Final 2 year results of the vascular imaging of acute stroke for identifying predictors of clinical outcome and recurrent ischemic eveNts (VISION) study

BMC Cardiovascular Disorders

Andrew M Demchuk³  Karyn Fischer¹  Misha Eliasziw⁴  Michael D Hill⁵  Shelagh B Coutts² 

[1] Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada;Room C1261, Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, University of Calgary, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada;Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, University of Calgary, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada;Department of Community Health Sciences, University of Calgary, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada;Calgary Stroke Program, Department of Clinical Neurosciences, Radiology, Community Health Sciences, and Medicine, University of Calgary, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada

关键词: recurrent stroke;    outcome;    Stroke;    Magnetic resonance Imaging;   

Others  :  1086094
DOI  :  10.1186/1471-2261-11-18

 received in 2010-11-03, accepted in 2011-04-23,  发布年份 2011

【 摘 要 】

Among patients with ischemic stroke, little attention has been paid to differentiation between stroke progression and recurrence. We assessed the role of MR imaging in predicting stroke progression, recurrent stroke, and death within 2 years of symptom onset.

Methods

Ischemic stroke or TIA patients were prospectively enrolled. They were examined within 12 hours and had a stroke MR completed within 24 hours of symptom onset. Patients were closely followed neurologically and examined if there was any deterioration in neurological status. Relationships between baseline clinical and imaging factors and outcomes were assessed. We also examined whether baseline stroke/TIA severity (NIHSS 0-5 versus NIHSS > 5) modified these relationships.

Results

A total of 334 patients were enrolled. The overall rates of progression, 2-year recurrence, and 2-year death were 8.7%, 8.0%, and 6.6%, respectively. Event rates were similar among patients with mild compared to more severe strokes: 8.3% versus 9.5% (p = 0.73) for progression, and 7.3% versus 9.9% (p = 0.59) for recurrence. The effect of baseline glucose > 8 mmol/l was consistent in predicting stroke progression, recurrent stroke and death, regardless of baseline stroke severity. In multivariable analyses, DWI lesion and intracranial occlusion predicted stroke progression only in the minor stroke/TIA group; symptomatic Internal Carotid Artery (ICA) stenosis predicted stroke recurrence only in the minor stroke/TIA group.

Conclusions

In a prospective study with early assessment and imaging we have found that stroke progression is different than stroke recurrence. Different imaging factors predict stroke progression versus stroke recurrence. Baseline hyperglycemia, a potentially modifiable factor, consistently predicted all three outcomes (stroke progression, recurrent stroke or death) regardless of baseline stroke severity.

【 授权许可】

   
2011 Coutts et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Weimar C, Ziegler A, Konig IR, Diener HC: Predicting functional outcome and survival after acute ischemic stroke. J Neurol 2002, 249(7):888-895.
• [2]Chambers BR, Norris JW, Shurvell BL, Hachinski VC: Prognosis of acute stroke. Neurology 1987, 37(2):221-225.
• [3]Sacco RL, Wolf PA, Kannel WB, McNamara PM: Survival and recurrence following stroke. The Framingham study. Stroke 1982, 13(3):290-295.
• [4]Henon H, Godefroy O, Leys D, Mounier-Vehier F, Lucas C, Rondepierre P, Duhamel A, Pruvo JP: Early predictors of death and disability after acute cerebral ischemic event. Stroke 1995, 26(3):392-398.
• [5]Johnston KC, Connors AF Jr, Wagner DP, Knaus WA, Wang X, Haley EC Jr: A predictive risk model for outcomes of ischemic stroke. Stroke 2000, 31(2):448-455.
• [6]Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS: The influence of age on stroke outcome. The Copenhagen Stroke Study. Stroke 1994, 25(4):808-813.
• [7]Adams HP Jr, Davis PH, Leira EC, Chang KC, Bendixen BH, Clarke WR, Woolson RF, Hansen MD: Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology 1999, 53(1):126-131.
• [8]Jorgensen H, Nakayama H, Raaschou HO, Olsen TS: Stroke in patients with diabetes. The Copenhagen Stroke Study. Stroke 1994, 25(10):1977-1984.
• [9]Weimar C, Konig IR, Kraywinkel K, Ziegler A, Diener HC: Age and National Institutes of Health Stroke Scale Score within 6 hours after onset are accurate predictors of outcome after cerebral ischemia: development and external validation of prognostic models. Stroke 2004, 35(1):158-162.
• [10]Hankey GJ, Jamrozik K, Broadhurst RJ, Forbes S, Burvill PW, Anderson CS, Stewart-Wynne EG: Long-term risk of first recurrent stroke in the Perth Community Stroke Study. Stroke 1998, 29(12):2491-2500.
• [11]Appelros P, Nydevik I, Viitanen M: Poor outcome after first-ever stroke: predictors for death, dependency, and recurrent stroke within the first year. Stroke 2003, 34(1):122-126.
• [12]Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, Sidney S: Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007, 369(9558):283-292.
• [13]Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, Hill MD, Patronas N, Latour L, Warach S: Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 2007, 369(9558):293-298.
• [14]Barber PA, Demchuk AM, Zhang J, Buchan AM: Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000, 355(9216):1670-1674.
• [15]Schramm P, Schellinger PD, Klotz E, Kallenberg K, Fiebach JB, Kulkens S, Heiland S, Knauth M, Sartor K: Comparison of perfusion computed tomography and computed tomography angiography source images with perfusion-weighted imaging and diffusion-weighted imaging in patients with acute stroke of less than 6 hours' duration. Stroke 2004, 35(7):1652-1658.
• [16]Baird AE, Dambrosia J, Janket S, Eichbaum Q, Chaves C, Silver B, Barber PA, Parsons M, Darby D, Davis S, et al.: A three-item scale for the early prediction of stroke recovery. Lancet 2001, 357(9274):2095-2099.
• [17]Johnston KC, Connors AF Jr, Wagner DP, Haley EC Jr: Predicting outcome in ischemic stroke: external validation of predictive risk models. Stroke 2003, 34(1):200-202.
• [18]Coutts SB, Hill MD, Campos CR, Choi YB, Subramaniam S, Kosior JC, Demchuk AM: Recurrent events in transient ischemic attack and minor stroke: what events are happening and to which patients? Stroke 2008, 39(9):2461-2466.
• [19]Lavallee PC, Meseguer E, Abboud H, Cabrejo L, Olivot JM, Simon O, Mazighi M, Nifle C, Niclot P, Lapergue B, et al.: A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol 2007, 6(11):953-960.
• [20]Coutts SB, Simon JE, Eliasziw M, Sohn CH, Hill MD, Barber PA, Palumbo V, Kennedy J, Roy J, Gagnon A, et al.: Triaging transient ischemic attack and minor stroke patients using acute magnetic resonance imaging. Ann Neurol 2005, 57(6):848-854.
• [21]Coutts SB, Eliasziw M, Hill MD, Scott JN, Subramaniam S, Buchan AM, Demchuk AM: An improved scoring system for identifying patients at high early risk of stroke and functional impairment after an acute transient ischemic attack or minor stroke. Int J Stroke 2008, 3(1):3-10.
• [22]Coutts SB, Hill MD, Simon JE, Sohn CH, Scott JN, Demchuk AM: Silent ischemia in minor stroke and TIA patients identified on MR imaging. Neurology 2005, 65(4):513-517.
• [23]Sylaja PN, Coutts SB, Krol A, Hill MD, Demchuk AM: When to expect negative diffusion-weighted images in stroke and transient ischemic attack. Stroke 2008, 39(6):1898-1900.
• [24]Sylaja PN, Coutts SB, Subramaniam S, Hill MD, Eliasziw M, Demchuk AM: Acute ischemic lesions of varying ages predict risk of ischemic events in stroke/TIA patients. Neurology 2007, 68(6):415-419.
• [25]Jones WJ, Williams LS, Meschia JF: Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by neurological history and examination. Stroke 2001, 32(10):2232-2236.
• [26]Benjamini Y, Hochberg Y: Controlling the False Discovery Rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society B 1995, 57:289-300.
• [27]Selvin S: Variation and Bias. In Statistical Analysis of Epidemiologic Data. 3rd edition. Oxford University Press; 2004:54-69.
• [28]The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators J Clin Epidemiol 1988, 41(2):105-114.
• [29]Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, Warlow CP, Barnett HJ: Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003, 361(9352):107-116.
• [30]Toni D, Fiorelli M, Gentile M, Bastianello S, Sacchetti ML, Argentino C, Pozzilli C, Fieschi C: Progressing neurological deficit secondary to acute ischemic stroke. A study on predictability, pathogenesis, and prognosis. Arch Neurol 1995, 52(7):670-675.
• [31]Hankey GJ, Slattery JM, Warlow CP: Transient ischaemic attacks: which patients are at high (and low) risk of serious vascular events? J Neurol Neurosurg Psychiatry 1992, 55(8):640-652.
• [32]Hankey GJ: Long-term outcome after ischaemic stroke/transient ischaemic attack. Cerebrovasc Dis 2003, 16(Suppl 1):14-19.
• [33]Kernan WN, Viscoli CM, Brass LM, Makuch RW, Sarrel PM, Roberts RS, Gent M, Rothwell P, Sacco RL, Liu RC, et al.: The stroke prognosis instrument II (SPI-II): A clinical prediction instrument for patients with transient ischemia and nondisabling ischemic stroke. Stroke 2000, 31(2):456-462.
• [34]van Wijk I, Kappelle LJ, van Gijn J, Koudstaal PJ, Franke CL, Vermeulen M, Gorter JW, Algra A: Long-term survival and vascular event risk after transient ischaemic attack or minor ischaemic stroke: a cohort study. Lancet 2005, 365(9477):2098-2104.
• [35]Lee LJ, Kidwell CS, Alger J, Starkman S, Saver JL: Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. Stroke 2000, 31(5):1081-1089.
• [36]Poppe AY, Majumdar SR, Jeerakathil T, Ghali W, Buchan AM, Hill MD: Admission hyperglycemia predicts a worse outcome in stroke patients treated with intravenous thrombolysis. Diabetes Care 2009, 32(4):617-622.
• [37]Gray CS, Hildreth AJ, Sandercock PA, O'Connell JE, Johnston DE, Cartlidge NE, Bamford JM, James OF, Alberti KG: Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia: the UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol 2007, 6(5):397-406.
• [38]Thijs VN, Lansberg MG, Beaulieu C, Marks MP, Moseley ME, Albers GW: Is early ischemic lesion volume on diffusion-weighted imaging an independent predictor of stroke outcome? A multivariable analysis. Stroke 2000, 31(11):2597-2602.
• [39]Hand PJ, Wardlaw JM, Rivers CS, Armitage PA, Bastin ME, Lindley RI, Dennis MS: MR diffusion-weighted imaging and outcome prediction after ischemic stroke. Neurology 2006, 66(8):1159-1163.