Sang Bong Lee

Background: Poor outcomes after acute ischemic stroke (AIS) revascularization are anticipated in patients with dementia due to advanced age, comorbidities, and reduced disease awareness. This study investigated clinical characteristics and short-term outcomes of AIS revascularization in patients undergoing dementia treatment.Methods: We retrospectively reviewed patients who underwent AIS revascularization therapy at eight centers of the Catholic University of Korea. Patients receiving anti-dementia medication for cognitive impairment before stroke onset were analyzed. Clinical characteristics and outcomes, including the modified Rankin Scale (mRS) score, hemorrhagic transformation, and mortality, were collected.Results: Among 1,379 patients who received AIS revascularization over 5 years, 13 (0.94%; mean age 83 years; 8 females) had a preexisting diagnosis of dementia (Alzheimer’s disease in 11, mild cognitive impairment in 2) and were on anti-dementia medication. Two patients underwent intravenous thrombolysis combined with endovascular therapy, whereas 11 underwent endovascular therapy alone. Most patients (11/13, 84.6%) presented with an unclear onset time. Stroke lesions were located in the right middle cerebral artery (MCA) in seven cases, left MCA in three, bilateral MCAs in one, and posterior circulation in two. Hemorrhagic transformation occurred in six patients (46%), of whom three (23%) were symptomatic. The mRS scores at discharge were 6 in two patients, 5 in one patient, 4 in nine patients, and 3 in one patient. Four patients died within 3 months of stroke onset.Conclusion: The proportion of patients with cognitive impairment receiving anti-dementia medication among those undergoing stroke revascularization therapy was very small. The rates of hemorrhagic transformation and mortality were high. None of the patients achieved favorable outcomes at discharge.

Purpose To compare the prognostic abilities of multiphase CT angiography (mCTA) and multiphase MR angiography (MRA) collateral map in acute anterior circulation ischemic stroke. Methods This secondary analysis of a prospective observational study included data from participants with acute ischemic stroke due to steno-occlusion of the internal carotid artery and/or middle cerebral artery within 8 h of symptom onset between January 1, 2016, and March 31, 2021. The intermethod agreement of the collateral scores (CSs) from mCTA and the collateral perfusion scores (CPSs) from the MRA collateral map was analyzed. Multiple logistic regression analyses were conducted to determine the prognostic value of mCTA and MRA collateral maps. Results 169 participants (106 men and 63 women, mean age 69 years ± 13) were included. The agreement between the CSs of mCTA and the CPSs of the MRA collateral map (weighted kappa = 0.44, 95% confidence interval [CI]: 0.37–0.52) of 168 participants was moderate. Younger age (Odds ratio [OR], 0.51; 95% CI, 0.34–0.76; p = 0.001), lower baseline NIHSS scores (OR, 0.89; 95% CI, 0.81–0.99; p = 0.024), CPS 4 (OR, 36.66; 95% CI, 1.79–750.29; p = 0.019) and CPS 5 (OR, 144.10; 95% CI, 1.11–18788.93; p = 0.046) on the MRA collateral map, and successful reperfusion (OR, 9.63; 95% CI, 3.00–30.94; p < 0.001) were independently associated with favorable functional outcomes. Conclusions Only the MRA collateral map demonstrated clinical prognostic value in acute anterior circulation ischemic stroke patients, demonstrating the superiority of the MRA collateral map over mCTA in collateral assessment.

Objective : Collateral circulation is associated with the differential treatment effect of endovascular thrombectomy (EVT) in acute ischemic stroke. We aimed to verify the ability of the collateral map to predict futile EVT in patients with acute anterior circulation ischemic stroke.Methods : This secondary analysis of a prospective observational study included data from participants underwent EVT for acute ischemic stroke due to occlusion of the internal carotid artery and/or the middle cerebral artery within 8 hours of symptom onset. Multiple logistic regression analyses were conducted to identify independent predictors of futile recanalization (modified Rankin scale score at 90 days of 4–6 despite of successful reperfusion).Results : In a total of 214 participants, older age (odds ratio [OR], 2.40; 95% confidence interval [CI], 1.56 to 3.67; p<0.001), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR, 1.12; 95% CI, 1.04 to 1.21; p=0.004), very poor collateral perfusion grade (OR, 35.09; 95% CI, 3.50 to 351.33; p=0.002), longer door-to-puncture time (OR, 1.08; 95% CI, 1.02 to 1.14; p=0.009), and failed reperfusion (OR, 3.73; 95% CI, 1.30 to 10.76; p=0.015) were associated with unfavorable functional outcomes. In 184 participants who achieved successful reperfusion, older age (OR, 2.30; 95% CI, 1.44 to 3.67; p<0.001), higher baseline NIHSS scores (OR, 1.12; 95% CI, 1.03 to 1.22; p=0.006), very poor collateral perfusion grade (OR, 4.96; 95% CI, 1.42 to 17.37; p=0.012), and longer door-to-reperfusion time (OR, 1.09; 95% CI, 1.03 to 1.15; p=0.003) were associated with unfavorable functional outcomes.Conclusion : The assessment of collateral perfusion status using the collateral map can predict futile EVT, which may help select ineligible patients for EVT, thereby potentially reducing the rate of futile EVT.

Background: Alzheimer’s disease (AD) is the main cause of cognitive impairment in late‐life, and the typical early presentation of AD in older adults is amnestic cognitive impairment. Mini‐Mental State Examination (MMSE) is widely used in screening cognitive impairment in elderly. The aim of this study was to examine which MMSE items would be more associated with the verbal memory impairment in individuals with mild cognitive impairment (MCI).Method: 249 MCI subjects (mean age: 73.67 ± 6.79 years) were included in this study. The participants underwent clinical assessments and completed detailed neuropsychological tests. The participants were divided into two groups according to Seoul Verbal Learning Test Delayed Recall (SVLT DR) scores: normal verbal memory performance (SVLT DR > = ‐1.5 SD) vs low verbal memory performance (SVLT DR < ‐1.5 SD) groups. Group comparisons between normal and low verbal memory performance were performed. In addition, associations between verbal memory performance and MMSE items were analysed.Result: Low verbal memory performance group (n = 91) had more males and a tendency to be older and more educated than normal verbal memory performance group (n = 158). For MMSE items, low verbal memory performance group had lower MMSE time orientation and lower MMSE recall subscores, and a tendency of higher MMSE copy score than normal verbal memory performance group. Multivariable analyses showed that male sex, MMSE time orientation and MMSE recall scores were associated with lower verbal memory performance.Conclusion: In MCI individuals, male sex, and MMSE time orientation and recall subscores among demographics and MMSE items were associated with low verbral memory performance. These results suggest that more consideration for MMSE sub‐items would be helpful for the clinical evaluation of individuals with MCI at first step.

Purpose This study aimed to verify the value of arterial spin labeling (ASL) collateral perfusion estimation for predicting functional outcomes in acute anterior circulation ischemic stroke. Methods This secondary analysis of an ongoing prospective observational study included data from participants with acute ischemic stroke due to steno-occlusion of the internal carotid artery and/or the middle cerebral artery within 8 h of symptom onset. We compared the collateral map, which is a 5-phase collateral imaging derived from dynamic contrast-enhanced magnetic resonance angiography, and ASL to validate the ASL collateral perfusion estimation. Multiple logistic regression analyses were conducted to identify independent predictors of favorable functional outcomes. Results One hundred forty-eight participants (68 ± 13 years, 96 men) were evaluated. The ASL collateral perfusion grade was positively correlated with the collateral perfusion grade of the collateral map (P < .001). Younger age (OR = 0.53, 95% CI = 0.36–0.78, P = .002), lower baseline NIHSS score (OR = 0.85, 95% CI = 0.78–0.92, P < .001), intermediate ASL collateral perfusion grade (OR = 4.02, 95% CI = 1.43–11.26, P = .008), good ASL collateral perfusion grade (OR = 26.37, 95% CI = 1.06–655.01, P = .046), and successful reperfusion (OR = 5.84, 95% CI = 2.08–16.42, P < .001) were independently associated with favorable functional outcomes. Conclusion ASL collateral perfusion estimation provides prognostic information, which can be helpful in guiding management decisions.

Background: Subjective cognitive decline (SCD) can be considered as the preclinical manifestation of Alzheimer’s disease. The objective of this study was to examine whether there would be differences of the clinical correlates due to evidence of subtle cognitive imparment (SCI) in inividuals with SCD.Method: One‐hundred‐and‐fifty‐five individuals with SCD (mean age: 68.18 ± 8.09 years) were included in this study. The participants underwent clinical assessments and completed detailed neuropsychological tests. The functional assessment was performed by the Korean Instrumental Activities of Daily Living (IADL) scale. Memory complaints were assessed using the Prospective and Retrospective Memory Questionnaire (PRMQ) consisting of 16 items that describe everyday memory failure.Result: SCD individuals with SCI (n = 20) had lower Mini‐Mental State Examination scores and showed lower performances in the neuropsychological tests than the SCD only group (n = 135). In addition, the SCI group had worse IADL performance than the SCD only group. There were no differenes in depressive symptoms and PRMQ scores between two groups.Conclusion: In SCD individuals, SCI was associated with subtle IADL deficits, but not with the severity of self‐reported memory complaints, compared to the SCD only group. These results suggest that functional assesments would be helpful for the clinical evaluation of individuals with SCD.

An MR angiography collateral map provided patient-specific collateral perfusion information to help inform the prognosis and guide management of acute ischemic stroke through a minimal MRI protocol. Background Collateral circulation determines tissue fate and affects treatment result in acute ischemic stroke. A precise method for collateral estimation in an optimal imaging protocol is necessar...

BACKGROUND AND PURPOSE: Assessment of the collateral status has been emphasized for appropriate treatment decisions in patients with acute ischemic stroke. The purpose of this study was to introduce a multiphase MRA collateral imaging method (collateral map) derived from time-resolved dynamic contrast-enhanced MRA and to verify the value of the multiphase MRA collateral map in acute ischemic stroke by comparing it with the multiphase collateral imaging method (MRP collateral map) derived from dynamic susceptibility contrast-enhanced MR perfusion. MATERIALS AND METHODS: From a prospectively maintained registry of acute ischemic stroke, MR imaging data of patients with acute ischemic stroke caused by steno-occlusive lesions of the unilateral ICA and/or the M1 segment of the MCA were analyzed. We generated collateral maps using dynamic signals from dynamic contrast-enhanced MRA and DSC-MRP using a Matlab-based in-house program and graded the collateral scores of the multiphase MRA collateral map and the MRP collateral map independently. Interobserver reliabilities and intermethod agreement between both collateral maps for collateral grading were tested. RESULTS: Seventy-one paired multiphase MRA and MRP collateral maps from 67 patients were analyzed. The interobserver reliabilities for collateral grading using multiphase MRA or MRP collateral maps were excellent (weighted κ = 0.964 and 0.956, respectively). The agreement between both collateral maps was also excellent (weighted κ = 0.884; 95% confidence interval, 0.819–0.949). CONCLUSIONS: We demonstrated that the dynamic signals of dynamic contrast-enhanced MRA could be used to generate multiphase collateral images and showed the possibility of the multiphase MRA collateral map as a useful collateral imaging method in acute ischemic stroke.

Lee SB, et al. J Gastric Cancer. 2010 Dec;10(4):219-225. https://doi.org/10.5230/jgc.2010.10.4.219