The role of imaging in acute ischemic stroke

Tong, Elizabeth; Hou, Qinghua; Fiebach, Jochen B.; Wintermark, Max

doi:10.3171/2013.10.focus13396

Cited by 39 publications

(32 citation statements)

References 215 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The relatively marginal differences in median ASPECTS values for each category of collateral grade, however, suggest that this scale may not discern subtle differences in collaterals and that alternative noninvasive imaging approaches may be warranted for selection of optimal acute stroke therapy candidates. 21–23 Collateral grade was linked with ASPECTS scores on 24-hour imaging obtained after endovascular therapy, indicating that the extent of ischemic injury may also be because of variation in collaterals at presentation. Hemorrhagic transformation was related to the presence of partial or worse collaterals, confirming prior studies.…”

Section: Discussionmentioning

confidence: 99%

Impact of Collaterals on Successful Revascularization in Solitaire FR With the Intention for Thrombectomy

Liebeskind

Jahan

Nogueira

et al. 2014

Stroke

165

129

View full text Add to dashboard Cite

Background and Purpose Collaterals at angiography before endovascular therapy were analyzed to ascertain the effect on a novel end point of successful revascularization without symptomatic hemorrhage in the Solitaire FR With the Intention for Thrombectomy (SWIFT) study. Methods Collateral grade (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology) on baseline angiography was independently assessed, blind to other data, with statistical analyses delineating the relationship with clinical, laboratory, and imaging parameters. Results Angiographic data on collaterals were available in 119 of 144 subjects (mean age, 67±12 years; 52% woman; median National Institutes of Health Stroke Scale, 18 [range, 8–28]). Worse collaterals were noted in subjects with elevated baseline blood glucose (P=0.013) and those with elevated baseline systolic blood pressure (P=0.039). Multivariate predictors of partial or worse collaterals included absence of prior hypertension (odds ratio, 4.049, P=0.012), smoking history (odds ratio, 3.822; P=0.013), and higher blood glucose (odds ratio, 1.017; P=0.022). Collaterals were strongly related to Alberta Stroke Program Early CT Score (ASPECTS) at baseline (0–1: median 8 [3–10]; 2–9 [5–10]; 3–9 [7–10]; 4–9 [8–10]; P<0.001) and 24 hours (0–1: median 1 [0–5]; 2–6 [0–10]; 3–8 [0–10]; 4–8 [4–8]; P<0.001). Better collaterals were linked with Thrombolysis in Cerebral Infarction 2b/3 reperfusion (P=0.019), better median National Institutes of Health Stroke Scale at day 7/discharge (P<0.001), and better day 90 modified Rankin Scale (P<0.001). Better collateral grade was associated with successful revascularization without symptomatic hemorrhage, mean 2.3 (95% confidence interval, 2.1–2.5) versus 1.9 (95% confidence interval, 1.7–2.2), P=0.021. Conclusions Better collaterals were associated with lower glucose, lower blood pressure, smaller baseline infarcts in SWIFT, and greater likelihood of successful revascularization without hemorrhage and good clinical outcomes. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01054560.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of Collaterals on Successful Revascularization in Solitaire FR With the Intention for Thrombectomy

Liebeskind

Jahan

Nogueira

et al. 2014

Stroke

165

129

View full text Add to dashboard Cite

show abstract

“…As mentioned, I am prejudiced because I worked in this field; I think imaging has been extremely important. [20][21][22] Another discovery would be better understanding of the pathophysiology of ischemic injury. We understand that targeted only one pathway doesn't make a whole lot of sense.…”

Section: Where Do You Get Inspired?mentioning

confidence: 99%

Translational Stroke Research: Where Have We Been and Where are We Going? Interviewing Dr. Marc Fisher (editor of Stroke)

Saposnik

Fisher

Schweizer

2014

Can. J. Neurol. Sci.

View full text Add to dashboard Cite

“…Initial imaging in AIS is crucial to rapidly obtain an accurate diagnosis, select patients for acute recanalization treatments, predict outcome, guide etiological work-up and initiate early secondary prevention [4][5][6]. Nevertheless, data on imaging characteristics of AIS in patients taking OAC, especially DOAC are sparse [7,8].…”

Section: Introductionmentioning

confidence: 99%

MRI characteristics in acute ischemic stroke patients with preceding direct oral anticoagulant therapy as compared to vitamin K antagonists

et al. 2020

View full text Add to dashboard Cite

Background: Despite the utility of neuroimaging in the diagnostic and therapeutic management of patients with acute ischemic stroke (AIS), imaging characteristics in patients with preceding direct oral anticoagulants (DOAC) compared to vitamin K antagonists (VKA) have hardly been described. We aimed to determine presence of large vessel occlusion (LVO), thrombus length, infarction diameter, and occurrence of hemorrhagic transformation in AIS patients with preceding DOAC as compared to VKA therapy. Methods: Using a prospectively collected cohort of AIS patients, we performed univariate and multivariable regression analyses regarding imaging outcomes. Additionally, we provide a sensitivity analysis for the subgroup of patients with confirmed therapeutic anticoagulation. Results: We included AIS in patients with preceding DOAC (N = 75) and VKA (N = 61) therapy, median age 79 (IQR 70-83), 39% female. Presence of any LVO between DOAC and VKA patients (29.3% versus 37.7%, P = 0.361), and target LVO for endovascular therapy (26.7% versus 27.9%, P = 1.0) was equal with a similar occlusion pattern. DOAC as compared to VKA were associated with a similar rate of target LVO for EVT (aOR 0.835, 95% CI 0.368-1.898). The presence of multiple lesions and characteristics of the thrombus were similar in DOAC and VKA patients. Acute ischemic lesion diameter in real world patients was equal in patients taking DOAC as compared to VKA. Lesion diameter in VKA patients (median 13 mm, IQR 6-26 versus median 20 mm, IQR 7-36, P = 0.001), but not DOAC patients was smaller in the setting of confirmed therapeutic VKA. The frequency of radiological hemorrhagic transformation and symptomatic intracranial hemorrhage in OAC patients was low. Sensitivity analysis considering only patients with confirmed therapeutic anticoagulation did not change any of the results. Conclusion: Preceding DOAC treatment showed equal rates of LVO and infarct size as compared to VKA in AIS patients. This study adds to the knowledge of imaging findings in AIS patients with preceding anticoagulation.

show abstract

The role of imaging in acute ischemic stroke

Cited by 39 publications

References 215 publications

Impact of Collaterals on Successful Revascularization in Solitaire FR With the Intention for Thrombectomy

Impact of Collaterals on Successful Revascularization in Solitaire FR With the Intention for Thrombectomy

Translational Stroke Research: Where Have We Been and Where are We Going? Interviewing Dr. Marc Fisher (editor of Stroke)

MRI characteristics in acute ischemic stroke patients with preceding direct oral anticoagulant therapy as compared to vitamin K antagonists

Contact Info

Product

Resources

About