I.; Hu, Han Hwa; Bai, Chyi Huey

doi:10.1007/s00415-018-8746-6

Cited by 27 publications

(30 citation statements)

References 26 publications

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“…Patients with symptomatic ICVA total occlusions may have low NIHSS scores, whereas the mRS scores of these patients can be high because of serious vertigo, dysphagia, diplopia, or ataxia, so we did not stratify the patients by NIHSS score. Pc-ASPECTS on DWI is helpful in predicting functional outcome in posterior circulation ischemic stroke ( 18 ), and the low pretreatment median pc-ASPECTS (6, IQR, 5–7) on DWI indicated a poor prognosis for these patients.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Atherosclerotic Non-acute Intracranial Vertebral Artery Total Occlusion: Clinical Features, Imaging Characteristics, Endovascular Recanalization, and Follow-up Outcomes

et al. 2020

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Background and Objectives: Previous studies on symptomatic atherosclerotic non-acute intracranial vertebral artery total occlusion that was refractory to medical therapy are rare. We aimed to assess the clinical features, imaging characteristics, endovascular treatment feasibility and follow-up outcomes of patients with this condition. Methods: Data from consecutive patients who had symptomatic atherosclerotic non-acute intracranial vertebral artery total occlusion and underwent endovascular recanalization from February 2016 to April 2020 were retrospectively collected in our prospective database. Clinical, imaging, procedural, and follow-up data were collected and analyzed. Results: Thirty-one patients, predominantly males, were enrolled in this study. These patients presented with recurrent/progressive stroke in the posterior circulation despite aggressive medical therapy. Angiographic analysis revealed asymmetric vertebral arteries due to unilateral hypoplasia and intracranial vertebral artery total occlusions in the dominant vertebral arteries, which were characterized by long lesion length and high clot burden. Multiple infarctions and perfusion defects in the posterior circulation were demonstrated by diffusion-weighted imaging and arterial spin labeling, respectively. Successful endovascular recanalization was achieved in 87.1% of the patients. Over a median clinical follow-up duration of 11.0 months, 74.1% of patients with successful recanalization achieved favorable clinical outcomes (mRS score ≤2). Conclusion: Symptomatic atherosclerotic non-acute intracranial vertebral artery total occlusion attributable to hypoperfusion is characterized by recurrent/progressive ischemic events, dominant intracranial vertebral artery total occlusion, long lesion length, and high clot burden. Endovascular recanalization of the dominant intracranial vertebral artery occlusion appears to be a feasible treatment for these patients.

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Section: Discussionmentioning

confidence: 99%

Symptomatic Atherosclerotic Non-acute Intracranial Vertebral Artery Total Occlusion: Clinical Features, Imaging Characteristics, Endovascular Recanalization, and Follow-up Outcomes

et al. 2020

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“…National Institutes of Health Stroke Scale at admission is also a factor which has an important influence on the rate of END occurring after thrombolytic therapy. Some researchers suggested that NIHSS at admission in high level might increase the mortality and cause poor functional outcomes of patients receiving thrombolytic therapy (Kim et al, ; Lin, Chen, Hu, & Bai, ; Mazya et al, ). However, our results in this meta‐analysis did not conform to these conclusions.…”

Section: Discussionmentioning

confidence: 99%

The rate of early neurological deterioration occurring after thrombolytic therapy: A meta‐analysis

Hou

Chen

et al. 2019

Brain and Behavior

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Objectives The rate of early neurological deterioration (END) occurring after thrombolytic therapy is controversial. To explore a more precise estimation of the rate, a meta‐analysis was conducted in the present study. Methods The relevant studies were identified by searching PubMed, EMBASE, and Cochrane Collaboration Database up to June 2018. The definition of END was prespecified according to the most commonly used definition: ≥4‐point increase in National Institutes of Health Stroke Scale between admission and 24 hr. The meta‐analysis was performed by using the STATA 12. Results Eleven studies with a total of 3,539 subjects, including 373 patients with END and 3,166 patients without END, were collected. The pooled analysis showed that the rate of END occurring after thrombolytic therapy was about 11.0% (95% CI: 7.8%–14.3%). Subgroup analysis by continent showed that the rate of END occurring after thrombolytic therapy of patients in Asia (15.9%, 95% CI: 7.4%–24.5%) was higher than in Europe (7.6%, 95% CI: 4.9%–10.3%) and in North America (11.8%, 95% CI: 8.5%–15.0%). Subgroup analysis by onset to treatment time (OTT) displayed that the rate of END occurring after thrombolytic therapy was 5.4% (95% CI: 1.2%–9.5%), 15.6% (95% CI: 9.6%–21.5%), and 18.5% (95% CI: 11.2%–25.8%) for the patients whose OTT ≤120.0 min, from 120.1 to 179.9 min, from 180.0 to 270.0 min, respectively. Conclusion The rate of END occurring after thrombolytic therapy is about 11.0%. This finding may provide a scientific reference for researchers to evaluate the efficacy and safety of thrombolytic therapy.

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“…In previous studies, various parameters have been used to assess the prognosis of patients with PCCI, including age, diabetes mellitus, GCS score, FOUR scores, atrial brillation, and ejection fraction [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Transcranial Doppler combined with quantitative electroencephalography brain function monitoring for estimating the prognosis of patients with posterior circulation cerebral infarction

Cao

Song

Wang

et al. 2020

Preprint

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Background: Posterior circulation cerebral infarction (PCCI) leads to decreased cerebral blood flow (CBF) and metabolism. Neural activity is closely related to regional CBF both spatially and temporally. Transcranial Doppler (TCD) combined with quantitative electroencephalography (QEEG) can evaluate neurovascular coupling and involves synergy between the metabolic and vascular systems. This study aimed to monitor brain function using TCD-QEEG and estimate its efficacy in predicting the prognosis of patients with PCCI.Methods: We used TCD-QEEG to perform quantitative brain function monitoring; we recorded the related clinical variables simultaneously. The data were analyzed using a Cox proportional hazards regression model. Receiver-operating characteristic (ROC) curve analysis was used to evaluate the cut-off for the diastolic flow velocity (VD) and (delta+theta)/(alpha+beta) ratio (DTABR). The area under the ROC curve (AUROC) was calculated to assess the predictive validity of the study variables. Results: Forty patients (aged 63.7±9.9 years; 30 men) were assessed. Mortality at 90 days was 40%. The TCD indicators of VD (hazards ratio [HR] 0.168, confidence interval [CI] 0.047–0.597, p=0.006), and QEEG indicators of DTABR (HR 12.527, CI 1.637–95.846, p=0.015) were the independent predictors of the clinical outcomes. The AUROC after the combination of VD and DTABR was 0.896 and showed better predictive accuracy than the Glasgow Coma Scale score (0.75), VD (0.76), and DTABR (0.781; all p<0.05).Conclusion: TCD-QEEG provides a good understanding of the coupling mechanisms in the brain and can improve our ability to predict the prognosis of patients with PCCI.

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Predicting functional outcomes of posterior circulation acute ischemic stroke in first 36 h of stroke onset

Cited by 27 publications

References 26 publications

Symptomatic Atherosclerotic Non-acute Intracranial Vertebral Artery Total Occlusion: Clinical Features, Imaging Characteristics, Endovascular Recanalization, and Follow-up Outcomes

Symptomatic Atherosclerotic Non-acute Intracranial Vertebral Artery Total Occlusion: Clinical Features, Imaging Characteristics, Endovascular Recanalization, and Follow-up Outcomes

The rate of early neurological deterioration occurring after thrombolytic therapy: A meta‐analysis

Transcranial Doppler combined with quantitative electroencephalography brain function monitoring for estimating the prognosis of patients with posterior circulation cerebral infarction

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