BACKGROUND Treatment decision making is strictly associated with the outcomes in patients with ischemic stroke who show a large core infarct.Medical care alone may result in suboptimal treatment efficacy,and endovascu...BACKGROUND Treatment decision making is strictly associated with the outcomes in patients with ischemic stroke who show a large core infarct.Medical care alone may result in suboptimal treatment efficacy,and endovascular treatment may be accompanied by safety issues.Whether endovascular treatment is superior to medical care is not well investigated in the clinical studies.AIM To investigate the efficacy of endovascular treatment and drug therapy alone in mild ischemic stroke patients with large infarct cores.METHODS Fifty patients with mild ischemic stroke and 50 patients with acute ischemic stroke caused by anterior large vessel occlusion were selected at the First Affiliated Hospital of Hebei North University between January 2021 and December 2021.Patients were divided into an endovascular therapy group and a drug therapy group according to different treatment methods.In the endovascular therapy group,there were 28 patients with minor stroke and 22 patients with large infarct cores.The drug therapy group had 22 patients with minor stroke and 28 patients with large infarct cores.The National Institutes of Health Stroke Scale(NIHSS) scores were collected and compared between the two groups immediately after the operation and 24 h and 7 d after the operation.The modified Rankin scale(m RS) and/or activity of daily living were assessed at hospital discharge.RESULTS There was no significant difference in NIHSS scores between the two groups before the operation(P > 0.05).NIHSS scores were lower in the endovascular therapy group than in the drug therapy group at 24 h and 7 d after the operation and at hospital discharge(all P < 0.05).The incidence of early neurologic deterioration was significantly lower in the endovascular therapy group than in the drug therapy group(P < 0.05).At hospital discharge,the m RS score was lower in the endovascular treatment group than in the drug therapy group,and the activity of daily living score was better in the endovascular treatment group than in the drug therapy group(all P < 0.05).During a follow-up of 3 mo,17 patients(34.0%) had good prognosis(m RS ≤ 2),33 patients(66.0%) had poor prognosis(m RS > 2),and 11 patients(22.0%) died.In the medical treatment group,16 patients(m RS ≤ 2) had good prognosis(32.0%),34 patients(m RS > 2) had poor prognosis(68.0%),and 14 patients(28.0%) died.There was no significant difference in prognosis and mortality between the two groups(P > 0.05).CONCLUSION Endovascular therapy can improve NIHSS score and m RS score in patients with mild ischemic stroke and large infarct cores.It is suitable for clinical application.展开更多
BACKGROUND With the increasingly extensive application of artificial intelligence(AI)in medical systems,the accuracy of AI in medical diagnosis in the real world deserves attention and objective evaluation.AIM To inve...BACKGROUND With the increasingly extensive application of artificial intelligence(AI)in medical systems,the accuracy of AI in medical diagnosis in the real world deserves attention and objective evaluation.AIM To investigate the accuracy of AI diagnostic software(Shukun)in assessing ischemic penumbra/core infarction in acute ischemic stroke patients due to large vessel occlusion.METHODS From November 2021 to March 2022,consecutive acute stroke patients with large vessel occlusion who underwent mechanical thrombectomy(MT)post-Shukun AI penumbra assessment were included.Computed tomography angiography(CTA)and perfusion exams were analyzed by AI,reviewed by senior neurointerventional experts.In the case of divergences among the three experts,discussions were held to reach a final conclusion.When the results of AI were inconsistent with the neurointerventional experts’diagnosis,the diagnosis by AI was considered inaccurate.RESULTS A total of 22 patients were included in the study.The vascular recanalization rate was 90.9%,and 63.6%of patients had modified Rankin scale scores of 0-2 at the 3-month follow-up.The computed tomography(CT)perfusion diagnosis by Shukun(AI)was confirmed to be invalid in 3 patients(inaccuracy rate:13.6%).CONCLUSION AI(Shukun)has limits in assessing ischemic penumbra.Integrating clinical and imaging data(CT,CTA,and even magnetic resonance imaging)is crucial for MT decision-making.展开更多
目的基于改进的YOLOv5深度学习模型,构建在CT平扫(non-contrast CT,NCCT)上自动检测急性小面积梗死灶的目标检测模型。方法回顾性纳入2018年1月—2023年12月于扬州大学附属医院就诊的急性缺血性卒中患者,按10∶1的比例随机分为训练/验...目的基于改进的YOLOv5深度学习模型,构建在CT平扫(non-contrast CT,NCCT)上自动检测急性小面积梗死灶的目标检测模型。方法回顾性纳入2018年1月—2023年12月于扬州大学附属医院就诊的急性缺血性卒中患者,按10∶1的比例随机分为训练/验证集与测试集。训练/验证集用于模型参数拟合,比较不同损失函数以优选模型,并采用精确率、召回率及平均精度(mean average precision,mAP)评估模型的检测效能;测试集用于独立评估模型的诊断效能。将MRI DWI图像与NCCT图像进行配准,并在NCCT图像上标记病灶。以DWI-Alberta卒中项目早期CT评分(Alberta stroke program early CT score,ASPECTS)为金标准,在测试集中分别计算模型及医师对ASPECTS各脑区梗死灶检出的敏感度、特异度及准确度,通过McNemar检验比较模型与医师的诊断效能差异。采用组内相关系数(intra-class correlation coefficient,ICC)与加权Kappa检验评估模型及医师CT-ASPECTS与金标准DWI-ASPECTS之间的一致性,并通过Bootstrap自助抽样法对两者的一致性系数进行差异性检验。结果共纳入急性缺血性卒中患者275例,其中训练/验证集250例,测试集25例。改进的YOLOv5深度学习模型在训练/验证阶段的性能最佳:精确率为0.824,召回率为0.810,mAP@0.5为0.785。测试集中,模型病灶检测效能的比较结果显示,模型组的总体准确度(96.00%vs.91.11%)及特异度(98.74%vs.94.70%)优于医师组(均P<0.001);模型组敏感度有高于医师组的趋势(75.93%vs.64.81%),但差异无统计学意义(P=0.288)。在各脑区的亚组分析中,模型组在M6脑区的准确度高于医师组(98.00%vs.84.00%,P=0.039)。模型组CT-ASPECTS与金标准DWI-ASPECTS的一致性(ICC 0.669,P<0.001;加权κ=0.447,P<0.001)较医师组CT-ASPECTS与金标准DWI-ASPECTS的一致性(ICC 0.452,P=0.010;加权κ=0.247,P=0.054)有提高趋势;Bootstrap分析显示,模型组与医师组加权κ的差异具有统计学意义(P=0.044)。结论本研究构建的目标检测模型可在急性缺血性卒中患者的NCCT图像上实现急性小面积梗死灶的自动检测,有助于减少漏诊、提高影像诊断效率,为临床提供可靠的辅助工具。展开更多
Several randomised controlled trials(RCTs)1–5 have established 3-month efficacy and safety of endovascular thrombectomy(EVT)in treating patients with acute ischaemic stroke(AIS)with a large infarct core and low Alber...Several randomised controlled trials(RCTs)1–5 have established 3-month efficacy and safety of endovascular thrombectomy(EVT)in treating patients with acute ischaemic stroke(AIS)with a large infarct core and low Alberta Stroke Program Early Computed Tomographic Scores(ASPECTS),between 3 and 5.Despite EVT,these patients have a higher rate of mortality and unfavourable outcomes at 3 months,delayed recovery or secondary deterioration.6 The long-term outcomes for these patients remain largely uncertain and unexplored.Recently,the SELECT-2,TESLA and TENSION trials have reported 1-year follow-up outcomes.展开更多
目的探究大动脉粥样硬化与心源性栓塞急性缺血性脑卒中(AIS)梗死特征的差异。方法回顾性纳入2016年10月至2018年6月于我院急诊入院治疗,且入院后、治疗前均行多模态计算机断层扫描(CT)检查的AIS患者99例,其中大动脉粥样硬化46例,心源性...目的探究大动脉粥样硬化与心源性栓塞急性缺血性脑卒中(AIS)梗死特征的差异。方法回顾性纳入2016年10月至2018年6月于我院急诊入院治疗,且入院后、治疗前均行多模态计算机断层扫描(CT)检查的AIS患者99例,其中大动脉粥样硬化46例,心源性栓塞53例。比较两组患者的入院时美国国立卫生研究院卒中量表(NIHSS)评分和格拉斯哥昏迷量表(GCS)评分、梗死核心区和缺血半暗带体积及二者差值以及后循环血管闭塞率、颅内大动脉闭塞率。结果大动脉粥样硬化组AIS患者入院时NIHSS评分低于心源性栓塞组[9.5(2.0,16.0)分vs 15.0(6.0,24.0)分,Z=2.31,P<0.001],GCS评分高于心源性栓塞组[(13.52±2.69)分vs(11.60±3.31)分,t=1.04,P=0.002]。心源性栓塞组梗死核心区和缺血半暗带体积分别为1(0,22)m L和64(30,126)m L,均大于大动脉粥样硬化组[分别为0(0,1)m L和10(0,70)m L;Z=3.85、3.43,P均<0.001];但心源性栓塞组和大动脉粥样硬化组缺血半暗带与梗死核心区体积的差值差异无统计学意义[46(4,103)m L vs 10(0,64)m L,Z=1.92,P>0.05]。大动脉粥样硬化组颅内大动脉闭塞率和后循环血管闭塞率分别为30.43%(14/46)和36.96%(17/46),与心源性栓塞组[分别为50.94%(27/53)和9.43%(5/53)]相比差异均有统计学意义(χ~2=11.82、6.77,P均<0.001)。结论大动脉粥样硬化与心源性栓塞AIS患者的临床症状、脑组织改变及颅内大动脉改变不同,基于临床及多模态CT检查的病因学评估有助于精确评估AIS患者缺血状态。展开更多
Objectives Endovascular therapy(EVT)now penetrates the once obscure realm of large infarct core volume acute ischaemic stroke(LICV-AIS).This research aimed to investigate the potential correlation between different an...Objectives Endovascular therapy(EVT)now penetrates the once obscure realm of large infarct core volume acute ischaemic stroke(LICV-AIS).This research aimed to investigate the potential correlation between different anaesthetic approaches and post-EVT outcomes in LICV-AIS patients.Methods Between October 2020 and May 2022,the China ANGEL-Alberta Stroke Programme Early CT Score(ASPECT)trial studied patients with LICV-AIS,randomly assigning them to the best medical management(BMM)or BMM with EVT.This post hoc subgroup analysis categorised subjects receiving BMM with EVT into general anaesthesia(GA)and non-GA groups based on anaesthesia type.We applied multivariable logistic regression to evaluate the relationship between anaesthesia during EVT and patient functional outcomes,as measured by the modified Rankin scale(mRS),in addition to the occurrence of complications.Further adjustment for selection bias was achieved through propensity score matching(PSM).Results In total,230 patients with LICV-AIS were enrolled(GA 84 vs Non-GA 146).No significant difference was observed between the two groups in terms of the proportion of patients who achieved an mRS score of 0-2 at 90 days(27.4%for the GA group vs 31.5%for the non-GA group,p=0.51).However,the GA group had significantly longer median surgical times(142 min vs 122 min,p=0.03).Furthermore,GA was associated with an increased risk of postoperative pneumonia(adjusted OR 2.03,95%CI 1.04 to 3.98).The results of PSM analysis agreed with the results of the multivariate regression analysis.No significant difference in intracranial haemorrhage incidence or mortality rate was observed between the groups.Conclusion This post hoc analysis of subgroups of the ANGEL-ASPECT trial suggested that there may be no significant association between the choice of anaesthesia and neurological outcomes in LICV-AIS patients.However,compared with non-GA,GA prolongs the duration of EVT and is associated with a greater postoperative pneumonia risk.展开更多
基金Supported by Scientific Research Fund of Hebei Health Commission 2022,No.20220591。
文摘BACKGROUND Treatment decision making is strictly associated with the outcomes in patients with ischemic stroke who show a large core infarct.Medical care alone may result in suboptimal treatment efficacy,and endovascular treatment may be accompanied by safety issues.Whether endovascular treatment is superior to medical care is not well investigated in the clinical studies.AIM To investigate the efficacy of endovascular treatment and drug therapy alone in mild ischemic stroke patients with large infarct cores.METHODS Fifty patients with mild ischemic stroke and 50 patients with acute ischemic stroke caused by anterior large vessel occlusion were selected at the First Affiliated Hospital of Hebei North University between January 2021 and December 2021.Patients were divided into an endovascular therapy group and a drug therapy group according to different treatment methods.In the endovascular therapy group,there were 28 patients with minor stroke and 22 patients with large infarct cores.The drug therapy group had 22 patients with minor stroke and 28 patients with large infarct cores.The National Institutes of Health Stroke Scale(NIHSS) scores were collected and compared between the two groups immediately after the operation and 24 h and 7 d after the operation.The modified Rankin scale(m RS) and/or activity of daily living were assessed at hospital discharge.RESULTS There was no significant difference in NIHSS scores between the two groups before the operation(P > 0.05).NIHSS scores were lower in the endovascular therapy group than in the drug therapy group at 24 h and 7 d after the operation and at hospital discharge(all P < 0.05).The incidence of early neurologic deterioration was significantly lower in the endovascular therapy group than in the drug therapy group(P < 0.05).At hospital discharge,the m RS score was lower in the endovascular treatment group than in the drug therapy group,and the activity of daily living score was better in the endovascular treatment group than in the drug therapy group(all P < 0.05).During a follow-up of 3 mo,17 patients(34.0%) had good prognosis(m RS ≤ 2),33 patients(66.0%) had poor prognosis(m RS > 2),and 11 patients(22.0%) died.In the medical treatment group,16 patients(m RS ≤ 2) had good prognosis(32.0%),34 patients(m RS > 2) had poor prognosis(68.0%),and 14 patients(28.0%) died.There was no significant difference in prognosis and mortality between the two groups(P > 0.05).CONCLUSION Endovascular therapy can improve NIHSS score and m RS score in patients with mild ischemic stroke and large infarct cores.It is suitable for clinical application.
文摘BACKGROUND With the increasingly extensive application of artificial intelligence(AI)in medical systems,the accuracy of AI in medical diagnosis in the real world deserves attention and objective evaluation.AIM To investigate the accuracy of AI diagnostic software(Shukun)in assessing ischemic penumbra/core infarction in acute ischemic stroke patients due to large vessel occlusion.METHODS From November 2021 to March 2022,consecutive acute stroke patients with large vessel occlusion who underwent mechanical thrombectomy(MT)post-Shukun AI penumbra assessment were included.Computed tomography angiography(CTA)and perfusion exams were analyzed by AI,reviewed by senior neurointerventional experts.In the case of divergences among the three experts,discussions were held to reach a final conclusion.When the results of AI were inconsistent with the neurointerventional experts’diagnosis,the diagnosis by AI was considered inaccurate.RESULTS A total of 22 patients were included in the study.The vascular recanalization rate was 90.9%,and 63.6%of patients had modified Rankin scale scores of 0-2 at the 3-month follow-up.The computed tomography(CT)perfusion diagnosis by Shukun(AI)was confirmed to be invalid in 3 patients(inaccuracy rate:13.6%).CONCLUSION AI(Shukun)has limits in assessing ischemic penumbra.Integrating clinical and imaging data(CT,CTA,and even magnetic resonance imaging)is crucial for MT decision-making.
文摘目的基于改进的YOLOv5深度学习模型,构建在CT平扫(non-contrast CT,NCCT)上自动检测急性小面积梗死灶的目标检测模型。方法回顾性纳入2018年1月—2023年12月于扬州大学附属医院就诊的急性缺血性卒中患者,按10∶1的比例随机分为训练/验证集与测试集。训练/验证集用于模型参数拟合,比较不同损失函数以优选模型,并采用精确率、召回率及平均精度(mean average precision,mAP)评估模型的检测效能;测试集用于独立评估模型的诊断效能。将MRI DWI图像与NCCT图像进行配准,并在NCCT图像上标记病灶。以DWI-Alberta卒中项目早期CT评分(Alberta stroke program early CT score,ASPECTS)为金标准,在测试集中分别计算模型及医师对ASPECTS各脑区梗死灶检出的敏感度、特异度及准确度,通过McNemar检验比较模型与医师的诊断效能差异。采用组内相关系数(intra-class correlation coefficient,ICC)与加权Kappa检验评估模型及医师CT-ASPECTS与金标准DWI-ASPECTS之间的一致性,并通过Bootstrap自助抽样法对两者的一致性系数进行差异性检验。结果共纳入急性缺血性卒中患者275例,其中训练/验证集250例,测试集25例。改进的YOLOv5深度学习模型在训练/验证阶段的性能最佳:精确率为0.824,召回率为0.810,mAP@0.5为0.785。测试集中,模型病灶检测效能的比较结果显示,模型组的总体准确度(96.00%vs.91.11%)及特异度(98.74%vs.94.70%)优于医师组(均P<0.001);模型组敏感度有高于医师组的趋势(75.93%vs.64.81%),但差异无统计学意义(P=0.288)。在各脑区的亚组分析中,模型组在M6脑区的准确度高于医师组(98.00%vs.84.00%,P=0.039)。模型组CT-ASPECTS与金标准DWI-ASPECTS的一致性(ICC 0.669,P<0.001;加权κ=0.447,P<0.001)较医师组CT-ASPECTS与金标准DWI-ASPECTS的一致性(ICC 0.452,P=0.010;加权κ=0.247,P=0.054)有提高趋势;Bootstrap分析显示,模型组与医师组加权κ的差异具有统计学意义(P=0.044)。结论本研究构建的目标检测模型可在急性缺血性卒中患者的NCCT图像上实现急性小面积梗死灶的自动检测,有助于减少漏诊、提高影像诊断效率,为临床提供可靠的辅助工具。
基金Shenyang Science and Technology Bureau(22-321-33-55,L190082,L230149).
文摘Several randomised controlled trials(RCTs)1–5 have established 3-month efficacy and safety of endovascular thrombectomy(EVT)in treating patients with acute ischaemic stroke(AIS)with a large infarct core and low Alberta Stroke Program Early Computed Tomographic Scores(ASPECTS),between 3 and 5.Despite EVT,these patients have a higher rate of mortality and unfavourable outcomes at 3 months,delayed recovery or secondary deterioration.6 The long-term outcomes for these patients remain largely uncertain and unexplored.Recently,the SELECT-2,TESLA and TENSION trials have reported 1-year follow-up outcomes.
文摘目的探究大动脉粥样硬化与心源性栓塞急性缺血性脑卒中(AIS)梗死特征的差异。方法回顾性纳入2016年10月至2018年6月于我院急诊入院治疗,且入院后、治疗前均行多模态计算机断层扫描(CT)检查的AIS患者99例,其中大动脉粥样硬化46例,心源性栓塞53例。比较两组患者的入院时美国国立卫生研究院卒中量表(NIHSS)评分和格拉斯哥昏迷量表(GCS)评分、梗死核心区和缺血半暗带体积及二者差值以及后循环血管闭塞率、颅内大动脉闭塞率。结果大动脉粥样硬化组AIS患者入院时NIHSS评分低于心源性栓塞组[9.5(2.0,16.0)分vs 15.0(6.0,24.0)分,Z=2.31,P<0.001],GCS评分高于心源性栓塞组[(13.52±2.69)分vs(11.60±3.31)分,t=1.04,P=0.002]。心源性栓塞组梗死核心区和缺血半暗带体积分别为1(0,22)m L和64(30,126)m L,均大于大动脉粥样硬化组[分别为0(0,1)m L和10(0,70)m L;Z=3.85、3.43,P均<0.001];但心源性栓塞组和大动脉粥样硬化组缺血半暗带与梗死核心区体积的差值差异无统计学意义[46(4,103)m L vs 10(0,64)m L,Z=1.92,P>0.05]。大动脉粥样硬化组颅内大动脉闭塞率和后循环血管闭塞率分别为30.43%(14/46)和36.96%(17/46),与心源性栓塞组[分别为50.94%(27/53)和9.43%(5/53)]相比差异均有统计学意义(χ~2=11.82、6.77,P均<0.001)。结论大动脉粥样硬化与心源性栓塞AIS患者的临床症状、脑组织改变及颅内大动脉改变不同,基于临床及多模态CT检查的病因学评估有助于精确评估AIS患者缺血状态。
基金funded by Covidien Healthcare International Trading(Shanghai),Johnson&Johnson MedTech,Genesis MedTech(Shanghai)and Shanghai HeartCare Medical Technologysupported by the Clinical Medicine Development of Special Funding Support(ZYLX201708+2 种基金DFL20180502)the Beijing Municipal Science&Technology Commission(Z19110700660000)the Capital’s Funds for Health Improvement and Research(CFH 2024-2-2046).
文摘Objectives Endovascular therapy(EVT)now penetrates the once obscure realm of large infarct core volume acute ischaemic stroke(LICV-AIS).This research aimed to investigate the potential correlation between different anaesthetic approaches and post-EVT outcomes in LICV-AIS patients.Methods Between October 2020 and May 2022,the China ANGEL-Alberta Stroke Programme Early CT Score(ASPECT)trial studied patients with LICV-AIS,randomly assigning them to the best medical management(BMM)or BMM with EVT.This post hoc subgroup analysis categorised subjects receiving BMM with EVT into general anaesthesia(GA)and non-GA groups based on anaesthesia type.We applied multivariable logistic regression to evaluate the relationship between anaesthesia during EVT and patient functional outcomes,as measured by the modified Rankin scale(mRS),in addition to the occurrence of complications.Further adjustment for selection bias was achieved through propensity score matching(PSM).Results In total,230 patients with LICV-AIS were enrolled(GA 84 vs Non-GA 146).No significant difference was observed between the two groups in terms of the proportion of patients who achieved an mRS score of 0-2 at 90 days(27.4%for the GA group vs 31.5%for the non-GA group,p=0.51).However,the GA group had significantly longer median surgical times(142 min vs 122 min,p=0.03).Furthermore,GA was associated with an increased risk of postoperative pneumonia(adjusted OR 2.03,95%CI 1.04 to 3.98).The results of PSM analysis agreed with the results of the multivariate regression analysis.No significant difference in intracranial haemorrhage incidence or mortality rate was observed between the groups.Conclusion This post hoc analysis of subgroups of the ANGEL-ASPECT trial suggested that there may be no significant association between the choice of anaesthesia and neurological outcomes in LICV-AIS patients.However,compared with non-GA,GA prolongs the duration of EVT and is associated with a greater postoperative pneumonia risk.
