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Late Endovascular Revascularization in Acute Ischemic Stroke Based on Clinical-Diffusion Mismatch
A clinical-diffusion mismatch (CDM) among stroke patients presenting within 12-24 hours has been correlated with neurologic deterioration and infarct expansion. We sought to study the feasibility and safety of reperfusion therapy in a series of 11 consecutive patients fulfilling this criterion. Pati...
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Published in: | American journal of neuroradiology : AJNR 2009-05, Vol.30 (5), p.1024-1027 |
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description | A clinical-diffusion mismatch (CDM) among stroke patients presenting within 12-24 hours has been correlated with neurologic deterioration and infarct expansion. We sought to study the feasibility and safety of reperfusion therapy in a series of 11 consecutive patients fulfilling this criterion.
Patients presenting with large vessel syndromes were considered for revascularization therapy. Of these patients, we identified those presenting beyond 8 hours who scored > or =8 on the National Institutes of Health Stroke Scale (NIHSS) and had limited abnormalities on diffusion-weighted MR imaging. One- and 7-day NIHSS scores were obtained. Rates of early neurologic deterioration (END, increase in NIHSS score by > or =4 points) and early neurologic improvement (ENI, decrease in NIHSS score by > or =4 points) at 1 week were determined. Follow-up imaging was obtained to evaluate intracranial hemorrhage (ICH).
Eleven patients were identified, 8 of whom were successfully revascularized. The mean age of all patients was 55 years with mean initial, 24-hour, and 1-week NIHSS scores of 14 +/- 4, 11 +/- 7, and 6 +/- 5, respectively, with lower scores at 24 hours and 1 week (8 +/- 5 and 4 +/- 3, respectively) among patients successfully revascularized. Eight of the treated patients (72% of the total, 100% of those successfully revascularized) experienced ENI. No patient had END or ICH.
Endovascular treatment for acute ischemic stroke beyond 8 hours is feasible and may prevent END and promote ENI in patients fulfilling the criteria of a CDM. A prospective study is planned. |
doi_str_mv | 10.3174/ajnr.A1474 |
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Patients presenting with large vessel syndromes were considered for revascularization therapy. Of these patients, we identified those presenting beyond 8 hours who scored > or =8 on the National Institutes of Health Stroke Scale (NIHSS) and had limited abnormalities on diffusion-weighted MR imaging. One- and 7-day NIHSS scores were obtained. Rates of early neurologic deterioration (END, increase in NIHSS score by > or =4 points) and early neurologic improvement (ENI, decrease in NIHSS score by > or =4 points) at 1 week were determined. Follow-up imaging was obtained to evaluate intracranial hemorrhage (ICH).
Eleven patients were identified, 8 of whom were successfully revascularized. The mean age of all patients was 55 years with mean initial, 24-hour, and 1-week NIHSS scores of 14 +/- 4, 11 +/- 7, and 6 +/- 5, respectively, with lower scores at 24 hours and 1 week (8 +/- 5 and 4 +/- 3, respectively) among patients successfully revascularized. Eight of the treated patients (72% of the total, 100% of those successfully revascularized) experienced ENI. No patient had END or ICH.
Endovascular treatment for acute ischemic stroke beyond 8 hours is feasible and may prevent END and promote ENI in patients fulfilling the criteria of a CDM. A prospective study is planned.</description><identifier>ISSN: 0195-6108</identifier><identifier>EISSN: 1936-959X</identifier><identifier>DOI: 10.3174/ajnr.A1474</identifier><identifier>PMID: 19193751</identifier><identifier>CODEN: AAJNDL</identifier><language>eng</language><publisher>Oak Brook, IL: Am Soc Neuroradiology</publisher><subject>Adolescent ; Adult ; Aged ; Biological and medical sciences ; Brain Ischemia - diagnosis ; Brain Ischemia - etiology ; Brain Ischemia - prevention & control ; Cerebral Revascularization - methods ; Child ; Diffusion Magnetic Resonance Imaging - methods ; Feasibility Studies ; Female ; Fibrinolytic Agents - therapeutic use ; Humans ; Interventional ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Nervous system ; Nervous system involvement in other diseases. Miscellaneous ; Neurology ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Retrospective Studies ; Stroke - complications ; Stroke - diagnosis ; Stroke - therapy ; Thrombolytic Therapy - methods ; Treatment Outcome ; Young Adult</subject><ispartof>American journal of neuroradiology : AJNR, 2009-05, Vol.30 (5), p.1024-1027</ispartof><rights>2009 INIST-CNRS</rights><rights>Copyright © American Society of Neuroradiology 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c437t-9259c77e48b63d1bd2223ae0b9f4068abe97f56819b2aebd188fb103be77c1273</citedby><cites>FETCH-LOGICAL-c437t-9259c77e48b63d1bd2223ae0b9f4068abe97f56819b2aebd188fb103be77c1273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7051658/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7051658/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21520350$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19193751$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Janjua, N</creatorcontrib><creatorcontrib>El-Gengaihy, A</creatorcontrib><creatorcontrib>Pile-Spellman, J</creatorcontrib><creatorcontrib>Qureshi, A.I</creatorcontrib><title>Late Endovascular Revascularization in Acute Ischemic Stroke Based on Clinical-Diffusion Mismatch</title><title>American journal of neuroradiology : AJNR</title><addtitle>AJNR Am J Neuroradiol</addtitle><description>A clinical-diffusion mismatch (CDM) among stroke patients presenting within 12-24 hours has been correlated with neurologic deterioration and infarct expansion. We sought to study the feasibility and safety of reperfusion therapy in a series of 11 consecutive patients fulfilling this criterion.
Patients presenting with large vessel syndromes were considered for revascularization therapy. Of these patients, we identified those presenting beyond 8 hours who scored > or =8 on the National Institutes of Health Stroke Scale (NIHSS) and had limited abnormalities on diffusion-weighted MR imaging. One- and 7-day NIHSS scores were obtained. Rates of early neurologic deterioration (END, increase in NIHSS score by > or =4 points) and early neurologic improvement (ENI, decrease in NIHSS score by > or =4 points) at 1 week were determined. Follow-up imaging was obtained to evaluate intracranial hemorrhage (ICH).
Eleven patients were identified, 8 of whom were successfully revascularized. The mean age of all patients was 55 years with mean initial, 24-hour, and 1-week NIHSS scores of 14 +/- 4, 11 +/- 7, and 6 +/- 5, respectively, with lower scores at 24 hours and 1 week (8 +/- 5 and 4 +/- 3, respectively) among patients successfully revascularized. Eight of the treated patients (72% of the total, 100% of those successfully revascularized) experienced ENI. No patient had END or ICH.
Endovascular treatment for acute ischemic stroke beyond 8 hours is feasible and may prevent END and promote ENI in patients fulfilling the criteria of a CDM. A prospective study is planned.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Brain Ischemia - diagnosis</subject><subject>Brain Ischemia - etiology</subject><subject>Brain Ischemia - prevention & control</subject><subject>Cerebral Revascularization - methods</subject><subject>Child</subject><subject>Diffusion Magnetic Resonance Imaging - methods</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Humans</subject><subject>Interventional</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system</subject><subject>Nervous system involvement in other diseases. Miscellaneous</subject><subject>Neurology</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Retrospective Studies</subject><subject>Stroke - complications</subject><subject>Stroke - diagnosis</subject><subject>Stroke - therapy</subject><subject>Thrombolytic Therapy - methods</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0195-6108</issn><issn>1936-959X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNpVkU1v1DAQhi0Eokvhwg9AucABKcUfcRxfkJalQKVFSHxI3KyJM2lcHKe1k67g1-OlSwunGWmeeefVvIQ8ZfREMFW9gosQT9asUtU9smJa1KWW-vt9sqJMy7JmtDkij1K6oJRKrfhDcsR0xpRkKwJbmLE4Dd10DckuHmLxGf-27hfMbgqFC8XaLpk7S3bA0dniyxynH1i8gYRdkYmNd8FZ8OVb1_dL2i99dGmE2Q6PyYMefMInh3pMvr07_br5UG4_vT_brLelrYSaS82ltkph1bS16Fjbcc4FIG11X9G6gRa16mXdMN1ywLZjTdO3jIoWlbKMK3FMXt_oXi7tiJ3FMEfw5jK6EeJPM4Ez_0-CG8z5dG0UlayWTRZ4cRCI09WCaTajSxa9h4DTkkytOFdM0Qy-vAFtnFKK2N8eYdTsEzH7RMyfRDL87F9bd-ghggw8PwD56-D7CMG6dMtxJjkVkt7ZG9z5sHMRTf6v91mWmd1uJ6iR-T6vxG9fiqON</recordid><startdate>20090501</startdate><enddate>20090501</enddate><creator>Janjua, N</creator><creator>El-Gengaihy, A</creator><creator>Pile-Spellman, J</creator><creator>Qureshi, A.I</creator><general>Am Soc Neuroradiology</general><general>American Society of Neuroradiology</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20090501</creationdate><title>Late Endovascular Revascularization in Acute Ischemic Stroke Based on Clinical-Diffusion Mismatch</title><author>Janjua, N ; El-Gengaihy, A ; Pile-Spellman, J ; Qureshi, A.I</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c437t-9259c77e48b63d1bd2223ae0b9f4068abe97f56819b2aebd188fb103be77c1273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Brain Ischemia - diagnosis</topic><topic>Brain Ischemia - etiology</topic><topic>Brain Ischemia - prevention & control</topic><topic>Cerebral Revascularization - methods</topic><topic>Child</topic><topic>Diffusion Magnetic Resonance Imaging - methods</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Humans</topic><topic>Interventional</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous system</topic><topic>Nervous system involvement in other diseases. Miscellaneous</topic><topic>Neurology</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Retrospective Studies</topic><topic>Stroke - complications</topic><topic>Stroke - diagnosis</topic><topic>Stroke - therapy</topic><topic>Thrombolytic Therapy - methods</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Janjua, N</creatorcontrib><creatorcontrib>El-Gengaihy, A</creatorcontrib><creatorcontrib>Pile-Spellman, J</creatorcontrib><creatorcontrib>Qureshi, A.I</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of neuroradiology : AJNR</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Janjua, N</au><au>El-Gengaihy, A</au><au>Pile-Spellman, J</au><au>Qureshi, A.I</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Late Endovascular Revascularization in Acute Ischemic Stroke Based on Clinical-Diffusion Mismatch</atitle><jtitle>American journal of neuroradiology : AJNR</jtitle><addtitle>AJNR Am J Neuroradiol</addtitle><date>2009-05-01</date><risdate>2009</risdate><volume>30</volume><issue>5</issue><spage>1024</spage><epage>1027</epage><pages>1024-1027</pages><issn>0195-6108</issn><eissn>1936-959X</eissn><coden>AAJNDL</coden><abstract>A clinical-diffusion mismatch (CDM) among stroke patients presenting within 12-24 hours has been correlated with neurologic deterioration and infarct expansion. We sought to study the feasibility and safety of reperfusion therapy in a series of 11 consecutive patients fulfilling this criterion.
Patients presenting with large vessel syndromes were considered for revascularization therapy. Of these patients, we identified those presenting beyond 8 hours who scored > or =8 on the National Institutes of Health Stroke Scale (NIHSS) and had limited abnormalities on diffusion-weighted MR imaging. One- and 7-day NIHSS scores were obtained. Rates of early neurologic deterioration (END, increase in NIHSS score by > or =4 points) and early neurologic improvement (ENI, decrease in NIHSS score by > or =4 points) at 1 week were determined. Follow-up imaging was obtained to evaluate intracranial hemorrhage (ICH).
Eleven patients were identified, 8 of whom were successfully revascularized. The mean age of all patients was 55 years with mean initial, 24-hour, and 1-week NIHSS scores of 14 +/- 4, 11 +/- 7, and 6 +/- 5, respectively, with lower scores at 24 hours and 1 week (8 +/- 5 and 4 +/- 3, respectively) among patients successfully revascularized. Eight of the treated patients (72% of the total, 100% of those successfully revascularized) experienced ENI. No patient had END or ICH.
Endovascular treatment for acute ischemic stroke beyond 8 hours is feasible and may prevent END and promote ENI in patients fulfilling the criteria of a CDM. A prospective study is planned.</abstract><cop>Oak Brook, IL</cop><pub>Am Soc Neuroradiology</pub><pmid>19193751</pmid><doi>10.3174/ajnr.A1474</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adolescent Adult Aged Biological and medical sciences Brain Ischemia - diagnosis Brain Ischemia - etiology Brain Ischemia - prevention & control Cerebral Revascularization - methods Child Diffusion Magnetic Resonance Imaging - methods Feasibility Studies Female Fibrinolytic Agents - therapeutic use Humans Interventional Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Nervous system Nervous system involvement in other diseases. Miscellaneous Neurology Radiodiagnosis. Nmr imagery. Nmr spectrometry Retrospective Studies Stroke - complications Stroke - diagnosis Stroke - therapy Thrombolytic Therapy - methods Treatment Outcome Young Adult |
title | Late Endovascular Revascularization in Acute Ischemic Stroke Based on Clinical-Diffusion Mismatch |
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