Early detection of small volume stroke and thromboembolic sources with computed tomography: Rationale and design of the ENCLOSE study
Kauw, Frans; van Ommen, Fasco; Bennink, Edwin; Cramer, Maarten J; Kappelle, L Jaap; Takx, Richard Ap; Velthuis, Birgitta K; Viergever, Max A; Wouter van Es, H; Schonewille, Wouter J; Coutinho, Jonathan M; Majoie, Charles Blm; Marquering, Henk A; de Jong, Hugo Wam; Dankbaar, Jan W
(2020) European Stroke Journal, volume 5, issue 4, pp. 432 - 440
(Article)
Abstract
Background: Computed tomography is the most frequently used imaging modality in acute stroke imaging protocols. Detection of small volume infarcts in the brain and cardioembolic sources of stroke is difficult with current computed tomography protocols. Furthermore, the role of computed tomography findings to predict recurrent ischemic stroke is unclear. With
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ENCLOSE, we aim to improve (1) the detection of small volume infarcts with thin slice computed tomography perfusion (CTP) images and thromboembolic source with cardiac computed tomography techniques in the acute stage of ischemic stroke and (2) prediction of recurrent ischemic stroke with computed tomography-derived predictors.Methods/design: ENCLOSE is a prospective multicenter observational cohort study, which will be conducted in three Dutch stroke centers (ClinicalTrials.gov Identifier: NCT04019483). Patients (≥18 years) with suspected acute ischemic stroke who undergo computed tomography imaging within 9 h after symptom onset are eligible. Computed tomography imaging includes non-contrast CT, CTP, and computed tomography angiography (CTA) from base of the heart to the top of the brain. Dual-energy CT data will be acquired when possible, and thin-slice CTP reconstructions will be obtained in addition to standard 5 mm CTP data. CTP data will be processed with commercially available software and locally developed model-based methods. The post-processed thin-slice CTP images will be compared to the standard CTP images and to magnetic resonance diffusion-weighted imaging performed within 48 h after admission. Detection of cardioembolic sources of stroke will be evaluated on the CTA images. Recurrence will be evaluated 90 days and two years after the index event. The added value of imaging findings to prognostic models for recurrent ischemic stroke will be evaluated. Conclusion: The aim of ENCLOSE is to improve early detection of small volume stroke and thromboembolic sources and to improve prediction of recurrence in patients with acute ischemic stroke.
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Keywords: Acute ischemic stroke, cardiac thrombus, computed tomography, detection, lacunar stroke, magnetic resonance imaging, prediction model, recurrent stroke, Clinical Neurology, Cardiology and Cardiovascular Medicine, Journal Article
ISSN: 2396-9873
Publisher: SAGE Publications Inc.
Note: Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This research has been made possible by the Dutch Heart Foundation and Technology Foundation STW, as part of their joint strategic research program: “Earlier recognition of cardiovascular diseases” (grant number 14732). Funding Information: The ENCLOSE investigators are University Medical Center Utrecht, The Netherlands: Frans Kauw, Fasco van Ommen, Edwin Bennink, Maarten J Cramer, L Jaap Kappelle, Richard AP Takx, Birgitta K Velthuis, Max A Viergever, Hugo WAM de Jong, and Jan W Dankbaar; Amsterdam UMC – location AMC, Amsterdam, The Netherlands: Guido PA Clerx, Valeria Guglielmi, Jonathan Coutinho, Henk A Marquering, Charles BLM Majoie, and Yvo BWEM Roos; St. Antonius Hospital, Nieuwegein, The Netherlands: Wouter J Schonewille, H Wouter van Es, and Jan A Vos. The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This research has been made possible by the Dutch Heart Foundation and Technology Foundation STW, as part of their joint strategic research program: “Earlier recognition of cardiovascular diseases” (grant number 14732). Publisher Copyright: © European Stroke Organisation 2020.
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