Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, March 28, 2021

Dynamics of cerebral perfusion and oxygenation parameters following endovascular treatment of acute ischemic stroke

All you are measuring is intermediate steps, survivors don't give a damn about those, they want to know how you are getting them 100% recovered.

Dynamics of cerebral perfusion and oxygenation parameters following endovascular treatment of acute ischemic stroke

  1. Gianluca Brugnara1,
  2. Christian Herweh1,
  3. Ulf Neuberger1,
  4. Mikkel Bo Hansen2,
  5. Christian Ulfert1,
  6. Mustafa Ahmed Mahmutoglu1,
  7. Martha Foltyn1,
  8. Simon Nagel3,
  9. Silvia Schönenberger3,
  10. Sabine Heiland1,
  11. Peter Arthur Ringleb3,
  12. Martin Bendszus1,
  13. Markus Möhlenbruch1,
  14. Johannes Alex Rolf Pfaff1,
  15. Philipp Vollmuth1
  1. Correspondence to Dr Philipp Vollmuth, Department of Neuroradiology, University Hospital Heidelberg, Heidelberg 69120, Baden-Württemberg, Germany; philipp.vollmuth@med.uni-heidelberg.de

Abstract

Background We studied the effects of endovascular treatment (EVT) and the impact of the extent of recanalization on cerebral perfusion and oxygenation parameters in patients with acute ischemic stroke (AIS) and large vessel occlusion (LVO).

Methods Forty-seven patients with anterior LVO underwent computed tomography perfusion (CTP) before and immediately after EVT. The entire ischemic region (Tmax >6 s) was segmented before intervention, and tissue perfusion (time-to-maximum (Tmax), time-to-peak (TTP), mean transit time (MTT), cerebral blood volume (CBV), cerebral blood flow (CBF)) and oxygenation (coefficientof variation (COV), capillary transit time heterogeneity (CTH), metabolic rate of oxygen (CMRO2), oxygen extraction fraction (OEF)) parameters were quantified from the segmented area at baseline and the corresponding area immediately after intervention, as well as within the ischemic core and penumbra. The impact of the extent of recanalization (modified Treatment in Cerebral Infarction (mTICI)) on CTP parameters was assessed with the Wilcoxon test and Pearson’s correlation coefficients.

Results The Tmax, MTT, OEF and CTH values immediately after EVT were lower in patients with complete (as compared with incomplete) recanalization, whereas CBF and COV values were higher (P<0.05) and no differences were found in other parameters. The ischemic penumbra immediately after EVT was lower in patients with complete recanalization as compared with those with incomplete recanalization (P=0.002), whereas no difference was found for the ischemic core (P=0.12). Specifically, higher mTICI scores were associated with a greater reduction of ischemic penumbra volumes (R²=−0.48 (95% CI –0.67 to –0.22), P=0.001) but not of ischemic core volumes (P=0.098).

Conclusions Our study demonstrates that the ischemic penumbra is the key target of successful EVT in patients with AIS and largely determines its efficacy on a tissue level. Furthermore, we confirm the validity of the mTICI score as a surrogate parameter of interventional success (There is no success if not 100% recovered! You are assuming your intermediate step of recanalization can be called success. NO IT CAN'T) on a tissue perfusion level.

Footnotes

  • Twitter @GianBrugna, @vollmuthp

  • Contributors Research concept and design: PV, GB, MB. Data acquisition: all authors. Imaging data post-processing: GB, MAM, MF, UN. Data analysis and interpretation: GB, PV. Statistical analysis: GB, PV. Drafting the manuscript: PV, GB. Critical revision of the manuscript for important intellectual content: all authors. Responsibility for funding and supervision: PV.

  • Funding PV was supported by the Else Kroner-Fresenius Foundation (Else-Kroner Memorial Scholarship).

No comments:

Post a Comment