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1.
Medicine (Baltimore) ; 99(2): e18665, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914055

RESUMEN

We assessed the value of fluid-attenuated inversion recovery vascular hyperintensity (FVH)-diffusion-weighted imaging (DWI) mismatch in predicting revascularization and functional outcome in stroke patients with large vessel occlusion (LVO) after endovascular thrombectomy (EVT).Seventy-two acute stroke patients within 6 hour of stroke onset who received EVT were enrolled. FVH-DWI mismatch, revascularization (mTICI score), functional outcome (mRS at 3 months) and other clinical data were collected. Statistical analysis was performed to predict revascularization and functional outcome after stroke.Twenty-nine patients (60.42%) had FVH-DWI mismatch in patients with complete revascularization and 8 patients (33.33%) had FVH-DWI mismatch in patients with no/partial revascularization, and there was significant difference in 2 groups (t = 4.698; P = .045). The good functional outcome group (37/72; 51.39%) had higher FVH score (4.38 ±â€Š1.53 vs 3.49 ±â€Š1.52; t = 2.478; P = .016), higher FVH-DWI mismatch ratio (81.25% vs 48.15%; t = 10.862; P = .002), higher complete revascularization ratio (83.78% vs 48.57%; t = 10.036; P = .002) than the poor functional outcome group (35/72; 48.61%). Spearman's rank correlation analysis revealed that FVH-DWI mismatch was positively correlated with complete revascularization (r = 0.255; P = .030) and good functional outcome (r = 0.417; P = .000). Multivariable logistic regression analysis demonstrated that FVH-DWI mismatch was independently associated with complete revascularization (OR, 0.328; 95% CI, 0.117-0.915; P = .033) and good functional outcome (OR, 0.169; 95% CI, 0.061-0.468; P = .001).Assessments of FVH-DWI mismatch before thrombectomy therapy might be useful for predicting revascularization and functional outcome in stroke patients with LVO.


Asunto(s)
Revascularización Cerebral/métodos , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/cirugía , Trombectomía/métodos , Anciano , Anciano de 80 o más Años , Comorbilidad , Imagen de Difusión por Resonancia Magnética , Procedimientos Endovasculares/métodos , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/tratamiento farmacológico , Factores de Tiempo , Activador de Tejido Plasminógeno/uso terapéutico
3.
Angiology ; 71(2): 122-130, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31303025

RESUMEN

The ability of carotid intima-media thickness (IMT) to predict risk beyond plaque is controversial. In 952 participants (critical limb ischemia [CLI] or stroke, n = 473; community, n = 479), we assessed whether relationships with events for IMT complement the impact of plaque in young patients depending on the extent of thrombotic versus atherosclerotic disease. The extent of atherosclerotic versus thrombotic occlusion was determined in 54 patients with CLI requiring amputations. Thrombotic occlusion in CLI was associated with younger age (P < .0001) and less plaque (P = .02). Independent relations between plaque and CLI were noted in older (>50 years; P < .005 to <.0001) but not younger (P > .38) participants, while independent relations between plaque and stroke (P < .005 to <.0001) and between IMT and CLI (P < .0001) were noted in younger participants. Although in performance (area under the receiver operating curve) for event detection, IMT thresholds failed to add to plaque alone in older patients (0.680 ± 0.020 vs 0.664 ± 0.017, P = .27), IMT improved performance for combined stroke and CLI detection when added to plaque in younger patients (0.719 ± 0.023 vs 0.631 ± 0.026, P < .0001). Because in younger participants the high prevalence of thrombotic occlusion in CLI is associated with less plaque, IMT adds information in associations with arterial vascular events.


Asunto(s)
Grosor Intima-Media Carotídeo , Isquemia/complicaciones , Isquemia/diagnóstico por imagen , Pierna/irrigación sanguínea , Pierna/diagnóstico por imagen , Placa Aterosclerótica/complicaciones , Placa Aterosclerótica/diagnóstico por imagen , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Factores de Edad , Anciano , Enfermedad Crítica , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas
4.
Radiol Med ; 125(1): 57-65, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31473929

RESUMEN

INTRODUCTION: A direct aspiration first pass technique (ADAPT) is an alternative technique as first-line thrombectomy for large vessel occlusion in acute ischemic stroke, still debated when compared to first-line stent retriever. To retrospectively evaluate technical and clinical outcomes of the ADAPT as first-line treatment for anterior circulation acute ischemic stroke with large-bore reperfusion catheters. METHODS: A multicentric data collection from 14 medical centers was retrospectively analyzed. Large-bore catheters had a distal diameter between 0.64 and 0.71 in; stent retriever was added when aspiration alone failed. Baseline characteristics, technical and clinical variables were collected, including NIHSS, thrombolysis in cerebral infarction (TICI), peri-procedural complications, 90-day mRS and 90-day mortality. RESULTS: Overall, 501 patients were treated. No statistically significant difference in terms of baseline features or tPA administration was recorded between patients treated with ADAPT and with additional stent retriever. ADAPT alone was successful in achieving TICI ≥ 2b in 71.8% with a median of 1.55 aspiration attempts. In terms of TICI ≥ 2b, ADAPT alone was better than additional stent retriever (p < 0.001), while no statistical difference was achieved from catheter diameter. Embolization to a new territory was less frequent in ADAPT group (5.2 vs 18%; p = 0.0026). Patients treated with ADAPT alone had better clinical outcomes in terms of mRS ≤ 2 (p < 0.001). CONCLUSIONS: ADAPT is a valid technique with respect to the rates of TICI 2b/3 recanalization and 90-day mRS scores. In this series, an attempt at recanalization with ADAPT with larger-bore reperfusion catheter may be warranted prior to stentriever thrombectomy.


Asunto(s)
Isquemia Encefálica/cirugía , Catéteres , Reperfusión/instrumentación , Accidente Cerebrovascular/cirugía , Trombectomía/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital , Isquemia Encefálica/diagnóstico por imagen , Angiografía Cerebral/métodos , Angiografía por Tomografía Computarizada , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Reperfusión/métodos , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico por imagen , Trombectomía/métodos , Trombectomía/estadística & datos numéricos , Terapia Trombolítica/métodos , Resultado del Tratamiento , Adulto Joven
5.
J Comput Assist Tomogr ; 44(1): 75-77, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31804241

RESUMEN

Computed tomography perfusion (CTP) is increasingly used to determine treatment eligibility for acute ischemic stroke patients. Automated postprocessing of raw CTP data is routinely used, but it can fail. In reviewing 176 consecutive acute ischemic stroke patients, failures occurred in 20 patients (11%) during automated postprocessing by the RAPID software. Failures were caused by motion (n = 11, 73%), streak artifacts (n = 2, 13%), and poor contrast bolus arrival (n = 2, 13%). Stroke physicians should review CTP results with care before they are being integrated in their decision-making process.


Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Procesamiento Automatizado de Datos/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Accidente Cerebrovascular/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Imagen de Perfusión/métodos , Factores de Riesgo , Sensibilidad y Especificidad , Programas Informáticos , Tomografía Computarizada por Rayos X
6.
Ideggyogy Sz ; 72(11-12): 407-412, 2019 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-31834684

RESUMEN

Background and purpose: Acute mortality rate of stroke in Hungary is significantly higher than in Western Europe, which is likely to be partially attributable to suboptimal treatment. Methods: We examined the use of acute vascular imaging and mechanical thrombectomy for acute ischaemic stroke patients. We collected data on 20 consecutive patients from Hungarian stroke centers before 31st August 2016. Results: Out of the reported 410 patients, 166 (40.4%) underwent CT angiography and 44 (10.7%) had mechanical thrombectomy. Conclusion: Only about 1/3 of acute ischaemic stroke patients eligible for thrombectomy actually had it. The underlying reasons include long onset-to-door time, low utilization of acute vessel imaging and a limited neuro-intervention capacity needing improvement.


Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/cirugía , Angiografía por Tomografía Computarizada/métodos , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/cirugía , Trombectomía/métodos , Humanos , Hungría , Resultado del Tratamiento
7.
J Med Life ; 12(3): 236-238, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31666824

RESUMEN

Dysphagia is recorded in approximately a third of ischemic stroke patients and is associated with malnutrition, aspiration, and pneumonia. We report a case study that assessed dysphagia (GUSS, Gugging Swallowing Screen), paralysis (MRC, Medical Research Council), and disability (mRS, modified Rankin Scale) in the AVANT program (Austrian Vietnamese Advancement Neurorehabilitation Treatment) - a collaboration program between Vietnam and Austria to standardize and systemize neurorehabilitation after stroke practice in Vietnam.


Asunto(s)
Aminoácidos/uso terapéutico , Trastornos de Deglución/tratamiento farmacológico , Trastornos de Deglución/etiología , Rehabilitación Neurológica , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/tratamiento farmacológico , Deglución , Trastornos de Deglución/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/diagnóstico por imagen
8.
Radiol Clin North Am ; 57(6): 1083-1091, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31582036

RESUMEN

This article reviews the current state of imaging for acute ischemic stroke. Protocolized imaging acquisition using computed tomography in conjunction with coordinated stroke care allows for rapid diagnosis and prompt revascularization. Following the initial evidence to support endovascular therapy for large-vessel occlusion, published between 2014 and 2015, there are now guidelines supporting treatment up to 24 hours after time of onset of symptoms. Neuroimaging remains a central component in diagnosing acute stroke and potentially excluding patients from stroke treatment, as outlined in this article.


Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Angiografía por Resonancia Magnética/métodos , Accidente Cerebrovascular/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Humanos , Neuroimagen/métodos
9.
Radiol Clin North Am ; 57(6): 1093-1108, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31582037

RESUMEN

Acute stroke is a leading cause of morbidity and mortality in the United States. Acute ischemic strokes have been classified according to The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system, and this system aids in proper management. Nearly every patient who presents to a hospital with acute stroke symptoms has some form of emergent imaging. As such, imaging plays an important role in early diagnosis and management. This article reviews the imaging patterns of acute strokes, and how the infarct pattern and imaging characteristics can suggest an underlying cause.


Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Angiografía por Resonancia Magnética/métodos , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/etiología , Humanos , Factores de Riesgo , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/diagnóstico por imagen
10.
Radiol Clin North Am ; 57(6): 1109-1116, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31582038

RESUMEN

Occlusion of a cervical or cerebral artery may cause acute ischemic stroke (AIS). Recent advances in AIS treatment by endovascular thrombectomy have led to more widespread use of advanced computed tomography (CT) imaging, including perfusion CT (PCT). This article reviews PCT for the evaluation of AIS patients.


Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Angiografía por Tomografía Computarizada/métodos , Accidente Cerebrovascular/diagnóstico por imagen , Encéfalo/irrigación sanguínea , Encéfalo/diagnóstico por imagen , Isquemia Encefálica/complicaciones , Angiografía Cerebral , Humanos , Accidente Cerebrovascular/complicaciones
11.
Zhonghua Yi Xue Za Zhi ; 99(37): 2943-2946, 2019 Oct 08.
Artículo en Chino | MEDLINE | ID: mdl-31607027

RESUMEN

Objective: To acquire the signal of neuron excitability and blood oxygen in mouse cortex after ischemic stroke, and to clarify the relationship between the change of neurovascular function and the degree of cerebral infarction. Methods: The male C57BL/6 mouse(n=20) about 6-8 weeks and 20 g weight were produced the embolic stroke modal by photochemical injury. The mouse cortex was scanned by the multispectral optical imaging while using electric stimulation in 1, 3 and 7 d after operation. Then several data around the infarction were acquired including neuron excitability, the total hemoglobin concentration and deoxygenated hemoglobin concentration. The ischemic cerebral infarction size was analyzed by TTC staining. Plasma TNF-α concentration was measured by enzyme-linked immunosorbent assay(ELISA). And modified neurological severity score (mNSS) was recorded after ischemic stroke(n=30). Then correlativity analysis was used between the optical signals and three indicators of cerebral infarction degree. Results: The changes of neuron excitability signals were 1.15%±0.28%, 2.84%±1.06%, 2.21%±0.55%. The total hemoglobin concentration signals were 3.71%±2.76%,3.19%±2.70%,4.27%±3.05%. The deoxygenated hemoglobin concentration signals were 2.93%±2.33%, 3.60%±1.74%, 2.08%±1.28%. The neural signal was correlated to cerebral infarction size, plasma TNF-α concentration and mNSS(r=-0.441, -0.449,-0.404, all P<0.05), and mNSS had a great effect on neuron excitability(ß=-0.169,P<0.05). Meanwhile, the total hemoglobin concentration was correlated to cerebral infarction size(r=0.440,P<0.05). Conclusion: The signal of neuron and blood oxygen is able to represent the change of neurovascular function and evaluate the progression of ischemic stroke.


Asunto(s)
Isquemia Encefálica , Infarto Cerebral , Infarto de la Arteria Cerebral Media , Accidente Cerebrovascular , Animales , Isquemia Encefálica/diagnóstico por imagen , Masculino , Ratones , Ratones Endogámicos C57BL , Accidente Cerebrovascular/diagnóstico por imagen
12.
BMC Neurol ; 19(1): 232, 2019 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-31578138

RESUMEN

BACKGROUND: Radiation therapy can cause cerebral arteriopahty, resulting in ischemic stroke. We document late-delayed cerebral arteriopathy by high-resolution magnetic resonance imaging (HR-MRI) in a middle aged man who had cranial irradiation 19 years earlier. CASE PRESENTATION: A 45-year-old man was diagnosed with frontal lobe glioma 19 years ago and was treated with radiation after surgical resection. He was admitted to our hospital with an acute cerebral infarction in November 8, 2017. Traditional MRI examination and HR-MRI (sagittal, reconstruction of coronal and axial) were performed at admission. He was treated with prednisone (30 mg/day) and clinical symptoms disappeared after 3 months by telephone follow-up. Our patient complained of dizziness and blurred vision and traditional MRI examination indicated acute ischemic stroke in temporal lobe and occipital lobe and microbleeds. In order to define the exact mechanism of stroke, blood tests, auto-immune screening and thrombophilia were performed and results were normal. Electrocardiography and echocardiography were negative and cardiogenic cerebral embolism was excluded. In cerebrospinal fluid (CSF) examination, level of albumin and IgG were elevated. HR-MRI showed vessel wall thickening in T1-weighted imaging, narrow lumen in proton density imaging and vessel wall concentric enhancement in contrast-enhanced T1- weighted imaging. Combined with radiotherapy history, the patient was diagnosed with radioactive vasculitis. CONCLUSION: Radiation-induced cerebrovascular damages could be a lasting progress, which we cannot ignore. HR-MRI can provide sensitive and accurate diagnostic assessment of radiation-induced arteritis and may be a useful tool for the screening of causes of cryptogenic stroke.


Asunto(s)
Irradiación Craneana/efectos adversos , Traumatismos por Radiación/diagnóstico por imagen , Vasculitis del Sistema Nervioso Central/diagnóstico por imagen , Vasculitis del Sistema Nervioso Central/etiología , Neoplasias Encefálicas/radioterapia , Glioma/radioterapia , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/etiología
14.
J Stroke Cerebrovasc Dis ; 28(11): 104391, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31542366

RESUMEN

OBJECTIVE: This study investigated the association of MRI and ultrasonography findings with stroke recurrence in patients with past histories of atherothrombotic infarctions (ATIs) or lacunar infarctions (LIs). METHODS: We prospectively analyzed the incidence of stroke recurrence. Deep and lobar cerebral microbleeds (MBs), asymptomatic lacunae, asymptomatic intracerebral hemorrhages (ICHs), severe white matter lesions (WML), and intima-media thickness (IMT) were investigated on enrollment. Stroke recurrence rates were compared by using the log-rank test. The odds ratios for recurrent strokes were derived using multivariate logistic regression models, adjusted for risk factors. RESULTS: We evaluated the stroke recurrence rate in 362 ATI patients and 309 LI patients. The log-rank test and multivariate analyses revealed that the incidence of recurrent stroke was significantly higher in ATI patients with mean IMT greater than or equal to 1.1 mm, asymptomatic ICHs, or lobar MBs than in those without. The incidence was significantly higher in LI patients with asymptomatic ICHs, asymptomatic LIs, and severe WMLs than in those without. In ATI patients, those with strictly lobar MBs or mixed MBs (deep and lobar MBs) had significantly higher recurrence rates than those without MB. In LI patients, those with strictly deep MBs or mixed MBs had higher recurrence rates than those without MB, and the incidences of those with mixed MBs was larger than those with strictly deep MBs. CONCLUSIONS: There were differences between ATI and LI patients in terms of the association of MRI and ultrasonography findings, in particularly strictly lobar or deep MBs, with the incidence of stroke recurrence.


Asunto(s)
Imagen por Resonancia Magnética , Accidente Vascular Cerebral Lacunar/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Ultrasonografía Doppler Transcraneal , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Recurrencia , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia , Accidente Vascular Cerebral Lacunar/epidemiología , Accidente Vascular Cerebral Lacunar/terapia , Factores de Tiempo
15.
NeuroRehabilitation ; 45(2): 213-220, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31498134

RESUMEN

BACKGROUND: With increased practice of real-time ultrasound imaging in the physical therapy profession, it is essential to evaluate the utility of its use post stroke. OBJECTIVE: Evaluate relationship of spastic brachialis muscle architectural parameters with clinical measures of upper extremity function and spasticity. METHODS: Eleven post stroke individuals with spasticity of the upper limb had their brachialis muscle pennation angle and fascicle length measured in the affected and unaffected upper arm, at rest. Involved side upper extremity Fugl-Meyer, Modified Ashworth Scale, and grip strength were collected and compared to muscle architectural parameters of affected and unaffected brachialis muscles. RESULTS: Affected side brachialis pennation angle was significantly greater than the unaffected side, and affected fascile length was significantly shorter than the unaffected side. Function levels were found to be significantly higher in those with greater fascile lengths and lower pennation angles. Higher Fugl-Meyer scores of the affected upper extremity were inversely correlated with lower Modified Ashworth Scale scores. CONCLUSIONS: An objective method of quantifying spasticity can assist in determining if functional gains made post stroke are due to compensations in movement, or due to physiological changes. Ultrasound imaging may be used as an alternative to the Modified Ashworth score to quantify muscular parameters in spastic muscles post stroke.


Asunto(s)
Movimiento , Espasticidad Muscular/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Ultrasonografía , Extremidad Superior/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Espasticidad Muscular/etiología , Espasticidad Muscular/fisiopatología , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/fisiopatología , Proyectos Piloto , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Extremidad Superior/fisiopatología
16.
World Neurosurg ; 132: 245-250, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31476466

RESUMEN

BACKGROUND: Little literature is available on mechanical thrombus aspiration in acute ischemic stroke with coincident ipsilateral unruptured aneurysm, especially with aneurysm proximal to the occlusion site. In this report, we describe a case of ischemic stroke in a patient with acute occlusion of M1 segment of the middle cerebral artery with coincident ipsilateral internal carotid artery-posterior communicating artery aneurysm who was successfully treated by mechanical clot retrieval using the Sofia (6F) PLUS technique (MicroVention Terumo, Tustin, California, USA). CASE DESCRIPTION: A 52-year-old woman presented at our hospital 6 hours after sudden onset of dysarthria and right limb hemiplegia on waking up in the morning. She was managed using a direct aspiration first pass technique for distal middle cerebral artery mechanical aspiration using the Sofia (6F) PLUS catheter. The thrombus was manually aspirated in 2 minutes, and Thrombolysis in Cerebral Infarction scale 3 flow was restored. Next, LVIS (MicroVention Terumo, Tustin, California, USA) stent-assisted coiling of the aneurysm of the posterior communicating segment of the left internal carotid artery was immediately undertaken. The National Institutes of Health Stroke Scale score was 4 at day 1 and 0 at day 7 postoperatively. No device-related or catheter-related complications occurred. CONCLUSIONS: Ischemic stroke patients with coincident aneurysm are at increased risk of aneurysmal rupture and should be managed with tailored endovascular strategies. Our case shows that a direct aspiration first pass technique using the Sofia (6F) PLUS catheter provides a safe, effective approach for thrombus aspiration in stroke patients.


Asunto(s)
Hallazgos Incidentales , Aneurisma Intracraneal/cirugía , Arteria Cerebral Media/cirugía , Accidente Cerebrovascular/cirugía , Trombectomía/métodos , Angiografía Cerebral , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares/métodos , Femenino , Humanos , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/diagnóstico por imagen , Persona de Mediana Edad , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Resultado del Tratamiento
17.
Eur J Radiol ; 119: 108636, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31493727

RESUMEN

PURPOSE: To highlight the importance of quantitative breast arterial calcifications (BAC) assessment for an effective stratification of cardiovascular (CV) risk in women, for whom current preventive strategies are inadequate. BAC, easily detectable on mammograms, are associated with CV disease and represent a potential imaging biomarker for CV disease prevention in women. METHOD: We summarized the available evidence on this topic. RESULTS: Age, parity, diabetes, and hyperlipidemia were found to positively correlate with BAC. Women with BAC have a higher CV risk than those without BAC: the relative risk was reported to be 1.4 for transient ischemic attack/stroke, 1.5 for thrombosis, 1.8 for myocardial infarction; the reported hazard ratio was 1.32 for coronary artery disease (CAD), 1.52 for heart failure, 1.29 for CV death, 1.44 for death from CAD. However, BAC do not alarm radiologists; when reported, they are commonly mentioned as "present", not impacting on CV decision-making. Of 18 published studies, 9 reported only presence/absence of BAC, 4 used a semi-quantitative scale, and 5 a continuous scale (with manual, automatic or semiautomatic segmentation). Various appearance, topological complexity, and vessels overlap make BAC quantification difficult to standardize. Nevertheless, machine learning approaches showed promising results in BAC quantification on mammograms. CONCLUSIONS: There is a strong rationale for mammography to become a dual test for breast cancer screening and CV disease prevention. However, robust and automated quantification methods are needed for a deeper insight on the association between BAC and CV disease, to stratifying CV risk and define personalized preventive actions.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Calcificación Vascular/diagnóstico por imagen , Anciano , Mama/diagnóstico por imagen , Enfermedades de la Mama/complicaciones , Enfermedad de la Arteria Coronaria/complicaciones , Angiopatías Diabéticas/complicaciones , Angiopatías Diabéticas/diagnóstico por imagen , Detección Precóz del Cáncer/métodos , Femenino , Humanos , Mamografía/métodos , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Embarazo , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen
18.
J Stroke Cerebrovasc Dis ; 28(11): 104353, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31494013

RESUMEN

OBJECTIVES: Endovascular therapy (EVT) improves outcomes for appropriately selected acute ischemic stroke patients. Guidelines suggest rapid acquisition of noninvasive vascular imaging to screen suspected ischemic stroke patients for large vessel occlusion (LVO) and candidacy for EVT. We sought to quantify the yield of an LVO stroke screening process in an undifferentiated emergency department (ED) suspected stroke population as well as identify predictors of successful EVT. METHODS: We identified a cohort of consecutive ED patients who received CT angiography and brain perfusion (CTA/P) imaging to determine candidacy for EVT during 2016. In keeping with the guidelines at that time, hospital protocol directed physicians to obtain CTA/P studies if time from the onset of symptoms was less than or equal to 6 hours, and the National Institute of Health Stroke Scale (NIHSS) more than or equal to 6 or if recommended by the consulting stroke neurologist. Final discharge diagnoses, EVT attempts, and successful reperfusion (TICI 2b or better) were recorded. Yield of CTA/P was compared among patients based on NIHSS and duration of symptoms. RESULTS: Over a 12-month period, 406 suspected stroke patients were screened with CTA/P; 273 (67%) received a final diagnosis of ischemic stroke. Among cases screened, 53 (13%) underwent attempted EVT; 35 (9%) achieved successful reperfusion. Only 1 of 113 (1%) patients with an NIHSS less than 6 was successfully treated with EVT compared to 34 of 285 (12%) with higher NIHSS (p = 0.001). The probability of successful EVT declined with increasing symptom duration (p = 0.009 for trend). In multivariable analysis, NIHSS more than or equal to 6 was associated with successful EVT (odds ratio [OR] 4.0 [1.6 to 9.9]) but presentation within 6 hours of onset was not (OR 2.3 [0.8 to 6.7]). CONCLUSIONS: EVT candidates were common among suspected stroke patients screened with CTA/P in the ED, however, patients with NIHSS less than 6 rarely received successful EVT.


Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Angiografía Cerebral/métodos , Angiografía por Tomografía Computarizada , Servicio de Urgencia en Hospital , Imagen de Perfusión/métodos , Accidente Cerebrovascular/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/fisiopatología , Isquemia Encefálica/terapia , Estenosis Carotídea/fisiopatología , Estenosis Carotídea/terapia , Toma de Decisiones Clínicas , Procedimientos Endovasculares , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Resultado del Tratamiento
19.
J Stroke Cerebrovasc Dis ; 28(11): 104328, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31471213

RESUMEN

OBJECTIVE: Present study was aimed to precisely evaluate the angio-architectures in patients with asymptomatic moyamoya disease (MMD) by comparing with those with hemorrhagic stroke. METHODS: This study used the data set of cerebral angiography in Asymptomatic Moyamoya Registry (AMORE) Study and Japan Adult Moyamoya (JAM) Trial at enrollment. The development of 3 subtypes of collateral vessels, including lenticulostriate, thalamic, and choroidal anastomosis, was evaluated on cerebral angiography. Suzuki's angiographical stage and posterior cerebral artery (PCA) involvement were also assessed. These findings were compared between asymptomatic (AMORE) and hemorrhagic (JAM) groups. RESULTS: This study included 55 hemispheres of 35 patients in asymptomatic group and 75 hemispheres of 75 patients in hemorrhagic group. In asymptomatic group, thalamic anastomosis was less developed than in hemorrhagic group (P = .011), but there were no significant differences in the development of lenticulostriate and choroidal anastomosis between the 2 groups (P = .077 and P = .26, respectively). Suzuki's stage was more progressed and the prevalence of PCA involvement was significantly higher in hemorrhagic group than in asymptomatic group (P = .0033 and P = .016, respectively). CONCLUSIONS: This study reveals no significant differences in the development of choroidal anastomoses between asymptomatic and hemorrhagic-onset MMD. On the other hand, disease stage and PCA involvement were less advanced in asymptomatic MMD than in hemorrhagic-onset MMD. These findings strongly suggest a certain subgroup of asymptomatic patients with MMD is at potential risk for hemorrhagic stroke.


Asunto(s)
Angiografía Cerebral/métodos , Arterias Cerebrales/diagnóstico por imagen , Hemorragias Intracraneales/diagnóstico por imagen , Angiografía por Resonancia Magnética , Enfermedad de Moyamoya/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Adolescente , Adulto , Anciano , Enfermedades Asintomáticas , Arterias Cerebrales/fisiopatología , Circulación Cerebrovascular , Circulación Colateral , Estudios Transversales , Femenino , Humanos , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/fisiopatología , Japón , Masculino , Persona de Mediana Edad , Enfermedad de Moyamoya/complicaciones , Enfermedad de Moyamoya/fisiopatología , Valor Predictivo de las Pruebas , Pronóstico , Sistema de Registros , Factores de Riesgo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Adulto Joven
20.
J Stroke Cerebrovasc Dis ; 28(11): 104282, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31401044

RESUMEN

BACKGROUND: Migraine, seizures, and psychiatric disorders are frequently reported as "stroke mimics" in patients with negative diffusion-weighted imaging (DWI) after IV-tPA. We sought to determine predictors of negative DWI in suspected stroke patients treated with IV-tPA. METHOD: A retrospective case-control study encompassing all acute stroke patients treated with IV-tPA (at our hospital or "dripped and shipped") from January 2013 to December 2014 was con- ducted. A total of 275 patients were identified with 47 negative DWI cases and 228 positive DWI controls. Variables including demographic factors, stroke characteristics, and clinical comorbidities were analyzed for statistical significance. A multivariate logistic regression was performed (SPSS-24) to identify predictors of negative DWI. RESULTS: Approximately 17% of patients had negative DWI after IV-tPA. Compared to controls, migraine history independently predicted negative DWI (odds ratio [OR] 5.0 95% confidence interval [CI] 1.03-24.6, P = .046). Increasing age (OR .97 95% CI .94-.99, P = .02) and atrial fibrillation (OR .25 95% CI .08-.77, P = .01) predicted lower probability of negative DWI. Gender, admission NIHSS, treatment location, preadmission modified Rankin scale, diabetes mellitus, hypertension, hyperlipidemia, symptom side, seizure history, and psychiatric history did not predict negative DWI status. CONCLUSIONS: In our study, roughly 1 in 6 patients treated with IV-tPA were later found to be stroke mimics with negative DWI. Despite a high proportion of suspected stroke mimics in our study, only preexisting migraine history independently predicted negative DWI status after IV-tPA treatment in suspected stroke patients.


Asunto(s)
Imagen de Difusión por Resonancia Magnética , Fibrinolíticos/administración & dosificación , Trastornos Migrañosos/diagnóstico por imagen , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Activador de Tejido Plasminógeno/administración & dosificación , Administración Intravenosa , Anciano , Anciano de 80 o más Años , Errores Diagnósticos , Femenino , Fibrinolíticos/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/fisiopatología , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/fisiopatología , Activador de Tejido Plasminógeno/efectos adversos , Resultado del Tratamiento , Procedimientos Innecesarios
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