• Title/Summary/Keyword: Acute ischemic stroke

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Fast MRI in Acute Ischemic Stroke: Applications of MRI Acceleration Techniques for MR-Based Comprehensive Stroke Imaging

  • You, Sung-Hye;Kim, Byungjun;Kim, Bo Kyu;Park, Sang Eun
    • Investigative Magnetic Resonance Imaging
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    • v.25 no.2
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    • pp.81-92
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    • 2021
  • The role of neuroimaging in patients with acute ischemic stroke has been gradually increasing. The ultimate goal of stroke imaging is to make a streamlined imaging workflow for safe and efficient treatment based on optimized patient selection. In the era of multimodal comprehensive imaging in strokes, imaging based on computed tomography (CT) has been preferred for use in acute ischemic stroke, because, despite the unique strengths of magnetic resonance imaging (MRI), MRI has a longer scan duration than does CT-based imaging. However, recent improvements, such as multicoil technology and novel MRI acceleration techniques, including parallel imaging, simultaneous multi-section imaging, and compressed sensing, highlight the potential of comprehensive MR-based imaging for strokes. In this review, we discuss the role of stroke imaging in acute ischemic stroke management, as well as the strengths and limitations of MR-based imaging. Given these concepts, we review the current MR acceleration techniques that could be applied to stroke imaging and provide an overview of the previous research on each essential sequence: diffusion-weighted imaging, gradient-echo, fluid-attenuated inversion recovery, contrast-enhanced MR angiography, and MR perfusion imaging.

Factors Affecting Delayed Hospital Arrival Times in Acute Ischemic Stroke Patients

  • Lim, Yong-Deok;Choi, Sung-Soo
    • Journal of the Korea Society of Computer and Information
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    • v.21 no.7
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    • pp.53-59
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    • 2016
  • The purpose of this study was to investigate the factors of hospital arrival delays of acute ischemic stroke patients. The study subjects were 126 cerebral infarction patients G Metropolitan City university hospital emergency center. General characteristics, disease-related characteristics and stroke-related were collected by self-reported questionnaires. Hospital arrival times by subjects' characteristics were tested by $x^2$ test and logistic regression analysis. Of 126 cerebral infarction patients, Their average hours taken to move to a hospital was 12.7 hours with the fastest case being 0.5 hour and the most delayed case being 127.8 hours. 61.1%(77 persons) of the stroke patients under this experiment said to have taken 3 hours or less. In logistic regression analyses, Coming to the hospital directly without passing through other hospitals was found to have higher probability of arriving less than 3 hours(${\beta}$=2.960, p=.009), And if LAPSS was tested positive, such cases are more likely to arrive within 3 hours(${\beta}$=2.219, p=.049). For acute ischemic stroke and caregivers need training to be conducted promptly admitted to hospitals for education and treatment hospital stroke screening will help to improve the treatment of stroke patients

Paradigm Shift in Intra-Arterial Mechanical Thrombectomy for Acute Ischemic Stroke : A Review of Randomized Controlled Trials after 2015

  • Sheen, Jae Jon;Kim, Young Woo
    • Journal of Korean Neurosurgical Society
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    • v.63 no.4
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    • pp.427-432
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    • 2020
  • Three randomized control trials (RCTs), published in 2013, investigated efficacy of mechanical thrombectomy in large vessel occlusions and did not show better results compared to intravenous (IV) recombinant tissue-type plasminogen activator (tPA) alone. However, most clinicians treating stroke consider mechanical thrombectomy as the standard treatment rather than using IV tPA alone. This paradigm shift was based on five RCTs investigating efficacy of mechanical thrombectomy in acute ischemic stroke conducted from 2010 to 2015. They demonstrated that mechanical thrombectomy was effective and safe in acute ischemic stroke with anterior circulation occlusion when performed within 6 hours of stroke onset. There are four reasons underlying the different results observed between the trials conducted in 2013 and 2015. First, the three RCTs of 2013 used low-efficiency thrombectomy devices. Second, the three RCTs used insufficient image selection criteria. Third, following the initial presentation at the hospital, reperfusion treatment required a long time. Fourth, the three RCTs showed a low rate of successful recanalization. Time is the most important factor in the treatment of acute ischemic stroke. However, current trends utilize advanced imaging techniques, such as diffusion-weighted imaging and multi-channel computer tomographic perfusion, to facilitate the detection of core infarction, penumbra, and collateral flows. These efforts demonstrate that patient selection may overcome the barriers of time in specific cases.

Acute Ischemic Stroke Involving Both Anterior and Posterior Circulation Treated by Endovascular Revascularization for Acute Basilar Artery Occlusion via Persistent Primitive Trigeminal Artery

  • Imahori, Taichiro;Fujita, Atsushi;Hosoda, Kohkichi;Kohmura, Eiji
    • Journal of Korean Neurosurgical Society
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    • v.59 no.4
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    • pp.400-404
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    • 2016
  • We report a case of acute ischemic stroke involving both the anterior and posterior circulation associated with a persistent primitive trigeminal artery (PPTA), treated by endovascular revascularization for acute basilar artery (BA) occlusion via the PPTA. An otherwise healthy 67-year-old man experienced sudden loss of consciousness and quadriplegia. Magnetic resonance imaging showed an extensive acute infarction in the right cerebral hemisphere, and magnetic resonance angiography showed occlusion of the right middle cerebral artery (MCA) and BA. Because the volume of infarction in the territory of the right MCA was extensive, we judged the use of intravenous tissue plasminogen activator to be contraindicated. Cerebral angiography revealed hypoplasia of both vertebral arteries and the presence of a PPTA from the right internal carotid artery. A microcatheter was introduced into the BA via the PPTA and revascularization was successfully performed using a Merci Retriever with adjuvant low-dose intraarterial urokinase. After treatment, his consciousness level and right motor weakness improved. Although persistent carotid-vertebrobasilar anastomoses such as a PPTA are relatively rare vascular anomalies, if the persistent primitive artery is present, it can be an access route for mechanical thrombectomy for acute ischemic stroke.

Treatment for Patients with Acute Ischemic Stroke Presenting beyond Six Hours of Ischemic Symptom Onset : Effectiveness of Intravenous Direct Thrombin Inhibitor, Argatroban

  • Park, Jung-Soo;Park, Seung-Soo;Koh, Eun-Jeong;Eun, Jong-Pil;Choi, Ha-Young
    • Journal of Korean Neurosurgical Society
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    • v.47 no.4
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    • pp.258-264
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    • 2010
  • Objective : The objectives of this study were to analyze the outcome and hemorrhagic risk of intravenous (IV) argatroban in patients with acute ischemic stroke presenting beyond six hours of ischemic symptom onset. Methods : Eighty patients with acute ischemic stroke who were admitted to the hospital beyond six hours from ischemic symptom onset were retrospectively analyzed. We could not perform IV thrombolysis or intra-arterial thrombolysis because of limited time window. So, IV argatroban was performed to prevent recurrent thrombosis and progression of infarcted area. The outcome was assessed by the National Institute of Health Stroke Scale (NIHSS) score and related hemorrhagic risk was analyzed. Also, each outcome was analyzed according to the initial stroke severity, subtype, and location. Results : The median NIHSS was 8.0 at admission, 4.1 upon discharge, and 3.3 after three months. A good outcome was achieved in 81% of patients upon discharge and 88% after three months. Symptomatic hemorrhage occurred in only two patients (3%). IV argatroban was effective regardless of initial stroke severity, subtype, and location. Conclusion : IV argatroban may be an effective and safe treatment modality for acute ischemic stroke presenting beyond six hours of ischemic symptom onset.

Safety and Effect of Oriental Medicine and Continuous Intravenous Urokinase combined Therapy in Acute Ischemic Stroke(open clinical trial) (급성 허혈성 뇌졸중에 있어 한방치료와 지속적 유로키나제 정주요법과의 병행요법의 효과와 안전성)

  • Kim, Tae-Youn;Jo, Young;Lee, Jun-Hee;Lew, Jae-Hwan;Lee, Beom-Jun
    • The Journal of Internal Korean Medicine
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    • v.22 no.4
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    • pp.633-638
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    • 2001
  • Objective : Stroke is the most frequent cause of death in Korea. Because it remains severe disablities disturbing normal life, it is important to carry out intervention preventing from progression of condition in patients with acute ischemic stroke within therapeutic time window. Thus early thrombolysis is beneficial for patients with acute ischemic stroke. However its therapeutic efficacy is not known in combination with oriental medical therapy. In this study, we investigated the safety and the clinical effect of continous intravenous urokinase therapy and oriental medical therapy. Methods : Twenty eight patients with acute onset of ischemic stroke no later than three days received continous infusion of urokinase and oriental medical therapy. We estimated the subjects's neurological deficit and functional status with National institute of Neurologic Disorders and Stroke Scale(NIHSS) and Europian Stroke Scale (ESS) prior to therapy, on day 3, 7, 14 after the starting urokinase therapy and on day at discharge. Results: After day 7, the scores of NIHSS and ESS were improved significantly. There are no differences in therapeutic effects of the interval between onset of stroke and initiation of therapy. Complication were noted in four(14%) patients, but these are not fatal complication and make no neurological deficiency. Conclusion : The results of these investment suggest that continuous intravenous urokinase with oriental medical therapy could be a safe and effective intervention to prevent from progression in acute ischemic stroke. But this findings should be confirmed in multicenter double blind controlled trial.

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Impact of an Early Hospital Arrival on Treatment Outcomes in Acute Ischemic Stroke Patients (급성 뇌경색 환자의 증상 발현 후 응급실 도착까지의 시간이 치료 결과에 미치는 영향)

  • Kwon, Young-Dae;Yoon, Sung-Sang;Chang, Hye-Jung
    • Journal of Preventive Medicine and Public Health
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    • v.40 no.2
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    • pp.130-136
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    • 2007
  • Objectives : Recent educational efforts have concentrated on patient's early hospital arrival after symptom onset. The purpose of this study was to evaluate the time interval between symptom onset and hospital arrival and to investigate its relation with clinical outcomes for patients with acute ischemic stroke. Methods : A prospective registry of patients with signs or symptoms of acute ischemic stroke, admitted to the OO Medical Center through emergency room, was established from September 2003 to December 2004. The interval between symptom onset and hospital arrival was recorded for each eligible patient and analyzed together with clinical characteristics, medication type, severity of neurologic deficits, and functional outcomes. Results : Based on the data of 256 patients, the median interval between symptom onset and hospital arrival was 13 hours, and 22% of patients were admitted to the hospital within 3 hours after symptom onset. Patients of not-mild initial severity and functional status showed significant differences between arrival hours of 0-3 and later than 3 in terms of their functional outcomes on discharge. Logistic regression models also showed that arrival within 3 hours was a significant factor influencing functional outcome (OR=5.6; 95% CI=2.1, 15.0), in addition to patient's initial severity, old age, cardioembolism subtype, and referral to another hospital. Conclusions : The time interval between symptom onset and hospital arrival significantly influenced treatment outcome for patients with acute ischemic stroke, even after controlling for other significant clinical characteristics. The findings provided initiatives for early hospital arrival of patients and improvement of emergency medical system.

Multimodal Therapy for Patients with Acute Ischemic Stroke : Outcomes and Related Prognostic Factors

  • Jeong, Seung-Young;Park, Seung-Soo;Koh, Eun-Jeong;Eun, Jong-Pil;Choi, Ha-Young
    • Journal of Korean Neurosurgical Society
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    • v.45 no.6
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    • pp.360-368
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    • 2009
  • Objective : The objectives of this study were to analyze the recanalization rates and outcomes of multimodal therapy that consisted of sequential intravenous (IV)/intra-arterial (IA) thrombolysis, mechanical thrombolysis including mechanical clot disruption using microcatheters and microwires, balloon angioplasty, and stenting for acute ischemic stroke, and to evaluate the prognostic factors related to the outcome. Methods : Fifty patients who were admitted to the hospital within 8 hours from ischemic symptom onset were retrospectively analyzed. Initial IV thrombolysis and subsequent cerebral angiography were performed in all patients. If successful recanalization was not achieved by IV thrombolysis, additional IA thrombolysis with mechanical thrombolysis, including balloon angioplasty and stenting, were performed. The outcomes were assessed by the National Institute of Health Stroke Scale (NIHSS) change and modified Rankin scale (mRS) and prognostic factors were analyzed. Results : Successful recanalization was achieved in 42 (84%) of 50 patients, which consisted of 8 patients after IV thrombolysis, 19 patients after IA thrombolysis with mechanical clot disruption, and 15 patients after balloon angioplasty or stenting. Symptomatic hemorrhage occurred in 4 (8%) patients. Good outcomes were achieved in 76% and 70% of patients upon discharge, and 93% and 84% of patients after 3 months according to the NIHSS change and mRS. The initial clinical status, recanalization achievement, and presence of symptomatic hemorrhage were statistically related to the outcomes. Conclusion : Multimodal therapy may be an effective and safe treatment modality for acute ischemic stroke. Balloon angioplasty and stenting is effective for acute thrombolysis, and produce higher recanalization rates with better outcomes.

A Quantitative Analysis on Clinical Course of Acute Ischemic Stroke with National Institute of Health Stroke Scale (National Institutes of Health Stroke Scale을 이용한 급성기 허혈성 뇌졸중의 증상 경과에 대한 정량적 고찰)

  • Choi, Jin-Young;Cho, Gwon-Il;Shin, Hak-Soo;Shin, Sun-Ho;Kim, Dong-Woung;Han, Myoung-Ah
    • The Journal of Internal Korean Medicine
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    • v.23 no.1
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    • pp.5-13
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    • 2002
  • Purpose : Studies on stroke were conducted by using the scaling system to estimate, compare severity and to predict prognosis. National Institute of Health Stroke Scale is widely used for this purpose due to its accuracy in predicting clinical symptoms. According to previous studies, neurologic symptoms in acute stage of ischemic stroke did not disappear, and approximately 27% to 43% of them were aggravated, We conducted this study to define clinical aggravation and to improve ischemic stroke in its acute stage by using NIHSS. Methods and Subjects : Due to their acute ischemic stroke, twenty five patients visited Wonkwang Oriental Medicine in Cheonju within forty eight hours from its beginning stage. Two oriental medicine doctors checked NIHSS every six hours during the first ninety six hours and later every twenty four hours for twelve days from the beginning of the disease. Results : The Aggravated group consisted of nineteen out of twenty five cases, which is seventy six % and NIHSS on admissions were $5.88{\pm}0.63$ and it increased linearly over time by the equation of NIHSS on admissions was $8.50{\pm}2.02$ and it decreased linearly over time by the equation of NIHSS=-0.01 one hour+7.91. Conclusion : During the study, we defined the clinical courses of acute ischemic stroke. There have been no reports on this so far. Therefore, we hope that this study will be beneficial to expand the scope of oriental medicine in dealing with aggravating ischemic stroke in the acute stage.

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Brain Hypoxia Imaging (뇌 저산소증 영상)

  • Song, Ho-Chun
    • Nuclear Medicine and Molecular Imaging
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    • v.41 no.2
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    • pp.91-96
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    • 2007
  • The measurement of pathologically low levels of tissue $pO_2$ is an important diagnostic goal for determining the prognosis of many clinically important diseases including cardiovascular insufficiency, stroke and cancer. The target tissues nowaday have mostly been tumors or the myocardium, with less attention centered on the brain. Radiolabelled nitroimidazole or derivatives may be useful in identifying the hypoxic cells in cerebrovascular disease or traumatic brain injury, and hypoxic-ischemic encephalopathy. In acute stroke, the target of therapy is the severely hypoxic but salvageable tissue. $^{18}F-MISO$ PET and $^{99}mTc-EC-metronidazole$ SPECT in patients with acute ischemic stroke identified hypoxic tissues and ischemic penumbra, and predicted its outcome. A study using $^{123}I-IAZA$ in patient with closed head injury detected the hypoxic tissues after head injury. Up till now these radiopharmaceuticals have drawbacks due to its relatively low concentration with hypoxic tissues associated with/without low blood-brain barrier permeability and the necessity to wait a long time to achieve acceptable target to background ratios for imaging in acute ischemic stroke. It is needed to develop new hypoxic marker exhibiting more rapid localization in the hypoxic region in the brain. And then, the hypoxic brain imaging with imidazoles or non-imidazoles may be very useful in detecting the hypoxic tissues, determining therapeutic strategies and developing therapeutic drugs in several neurological disease, especially, in acute ischemic stroke.