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Gory B, Mazighi M, Labreuche J, Blanc R, Piotin M, Turjman F, Lapergue B. Predictors for Mortality after Mechanical Thrombectomy of Acute Basilar Artery Occlusion. Cerebrovasc Dis 2018; 45:61-67. [DOI: 10.1159/000486690] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/04/2018] [Indexed: 11/19/2022] Open
Abstract
Background: Modern endovascular thrombectomy (MET), using stent retrievers or large-bore distal aspiration catheters in stroke patients with acute basilar artery occlusion (BAO), is routinely performed to date. However, more than 35% of BAO patients treated with MET die within 90 days despite high recanalization rates. The purpose of this study is to investigate the parameters associated with 90-day mortality in patients with BAO after MET. Methods: We analyzed 117 consecutive BAO patients included in the Endovascular Treatment in Ischemic Stroke prospective clinical registry of consecutive acute ischemic stroke patients treated with MET (60 patients [51.3%] treated with a stent retriever as first-line technique) between March 2010 and April 2017. Successful recanalization was defined as modified thrombolysis In cerebral infarction scores 2b-3 at the end of MET, and mortality was defined as modified Rankin Scale 6 at 90 days. Associations of baseline characteristics (patient and treatment characteristics) and intermediate outcomes (recanalization, complications) with 90-day mortality were investigated in univariate and multivariate analyses. Results: Overall successful recanalization rate was 79.5, and 41.9% (95% CI 32.8–51.0%) of patients died within 90 days after MET. Patients with successful recanalization had a lower mortality rate (32.9 vs. 74.4%; p < 0.001). Failure of successful recanalization was an independent predictor of mortality (OR 5.1; 95% CI 1.34–19.33). In multivariate analysis, age ≥60 years (OR 6.37; 95% CI 1.74–23.31), admission National Institute of Health Stroke Scale (NIHSS) ≥13 (OR 4.62; 95% CI 1.42–15.03), lower posterior circulation-Alberta Stroke Program Early CT Score (pc-ASPECTS; OR 1.71; 95% CI 1.19–2.44), use of antithrombotic medication prior to stroke onset (OR 3.38; 95% CI 1.03–11.08), absence of intravenous thrombolysis (OR 3.36; 95% CI 1.12–10.03), and angioplasty/stenting of the basilar artery (OR 4.71; 95% CI 1.34–16.54) were independent predictors for mortality after MET. Conclusions: Failure of successful recanalization was a strong predictor for mortality. In the setting of recanalization, age, admission NIHSS, pc-ASPECTS, absence of intravenous thrombolysis, and angioplasty/stenting of the basilar artery were also independent predictors for mortality after MET of BAO patients.
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Savello AV, Voznyk IA, Svistov DV, Babichev KN, Kandyba DV, Shenderov SV, Vlasenko SV, Shloydo EA, Kachesov EU, Esipovich ID, Kharitonova TV. [Outcomes of endovascular thrombectomy for acute stroke in regional vascular centers of a metropolis (St.-Petersburg)]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:54-63. [PMID: 30830118 DOI: 10.17116/jnevro201811812254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess technical results and close functional outcomes of acute ischemic stroke (AIS) in patients treated with endovascular thrombecomy (ET) in regional vascular centers (RVC) of St-Petersburg. MATERIAL AND METHODS Retrospective analysis of 183 patients with AIS, including 143 patients with AIS due to a large intracranial vessel occlusion in anterior (AC) and 25 patients in posterior cerebral (PC) circulation, 15 with isolated extracranial carotid occlusion treated in 6 RVC in 2017 was performed. All patients underwent ET. RESULTS AND CONCLUSION Effective reperfusion (mTICI 2b-3) was achieved in 71.5% (71.3% AC, 72% PC). On discharge, 35,7% patients had good (mRs 0-2) functional outcome (37.1% AC, 28% PC). The incidence of symptomatic intracranial hemorrhage (according to ECASS II criteria) was 10.7% (9.1% AC, 20% PC), the mortality was 29.2% (22.4% AC, 68% PC).). The results of our study show the possibility of effective and safe application of ET in patients with AIS in the anterior and posterior cerebral circulation in regional vascular centers of St.-Petersburg.
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Affiliation(s)
- A V Savello
- Kirov Medical Military Academy, St.-Petersburg, Russia; Almazov National Medical Research Centre, St.-Petersburg, Russia
| | - I A Voznyk
- Kirov Medical Military Academy, St.-Petersburg, Russia; Dzhanelidze St.-Petersburg Research Institute of Emergency Medicine, St.-Petersburg, Russia
| | - D V Svistov
- Kirov Medical Military Academy, St.-Petersburg, Russia
| | - K N Babichev
- Kirov Medical Military Academy, St.-Petersburg, Russia; Dzhanelidze St.-Petersburg Research Institute of Emergency Medicine, St.-Petersburg, Russia
| | - D V Kandyba
- Dzhanelidze St.-Petersburg Research Institute of Emergency Medicine, St.-Petersburg, Russia
| | - S V Shenderov
- City Multi-Field Hospital #26, St.-Petersburg, Russia
| | - S V Vlasenko
- City Multi-Field Hospital #40, Sestroretsk, Russia
| | - E A Shloydo
- City Multi-Field Hospital #2, St.-Petersburg, Russia
| | - E U Kachesov
- City Multi-Field Hospital 'Alexandrovskaya Bolnitsa', St.-Petersburg, Russia
| | - I D Esipovich
- Almazov National Medical Research Centre, St.-Petersburg, Russia
| | - T V Kharitonova
- Dzhanelidze St.-Petersburg Research Institute of Emergency Medicine, St.-Petersburg, Russia
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103
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Luo G, Mo D, Tong X, Liebeskind DS, Song L, Ma N, Gao F, Sun X, Zhang X, Wang B, Jia B, Fernandez-Escobar A, Miao Z. Factors Associated with 90-Day Outcomes of Patients with Acute Posterior Circulation Stroke Treated By Mechanical Thrombectomy. World Neurosurg 2018; 109:e318-e328. [DOI: 10.1016/j.wneu.2017.09.171] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/23/2017] [Accepted: 09/25/2017] [Indexed: 12/22/2022]
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104
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Mechanical Thrombectomy in Basilar Artery Occlusion. Clin Neuroradiol 2017; 29:153-160. [DOI: 10.1007/s00062-017-0651-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
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105
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Wyszomirski A, Szczyrba S, Tomaka D, Karaszewski B. Treatment of acute basilar artery occlusion: Systematic review and meta-analysis. Neurol Neurochir Pol 2017; 51:486-496. [DOI: 10.1016/j.pjnns.2017.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
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106
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Bouslama M, Haussen DC, Aghaebrahim A, Grossberg JA, Walker G, Rangaraju S, Horev A, Frankel MR, Nogueira RG, Jovin TG, Jadhav AP. Predictors of Good Outcome After Endovascular Therapy for Vertebrobasilar Occlusion Stroke. Stroke 2017; 48:3252-3257. [PMID: 29089457 DOI: 10.1161/strokeaha.117.018270] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular therapy is increasingly used in acute ischemic stroke treatment and is now considered the gold standard approach for selected patient populations. Prior studies have demonstrated that eventual patient outcomes depend on both patient-specific factors and procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome in acute posterior circulation large vessel occlusion strokes treated with endovascular therapy. METHODS We reviewed our prospectively collected endovascular databases at 2 US tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015 who had 3-month modified Rankin Scale documented. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. The association between clinical and procedural parameters and functional outcome was assessed. RESULTS A total of 214 patients qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score, anesthesia modality (conscious sedation versus general anesthesia), procedural length, and reperfusion status were significantly associated with good outcomes in the univariate analysis. Multivariate logistic regression indicated that only smoking (odds ratio=2.61; 95% confidence interval, 1.23-5.56; P=0.013), low baseline National Institutes of Health Stroke Scale score (odds ratio=1.09; 95% confidence interval, 1.04-1.13; P<0.0001), and successful reperfusion status (odds ratio=10.80; 95% confidence interval, 1.36-85.96; P=0.025) were associated with good outcome. CONCLUSIONS In our retrospective case series, only smoking, low baseline National Institutes of Health Stroke Scale score, and successful reperfusion status were associated with good outcome in patients with posterior circulation stroke treated with endovascular therapy.
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Affiliation(s)
- Mehdi Bouslama
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Diogo C Haussen
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Amin Aghaebrahim
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Jonathan A Grossberg
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Gregory Walker
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Srikant Rangaraju
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Anat Horev
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Michael R Frankel
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Raul G Nogueira
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Tudor G Jovin
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Ashutosh P Jadhav
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.).
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107
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Patro SN, Iancu D. Dual-stent retrieval for mechanical thrombectomy of refractory clot in acute stroke as a rescue technique. CMAJ 2017; 189:E634-E637. [PMID: 28461375 DOI: 10.1503/cmaj.160472] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Satya Narayana Patro
- Department of Radiology (Iancu), University of Ottawa; Department of Medical Imaging (Patro), The Ottawa Hospital, Ottawa, Ont
| | - Daniela Iancu
- Department of Radiology (Iancu), University of Ottawa; Department of Medical Imaging (Patro), The Ottawa Hospital, Ottawa, Ont.
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108
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Hu SY, Yi HJ, Lee DH, Hong JT, Sung JH, Lee SW. Effectiveness and Safety of Mechanical Thrombectomy with Stent Retrievers in Basilar Artery Occlusion: Comparison with Anterior Circulation Occlusions. J Korean Neurosurg Soc 2017; 60:635-643. [PMID: 29142622 PMCID: PMC5678059 DOI: 10.3340/jkns.2017.0404.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/04/2017] [Accepted: 08/02/2017] [Indexed: 11/27/2022] Open
Abstract
Objective Acute basilar artery occlusion (BAO) is associated with severe neurological dysfunction and high mortality rates. The benefits of mechanical thrombectomy in BAO have not been explored in recent clinical trials. Therefore, we analyzed outcomes of stent retriever mechanical thrombectomy for BAO, and compared with anterior circulation occlusions (ACO). Methods In total, 161 consecutive patients (24 BAO, 137 ACO) who underwent mechanical thrombectomy with the stent retriever between January 2013 and August 2016 enrolled in our study. All patients underwent clinical assessment with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS). Radiological results were used to evaluate thrombolysis in cerebral infarction (TICI) scores and successful recanalization was defined by TICI 2b or 3. Results Mean NIHSS scores at 24 hours and 30 days were significantly higher in the BAO group than the ACO group (p=0.021, p=0.001). mRS at 90 days was significantly higher in the BAO group (4.2) compared with the ACO group (3.0) (p=0.003). The BAO group (2.0) performed fewer stent retriever passages than the ACO group (2.7) (p=0.049). There were no significant differences between the two groups in terms of complications, but the BAO patients experienced a higher mortality (16.6%) rate than ACO patients (5.8%) (p=0.001). In subgroup analysis of BAO, patients with short procedure times achieved successful recanalization (p=0.001) and successfully recanalized patients exhibited more favorable mRS at 90 days (p=0.027). Conclusion In our study, mechanical thrombectomy of BAO patients showed worse clinical outcome and higher mortality rate than ACO patients. However, mechanical thrombectomy with a stent retriever in BAO is an effective treatment, because successfully recanalized patients showed good clinical outcome in BAO patients.
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Affiliation(s)
- Soo Young Hu
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ho Jun Yi
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Dong Hoon Lee
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Sang Won Lee
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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109
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Gory B, Turjman F. Contact Aspiration with the New ARC Catheter for Thrombectomy of Acute Ischemic Stroke: Single-Center Results. World Neurosurg 2017; 109:e374-e381. [PMID: 28987854 DOI: 10.1016/j.wneu.2017.09.180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/23/2017] [Accepted: 09/25/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVE Contact aspiration has gained growing acceptance in endovascular stroke therapy. The safety and efficacy data of the novel ARC catheter (Medtronic, Irvine, California, USA) used for intracranial thrombectomy have been poorly evaluated thus far. We report our preliminary results with the ARC with regard to angiographic reperfusion, duration of thrombectomy, safety, and clinical outcome at 90 days. METHODS In a single-center series including 20 large-vessel occlusion stroke patients who were collected prospectively, we retrospectively evaluated the safety and efficacy profiles of the ARC intracranial catheter for first-line contact aspiration. Successful reperfusion was defined as modified Thrombolysis in Cerebrovascular Infarction (mTICI) scores 2b-3 at final angiogram and functional independence as modified Rankin Scale score 0-2 at 90 days. RESULTS Median admission National Institutes of Health Stroke Scale score was 15, and previous intravenous thrombolysis was administered in 12 patients (60%). Proximal occlusion was located in the anterior circulation in 16 patients (80%). Primary aspiration alone was successful in 10 of 15 patients (67%) within a median time of 26 minutes. Overall successful reperfusion was achieved in 16 patients (80%) within a median time of 31 minutes. There were no device-related events. Median National Institutes of Health Stroke Scale score was 2.5 at discharge. Six of 17 patients (35%) were independent, and 6 (35%) died at 90 days. Symptomatic intracerebral hemorrhage occurred in 5%. CONCLUSIONS In our initial experience, the ARC appears safe and efficient for contact aspiration thrombectomy in large-vessel stroke therapy. However, improvement of its distal navigability needs further development to improve the success of aspiration alone, and large prospective studies are warranted.
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Affiliation(s)
- Benjamin Gory
- Physiopathology and Imaging for Neurological Disorders (PhIND), Normandie University, UNICAEN, INSERM U1237, Cyceron, Caen, France.
| | - Francis Turjman
- Department of Interventional Neuroradiology, Hospices Civils de Lyon, Lyon, France
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110
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Uno J, Kameda K, Otsuji R, Ren N, Nagaoka S, Maeda K, Ikai Y, Gi H. Mechanical Thrombectomy for Acute Basilar Artery Occlusion in Early Therapeutic Time Window. Cerebrovasc Dis 2017; 44:217-224. [DOI: 10.1159/000479939] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/27/2017] [Indexed: 11/19/2022] Open
Abstract
Background: The natural history of basilar artery occlusion (BAO) is devastating, with morbidity rates increasing up to 80%. However, the efficacy of recanalization therapy for BAO has not been established as yet. Objective: We analyzed consecutive cases of BAO treated with mechanical thrombectomy (MT) to evaluate its safety and efficacy and to determine factors associated with the prognosis. Methods: Between October 2011 and September 2016, MT was performed in 34 patients with BAO. MT was performed using the Penumbra system and stent retriever. CT perfusion was used for evaluating patients. Cerebral blood flow (CBF) maps and cerebral blood volume (CBV) maps were evaluated. CBF/CBV mismatch was defined as ≥50% penumbra. Clinical outcomes were correlated with demographic, clinical, and radiographic findings. Results: The median baseline National Institutes of Health Stroke Scale score was 29 (14-33). The recanalization rate (≥thrombolysis in cerebral infarction grades 2b) was 100%. The median onset to recanalization time (OTR) was 197 (160-256) min. Favorable outcomes (modified Rankin Scale ≤2) at 90 days occurred in 56% (n = 19 of 34). The mortality rate at 90 days was 12% (n = 4 of 34). In univariate analysis, intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA) use, and OTR were significantly associated with favorable outcomes. In a multivariate logistic regression model, IV rt-PA use and lower National Institute of Health Stroke Scale score were significantly related to favorable outcomes. Conclusion and Relevance: Multimodal endovascular therapy using the Penumbra system and stent retriever demonstrated a high recanalization rate and favorable outcomes for BAO. Both devices were feasible and effective in the treatment of BAO. An approach combining MT with IV thrombolysis provided a better recanalization rate and more favorable clinical outcomes.
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111
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Wen WL, Li ZF, Zhang YW, Yang PF, Simfukwe K, Fang YB, Zhang TY, Deng BQ, Hong B, Liu JM, Huang QH. Effect of Baseline Characteristics on the Outcome of Stent Retriever–Based Thrombectomy in Acute Basilar Artery Occlusions: A Single-Center Experience and Pooled Data Analysis. World Neurosurg 2017; 104:1-8. [DOI: 10.1016/j.wneu.2017.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 11/25/2022]
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112
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Lee YY, Yoon W, Kim SK, Baek BH, Kim GS, Kim JT, Park MS. Acute Basilar Artery Occlusion: Differences in Characteristics and Outcomes after Endovascular Therapy between Patients with and without Underlying Severe Atherosclerotic Stenosis. AJNR Am J Neuroradiol 2017; 38:1600-1604. [PMID: 28546252 DOI: 10.3174/ajnr.a5233] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/24/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Prediction of underlying intracranial atherosclerotic stenosis before endovascular therapy might be helpful for appropriate therapeutic planning in patients with acute ischemic stroke. This study aimed to compare the characteristics and treatment outcomes in patients with acute basilar artery occlusion relative to the existence or nonexistence of underlying intracranial atherosclerotic stenosis. MATERIALS AND METHODS Sixty-two patients with acute basilar artery occlusion underwent multimodal endovascular therapy. All patients underwent stent-retriever thrombectomy as a first-line endovascular therapy. Patients with underlying intracranial atherosclerotic stenosis underwent additional intracranial angioplasty and stent placement. The clinical and imaging characteristics and treatment outcomes were retrospectively analyzed and compared between patients with and without intracranial atherosclerotic stenosis. RESULTS Underlying intracranial atherosclerotic stenosis was identified at the occlusion site in 15 patients (24.1%). Occlusion in the proximal segment of the basilar artery was more common in patients with intracranial atherosclerotic stenosis (60% versus 6.4%, P < .001), whereas occlusion in the distal segment was more common in those without it (91.5% versus 26.7%, P < .001). Bilateral thalamic infarction on a pretreatment DWI was less common in patients with intracranial atherosclerotic stenosis (0% versus 27.7%, P = .027) compared with those without it. There were no significant differences in the rates of successful revascularization, favorable outcome, symptomatic hemorrhage, and mortality between the 2 groups. CONCLUSIONS Underlying intracranial atherosclerotic stenosis was not uncommon in patients with acute basilar artery occlusion. The occlusion segment of the basilar artery and the presence or absence of bilateral thalamic infarction on a pretreatment DWI might be helpful for predicting underlying intracranial atherosclerotic stenosis in patients with acute basilar artery occlusion. Patients with and without underlying intracranial atherosclerotic stenosis who underwent endovascular therapy had similar outcomes.
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Affiliation(s)
- Y Y Lee
- From the Departments of Radiology (Y.Y.L., W.Y., S.K.K., B.H.B., G.S.K.)
| | - W Yoon
- From the Departments of Radiology (Y.Y.L., W.Y., S.K.K., B.H.B., G.S.K.)
| | - S K Kim
- From the Departments of Radiology (Y.Y.L., W.Y., S.K.K., B.H.B., G.S.K.)
| | - B H Baek
- From the Departments of Radiology (Y.Y.L., W.Y., S.K.K., B.H.B., G.S.K.)
| | - G S Kim
- From the Departments of Radiology (Y.Y.L., W.Y., S.K.K., B.H.B., G.S.K.)
| | - J T Kim
- Neurology (J.T.K., M.S.P.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - M S Park
- Neurology (J.T.K., M.S.P.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
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Dias FA, Alessio-Alves FF, Castro-Afonso LH, Cougo PT, Barreira CMA, Camilo MR, Nakiri GS, Abud DG, Pontes-Neto OM. Clinical Outcomes of Patients with Acute Basilar Artery Occlusion in Brazil: An Observational Study. J Stroke Cerebrovasc Dis 2017; 26:2191-2198. [PMID: 28551292 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Intravenous thrombolysis (IVT) and endovascular therapy (EVT) were proven safe and effective for anterior circulation proximal occlusions. However, the most appropriate recanalization strategy in patients with acute basilar artery occlusion (BAO) is still controversial. This study aimed to assess outcomes of patients with BAO at an academic stroke center in Brazil. METHODS This is a retrospective analysis of consecutive patients with BAO from a prospective stroke registry at Ribeirão Preto Medical School. Primary outcomes were mortality and favorable outcome (modified Rankin score [mRS] ≤3) at 90 days. After univariate analyses, multivariate logistic regressions were used to identify independent predictors of primary outcomes. RESULTS Between August 2004 and December 2015, 63 (65% male) patients with BAO and median National Institutes of Health Stroke Scale (NIHSS) score of 31 (interquartile range: 19-36) were identified. Twenty-nine (46%) patients received no acute recanalization therapy, 15 (24%) received IVT, and 19 (30%) received EVT (68% treated with stent retrievers). Twenty-four (83%) patients treated conservatively died, and only 2 (7%) achieved an mRS less than or equal to 3. Among patients treated with acute recanalization therapies, 15 (44%) died, and 9 (26.5%) had a favorable outcome. On multivariate analysis, baseline systolic blood pressure (odds ratio [OR] = .97; 95% confidence interval [CI]: .95-0.99; P = .023), posterior circulation Alberta Stroke Program Early CT score (OR = .62; 95% CI: .41-0.94; P = .026), and successful recanalization (OR = .18; 95% CI: .04-0.71; P = .015) were independent predictors of lower mortality. Baseline NIHSS (OR = 1.40; 95% CI: 1.08-1.82; P = .012), prior use of statins (OR = .003; 95% CI: .001-0.28; P = .012), and successful recanalization (OR = .05; 95% CI: .001-0.27; P = .009) were independent predictors of favorable outcome. There was no significant difference between the IVT group and the EVT group on primary outcomes. CONCLUSIONS BAO is associated with high morbidity and mortality in Brazil. Access to acute recanalization therapies may decrease mortality in those patients.
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Affiliation(s)
- Francisco Antunes Dias
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Frederico Fernandes Alessio-Alves
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Luis Henrique Castro-Afonso
- Department of Internal Medicine, Radiology Division, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Pedro Telles Cougo
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Clara Monteiro Antunes Barreira
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Millene Rodrigues Camilo
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Guilherme Seizem Nakiri
- Department of Internal Medicine, Radiology Division, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniel Giansante Abud
- Department of Internal Medicine, Radiology Division, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Octavio Marques Pontes-Neto
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Fahed R, Di Maria F, Rosso C, Sourour N, Degos V, Deltour S, Baronnet-Chauvet F, Léger A, Crozier S, Gabrieli J, Samson Y, Chiras J, Clarençon F. A leap forward in the endovascular management of acute basilar artery occlusion since the appearance of stent retrievers: a single-center comparative study. J Neurosurg 2017; 126:1578-1584. [DOI: 10.3171/2016.2.jns151983] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVEContrary to acute ischemic stroke involving the anterior circulation, no randomized trial has yet demonstrated the safety and effectiveness of endovascular management in acute basilar artery occlusion (BAO). Recently developed thrombectomy devices, such as stentrievers and aspiration systems, have helped in improving the endovascular management of acute ischemic stroke. The authors sought to assess the impact of these devices in the endovascular treatment of acute BAO.METHODSA retrospective analysis of 34 consecutive patients treated in Pitié-Salpêtrière Hospital for acute BAO was carried out. All patients had undergone an endovascular procedure. In addition to the global results in terms of safety and effectiveness (recanalization rate and 3-month clinical outcome based on the modified Rankin Scale [mRS]), the authors aimed to determine if the patients treated with the most recently developed devices (i.e., the Solitaire stentriever or the ADAPT catheter) had better angiographic and clinical outcomes than those treated with older endovascular strategies.RESULTSThe overall successful recanalization rate (thrombolysis in cerebral infarction score 2b–3) was 50% (17 of 34 patients). A good clinical outcome (mRS score 0–2 at 3-month follow-up) was achieved in 11 (32.3%) of 34 patients. The mortality rate at 3-month follow-up was 29.4% (10 of 34 patients). Patients treated with the Solitaire stentriever and the ADAPT catheter had a higher recanalization rate (12 [92.3%] of 13 patients vs 5 [23.8%] of 21 patients, p = 0.0002) and a shorter mean (± SD) procedure duration (88 ± 31 minutes vs 126 ± 58 minutes, p = 0.04) than patients treated with older devices.CONCLUSIONSThe latest devices have improved the effectiveness of mechanical thrombectomy in acute BAO. Their use in further studies may help demonstrate a benefit in the endovascular management of acute BAO.
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Affiliation(s)
| | | | - Charlotte Rosso
- 2Vascular Neurology, and
- 3Paris VI University, Pierre et Marie Curie; and
- 4Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, INSERM, Paris, France
| | | | - Vincent Degos
- 3Paris VI University, Pierre et Marie Curie; and
- 5Anesthesiology, Pitié-Salpêtrière Hospital
| | | | | | | | | | - Joseph Gabrieli
- Departments of 1Interventional Neuroradiology,
- 3Paris VI University, Pierre et Marie Curie; and
| | - Yves Samson
- 2Vascular Neurology, and
- 3Paris VI University, Pierre et Marie Curie; and
- 4Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, INSERM, Paris, France
| | - Jacques Chiras
- Departments of 1Interventional Neuroradiology,
- 3Paris VI University, Pierre et Marie Curie; and
| | - Frédéric Clarençon
- Departments of 1Interventional Neuroradiology,
- 3Paris VI University, Pierre et Marie Curie; and
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Sarzetto F, Gupta S, Alotaibi NM, Howard P, da Costa L, Heyn C, Maralani PJ, Guha D, Swartz RH, Boyle K, Yang VX. Outcome Evaluation of Acute Ischemic Stroke Patients Treated with Endovascular Thrombectomy: A Single-Institution Experience in the Era of Randomized Controlled Trials. World Neurosurg 2017; 99:593-598. [DOI: 10.1016/j.wneu.2016.12.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
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Efficacy and safety of direct aspiration first pass technique versus stent-retriever thrombectomy in acute basilar artery occlusion—a retrospective single center experience. Neuroradiology 2017; 59:297-304. [DOI: 10.1007/s00234-017-1802-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
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Schulz UG, Fischer U. Posterior circulation cerebrovascular syndromes: diagnosis and management. J Neurol Neurosurg Psychiatry 2017; 88:45-53. [PMID: 27071644 DOI: 10.1136/jnnp-2015-311299] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/18/2016] [Accepted: 03/22/2016] [Indexed: 11/04/2022]
Abstract
One in five strokes affects the posterior circulation. Diagnosing posterior circulation stroke can be challenging, as the vascular anatomy can be variable, and because presenting symptoms are often non-specific and fluctuating. Nevertheless, making the correct diagnosis is important, as these strokes have a high chance of recurrence, can be life threatening, and can lead to equally life-threatening complications. Investigation and management largely follow those for stroke in general, although some specific differences exist. These include the preferred use of MRI for diagnosing posterior fossa lesions, the management of basilar artery thrombosis, which may have a longer time window for recanalisation therapy, and the use of endovascular therapies for secondary prevention, which, so far, have not shown any benefit in the treatment of vertebral or basilar artery stenosis. In this review, we summarise the anatomy, aetiology and presentation of posterior circulation stroke, and discuss current approaches to management.
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Affiliation(s)
- Ursula G Schulz
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, Oxford, UK
| | - Urs Fischer
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
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Alonso de Leciñana M, Kawiorski MM, Ximénez-Carrillo Á, Cruz-Culebras A, García-Pastor A, Martínez-Sánchez P, Fernández-Prieto A, Caniego JL, Méndez JC, Zapata-Wainberg G, De Felipe-Mimbrera A, Díaz-Otero F, Ruiz-Ares G, Frutos R, Bárcena-Ruiz E, Fandiño E, Marín B, Vivancos J, Masjuan J, Gil-Nuñez A, Díez-Tejedor E, Fuentes B. Mechanical thrombectomy for basilar artery thrombosis: a comparison of outcomes with anterior circulation occlusions. J Neurointerv Surg 2016; 9:1173-1178. [DOI: 10.1136/neurintsurg-2016-012797] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 11/04/2022]
Abstract
Background and purposeThe benefits of mechanical thrombectomy (MT) in basilar artery occlusions (BAO) have not been explored in recent clinical trials. We compared outcomes and procedural complications of MT in BAO with anterior circulation occlusions.MethodsData from the Madrid Stroke Network multicenter prospective registry were analyzed, including baseline characteristics, procedure times, procedural complications, symptomatic intracranial hemorrhage (SICH), modified Rankin Scale (mRS), and mortality at 3 months.ResultsOf 479 patients treated with MT, 52 (11%) had BAO. The onset to reperfusion time lapse was longer in patients with BAO (median (IQR) 385 min (320–540) vs 315 min (240–415), p<0.001), as was the duration of the procedures (100 min (40–130) vs 60 min (39–90), p=0.006). Moreover, the recanalization rate was lower (75% vs 84%, p=0.01). A trend toward more procedural complications was observed in patients with BAO (32% vs 21%, p=0.075). The frequency of SICH was 2% vs 5% (p=0.25). At 3 months, patients with BAO had a lower rate of independence (mRS 0–2) (40% vs 58%, p=0.016) and higher mortality (33% vs 12%, p<0.001). The rate of futile recanalization was 50% in BAO versus 35% in anterior circulation occlusions (p=0.05). Age and duration of the procedure were significant predictors of futile recanalization in BAO.ConclusionsMT is more laborious and shows more procedural complications in BAO than in anterior circulation strokes. The likelihood of futile recanalization is higher in BAO and is associated with greater age and longer procedure duration. A refinement of endovascular procedures for BAO might help optimize the results.
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120
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Phan K, Phan S, Huo YR, Jia F, Mortimer A. Outcomes of endovascular treatment of basilar artery occlusion in the stent retriever era: a systematic review and meta-analysis. J Neurointerv Surg 2015; 8:1107-1115. [DOI: 10.1136/neurintsurg-2015-012089] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/30/2015] [Indexed: 11/03/2022]
Abstract
BackgroundStent retriever thrombectomy has recently been found to be effective for anterior circulation strokes, but its efficacy for basilar artery occlusion (BAO) is unclear.ObjectiveTo carry out a systematic review and meta-analysis to analyze the available evidence for the use of stent retrievers for BAO.MethodsTwo independent reviewers searched six databases for studies reporting outcomes following endovascular treatment for BAO.ResultsA total of 17 articles (6 prospective and 11 retrospective) were included. The weighted mean age of patients was 67 years (range 59–82) and 59% were male. Thrombolytic drugs were administered intravenously and intra-arterially in 46% (range 0–88%) and 38% (range 0–90%) of patients, respectively. Weighted pooled estimates of successful recanalization (TICI 2b–3) and good outcome (modified Rankin Scale ≤2) were 80.0% (95% CI 70.7% to 88.0%; I2=80.28%; p<0.001) and 42.8% (95% CI 34.0% to 51.8%; I2=61.83%; p=0.002), respectively. Pooled mortality was 29.4% (95% CI 23.9% to 35.3%; I2=37.01%; p=0.087). Incidence of procedure-related complications and symptomatic hemorrhage was 10.0% (95% CI 3.7% to 18.3%; I2=61.05%; p=0.017) and 6.8% (95% CI 3.5% to 10.8%; I2=37.99%; p=0.08), respectively.ConclusionsStent retriever thrombectomy achieves a high rate of recanalization and functional independence while being relatively safe for patients with BAO. Future prospective studies with long-term follow-up are warranted.
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121
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Carneiro AAS, Rodrigues JTL, Pereira JPR, Alves JV, Xavier JAM. Mechanical thrombectomy in patients with acute basilar occlusion using stent retrievers. Interv Neuroradiol 2015; 21:710-4. [PMID: 26490830 DOI: 10.1177/1591019915609781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/07/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Early arterial recanalisation with stent retrievers (SR) has been recently demonstrated to improve clinical outcome of patients with large-vessel occlusion of the anterior circulation. However, the benefit of SR thrombectomy in the setting of acute basilar artery occlusion (BAO) has not been proven yet. This study evaluated a series of consecutive patients with BAO treated with SR, focusing on the efficacy, safety and clinical results. METHODS We analysed 24 consecutive patients with acute BAO who were treated with SR mechanical thrombectomy. Good clinical outcome at three months was defined as mRS ≤ 2. Data from patients with good outcome were compared to that from patients with poor outcome. RESULTS Sufficient recanalisation (TICI 2 b or 3) was achieved in 63% (15/24) of patients. At three months, 33% (8/24) of patients had died; good clinical outcome was obtained in 21% (5/24). Age (46 vs. 60 years old, p = 0.05) and time from symptoms onset to recanalisation (370 vs. 521 minutes, p = 0.048) was significantly lower in patients with good outcome as compared to patients with poor outcome. There were three cases (12.5%) of periprocedural complications, all of them related to arterial wall dissection/perforation. CONCLUSIONS SR thrombectomy might be an efficient and safe treatment for patients with acute BAO occlusion and might help improve outcome.
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