Papel del diffusion tensor imaging en la resonancia magnética cerebral como marcador predictivo del estado motor y evolución funcional en pacientes con hemorragia intracerebral

The present thesis, aims to study whether the evaluation of the CT through DTI and tractography sequences in the first 12 hours from the ICH onset, is able to predict the motor and functional outcome at 3 months. The results of this thesis allow us to affirm that the fractional anisotropy (FA) valours of the CT, evaluated in the first 12 hours since the ICH onset, is an excellent independent and early predictor of motor function and functional prognosis at 3 months in patients with HIC. In addition, the study with the same sequences at 30 days, does not demonstrate better results. Therefore, the inclusion of MRI sequences such as DTI in the study of ICH in the acute phase, would allow the identification of those patients who could benefit from intensive medical and rehabilitative therapies from the first hours, as well as providing information regarding the prognosis to patients and relativesLa presente tesis doctoral, pretende estudiar si la evaluación del TCE mediante secuencias de DTI y tractografía en las primeras 12 horas desde el inicio de la HIC, es capaz de predecir el déficit motor y el estado funcional a los 3 meses. Los resultados de esta tesis permiten afirmar que la anisotropía fraccionada (FA) del TCE, evaluada en las primeras 12 horas desde el inicio de la HIC es un excelente predictor independiente y precoz de la función motora y del pronóstico funcional a los 3 meses en pacientes que sufren una HIC. Además, el estudio mediante la misma técnica a los 30 días, no ofrece mejores resultados. Por tanto, la inclusión de secuencias de RM como el DTI en el estudio de la HIC en la fase aguda, permitiría identificar aquellos pacientes que pudieran beneficiarse de un tratamiento médico y rehabilitador intensivos desde las primeras horas, así como facilitar la información en cuanto al pronóstico a pacientes y familiare

Papel del diffusion tensor imaging en la resonancia magnética cerebral como marcador predictivo del estado motor y evolución funcional en pacientes con hemorragia intracerebral

The present thesis, aims to study whether the evaluation of the CT through DTI and tractography sequences in the first 12 hours from the ICH onset, is able to predict the motor and functional outcome at 3 months. The results of this thesis allow us to affirm that the fractional anisotropy (FA) valours of the CT, evaluated in the first 12 hours since the ICH onset, is an excellent independent and early predictor of motor function and functional prognosis at 3 months in patients with HIC. In addition, the study with the same sequences at 30 days, does not demonstrate better results. Therefore, the inclusion of MRI sequences such as DTI in the study of ICH in the acute phase, would allow the identification of those patients who could benefit from intensive medical and rehabilitative therapies from the first hours, as well as providing information regarding the prognosis to patients and relativesLa presente tesis doctoral, pretende estudiar si la evaluación del TCE mediante secuencias de DTI y tractografía en las primeras 12 horas desde el inicio de la HIC, es capaz de predecir el déficit motor y el estado funcional a los 3 meses. Los resultados de esta tesis permiten afirmar que la anisotropía fraccionada (FA) del TCE, evaluada en las primeras 12 horas desde el inicio de la HIC es un excelente predictor independiente y precoz de la función motora y del pronóstico funcional a los 3 meses en pacientes que sufren una HIC. Además, el estudio mediante la misma técnica a los 30 días, no ofrece mejores resultados. Por tanto, la inclusión de secuencias de RM como el DTI en el estudio de la HIC en la fase aguda, permitiría identificar aquellos pacientes que pudieran beneficiarse de un tratamiento médico y rehabilitador intensivos desde las primeras horas, así como facilitar la información en cuanto al pronóstico a pacientes y familiare

Early and delayed infarct growth in patients undergoing mechanical thrombectomy: a prospective, serial MRI study

BACKGROUND: We studied the evolution over time of diffusion weighted imaging (DWI) lesion volume and the factors involved on early and late infarct growth (EIG and LIG) in stroke patients undergoing endovascular treatment (EVT) according to the final revascularization grade. METHODS: This is a prospective cohort of patients with anterior large artery occlusion undergoing EVT arriving at 1 comprehensive stroke center. Magnetic resonance imaging was performed on arrival (pre-EVT), <2 hours after EVT (post-EVT), and on day 5. DWI lesions and perfusion maps were evaluated. Arterial revascularization was assessed according to the modified Thrombolysis in Cerebral Infarction (mTICI) grades. We recorded National Institutes of Health Stroke Scale at arrival and at day 7. EIG was defined as (DWI volume post-EVT–DWI volume pre-EVT), and LIG was defined as (DWI volume at 5d–DWI volume post-EVT). Factors involved in EIG and LIG were tested via multivariable lineal models. RESULTS: We included 98 patients (mean age 70, median National Institutes of Health Stroke Scale score 17, final mTICI=2b 86%). Median EIG and LIG were 48 and 63.3 mL in patients with final mTICI<2b, and 3.6 and 3.9 cc in patients with final mTICI=2b. Both EIG and LIG were associated with higher National Institutes of Health Stroke Scale at day 7 (¿=0.667; P<0.01 and ¿=0.614; P<0.01, respectively). In patients with final mTICI=2b, each 10% increase in the volume of DWI pre-EVT and each extra pass leaded to growths of 9% (95% CI, 7%–10%) and 14% (95% CI, 2%–28%) in the DWI volume post-EVT, respectively. Furthermore, each 10% increase in the volume of DWI post-EVT, each extra pass, and each 10 mL increase in TMax6s post-EVT were associated with growths of 8% (95% CI, 6%–9%), 9% (95% CI, 0%–19%), and 12% (95% CI, 5%–20%) in the volume of DWI post-EVT, respectively. CONCLUSIONS: Infarct grows during and after EVT, especially in nonrecanalizers but also to a lesser extent in recanalizers. In recanalizers, number of passes and DWI volume influence EIG, while number of passes, DWI, and hypoperfused volume after the procedure determine LIG.Postprint (author's final draft

Additional file 1 of Statistical analysis plan for the multicenter, open, randomized controlled clinical trial to assess the efficacy and safety of intravenous tirofiban vs aspirin in acute ischemic stroke due to tandem lesion, undergoing recanalization therapy by endovascular treatment (ATILA trial)

Additional file 1: Supplementary Material 1. Minor Revision. Supplementary Material 2. DSMB. Supplementary Material 3. Full protocol