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Amador K, Gutierrez A, Winder A, Fiehler J, Wilms M, Forkert ND. Providing clinical context to the spatio-temporal analysis of 4D CT perfusion to predict acute ischemic stroke lesion outcomes. J Biomed Inform 2024; 149:104567. [PMID: 38096945 DOI: 10.1016/j.jbi.2023.104567] [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: 06/09/2023] [Revised: 10/25/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023]
Abstract
Acute ischemic stroke is a leading cause of mortality and morbidity worldwide. Timely identification of the extent of a stroke is crucial for effective treatment, whereas spatio-temporal (4D) Computed Tomography Perfusion (CTP) imaging is playing a critical role in this process. Recently, the first deep learning-based methods that leverage the full spatio-temporal nature of perfusion imaging for predicting stroke lesion outcomes have been proposed. However, clinical information is typically not integrated into the learning process, which may be helpful to improve the tissue outcome prediction given the known influence of various factors (i.e., physiological, demographic, and treatment factors) on lesion growth. Cross-attention, a multimodal fusion strategy, has been successfully used to combine information from multiple sources, but it has yet to be applied to stroke lesion outcome prediction. Therefore, this work aimed to develop and evaluate a novel multimodal and spatio-temporal deep learning model that utilizes cross-attention to combine information from 4D CTP and clinical metadata simultaneously to predict stroke lesion outcomes. The proposed model was evaluated using a dataset of 70 acute ischemic stroke patients, demonstrating significantly improved volume estimates (mean error = 19 ml) compared to a baseline unimodal approach (mean error = 35 ml, p< 0.05). The proposed model allows generating attention maps and counterfactual outcome scenarios to investigate the relevance of clinical variables in predicting stroke lesion outcomes at a patient level, helping to provide a better understanding of the model's decision-making process.
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Affiliation(s)
- Kimberly Amador
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, Canada; Department of Radiology, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.
| | - Alejandro Gutierrez
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, Canada; Department of Radiology, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Anthony Winder
- Department of Radiology, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Wilms
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Nils D Forkert
- Department of Radiology, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
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Kim H, Ahn JH, Ko SM, Kim JW. Pre-navigation balloon technique: Distal emboli protection during stent retriever thrombectomy. Clin Neurol Neurosurg 2024; 236:108057. [PMID: 37995622 DOI: 10.1016/j.clineuro.2023.108057] [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: 06/21/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE During stent retriever thrombectomy, a balloon guide catheter reduces distal emboli and consequently improves clinical outcomes. Because balloons are usually used before stent retrieval, these can affect the thrombus including the distal emboli while performing microcatheter navigation. This study aimed to evaluate the usefulness and safety of the pre-navigation balloon technique during microcatheter and microwire navigation. METHODS Patients who underwent stent retriever thrombectomy secondary to an anterior circulation large-artery occlusion were retrospectively evaluated. The pre-navigation balloon technique was used, and the number of retrievals, procedure time, final recanalization, presence of distal emboli, first-pass effect (FPE), symptomatic intracranial hemorrhage including procedure-related complications, and clinical outcomes at 3 months were evaluated. RESULTS In total 123 patients were analyzed, and occurrence of distal emboli was lesser in the pre-navigation balloon than in the non-preballoon group (4.4% vs. 11.5%, p = 0.02). No statistical difference was found in successful recanalization, mortality, and procedure-related complications. Moreover, the pre-navigation balloon group had a higher FPE than the non-balloon group (37.8% vs. 20.5%, p = 0.004). Although no statistical difference was found in the pre-navigation balloon group, a trend toward a higher rate of good clinical outcomes was observed (mRS 0-2 at 3 months, 55.6% vs. 48.7%, p = 0.09). For ICA occlusion(n = 35), significant effects were seen in decreasing distal embolism (0(0%) vs 3(16%), p = 0.01), increasing FPE (8(50%) vs 6(32%), p = 0.003), and improving clinical outcomes (mRS 0-2 at 3 months, 9(56%) vs 7(37%), p = 0.03) in the pre-navigation balloon group. In the multivariate analysis, lesser distal embolism (0.91 [0.80-1.00], p = 0.02), higher successful recanalization (3.52 [1.11-7.03], p = 0.016), and higher FPE (3.17 [1.83-7.37], p = 0.001) secondary to the procedure was a predictor of favorable clinical outcomes. CONCLUSIONS The pre-navigation balloon technique significantly reduced occurrence of distal embolism and increased the FPE.
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Affiliation(s)
- Hyunjung Kim
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jhii-Hyun Ahn
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Sung Min Ko
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jin Woo Kim
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea.
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Alexandre AM, Scarcia L, Brunetti V, Scala I, Kalsoum E, Valente I, Camilli A, De Leoni D, Colò F, Frisullo G, Piano M, Rollo C, Macera A, Ruggiero M, Lafe E, Gabrieli JD, Cester G, Limbucci N, Arba F, Ferretti S, Da Ros V, Bellini L, Salsano G, Mavilio N, Russo R, Bergui M, Caragliano AA, Vinci SL, Romano DG, Frauenfelder G, Semeraro V, Ganimede MP, Lozupone E, Romi A, Cavallini A, Milonia L, Muto M, Giordano F, Cirillo L, Calabresi P, Pedicelli A, Broccolini A. Predictors of parenchymal hematoma and clinical outcome after mechanical thrombectomy in patients with large ischemic core due to large vessel occlusion: a retrospective multicenter study. J Neurointerv Surg 2023:jnis-2023-021146. [PMID: 38129110 DOI: 10.1136/jnis-2023-021146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The aim of our study was to find predictors of parenchymal hematoma (PH) and clinical outcome after mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO) and baseline large infarct. METHODS The databases of 16 stroke centers were retrospectively screened for patients with anterior circulation LVO and baseline Alberta Stroke Program Early CT Score (ASPECTS) ≤5 that received MT. Procedural parameters, including the number of passes during first and second technique of MT, were recorded. Outcome measures were occurrence of PH type 2 and any type of PH after MT, and the 90-day modified Rankin Scale (mRS) score of 0-3 and 0-2. RESULTS In total, 408 patients were available for analysis. A higher number of passes in the second technique was predictive of PH type 2 (odds ratio (OR) - 3.204, 95% confidence interval (CI) 1.140 to 9.005), whereas procedure conducted under general anesthesia was associated with lower risk (OR 0.127, 95% CI 0.002 to 0.808). The modified thrombolysis in cerebral infarction grade 2c-3 was associated with the mRS score 0-3 (OR 3.373, 95% CI 1.891 to 6.017), whereas occurrence of PH type 2 was predictive of unfavorable outcome (OR 0.221, 95% CI 0.063 to 0.773). Similar results were found for the mRS score 0-2 outcome measure. CONCLUSION In patients with large ischemic core, a higher number of passes during MT and procedure not conducted under general anesthesia are associated with increased rate of PH type 2, that negatively impact the clinical outcome. Our data outline a delicate balance between the need of a complete recanalization and the risk of PH following MT.
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Affiliation(s)
- Andrea M Alexandre
- Interventional Neuroradiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Scarcia
- Neuroradiology Unit, Henri Mondor Hospital, Creteil, France
| | - Valerio Brunetti
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Irene Scala
- Catholic University School of Medicine, Rome, Italy
| | - Erwah Kalsoum
- Neuroradiology Unit, Henri Mondor Hospital, Creteil, France
| | - Iacopo Valente
- Interventional Neuroradiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Giovanni Frisullo
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mariangela Piano
- Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Claudia Rollo
- Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonio Macera
- Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Ruggiero
- Neuroradiology Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Elvis Lafe
- Neuroradiology Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Joseph D Gabrieli
- Neuroradiology Unit, Policlinico Universitario di Padova, Padua, Italy
| | - Giacomo Cester
- Neuroradiology Unit, Policlinico Universitario di Padova, Padua, Italy
| | - Nicola Limbucci
- Interventional Neurovascular Unit, A.O.U. Careggi, Florence, Italy
| | | | - Simone Ferretti
- NEUROFARBA Department, University of Florence, Florence, Italy
| | - Valerio Da Ros
- Department of Biomedicine and Prevention, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Luigi Bellini
- Department of Biomedicine and Prevention, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Giancarlo Salsano
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genua, Italy
| | - Nicola Mavilio
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genua, Italy
| | - Riccardo Russo
- Neuroradiology Unit, A.O. Città della Salute e della Scienza, Turin, Italy
| | - Mauro Bergui
- Neuroradiology Unit, A.O. Città della Salute e della Scienza, Turin, Italy
| | | | - Sergio L Vinci
- Neuroradiology Unit, A.O.U. Policlinico G. Martino, Messina, Italy
| | - Daniele G Romano
- Neuroradiology Unit, A.O.U. S. Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
| | - Giulia Frauenfelder
- Neuroradiology Unit, A.O.U. S. Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
| | - Vittorio Semeraro
- Interventional Radiology Unit, "SS Annunziata" Hospital, Taranto, Italy
| | | | | | - Andrea Romi
- Neuroradiology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Cavallini
- Department of Emergency Neurology and Stroke Unit, IRCCS Fondazione Mondino, Rome, Italy
| | - Luca Milonia
- Interventional Neuroradiology, University Hospital Policlinico Umberto I, Rome, Italy
| | - Massimo Muto
- Neuroradiology Unit, Azienda Ospedaliera di Rilievo Nazionale "A. Cardarelli", Naples, Italy
| | - Flavio Giordano
- Neuroradiology Unit, Azienda Ospedaliera di Rilievo Nazionale "A. Cardarelli", Naples, Italy
| | - Luigi Cirillo
- Neurology and Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna - Maggiore Hospital, Bolona, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, Bologna, Italy
| | - Paolo Calabresi
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University School of Medicine, Rome, Italy
| | - Alessandro Pedicelli
- Interventional Neuroradiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University School of Medicine, Rome, Italy
| | - Aldobrando Broccolini
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University School of Medicine, Rome, Italy
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Fan H, Wei L, Zhao X, Zhu Z, Lu W, Roshani R, Huang K. White matter hyperintensity burden and functional outcomes in acute ischemic stroke patients after mechanical thrombectomy: A systematic review and meta-analysis. Neuroimage Clin 2023; 41:103549. [PMID: 38071889 PMCID: PMC10750174 DOI: 10.1016/j.nicl.2023.103549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/13/2023] [Accepted: 12/03/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND The influence of white matter hyperintensity (WMH) on clinical outcomes in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT) remains controversial. We performed a systematic review and meta-analysis to examine whether WMH burden is associated with clinical outcomes in AIS patients after MT. METHODS PubMed, Embase, and Web of Science were searched from inception to Sep 03, 2023. The registration number for PROSPERO is CRD42022340568. Studies reporting an association between the burden of WMH in AIS patients and clinical outcomes after MT were included in the meta-analysis. A random-effects model was used for meta-analysis. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Additionally, the presence of imprecise-study effects was evaluated using Egger's test and funnel plot. RESULTS Fifteen studies with 3,456 patients were enrolled in this meta-analysis. Among AIS patients who underwent MT, moderate/severe WMH had higher odds of 90-day unfavorable functional outcomes (odds ratio [OR] 2.72, 95% confidence interval [CI] 2.14-3.44; I2 = 0.0%; 95% CI 0.0%-42.7%), 90-day mortality (OR 1.94, 95% CI 1.45-2.60; I2 = 19.5%; 95% CI 0.0%-65.2%) and futile recanalization (OR 2.99, 95% CI 1.42-6.28; I2 = 69.7%; 95% CI 0.0%-91.0%) compared with none/mild WMH. However, the two groups had no significant difference in successful recanalization, symptomatic hemorrhagic transformation, and hemorrhagic transformation. A subset analysis of patients from 3 articles showed that WMH volume was not significantly associated with these outcomes. A notable limitation is that this meta-analysis lacks direct adjustment for imbalances in important baseline covariates. CONCLUSIONS Patients with moderate/severe WMH on baseline imaging are associated with substantially increased odds of 90-day unfavorable outcomes, futile recanalization, and 90-day mortality after MT. This association suggests that moderate/severe WMH may contribute to the prediction of clinical outcomes in AIS patients after MT.
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Affiliation(s)
- Huanhuan Fan
- Department of Neurology, Nanfang Hospital, Southern Medical University, China
| | - Lihua Wei
- Department of Neurology, Nanfang Hospital, Southern Medical University, China
| | - Xiaolin Zhao
- Department of Neurology, Nanfang Hospital, Southern Medical University, China
| | - Zhiliang Zhu
- Department of Neurology, Nanfang Hospital, Southern Medical University, China
| | - Wenting Lu
- Department of Neurology, Nanfang Hospital, Southern Medical University, China
| | - Ramzi Roshani
- Department of Neurology, Nanfang Hospital, Southern Medical University, China
| | - Kaibin Huang
- Department of Neurology, Nanfang Hospital, Southern Medical University, China.
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Cho BR, Jang DK, Jang KS, Moon BH, Cho H. Predictors for intracerebral hemorrhage after intravenous or intraarterial recanalization in acute major cerebral artery occlusion in Korean patients. Int J Neurosci 2023; 133:1271-1284. [PMID: 35575757 DOI: 10.1080/00207454.2022.2078206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/07/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate predictors for intracerebral hemorrhage (ICH) and 1-month mortality after intravenous (IV) or intraarterial (IA) recanalization therapy for major cerebral artery occlusion in Korean patients. METHODS From 2011 to 2015, we prospectively gathered data from consecutive patients treated with IV/IA recanalization within 8 h of symptoms in a single center. The effects of demographic, clinical, laboratory, and radiological factors on ICH within 2 weeks were assessed, as well as 1-month mortality. RESULTS From a total of 183 patients, symptomatic intracerebral hemorrhage (SICH) occurred in 32 patients (17.5%), and asymptomatic ICH occurred in 37 patients (20.2%). The mortality rate at 1 month in ICH patients was 37.7%. The international normalized ratio (INR) (OR, 4.9; 95% CI, 1.03-23.4; p = 0.046), glucose (OR, 1.119 per mmol/L; 95% CI, 1.015-1.233; p = 0.023), medium-volume infarct (15-69.9 mL) (OR, 2.62; 95% CI, 1.1-6.26; p = 0.03), large-volume infarct (≥70 mL) (OR, 5.54; 95% CI, 2.1-14.6; p = 0.001), and angioplasty or stenting (OR, 6.29; 95% CI, 1.71-23.22; p = 0.006) were predictors of any ICH. Hyperlipidemia or statin medication (OR, 4.17; 95% CI, 1.38-12.59; p = 0.011), INR (OR, 7.13; 95% CI, 0.94-54.22 p = 0.058), and large-volume infarct (≥70 mL) (OR, 7.96; 95% CI, 2.31-27.39; p = 0.001) were predictors of SICH. Hypertension (OR, 5.77; 95% CI, 1.43-23.3; p = 0.014), initial NIHSS score (OR, 1.09; 95% CI, 1.01-1.18; p = 0.27), and SICH (OR, 15.7; 95% CI, 4.04-61.08; p < 0.001) were predictors of 1-month mortality. CONCLUSION INR and glucose may be strong modifiable predictors of critical ICH leading to death after IV/IA recanalization therapy in acute cerebral artery occlusion.
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Affiliation(s)
- Byung-Rae Cho
- Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Dong-Kyu Jang
- Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Kyung-Sool Jang
- Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Byung-Hoo Moon
- Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Hyunji Cho
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
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Zidan M, Ghaei S, Bode FJ, Weller JM, Krueger N, Lehnen NC, Petzold GC, Radbruch A, Dorn F, Paech D. Clinical significance and prevalence of subarachnoid hyperdensities on flat detector CT after mechanical thrombectomy: does it really matter? J Neurointerv Surg 2023:jnis-2023-020661. [PMID: 37648432 DOI: 10.1136/jnis-2023-020661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Subarachnoid hyperdensities after mechanical thrombectomy (MT) are a common finding. However, it is often regarded as clinically insignificant. OBJECTIVE With this single-center investigation, to identify the prevalence of subarachnoid hyperdensities following MT, associated predictors, and the impact on the clinical outcome of the patients. METHODS 383 patients from the stroke registry were analyzed for the presence of subarachnoid hyperdensities on flat detector CT (FDCT) directly after the completion of MT, and on follow-up dual-energy CT, then classified according to a visual grading scale. 178 patients were included with anterior circulation occlusions. Regression analysis was performed to identify significant predictors, and Kruskal-Wallis analysis and Χ2 test were performed to test the variables among the different groups. The primary outcome was the modified Rankin Scale (mRS) score at 90 days and was analyzed with the Wilcoxon-Mann-Whitney rank-sum test. RESULTS The prevalence of subarachnoid hyperdensities on FDCT was (66/178, 37.1%) with patients experiencing a significant unfavorable outcome (P=0.035). Significantly fewer patients with subarachnoid hyperdensities achieved a mRS score of ≤3 at 90 days 25/66 (37.9%) vs 60/112 (53.6%), P=0.043). In addition, mortality was significantly higher in the subarachnoid hyperdensities group (34.8% vs 19.6%, P=0.024). Distal occlusions and a higher number of device passes were significantly associated with subarachnoid hyperdensities (P=0.026) and (P=0.001), respectively. Patients who received intravenous tissue plasminogen activator had significantly fewer subarachnoid hyperdensities (P=0.029). CONCLUSIONS Postinterventional subarachnoid hyperdensities are a frequent finding after MT and are associated with neurological decline and worse functional outcome. They are more common with distal occlusions and multiple device passes.
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Affiliation(s)
- Mousa Zidan
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Shiwa Ghaei
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Felix J Bode
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | - Nadine Krueger
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Nils Christian Lehnen
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Gabor C Petzold
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
- Department of Neuroradiology, LMU Klinikum der Universität München Medizinische Klinik und Poliklinik IV, Munchen, Bayern, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
- Department of Radiology, German Cancer Research Centre, Heidelberg, Germany
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Dumas V, Martin K, Giraud C, Prigent J, Bloch W, Soualmi K, Herpe G, Boucebci S, Neau JP, Guillevin R, Velasco S. Functional outcome in low-ASPECTS (0-5) acute ischemic stroke treated with mechanical thrombectomy: impact of laterality explored in a single-center study. Front Neurol 2023; 14:1205256. [PMID: 37470004 PMCID: PMC10353876 DOI: 10.3389/fneur.2023.1205256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
Background There is no consensus regarding the influence of infarct laterality in patients with acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO) treated with mechanical thrombectomy (MT), particularly in low-ASPECT (0-5) patients who were excluded from the initial MT studies and that participated in dedicated randomized-controlled trials that do not consider the side of the occlusion. We aimed to evaluate the role of infarct laterality on the clinical outcome in low-ASPECT AIS patients treated with MT. Material and methods We retrospectively analyzed our institutional stroke database in our Thrombectomy-Capable Stroke Center (TCSC), including patient characteristics, procedural variables, and outcomes, between January 2015 and January 2022. Patients with acute intracranial ICA and/or proximal MCA occlusions with ASPECT ≤ 5 either on CT or MRI were included and divided into 2 groups according to the location of ischemia. The primary endpoint was a good clinical outcome at 90 days (modified Rankin Scale (mRS) score of 0-3). Results Between January 2015 and November 2021, 817 MT were performed, of which 82 were low-ASPECT (10.0%): 41 left-sided and 41 right-sided strokes. The rates of good clinical outcome were 30.8% (12/41) for the left-sided group and 43.6% (17/41) for the right-sided group, with a p-value of 0.349. The morality rate showed no significant difference between the two groups: 39.0% (16/41) in the right stroke group and 36.6% (15/41) in the left stroke group. Conclusion The clinical outcome was not significantly influenced by stroke laterality. The results of this single-center retrospective study indicate either a lack of strength or equal value in performing mechanical thrombectomy regardless of stroke laterality.
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Affiliation(s)
- Victor Dumas
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Killian Martin
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Clément Giraud
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France
| | - Julia Prigent
- Department of Neurology, Poitiers University Medical Center, Poitiers, France
| | - William Bloch
- Department of Neurology, Poitiers University Medical Center, Poitiers, France
| | - Karim Soualmi
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Guillaume Herpe
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Samy Boucebci
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Jean Philippe Neau
- Department of Neurology, Poitiers University Medical Center, Poitiers, France
| | - Rémy Guillevin
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Stéphane Velasco
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
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Arrarte Terreros N, Bruggeman AAE, van Voorst H, Konduri PR, Jansen IGH, Kappelhof M, Tolhuisen ML, Boodt N, Dippel DWJ, van der Lugt A, van Zwam WH, van Oostenbrugge RJ, van der Worp HB, Emmer BJ, Meijer FJA, Roos YBWEM, van Bavel E, Marquering HA, Majoie CBLM. Bifurcation occlusions and endovascular treatment outcome in acute ischemic stroke. J Neurointerv Surg 2023; 15:355-362. [PMID: 35318957 PMCID: PMC10086510 DOI: 10.1136/neurintsurg-2021-018560] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/03/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND A thrombus in the M1 segment of the middle cerebral artery (MCA) can occlude this main stem only or extend into the M1-M2 bifurcation. The occlusion pattern may affect endovascular treatment (EVT) success, as a bifurcated thrombus may be more prone to fragmentation during retrieval. OBJECTIVE To investigate whether bifurcated thrombus patterns are associated with EVT procedural and clinical outcomes. METHODS Occlusion patterns of MCA thrombi on CT angiography from MR CLEAN Registry patients were classified into three groups: main stem occlusion, bifurcation occlusion extending into one M2 branch, and bifurcation occlusion extending into both M2 branches. Procedural parameters, procedural outcomes (reperfusion grade and embolization to new territory), and clinical outcomes (24-48 hour National Institutes of Health Stroke Scale [NIHSSFU] score, change in NIHSS scores between 24 and 48 hours and baseline ∆ [NIHSS], and 90-day modified Rankin Scale [mRS] scores) were compared between occlusion patterns. RESULTS We identified 1023 patients with an MCA occlusion of whom 370 (36%) had a main stem occlusion, 151 (15%) a single branch, and 502 (49%) a double branch bifurcation occlusion. There were no statistically significant differences in retrieval method, procedure time, number of retrieval attempts, reperfusion grade, and embolization to new territory between occlusion patterns. Patients with main stem occlusions had lower NIHSSFU scores than patients with single (7 vs 11, p=0.01) or double branch occlusions (7 vs 9, p=0.04). However, there were no statistically significant differences in ∆ NIHSS or in 90-day mRS scores. CONCLUSIONS In our population, EVT procedural and long-term clinical outcomes were similar for MCA bifurcation occlusions and MCA main stem occlusions.
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Affiliation(s)
- Nerea Arrarte Terreros
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands .,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Agnetha A E Bruggeman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Henk van Voorst
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Praneeta R Konduri
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Ivo G H Jansen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Manon Kappelhof
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Manon L Tolhuisen
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Nikki Boodt
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Wim H van Zwam
- Department of Radiology, Maastricht UMC, Maastricht, The Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Maastricht UMC, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery Brain Center, UMC Utrecht, Utrecht, The Netherlands
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | | | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Ed van Bavel
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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9
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Kang Z, Wu L, Sun D, Zhou G, Wu X, Qiu H, Mei B, Zhang J. Proximal hyperdense middle cerebral artery sign is associated with increased risk of asymptomatic hemorrhagic transformation after endovascular thrombectomy: a multicenter retrospective study. J Neurol 2023; 270:1587-1599. [PMID: 36446912 PMCID: PMC9971136 DOI: 10.1007/s00415-022-11500-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether hyperdense middle cerebral artery sign (HMCAS) on pretreatment no-contrast CT (NCCT) is associated with hemorrhagic transformation (HT) after endovascular thrombectomy (EVT). METHODS Patients with acute middle cerebral artery (MCA) occlusion who received EVT in three comprehensive hospitals were retrospectively evaluated. They were divided into four groups based on the presence or absence of HMCAS and corresponding CTA findings, among whom differences were compared. Univariate and multivariate logistic regression analyses were performed to investigate the association between HMCAS and HT and its subtypes. RESULTS 318 patients were included, among whom 149 (46.9%) had HMCAS. Patients in the proximal positive HMCAS group had higher National Institute of Health Stroke Scale scores and lower Alberta Stroke Program Early CT Scores (ASPECTS) than those in the proximal negative HMCAS group. The rate of HT was higher in the proximal positive HMCAS group than that in the proximal negative HMCAS group. In multivariate logistic regression analysis, the proximal HMCAS were independently associated with HT (adjusted OR = 2.073, 95% CI 1.211-3.551, p = 0.008) and aHT (adjusted OR = 2.271, 95% CI 1.294-3.986, p = 0.004), but not with sHT. Patients who developed HT, including aHT and sHT, had a lower rate of good outcome. CONCLUSION Proximal HMCAS on initial NCCT was independently associated with aHT in patients who received EVT for acute MCA occlusion. Both aHT and sHT had a detrimental effect on clinical outcome.
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Affiliation(s)
- Zhiming Kang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lishuo Wu
- Department of Neurology, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, 530022, China
| | - Dong Sun
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Gang Zhou
- Department of Neurology, Huanggang Central Hospital, Huanggang, 438000, China
| | - Xiangbo Wu
- Department of Neurology, Huanggang Central Hospital, Huanggang, 438000, China
| | - Han Qiu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Bin Mei
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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10
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Dong S, Yu C, Wu Q, Xia H, Xu J, Gong K, Wang T. Predictors of Symptomatic Intracranial Hemorrhage after Endovascular Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Cerebrovasc Dis 2022; 52:363-375. [PMID: 36423584 DOI: 10.1159/000527193] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/16/2022] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION This meta-analysis assessed the predictors of symptomatic intracranial hemorrhage (sICH) after endovascular thrombectomy (EVT) for patients with acute ischemic stroke. METHODS PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science were searched for studies published from inception to February 16, 2021. We included studies that evaluated the predictors of sICH after EVT. The random-effect model or fixed-effect model was used to pool the estimates according to the heterogeneity. RESULTS A total of 25 cohort studies, involving 15,324 patients, were included in this meta-analysis. The total incidence of sICH was 6.72 percent. Age (MD = 2.57, 95% CI: 1.53-3.61; p < 0.00001), higher initial NIHSS score (MD = 1.71, 95% CI: 1.35-2.08, p < 0.00001), higher initial systolic blood pressure (MD = 7.40, 95% CI: 5.11-9.69, p < 0.00001), diabetes mellitus (OR = 1.36, 95% CI: 1.10-1.69, p = 0.005), poor collaterals (OR = 3.26, 95% CI: 2.35-4.51; p < 0.0001), internal carotid artery occlusion (OR = 1.55, 95% CI: 1.26-1.90; p < 0.0001), longer procedure time (MD = 18.92, 95% CI: 11.49-26.35; p < 0.0001), and passes of retriever >3 (OR = 3.39, 95% CI: 2.45-4.71; p < 0.0001) were predictors of sICH, while modified thrombolysis in cerebral infarction score ≥2b (OR = 0.61, 95% CI: 0.46-0.79; p = 0.0002) was associated with a decreased risk of sICH. There were no significant differences in the female gender, initial serum glucose, initial ASPECT score, atrial fibrillation, oral anticoagulants, antiplatelet therapy, intravenous thrombolysis, general anesthesia, neutrophil-to-lymphocyte ratio, and emergent stenting. CONCLUSIONS This study identified many predictors of sICH. Some of the results lack robust evidence given the limitations of the study. Therefore, larger cohort studies are needed to confirm these predictors.
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Affiliation(s)
- Shuyang Dong
- Department of Neurology, The First People's Hospital of Huainan, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China,
| | - Chuanqing Yu
- Department of Neurology, The First People's Hospital of Huainan, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China
| | - Qingbin Wu
- Department of Neurology, The First People's Hospital of Huainan, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China
| | - Henglei Xia
- Department of Neurology, The First People's Hospital of Huainan, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China
| | - Jialong Xu
- Department of Neurology, The First People's Hospital of Huainan, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China
| | - Kun Gong
- Department of Neurology, The First People's Hospital of Huainan, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China
| | - Tao Wang
- Department of Neurology, The First People's Hospital of Huainan, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China
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11
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Matusevicius M, Cooray C, Rand VM, Nunes AP, Moreira T, Tassi R, Egido JA, Ollikainen J, Bigliardi G, Holmin S, Ahmed N. Stroke Etiology and Outcomes after Endovascular Thrombectomy: Results from the SITS Registry and a Meta-Analysis. J Stroke 2021; 23:388-400. [PMID: 34649383 PMCID: PMC8521251 DOI: 10.5853/jos.2021.00850] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/04/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE The influence of stroke etiology on outcomes after endovascular thrombectomy (EVT) is not well understood. We aimed to investigate whether stroke etiology subgrouped as large artery atherosclerosis (LAA) and cardiac embolism (CE) influences outcomes in large artery occlusion (LAO) treated by EVT. METHODS We included EVT treated LAO stroke patients registered in the Safe Implementation of Treatment in Stroke (SITS) thrombectomy register between January 1, 2014 and September 3, 2019. Primary outcome was successful reperfusion (modified Treatment in Cerebral Infarction 2b-3). Secondary outcomes were symptomatic intracranial hemorrhage (SICH), 3-month functional independence (modified Ranking Scale 0-2) and death. Multivariable logistic regression models were used for comparisons. In addition, a meta-analysis of aggregate data from the current literature was conducted (PROSPERO, ID 167447). RESULTS Of 7,543 patients, 1,903 (25.2%) had LAA, 3,214 (42.6%) CE, and 2,426 (32.2%) unknown, other, or multiple etiologies. LAA patients were younger (66 vs. 74, P<0.001) and had lower National Institutes of Health Stroke Scale score at baseline (15 vs. 16, P<0.001) than CE patients. Multivariable analyses showed that LAA patients had lower odds of successful reperfusion (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.57 to 0.86) and functional independence (OR, 0.74; 95% CI, 0.63 to 0.85), higher risk of death (OR, 1.44; 95% CI, 1.21 to 1.71), but no difference in SICH (OR, 1.09; 95% CI, 0.71 to 1.66) compared to CE patients. The systematic review found 25 studies matching the criteria. The meta-analysis did not find any difference between etiologies. CONCLUSIONS From the SITS thrombectomy register, we observed a lower chance of reperfusion and worse outcomes after thrombectomy in patients with LAA compared to CE etiology, despite more favorable baseline characteristics. In contrast, the meta-analysis did not find any difference between etiologies with aggregate data.
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Affiliation(s)
- Marius Matusevicius
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Research and Education, Karolinska University Hospital, Stockholm, Sweden
| | - Charith Cooray
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Viiu-Marika Rand
- Department of Neurology, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Ana Paiva Nunes
- Stroke Unit, Saint Joseph's Hospital, Central Lisbon University Hospital Centre, Lisbon, Portugal
| | - Tiago Moreira
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Rossana Tassi
- Stroke Unit, University Hospital of Siena, Siena, Italy
| | - Jose Antonio Egido
- Stroke Unit, Department of Neurology, San Carlos Clinical Hospital, Madrid, Spain
| | | | - Guido Bigliardi
- Department of Neuroscience, Neurologal Clinic, Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Niaz Ahmed
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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12
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Mizowaki T, Fujita A, Imura J, Nakahara M, Tanaka H, Takaishi Y, Kondoh T. Ostial common carotid artery occlusion and balloon-mounted stenting: Implication of embolic protection device in tandem lesion. Radiol Case Rep 2021; 16:2783-2786. [PMID: 34367395 PMCID: PMC8326589 DOI: 10.1016/j.radcr.2021.06.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/18/2022] Open
Abstract
Ostial common carotid artery (CCA) stenosis is rare, compared to extracranial internal carotid artery bifurcation lesions. In cases of a tandem lesion, the proximal lesion usually involves the extracranial internal carotid artery, and the ostial CCA is rarely implicated. A 69-year-old woman who underwent 3 months of antiplatelet therapy for asymptomatic, right ostial, severely calcified CCA stenosis presented with sudden onset left hemiparesis. Radiographic examination revealed an ostial CCA-intracranial artery tandem lesion. After intracranial revascularization using a clot retrieval stent, we performed the endovascular treatment with a balloon-mounted stent using an embolic protection device. This procedure may be superior to others because it is possible to achieve early intracranial revascularization and prevent distal embolism during the complete treatment of proximal lesions.
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Affiliation(s)
- Takashi Mizowaki
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, Kobe, Hyogo, 654-0048, Japan
| | - Atsushi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Jun Imura
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, Kobe, Hyogo, 654-0048, Japan
| | - Masahiro Nakahara
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, Kobe, Hyogo, 654-0048, Japan
| | - Hirotomo Tanaka
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, Kobe, Hyogo, 654-0048, Japan
| | - Yoshiyuki Takaishi
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, Kobe, Hyogo, 654-0048, Japan
| | - Takeshi Kondoh
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, Kobe, Hyogo, 654-0048, Japan
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13
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Zheng Q, Liu X, Yan K, He L, Chen Y. ASPECT scores of patients with focal intracerebral hemorrhage were correlated with their short- and medium-term functional outcomes. Neurol Res 2021; 43:970-976. [PMID: 34240679 DOI: 10.1080/01616412.2021.1948747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The Alberta Stroke Program Early CT Score (ASPECTS) is widely used to guide thrombolytic therapy and predict the functional outcome of patients with acute ischemic stroke (AIS). Whether ASPECTS can predict the functional outcome of patients with intracerebral hemorrhage (ASPECTS-H) remains unclear. METHODS Patients with primary intracerebral hemorrhage (ICH) were collected and retrospectively analyzed. ASPECTS-H was assessed at admission. Patients were followed up at 30 days and 90 days after the onset of ICH. Occurrence of death within 90 days after ICH was the primary endpoint. Modified Rankin Scale (mRS) ≥ 3 was considered a poor functional outcome. RESULTS A total of 149 patients met eligibility criteria; 61 (40.9%) had poor functional outcome at 30 days, and 37 (24.8%) had poor functional outcome at 90 days. Using binary logistic regression modeling, we found that a low ASPECTS-H was associated with a poor functional outcome. The risk ratio of a low ASPECTS-H was 2.31 at 30 days (P = 0.000; 95% CI, 1.560-3.421) and 2.711 at 90 days (P = 0.000; 95% CI, 1.677-4.381). The optimal cutoff value of ASPECTS-H to discriminate good and poor 30-day and 90-day outcomes was 7.5 (Sensitivity30-day = 0.636, 1-Specificity30 - day = 0.311; Sensitivity90-day = 0.580, 1-Specificity90-day = 0.270). CONCLUSIONS A low ASPECTS-H was an indicator of poor short-term and long-term functional outcomes of ICH.
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Affiliation(s)
- Qiuyue Zheng
- The Department of Neurology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu China.,Graduate School, Dalian Medical University, Dalian, Liaoning, China
| | - Xiaojie Liu
- The Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu China
| | - Ke Yan
- The Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu China
| | - Liang He
- The Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu China
| | - Yingzhu Chen
- The Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu China
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14
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Gigliotti MJ, Sweid A, El Naamani K, Patel N, Cockroft KM, Park C, Kanekar S, Church EW, Tjoumakaris SI, Simon SD. Management of Internal Carotid Artery and Intracranial Anterior Circulation Tandem Occlusion with Stenting versus No Stenting: A Multicenter Study. World Neurosurg 2021; 153:e237-e243. [PMID: 34175489 DOI: 10.1016/j.wneu.2021.06.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tandem occlusion (TO) describes not only occlusion of the middle cerebral artery but a contemporaneous occlusion of the cervical internal carotid artery. There is a paucity of data over whether mechanical thrombectomy (MT) alone, MT with angioplasty, or MT with carotid artery stent placement is superior. We aim to address a gap in the literature comparing carotid stenting with mechanical thrombectomy (CSMT) and carotid angioplasty with mechanical thrombectomy (CAMT) in patients presenting with acute anterior circulation TOs. METHODS This is a multicenter, retrospective study from 2012 to 2020 comparing CSMT and CAMT presenting with acute anterior circulation TOs. Primary outcomes of interest were functional status, perioperative stroke, mortality, and symptomatic intracranial hemorrhage (sICH). A total of 92 patients (66 vs. 26 in CSMT and CAMT, respectively) met inclusion criteria for analysis. RESULTS There was no statistically significant difference in functional outcomes at 90-day follow-up (adjusted odds ratio [aOR] 0.82; 95% confidence interval [CI] 0.20-3.5; P = 0.46). In addition, there was no statistically significant difference in 90-day mortality (aOR 0.361; 95% CI 0.016-2.92; P = 0.532) and perioperative stroke rate (aOR 1.76; 95% CI 0.160-15.6; P = 0.613). However, sICH risk was significantly greater in the stent-treated cohort (aOR 3.94; 95% CI 0.529-37.4; P = 0.003). CONCLUSIONS Functional outcomes, mortality, and perioperative stroke rates do not significantly differ in CSMT and CAMT procedures in the acute setting. However, CSMT-treated patients do appear to have an increased risk of sICH, potentially due to the use of additional antiplatelet agents following stent placement.
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Affiliation(s)
- Michael J Gigliotti
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
| | - Ahmad Sweid
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Neel Patel
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Kevin M Cockroft
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Christian Park
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Sangam Kanekar
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Ephraim W Church
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Scott D Simon
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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15
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Xu T, Wang Y, Yuan J, Chen Y, Luo H. Small Vessel Disease Burden and Outcomes of Mechanical Thrombectomy in Ischemic Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:602037. [PMID: 33897580 PMCID: PMC8058474 DOI: 10.3389/fneur.2021.602037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/01/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Cerebral small vessel disease (SVD) is prevalent in the population, especially among elderly individuals. Substantial uncertainties remain about the clinical relevance of SVD with outcomes of mechanical thrombectomy (MT) in acute ischemic stroke (AIS). Objectives: This systematic review and meta-analysis was performed to evaluate the association between SVD and clinical outcomes in patients with AIS undergoing MT. Methods: We systematically searched the Medline, Embase, and Cochrane databases for relevant clinical studies. The exposure of SVD mainly included leukoaraiosis, cerebral microbleeds (CMBs), and lacunes. The pooled OR was used to calculate the association between each subtype of SVD and outcomes of MT. The primary outcome was poor functional outcome, which was defined as a modified Rankin Scale score (mRS) ≥3 at 90 days after MT. The secondary outcomes included mortality at 90 days, in-hospital mortality, intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH), successful recanalization and futile recanalization (FR), early neurological improvement, and early neurological deterioration (END) after MT. Results: Overall, 20 studies with 5,189 patients with AIS undergoing MT were included. High leukoaraiosis burden (HLB) at baseline was associated with increased risks of poor functional outcome at 90 days (OR 2.70, 95% CI 2.01–3.63; p < 0.001; 10 studies; n = 2,004), in-hospital mortality (OR 4.06, 95% CI 1.48–11.13; p = 0.006; 2 studies; n = 314), FR (OR 5.00, 95% CI 2.86–8.73; p < 0.001; 3 studies; n = 493), and END (OR 2.65, 95% CI 1.09–6.45; 1 study; n = 273) after MT. HLB (VSS 3–4 or FS ≥ 2) at baseline was not associated with mortality at 90 days, ICH, or sICH after MT. CMBs at baseline were found to be associated with increased risks of poor functional outcome at 90 days (OR 1.84, 95% CI 1.17–2.90; p = 0.008; 2 studies; n = 1,924) after MT. We found no association between the presence of lacunes and poor functional outcome at 90 days after MT. Conclusions: In patients with AIS undergoing MT, HLB and CMBs were associated with increased risks of unfavorable outcomes after MT.
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Affiliation(s)
- Tao Xu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - You Wang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinxian Yuan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiyan Luo
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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16
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Morinaga Y, Nii K, Takemura Y, Hanada H, Sakamoto K, Hirata Y, Inoue R, Tsugawa J, Kimura S, Kurihara K, Tateishi Y, Higashi T. Types of intraparenchymal hematoma as a predictor after revascularization in patients with anterior circulation acute ischemic stroke. Surg Neurol Int 2021; 12:102. [PMID: 33880207 PMCID: PMC8053447 DOI: 10.25259/sni_792_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/17/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Intracranial hemorrhage after revascularization for acute ischemic stroke is associated with poor outcomes. Few reports have examined the relationship between parenchymal hematoma after revascularization and clinical outcomes. This retrospective study aimed to investigate the risk factors and clinical outcomes of parenchymal hematoma after revascularization for acute ischemic stroke. Methods: Ninety-three patients underwent revascularization for anterior circulation acute ischemic stroke. Patient characteristics and clinical outcomes were compared between patients with and without post procedural parenchymal hematoma using the following parameters: age, sex, occlusion location, presence of atrial fibrillation, diffusion-weighted imaging-Alberta stroke program early computed tomography score (DWI-ASPECTS), National Institute of Health Stroke Scale (NIHSS) score, recombinant tissue plasminogen activator, thrombolysis in cerebral infarction > 2b, door-to-puncture time, onset-to-recanalization time, number of passes, and modified Rankin Scale scores. Results: Parenchymal hematomas were not significantly correlated with age, sex, occlusion location, atrial fibrillation, DWI-ASPECTS, NIHSS score, recombinant tissue plasminogen activator, thrombolysis in cerebral infarction > 2b, door-to-puncture time, onset-to-recanalization time, and number of passes, but were significantly correlated with poor clinical outcomes (P = 0.001) and absence of the anterior communicating artery evaluated using pre procedural time-of-flight magnetic resonance angiography (P = 0.03). Conclusion: Parenchymal hematoma was a predictor of poor outcomes. In particular, the absence of the anterior communicating artery on pre procedural time-of-flight magnetic resonance angiography is a potential risk factor for parenchymal hematoma after revascularization for anterior circulation acute ischemic stroke.
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Affiliation(s)
- Yusuke Morinaga
- Department of Neurosurgery, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Kouhei Nii
- Department of Neurosurgery, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Yusuke Takemura
- Department of Neurosurgery, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Hayatsura Hanada
- Department of Neurosurgery, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Kimiya Sakamoto
- Department of Neurosurgery, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Yoko Hirata
- Department of Neurosurgery, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Ritsurou Inoue
- Department of Neurosurgery, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Jun Tsugawa
- Stroke Center, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Satoshi Kimura
- Stroke Center, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Kanako Kurihara
- Stroke Center, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Yuji Tateishi
- Stroke Center, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Toshio Higashi
- Stroke Center, Fukuoka University, Chikushi Hospital, Chikushino, Fukuoka, Japan
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Ume KL, Dandapat S, Weber MW, Zevallos CB, Fifer A, Levy A, Delfino K, Ortega-Gutierrez S, Siddiqui FM. Absent hyperdense middle cerebral artery sign is associated with poor functional outcome after mechanical thrombectomy. Int J Stroke 2021; 17:101-108. [PMID: 33557722 DOI: 10.1177/1747493021991972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The hyperdense middle cerebral artery sign on computed tomography indicates proximal middle cerebral artery occlusion. Recent reports suggest an association between the hyperdense sign and successful reperfusion. The prognostic value of the hyperdense middle cerebral artery sign in patients receiving mechanical thrombectomy has not been extensively studied. AIMS Our study aims to evaluate the association between the hyperdense middle cerebral artery sign and functional outcome in patients with M1 occlusions that had undergone mechanical thrombectomy. METHODS We conducted a single-center retrospective observational cohort study of 102 consecutive patients presenting with acute M1 occlusions that had undergone mechanical thrombectomy. Patients were stratified into cohorts based on the presence of hyperdense middle cerebral artery sign visually assessed on computed tomography by two readers. The outcomes of interests were functional disability measured by the ordinal Modified Rankin Scale (mRS) at 90 days, mortality, reperfusion status and hemorrhagic conversion. RESULTS Out of the 102 patients with M1 occlusions, 71 had hyperdense middle cerebral artery sign. There was no significant difference between the cohorts in age, baseline mRS, NIHSS, ASPECTS, and time to reperfusion. The absence of hyperdense middle cerebral artery sign was associated with increased odds of being dependent or dying (higher mRS) (OR: 3.24, 95% CI: 1.30-8.06, p = 0.011) after adjusting for other significant predictors, including age, female sex, hypertension, presenting serum glucose, ASPECTS, CTA collateral score, and successful reperfusion. CONCLUSION The absence of hyperdense middle cerebral artery sign is associated with worse functional outcome in patients presenting with M1 occlusions undergoing thrombectomy.
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Affiliation(s)
- Kiddy L Ume
- Department of Neurology, 12249Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Sudeepta Dandapat
- Department of Neurology, University of Iowa Medical Center, Iowa City, IA, USA
| | - Matthew W Weber
- Department of Neurology, 12249Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Cynthia B Zevallos
- Department of Neurology, University of Iowa Medical Center, Iowa City, IA, USA
| | - Amber Fifer
- Department of Neurology, 12249Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Abigail Levy
- Department of Neurology, 12249Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Kristin Delfino
- Department of Neurology, 12249Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Medical Center, Iowa City, IA, USA.,Department of Neurosurgery and Radiology, University of Iowa Medical Center, Iowa City, IA, USA
| | - Fazeel M Siddiqui
- Department of Neurology, 12249Southern Illinois University School of Medicine, Springfield, IL, USA.,Department of Neurology, Metro Health University of Michigan, Grand Rapids, MI, USA
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Machado M, Alves M, Fior A, Fragata I, Papoila AL, Reis J, Nunes AP. Functional Outcome After Mechanical Thrombectomy with or without Previous Thrombolysis. J Stroke Cerebrovasc Dis 2020; 30:105495. [PMID: 33310592 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Combined intravenous therapy (IVT) and mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, the use of IVT before MT is recently being questioned. OBJECTIVES To compare patients treated with IVT before MT with those treated with MT alone, in a real-world scenario. METHODS Retrospective analysis of AIS patients with LVO of the anterior circulation who underwent MT, with or without previous IVT, between 2016 and 2018. RESULTS A total of 524 patients were included (347 submitted to IVT+MT; 177 to MT alone). No differences between groups were found except for a higher time from stroke onset to CT and to groin puncture in the MT group (297.5 min vs 115.0 min and 394.0 min vs 250.0 min respectively, p < 0.001). Multivariable analysis showed that age<75 years (OR 2.65, 95% CI 1.71-4.07, p < 0.001), not using antiplatelet therapy (OR 1.93, 95% CI 1.21-3.08, p = 0.006), low prestroke mRS (OR 4.33, 95% CI 1.89-9.89, p < 0.001), initial NIHSS (OR 0.89, 95% CI 0.86-0.93, p < 0.001), absent cerebral edema (OR 7.83, 95% CI 3.31-18.51, p < 0.001), and mTICI 2b/3 (OR 4.56, 95% CI 2.17-9.59, p < 0.001) were independently associated with good outcome (mRS 0-2). CONCLUSIONS Our findings support the idea that IVT before MT does not influence prognosis, in a real-world setting.
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Affiliation(s)
- Manuel Machado
- Unidade Cerebrovascular, Departamento de Neurociências do Centro Hospitalar Universitário Lisboa Central Portugal.
| | - Marta Alves
- Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal; NOVA Medical School/Faculdade de Ciências Médicas, Lisbon, Portugal.
| | - Alberto Fior
- Unidade Cerebrovascular, Departamento de Neurociências do Centro Hospitalar Universitário Lisboa Central Portugal.
| | - Isabel Fragata
- Unidade Cerebrovascular, Departamento de Neurociências do Centro Hospitalar Universitário Lisboa Central Portugal; NOVA Medical School/Faculdade de Ciências Médicas, Lisbon, Portugal.
| | - Ana Luísa Papoila
- Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal; NOVA Medical School/Faculdade de Ciências Médicas, Lisbon, Portugal.
| | - João Reis
- Unidade Cerebrovascular, Departamento de Neurociências do Centro Hospitalar Universitário Lisboa Central Portugal.
| | - Ana Paiva Nunes
- Unidade Cerebrovascular, Departamento de Neurociências do Centro Hospitalar Universitário Lisboa Central Portugal.
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Salsano G, Pracucci G, Mavilio N, Saia V, Bandettini di Poggio M, Malfatto L, Sallustio F, Wlderk A, Limbucci N, Nencini P, Vallone S, Zini A, Bigliardi G, Velo M, Francalanza I, Gennari P, Tassi R, Bergui M, Cerrato P, Carità G, Azzini C, Gasparotti R, Magoni M, Isceri S, Commodaro C, Cordici F, Menozzi R, Latte L, Cosottini M, Mancuso M, Comai A, Franchini E, Alexandre A, Marca GD, Puglielli E, Casalena A, Causin F, Baracchini C, Di Maggio L, Naldi A, Grazioli A, Forlivesi S, Chiumarulo L, Petruzzellis M, Sanfilippo G, Toscano G, Cavasin N, Adriana C, Ganimede MP, Prontera MP, Giorgianni A, Mauri M, Auteri W, Petrone A, Cirelli C, Falcou A, Corraine S, Piras V, Ganci G, Tassinari T, Nuzzi NP, Corato M, Sacco S, Squassina G, Invernizzi P, Gallesio I, Ferrandi D, Dui G, Deiana G, Amistà P, Russo M, Pintus F, Baule A, Craparo G, Mannino M, Castellan L, Toni D, Mangiafico S. Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke. Int J Stroke 2020; 16:818-827. [PMID: 33283685 DOI: 10.1177/1747493020976681] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. AIMS We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. METHODS From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. RESULTS The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21-2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13-8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66-12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31-0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97-0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19-0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6-0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02-1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02-1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25-2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26-3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08-2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55-0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up. CONCLUSIONS Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits.
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Affiliation(s)
- Giancarlo Salsano
- IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Nicola Mavilio
- IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy
| | - Valentina Saia
- Neuroradiology Unit and Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Monica Bandettini di Poggio
- IRCCS San Martino Policlinic Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genoa, Italy
| | - Laura Malfatto
- IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy
| | - Fabrizio Sallustio
- Imaging and Interventional Radiology and Stroke Unit, Policlinico Tor Vergata, Roma, Italy
| | - Andrea Wlderk
- Imaging and Interventional Radiology and Stroke Unit, Policlinico Tor Vergata, Roma, Italy
| | - Nicola Limbucci
- Interventional Neurovascular Unit and Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy
| | - Patrizia Nencini
- Interventional Neurovascular Unit and Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy
| | - Stefano Vallone
- Neuroradiology and Neurology, Ospedale Civile S. Agostino-Estense, University Hospital, Modena, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center and Neuroradiology, Maggiore Hospital, Bologna, Italy
| | - Guido Bigliardi
- Neuroradiology and Neurology, Ospedale Civile S. Agostino-Estense, University Hospital, Modena, Italy
| | - Mariano Velo
- Neuroradiology and Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Policlinico G. Martino Messina, Italy
| | - Isabella Francalanza
- Neuroradiology and Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Policlinico G. Martino Messina, Italy
| | - Paola Gennari
- Neuroradiology and Neurology, 161157AOU Senese, Siena, Italy
| | - Rossana Tassi
- Neuroradiology and Neurology, 161157AOU Senese, Siena, Italy
| | - Mauro Bergui
- Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paolo Cerrato
- Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Giuseppe Carità
- Neuroradiology and Neurology, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Cristiano Azzini
- Neuroradiology and Neurology, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | | | - Mauro Magoni
- Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy
| | - Salvatore Isceri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center and Neuroradiology, Maggiore Hospital, Bologna, Italy
| | - Christian Commodaro
- Department of Neuroradiology, Neurology and Stroke Unit, Cesena-Forlì, AUSL Romagna Azienda Ospedaliera, Cesena, Italy
| | - Francesco Cordici
- Department of Neuroradiology, Neurology and Stroke Unit, Cesena-Forlì, AUSL Romagna Azienda Ospedaliera, Cesena, Italy
| | - Roberto Menozzi
- Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy
| | - Lilia Latte
- Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, 9310University of Pisa, Pisa, Italy
| | - Michelangelo Mancuso
- Department of Translational Research and New Technologies in Medicine and Surgery, 9310University of Pisa, Pisa, Italy
| | - Alessio Comai
- Radiology Unit and Stroke Unit, Ospedale Centrale, Bolzano, Italy
| | - Enrica Franchini
- Radiology Unit and Stroke Unit, Ospedale Centrale, Bolzano, Italy
| | - Andrea Alexandre
- Institute of Neuroradiology and Neurology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giacomo Della Marca
- Institute of Neuroradiology and Neurology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | | | | | - Francesco Causin
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Padua, Italy
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Padua, Italy
| | - Luca Di Maggio
- Neuroradiology and Neurology, 18698Ospedale San Giovanni Bosco, Torino, Italy
| | - Andrea Naldi
- Neuroradiology and Neurology, 18698Ospedale San Giovanni Bosco, Torino, Italy
| | - Andrea Grazioli
- UOC Neuroradiologia, DAI Patologia e Diagnostica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stefano Forlivesi
- UOC Neuroradiologia, DAI Patologia e Diagnostica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Luigi Chiumarulo
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico, Bari, Italy
| | - Marco Petruzzellis
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico, Bari, Italy
| | - Giuseppina Sanfilippo
- Diagnostic and Interventional Neuroradiology Unit and Stroke Unit, IRCCS Mondino Foundation San Matteo Hospital, Pavia, Italy
| | - Gianpaolo Toscano
- Diagnostic and Interventional Neuroradiology Unit and Stroke Unit, IRCCS Mondino Foundation San Matteo Hospital, Pavia, Italy
| | - Nicola Cavasin
- Neuroradiology Unit and Neurology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy
| | - Critelli Adriana
- Neuroradiology Unit and Neurology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy
| | - Maria Porzia Ganimede
- Interventional Radiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy
| | - Maria Pia Prontera
- Interventional Radiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy
| | - Andrea Giorgianni
- Neuroradiology Unit and Stroke Unit, Ospedale Universitario Circolo, ASST Sette Laghi, Varese, Italy
| | - Marco Mauri
- Neuroradiology Unit and Stroke Unit, Ospedale Universitario Circolo, ASST Sette Laghi, Varese, Italy
| | - William Auteri
- Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Alfredo Petrone
- Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Carlo Cirelli
- Department of Human Neurosciences, Interventional Neuroradiology and Neurology, Università degli Studi di Roma Sapienza, Roma, Lazio, Italy
| | - Anne Falcou
- Department of Human Neurosciences, Interventional Neuroradiology and Neurology, Università degli Studi di Roma Sapienza, Roma, Lazio, Italy
| | - Simona Corraine
- Neuroscience Department, Azienda Ospedaliera G. Brotzu, Cagliari, Sardinia, Italy
| | - Valeria Piras
- Neuroscience Department, Azienda Ospedaliera G. Brotzu, Cagliari, Sardinia, Italy
| | - Giuseppe Ganci
- Neuroradiology Unit and Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Tiziana Tassinari
- Neuroradiology Unit and Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | | | - Manuel Corato
- IRCCS Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | - Simona Sacco
- Department of Clinical Scieces and Biotechnology, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
| | - Guido Squassina
- Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy
| | - Paolo Invernizzi
- Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy
| | - Ivan Gallesio
- Department of Radiology and Neuroradiological Unit, Department of Neurology, Azienda ospedaliera "SS Antonio e Biagio e C. Arrigo," Alessandria, Italy
| | - Delfina Ferrandi
- Department of Radiology and Neuroradiological Unit, Department of Neurology, Azienda ospedaliera "SS Antonio e Biagio e C. Arrigo," Alessandria, Italy
| | - Giovanni Dui
- Radiology and Interventional Radiology Unit and Neurology Unit, 97998Ospedale San Francesco, Nuoro, Italy
| | - Gianluca Deiana
- Radiology and Interventional Radiology Unit and Neurology Unit, 97998Ospedale San Francesco, Nuoro, Italy
| | - Pietro Amistà
- Department of Neuroradiology and Neurology, Hospital of Rovigo, Rovigo, Italy
| | - Monia Russo
- Department of Neuroradiology and Neurology, Hospital of Rovigo, Rovigo, Italy
| | - Francesco Pintus
- Unit of Neuroradiology and Stroke Unit, Santissima Annunziata Hospital, Sassari, Italy
| | - Antonio Baule
- Unit of Neuroradiology and Stroke Unit, Santissima Annunziata Hospital, Sassari, Italy
| | - Giuseppe Craparo
- Department of Neuroradiology and Neurology, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Marina Mannino
- Department of Neuroradiology and Neurology, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Lucio Castellan
- IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Salvatore Mangiafico
- Interventional Neurovascular Unit and Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy
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20
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Chueh JY, Marosfoi MG, Anagnostakou V, Arslanian RA, Marks MP, Gounis MJ. Quantitative Characterization of Recanalization and Distal Emboli with a Novel Thrombectomy Device. Cardiovasc Intervent Radiol 2020; 44:318-324. [PMID: 33179161 DOI: 10.1007/s00270-020-02683-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/07/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The first-pass effect during mechanical thrombectomy improves clinical outcomes regardless of first-line treatment approach, but current success rates for complete clot capture with one attempt are still less than 40%. We hypothesize that the ThrombX retriever (ThrombX Medical Inc.) can better engage challenging clot models during retrieval throughout tortuous vasculature in comparison with a standard stent retriever without increasing distal emboli. MATERIALS AND METHODS Thrombectomy testing with the new retriever as compared to the Solitaire stent retriever was simulated in a vascular replica with hard and soft clot analogs to create a challenging occlusive burden. Parameters included analysis of distal emboli generated per clot type, along with the degree of recanalization (complete, partial or none) by retrieval device verified by angiography. RESULTS The ThrombX device exhibited significantly higher rates of first-pass efficacy (90%) during hard clot retrieval in comparison with the control device (20%) (p < 0.009), while use of both techniques during soft clot retrieval resulted in equivalent recanalization. The soft clot model generated higher numbers of large emboli (>200 μm) across both device groups (p = 0.0147), and no significant differences in numbers of distal emboli were noted between the ThrombX and Solitaire techniques. CONCLUSIONS Irrespective of clot composition, use of the ThrombX retriever demonstrated high rates of complete recanalization at first pass in comparison with a state-of-the-art stent retriever and proved to be superior in the hard clot model. Preliminary data suggest that risk of distal embolization associated with the ThrombX system is comparable to that of the control device.
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Affiliation(s)
- Ju-Yu Chueh
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, 55 Lake Ave N, SA-107R, Worcester, MA, 01655, USA
| | - Miklos G Marosfoi
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, 55 Lake Ave N, SA-107R, Worcester, MA, 01655, USA
| | - Vania Anagnostakou
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, 55 Lake Ave N, SA-107R, Worcester, MA, 01655, USA
| | - Rose A Arslanian
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, 55 Lake Ave N, SA-107R, Worcester, MA, 01655, USA
| | - Michael P Marks
- Department of Radiology, Stanford University School of Medicine, 730 Welch Rd 1st Fl, Palo Alto, CA, 94304, USA
| | - Matthew J Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, 55 Lake Ave N, SA-107R, Worcester, MA, 01655, USA.
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Park H, Kim BM, Baek JH, Kim JH, Heo JH, Kim DJ, Nam HS, Kim YD. Predictors of Good Outcomes in Patients with Failed Endovascular Thrombectomy. Korean J Radiol 2020; 21:582-587. [PMID: 32323503 PMCID: PMC7183835 DOI: 10.3348/kjr.2019.0578] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/02/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Endovascular thrombectomy (EVT) fails in approximately 20% of anterior circulation large vessel occlusion (AC-LVO). Nonetheless, the factors that affect clinical outcomes of non-recanalized AC-LVO despite EVT are less studied. The purpose of this study was to identify the factors affecting clinical outcomes in non-recanalized AC-LVO patients despite EVT. MATERIALS AND METHODS This was a retrospective analysis of clinical and imaging data from 136 consecutive patients who demonstrated recanalization failure (modified thrombolysis in cerebral ischemia [mTICI], 0-2a) despite EVT for AC-LVO. Data were collected in prospectively maintained registries at 16 stroke centers. Collateral status was categorized into good or poor based on the CT angiogram, and the mTICI was categorized as 0-1 or 2a on the final angiogram. Patients with good (modified Rankin Scale [mRS], 0-2) and poor outcomes (mRS, 3-6) were compared in multivariate analysis to evaluate the factors associated with a good outcome. RESULTS Thirty-five patients (25.7%) had good outcomes. The good outcome group was younger (odds ratio [OR], 0.962; 95% confidence interval [CI], 0.932-0.992; p = 0.015), had a lower incidence of hypertension (OR, 0.380; 95% CI, 0.173-0.839; p = 0.017) and distal internal carotid artery involvement (OR, 0.149; 95% CI, 0.043-0.520; p = 0.003), lower initial National Institute of Health Stroke Scale (NIHSS) (OR, 0.789; 95% CI, 0.713-0.873; p < 0.001) and good collateral status (OR, 13.818; 95% CI, 3.971-48.090; p < 0.001). In multivariate analysis, the initial NIHSS (OR, 0.760; 95% CI, 0.638-0.905; p = 0.002), good collateral status (OR, 14.130; 95% CI, 2.264-88.212; p = 0.005) and mTICI 2a recanalization (OR, 5.636; 95% CI, 1.216-26.119; p = 0.027) remained as independent factors with good outcome in non-recanalized patients. CONCLUSION Baseline NIHSS score, good collateral status, and mTICI 2a recanalization remained independently associated with clinical outcome in non-recanalized patients. mTICI 2a recanalization would benefit patients with good collaterals in non-recanalized AC-LVO patients despite EVT.
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Affiliation(s)
- Hyungjong Park
- Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, Korea.,Department of Neurology, Keimyung University School of Medicine, Daegu, Korea
| | - Byung Moon Kim
- Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, Korea.
| | - Jang Hyun Baek
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Hwee Kim
- Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Joon Kim
- Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, Korea
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Ko CC, Liu HM, Chen TY, Wu TC, Tsai LK, Tang SC, Tsui YK, Jeng JS. Prediction of mTICI 3 recanalization and clinical outcomes in endovascular thrombectomy for acute ischemic stroke: a retrospective study in the Taiwan registry. Neurol Sci 2020; 42:2325-2335. [PMID: 33037513 DOI: 10.1007/s10072-020-04800-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Early recanalization for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) by endovascular thrombectomy (EVT) is strongly related to improved functional outcomes. With data obtained from the Taiwan registry, the factors associated with mTICI 3 recanalization and clinical outcomes in EVT are investigated. METHODS From January 2014 to September 2016, 108 patients who underwent EVT for AIS due to LVO in 11 medical centers throughout Taiwan were included. Complete recanalization is defined as achieving modified thrombolysis in cerebral infarction (mTICI) grade 3. Good clinical outcomes are defined by the modified Rankin scale (mRS) 0-2 at 3 months after EVT. Clinical and imaging parameters for predicting mTICI 3 recanalization and good clinical outcomes are analyzed. RESULTS Of the 108 patients who received EVT, 54 (50%) patients had mTICI 3 recanalization. Having received aspiration only and the use of IV-tPA are shown to be significant predictors for mTICI 3 recanalization with odds ratios of 2.61 and 2.53 respectively. Forty-six (42.6%) patients experienced good 3-month clinical outcomes (mRS 0-2). Pretreatment collateral statuses, NIHSS scores, time lapses between symptoms to needle, and the occurrence of hemorrhage at 24 h are all significant predictors for good outcomes with odds ratios of 2.88, 0.91, 0.99, and 0.31 respectively. CONCLUSIONS Prediction of mTICI 3 recanalization and clinical outcomes offer valuable clinical information for treatment planning in EVT.
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Affiliation(s)
- Ching-Chung Ko
- Department of Medical Imaging, Chi Mei Medical Center, No.901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, Republic of China
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Hon-Man Liu
- Department of Medical Imaging, Fu Jen Catholic University Hospital, Fu Jen Catholic University, No.69, Guizi Rd., Taishan Dist, New Taipei City, 24352, Taiwan, Republic of China
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Tai-Yuan Chen
- Department of Medical Imaging, Chi Mei Medical Center, No.901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Te-Chang Wu
- Department of Medical Imaging, Chi Mei Medical Center, No.901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Li-Kai Tsai
- Stroke Center and Department of Neurology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan, Republic of China
| | - Sung-Chun Tang
- Stroke Center and Department of Neurology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan, Republic of China
| | - Yu-Kun Tsui
- Department of Medical Imaging, Chi Mei Medical Center, No.901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, Republic of China.
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan, Republic of China
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23
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Zhang X, Xie Y, Wang H, Yang D, Jiang T, Yuan K, Gong P, Xu P, Li Y, Chen J, Wu M, Sheng L, Liu D, Liu X, Xu G. Symptomatic Intracranial Hemorrhage After Mechanical Thrombectomy in Chinese Ischemic Stroke Patients: The ASIAN Score. Stroke 2020; 51:2690-2696. [PMID: 32811387 DOI: 10.1161/strokeaha.120.030173] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Symptomatic intracranial hemorrhage (sICH), potentially associated with poor prognosis, is a major complication of endovascular thrombectomy (EVT) for ischemic stroke patients. We aimed to develop and validate a risk model for predicting sICH after EVT in Chinese patients due to large-artery occlusions in the anterior circulation. METHODS The derivation cohort recruited patients with EVT from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry in China. sICH was diagnosed according to the Heidelberg Bleeding Classification within 24 hours of EVT. Stepwise logistic regression was performed to derive the predictive model. The discrimination and calibration of the risk model were assessed using the C index and the calibration plot. An additional cohort of 503 patients from 2 stroke centers was prospectively enrolled to validate the new model. RESULTS We enrolled 629 patients who underwent EVT as the derivation cohort, among whom 87 developed sICH (13.8%). In the multivariate adjustment, Alberta Stroke Program Early CT Score (odds ratio [OR], 0.85; P=0.005), baseline glucose (OR, 1.13; P=0.001), poor collateral circulation (OR, 3.06; P=0.001), passes with retriever (OR, 1.52; P=0.001), and onset-to-groin puncture time (OR, 1.79; P=0.024) were independent factors of sICH and were incorporated as the Alberta Stroke Program Early CT Score, Baseline Glucose, Poor Collateral Circulation, Passes With Retriever, and Onset-to-Groin Puncture Time (ASIAN) score. The ASIAN score demonstrated good discrimination in the derivation cohort (C index, 0.771 [95% CI, 0.716-0.826]), as well as the validation cohort (C index, 0.758 [95% CI, 0.691-0.825]). CONCLUSIONS The ASIAN score reliably predicts the risk of sICH in Chinese ischemic stroke patients treated by EVT.
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Affiliation(s)
- Xiaohao Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.)
| | - Yi Xie
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.)
| | - Huaiming Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.).,Department of Neurology, The 89th Hospital of The People's Liberation Army, Weifang, Shandong, China (H.W.)
| | - Dong Yang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.)
| | - Teng Jiang
- Department of Neurology, Nanjing First Hospital (T.J., P.G.), Nanjing Medical University, Jiangsu, China
| | - Kang Yuan
- Department of Neurology, Jinling Hospital (K.Y., J.C.), Nanjing Medical University, Jiangsu, China
| | - Pengyu Gong
- Department of Neurology, Nanjing First Hospital (T.J., P.G.), Nanjing Medical University, Jiangsu, China
| | - Pengfei Xu
- Stroke Center and Department of Neurology, Division of Life Sciences and Medicine, First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui (P.X.)
| | - Yunzi Li
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.)
| | - Jingjing Chen
- Department of Neurology, Jinling Hospital (K.Y., J.C.), Nanjing Medical University, Jiangsu, China
| | - Min Wu
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China (M.W.)
| | - Lei Sheng
- Department of Neurology, Jiangsu Provincial Second Chinese Medicine Hospital, Second Affiliated Hospital of Nanjing University of Chinese Medicine, China (L.S.)
| | - Dezhi Liu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China (D.L.)
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.)
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.)
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24
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Wadhwa A, Joundi RA, Menon B. Clinical considerations and assessment of risk factors when choosing endovascular thrombectomy for acute stroke. Expert Rev Cardiovasc Ther 2020; 18:541-556. [PMID: 32686967 DOI: 10.1080/14779072.2020.1798229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The advent of endovascular thrombectomy (EVT) has been a game changer for the management of acute ischemic stroke due to large vessel occlusion. However, the selection of suitable candidates for EVT remains a significant challenge. AREAS COVERED This review focuses on the clinical, radiological, and procedural considerations for EVT in acute stroke that assist in optimal patient selection. EXPERT OPINION All patients presenting with significant clinical deficits with treatable occlusions, who have salvageable brain tissue at presentation might benefit from treatment up to twenty-four hours from symptom onset. Neuroimaging tools form the backbone for this decision making.
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Affiliation(s)
- Ankur Wadhwa
- Calgary Stroke Program, University of Calgary, Foot Hills Medical Center , Calgary, AB, Canada
| | - Raed A Joundi
- Calgary Stroke Program, University of Calgary, Foot Hills Medical Center , Calgary, AB, Canada
| | - Bijoy Menon
- Clinical Neurosciences, University of Calgary, Foot Hills Medical Center , Calgary, AB, Canada
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25
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Elakkad A, Drocton G, Hui F. Endovascular Stroke Interventions: Procedural Complications and Management. Semin Intervent Radiol 2020; 37:199-200. [PMID: 32419733 PMCID: PMC7224977 DOI: 10.1055/s-0040-1709206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Endovascular mechanical thrombectomy has evolved significantly and has become the mainstay and most effective currently available treatment for acute ischemic stroke patients due to large vessel occlusion. Mechanical thrombectomy is presently performed using a stent retriever or stent-like device, an aspiration catheter, or a combination of the two. Much of the literature has focused on the benefits of endovascular mechanical thrombectomy with only limited data about procedural complications and management. Awareness of risk factors and early recognition of these complications can potentially reduce complication rates, improve management, and yield better overall outcomes. In this review, the authors present a description of intraprocedural complications and strategies to prevent and treat these complications.
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Affiliation(s)
- Ahmed Elakkad
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Gerald Drocton
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Ferdinand Hui
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland
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26
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Kaesmacher J, Chaloulos-Iakovidis P, Panos L, Mordasini P, Michel P, Hajdu SD, Ribo M, Requena M, Maegerlein C, Friedrich B, Costalat V, Benali A, Pierot L, Gawlitza M, Schaafsma J, Mendes Pereira V, Gralla J, Fischer U. Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0-5. Stroke 2020; 50:880-888. [PMID: 30827193 PMCID: PMC6430594 DOI: 10.1161/strokeaha.118.023465] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— If anterior circulation large vessel occlusion acute ischemic stroke patients presenting with ASPECTS 0–5 (Alberta Stroke Program Early CT Score) should be treated with mechanical thrombectomy remains unclear. Purpose of this study was to report on the outcome of patients with ASPECTS 0–5 treated with mechanical thrombectomy and to provide data regarding the effect of successful reperfusion on clinical outcomes and safety measures in these patients. Methods— Multicenter, pooled analysis of 7 institutional prospective registries: Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy (Clinical Trial Registration—URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064). Primary outcome was defined as modified Rankin Scale 0–3 at day 90 (favorable outcome). Secondary outcomes included rates of day 90 modified Rankin Scale 0–2 (functional independence), day 90 mortality and occurrence of symptomatic intracerebral hemorrhage. Multivariable logistic regression analyses were performed to assess the association of successful reperfusion with clinical outcomes. Outputs are displayed as adjusted Odds Ratios (aOR) and 95% CI. Results— Two hundred thirty-seven of 2046 patients included in this registry presented with anterior circulation large vessel occlusion and ASPECTS 0–5. In this subgroup, the overall rates of favorable outcome and mortality at day 90 were 40.1% and 40.9%. Achieving successful reperfusion was independently associated with favorable outcome (aOR, 5.534; 95% CI, 2.363–12.961), functional independence (aOR, 5.583; 95% CI, 1.964–15.873), reduced mortality (aOR, 0.180; 95% CI, 0.083–0.390), and lower rates of symptomatic intracerebral hemorrhage (aOR, 0.235; 95% CI, 0.062–0.887). The mortality-reducing effect remained in patients with ASPECTS 0–4 (aOR, 0.167; 95% CI, 0.056–0.499). Sensitivity analyses did not change the primary results. Conclusions— In patients presenting with ASPECTS 0–5, who were treated with mechanical thrombectomy, successful reperfusion was beneficial without increasing the risk of symptomatic intracerebral hemorrhage. Although the results do not allow for general treatment recommendations, formal testing of mechanical thrombectomy versus best medical treatment in these patients in a randomized controlled trial is warranted.
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Affiliation(s)
- Johannes Kaesmacher
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,University Institute of Diagnostic, Interventional and Pediatric Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Panagiotis Chaloulos-Iakovidis
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Leonidas Panos
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Pasquale Mordasini
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Patrik Michel
- Department of Neurology (P. Michel) and Department of Radiology (S.D.H.), CHUV Lausanne, Switzerland
| | - Steven D Hajdu
- Department of Neurology (P. Michel) and Department of Radiology (S.D.H.), CHUV Lausanne, Switzerland
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain (M. Ribo, M. Requena)
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain (M. Ribo, M. Requena)
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M., B.F.)
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M., B.F.)
| | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, France (V.C., A.B.), Toronto Western Hospital, ON
| | - Amel Benali
- Department of Neuroradiology, CHU Montpellier, France (V.C., A.B.), Toronto Western Hospital, ON
| | - Laurent Pierot
- Department of Neuroradiology, CHU Reims, France (L.P., M.G.), Toronto Western Hospital, ON
| | - Matthias Gawlitza
- Department of Neuroradiology, CHU Reims, France (L.P., M.G.), Toronto Western Hospital, ON
| | | | | | - Jan Gralla
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Urs Fischer
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
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27
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Li G, Wu G, Qin Z, Li H, Cheng X, Cai Y. Prognostic Value of Clot Burden Score in Acute Ischemic Stroke after Reperfusion Therapies: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2019; 28:104293. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/12/2019] [Accepted: 07/10/2019] [Indexed: 01/08/2023] Open
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28
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Hao Z, Yang C, Xiang L, Wu B, Liu M. Risk factors for intracranial hemorrhage after mechanical thrombectomy: a systematic review and meta-analysis. Expert Rev Neurother 2019; 19:927-935. [PMID: 31200607 DOI: 10.1080/14737175.2019.1632191] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Zilong Hao
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
| | - Chunsong Yang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China second hospital, Sichuan University, Chengdu, China
| | - Lingbao Xiang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Bo Wu
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
| | - Ming Liu
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
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29
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Nawabi J, Kniep H, Schön G, Flottmann F, Leischner H, Kabiri R, Sporns P, Kemmling A, Thomalla G, Fiehler J, Broocks G, Hanning U. Hemorrhage After Endovascular Recanalization in Acute Stroke: Lesion Extent, Collaterals and Degree of Ischemic Water Uptake Mediate Tissue Vulnerability. Front Neurol 2019; 10:569. [PMID: 31214107 PMCID: PMC6558047 DOI: 10.3389/fneur.2019.00569] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/15/2019] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose: Intracranial hemorrhage (ICH) remains a major complication of endovascular treatment (ET) in acute stroke. The aim of this study was to identify clinical and imaging predictors for ICH in patients with acute ischemic stroke undergoing successful ET. Methods: We performed a retrospective analysis of patients with large vessel occlusion in the anterior circulation who underwent successful ET at our university medical center between 2015 and 2018. ICH was diagnosed on non-enhanced CT and a binary outcome was defined: ICH occurrence in the immediate post-interventional phase within 12–36 h (yes/no). The impacts of clinical, radiological, and interventional parameters on outcome were assessed in logistic regression models. Results: One hundred and seven patients fulfilled the inclusion criteria. 37 (34.6%) showed an ICH of which 7 (6.5%) patients were diagnosed as symptomatic and 30 (28.04%) as asymptomatic. Multivariable regression analyses identified a lower ASPECTS (adjusted odds ratio (OR) 1.95, 95%CI: 1.4–3.63, P = 0.037), low collateral score (adjusted OR 0.12, 95%CI: 0.03–0.49, P = 0.003) and high Net Water Uptake (NWU) (adjusted OR 1.56, 95%CI: 2.34–1.03, P = 0.007) as independent predictors of ICH after successful ET. Conclusions: CT-based quantitative NWU, ASPECTS, and collateral score mediate tissue vulnerability and are reliable independent predictors of a bleeding event after successful ET. This imaging-based prediction model might be useful for early stratification of patients at high risk of a bleeding event after ET, especially with low ASPECTS.
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Affiliation(s)
- Jawed Nawabi
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannes Leischner
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reza Kabiri
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Sporns
- Department of Radiology, University Hospital Münster, Münster, Germany
| | - André Kemmling
- Department of Radiology, University Hospital Münster, Münster, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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30
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Yogendrakumar V, Al-Ajlan F, Najm M, Puig J, Calleja A, Sohn SI, Ahn SH, Mikulik R, Asdaghi N, Field TS, Jin A, Asil T, Boulanger JM, Hill MD, Demchuk AM, Menon BK, Dowlatshahi D. Clot Burden Score and Early Ischemia Predict Intracranial Hemorrhage following Endovascular Therapy. AJNR Am J Neuroradiol 2019; 40:655-660. [PMID: 30872416 DOI: 10.3174/ajnr.a6009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/11/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial hemorrhage is a known complication following endovascular thrombectomy. The radiologic characteristics of a CT scan may assist with hemorrhage risk stratification. We assessed the radiologic predictors of intracranial hemorrhage following endovascular therapy using data from the INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) study. MATERIALS AND METHODS Patients undergoing endovascular therapy underwent baseline imaging, postprocedural angiography, and 24-hour follow-up imaging. The primary outcome was any intracranial hemorrhage observed on follow-up imaging. The secondary outcome was symptomatic hemorrhage. We assessed the relationship between hemorrhage occurrence and baseline patient characteristics, clinical course, and imaging factors: baseline ASPECTS, thrombus location, residual flow grade, collateralization, and clot burden score. Multivariable logistic regression with backward selection was used to adjust for relevant covariates. RESULTS Of the 199 enrolled patients who met the inclusion criteria, 46 (23%) had an intracranial hemorrhage at 24 hours. On multivariable analysis, postprocedural hemorrhage was associated with pretreatment ASPECTS (OR, 1.56 per point lost; 95% CI, 1.12-2.15), clot burden score (OR, 1.19 per point lost; 95% CI, 1.03-1.38), and ICA thrombus location (OR, 3.10; 95% CI, 1.07-8.91). In post hoc analysis, clot burden scores of ≤3 (sensitivity, 41%; specificity, 82%; OR, 3.12; 95% CI, 1.36-7.15) and pretreatment ASPECTS ≤ 7 (sensitivity, 48%; specificity, 82%; OR, 3.17; 95% CI, 1.35-7.45) robustly predicted hemorrhage. Residual flow grade and collateralization were not associated with hemorrhage occurrence. Symptomatic hemorrhage was observed in 4 patients. CONCLUSIONS Radiologic factors, early ischemia on CT, and increased CTA clot burden are associated with an increased risk of intracranial hemorrhage in patients undergoing endovascular therapy.
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Affiliation(s)
- V Yogendrakumar
- From the Department of Medicine (Neurology) (V.Y., D.D.), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
| | - F Al-Ajlan
- Department of Neurosciences (F.A.-A.), King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - M Najm
- Calgary Stroke Program (M.N., M.D.H., A.M.D., B.K.M.), Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - J Puig
- Institut de Diagnostic per la Imatge (J.P.), Girona Biomedical Research Institute, University Hospital Dr Josep Trueta, Girona, Spain
| | - A Calleja
- Department of Neurology (A.C.), Stroke Unit, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - S-I Sohn
- Department of Neurology (S-.I.S.), Keimyung University, Daegu, Republic of Korea
| | - S H Ahn
- Department of Neurology (S.H.A.), Chosun University School of Medicine and Hospital, Gwangju, Republic of Korea
| | - R Mikulik
- International Clinical Research Center (R.M.), St. Anne's University Hospital, Brno, Czech Republic
| | - N Asdaghi
- Department of Neurology (N.A.), Miller School of Medicine, University of Miami, Miami, Florida
| | - T S Field
- Division of Neurology (T.S.F.), Vancouver Stroke Program, University of British Columbia, Vancouver, Canada
| | - A Jin
- Division of Neurology (A.J.), Queen's University, Kingston, Canada
| | - T Asil
- Bezmialem Vakif Üniversitesi Nöroloji (T.A., J.-M.B.), Istanbul, Turkey
| | - J-M Boulanger
- Bezmialem Vakif Üniversitesi Nöroloji (T.A., J.-M.B.), Istanbul, Turkey
- Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, Greenfield Park, Canada
| | - M D Hill
- Calgary Stroke Program (M.N., M.D.H., A.M.D., B.K.M.), Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - A M Demchuk
- Calgary Stroke Program (M.N., M.D.H., A.M.D., B.K.M.), Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - B K Menon
- Calgary Stroke Program (M.N., M.D.H., A.M.D., B.K.M.), Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - D Dowlatshahi
- From the Department of Medicine (Neurology) (V.Y., D.D.), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
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Yeo LLL, Bhogal P, Gopinathan A, Cunli Y, Tan B, Andersson T. Why Does Mechanical Thrombectomy in Large Vessel Occlusion Sometimes Fail? Clin Neuroradiol 2019; 29:401-414. [DOI: 10.1007/s00062-019-00777-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/08/2019] [Indexed: 11/28/2022]
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Yeo LLL, Holmberg A, Mpotsaris A, Söderman M, Holmin S, Kuntze Söderqvist A, Ohlsson M, Bhogal P, Gontu V, Andersson T, Brouwer PA. Posterior Circulation Occlusions May Be Associated with Distal Emboli During Thrombectomy : Factors for Distal Embolization and a Review of the Literature. Clin Neuroradiol 2018; 29:425-433. [PMID: 29569010 PMCID: PMC6710331 DOI: 10.1007/s00062-018-0679-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 02/22/2018] [Indexed: 01/24/2023]
Abstract
Background Distal embolization or movement of the thrombus to previously uninvolved vasculature are feared complications during stroke thrombectomy. We looked at associated factors in a consecutive series of patients who underwent thrombectomy with the same endovascular device. Methods We included all patients with acute ischemic stroke in the anterior or posterior circulation, who underwent thrombectomy with the same thrombectomy device for acute stroke from 2013 to 2016. Distal embolization was defined as any movement of the thrombus into a previously uninvolved portion of the cerebral vasculature or the presence of thrombotic material further downstream in the affected vessel, which occurred after the initial angiogram. We studied patient-related as well as technical factors to determine their association with distal emboli. Results In this study 167 consecutive acute stroke patients treated with the emboTrap® device (Cerenovus, Irvine, CA, USA) were included with a median National Institutes of Health Stroke Scale (NIHSS) of 15 (range 2–30) and mean age of 67 years (SD 13.1 years). Of the patients in our cohort 20 (11.9%) experienced distal emboli, with 2.3% into a new territory and 9.6% into a territory distal to the primary occlusion. On univariate analysis, age, intravenous tissue plasminogen activator (tPA), posterior circulation occlusions, and general anesthesia were associated with distal emboli. On multivariate analysis, only posterior circulation occlusions (odds ratio OR 4.506 95% confidence interval CI 1.483–13.692, p = 0.008) were significantly associated with distal emboli. Distal embolization was not significantly associated with worse functional outcomes at 3 months, increased mortality or increased bleeding risk. Conclusion Posterior circulation occlusions were significantly associated with distal emboli during thrombectomy, possibly due to the lack of flow arrest during such procedures. New techniques and devices should be developed to protect against embolic complications during posterior circulation stroke thrombectomy.
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Affiliation(s)
- Leonard L L Yeo
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden. .,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore.
| | - Ake Holmberg
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
| | | | - Michael Söderman
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
| | - Asa Kuntze Söderqvist
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
| | - Marcus Ohlsson
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
| | - Pervinder Bhogal
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden.,Neuroradiology Clinic, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Vamsi Gontu
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
| | - Tommy Andersson
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden.,Department of Medical Imaging, AZ Groeninge, 8500, Kortrijk, Belgium
| | - Patrick A Brouwer
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
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Dekker L, Geraedts VJ, Hund H, Cannegieter SC, Nogueira RG, Goyal M, van den Wijngaard IR. Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke. INTERVENTIONAL NEUROLOGY 2018; 7:137-147. [PMID: 29719551 DOI: 10.1159/000486246] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 01/19/2023]
Abstract
Background Reperfusion status after intra-arterial thrombectomy (IAT) is a critical predictor of functional outcome after acute ischemic stroke. However, most prognostic models have not included a detailed assessment of reperfusion status after IAT. Objective The aim of this work was to assess the association between successful reperfusion and clinical outcome. Methods Clinical, radiological, and procedural variables of patients treated with IAT were extracted from our prospective stroke registry. The association with functional outcome using the modified Rankin Scale (mRS) after 3 months was assessed using multivariable logistic regression. An extension of the modified TICI score, eTICI, was used to classify reperfusion status. The prognostic value of reperfusion status after IAT in addition to age, stroke severity, imaging characteristics, treatment with intravenous thrombolysis, and time from symptom onset to the end of IAT was assessed with logistic regression and summarized with receiver operating characteristic curves. Results In total, 119 patients were included (mean age 66 years). In multivariable analysis, age >80 years (OR 6.8, 95% CI 1.2-39.8), NIHSS at presentation >15 (OR 7.3, 95% CI 2.3-23.5), and incomplete reperfusion status (eTICI score <2C; OR 10.3, 95% CI 3.5-30.6) were the strongest predictors of a poor outcome (mRS 3-6). Adding reperfusion status to the model improved the prognostic accuracy (AUC 0.88, 95% CI 0.91-0.94). Our results indicate a large difference between using an eTICI cutoff of ≥2C versus ≥2B: a cutoff ≥2C improved the predictive value for a good clinical outcome (2C: positive predictive value, PPV, 0.78; 2B: PPV 0.32). Conclusion Our results promote using reperfusion status for assessing prognosis in ischemic stroke patients treated with IAT. A model using eTICI ≥2C had greater PPV than eTICI ≥2B and could improve prognostic accuracy.
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Affiliation(s)
- Luuk Dekker
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victor J Geraedts
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hajo Hund
- Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mayank Goyal
- Department of Neurosciences, Radiology and Community Health Services, University of Calgary, Calgary, Alberta, Canada
| | - Ido R van den Wijngaard
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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Balami JS, White PM, McMeekin PJ, Ford GA, Buchan AM. Complications of endovascular treatment for acute ischemic stroke: Prevention and management. Int J Stroke 2017; 13:348-361. [PMID: 29171362 DOI: 10.1177/1747493017743051] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Endovascular mechanical thrombectomy (MT) for the treatment of acute stroke due to large vessel occlusion has evolved significantly with the publication of multiple positive thrombectomy trials. MT is now a recommended treatment for acute ischemic stroke. Mechanical thrombectomy is associated with a number of intra-procedural or post-operative complications, which need to be minimized and effectively managed to maximize the benefits of thrombectomy. Procedural complications include: access-site problems (vessel/nerve injury, access-site hematoma and groin infection); device-related complications (vasospasm, arterial perforation and dissection, device detachment/misplacement); symptomatic intracerebral hemorrhage; subarachnoid hemorrhage; embolization to new or target vessel territory. Other complications include: anesthetic/contrast-related, post-operative hemorrhage, extra-cranial hemorrhage and pseudoaneurysm. Some complications are life-threatening and many lead to increased length of stay in intensive care and stroke units. Complications increase costs and delay the commencement of rehabilitation. Some may be preventable; the impact of others can be minimized with early detection and appropriate management. Both neurointerventionists and stroke specialists need to be aware of the risk factors, strategies for prevention, and management of these complications. With the increasing use of mechanical thrombectomy for the treatment of acute ischemic stroke, incidence and outcome of complications will need to be carefully monitored by stroke teams. In this narrative review, we examine the frequency of complications of MT in the treatment of acute ischemic stroke with an emphasis on periprocedural complications. Overall, from recent randomized controlled trials, the risk of complications with sequelae for patient from mechanical thrombectomy is ∼15%. We discuss the management of complications and identify areas with limited evidence, which need further research. Search strategy and selection criteria Relevant evidence was found by searches of Medline and Cochrane Library, reference list, cross-referencing and main journal content pages. Search terms included "brain ischemia", "acute ischemic stroke", "cerebral infarction" AND "mechanical thrombectomy", "endovascular therapy", "endovascular treatment", "endovascular embolectomy", "intra-arterial" AND "randomized controlled trial", "non-randomised trials", "observational studies" AND "complications", "procedural complications", "peri-procedural complications", "device-related complications", "management", "treatment", "outcome". The search included only human studies, and was limited to studies published in English between January 2014 and November 2016. The final reference list was selected on the basis of relevance to the topics covered in the Review. Guidelines for management of acute ischaemic stroke by the American Heart Association, the European Stroke Organisation, multi-disciplinary guidelines and the National Institute for Health and Care Excellence (NICE) were also reviewed.
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Affiliation(s)
- Joyce S Balami
- 1 Centre for Evidence Based Medicine, University of Oxford, Oxford, UK.,2 Norfolk and Norwich University Teaching Hospital NHS Trust, Norwich, UK
| | - Philip M White
- 3 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Peter J McMeekin
- 4 School of Health, Community and Education Studies, Northumbria University, London, UK
| | - Gary A Ford
- 5 John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.,6 Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alastair M Buchan
- 7 Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,8 Acute Vascular Imaging Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
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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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Abstract
PURPOSE OF REVIEW This article provides a synopsis of the immediate and delayed medical complications of stroke, with an emphasis on prevention and management of these complications. RECENT FINDINGS Meta-analysis of the trials for endovascular treatment of acute stroke shows no significant increase in hemorrhagic events. Rehabilitation guidelines published by the American Heart Association and American Stroke Association in 2016 aid in providing the best clinical practice for patients with stroke, from the time of their initial hospitalization to their return to the community. SUMMARY Medical complications from stroke are common and are associated with poor clinical outcomes, increased length of hospital stays and higher rates of readmission, increased cost of care, delayed time to rehabilitation, and increased mortality. Being cognizant of the common complications encountered, taking appropriate measures to prevent them, and knowing how to manage them when they do occur are essential to the continued care of patients with stroke.
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Yoon W, Kim SK, Park MS, Baek BH, Lee YY. Predictive Factors for Good Outcome and Mortality After Stent-Retriever Thrombectomy in Patients With Acute Anterior Circulation Stroke. J Stroke 2017; 19:97-103. [PMID: 28178407 PMCID: PMC5307937 DOI: 10.5853/jos.2016.00675] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/22/2016] [Accepted: 12/29/2016] [Indexed: 01/19/2023] Open
Abstract
Background and Purpose Predictive factors associated with stent-retriever thrombectomy for patients with acute anterior circulation stroke remain to be elucidated. This study aimed to investigate clinical and procedural factors predictive of good outcome and mortality after stent-retriever thrombectomy in a large cohort of patients with acute anterior circulation stroke. Methods We analyzed clinical and procedural data in 335 patients with acute anterior circulation stroke treated with stent-retriever thrombectomy. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The associations between clinical, imaging, and procedural factors and good outcome and mortality, respectively, were evaluated using logistic regression analysis. Results Using multivariate analysis, age (odds ratio [OR], 0.965; 95% confidence interval [CI], 0.944-0.986; P=0.001), successful revascularization (OR, 4.658; 95% CI, 2.240-9.689; P<0.001), parenchymal hemorrhage (OR, 0.150; 95% CI, 0.049-0.460; P=0.001), and baseline NIHSS score (OR, 0.908; 95% CI, 0.855-0.965; P=0.002) were independent predictors of good outcome. Independent predictors of mortality were age (OR, 1.043; 95% CI, 1.002-1.086; P=0.041), successful revascularization (OR, 0.171; 95% CI, 0.079-0.370; P<0.001), parenchymal hemorrhage (OR, 2.961; 95% CI, 1.059-8.276; P=0.038), and a history of previous stroke/TIA (OR, 3.124; 95% CI, 1.340-7.281; P=0.008). Conclusions Age, revascularization status, and parenchymal hemorrhage are independent predictors of both good outcome and mortality after stent retriever thrombectomy for acute anterior circulation stroke. In addition, NIHSS score on admission is independently associated with good outcome, whereas a history of previous stroke is independently associated with mortality.
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Affiliation(s)
- Woong Yoon
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Seul Kee Kim
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Man Seok Park
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Byung Hyun Baek
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Yun Young Lee
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
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Schröder J, Thomalla G. A Critical Review of Alberta Stroke Program Early CT Score for Evaluation of Acute Stroke Imaging. Front Neurol 2017; 7:245. [PMID: 28127292 PMCID: PMC5226934 DOI: 10.3389/fneur.2016.00245] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/29/2016] [Indexed: 01/19/2023] Open
Abstract
Assessment of ischemic stroke lesions on computed tomography (CT) or MRI using the Alberta Stroke Program Early CT Score (ASPECTS) is widely used to guide acute stroke treatment. We aimed to review the current evidence on ASPECTS. Originally, the score was developed for standardized lesion assessment on non-contrast CT (NCCT). Early studies described ASPECTS as a predictor of functional outcome and symptomatic intracranial hemorrhage after iv-thrombolysis with a threshold of ≤7 suggested to identify patients at high risk. Following studies rather pointed toward a linear relationship between ASPECTS and functional outcome. ASPECTS has also been applied to assess perfusion CT and diffusion-weighted MRI (DWI). Cerebral blood volume ASPECTS proved to be the best predictor of outcome, outperforming NCCT-ASPECTS in some studies. For DWI-ASPECTS varying thresholds to identify patients at risk for poor outcome were reported. ASPECTS has been used for patient selection in three of the five groundbreaking trials proving efficacy of mechanical thrombectomy published in 2015. ASPECTS values predict functional outcome after thrombectomy. Moreover, treatment effect of thrombectomy appears to depend on ASPECTS values being smaller or not present in low ASPECTS, while patients with ASPECTS 5–10 do clearly benefit from mechanical thrombectomy. However, as patients with low ASPECTS values were excluded from recent trials data on this subgroup is limited. There are several limitations to ASPECTS addressed in a growing number of studies. The score is limited to the anterior circulation, the template is unequally weighed and correlation with lesion volume depends on lesion location. Overall ASPECTS is a useful and easily applicable tool for assessment of prognosis in acute stroke treatment and to help guide acute treatment decisions regardless whether MRI or CT is used. Patients with low ASPECTS values are unlikely to achieve good outcome. However, methodological constraints of ASPECTS have to be considered, and based on present data, a clear cutoff value to define “low ASPECTS values” cannot be given.
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Affiliation(s)
- Julian Schröder
- Department of Neurology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Protto S, Pienimäki JP, Seppänen J, Numminen H, Sillanpää N. Low Cerebral Blood Volume Identifies Poor Outcome in Stent Retriever Thrombectomy. Cardiovasc Intervent Radiol 2016; 40:502-509. [DOI: 10.1007/s00270-016-1532-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/01/2016] [Indexed: 11/28/2022]
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40
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Treurniet KM, Yoo AJ, Berkhemer OA, Lingsma HF, Boers AMM, Fransen PSS, Beumer D, van den Berg LA, Sprengers MES, Jenniskens SFM, Lycklama À Nijeholt GJ, van Walderveen MAA, Bot JCJ, Beenen LFM, van den Berg R, van Zwam WH, van der Lugt A, van Oostenbrugge RJ, Dippel DWJ, Roos YBWEM, Marquering HA, Majoie CBLM. Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke. Stroke 2016; 47:2972-2978. [PMID: 27827328 DOI: 10.1161/strokeaha.116.014565] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/23/2016] [Accepted: 09/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE A high clot burden score (CBS) is associated with favorable outcome after intravenous treatment for acute ischemic stroke. The added benefit of intra-arterial treatment might be less in these patients. The aim of this exploratory post hoc analysis was to assess the relation of CBS with neurological improvement and endovascular treatment effect. METHODS For 499 of 500 patients in the MR CLEAN study (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), the CBS was determined. Ordinal logistic regression models with and without main baseline prognostic variables were used to assess the association between CBS (continuous or dichotomized at CBS of 6) and a shift toward better outcome on the modified Rankin Scale. The model without main baseline prognostic variables only included treatment allocation and CBS. Models with and without a multiplicative interaction term of CBS and treatment were compared using the χ2 test to assess treatment effect modification by CBS. RESULTS Higher CBS was associated with a shift toward better outcome on the modified Rankin Scale; adjusted common odds ratio per point CBS was 1.12 (95% confidence interval, 1.04-1.20]. Dichotomized CBS had an adjusted common odds ratio of 1.67 (95% confidence interval, 1.12-2.51). Both effect estimates were slightly attenuated by adding baseline prognostic variables. The addition of the interaction terms did not significantly improve the fit of the models. There was a small and insignificant increase of intra-arterial treatment efficacy in the high CBS group. CONCLUSIONS A higher CBS is associated with improved outcome and may be used as a prognostic marker. We found no evidence that CBS modifies the effect of intra-arterial treatment. CLINICAL TRIAL REGISTRATION URL: http://www.trialregister.nl. Unique identifier: NTR1804. URL: http://www.controlled-trials.com. Unique identifier: ISRCTN10888758.
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Affiliation(s)
- Kilian M Treurniet
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.).
| | - Albert J Yoo
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Olvert A Berkhemer
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Hester F Lingsma
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Anna M M Boers
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Puck S S Fransen
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Debbie Beumer
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Lucie A van den Berg
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Marieke E S Sprengers
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Sjoerd F M Jenniskens
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Geert J Lycklama À Nijeholt
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Marianne A A van Walderveen
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Joseph C J Bot
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Ludo F M Beenen
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - René van den Berg
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Wim H van Zwam
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Aad van der Lugt
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Robert J van Oostenbrugge
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Diederik W J Dippel
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Yvo B W E M Roos
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Henk A Marquering
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Charles B L M Majoie
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
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Seker F, Pfaff J, Wolf M, Schönenberger S, Nagel S, Herweh C, Pham M, Bendszus M, Möhlenbruch MA. Impact of thrombus length on recanalization and clinical outcome following mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg 2016; 9:937-939. [PMID: 27634955 DOI: 10.1136/neurintsurg-2016-012591] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/21/2016] [Accepted: 08/29/2016] [Indexed: 01/29/2023]
Abstract
PURPOSE The impact of thrombus length on recanalization in IV thrombolysis for acute intracranial artery occlusion has been well studied. Here we analyzed the influence of thrombus length on the number of thrombectomy maneuvers needed for recanalization, intraprocedural complications, recanalization success, and clinical outcome after mechanical thrombectomy. METHODS We retrospectively analyzed angiographic and clinical data from 72 consecutive patients with acute occlusion of the M1 segment of the middle cerebral artery who were treated with mechanical thrombectomy using stent retrievers. Successful recanalization was defined as a Thrombolysis in Cerebral Infarction score of 2b or 3. Good neurological outcome was defined as a modified Rankin Scale score of ≤2 at 90 days after stroke onset. RESULTS Mean thrombus length was 13.4±5.2 mm. Univariate binary logistic regression did not show an association of thrombus length with the probability of a good clinical outcome (OR 0.95, 95% CI 0.84 to 1.03, p=0.176) or successful recanalization (OR 0.92, 95% CI 0.81 to 1.05, p=0.225). There was no significant correlation between thrombus length and the number of thrombectomy maneuvers needed for recanalization (p=0.112). Furthermore, thrombus length was not correlated with the probability of intraprocedural complications (p=0.813), including embolization in a new territory (n=3). CONCLUSIONS In this study, thrombus length had no relevant impact on recanalization, neurological outcome, or intraprocedural complications following mechanical thrombectomy of middle cerebral artery occlusions. Therefore, mechanical thrombectomy with stent retrievers can be attempted with large clots.
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Affiliation(s)
- Fatih Seker
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Pfaff
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcel Wolf
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Herweh
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Mirko Pham
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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Khan MA, Baird GL, Miller D, Patel A, Tsekhan S, Yaghi S, Puri A, Jayaraman M, Henninger N, Silver B. Endovascular treatment of acute ischemic stroke in nonagenarians compared with younger patients in a multicenter cohort. J Neurointerv Surg 2016; 9:727-731. [PMID: 27402857 DOI: 10.1136/neurintsurg-2016-012427] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/10/2016] [Accepted: 06/20/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recent studies have demonstrated the superiority of endovascular therapy (EVT) for emergent large vessel occlusion. OBJECTIVE To determine the effectiveness of EVT in nonagenarians, for whom data are limited. METHODS We retrospectively reviewed clinical and imaging data of all patients who underwent EVT at two stroke centers between January 2012 and August 2014. The 90-day functional outcome (modified Rankin Scale (mRS) score) was compared between younger patients (age 18-89 years; n=175) and nonagenarians (n=18). The relationship between pre-stroke and 90-day post-stroke mRS was analyzed in these two groups. Multivariable analysis of age, recanalization grade, and admission National Institutes of Health Stroke Scale (NIHSS) for predicting outcome was performed. RESULTS Age ≥90 years was associated with a poor (mRS >2) 90-day outcome relative to those under 90 (89% vs 52%, OR=8, 95% CI 1.7 to 35.0; p=0.0081). Nonagenarians had a higher pre-stroke mRS score (0.77; 95% CI 0.44 to 1.30) than younger patients (0.24; 95% CI 0.17 to 0.35; p=0.005). No difference was observed between nonagenarians and younger patients in the rate of mRS change from pre-stroke to 90 days (p=0.540). On multivariable regression, age (OR=1.05, 95% CI 1.03 to 1.08; p<0.0001), recanalization grade (OR=0.62 95% CI 0.42 to 0.91; p=0.015), and admission NIHSS (OR=1.07 95% CI 1.02 to 1.13; p=0.01) were associated with a poor 90-day outcome. CONCLUSIONS Nonagenarians are at a substantially higher risk of a poor 90-day outcome after EVT than younger patients. However, a small subset of nonagenarians may benefit from EVT, particularly if they have a good pre-stroke functional status. Further research is needed to identify factors associated with favorable outcome in this age cohort.
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Affiliation(s)
- Muhib A Khan
- Department of Neurology, Brown University, Providence, Rhode Island, USA.,Neuroscience Institute (Division of Neurology), Spectrum Health, Michigan State University, Grand Rapids, Michigan, USA
| | - Grayson L Baird
- Lifespan Biostatistics Core, Lifespan Hospital System, Providence, Rhode Island, USA.,Department of Diagnostic Imaging, Brown University, Providence, Rhode Island, USA
| | - David Miller
- Department of Neurology, Brown University, Providence, Rhode Island, USA
| | - Anand Patel
- Department of Neurology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Shawn Tsekhan
- Department of Neurology, Brown University, Providence, Rhode Island, USA
| | - Shadi Yaghi
- Department of Neurology, Brown University, Providence, Rhode Island, USA
| | - Ajit Puri
- Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Mahesh Jayaraman
- Department of Diagnostic Imaging, Brown University, Providence, Rhode Island, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts, Worcester, Massachusetts, USA.,Department of Psychiatry, University of Massachusetts, Worcester, Massachusetts, USA
| | - Brian Silver
- Department of Neurology, Brown University, Providence, Rhode Island, USA
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Bouchez L, Lovblad KO, Kulcsar Z. Pretherapeutic characterization of the clot in acute stroke. J Neuroradiol 2016; 43:163-6. [DOI: 10.1016/j.neurad.2016.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 10/22/2022]
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Enomoto Y, Yoshimura S, Egashira Y, Yamagami H, Sakai N. The Risk of Intracranial Hemorrhage in Japanese Patients with Acute Large Vessel Occlusion; subanalysis of the RESCUE-Japan registry. J Stroke Cerebrovasc Dis 2016; 25:1076-1080. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/10/2015] [Accepted: 12/18/2015] [Indexed: 11/28/2022] Open
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Chueh JY, Puri AS, Gounis MJ. An in vitro evaluation of distal emboli following Lazarus Cover-assisted stent retriever thrombectomy. J Neurointerv Surg 2016; 9:183-187. [DOI: 10.1136/neurintsurg-2015-012256] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 01/28/2016] [Accepted: 01/30/2016] [Indexed: 11/04/2022]
Abstract
BackgroundFormation of clot fragments during mechanical thrombectomy for acute ischemic stroke can occlude the distal vasculature, which may reduce the rate of good clinical outcome.ObjectiveTo examine the hypothesis that distal embolization can be reduced using stent retriever thrombectomy in combination with Lazarus Cover technology.MethodsHard, fragment-prone clots were used to create middle cerebral artery occlusions in a vascular phantom. Three different treatment strategies using Solitaire FR included: group 1—proximal flow control with an 8F balloon guide catheter (BGC), group 2—thrombectomy through a 6F conventional guide catheter (CGC), and group 3—a similar thrombectomy procedure to group 2 but including the Lazarus Cover device. The primary endpoint was distal emboli quantified by the number and size of the clot debris.ResultsThe Cover-assisted stent retriever thrombectomy significantly reduced the generation of clot fragments >200 μm as compared with thrombectomy with a CGC, and was similar to the BGC group. Particle size distribution <200 μm was similar across the groups. All groups were associated with high rates of recanalization, with only one failed recanalization with partial clot retention after three passes in one experiment of stent retriever thrombectomy through a CGC. Use of the adjunctive Cover device did not prolong the procedure as compared with control groups.ConclusionsFor a fragment-prone clot, Solitaire thrombectomy in conjunction with the Cover device may lower the risk of distal embolization and is comparable to BGC-protected embolectomy.
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Intravenous Thrombolysis Facilitates Successful Recanalization with Stent-Retriever Mechanical Thrombectomy in Middle Cerebral Artery Occlusions. J Stroke Cerebrovasc Dis 2016; 25:954-9. [PMID: 26851970 DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/28/2015] [Accepted: 01/02/2016] [Indexed: 12/14/2022] Open
Abstract
AIM Several factors influence the outcome after acute ischemic stroke secondary to proximal occlusions of cerebral vessels. Among others, noneligibility for intravenous thrombolysis (IVT) and incomplete revascularization have been identified as predictors of unfavorable outcome. The aim of this study was to investigate whether concomitant IVT influences the revascularization efficacy in mechanical thrombectomy (MT). METHODS This study conducted a retrospective analysis of all consecutive patients presenting with an anterior circulation stroke due to large-artery occlusion with imaging evidence who were treated with MT between July 2012 and December 2013 at 2 high-volume stroke centers. Imaging data were regraded and re-evaluated according to the modified Treatment in Cerebral Ischemia scale and its respective vessel occlusion site definitions. Clinical end points included National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale; imaging and procedural measures were technical end points. RESULTS We identified 93 patients who presented with an occlusion of the middle cerebral artery (MCA): of these patients, 66 (71%) received IVT. We did not find statistically significant differences in the baseline NIHSS score, time from symptom onset to groin puncture, and age when comparing the IVT group with the non-IVT group. The rate of successful recanalizations (modified Treatment in Cerebral Ischemia score ≥ 2b) was significantly higher in patients with MCA occlusion and concomitant IVT (P = .01). Stepwise logistic regression identified IVT and thrombus length as predictive factors for successful mechanical recanalization (P = .004, P = .002). CONCLUSION IVT and thrombus length are predictive factors for a successful recanalization in MT for acute ischemic stroke with underlying MCA occlusion.
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Jiang S, Fei A, Peng Y, Zhang J, Lu YR, Wang HR, Chen M, Pan S. Predictors of Outcome and Hemorrhage in Patients Undergoing Endovascular Therapy with Solitaire Stent for Acute Ischemic Stroke. PLoS One 2015; 10:e0144452. [PMID: 26642052 PMCID: PMC4671621 DOI: 10.1371/journal.pone.0144452] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/18/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endovascular mechanical thrombectomy is emerging as a promising therapeutic approach for acute ischemic stroke and show some advantages. However, the data of predicting clinical outcome after thrombectomy with Solitaire retriever were limited. We attempt to identify prognostic factors of clinical outcome in patients with acute ischemic stroke undergoing thrombectomy with Solitaire retriever. METHODS We conducted a retrospective analysis of consecutive acute ischemic strokes cases treated between December 2010 and December2013 where the Solitaire stent retriever was used for acute ischemic stroke. We assessed the effect of selected demographic characteristics, clinical factors on poor outcome at 3 months (modified Rankin score 3-6), mortality at 3 months, and hemorrhage within 24 h (symptomatic and asymptomatic). Clinical, imaging and logistic variables were analyzed. A multivariate logistic regression analysis was used to identify variables influencing clinical outcome, based on discharge NIHSS score change and mRS at 3 months. RESULTS Eighty nine consecutive patients with acute ischemic stroke underwent mechanical thrombectomy. Multivariate analysis revealed that admission NIHSS score, Serum glucose and endovascular procedure duration were independently associated with clinical outcome. Sex, NIHSS score at admission, diabetes and time of operation were associated with sICH in 1 day. NIHSS score ≥20 (OR 9.38; 95% CI 2.41-36.50), onset to reperfusion >5 hours (OR 5.23; 95% CI1.34,20.41) and symptomatic intracranial hemorrhage (OR 10.19; 95% CI1.80,57.83) were potential predictive factors of mortality at 3 months. CONCLUSION Multiple pre- and intra-procedural factors can be used to predict clinical outcome, symptomatic intracranial hemorrhage and mortality in acute ischemic stroke patients undergoing endovascular therapy. This knowledge is helpful for patients selection for endovascular mechanical thrombectomy.
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Affiliation(s)
- Shaowei Jiang
- Emergency Department, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Aihua Fei
- Emergency Department, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Ya Peng
- Cerebral Vascular Disease Center, The First People’s Hospital of Changzhou, Soochow University, Changzhou, 213003, China
| | - Jun Zhang
- Department of Medical Imaging, The First People’s Hospital of Changzhou, Soochow University, Changzhou, 213003, China
| | - You-ran Lu
- Department of Medical Imaging, The First People’s Hospital of Changzhou, Soochow University, Changzhou, 213003, China
| | - Hai-rong Wang
- Emergency Department, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Miao Chen
- Emergency Department, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Shuming Pan
- Emergency Department, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
- * E-mail:
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Takagi T, Yoshimura S, Uchida K, Enomoto Y, Egashira Y, Yamagami H, Sakai N. Intravenous tissue plasminogen activator before endovascular treatment increases symptomatic intracranial hemorrhage in patients with occlusion of the middle cerebral artery second division: subanalysis of the RESCUE-Japan Registry. Neuroradiology 2015; 58:147-53. [PMID: 26494464 DOI: 10.1007/s00234-015-1608-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/06/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION No previous study has investigated the relationship between intravenous tissue plasminogen activator (IV t-PA) and intracranial hemorrhage (ICH) according to the location of vessel occlusion. The aim of the present study was to investigate the relationship between preprocedural IV t-PA and endovascular treatment (EVT) and ICH according to the location of occlusion using data from the nationwide prospective registry of acute cerebral large vessel occlusion (LVO), the RESCUE-Japan Registry. METHODS Among 1442 patients with acute LVO enrolled in the registry, we examined 410 patients who received EVT. Patients were divided into the following four groups according to the location of occlusion: the internal carotid artery (ICA), middle cerebral artery first division (M1), middle cerebral artery second division (M2), and vertebral artery (VA)/basilar artery (BA) groups. RESULTS A total of 399 patients in whom the occlusion was located in these vessels were finally included. Any ICH (aICH) was identified in 127 (30.9%) patients, and symptomatic ICH (sICH) was identified in 20 (4.9%). Preprocedural IV t-PA did not increase the incidence of aICH in any group and tended to increase the incidence of sICH in only the M2 group. In multivariate analysis of the M2 group, IV t-PA was an independent risk factor for sICH. CONCLUSION Preprocedural IV t-PA did not increase the incidence of ICH in total, but could increase the incidence of sICH in those with M2 occlusion. IV t-PA before EVT may be an independent risk factor for sICH in patients with M2 occlusion.
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Affiliation(s)
- Toshinori Takagi
- Department of Neurosurgery, Gifu Prefectural Gero Hot Spring Hospital, Gifu, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yukiko Enomoto
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yusuke Egashira
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroshi Yamagami
- Department of Medicine, Cerebrovascular Division, National Cerebral Cardiovascular Center, Osaka, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Pielen A, Pantenburg S, Schmoor C, Schumacher M, Feltgen N, Junker B, Callizo J. Predictors of prognosis and treatment outcome in central retinal artery occlusion: local intra-arterial fibrinolysis vs. conservative treatment. Neuroradiology 2015; 57:1055-62. [PMID: 26349479 DOI: 10.1007/s00234-015-1588-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/25/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The study analyses patients' risk factors to determine prognostic and predictive factors in patients with acute central retinal artery occlusion (CRAO) treated in the randomized European Assessment Group for Lysis in the Eye (EAGLE) Study with local intra-arterial fibrinolysis (LIF) or conservative standard treatment (CST). These data could improve patient selection for either method. METHODS Post hoc statistical analysis of effects of risk factors on overall best corrected visual acuity (BCVA [logarithm of the minimum angle of resolution (logMAR)]) at baseline and month 1 (prognostic effect) and on the difference between outcome of CST and LIF (predictive effect) was conducted. RESULTS Seventy two of 84 EAGLE datasets were included. Prognostic effect: Patients with coronary heart disease (CHD) presented worse BCVA at baseline (0.39 logMAR, p = 0.0097). Patients with time from occlusion to treatment <12 h showed a trend to better vision gain at month 1 (-0.23 logMAR, p = 0.086), similarly smoking (-0.24 logMAR, p = 0.077). Predictive effect: Age (<60 years favours LIF -0.54 logMAR; >70 years favours CST 0.28 logMAR; interaction p = 0.070) and CHD (favours CST 0.44 logMAR; interaction p = 0.073) might be predictors of therapeutic outcome. There were no strong effects in multivariate analysis. CONCLUSION CHD, time from occlusion to treatment and smoking influence BCVA at baseline and at month 1 (prognostic effect). Patients treated within 12 h are more likely to profit from treatment. In multivariate analysis, there is no clear trend to benefit from LIF even in patients with young age, no CHD and early treatment. Based on this preliminary report on a rather small sample size, we do not recommend LIF in CRAO patients.
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Affiliation(s)
- Amelie Pielen
- University Medical Center Freiburg, University Eye Hospital, Freiburg, Germany.
- Hannover Medical School, University Eye Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | | | - Claudia Schmoor
- University Medical Center Freiburg, Clinical Trials Unit, Freiburg, Germany
| | - Martin Schumacher
- University Medical Center Freiburg, Neuroradiology, Freiburg, Germany
| | - Nicolas Feltgen
- University Hospital Göttingen, University Eye Hospital, Göttingen, Germany
| | - Bernd Junker
- University Medical Center Freiburg, University Eye Hospital, Freiburg, Germany
- Hannover Medical School, University Eye Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Josep Callizo
- University Hospital Göttingen, University Eye Hospital, Göttingen, Germany
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Puñal-Riobóo J, Atienza G, Blanco M. Safety and Efficacy of Mechanical Thrombectomy Using Stent Retrievers in the Endovascular Treatment of Acute Ischaemic Stroke: A Systematic Review. INTERVENTIONAL NEUROLOGY 2015; 3:149-64. [PMID: 26279662 DOI: 10.1159/000430474] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The treatment of choice for acute ischaemic stroke is the intravenous administration of recombinant tissue plasminogen activator within 3-4.5 h of symptom onset. However, the use of a thrombolytic would be limited by its narrow therapeutic window and contraindications. As a result, in recent years, techniques such as mechanical thrombectomy have emerged, which employ thrombus retrieval devices, such as stent retrievers (Solitaire™, Trevo® or Revive™), whose safety and efficacy in the endovascular treatment of acute ischaemic stroke is analysed in this article. METHODS A systematic literature search was undertaken until March 2015. The quality of evidence was assessed according to the GRADE methodology. A meta-analysis of the results of randomised controlled trials (RCTs) was performed, and the weighted average for the case series' sample size was calculated (Review Manager v5.2 and SPSS v19). RESULTS Seventeen primary studies (2 RCTs, Solitaire™ and Trevo® vs. Merci®, and 15 case series) were selected. The RCT results show that stent retrievers have a safety profile similar to the Merci® device. However, both Solitaire™ and Trevo® achieved a higher recanalisation success rate (OR, 4.56; 95% CI, 2.63-7.90; p < 0.00001) and appropriate clinical outcome at 90 days (OR, 2.54; 95% CI, 1.52-4.25; p < 0.0004), although the 90-day mortality rate was similar in both groups (OR, 0.75; 95% CI, 0.17-3.37; p = 0.70). CONCLUSIONS Stent retrievers appear to be safe and effective devices, achieving high recanalisation rates and good clinical outcomes in the endovascular treatment of patients with acute ischaemic stroke due to the occlusion of intracranial arteries in comparison with the clot retriever Merci®.
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Affiliation(s)
- Janet Puñal-Riobóo
- Galician Department of Health, Galician Agency for Health Technology Assessment (avalia-t), Santiago de Compostela, Spain
| | - Gerardo Atienza
- Galician Department of Health, Galician Agency for Health Technology Assessment (avalia-t), Santiago de Compostela, Spain
| | - Miguel Blanco
- Neurovascular Area, Neurology Department, Clinic University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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