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Management of patients with diffusion-weighted imaging-negative acute ischemic stroke: Retrospective analysis of 47 consecutive patients.
Mekue Fotso, Vicky; Leibinger, Franck; Rivas Lamelo, Sara; Azaïs, Benoit; Plantard, Carole; Farouil, Geoffroy; Fadat, Bénédicte; Mahmoudi, Mehdi; Olivier, Nadège; Mas, Julie; Fryder, Ivan; Balde, Alpha Amadou; Tardieu, Maxime; Ekue, Wilfried; Seiller, Ian; Dumitrana, Adrian; Utges, Renata; Schmidt, Julia; Ortega, Laurent; Mesmoudi, Amina; Van Damme, Laurène; Sablot, Denis.
Afiliación
  • Mekue Fotso V; Neurology Department, Perpignan.
  • Leibinger F; Intensive Care Unit, Perpignan.
  • Rivas Lamelo S; Neurology Department, Perpignan.
  • Azaïs B; Radiology Department, Perpignan.
  • Plantard C; Neurology Department, Perpignan.
  • Farouil G; Radiology Department, Perpignan.
  • Fadat B; Neurology Department, Perpignan.
  • Mahmoudi M; Radiology Department, Perpignan.
  • Olivier N; Neurology Department, Perpignan.
  • Mas J; Neurology Department, Perpignan.
  • Fryder I; Radiology Department, Perpignan.
  • Balde AA; Neurology Department, Perpignan.
  • Tardieu M; Radiology Department, Perpignan.
  • Ekue W; Neurology Department, Perpignan.
  • Seiller I; Radiology Department, Perpignan.
  • Dumitrana A; Neurology Department, Perpignan.
  • Utges R; Emergency Department, Perpignan.
  • Schmidt J; Neurology Department, Perpignan.
  • Ortega L; Emergency Department, Perpignan.
  • Mesmoudi A; Neurology Department, Perpignan.
  • Van Damme L; Neurology Department, Perpignan.
  • Sablot D; Neurology Department, Perpignan; Regional Health Agency of Occitanie, Montpellier. Electronic address: denis.sablot@ch-perpignan.fr.
J Stroke Cerebrovasc Dis ; 33(11): 107924, 2024 Aug 11.
Article en En | MEDLINE | ID: mdl-39137824
ABSTRACT

BACKGROUND:

Few studies with a limited number of patients focused on the outcomes of patients with diffusion-weighted imaging (DWI)-negative acute ischemic stroke (AIS) after intravenous thrombolysis (IVT) and/or endovascular treatment (EVT).

METHODS:

This retrospective observational, single-center study included all consecutive patients admitted for AIS involving the anterior circulation and treated with IVT and/or EVT between January 1, 2015 and December 31, 2023. The collected data were used to identify the characteristics of patients with negative DWI and to compare outcomes in patients with negative and positive DWI.

RESULTS:

Among the 1210 patients included, 47 (3.9 %) had negative (DWI-negative group) and 1163 had increased DWI signal (DWI-positive group). In the DWI-negative group, the mean age was 69 years (SD=19.4), 55.3 % were men, and 27 (57.4 %) had a large vessel occlusion. Thirty eight (80.9 %) were treated with IVT alone, 7 (14.9 %) with EVT alone, and 2 (4.3 %) with both. Fluid attenuated inversion recovery (FLAIR) sequences were the most sensitive to detect predictive factors of cerebral ischemia, such as vessel thrombosis and the spaghetti sign that were found in 68.1 % and 83 %, of patients, respectively. Oxyhemoglobin-sensitive (T2*) and susceptibility-weighted angiography (SWAN) sequences were less sensitive vessel thrombosis and the brush sign were detected in 55.3 % and 19.1 % of patients, respectively. Comparison of the two DWI groups showed that M2 occlusion was more frequent (31.9 % vs 13 %, p<0.001) and M1 occlusion rarer (19.1 % vs 36 %, p<0.02) in the DWI-negative than DWI-positive group. At admission, the median National Institutes of Health Stroke Scale score was lower in the DWI-negative than DWI-positive group (2 vs 6, p=0.0001), but the median symptom onset-to-MRI time was similar in both groups (108 vs 111 min, p=0.88).

CONCLUSIONS:

In patients with DWI-negative AIS, symptoms are less severe. Large vessel occlusions, notably in the M2 segment, are more distal at the expense of the M1 segment of MCA. The spaghetti sign remains the most predictive feature of AIS that should be specifically searched in the absence of DWI lesions.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Stroke Cerebrovasc Dis Asunto de la revista: ANGIOLOGIA / CEREBRO Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Stroke Cerebrovasc Dis Asunto de la revista: ANGIOLOGIA / CEREBRO Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos