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Gautheron V, Xie Y, Tisserand M, Raoult H, Soize S, Naggara O, Bourcier R, Richard S, Guillemin F, Bracard S, Oppenheim C. Outcome After Reperfusion Therapies in Patients With Large Baseline Diffusion-Weighted Imaging Stroke Lesions. Stroke 2018; 49:750-753. [DOI: 10.1161/strokeaha.117.020244] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/20/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Stroke patients with large diffusion-weighted imaging (DWI) volumes are often excluded from reperfusion because of reckoned futility. In those with DWI
volume
>70 mL, included in the THRACE trial (Mechanical Thrombectomy After Intravenous Alteplase Versus Alteplase Alone After Stroke), we report the associations between baseline parameters and outcome.
Methods—
We examined 304 patients with anterior circulation stroke and pretreatment magnetic resonance imaging. Variables were extracted from the THRACE database, and DWI volumes were measured semiautomatically.
Results—
Among 53 patients with DWI
volume
>70 mL, 12 had favorable outcome (modified Rankin Scale score, ≤2) at 3 months; they had less coronary disease (0/12 versus 12/38;
P
=0.046) and less history of smoking (1/10 versus 12/31;
P
=0.013) than patients with modified Rankin Scale score >2. None of the 8 patients >75 years of age reached modified Rankin Scale score ≤2. Favorable outcome occurred in 12 of 37 M1-occluded patients but in 0 of 16 internal carotid-T/L–occluded patients (
P
=0.010). Favorable outcome was more frequent (6/13) when DWI lesion was limited to the superficial middle cerebral artery territory than when it extended to the deep middle cerebral artery territory (6/40;
P
=0.050).
Conclusions—
Stroke patients with DWI lesion >70 mL may benefit from reperfusion therapy, especially those with isolated M1 occlusion or ischemia restricted to the superficial middle cerebral artery territory. The benefit of treatment seems questionable for patients with carotid occlusion or lesion extending to the deep middle cerebral artery territory.
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Affiliation(s)
- Vincent Gautheron
- From the Department of Neuroradiology, INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, France (V.G., O.N., C.O.); Department of Neuroradiology, INSERM U947 (Y.X., S.B.), Department of Neurology (S.R.), and INSERM U1116, CIC-P1433 (S.R., F.G.), Lorraine University, Nancy, France; Department of Neuroradiology, Foch Hospital, Suresnes, France (M.T.); Department of Neuroradiology, CHU Rennes, France (H.R.); Department of Neuroradiology, CHU de Reims, France (S.R.); and Department of
| | - Yu Xie
- From the Department of Neuroradiology, INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, France (V.G., O.N., C.O.); Department of Neuroradiology, INSERM U947 (Y.X., S.B.), Department of Neurology (S.R.), and INSERM U1116, CIC-P1433 (S.R., F.G.), Lorraine University, Nancy, France; Department of Neuroradiology, Foch Hospital, Suresnes, France (M.T.); Department of Neuroradiology, CHU Rennes, France (H.R.); Department of Neuroradiology, CHU de Reims, France (S.R.); and Department of
| | - Marie Tisserand
- From the Department of Neuroradiology, INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, France (V.G., O.N., C.O.); Department of Neuroradiology, INSERM U947 (Y.X., S.B.), Department of Neurology (S.R.), and INSERM U1116, CIC-P1433 (S.R., F.G.), Lorraine University, Nancy, France; Department of Neuroradiology, Foch Hospital, Suresnes, France (M.T.); Department of Neuroradiology, CHU Rennes, France (H.R.); Department of Neuroradiology, CHU de Reims, France (S.R.); and Department of
| | - Hélène Raoult
- From the Department of Neuroradiology, INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, France (V.G., O.N., C.O.); Department of Neuroradiology, INSERM U947 (Y.X., S.B.), Department of Neurology (S.R.), and INSERM U1116, CIC-P1433 (S.R., F.G.), Lorraine University, Nancy, France; Department of Neuroradiology, Foch Hospital, Suresnes, France (M.T.); Department of Neuroradiology, CHU Rennes, France (H.R.); Department of Neuroradiology, CHU de Reims, France (S.R.); and Department of
| | - Sébastien Soize
- From the Department of Neuroradiology, INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, France (V.G., O.N., C.O.); Department of Neuroradiology, INSERM U947 (Y.X., S.B.), Department of Neurology (S.R.), and INSERM U1116, CIC-P1433 (S.R., F.G.), Lorraine University, Nancy, France; Department of Neuroradiology, Foch Hospital, Suresnes, France (M.T.); Department of Neuroradiology, CHU Rennes, France (H.R.); Department of Neuroradiology, CHU de Reims, France (S.R.); and Department of
| | - Olivier Naggara
- From the Department of Neuroradiology, INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, France (V.G., O.N., C.O.); Department of Neuroradiology, INSERM U947 (Y.X., S.B.), Department of Neurology (S.R.), and INSERM U1116, CIC-P1433 (S.R., F.G.), Lorraine University, Nancy, France; Department of Neuroradiology, Foch Hospital, Suresnes, France (M.T.); Department of Neuroradiology, CHU Rennes, France (H.R.); Department of Neuroradiology, CHU de Reims, France (S.R.); and Department of
| | - Romain Bourcier
- From the Department of Neuroradiology, INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, France (V.G., O.N., C.O.); Department of Neuroradiology, INSERM U947 (Y.X., S.B.), Department of Neurology (S.R.), and INSERM U1116, CIC-P1433 (S.R., F.G.), Lorraine University, Nancy, France; Department of Neuroradiology, Foch Hospital, Suresnes, France (M.T.); Department of Neuroradiology, CHU Rennes, France (H.R.); Department of Neuroradiology, CHU de Reims, France (S.R.); and Department of
| | - Sébastien Richard
- From the Department of Neuroradiology, INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, France (V.G., O.N., C.O.); Department of Neuroradiology, INSERM U947 (Y.X., S.B.), Department of Neurology (S.R.), and INSERM U1116, CIC-P1433 (S.R., F.G.), Lorraine University, Nancy, France; Department of Neuroradiology, Foch Hospital, Suresnes, France (M.T.); Department of Neuroradiology, CHU Rennes, France (H.R.); Department of Neuroradiology, CHU de Reims, France (S.R.); and Department of
| | - Francis Guillemin
- From the Department of Neuroradiology, INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, France (V.G., O.N., C.O.); Department of Neuroradiology, INSERM U947 (Y.X., S.B.), Department of Neurology (S.R.), and INSERM U1116, CIC-P1433 (S.R., F.G.), Lorraine University, Nancy, France; Department of Neuroradiology, Foch Hospital, Suresnes, France (M.T.); Department of Neuroradiology, CHU Rennes, France (H.R.); Department of Neuroradiology, CHU de Reims, France (S.R.); and Department of
| | - Serge Bracard
- From the Department of Neuroradiology, INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, France (V.G., O.N., C.O.); Department of Neuroradiology, INSERM U947 (Y.X., S.B.), Department of Neurology (S.R.), and INSERM U1116, CIC-P1433 (S.R., F.G.), Lorraine University, Nancy, France; Department of Neuroradiology, Foch Hospital, Suresnes, France (M.T.); Department of Neuroradiology, CHU Rennes, France (H.R.); Department of Neuroradiology, CHU de Reims, France (S.R.); and Department of
| | - Catherine Oppenheim
- From the Department of Neuroradiology, INSERM U894, Sainte-Anne Hospital, Université Paris Descartes, France (V.G., O.N., C.O.); Department of Neuroradiology, INSERM U947 (Y.X., S.B.), Department of Neurology (S.R.), and INSERM U1116, CIC-P1433 (S.R., F.G.), Lorraine University, Nancy, France; Department of Neuroradiology, Foch Hospital, Suresnes, France (M.T.); Department of Neuroradiology, CHU Rennes, France (H.R.); Department of Neuroradiology, CHU de Reims, France (S.R.); and Department of
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Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke: From the American Association of Neurological Surgeons (AANS), American Society of Neuroradiology (ASNR), Cardiovascular and Interventional Radiology Society of Europe (CIRSE), Canadian Interventional Radiology Association (CIRA), Congress of Neurological Surgeons (CNS), European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), European Stroke Organization (ESO), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Interventional Radiology (SIR), Society of NeuroInterventional Surgery (SNIS), and World Stroke Organization (WSO). J Vasc Interv Radiol 2018; 29:441-453. [PMID: 29478797 DOI: 10.1016/j.jvir.2017.11.026] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 01/19/2023] Open
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Ohta T, Morimoto M, Okada K, Fukuda M, Onishi H, Masahira N, Matsuoka T, Tsuno T, Takemura M. Mechanical Thrombectomy in Anterior Circulation Occlusion Could Be More Effective than Medical Management Even in Low DWI-ASPECTS Patients. Neurol Med Chir (Tokyo) 2018; 58:156-163. [PMID: 29479041 PMCID: PMC5929913 DOI: 10.2176/nmc.oa.2017-0203] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The purpose of this study was to investigate whether patients with low preoperative Diffusion-weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) could benefit from mechanical thrombectomy for acute anterior circulation occlusion. This was a retrospective, non-blinded, cohort study. From September 2012 to August 2016, 83 consecutive patients of acute anterior circulation occlusion were treated with thrombectomy using second-generation devices or medical management. The DWI-ASPECTS was scored after the first MRI. Patient characteristics and clinical outcomes were compared between the treatment groups. Significant dependence was defined as a modified Rankin scale score ≥3 at 90 days. As a result, 33 patients underwent mechanical thrombectomy and 50 received medical management. In the mechanical thrombectomy group, the variable of lower DWI-ASPECTS (5, 4–6 vs. 8, 7–8, P < 0.001), especially ≤6, was significantly associated with poor prognosis. However, compared with patients of DWI-ASPECTS ≤ 6 who received medical management, there were significantly fewer patients with poor outcomes in thrombectomy (dependent in 11 of 15 vs. 23 of 23, respectively; P = 0.019). Although patients with lower pretreatment DWI-ASPECTS could benefit less from thrombectomy, their outcomes were still better than medical management. Therefore, mechanical thrombectomy could be considered in some patients with low pretreatment DWI-ASPECTS.
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Affiliation(s)
- Tsuyoshi Ohta
- Department of Neurosurgery, Kochi Health Sciences Center
| | | | - Kenji Okada
- Department of Neurosurgery, Kochi Health Sciences Center
| | - Maki Fukuda
- Department of Neurosurgery, Kochi Health Sciences Center
| | - Hirokazu Onishi
- Department of Emergency Medicine, Kochi Health Sciences Center
| | | | | | - Takaya Tsuno
- Department of Neurosurgery, Kochi Health Sciences Center
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Xie Y, Oppenheim C, Guillemin F, Gautheron V, Gory B, Raoult H, Soize S, Felblinger J, Hossu G, Bracard S. Pretreatment lesional volume impacts clinical outcome and thrombectomy efficacy. Ann Neurol 2018; 83:178-185. [DOI: 10.1002/ana.25133] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Yu Xie
- IADI, U1254, INSERM, Université de Lorraine, CHRU Nancy; Nancy France
| | - Catherine Oppenheim
- Department of Neuroradiology; Sainte-Anne Hospital and Paris-Descartes University, INSERM U894; Paris France
| | - Francis Guillemin
- CIC 1433 Epidémiologie Clinique, INSERM, Université de Lorraine, CHRU Nancy; Nancy France
| | - Vincent Gautheron
- Department of Neuroradiology; Sainte-Anne Hospital and Paris-Descartes University, INSERM U894; Paris France
| | - Benjamin Gory
- INSERM U1237, “Physiopathology and Imaging for Neurological Disorders (PhIND)”, GIP Cyceron; Caen France
| | - Hélène Raoult
- Department of Neuroradiology; University Hospital of Rennes; Rennes France
| | - Sébastien Soize
- Department of Neuroradiology; University Hospital of Reims; Reims France
| | - Jacques Felblinger
- IADI, U1254, INSERM, Université de Lorraine, CHRU Nancy; Nancy France
- CIC 1433 Innovation Technologique, INSERM, Université de Lorraine, CHRU Nancy; Nancy France
| | - Gabriela Hossu
- CIC 1433 Innovation Technologique, INSERM, Université de Lorraine, CHRU Nancy; Nancy France
| | - Serge Bracard
- IADI, U1254, INSERM, Université de Lorraine, CHRU Nancy; Nancy France
- Department of Diagnostic and Interventional Neuroradiology; CHRU Nancy; Nancy France
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Krajíčková D, Krajina A, Šteiner I, Vyšata O, Herzig R, Lojík M, Chovanec V, Raupach J, Renc O, Waishaupt J, Vítková E, Dulíček P, Čabelková P, Vališ M. Fibrin Clot Architecture in Acute Ischemic Stroke Treated With Mechanical Thrombectomy With Stent-Retrievers - Cohort Study. Circ J 2017; 82:866-873. [PMID: 29176266 DOI: 10.1253/circj.cj-17-0375] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The composition of intra-arterial clots might influence the efficacy of mechanical thrombectomy (MT) in ischemic stroke (IS) due to the acute occlusions within large cerebral arteries. The aims were to assess the factors associated with blood clot structure and the impact of thromboembolus structure on MT using stent-retrievers in patients with acute large artery IS in the anterior circulation.Methods and Results:In an observational cohort study, we studied the components of intra-arterial clots retrieved from large cerebral arteries in 80 patients with acute IS treated with MT with or without i.v. thrombolysis (IVT). Histology of the clots was carried out without knowledge of the clinical findings, including the treatment methods. The components of the clots, their age, origin and semi-quantitative graded changes in the architecture of the fibrin components (e.g., "thinning") were compared via neuro-interventional, clinical and laboratory data. The most prominent changes in the architecture of the fibrin components in the thromboemboli were associated with IVT (applied in 44 patients; OR, 3.50; 95% CI: 1.21-10.10, P=0.02) and platelet count (OR, 2.94; 95% CI: 1.06-8.12, P=0.04). CONCLUSIONS In patients with large artery IS treated with the MT using stent-retrievers, bridging therapy with IVT preceding MT and higher platelet count were associated with significant changes of the histological structure of blood clots.
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Affiliation(s)
- Dagmar Krajíčková
- Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Antonín Krajina
- Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Ivo Šteiner
- The Fingerland Department of Pathology, University Hospital
| | - Oldřich Vyšata
- Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Roman Herzig
- Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Miroslav Lojík
- Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Vendelín Chovanec
- Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Jan Raupach
- Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Ondřej Renc
- Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Jan Waishaupt
- Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Eva Vítková
- Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Petr Dulíček
- Fourth Department of Internal Medicine - Haematology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Pavla Čabelková
- Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Martin Vališ
- Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
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Olivot J. Which imaging before reperfusion strategy? Rev Neurol (Paris) 2017; 173:584-589. [DOI: 10.1016/j.neurol.2017.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/23/2017] [Accepted: 09/01/2017] [Indexed: 11/16/2022]
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Boulouis G, Lauer A, Siddiqui AK, Charidimou A, Regenhardt RW, Viswanathan A, Rost N, Leslie-Mazwi TM, Schwamm LH. Clinical Imaging Factors Associated With Infarct Progression in Patients With Ischemic Stroke During Transfer for Mechanical Thrombectomy. JAMA Neurol 2017; 74:1361-1367. [PMID: 28973081 PMCID: PMC5710581 DOI: 10.1001/jamaneurol.2017.2149] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/07/2017] [Indexed: 01/07/2023]
Abstract
Importance When transferred from a referring hospital (RH) to a thrombectomy-capable stroke center (TCSC), patients with initially favorable imaging profiles (Alberta Stroke Program Early CT Score [ASPECTS] ≥6) often demonstrate infarct progression significant enough to make them ineligible for mechanical thrombectomy at arrival. In rapidly evolving stroke care networks, the question of the need for vascular imaging at the RHs remains unsolved, resulting in an important amount of futile transfers for thrombectomy. Objective To examine the clinical imaging factors associated with unfavorable imaging profile evolution for thrombectomy in patients with ischemic stroke initially transferred to non-TCSCs. Design, Setting, and Participants Data from patients transferred from 1 of 30 RHs in our regional stroke network and presenting at our TCSC from January 1, 2010, to January 1, 2016, were retrospectively analyzed. Consecutive patients with acute ischemic stroke initially admitted to a non-thrombectomy-capable RH and transferred to our center for which a RH computed tomography (CT) and a CT angiography (CTA) at arrival were available for review. Main Outcomes and Measures ASPECTS were evaluated. The adequacy of leptomeningeal collateral blood flow was rated as no or poor, decreased, adequate, or augmented per the adapted Maas scale. The main outcome was an ASPECTS decay, defined as an initial ASPECTS of 6 or higher worsening between RH and TCSC CTs to a score of less than 6 (making the patient less likely to derive clinical benefit from thrombectomy at arrival). Results A total of 316 patients were included in the analysis (mean [SD] age, 70.3 [14.2] years; 137 [43.4%] female). In multivariable models, higher National Institutes of Health Stroke Score, lower baseline ASPECTSs, and no or poor collateral blood vessel status were associated with ASPECTS decay, with collateral blood vessel status demonstrating the highest adjusted odds ratio of 5.14 (95% CI, 2.20-12.70; P < .001). Similar results were found after stratification by vessel occlusion level. Conclusions and Relevance In patients with ischemic stroke transferred for thrombectomy, poor collateral blood flow and stroke clinical severity are the main determinants of ASPECTS decay. Our findings suggest that in certain subgroups vascular imaging, including collateral assessment, can play a crucial role in determining the benefits of transfer for thrombectomy.
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Affiliation(s)
- Gregoire Boulouis
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Neuroradiology, Université Paris-Descartes, INSERM U894, Centre Hospitalier Sainte-Anne, Paris, France
| | - Arne Lauer
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Neuroradiology, Goethe University, Frankfurt, Germany
| | | | - Andreas Charidimou
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Robert W. Regenhardt
- Stroke Service, Massachusetts General Hospital, Harvard Medical School, Boston
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anand Viswanathan
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
- Stroke Service, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Natalia Rost
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
- Stroke Service, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Thabele M. Leslie-Mazwi
- Stroke Service, Massachusetts General Hospital, Harvard Medical School, Boston
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Lee H. Schwamm
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
- Stroke Service, Massachusetts General Hospital, Harvard Medical School, Boston
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Abstract
PURPOSE OF REVIEW Acute ischemic stroke (AIS) care is rapidly evolving. This review discusses current diagnostic, therapeutic, and process models that can expedite stroke treatment to achieve best outcomes. RECENT FINDINGS Use of stent retrievers after selection via advanced imaging is safe and effective, and is an important option for AIS patients with large vessel occlusion (LVO). Significant time delays occur before and during patient transfers, and upon comprehensive stroke center (CSC) arrival, and have deleterious effects on functional outcome. Removing obstacles, enhancing inter-facility communication, and creating acute stroke management processes and protocols are paramount strategies to enhance network efficiency. Inter-departmental CSC collaboration can significantly reduce door-to-treatment times. Streamlined stroke systems of care may result in higher treatment rates and better functional outcomes for AIS patients, simultaneously conserving healthcare dollars. Stroke systems of care should be structured regionally to minimize time to treatment. A proactive approach must be employed; a management plan incorporating stroke team prenotification and parallel processes between departments can save valuable time, maximize brain salvage, and reduce disability from stroke.
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Manceau PF, Soize S, Gawlitza M, Fabre G, Bakchine S, Durot C, Serre I, Metaxas GE, Pierot L. Is there a benefit of mechanical thrombectomy in patients with large stroke (DWI-ASPECTS ≤ 5)? Eur J Neurol 2017; 25:105-110. [DOI: 10.1111/ene.13460] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/06/2017] [Indexed: 12/17/2022]
Affiliation(s)
- P. -F. Manceau
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - S. Soize
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - M. Gawlitza
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - G. Fabre
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - S. Bakchine
- Department of Neurology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - C. Durot
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - I. Serre
- Department of Neurology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - G. -E. Metaxas
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - L. Pierot
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
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Racchiusa S, Longo M, Bernava G, Pitrone A, Papa R, Granata F, Centorrino G, Vinci SL. Endovascular Treatment of Spontaneous Intracranial Internal Carotid Dissection in a Young Patient Affected by Systemic Lupus Erythematosus: A Case Report. JOURNAL OF VASCULAR AND INTERVENTIONAL NEUROLOGY 2017; 9:1-7. [PMID: 29163742 PMCID: PMC5683017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Systemic lupus erythematosus (SLE) increases the risk of cerebrovascular events due to vascular changes, resulting in the weakening of the vessel walls. Moreover, patients with SLE have more incidence of arterial lesions such as dissections. Internal carotid dissection (ICA) is an infrequent cause of ischemic stroke, representing 2% of all ischemic events. We present a case of ischemic stroke, caused by a spontaneous dissection of intracranial ICA, treated with endovascular stent implantation, in a 22-year-old woman affected by SLE, newly diagnosed. ICA dissection with consequent ischemic stroke is an unusual first presentation of SLE disease. Our case highlights how, despite an infrequent occurrence, ICA dissection should be considered for young adults presenting with ischemic stroke, especially in those affected by SLE. This paper also shows the good technical result in the use of stenting in case of intracranial ICA dissection.
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Affiliation(s)
- Sergio Racchiusa
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Marcello Longo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Gianmarco Bernava
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Antonio Pitrone
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Rosario Papa
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Francesca Granata
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Giuseppe Centorrino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Sergio Lucio Vinci
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
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Meisterernst J, Klinger-Gratz PP, Leidolt L, Lang MF, Schroth G, Mordasini P, Heldner MR, Mono ML, Kurmann R, Buehlmann M, Fischer U, Arnold M, Gralla J, Mattle HP, El-Koussy M, Jung S. Focal T2 and FLAIR hyperintensities within the infarcted area: A suitable marker for patient selection for treatment? PLoS One 2017; 12:e0185158. [PMID: 28957339 PMCID: PMC5619762 DOI: 10.1371/journal.pone.0185158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/07/2017] [Indexed: 12/03/2022] Open
Abstract
Background and purpose Some authors use FLAIR imaging to select patients for stroke treatment. However, the effect of hyperintensity on FLAIR images on outcome and bleeding has been addressed in only few studies with conflicting results. Methods 466 patients with anterior circulation strokes were included in this study. They all were examined with MRI before intravenous or endovascular treatment. Baseline data and 3 months outcome were recorded prospectively. Focal T2 and FLAIR hyperintensities within the ischemic lesion were evaluated by two raters, and the PROACT II classification was applied to assess bleeding complications on follow up imaging. Logistic regression analysis was used to determine predictors of bleeding complications and outcome and to analyze the influence of T2 or FLAIR hyperintensity on outcome. Results Focal hyperintensities were found in 142 of 307 (46.3%) patients with T2 weighted imaging and in 89 of 159 (56%) patients with FLAIR imaging. Hyperintensity in the basal ganglia, especially in the lentiform nucleus, on T2 weighted imaging was the only independent predictor of any bleeding after reperfusion treatment (33.8% in patients with vs. 18.2% in those without; p = 0.003) and there was a non-significant trend for more bleedings in patients with FLAIR hyperintensity within the basal ganglia (p = 0.069). However, there was no association of hyperintensity on T2 weighted or FLAIR images and symptomatic bleeding or worse outcome. Conclusion Our results question the assumption that T2 or FLAIR hyperintensities within the ischemic lesion should be used to exclude patients from reperfusion therapy, especially not from endovascular treatment.
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Affiliation(s)
- Julia Meisterernst
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Pascal P. Klinger-Gratz
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- Department of Radiology, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Lars Leidolt
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Matthias F. Lang
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gerhard Schroth
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Mirjam R. Heldner
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marie-Luise Mono
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Rebekka Kurmann
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Monika Buehlmann
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Heinrich P. Mattle
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marwan El-Koussy
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- * E-mail:
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63
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Regenhardt RW, Das AS, Stapleton CJ, Chandra RV, Rabinov JD, Patel AB, Hirsch JA, Leslie-Mazwi TM. Blood Pressure and Penumbral Sustenance in Stroke from Large Vessel Occlusion. Front Neurol 2017; 8:317. [PMID: 28717354 PMCID: PMC5494536 DOI: 10.3389/fneur.2017.00317] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/16/2017] [Indexed: 12/11/2022] Open
Abstract
The global burden of stroke remains high, and of the various subtypes of stroke, large vessel occlusions (LVOs) account for the largest proportion of stroke-related death and disability. Several randomized controlled trials in 2015 changed the landscape of stroke care worldwide, with endovascular thrombectomy (ET) now the standard of care for all eligible patients. With the proven success of this therapy, there is a renewed focus on penumbral sustenance. In this review, we describe the ischemic penumbra, collateral circulation, autoregulation, and imaging assessment of the penumbra. Blood pressure goals in acute stroke remain controversial, and we review the current data and suggest an approach for induced hypertension in the acute treatment of patients with LVOs. Finally, in addition to reperfusion and enhanced perfusion, efforts focused on developing therapeutic targets that afford neuroprotection and augment neural repair will gain increasing importance. ET has revolutionized stroke care, and future emphasis will be placed on promoting penumbral sustenance, which will increase patient eligibility for this highly effective therapy and reduce overall stroke-related death and disability.
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Affiliation(s)
- Robert W. Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Alvin S. Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Christopher J. Stapleton
- Neuroendovascular Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ronil V. Chandra
- Interventional Neuroradiology, Monash Imaging, Monash Health, Monash University, Melbourne, VIC, Australia
| | - James D. Rabinov
- Neuroendovascular Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Aman B. Patel
- Neuroendovascular Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Joshua A. Hirsch
- Neuroendovascular Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Thabele M. Leslie-Mazwi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Neuroendovascular Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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64
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Mueller L, Pult F, Meisterernst J, Heldner MR, Mono ML, Kurmann R, Buehlmann M, Fischer U, Mattle HP, Arnold M, Mordasini P, Gralla J, Schroth G, El-Koussy M, Jung S. Impact of intravenous thrombolysis on recanalization rates in patients with stroke treated with bridging therapy. Eur J Neurol 2017. [DOI: 10.1111/ene.13330] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- L. Mueller
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - F. Pult
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - J. Meisterernst
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - M. R. Heldner
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - M.-L. Mono
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - R. Kurmann
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - M. Buehlmann
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - U. Fischer
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - H. P. Mattle
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - M. Arnold
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - P. Mordasini
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - J. Gralla
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - G. Schroth
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - M. El-Koussy
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - S. Jung
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
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Desilles JP, Consoli A, Redjem H, Coskun O, Ciccio G, Smajda S, Labreuche J, Preda C, Ruiz Guerrero C, Decroix JP, Rodesch G, Mazighi M, Blanc R, Piotin M, Lapergue B, Wang A, Evrard S, Tchikviladzé M, Bourdain F, Gonzalez-Valcarcel J, Di Maria F, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Corabianu O, de Broucker T, Smadja D, Alamowitch S, Obadia M, Ille O, Manchon E, Garcia PY. Successful Reperfusion With Mechanical Thrombectomy Is Associated With Reduced Disability and Mortality in Patients With Pretreatment Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomography Score ≤6. Stroke 2017; 48:963-969. [DOI: 10.1161/strokeaha.116.015202] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/10/2016] [Accepted: 12/29/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
In acute ischemic stroke patients, diffusion-weighted imaging (DWI)–Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is correlated with infarct volume and is an independent factor of functional outcome. Patients with pretreatment DWI-ASPECTS ≤6 were excluded or under-represented in the recent randomized mechanical thrombectomy trials. Our aim was to assess the impact of reperfusion in pretreatment DWI-ASPECTS ≤6 patients treated with mechanical thrombectomy.
Methods—
We analyzed data collected between January 2012 and August 2015 in a bicentric prospective clinical registry of consecutive acute ischemic stroke patients treated with mechanical thrombectomy. Every patient with a documented internal carotid artery or middle cerebral artery occlusion with pretreatment DWI-ASPECTS ≤6 was eligible for this study. The primary end point was a favorable outcome defined by a modified Rankin Scale score ≤2 at 90 days.
Results—
Two hundred and eighteen patients with a DWI-ASPECTS ≤6 were included. Among them, 145 (66%) patients had successful reperfusion at the end of mechanical thrombectomy. Reperfused patients had an increased rate of favorable outcome (38.7% versus 17.4%;
P
=0.002) and a decreased rate of mortality at 3 months (22.5% versus 39.1%;
P
=0.013) compared with nonreperfused patients. The symptomatic intracranial hemorrhage rate was not different between the 2 groups (13.0% versus 14.1%;
P
=0.83). However, in patients with DWI-ASPECTS <5, favorable outcome was low (13.0% versus 9.5%;
P
=0.68) with a high mortality rate (45.7% versus 57.1%;
P
=0.38) with or without successful reperfusion.
Conclusions—
Successful reperfusion is associated with reduced mortality and disability in patients with a pretreatment DWI-ASPECTS ≤6. Further data from randomized studies are needed, particularly in patients with DWI-ASPECTS <5.
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Affiliation(s)
- Jean-Philippe Desilles
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Arturo Consoli
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Hocine Redjem
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Oguzhan Coskun
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Gabriele Ciccio
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Stanislas Smajda
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Julien Labreuche
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Cristian Preda
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Clara Ruiz Guerrero
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Jean-Pierre Decroix
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Georges Rodesch
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Mikael Mazighi
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Raphaël Blanc
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Michel Piotin
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
| | - Bertrand Lapergue
- From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM)
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Bateman M, Slater LA, Leslie-Mazwi T, Simonsen CZ, Stuckey S, Chandra RV. Diffusion and Perfusion MR Imaging in Acute Stroke: Clinical Utility and Potential Limitations for Treatment Selection. Top Magn Reson Imaging 2017; 26:77-82. [PMID: 28277459 DOI: 10.1097/rmr.0000000000000124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Magnetic resonance (MR) diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) offer unique insight into acute ischemic stroke pathophysiology. These techniques may offer the ability to apply pathophysiology to accurately individualize acute stroke reperfusion treatment, including extending the opportunity of reperfusion treatment to well beyond the current time-based treatment windows.This review examines the use of DWI and PWI in the major stroke trials, their current clinical utility, and potential limitations for reperfusion treatment selection. DWI and PWI continue to be investigated in ongoing randomized controlled trials, and continued research into these techniques will help achieve the goal of tissue-based decision making and individualized acute stroke treatment.
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Affiliation(s)
- Mathew Bateman
- *Neuroradiology Service, Monash Imaging, Monash Health †School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia ‡NeuroEndovascular Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA §Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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67
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Mundiyanapurath S, Diatschuk S, Loebel S, Pfaff J, Pham M, Möhlenbruch MA, Wick W, Bendszus M, Ringleb PA, Radbruch A. Outcome of patients with proximal vessel occlusion of the anterior circulation and DWI-PWI mismatch is time-dependent. Eur J Radiol 2017. [PMID: 28629575 DOI: 10.1016/j.ejrad.2017.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Patients with ischemic stroke and large vessel occlusion are assumed to benefit from endovascular therapy (ET) independent of the symptom onset-to-treatment time (OTT) if they present with a mismatch of diffusion- and perfusion-weighted imaging (DWI-PWI mismatch). We aimed at studying the influence of OTT on clinical outcome in these patients. METHODS Retrospective database review in a tertiary care university hospital. All patients presented with proximal vessel occlusion of the anterior circulation and DWI-PWI mismatch. Primary outcome was the influence of OTT on modified Rankin scale (mRS) score three months after treatment, dichotomized in favourable (0-2) and unfavourable outcome (3-6). Secondary outcome was the effect of OTT on the shift of the mRS score. Patients treated within an early time window (<340min) and a late time window (≥340min) were compared. RESULTS 139 patients were included. The rate of favourable outcome was significantly higher in patients who were treated in an early compared to those treated in a late time window (31 [49%] vs. 20 patients [27%], p=0.005). Adjusted multivariate logistic regression revealed that late treatment was an independent negative predictor of favourable outcome (odds ratio 0.39, confidence interval [0.18-0.84]; p=0.016). A shift towards higher mRS scores for late treatment was evident (p=0.015). In sensitivity analysis, OTT remained an independent predictor when evaluated as continuous variable. These findings were confirmed in patients with a comparable DWI-PWI mismatch according to the definitions from large trials (DEFUSE 2, DEFUSE 3, SWIFT-PRIME, EXTEND-IA). CONCLUSION Outcome of patients with comparable DWI-PWI mismatch is time-dependent.
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Affiliation(s)
| | - Sascha Diatschuk
- German Cancer Research Centre, Department of Radiology, Heidelberg, Germany
| | - Sarah Loebel
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Pfaff
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mirko Pham
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany; Institute for Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Germany
| | | | - Wolfgang Wick
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany; CCU Neurooncology, German Cancer Consortium (DKTK) & German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter A Ringleb
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Radbruch
- German Cancer Research Centre, Department of Radiology, Heidelberg, Germany; Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
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Olivot JM, Sissani L, Meseguer E, Inoue M, Labreuche J, Mlynash M, Amarenco P, Mazighi M. Impact of Initial Diffusion-Weighted Imaging Lesion Growth Rate on the Success of Endovascular Reperfusion Therapy. Stroke 2016; 47:2305-10. [DOI: 10.1161/strokeaha.116.013916] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/11/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Initial diffusion-weighted imaging lesion growth rate (IGR) assessed by diffusion-weighted imaging lesion volume divided by the delay from onset to magnetic resonance imaging offers an estimate of early brain infarction progression. We investigated the impact of IGR on the rate of favorable outcome according to the occurrence of a successful endovascular revascularization within 6 hours after onset in patients experiencing an acute brain infarction complicating internal carotid artery terminus/middle cerebral artery M1 occlusion.
Methods—
The primary study end point was a favorable outcome defined by a modified Rankin Scale score of ≤2, 90 days after onset. A Thrombolysis in Cerebral Infarction score 2b/3 defined a successful recanalization.
Results—
A total of 166 patients were included. Median IGR was 7 mL/h (interquartile range, 2–26). Sixty-eight patients (41%) experienced a favorable outcome. After adjustment on age, systolic blood pressure, vessel site occlusion, National Institutes of Health Stroke Scale, and antithrombotic medication, increase in IGR was associated with a decreased occurrence of favorable outcome with an odds ratio per SD increase of 0.60 (95% confidence interval, 0.38–0.94;
P
=0.03). A successful recanalization was achieved among 56% of the patients after a median delay of 251 minutes (interquartile range, 211–291 minutes). Increasing IGR was associated with a decreased favorable outcome only when a successful recanalization was not achieved (adjusted odds ratio, 0.32; 95% confidence interval, 0.12–0.85;
P
=0.02).
Conclusions—
Proximal internal carotid artery/M1 occlusion did result into a wide range of IGR within 6 hours after onset. Increasing IGR was associated with a lower rate of favorable outcome after endovascular treatment overall and when a successful recanalization was not achieved.
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Affiliation(s)
- Jean-Marc Olivot
- From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d’Accueil et de Traitement de l’Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et
| | - Leila Sissani
- From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d’Accueil et de Traitement de l’Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et
| | - Elena Meseguer
- From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d’Accueil et de Traitement de l’Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et
| | - Manabu Inoue
- From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d’Accueil et de Traitement de l’Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et
| | - Julien Labreuche
- From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d’Accueil et de Traitement de l’Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et
| | - Michael Mlynash
- From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d’Accueil et de Traitement de l’Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et
| | - Pierre Amarenco
- From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d’Accueil et de Traitement de l’Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et
| | - Mikael Mazighi
- From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d’Accueil et de Traitement de l’Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et
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Dichgans M, Planas AM, Biessels GJ, van der Worp B, Sudlow C, Norrving B, Lees K, Mattle HP. Third European Stroke Science Workshop. Stroke 2016; 47:e178-86. [PMID: 27283200 DOI: 10.1161/strokeaha.116.013516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/16/2016] [Indexed: 11/16/2022]
Abstract
Lake Eibsee, Garmisch-Partenkirchen, November 19 to 21, 2015: The European Stroke Organization convened >120 stroke experts from 27 countries to discuss latest results and hot topics in clinical, translational, and basic stroke research. Since its inception in 2011, the European Stroke Science Workshop has become a cornerstone of European Stroke Organization's academic activities and major highlight for researchers in the field. Participants include stroke researchers at all career stages who convene for plenary lectures and discussions, thus facilitating crosstalk among researchers from different fields. As in previous years, the workshop was organized into 7 scientific sessions each focusing on a major research topic. All sessions started with a keynote lecture that provided an overview on current developments and set the scene for the following presentations. The latter were short focused talks on a timely topic and included the most recent findings, including unpublished data. A new element at this year's meeting was a hot topic session in which speakers had to present a provocative concept or update sharply within 5 minutes. In the following, we summarize the key contents of the meeting. The program is provided in the online-only Data Supplement.
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Affiliation(s)
- Martin Dichgans
- From the Institute for Stroke and Dementia Research, Klinikum der Universtität München, Ludwig-Maximilians University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.); Institutd' Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), Institutd' Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain (A.M.P.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (G.J.B., B.v.d.W.); Centre for Clinical Brain Sciences, Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.L.); and Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.)
| | - Anna M Planas
- From the Institute for Stroke and Dementia Research, Klinikum der Universtität München, Ludwig-Maximilians University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.); Institutd' Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), Institutd' Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain (A.M.P.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (G.J.B., B.v.d.W.); Centre for Clinical Brain Sciences, Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.L.); and Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.)
| | - Geert Jan Biessels
- From the Institute for Stroke and Dementia Research, Klinikum der Universtität München, Ludwig-Maximilians University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.); Institutd' Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), Institutd' Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain (A.M.P.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (G.J.B., B.v.d.W.); Centre for Clinical Brain Sciences, Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.L.); and Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.)
| | - Bart van der Worp
- From the Institute for Stroke and Dementia Research, Klinikum der Universtität München, Ludwig-Maximilians University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.); Institutd' Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), Institutd' Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain (A.M.P.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (G.J.B., B.v.d.W.); Centre for Clinical Brain Sciences, Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.L.); and Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.)
| | - Cathie Sudlow
- From the Institute for Stroke and Dementia Research, Klinikum der Universtität München, Ludwig-Maximilians University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.); Institutd' Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), Institutd' Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain (A.M.P.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (G.J.B., B.v.d.W.); Centre for Clinical Brain Sciences, Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.L.); and Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.)
| | - Bo Norrving
- From the Institute for Stroke and Dementia Research, Klinikum der Universtität München, Ludwig-Maximilians University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.); Institutd' Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), Institutd' Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain (A.M.P.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (G.J.B., B.v.d.W.); Centre for Clinical Brain Sciences, Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.L.); and Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.)
| | - Kennedy Lees
- From the Institute for Stroke and Dementia Research, Klinikum der Universtität München, Ludwig-Maximilians University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.); Institutd' Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), Institutd' Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain (A.M.P.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (G.J.B., B.v.d.W.); Centre for Clinical Brain Sciences, Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.L.); and Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.)
| | - Heinrich P Mattle
- From the Institute for Stroke and Dementia Research, Klinikum der Universtität München, Ludwig-Maximilians University, Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.); Institutd' Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), Institutd' Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain (A.M.P.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (G.J.B., B.v.d.W.); Centre for Clinical Brain Sciences, Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.L.); and Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (H.P.M.).
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Tisserand M, Turc G, Charron S, Legrand L, Edjlali M, Seners P, Roca P, Lion S, Naggara O, Mas JL, Méder JF, Baron JC, Oppenheim C. Does Diffusion Lesion Volume Above 70 mL Preclude Favorable Outcome Despite Post-Thrombolysis Recanalization? Stroke 2016; 47:1005-11. [DOI: 10.1161/strokeaha.115.012518] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/12/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Marie Tisserand
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Guillaume Turc
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Sylvain Charron
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Laurence Legrand
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Myriam Edjlali
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Pierre Seners
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Pauline Roca
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Stéphanie Lion
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Olivier Naggara
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-Louis Mas
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-François Méder
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-Claude Baron
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Catherine Oppenheim
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
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Akbik F, Hirsch JA, Cougo-Pinto PT, Chandra RV, Simonsen CZ, Leslie-Mazwi T. The Evolution of Mechanical Thrombectomy for Acute Stroke. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:32. [PMID: 26932587 DOI: 10.1007/s11936-016-0457-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OPINION STATEMENT The natural history of an acute ischemic stroke from a large vessel occlusion (LVO) is poor and has long challenged stroke therapy. Recently, endovascular therapy has demonstrated superiority to medical management in appropriately selected patients. This advance has revolutionized acute care for LVO and mandates a reevaluation of the entire chain of stroke care delivery, including patient selection, intervention, and post-procedural care. Since endovascular therapy is a therapy specifically targeting LVO, its application should be restricted to those patients only. Clinical and radiologic parameters need to be considered in patient selection. Data supports that all patients over the age of 18 years presenting with a National Institutes of Health Stroke Scale (NIHSS) of 6 or greater within 6 hours of symptom onset should be considered for emergent endovascular therapy. Radiologically, those with a LVO of the internal carotid artery (ICA) or middle cerebral artery (MCA) M1 portion, intermediate or good collaterals and without large established infarct should be considered endovascular candidates. Selection beyond these parameters remains an open question and is being actively evaluated. In all cases, revascularization should be attempted with a new generation device (stentriever or direct aspiration), as these techniques are most likely to deliver adequate reperfusion. Post-revascularization, patients are closely monitored in an intensive care setting followed by discharge to rehabilitation, if required, or directly home. Patients should be evaluated in delayed fashion to assess recovery (typically at 3 months post-treatment). Ultimately, the poor natural history of ischemic stroke from LVO and the potential significant benefit from endovascular therapy over medical management alone necessitate a national response to ensure we identify and treat all eligible patients as rapidly and effectively as possible.
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Affiliation(s)
- Feras Akbik
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua A Hirsch
- Neuroendovascular Service, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Pedro Telles Cougo-Pinto
- Department of Neurosciences and Behavior Sciences, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil
| | - Ronil V Chandra
- Interventional Neuroradiology, Monash Health, Monash University, Melbourne, Australia
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Thabele Leslie-Mazwi
- Neuroendovascular Service, Massachusetts General Hospital, Boston, MA, 02114, USA.
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Campbell BC, Hill MD, Rubiera M, Menon BK, Demchuk A, Donnan GA, Roy D, Thornton J, Dorado L, Bonafe A, Levy EI, Diener HC, Hernández-Pérez M, Pereira VM, Blasco J, Quesada H, Rempel J, Jahan R, Davis SM, Stouch BC, Mitchell PJ, Jovin TG, Saver JL, Goyal M. Safety and Efficacy of Solitaire Stent Thrombectomy: Individual Patient Data Meta-Analysis of Randomized Trials. Stroke 2016; 47:798-806. [PMID: 26888532 PMCID: PMC4760381 DOI: 10.1161/strokeaha.115.012360] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/12/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Recent positive randomized trials of endovascular therapy for ischemic stroke used predominantly stent retrievers. We pooled data to investigate the efficacy and safety of stent thrombectomy using the Solitaire device in anterior circulation ischemic stroke. METHODS Patient-level data were pooled from trials in which the Solitaire was the only or the predominant device used in a prespecified meta-analysis (SEER Collaboration): Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME), Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE), Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial (EXTEND-IA), and Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset (REVASCAT). The primary outcome was ordinal analysis of modified Rankin Score at 90 days. The primary analysis included all patients in the 4 trials with 2 sensitivity analyses: (1) excluding patients in whom Solitaire was not the first device used and (2) including the 3 Solitaire-only trials (excluding ESCAPE). Secondary outcomes included functional independence (modified Rankin Score 0-2), symptomatic intracerebral hemorrhage, and mortality. RESULTS The primary analysis included 787 patients: 401 randomized to endovascular thrombectomy and 386 to standard care, and 82.6% received intravenous thrombolysis. The common odds ratio for modified Rankin Score improvement was 2.7 (2.0-3.5) with no heterogeneity in effect by age, sex, baseline stroke severity, extent of computed tomography changes, site of occlusion, or pretreatment with alteplase. The number needed to treat to reduce disability was 2.5 and for an extra patient to achieve independent outcome was 4.25 (3.29-5.99). Successful revascularization occurred in 77% treated with Solitaire device. The rate of symptomatic intracerebral hemorrhage and overall mortality did not differ between treatment groups. CONCLUSIONS Solitaire thrombectomy for large vessel ischemic stroke was safe and highly effective with substantially reduced disability. Benefits were consistent in all prespecified subgroups.
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Affiliation(s)
| | | | | | | | - Andrew Demchuk
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - Geoffrey A. Donnan
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - Daniel Roy
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - John Thornton
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - Laura Dorado
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - Alain Bonafe
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - Elad I. Levy
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - Hans-Christoph Diener
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - María Hernández-Pérez
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - Vitor Mendes Pereira
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - Jordi Blasco
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - Helena Quesada
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - Jeremy Rempel
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - Reza Jahan
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - Stephen M. Davis
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
| | - Bruce C. Stouch
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C., S.M.D.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.D.H., B.K.M., A.D.); Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Department of Radiology, CHUM-Hopital Notre Dame, University of Montreal, Montreal, Canada (D.R.); Department of Radiology, Beaumont Hospital, Dublin, Ireland (J.T.); Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain (L.D., M.H.-P.); Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France (A.B.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York (E.I.L.); Department of Neurology, University Hospital of University Duisburg–Essen, Essen, Germany (H.-C.D.); Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (V.M.P.); Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.); Department of Neurology, Hospital de Bellvitge, Barcelona, Spain (H.Q.); Department of Radiology, University of Alberta, Edmonton, Canada (J.R.); Division of Interventional Neuroradiology, Department of Radiology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (R.J.); Department of Biostatistics and Clinical Epidemiology, The Philadelphia College of Osteopathic Medicine, PA (B.C.S.); Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.); Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center (T.G.J.); Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); and Department of Radiology, University of Calgary, Foothills Hospital, Calgary AB, Canada (M.G.)
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Campbell BCV, Donnan GA, Mitchell PJ, Davis SM. Endovascular thrombectomy for stroke: current best practice and future goals. Stroke Vasc Neurol 2016; 1:16-22. [PMID: 28959994 PMCID: PMC5435188 DOI: 10.1136/svn-2015-000004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/19/2016] [Indexed: 12/02/2022] Open
Abstract
Endovascular thrombectomy for large vessel ischaemic stroke substantially reduces disability, with recent positive randomised trials leading to guideline changes worldwide. This review discusses in detail the evidence provided by recent randomised trials and meta-analyses, the remaining areas of uncertainty and the future directions for research. The data from existing trials have demonstrated the robust benefit of endovascular thrombectomy for internal carotid and proximal middle cerebral artery occlusions. Uncertainty remains for more distal occlusions where the efficacy of alteplase is greater, less tissue is at risk and the safety of endovascular procedures is less established. Basilar artery occlusion was excluded from the trials, but with a dire natural history and proof of principle that rapid reperfusion is effective, it seems reasonable to continue treating these patients pending ongoing trial results. There has been no evidence of heterogeneity in treatment effect in clinically defined subgroups by age, indeed, those aged >80 years have at least as great an overall reduction in disability and reduced mortality. Similarly there was no heterogeneity across the range of baseline stroke severities included in the trials. Evidence that routine use of general anaesthesia reduces the benefit of endovascular thrombectomy is increasing and conscious sedation is generally preferred unless severe agitation or airway compromise is present. The impact of time delays has become clearer with description of onset to imaging and imaging to reperfusion epochs. Delays in the onset to imaging reduce the proportion of patients with salvageable brain tissue. However, in the presence of favourable imaging, rapid treatment appears beneficial regardless of the onset to imaging time elapsed. Imaging to reperfusion delays lead to decay in the clinical benefit achieved, particularly in those with less robust collateral flow. The brain imaging options to assess prognosis have various advantages and disadvantages, but whatever strategy is employed must be fast. Ongoing trials are investigating extended time windows, using advanced brain imaging selection. There is also a need for further technical advances to maximise rates of complete reperfusion in the minimum time.
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Affiliation(s)
- Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Geoffrey A Donnan
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Peter J Mitchell
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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