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Lesion-symptom mapping with NIHSS sub-scores in ischemic stroke patients

Stroke & Vascular Neurology 2022年第2期7卷 124-131页

作者： Deepthi Rajashekar matthias Wilms m Ethan macDonald Serena Schimert michael D Hill andrew demchuk mayank Goyal Sean P Dukelow Nils Daniel Forkert Biomedical Engineering Graduate Program Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada Department of Radiology Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada Hotchkiss Brain Institute University of CalgaryCalgaryAlbertaCanada Department of Clinical Neurosciences University of CalgaryCalgaryAlbertaCanada Department of Electrical and Computer Engineering University of CalgaryCalgaryAlbertaCanada Department of Community Health Sciences Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada Department of medicine Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research Institute University of CalgaryCalgaryABCanada

Background Lesion-symptom mapping(LSm)is a statistical technique to investigate the population-specific relationship between structural integrity and post-stroke clinical *** clinical practice,patients are commonly evaluated using the National Institutes of Health Stroke Scale(NIHSS),an 11-domain clinical score to quantitate neurological deficits due to *** far,LSm studies have mostly used the total NIHSS score for analysis,which might not uncover subtle structure–function relationships associated with the specific sub-domains of the NIHSS ***,the aim of this work was to investigate the feasibility to perform LSm analyses with sub-score information to reveal category-specific structure–function relationships that a total score may not *** Employing a multivariate technique,LSm analyses were conducted using a sample of 180 patients with NIHSS assessment at 48-hour post-stroke from the ESCAPE *** NIHSS domains were grouped into six categories using two *** was conducted for each category of the two groupings and the total NIHSS *** Sub-score LSms not only identify most of the brain regions that are identified as critical by the total NIHSS score but also reveal additional brain regions critical to each function category of the NIHSS assessment without requiring extensive,specialised *** These findings show that widely available sub-scores of clinical outcome assessments can be used to investigate more specific structure–function relationships,which may improve predictive modelling of stroke outcomes in the context of modern clinical stroke assessments and neuroimaging.

关键词： patients score category

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Rapid endovascular treatment of ischemic stroke

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中华物理医学与康复杂志 2015年第5期37卷 339-339页

作者： Goyal m demchuk Am menon BK

BACKGROUND AND OBJECTIVE Among patients with proximal vessel occlusion in the anterior circulation,up to 80%die within90 days of stroke,or do not regain functional independence despite alteplase *** studies have demonstrated the efficacy of endovascular treatment as an alternative to chemical *** study was designed to determine the efficacy of rapid endovascular treatment,in addition to standard care,for patients with acute ischemic stroke.

关键词：治疗功能缺血脑卒中腔内化学处理中风功效

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Intra-arterial therapy and infarct volumes

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中华物理医学与康复杂志 2016年第3期38卷 174-174页

作者： Al-Ajlan FS Goyal m demchuk Am

BACKGROUND AND OBJECTIVE The Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on minimizing CT to Recanalization Times (ESCAPE) is a multicenter, randomized, controlled trial assessing endovascular treatment as compared with guideline based standard of care. Using data from that study, the authors sought to determine the efficacy of endovascular therapy in patients with acute ischemic stroke and proximal anterior circulation *** Subjects presenting within 12 hours of stroke onset with pre-specified neurovascular imaging criteria were studied. All underwent follow-up imaging at 24 and 48 hours from stroke symptom onset. The data were reviewed for differences in stroke volume between treatment groups (endovascular and standard of care) and between subjects who did and who did not achieve early *** The median post-treatment infarct volume in all subjects was 21 mL, with the median infarct volume in the endovascular group of 15.5 mL and that in the control of 33.5 mL (Pm Early CT score [ASPECTS], and recanalization status were independently associated with posttreatment infarct volume (Pmparisons).CONCLUSION This study, using data from the ESCAPE trial showed that endovascular treatment among subjects with acute ischemic stroke and proximal anterior circulation occlusion is associated with smaller infarct volumes.

关键词：物理医学康复医学动脉疗法梗死

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STAIRX:血管内治疗试验设计和新增人群扩展适应证

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国际脑血管病杂志 2019年第8期27卷 566-572页

作者： andrew.m.demchuk Gregory W.Albers Raul G.Nogueira 吴航(译) 朱武生(译) STAIRⅩ联盟南京大学医学院 210093 东部战区总医院神经内科南京210002

卒中治疗学术产业圆桌会议(Stroke Treatment Academic Industry Roundtable,STAIR)每2年一次将研究型医生、产业届以及监管机构代表召集在一起,讨论促进卒中治疗发展的途径。STAIRⅩ会议的主要目标之一是就如何设计将血管内治疗(endova... 详细信息

卒中治疗学术产业圆桌会议(Stroke Treatment Academic Industry Roundtable,STAIR)每2年一次将研究型医生、产业届以及监管机构代表召集在一起,讨论促进卒中治疗发展的途径。STAIRⅩ会议的主要目标之一是就如何设计将血管内治疗(endovascular treatment,EVT)扩展至新增人群的试验提出共识建议,以扩展这种治疗方法的适应证。本报告基于2017年10月23日至24日STAIRⅩ会议期间举行的一次研讨会总结的专家意见。

关键词：血管内治疗试验设计适应证人群监管机构治疗方法会议产业

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在NINDS rtPA卒中研究中采用ASPECTS评估CT早期缺血改变的重要意义

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世界核心医学期刊文摘（神经病学分册） 2006年第3期2卷 38-39页

作者： demchuk A.m. Hill m.D Barber P.A. 谢琰臣 Department of Clinical Neurosciences Foothills Medical Centre 1403 29th St NW Calgary Alta. T2N 2T9 Canada

Background and Purpose -The importance of early ischemic change (EIC) on baseline computed tomography (CT) in the decision to thrombolyze the patient with acute ischemic stroke has been controversial. ASPECTS is a semiquantitative scale that scores the extent of EIC within the middle cerebral artery territory. We examined whether ASPECTS could be a treatment modifier by systematically reviewing the CT scans in the NINDS rtPA Stroke Study. methods -Six hundred eight of the 624 CT scans were available and of sufficient quality. One of 2 teams (n=3 each) of expert ASPECTS readers evaluated each scan for an ASPECTS value using a con sensus score approach. Each team was blind to all clinical information except symptom side and blind to follow-up imaging and outcome information. ASPECTS values were stratified before analysis. multivariable logistic regression was used to determine if an ASPECTS by treatment interaction existed on treatment response, outcome, and intracerebral hemorrhage risk. Results -A total of 57.2%(348 of 608) of scans showed EIC with an ASPECTS mized into 8 to 1 0 and ment-modifying effect on good outcome but showed a trend to lower mortality at 90 days with tPA (relative risk 0.67, 95%confidence interval 0.41 to 1.06, P=0.10). ASPECTS 8 to 10 were associated with a trend to larger benefit of tPA with a number needed to treat (NNT) of 5 versus ASPECTS 3 to 7 with a NNT of 8. Conclusion -There was no evidence of treatment effect modification by the baseline ASPECTS value in the NINDS rtPA Stroke Study. There fore, exclusion of patients for thrombolysis within 3 hours of symptom onset based on EIC is not supported by our data. There is a trend to reduced mortality and increased benefit to rtPA if the baseline CT scan is favorable (ASPECTS >7).

关键词： NINDS CT ASPECTS 行溶栓治疗急性缺血性卒中临床信息大脑中动脉预后信息脑内出

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急性缺血性卒中血管内治疗后颅内出血的影像学特征和临床结果：ESCAPE-NA1试验的结果

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国际医学放射学杂志 2021年第5期 605-605页

作者： J.m.Ospel W.Qiu B.K.menon A.mayank A.demchuk R.mcTaggart 丁换娜

摘要颅内出血是大血管闭塞引起的急性缺血性卒中病人血管内治疗后的一个已知并发症,但影像学出血的严重程度与预后之间的关联存在争议。目的探讨血管内卒中治疗

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大脑中动脉mRA血流信号异常与定量CT判断缺血改变的一致性:未来治疗学的研究目标

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世界核心医学期刊文摘（神经病学分册） 2005年第2期1卷 35-35页

作者： Barber P.A. demchuk A.m. Hill m.D. 高中宝 Department of Clinical Neurosciences University of Calgary Institute for Biodiagnostics (West) 3330 Hospital Drive Calgary Alta. T2N 4N 1 Canada

Objectives: In this study we define the probability of vascular abnormality in the middle cerebral artery (mCA) territory according to the extent of ischaemic change seen using computed tomography (CT). We assessed the sensitivity and spe cificity of the hyperdense middle cerebral artery (HmCA) and the “dot”sign usi ng magnetic resonance angiography (mRA). methods: Patients presenting with ischa emic stroke had a CT scan ( mRI (m (ASPECTS) was applied to CT and diffusion weighted images (DWI) at basel ine and follow up (24 h) by five independent observers. The presence of HmCA and the mCA "dot" sign was also evaluated. An expert reader assessed the 3D time of flight (TOF) mRA in the anterior circulation for areas of decreased vascular si gnal in the mCA territory, with an absent signal taken to represent severely red uced or absent flow. Results: A total of 100 consecutive patients had baseline C T and mR scans. The median NIHSS was 9. The median CT ASPECTS was 8 and equalled the median DWI ASPECTS. There were a total of 10 HmCA and 19 mCA “dot”signs, with four patients having both HmCA and “dot”signs. A total of 47 mRA flow sig nal abnormalities were observed in the anterior circulation. Conclusions: In the absence of accessible neurovascular imaging, the extent of CT ischaemia (ASPECT S) is a strong predictor of vascular occlusion. The CT hyperdense artery signs h ave a high positive predictive value but low negative predictive value.

关键词：大脑中动脉 mRA血流信号动脉高密度征弥散加权影像缺血性卒中血管闭塞前循环金标准基线水平阴性预测值

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脑卒中III期介入治疗临床试验中基线CT血管成像所见血栓闭塞点的再通和临床结果

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国际医学放射学杂志 2014年第6期 588-588页

作者： A.m.demchuk m.Goyal S.D.Yeatts J.Carrozzella L.D.Foster E.Qazi 张扬 Calgary Stroke Program Dept of Clinical Neurosciences and RadiologyHotchkiss Brain InstUniv of Calg.ary1403 29 St NWRoom 112CalgaryABCanada T2N 2T9

摘要目的使用基线CT(CT)血管成像分析影像表现和脑卒中Ⅲ期介入治疗中临床终点来确定将从血管内卒中治疗中获益的病人。材料与方法主要临床终点为90 d二分改

关键词：血管成像 III 基线脑卒中介入治疗 CT

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多期相CT血管成像:急性缺血性脑卒中病人影像筛选的新方法

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国际医学放射学杂志 2015年第4期 375-375页

作者： B.K.menon C.D.d'Esterre E.m.Qazi m.Almekhlafi L.Hahn A.m.demchuk 麻智慧 Department of Internal medicine King Abdulaziz University

摘要目的介绍多期相CT血管成像作为一种影像筛选方法在急性缺血性脑卒中(AIS)病人中的应用,并论证其评判者间信度及辅助确定临床结局的能力。材料与方法本

关键词：急性缺血性脑卒中多期血管成像 CT 病人

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急性卒中影像学研究路径图Ⅱ

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国际脑血管病杂志 2014年第2期22卷 81-92页

作者： max Wintermark Gregory W. Albers Joseph P. Broderick andrew.m. demchuk Jochen B. Fiebach Jens Fiehler James C. Grotta Gary Houser Tudor G. Jovin Kennedy R. Lees michael H. Lev David S. Liebeskind marie Luby Keith W. muir mark W. Parsons Rudiger von Kummer Joanna m. Wardlaw Ona Wu Albert J. Yoo Andrei V. Alexandrov Jeffry R. Alger Richard I. Aviv Roland Bammer Jean-Claude Baron Fernando Calamante Bruce C.V. Campbell Trevor C. Carpenter Sφren Christensen William A. Copen Colin P. Derdeyn E. Clarke Haley Jr Pooja Khatri Kohsuke Kudo maarten G. Lansberg Lawrence L. Latour Ting-Yim Lee Richard Leigh Weili Lin Patrick Lyden Grant mair Bijoy IC menon Patrik michel Robert mikulik Raul G. Nogueira Left φstergaard Salvador Pedraza Christian H. Riedel Howard A. Rowley Pina C. Sanelli makoto Sasaki Jeffrey L. Saver Pamela W. Schaefer Peter D. Schellinger Georgios Tsivgoulis Lawrence R. Wechsler Philip m. White Greg Zaharchuk Osama O. Zaidat Stephen m. Davis Geoffrey A. Donnan Anthony J. Furlan Werner Hacke Dong-Wha Kang Chelsea Kidw ell Vincent N. Thijs Gotz Thomalla Steven J. Warach 严晓铭刘牧张晶晶柯开富不详南通大学附属医院神经内科 226001

卒中影像学研究组（StrokeImagingResearchGroup，STIR）、美国神经放射学学会和美国神经放射学学会基金会在过去1年多的时间时举办了一系列的工作会议，最后一次会议于2013年3月9日至10日在华盛顿召开的卒中治疗专业学术圆桌会议（Stro... 详细信息

卒中影像学研究组（StrokeImagingResearchGroup，STIR）、美国神经放射学学会和美国神经放射学学会基金会在过去1年多的时间时举办了一系列的工作会议，最后一次会议于2013年3月9日至10日在华盛顿召开的卒中治疗专业学术圆桌会议（Stroke Treatment Academy Industry Roundtable，STAIR）期间举行。

关键词：急性卒中影像学神经放射学路径会议基金会学会美国

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