Infarction Lesion Research Articles

Independent Predictors of Major Adverse Cardiovascular Events at 3 Years after Aortoiliac Stent Implantation

PurposeTo identify the risk factors for major adverse cardiovascular events (MACEs) in real-world practice for symptomatic peripheral artery disease in Japan. Materials and MethodsData on Japanese patients (N = 880) from the Observational Prospective Multicenter Registry Study on Outcomes of Peripheral Arterial Disease Patients Treated by Angioplasty Therapy for Aortoiliac Artery who underwent de novo aortoiliac stent placement. The 3-year risk of incident MACEs was investigated. ResultsThe median age of the patients was 72.6 years (range, 34–97 years), and 83.1% of the patients were men. The patients had the following conditions: smoking (35.6%), hypertension (94.1%), dyslipidemia (81.7%), diabetes (48.0%), renal failure on dialysis (12.6%), myocardial infarction (12.7%), stroke (15.8%), and chronic limb-threatening ischemia (7.1%). Femoropopliteal lesions were present in 38.8% of the limbs with aortoiliac lesions. The 3-year rate of freedom from MACEs was 89.1%. Baseline characteristics, such as age, renal failure on dialysis, myocardial infarction, stroke, and femoropopliteal lesions, were independently associated with the risk of incident MACEs. When the study population was stratified according to these risk factors, the rate of MACEs was highest in patients with at least 3 risk factors (32.9% at 3 years). ConclusionsThe 3-year rate of freedom from MACEs was reported. Baseline characteristics, such as age, renal failure on dialysis, myocardial infarction, stroke, and femoropopliteal lesions, are independent risk factors for MACEs after aortoiliac stent placement.

Probability maps classify ischemic stroke regions more accurately than CT perfusion summary maps

ObjectivesTo compare single parameter thresholding with multivariable probabilistic classification of ischemic stroke regions in the analysis of computed tomography perfusion (CTP) parameter maps.MethodsPatients were included from two multicenter trials and were divided into two groups based on their modified arterial occlusive lesion grade. CTP parameter maps were generated with three methods—a commercial method (ISP), block-circulant singular value decomposition (bSVD), and non-linear regression (NLR). Follow-up non-contrast CT defined the follow-up infarct region. Conventional thresholds for individual parameter maps were established with a receiver operating characteristic curve analysis. Probabilistic classification was carried out with a logistic regression model combining the available CTP parameters into a single probability.ResultsA total of 225 CTP data sets were included, divided into a group of 166 patients with successful recanalization and 59 with persistent occlusion. The precision and recall of the CTP parameters were lower individually than when combined into a probability. The median difference [interquartile range] in mL between the estimated and follow-up infarct volume was 29/23/23 [52/50/52] (ISP/bSVD/NLR) for conventional thresholding and was 4/6/11 [31/25/30] (ISP/bSVD/NLR) for the probabilistic classification.ConclusionsMultivariable probability maps outperform thresholded CTP parameter maps in estimating the infarct lesion as observed on follow-up non-contrast CT. A multivariable probabilistic approach may harmonize the classification of ischemic stroke regions.Key Points• Combining CTP parameters with a logistic regression model increases the precision and recall in estimating ischemic stroke regions.• Volumes following from a probabilistic analysis predict follow-up infarct volumes better than volumes following from a threshold-based analysis.• A multivariable probabilistic approach may harmonize the classification of ischemic stroke regions.

Lenticulostriate artery length and middle cerebral artery plaque as predictors of early neurological deterioration in single subcortical infarction.

Early neurological deterioration (END) is not a rare phenomenon in single subcortical infarction (SSI; traditionally known as lacunar infarction) patients. Predictors of END in SSI patients are uncertain. We aimed to investigate the association between infarct lesion characteristics, penetrating artery morphology, carrier artery plaque features and END using whole-brain vessel-wall imaging. We prospectively collected data from SSI patients without stenosis of the corresponding carrier artery. The infarct lesion size and location, lenticulostriate artery (LSA) morphological characteristics, and features of the middle cerebral artery (MCA) plaques involving M1 segment adjacent to LSA origin on the symptomatic side were compared between patients with or without END. A total of 74 participants were enrolled, of whom 23 cases (31.1%) showed END. Multivariable logistic regression analysis adjusted for baseline National Institutes of Health Stroke Scale score and axial maximal diameter of infarct lesion revealed that the patients with MCA plaques adjacent to the LSA origin were more likely to develop END (odds ratio (OR) = 3.87, 95% confidence interval (CI) = 1.21-12.33), while with longer average length of LSAs were less likely to occur END (OR = 0.21, 95% CI = 0.05-0.92). MCA plaques located adjacent to the LSA origin and average length of LSAs on the symptomatic side were independent predictors of END in SSI patients. This finding might provide new insights into the mechanisms of the neurological progression in SSI and facilitate therapeutic interventions.

Interpretation of infarct location in relationship to perfusion territories using territorial arterial spin labeling in a patient with multiple infarctions: A case report

We, herein, describe a 50-year-old man with steno-occlusive cerebrovascular disease and multiple infarcts that were expected to be within the perfusion territories of the basilar artery (BA) and left internal carotid artery. However, territorial arterial spin labeling (T-ASL) perfusion magnetic resonance imaging showed that the infarct lesions were only located in the perfusion territory of the BA and confirmed the stroke etiology of large artery atherosclerosis. This case implies that the diagnostic information provided by T-ASL is valuable for identifying the symptomatic perfusion territories and stroke etiology. This technique is, therefore, able to guide therapeutic management in patients with multiple infarcts.

Review of net water uptake in the management of acute ischemic stroke.

CT densitometry-based methods to directly quantify net water uptake in ischemic brain tissue have been increasingly applied recently. There is potential for net water uptake to be used as an imaging biomarker for the pathophysiology of infarcted lesions. This review is aimed at summarizing the potential and current status of the application of net water uptake as a biomarker in the management of ischemic stroke and future directions in this context. Specifically, we provide a brief overview of the principle and different methods of net water uptake measurement, followed by a discussion of the role of net water uptake in predicting malignant brain edema and hemorrhagic transformation, evaluating lesion age, and predicting the efficacy of reperfusion therapy and long-term clinical prognosis. Artificial intelligence will help address the lack of automation and standardization in the measurement of net water absorption. Further validation of net water uptake in a prospective multicenter setting is necessary. KEY POINTS: • NWU can be used as a quantitative imaging biomarker for developing malignant brain edema in anterior and posterior circulation strokes. • The difference in NWU in edema arrest or reversibility suggests that rapid and successful revascularization can influence the progression of ischemic edema. • NWU can be used to predict the age of a lesion, with predictive power comparable to that of DWI/FLAIR mismatch.

Effects of Galvanic Vestibular Stimulation on Subjective Visual Vertical and Sitting Balance in Patients with Stroke

ObjectiveThis study aimed to examine the effects of galvanic vestibular stimulation (GVS) on visual vertical cognition and sitting balance in stroke patients. Materials and MethodsPatients with unilateral supratentorial infarction and hemorrhagic lesions and healthy controls were recruited. Bipolar GVS was performed through the bilateral mastoid processes with an 1.5-mA electric current. Each participant received three stimulation patterns: right anode-left cathode, left anode-right cathode, and sham. The subjective visual vertical (SVV) and center of gravity positions in the sitting posture were measured in three groups of participants: patients with right hemisphere lesions, patients with left hemisphere lesions, and in healthy controls. Changes in the SVV and center of gravity positions before and during galvanic vestibular stimulation were assessed. ResultsIn each group, eight individuals were recruited for SVV measurements and nine individuals for center of gravity measurements. We found changes due to polarity of stimulation on the SVV and mediolateral changes in the center of gravity in the sitting position of patients with stroke, while there was no significant difference between groups or interaction of the two factors (polarity vs. group). ConclusionChanges in the visual vertical cognition and sitting balance occur during GVS in patients with stroke. GVS is a potential tool for ameliorating balance dysfunction in patients with stroke.

Cognitive Impairment of Patient With Neurological Cerebrovascular Disease Using the Artificial Intelligence Technology Guided by MRI.

This study was to explore the application of MRI based on artificial intelligence technology combined with neuropsychological assessment to the cognitive impairment of patients with neurological cerebrovascular diseases. A total of 176 patients were divided into a control group, a vascular cognitive impairment non-dementia (VCIND) group, a vascular dementia (VD) group, and an Alzheimer's disease (AD) group. All patients underwent MRI and neuropsychological evaluation and examination, and an improved fuzzy C-means (FCM) clustering algorithm was proposed for MRI processing. It was found that the segmentation accuracy (SA) and similarity (KI) data of the improved FCM algorithm used in this study were higher than those of the standard FCM algorithm, bias-corrected FCM (BCFCM) algorithm, and rough FCM (RFCM) algorithm (p < 0.05). In the activities of daily living (ADL), the values in the VCIND group (23.55 ± 6.12) and the VD group (28.56 ± 3.1) were higher than that in the control group (19.17 ± 3.67), so the hippocampal volume was negatively correlated with the ADL (r = −0.872, p < 0.01). In the VCIND group (52.4%), VD group (31%), and AD group (26.1%), the proportion of patients with the lacunar infarction distributed on both sides of the brain and the number of multiple cerebral infarction lesions (76.2, 71.4, and 71.7%, respectively) were significantly higher than those in the control group (23.9 and 50%). In short, the improved FCM algorithm showed a higher segmentation effect and SA for MRI of neurological cerebrovascular disease. In addition, the distribution, number, white matter lesions, and hippocampal volume of lacunar cerebral infarction were related to the cognitive impairment of patients with cerebrovascular diseases.

Reduced Severity of Tissue Injury Within the Infarct May Partially Mediate the Benefit of Reperfusion in Ischemic Stroke.

Emerging data suggest tissue within the infarct lesion is not homogenously damaged following ischemic stroke but has a gradient of injury. Using blood-brain-barrier (BBB) disruption as a marker of tissue injury, we tested whether therapeutic reperfusion improves clinical outcome by reducing the severity of tissue injury within the infarct in patients with ischemic stroke. In a pooled analysis of patients treated for anterior circulation large vessel occlusion in the EXTEND-IA TNK (Tenecteplase Versus Alteplase Before Endovascular Therapy for Ischemic Stroke) and EXTEND-IA part-2 (Determining the Optimal Dose of Tenecteplase Before Endovascular Therapy for Ischaemic Stroke) trials, post-treatment BBB permeability at 24 hours was calculated based on the extent of T1-brightening by extravascular gadolinium on T2* perfusion-weighted imaging and measured within the diffusion-weighted-imaging lesion. First, to determine the clinical significance of BBB disruption as a marker of severity of tissue injury, we examined the association between post-treatment BBB permeability and functional outcome. Second, we performed an exploratory (reperfusion, BBB permeability, functional outcome) mediation analysis to estimate the proportion of the reperfusion-outcome relationship that is mediated by change in BBB permeability. In the 238 patients analyzed, an increased BBB permeability measured within the infarct at 24 hours was associated with a reduced likelihood of favorable outcome (90-day modified Rankin Scale score of ≤2) after adjusting for age, baseline National Institutes of Health Stroke Scale, premorbid modified Rankin Scale, infarct topography, laterality, thrombolytic agent, sex, parenchymal hematoma, and follow-up infarct volume (adjusted odds ratio, 0.86 [95% CI, 0.75-0.98]; P=0.023). Mediation analysis suggested reducing the severity of tissue injury (as estimated by BBB permeability) accounts for 18.2% of the association between reperfusion and favorable outcome, as indicated by a reduction in the regression coefficient of reperfusion after addition of BBB permeability as a covariate. In patients with ischemic stroke, reduced severity of tissue injury within the infarct, as determined by assessing the integrity of the BBB, is independently associated with improved functional outcome. In addition to reducing diffusion-weighted imaging-defined infarct volume, reperfusion may also improve clinical outcome by reducing tissue injury severity within the infarct.

Cerebrovascular Complications After Adult-Onset Varicella-Zoster Virus Encephalitis in the Central Nervous System: A Literature Review.

BackgroundCerebrovascular complications after adult-onset varicella-zoster virus (VZV) encephalitis have been increasingly recognized. The aim of this study was to analyze clinical and neuroimaging findings, treatment and outcome of these patients.MethodsLiterature review from January 2000 to December 2019. We searched for studies published in PubMed, Embase and Chinese Biomedical Literature Database. Clinical symptoms, neuroimaging findings, treatment and outcome were evaluated.ResultsWe analyzed 31 articles with a total of adult-onset 34 cases, including 25 cases of ischemic stroke, 6 of intracerebral hemorrhage and 3 with venous sinus thrombosis. Ischemic stroke was the major complication after VZV encephalitis accounting of 73.35%. There were more males than females in ischemia or venous sinus thrombosis groups. The middle-aged was prone to cerebral infarction, the elderly was for cerebral hemorrhage, and the young was for venous sinus thrombosis. Cognitive impairment was the most common symptom either in the ischemic group or hemorrhagic group. The lesions of VZV-associated cerebral infarction or hemorrhage were multifocal and mostly involved in the parietal lobe, followed by frontal or temporal lobes. Venous sinus thrombosis was common in the transverse sinus. Multiple stenosis of the anterior and posterior circulation vessels was found. A 60.87% of the patients with antiviral treatment in the ischemic group had favorable prognosis. All patients with anticoagulant therapy in venous sinus thrombosis group improved well; however, 60% of the patients with intracerebral hemorrhage had a poor prognosis or died.ConclusionIschemic stroke was the majority of cerebrovascular complications after VZV encephalitis, which mainly occurred in middle-aged men. The lesions of VZV-associated cerebral infarction or hemorrhage were multifocal and did not accord with the characteristics of cerebrovascular diseases induced by atherosclerosis. The patients with venous sinus thrombosis had a relatively good prognosis. When the patient represents with some neurological symptoms about one month after VZV encephalitis, and multiple lesions probably induced by vasculitis are showed in neuroimaging, cerebrovascular complications related to VZV infection should be considered.

Effect of Wire Jailing at Side Branch in 1-Stent Strategy for Coronary BifurcationLesions.

This study aimed to determine whether side branch (SB) wire jailing before main vessel (MV) stenting could prevent SB occlusion after the 1-stent strategy for bifurcation percutaneous coronary intervention. The benefits of SB wire jailing in the 1-stent strategy remain unclear. From the COBIS (Coronary Bifurcation Stenting) III registry, 1,890 patients with bifurcation lesions who underwent the 1-stent strategy using second-generation drug-eluting stents were identified and classified into 2 groups according to the use of SB wire jailing: wire jailing (n=819) and non-wire jailing (n=1,071). The incidence of SB occlusion (Thrombolysis In Myocardial Infarction flow grade<3) and target lesion failure (cardiac death, myocardial infarction, or target lesion revascularization) was compared. The incidence of final SB occlusion was not significantly different between wire jailing (1.8%) vs non-wire jailing (2.9%; P = 0.182). However, wire jailing at the SB was a significant protective factor for SB occlusion after MV stenting on multivariate analysis and was significantly associated with a lower incidence of SB occlusion in patients with significant stenoses (≥60%) at the SB (5.1% vs 11.3%; odds ratio: 0.42; 95% CI: 0.19-0.89; P = 0.028) or MV (3.1% vs 6.2%; odds ratio: 0.49; 95% CI: 0.24-0.95; P = 0.039). During follow-up (median 52months), the incidence of target lesion failure was not significantly different between wire jailing and non-wire jailing (7.6% vs 6.3%; P = 0.343). During bifurcation percutaneous coronary intervention with the 1-stent strategy, wire jailing at the SB was associated with a lower rate of final SB occlusion following MV stenting in patients with severe stenoses at the SB or MV but not with overall bifurcation lesions. Long-term clinical outcomes were comparable between the 2 groups.

Abstract WP103: Comparison Of Acute Infarct Lesions Between Non-contrast CT, DWI And FLAIR Using Back-to-back Imaging

Introduction: Size and location of the acute infarct is a major determinant of stroke outcome and eligibility for therapy. Recently, there have been efforts to train deep learning networks to detect lesions on Non-Contrast CT (NCCT) using concurrent DWI imaging as the gold standard. However, little is known about the radiological correspondence between concurrent NCCT and DWI lesion sizes. We performed an exploratory analysis comparing the stroke lesion volume on acute NCCT to that on DWI and FLAIR images performed shortly after. Methods: Population: DEFUSE 3 trial patients scanned 6-16h after last known well with DWI and NCCT &lt;1h apart. NCCT was segmented using an algorithm detecting more than 5% depression compared to the contralateral homologous region. The DWIs and FLAIR were co-registered to NCCT and manually segmented in ITK-Snap. Results: Thirteen patients fulfilled inclusion criteria. DWI volumes were (median, [IQR]) 52 mL [39 - 102], FLAIR volumes 35 mL [18 - 66] and NCCT lesion volumes 14 mL [8 - 22]. NCCT lesions were significantly smaller than both DWI and FLAIR, p &lt; 0.001 and p &lt; 0.048. The Dice coefficient was 0.2 [0.1 - 0.3] for FLAIR vs NCCT and 0.3 [0.1 - 0.5] for DWI vs NCCT. Conclusion: NCCT lesion volumes were consistently smaller than both DWI and FLAIR lesions although the volumetric agreement with FLAIR lesions was better. Both FLAIR and NCCT are sensitive to influx of parenchymal water and as such may have more similar lesions than DWI imaging which is sensitive to early occurring intraparenchymal displacements. The findings suggest that the training of deep learning networks to detect early NCCT hypodensity should focus on FLAIR or expert outlines drawn directly on the NCCT rather than DWI as the gold standard.

Stroke population–specific neuroanatomical CT-MRI brain atlas

PurposeDevelopment of a freely available stroke population–specific anatomical CT/MRI atlas with a reliable normalisation pipeline for clinical CT.MethodsBy reviewing CT scans in suspected stroke patients and filtering the AIBL MRI database, respectively, we collected 50 normal-for-age CT and MRI scans to build a standard-resolution CT template and a high-resolution MRI template. The latter was manually segmented into anatomical brain regions. We then developed and validated a MRI to CT registration pipeline to align the MRI atlas onto the CT template. Finally, we developed a CT-to-CT-normalisation pipeline and tested its reliability by calculating Dice coefficient (Dice) and Average Hausdorff Distance (AHD) for predefined areas in 100 CT scans from ischaemic stroke patients.ResultsThe resulting CT/MRI templates were age and sex matched to a general stroke population (median age 71.9 years (62.1–80.2), 60% male). Specifically, this accounts for relevant structural changes related to aging, which may affect registration. Applying the validated MRI to CT alignment (Dice > 0.78, Average Hausdorff Distance < 0.59 mm) resulted in our final CT-MRI atlas. The atlas has 52 manually segmented regions and covers the whole brain. The alignment of four cortical and subcortical brain regions with our CT-normalisation pipeline was reliable for small/medium/large infarct lesions (Dice coefficient > 0.5).ConclusionThe newly created CT-MRI brain atlas has the potential to standardise stroke lesion segmentation. Together with the automated normalisation pipeline, it allows analysis of existing and new datasets to improve prediction tools for stroke patients (free download at https://forms.office.com/r/v4t3sWfbKs).

Clinical Observation of Salvianolic Acid Combined with Panax Notoginseng Saponins Combined with Basic Nursing Intervention on Cerebral Ischemia-Reperfusion Injury in Rats.

Objective To analyze the clinical observation of salvianolic acid combined with panax notoginseng saponins combined with basic nursing intervention on cerebral ischemia-reperfusion injury in rats and its effects on the expression of apoptosis-related proteins Bcl-2, Bax and caspase-3. Methods A total of 72 male Wistar rats were randomly divided into sham, ischemia/reperfusion (I/R), edaravone (Eda), salvianolic acid (SA), panax notoginseng saponins (PNS), and SA+PNS group. After administration for 5 days, the neurological function, cerebral infarction volume, brain index, and brain water content of rats were observed. ELISA kit assay was applied to measure the levels of IL-1β, IL-6, IL-8, TNF-α, MDA, SOD, GSH-Px, and T-AOC activity. Western blotting assay was used to detect the protein levels of p-53, NF-κB, Bcl-2, Bax, and Caspase-3 in the brain tissues surrounding infarction lesion. Results Compared with sham group, the mNSS score, brain index, brain water content, infarction volumes, MDA activity, and the levels of IL-6, IL-8, TNF-α and IL-1β as well as the protein levels of p-53, NF-κB, Bax and Caspase-3 were significantly increased, while the levels of Bcl-2 protein, SOD, GSH-Px and T-AOC were significantly decreased in I/R group. However, these levels were reversed in SA group, PNS group and SA + PNS group. Moreover, these changes in SA + PNS group were more obvious than those in SA and PNS group, and the differences were statistically significant. Conclusions SA, PNS and they combined with basic nursing have protective effects on cerebral I/R injury, and the combination with basic nursing has better effects than that used alone. The mechanism may be to regulate the expression of downstream apoptotic proteins by inhibiting the TLR4/NF-κB signaling pathway, thereby reducing neurological damage in rats.

Effects of cardiac surgical support on long-term outcomes of emergent or complex percutaneous coronary intervention cases: a sub-analysis of the SHINANO 5-year registry

Significant improvements in percutaneous coronary intervention (PCI) technology have enabled cardiovascular procedures to be performed without onsite cardiac surgery facilities. However, little is known about the association between onsite cardiac surgical support and long-term outcomes of PCI, particularly among emergent and complex cases. We investigated whether the presence or absence of cardiovascular surgery affects the long-term prognosis after PCI, emergent and complex elective cases. The SHINANO 5-year registry, a prospective, observational, and multicenter cohort study registry in Nagano, Japan, consecutively included 1665 patients who underwent PCI between August 2012 and July 2013. The procedures were performed at 11 hospitals with onsite cardiac surgery facilities [onsite surgery (+) group; n = 1257] and 8 hospitals without onsite cardiac surgery facilities [onsite surgery (−) group; n = 408]. The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiac and cerebrovascular events [MACCE: all-cause death, Q-wave myocardial infarction, non-fatal stroke, and target lesion revascularization]. The onsite surgery group (+) had a lower rate of emergent PCI and ST-segment elevation myocardial infarction (40.8% vs. 51.7%, p < 0.01 and 24.9% vs. 39.2%, p < 0.01, respectively), and a higher prevalence of hemodialysis and history of peripheral artery disease (7.6% vs. 2.45%, p < 0.01 and 12.1% vs. 6.9%, p < 0.01, respectively). However, the Kaplan–Meier analysis showed no difference in the 5-year mortality rate (16.4% vs. 15.2%, p = 0.421) and MACCE incidence (31.6% vs. 28.9%, p = 0.354) between the groups. Also, there were no differences in the mortality rate and incidence of MACCE among emergent cases of ST-segment elevation myocardial infarction and complex elective cases who underwent PCI. Long-term outcomes of PCI appear to be comparable between institutions with and without onsite cardiac surgical facilities.

Evaluation of right-to-left shunt on contrast-enhanced transcranial Doppler in patent foramen ovale-related cryptogenic stroke: Research based on imaging.

BACKGROUNDCardiogenic embolism caused by patent foramen ovale (PFO) is a common etiology of cryptogenic stroke (CS), particularly in young and middle-aged patients. Studies about right-to-left shunt (RLS) detection using contrast-enhanced transcranial Doppler (c-TCD) are numerous. According to the time phase and number of microbubbles detected on c-TCD, RLS can be classified and graded. We hypothesized that the characteristics of an infarction lesion on diffusion-weighted imaging differs when combining the type and grade of RLS on c-TCD in patients with PFO-related CS.AIMTo explore the characteristics of infarction lesions on diffusion-weighted imaging when combining the RLS type and grade determined by c-TCD.METHODSWe retrospectively evaluated CS patients from August 2015 to December 2019 at a tertiary hospital. In total, 111 PFO-related CS patients were divided according to whether RLS was permanent (microbubbles detected both at resting state and after the Valsalva maneuver) or latent (microbubbles detected only after the Valsalva maneuver) on c-TCD. Each group was subdivided into small, mild and large RLS according to the grade of shunt on c-TCD. A normal control group was composed of 33 patients who suffered from simple dizziness. Intragroup and intergroup differences were analyzed in terms of clinical, laboratory and diffusion-weighted imaging lesion characteristics. The correlation between RLS grade evaluated by c-TCD and size of PFO determined by transesophageal echocardiography were also analyzed.RESULTSIn 111 patients with PFO-related CS, 68 had permanent RLS and 43 had latent RLS. Clinical characteristics and laboratory tests were not significantly different among the permanent RLS, latent RLS and normal control groups. The proportion of patients with multiple territory lesions in the permanent RLS group (50%) was larger than that in the latent RLS group (27.91%; P = 0.021). Posterior circulation was more likely to be affected in the latent RLS group than in the permanent RLS group (30.23% vs 8.82%, P = 0.004). Permanent-large and latent-large RLS were both more likely to be related to multiple (Ptrend = 0.017 and 0.009, respectively), small (Ptrend = 0.035 and 0.006, respectively) and cortical (Ptrend = 0.031 and 0.033, respectively) lesions. The grade of RLS evaluated by c-TCD was correlated to the size of PFO determined by transesophageal echocardiography (r = 0.758, P < 0.001).CONCLUSIONDistribution of the infarct suggested the possible type of RLS. Multiple, small and cortical infarcts suggest large RLS induced by a large PFO.

Osstem Cardiotec Centum Stent Versus Xience Alpine Stent for De Novo Coronary Artery Lesion: A Multicenter, Randomized, Parallel-Designed, Single Blind Test.

To compare the safety and efficacy of a new everolimus-eluting stent with an abluminal-coated biodegradable polymer (Osstem Cardiotec Centum) with those of the Xience Alpine stent (Xience). This randomized, prospective, multicenter, parallel-designed, single-blind trial was conducted among patients with myocardial ischemia undergoing percutaneous coronary intervention (PCI) from 21st September 2018 until 3rd July 2020. The primary efficacy endpoint was in-segment late lumen loss (LLL) at 270 days after the procedure and the primary safety endpoints were major adverse cardiac events (MACE), composite of cardiac death, myocardial infarction, and target lesion revascularization. We enrolled 121 patients and analyzed 113 patients who finished 270 days of follow-up for the primary efficacy endpoint. The mean age of the participants was 66.8 years. As for the primary efficacy endpoint, LLL of the Osstem Cardiotec Centum group was 0.09±0.13 mm and that of the Xience group was 0.12±0.14 mm (upper limit of 1-sided 95% confidence interval, 0.02; p for non-inferiority, 0.0084). This result demonstrates the non-inferiority of the Osstem Cardiotec Centum. As for the primary safety endpoint, MACE occurred in one patient (1.59% of the Xience group). Meanwhile, no MACE occurred in the Osstem Cardiotec Centum group. The Osstem Cardiotec Centum is non-inferior to the Xience Alpine® stent and is confirmed to be safe. It could be safely and effectively applied to patients with coronary artery disease undergoing PCI.

Early Diagnosis of Acute Ischemic Stroke by Brain Computed Tomography Perfusion Imaging Combined with Head and Neck Computed Tomography Angiography on Deep Learning Algorithm.

The purpose of the research was to discuss the application values of deep learning algorithm-based computed tomography perfusion (CTP) imaging combined with head and neck computed tomography angiography (CTA) in the diagnosis of ultra-early acute ischemic stroke. Firstly, 88 patients with acute ischemic stroke were selected as the research objects and performed with cerebral CTP and CTA examinations. In order to improve the effect of image diagnosis, a new deconvolution network model AD-CNNnet based on deep learning was proposed and used in patient CTP image evaluation. The results showed that the peak signal-to-noise ratio (PSNR) and feature similarity (FSIM) of the AD-CNNnet method were significantly higher than those of traditional methods, while the normalized mean square error (NMSE) was significantly lower than that of traditional algorithms (P < 0.05). 80 cases were positive by CTP-CTA, including 16 cases of hyperacute ischemic stroke and 64 cases of acute ischemic stroke. The diagnostic sensitivity was 93.66%, and the specificity was 96.18%. The cerebral blood flow (CBF), cerebral blood volume (CBV), and the mean transit time (MTT) in the infarcted area were significantly greater than those in the corresponding healthy side area, and the time to peak (TTP) was significantly less than that in the corresponding healthy side area (P < 0.05). The cerebral perfusion parameters CBF, TTP, and MTT in the penumbra were significantly different from those in the infarct central area and the corresponding contralateral area, and TTP was the most sensitive (P < 0.05). To sum up, deep learning algorithm-based CTP combined with CTA could find the location of cerebral infarction lesions as early as possible to provide a reliable diagnostic result for the diagnosis of ultra-early acute ischemic stroke.

Deep learning approach for classifying ischemic stroke using DWI sequences of brain MRIs

Stroke is an emergency condition and must be treated immediately to increase the survivability rate. We propose an automatic detection approach to identify the ischemic stroke infarcts based on deep neural network (DNN) architecture using diffusion-weighted imaging (DWI) sequences of magnetic resonance imaging (MRI) images of the brain. A total 192 stroke images were collected at Kalinga Institute of Medical Science, India. Initially, all the images were pre-processed to reduce the noise and then taken for segmentation of infarct using a Delaunay triangulation (DT) approach. Thirty-four important features are extracted from the segmented infarct lesions and then classified with the DNN classifier. We achieved high detection rate with sensitivity 89.18%, specificity 95.37, Jaccard index 81.46% and accuracy of 92.8% in classifying the ischemic stroke into three sub-types. It is observed from compared results that the deep learning is an effective way to detect the stroke infarcts.

Impact of Diffusion–Perfusion Mismatch on Predicting Final Infarction Lesion Using Deep Learning

We report a study that validates the impact of diffusion-perfusion mismatch in a deep learning (DL) model predicting the final infarction lesion from baseline magnetic resonance imaging (MRI). From 472 consecutive patients with acute ischemic stroke, we gathered baseline and follow-up MRI having intervals of 3–7 days, and initial and final infarction lesions were segmented. Four U-Net-based DL models from baseline MRI with different combinations of diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI) maps, and initial diffusion-restricted lesion prediction map (Pred <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">init</sub> map) were trained to predict the final infarction lesion. Five-fold cross-validation was used for training and testing. As an external test set, 55 patients from another institution were analyzed. Dice similarity coefficient (DSC) was compared between the models and subgroups according to the presence of lesion growth and/or diffusion-perfusion mismatch. The model using the PWI maps and Pred <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">init</sub> map showed the best mean DSC (0.422 and 0.486 for internal and external test set, respectively). This model showed better performance in predicting rapid lesion growth compared with the baseline model (mean DSC difference, 0.040; 95% confidence interval: 0.018–0.062). Using the PWI map with initial diffusion-restricted lesion prediction improved the performance of DL model in predicting the final infarction lesion from baseline MRI.

Ability of weakly supervised learning to detect acute ischemic stroke and hemorrhagic infarction lesions with diffusion-weighted imaging

Gradient-recalled echo (GRE) sequence is time-consuming and not routinely performed. Herein, we aimed to investigate the ability of weakly supervised learning to identify acute ischemic stroke (AIS) and concurrent hemorrhagic infarction based on diffusion-weighted imaging (DWI). First, we proposed spatially locating small stroke lesions in different positions and hemorrhagic infarction lesions by residual neural and visual geometry group networks using weakly supervised learning. Next, we compared the sensitivity and specificity for identifying automatically concurrent hemorrhagic infarction in stroke patients with the sensitivity and specificity of human readings of diffusion and b0 images to evaluate the performance of the weakly supervised methods. Also, the labeling time of the weakly supervised approach was compared with that of the fully supervised approach. Data from a total of 1,027 patients were analyzed. The residual neural network displayed a higher sensitivity than did the visual geometry group network in spatially locating the small stroke and hemorrhagic infarction lesions. The residual neural network had significantly greater patient-level sensitivity than did the human readers (98.4% versus 86.2%, P=0.008) in identifying concurrent hemorrhagic infarction with GRE as the reference standard; however, their specificities were comparable (95.4% versus 96.9%, P>0.99). Weak labeling of lesions required significantly less time than did full labeling of lesions (2.667 versus 10.115 minutes, P<0.001). Weakly supervised learning was able to spatially locate small stroke lesions in different positions and showed more sensitivity than did human reading in identifying concurrent hemorrhagic infarction based on DWI. The proposed approach can reduce the labeling workload.