Articles from Stroke

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Hur, Jin ; Kim, Young Jin ; Lee, Hye-Jeong ; Ha, Jong-Won ; Heo, Ji Hoe ; Choi, Eui-Young et al
Cardiac Computed Tomographic Angiography for Detection of Cardiac Sources of Embolism in Stroke Patients.
Stroke. 40(6):2073-2078, June 2009.
Abstract
Background and Purpose-: We assessed the diagnostic performance of 2-phase 64-slice cardiac computed tomographic angiography (CCTA) for the detection of a cardiac source of embolism in stroke patients using transesophageal echocardiography (TEE) as the reference standard.Methods-: We selected 137 patients who had experienced a recent episode of stroke and had undergone both 2-phase 64-slice CCTA and TEE within a period of 5 days. A potential cardiac source of embolism detected at both CCTA and TEE was recorded, and echocardiographic findings were categorized into high- and medium-risk sources based on the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification.Results-: Of 137 patients, 100 abnormal findings in 91 patients were found on TEE, and 46 patients had no abnormal finding on TEE. The overall sensitivity, specificity, positive predictive value, and negative predictive value of the 64-slice CCTA for detecting cardiac sources of embolism were 89% (95% CI, 82%, 95%), 100% (95% CI, 90%, 100%), 100% (95% CI, 95%, 100%), and 81% (95% CI, 70%, 92%), respectively. TEE detected a total of 47 high-risk sources of embolism, whereas CT detected 44 lesions. For medium-risk sources of cardiac embolic stroke, TEE detected a total of 53 abnormal findings, whereas CT detected 44 abnormal findings. Of 53 lesions, there were 8 false-negative results on CT (5 patent foramen ovale and 3 atrial septal aneurysm).Conclusions-: Two-phase 64-slice CCTA is a noninvasive and useful modality for detecting high-risk cardiac sources of embolism in stroke patients.(C) 2009 American Heart Association, Inc.


Yoo, Albert J. ; Verduzco, Luis A. ; Schaefer, Pamela W. ; Hirsch, Joshua A. ; Rabinov, James D. ; Gonzalez, R Gilberto
MRI-Based Selection for Intra-Arterial Stroke Therapy: Value of Pretreatment Diffusion-Weighted Imaging Lesion Volume in Selecting Patients With Acute Stroke Who Will Benefit From Early Recanalization
Stroke. 40(6):2046-2054, June 2009.
Abstract
Background and Purpose-: Recent studies demonstrate that an acute diffusion-weighted imaging lesion volume >70 cm3 predicts poor outcome in patients with stroke. We sought to determine if this threshold could identify patients treated with intra-arterial therapy who would do poorly despite reperfusion. In patients with initial infarcts <70>70 cm3, all had poor outcomes despite a 50% recanalization rate with mean infarct growth of 114 cm3. These patients also had the largest mean transit time volumes (P<0.04).>


Brunser, Alejandro M. ; Lavados, Pablo M. ; Hoppe, Arnold ; Lopez, Javiera et al
Accuracy of Transcranial Doppler Compared With CT Angiography in Diagnosing Arterial Obstructions in Acute Ischemic Strokes.
Stroke. 40(6):2037-2041, June 2009.
Abstract
Background and Purpose-: Patients with acute ischemic stroke and intracranial arterial obstructions have a poor prognosis and a high probability of deteriorating at 24 hours. We aimed to evaluate the diagnostic accuracy of power motion mode Doppler (PMD-TCD) compared with CT angiography as standard in diagnosing intracranial arterial obstructions in patients presenting with ischemic stroke of <24>1000, negative likelihood ratio 0.42, sensitivity 57.1%, and specificity 100%. The post-test probability for any occluded artery when PMD-TCD was positive increased for any admission National Institutes of Health Stroke Scale score but was especially remarkable for National Institutes of Health Stroke Scale scores between 7 and 15 points.Conclusions-: PMD-TCD is valid compared with CT angiography for the diagnosis of arterial occlusions in patients with acute ischemic stroke, especially in middle cerebral artery obstructions.