Early Neurologic Deterioration after Stroke Depends on Vascular Territory and Stroke Etiology

James E. Siegler,Alyana Samai,Eleanor Semmes,Sheryl Martin-Schild 대한뇌졸중학회 2016 Journal of stroke Vol.18 No.2

Background and Purpose Early neurologic deterioration (END) occurs in up to one-third of patients with ischemic stroke and is associated with poor outcomes. The purpose of the present study was to determine which stroke etiologies and vascular distributions pose a greater threat of END in stroke patients. Methods Using a single-center registry of prospectively maintained clinical data, adult ischemic stroke patients admitted (July 2008 to June 2014) within 48 hours of symptom onset were evaluated according to stroke etiology and vascular distribution using diffusion-weighted MRI. Major stroke etiologies were divided into cardioembolic, large vessel, small vessel, other, unknown source, and multiple possible etiologies. END was defined as a worsening of 2 or more points on the National Institutes of Health Stroke Scale during a 24-hour period of hospitalization. Crude and backward stepwise regression models were generated to associate stroke etiology and vascular distribution with END. Results Of the included 961 patients (median age 65 years, 47% female, 72% non-White), 323 (34%) experienced END. Strokes involving the internal carotid artery (ICA) were associated with a threefold higher odds of END in stepwise regression models (OR 3.0, 95% CI 1.4-6.6, P= 0.006). Among stroke etiologies, those with unclear mechanisms had the lowest odds of END in the fully adjusted model (OR 0.6, 95% CI 0.4-1.0, P= 0.029). Conclusions In our single-center cohort of patients, ICA infarctions were independently associated with END whereas strokes of unknown etiology were least often associated with END. Larger cohorts are necessary to determine which steps, if any, can be taken to prevent END in these vulnerable populations.

Therapeutic Trends of Cerebrovascular Disease during the COVID-19 Pandemic and Future Perspectives

James E. Siegler,Mohamad Abdalkader,Patrik Michel,Thanh N. Nguyen 대한뇌졸중학회 2022 Journal of stroke Vol.24 No.2

As of May 2022, there have been more than 400 million cases (including re-infections) of the systemic acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), and nearly 5 million deaths worldwide. Not only has the coronavirus disease 2019 (COVID-19) pandemic been responsible for diagnosis and treatment delays of a wide variety of conditions, and overwhelmed the allocation of healthcare resources, it has impacted the epidemiology and management of cerebrovascular disease. In this narrative review, we summarize the changing paradigms and latest data regarding the complex relationship between COVID-19 and cerebrovascular disease. Paradoxically, although SARS-CoV-2 has been associated with many thrombotic complications—including ischemic stroke—there have been global declines in ischemic stroke and other cerebrovascular diseases. These epidemiologic shifts may be attributed to patient avoidance of healthcare institutions due to fear of contracting the novel human coronavirus, and also related to declines in other transmissible infectious illnesses which may trigger ischemic stroke. Despite the association between SARS-CoV-2 and thrombotic events, there are inconsistent data regarding targeted antithrombotics to prevent venous and arterial events. In addition, we provide recommendations for the conduct of stroke research and clinical trial planning during the ongoing COVID-19 pandemic, and for future healthcare crises.

Neuroimaging of Acute Ischemic Stroke: Multimodal Imaging Approach for Acute Endovascular Therapy

Mohamad Abdalkader,James E. Siegler,Jin Soo Lee,Shadi Yaghi,Zhongming Qiu,Xiaochuan Huo,Zhongrong Miao,Bruce C.V. Campbell,Thanh N. Nguyen 대한뇌졸중학회 2023 Journal of stroke Vol.25 No.1

Advances in acute ischemic stroke (AIS) treatment have been contingent on innovations in neuroimaging. Neuroimaging plays a pivotal role in the diagnosis and prognosis of ischemic stroke and large vessel occlusion, enabling triage decisions in the emergent care of the stroke patient. Current imaging protocols for acute stroke are dependent on the available resources and clinicians’ preferences and experiences. In addition, differential application of neuroimaging in medical decision-making, and the rapidly growing evidence to support varying paradigms have outpaced guideline-based recommendations for selecting patients to receive intravenous or endovascular treatment. In this review, we aimed to discuss the various imaging modalities and approaches used in the diagnosis and treatment of AIS.

Outcome Prediction in Cerebral Venous Thrombosis: The IN-REvASC Score

Piers Klein,Liqi Shu,Thanh N. Nguyen,James E. Siegler,Setareh Salehi Omran,Alexis N. Simpkins,Mirjam Heldner,Adam de Havenon,Hugo J. Aparicio,Mohamad Abdalkader,Marios Psychogios,Maria Cristina Vedova 대한뇌졸중학회 2022 Journal of stroke Vol.24 No.3

Background We identified risk factors, derived and validated a prognostic score for poor neurological outcome and death for use in cerebral venous thrombosis (CVT). Methods We performed an international multicenter retrospective study including consecutive patients with CVT from January 2015 to December 2020. Demographic, clinical, and radiographic characteristics were collected. Univariable and multivariable logistic regressions were conducted to determine risk factors for poor outcome, mRS 3-6. A prognostic score was derived and validated. Results A total of 1,025 patients were analyzed with median 375 days (interquartile range [IQR], 180 to 747) of follow-up. The median age was 44 (IQR, 32 to 58) and 62.7% were female. Multivariable analysis revealed the following factors were associated with poor outcome at 90- day follow-up: active cancer (odds ratio [OR], 11.20; 95% confidence interval [CI], 4.62 to 27.14; P<0.001), age (OR, 1.02 per year; 95% CI, 1.00 to 1.04; P=0.039), Black race (OR, 2.17; 95% CI, 1.10 to 4.27; P=0.025), encephalopathy or coma on presentation (OR, 2.71; 95% CI, 1.39 to 5.30; P=0.004), decreased hemoglobin (OR, 1.16 per g/dL; 95% CI, 1.03 to 1.31; P=0.014), higher NIHSS on presentation (OR, 1.07 per point; 95% CI, 1.02 to 1.11; P=0.002), and substance use (OR, 2.34; 95% CI, 1.16 to 4.71; P=0.017). The derived IN-REvASC score outperformed ISCVT-RS for the prediction of poor outcome at 90-day follow-up (area under the curve [AUC], 0.84 [95% CI, 0.79 to 0.87] vs. AUC, 0.71 [95% CI, 0.66 to 0.76], χ2 P<0.001) and mortality (AUC, 0.84 [95% CI, 0.78 to 0.90] vs. AUC, 0.72 [95% CI, 0.66 to 0.79], χ2 P=0.03). Conclusions Seven factors were associated with poor neurological outcome following CVT. The INREvASC score increased prognostic accuracy compared to ISCVT-RS. Determining patients at highest risk of poor outcome in CVT could help in clinical decision making and identify patients for targeted therapy in future clinical trials.

Transmission and Capture Measurements for ^(241)Am at GELINA

C. Lampoudis,S. Kopecky,A. Plompen,P. Schillebeeckx,P. Siegler 한국물리학회 2011 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.59 No.23

The precise knowledge of cross sections for neutron induced reactions of major and minor actinides is essential for the design of advanced reactors. Furthermore, the present evaluated data files disagree with the results of some recent measurements. Therefore it was decided to perform new transmission and capture measurements for ^(241)Am at GELINA aiming to improve the evaluations. For the measurements a novel sample preparation method has been employed, for ensuring the homogeneity of the samples. The first results of capture and transmission measurements are consistent with each other, and with recent experimental values, but seem to be inconsistent with the evaluated data files. Before the final results can be reported, a careful characterisation of the americium sample is required.

Chromium(IV)–Peroxo Complex Formation and Its Nitric Oxide Dioxygenase Reactivity

Yokoyama, Atsutoshi,Han, Jung Eun,Cho, Jaeheung,Kubo, Minoru,Ogura, Takashi,Siegler, Maxime A.,Karlin, Kenneth D.,Nam, Wonwoo American Chemical Society 2012 JOURNAL OF THE AMERICAN CHEMICAL SOCIETY - Vol.134 No.37

<P>The O<SUB>2</SUB> and NO reactivity of a Cr(II) complex bearing a 12-membered tetraazamacrocyclic <I>N</I>-tetramethylated cyclam (TMC) ligand, [Cr<SUP>II</SUP>(12-TMC)(Cl)]<SUP>+</SUP> (<B>1</B>), and the NO reactivity of its peroxo derivative, [Cr<SUP>IV</SUP>(12-TMC)(O<SUB>2</SUB>)(Cl)]<SUP>+</SUP> (<B>2</B>), are described. By contrast to the previously reported Cr(III)–superoxo complex, [Cr<SUP>III</SUP>(14-TMC)(O<SUB>2</SUB>)(Cl)]<SUP>+</SUP>, the Cr(IV)–peroxo complex <B>2</B> is formed in the reaction of <B>1</B> and O<SUB>2</SUB>. Full spectroscopic and X-ray analysis revealed that <B>2</B> possesses side-on η<SUP>2</SUP>-peroxo ligation. The quantitative reaction of <B>2</B> with NO affords a reduction in Cr oxidation state, producing a Cr(III)–nitrato complex, [Cr<SUP>III</SUP>(12-TMC)(NO<SUB>3</SUB>)(Cl)]<SUP>+</SUP> (<B>3</B>). The latter is suggested to form via a Cr(III)–peroxynitrite intermediate. [Cr<SUP>II</SUP>(12-TMC)(NO)(Cl)]<SUP>+</SUP> (<B>4</B>), a Cr(II)–nitrosyl complex derived from <B>1</B> and NO, could also be synthesized; however, it does not react with O<SUB>2</SUB>.</P><P><B>Graphic Abstract</B> <IMG SRC='http://pubs.acs.org/appl/literatum/publisher/achs/journals/content/jacsat/2012/jacsat.2012.134.issue-37/ja307384e/production/images/medium/ja-2012-07384e_0007.gif'></P><P><A href='http://pubs.acs.org/doi/suppl/10.1021/ja307384e'>ACS Electronic Supporting Info</A></P>

A Transparent Detector for n_TOF Neutron Beam Monitoring

S. Andriamonje,M. Calviani,Y. Kadi,R. Losito,V. Vlachoudis,E. Berthoumieux,F. Gunsing,A. Giganon,Y. Giomataris,C. Guerrero,R. Sarmento,P. Schillebeeckx,P. Siegler 한국물리학회 2011 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.59 No.23

In order to obtain high precision cross-section measurements using the time-of-flight technique, it is important to know with good accuracy the neutron uence at the measuring station. The detector dedicated to these measurements should be placed upstream of the detectors used for capture and fission cross-section measurements. The main requirement is to reduce the material of the detector as much as possible, in order to minimize the perturbation of the neutron beam and, especially, the background produced by the device itself. According to these considerations, a new neutron detector equipped with a small-mass device based on MicroMegas "Micro-bulk" technology has been developed as a monitoring detector for the CERN n TOF neutron beam. A description of the different characteristics of this innovative concept of transparent detector for neutron beam monitoring is presented. The result obtained in the commissioning of the new spallation targetof the n TOF facility at CERN is shown, compared with simulations performed with the FLUKA code.

Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions

Galecio-Castillo Milagros,Farooqui Mudassir,Hassan Ameer E.,Jumaa Mouhammad A.,Divani Afshin A.,Ribo Marc,Abraham Michael,Petersen Nils H.,Fifi Johanna T.,Guerrero Waldo R.,Malik Amer M.,Siegler James 대한뇌졸중학회 2023 Journal of stroke Vol.25 No.3

Background and Purpose Effect of endovascular therapy (EVT) in acute large vessel occlusion (LVO) patients with tandem lesions (TLs) within 6–24 hours after last known well (LKW) remains unclear. We evaluated the clinical and safety outcomes among TL-LVO patients treated within 6–24 hours. Methods This multicenter cohort was divided into two groups, based on LKW to puncture time: early window (<6 hours), and late window (6–24 hours). Primary clinical and safety outcomes were 90-day functional independence measured by the modified Rankin Scale (mRS: 0–2) and symptomatic intracranial hemorrhage (sICH). Secondary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b), first-pass effect, early neurological improvement, ordinal mRS, and in-hospital and 90-day mortality. Results Of 579 patients (median age 68, 32.1% females), 268 (46.3%) were treated in the late window and 311 (53.7%) in the early window. Late window group had lower median National Institutes of Health Stroke Scale score at admission, Alberta Stroke Program Early Computed Tomography Score, rates of intravenous thrombolysis, and higher rates for perfusion imaging. After adjusting for confounders, the odds of 90-day mRS 0–2 (47.7% vs. 45.0%, adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.49–1.02), favorable shift in mRS (aOR 0.88, 95% CI 0.44–1.76), and sICH (3.7% vs. 5.2%, aOR 0.56, 95% CI 0.20–1.56) were similar in both groups. There was no difference in secondary outcomes. Increased time from LKW to puncture did not predicted the probability of 90-day mRS 0–2 (aOR 0.99, 95% CI 0.96–1.01, for each hour delay) among patients presenting <24 hours. Conclusion EVT for acute TL-LVO treated within 6–24 hours after LKW was associated with similar rates of clinical and safety outcomes, compared to patients treated within 6 hours.

Endovascular versus Medical Management of Acute Basilar Artery Occlusion: A Systematic Review and Meta-Analysis of the Randomized Controlled Trials

Mohamad Abdalkader,Stephanos Finitsis,Chuanhui Li,c Wei Hu,Xinfeng Liu,Xunming Ji,Xiaochuan Huo,Fana Alemseged,Zhongming Qiu,Daniel Strbian,Volker Puetz,James E. Siegler,Shadi Yaghi,Kaiz Asif,Piers Kl 대한뇌졸중학회 2023 Journal of stroke Vol.25 No.1

Background and Purpose The optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) compared to medical management (MM) for acute BAO through a meta-analysis of randomized controlled trials (RCTs). Methods We performed a systematic review and meta-analysis of RCTs of patients with acute BAO. We analyzed the pooled effect of EVT compared to MM on the primary outcome (modified Rankin Scale [mRS] of 0–3 at 3 months), secondary outcome (mRS 0–2 at 3 months), symptomatic intracranial hemorrhage (sICH), and 3-month mortality rates. For each study, effect sizes were computed as odds ratios (ORs) with random effects and Mantel-Haenszel weighting. Results Four RCTs met inclusion criteria including 988 patients. There were higher odds of mRS of 0-3 at 90 days in the EVT versus MM group (45.1% vs. 29.1%, OR 1.99, 95% confidence interval [CI] 1.04–3.80; P=0.04). Patients receiving EVT had a higher sICH compared to MM (5.4% vs. 0.8%, OR 7.89, 95% CI 4.10–15.19; P<0.01). Mortality was lower in the EVT group (35.5% vs. 45.1%, OR 0.64, 95% CI 0.42–0.99; P=0.05). In an analysis of two trials with BAO patients and National Institutes of Health Stroke Scale (NIHSS) <10, there was no difference in 90-day outcomes between EVT versus MM. Conclusion In this systematic review and meta-analysis, EVT was associated with favorable outcome and decreased mortality in patients with BAO up to 24 hours from stroke symptoms compared to MM. The treatment effect in BAO patients with NIHSS <10 was less certain. Further studies are of interest to evaluate the efficacy of EVT in basilar occlusion patients with milder symptoms.