CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct.
I.Y.L. Tan,Andrew M. Demchuk,Julia Hopyan,Liying Zhang,David J. Gladstone,Kelvin K. L. Wong,M. Martin,Sean P. Symons,Allan J. Fox,Richard I. Aviv +9 more
TLDR
In this article, a novel clot burden score (CBS) and collateral score (CS) were proposed to predict clinical and radiologic outcomes in patients with anterior circulation infarct presenting within 3 hours of stroke onset.Abstract:
BACKGROUND AND PURPOSE: Clot extent, location, and collateral integrity are important determinants of outcome in acute stroke. We hypothesized that a novel clot burden score (CBS) and collateral score (CS) are important determinants of clinical and radiologic outcomes and serve as useful additional stroke outcome predictors. MATERIALS AND METHODS: One hundred twenty-one patients with anterior circulation infarct presenting within 3 hours of stroke onset were reviewed. The Spearman correlation was performed to assess the correlation between CBS and CS and clinical and radiologic outcome measures. Patients were dichotomized by using a 90-day modified Rankin scale (mRS) score. Uni- and multivariate logistic regression models were used to assess variables predicting favorable clinical and radiologic outcomes. Receiver operating characteristic and intraclass correlation coefficient (ICC) analyses were performed. Diagnostic performance of a CBS threshold of >6 was assessed. RESULTS: There were 85 patients (mean age, 70 ± 14.5 years). Patients with higher CBS and CS demonstrated smaller pretreatment perfusion defects and final infarct volume and better clinical outcome (all, P 6 predicted good clinical outcome with an area under the curve of 0.75 (95% confidence interval [CI], 0.65–0.84; P = .0001), sensitivity of 73.0 (95% CI, 55.9–86.2), and specificity of 64.6 (95% CI, 49.5–77.8). The recanalization rate with intravenous recombinant tissue plasminogen activator was higher in patients with CBS >6 (P = .04; odds ratio, 3.2; 95% CI, 1.1–9.4). The ICC was 0.97 (95% CI, 0.95–0.98) and 0.87 (95% CI, 0.80–0.91) for CBS and CS, respectively. CONCLUSIONS: CBS and CS are useful additional markers predicting clinical and radiologic outcomes.read more
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Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
William J. Powers,Alejandro A. Rabinstein,Teri Ackerson,Opeolu Adeoye,Nicholas C. Bambakidis,Kyra J. Becker,José Biller,Michael D. Brown,Bart M. Demaerschalk,Brian L. Hoh,Edward C. Jauch,Chelsea S. Kidwell,Thabele M Leslie-Mazwi,Bruce Ovbiagele,Phillip A. Scott,Kevin N. Sheth,Andrew M. Southerland,Deborah V. Summers,David L. Tirschwell +18 more
TL;DR: These guidelines supersede the prior 2007 guidelines and 2009 updates and support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit.
Journal ArticleDOI
Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke
Pengfei Yang,Yongwei Zhang,Lei Zhang,Yongxin Zhang,Kilian M. Treurniet,Wenhuo Chen,Ya Peng,Hongxing Han,Jiyue Wang,Shouchun Wang,Congguo Yin,Sheng Liu,Peng Wang,Qi Fang,Hongchao Shi,Jianhong Yang,Changming Wen,Conghui Li,Changchun Jiang,Jun Sun,Xincan Yue,Min Lou,Meng Zhang,Hansheng Shu,Dianjing Sun,Hui Liang,Tong Li,Fuqiang Guo,Kaifu Ke,Haicheng Yuan,Guoping Wang,Weimin Yang,Huaizhang Shi,Tianxiao Li,Zifu Li,Pengfei Xing,Ping Zhang,Yu Zhou,Hao Wang,Yi Xu,Qinghai Huang,Tao Wu,Rui Zhao,Qiang Li,Yibin Fang,Laixing Wang,Jianping Lu,Yansheng Li,Jianhui Fu,Xihua Zhong,Yongjun Wang,Longde Wang,Mayank Goyal,Diederik W.J. Dippel,Bo Hong,Benqiang Deng,Yvo B W E M Roos,Charles B.L.M. Majoie,Jianmin Liu +58 more
TL;DR: In Chinese patients with acute ischemic stroke from large-vessel occlusion, endovascular thrombectomy alone was noninferior with regard to functional outcome, within a 20% margin of confidence, to endov vascular thromBectomy preceded by intravenous alteplase administered within 4.5 hours after symptom onset.
Journal ArticleDOI
Collateral blood vessels in acute ischaemic stroke: a potential therapeutic target
TL;DR: Imaging of the brain and vessels has shown that collateral flow can sustain brain tissue for hours after the occlusion of major arteries to the brain, and the augmentation or maintenance of collateral flow is therefore a potential therapeutic target.
Journal ArticleDOI
The Pattern of Leptomeningeal Collaterals on CT Angiography Is a Strong Predictor of Long-Term Functional Outcome in Stroke Patients With Large Vessel Intracranial Occlusion
Fabricio O Lima,Karen L. Furie,Gisele Sampaio Silva,Michael H. Lev,Erica C.S. Camargo,Aneesh B. Singhal,Gordon J. Harris,Elkan F. Halpern,Walter J. Koroshetz,Wade S. Smith,Albert J Yoo,Raul G Nogueira +11 more
TL;DR: Consistent with angiographic studies, leptomeningeal collaterals on CT angiography are also a reliable marker of good outcome in ischemic stroke.
Journal ArticleDOI
Endovascular therapy for acute ischaemic stroke: the Pragmatic Ischaemic Stroke Thrombectomy Evaluation (PISTE) randomised, controlled trial
Keith W. Muir,Gary A. Ford,Claudia-Martina Messow,Ian Ford,Alicia Murray,Andrew Clifton,Martin M. Brown,Jeremy Madigan,Rob Lenthall,Fergus Robertson,Anand Dixit,Geoffrey Cloud,Joanna M. Wardlaw,Janet Freeman,Philip White +14 more
TL;DR: The Pragmatic Ischaemic Thrombectomy Evaluation (PISTE) trial as discussed by the authors was a multicentre, randomised, controlled clinical trial comparing intravenous thrombolysis (IVT) alone with IVT and adjunctive intra-arterial mechanical thrombectoration (MT) in patients who had acute ischaemic stroke with large artery occlusive anterior circulation stroke confirmed on CT angiography (CTA).
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