Neuroprotection in Malignant MCA Infarction

Delgado, Pilar; Sahuquillo, Juan; Poca, María A.; Alvarez-Sabin, José

doi:10.1159/000091709

Cited by 7 publications

(4 citation statements)

References 97 publications

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“…CT and MRI based surrogate markers may aid in the early diagnosis of edema after stroke. 38-40 Hypothermia should be induced as early as possible to achieve maximum neuroprotection and edema blocking effect 41 . Controversy remains, however, regarding the therapeutic window for hypothermia and the optimum cooling duration.…”

Section: Treatmentmentioning

confidence: 99%

Overview of Therapeutic Hypothermia

Song

Lyden

2012

Curr Treat Options Neurol

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Therapeutic Hypothermia has proven neuroprotective effects in global cerebral ischemia. Indications for hypothermia induction include cardiac arrest and neonatal asphyxia. The two general methods of induced hypothermia are either surface cooling or endovascular cooling. Hypothermia should be induced as early as possible to achieve maximum neuroprotection and edema blocking effect. Endovascular cooling has the benefit of shorter time to reach target temperature but catheter insertion requires expertise and training, which may be a barrier to widespread availability. The optimum method of cooling is yet to be determined but a multimodal approach is necessary to address three phases of cooling: induction, maintentance, and re-warm. Specifying core practitioners who are well-versed in established guidelines can help integrate the multidisciplinary team that is needed to successfully implement cooling protocols. Reducing shivering to make heat exchange more efficient with tighter temperature control enables quicker time to target temperature and avoids re-warming which can lead to inadvertent increase in intracranial pressure and cerebral edema. Promising applications but yet to be determined is whether hypothermia treatment can improve outcomes in acute ischemic stroke or traumatic brain injury.

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Section: Treatmentmentioning

confidence: 99%

Overview of Therapeutic Hypothermia

Song

Lyden

2012

Curr Treat Options Neurol

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“…1,2 Decompressive surgery in patients with malignant MCA infarction has been accepted as the most effective therapy to improve patient outcome in malignant MCA infarction. [3][4][5][6] However, the extent of decompressive craniectomy varies according to the neurosurgeons and there are currently no standard landmarks for this surgery.…”

mentioning

confidence: 99%

Newly Suggested Surgical Method of Decompressive Craniectomy for Patients With Middle Cerebral Artery Infarction

et al. 2011

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Objectives:The purpose of this study is to suggest the landmarks for decompressive craniectomy so that surgery can be standardized to achieve adequate decompression in patients with malignant middle cerebral artery infarction. We also analyzed the efficacy and safety of this newly suggested surgical method. Methods:Eleven patients (group A) underwent this newly suggested decompressive surgery. The bony landmarks for decompressive craniectomy are described. The area of the bone flap and the brain volume protruding out of the skull surface were measured. The outcomes were evaluated 3 months after the surgery. All the results were compared with that of 13 patients (group B) who were treated with conventional surgical methods.

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“…The Midline shift was defined as midline shift of more than 5 mm at the septum pellucidum level or more than 2 mm at the pineal gland level. 17 The extent of hypodensity was classified as whether or not the visible hypodensity involved > 1/3 of the MCA territory. The location of infarction was classified into anterior circulation infarction, posterior circulation infarction, or both anterior and posterior circulation infarction.…”

Section: Methodsmentioning

confidence: 99%

Radiomics-based prediction of hemorrhage expansion among patients with thrombolysis/thrombectomy related-hemorrhagic transformation using machine learning

Liu

Tao

Wang

et al. 2021

Ther Adv Neurol Disord

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Introduction: Patients with hemorrhagic transformation (HT) were reported to have hemorrhage expansion. However, identification these patients with high risk of hemorrhage expansion has not been well studied. Objectives: We aimed to develop a radiomic score to predict hemorrhage expansion after HT among patients treated with thrombolysis/thrombectomy during acute phase of ischemic stroke. Methods: A total of 104 patients with HT after reperfusion treatment from the West China hospital, Sichuan University, were retrospectively included in this study between 1 January 2012 and 31 December 2020. The preprocessed initial non-contrast-enhanced computed tomography (NECT) imaging brain images were used for radiomic feature extraction. A synthetic minority oversampling technique (SMOTE) was applied to the original data set. The after-SMOTE data set was randomly split into training and testing cohorts with an 8:2 ratio by a stratified random sampling method. The least absolute shrinkage and selection operator (LASSO) regression were applied to identify candidate radiomic features and construct the radiomic score. The performance of the score was evaluated by receiver operating characteristic (ROC) analysis and a calibration curve. Decision curve analysis (DCA) was performed to evaluate the clinical value of the model. Results: Among the 104 patients, 17 patients were identified with hemorrhage expansion after HT detection. A total of 154 candidate predictors were extracted from NECT images and five optimal features were ultimately included in the development of the radiomic score by using logistic regression machine-learning approach. The radiomic score showed good performance with high area under the curves in both the training data set (0.91, sensitivity: 0.83; specificity: 0.89), test data set (0.87, sensitivity: 0.60; specificity: 0.85), and original data set (0.82, sensitivity: 0.77; specificity: 0.78). The calibration curve and DCA also indicated that there was a high accuracy and clinical usefulness of the radiomic score for hemorrhage expansion prediction after HT. Conclusions: The currently established NECT-based radiomic score is valuable in predicting hemorrhage expansion after HT among patients treated with reperfusion treatment after ischemic stroke, which may aid clinicians in determining patients with HT who are most likely to benefit from anti-expansion treatment.

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Neuroprotection in Malignant MCA Infarction

Cited by 7 publications

References 97 publications

Overview of Therapeutic Hypothermia

Overview of Therapeutic Hypothermia

Newly Suggested Surgical Method of Decompressive Craniectomy for Patients With Middle Cerebral Artery Infarction

Radiomics-based prediction of hemorrhage expansion among patients with thrombolysis/thrombectomy related-hemorrhagic transformation using machine learning

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