1
|
Abou Loukoul W, Richard S, Mione G, Finitsis S, Derelle AL, Zhu F, Liao L, Anxionnat R, Douarinou M, Humbertjean L, Gory B. Outcome of stroke patients eligible to mechanical thrombectomy managed by spoke center, primary stroke center or comprehensive stroke center in the East of France. Rev Neurol (Paris) 2024; 180:517-523. [PMID: 38036405 DOI: 10.1016/j.neurol.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/20/2023] [Accepted: 08/25/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND AND PURPOSE Patients with suspected stroke are referred to the nearest hospital and are managed either in a spoke center (SC), a primary stroke center (PSC), or a comprehensive stroke center (CSC) in order to benefit from early intravenous thrombolysis (IVT). In case of large vessel occlusion (LVO), mechanical thrombectomy (MT) is only performed in the CSC, whereas the effectiveness of MT is highly time-dependent. There is a debate about the best management model of patients with suspected LVO. Therefore, we aimed to compare functional and safety outcomes of LVO patients eligible for MT managed through our regional telestroke system. METHOD We performed a retrospective analysis of our observational prospective clinical registry in all consecutive subjects with LVO within six hours of onset who were admitted to the SC, PSC, or CSC in the east of France between October 2017 and November 2022. The primary endpoint was the functional independence defined as modified Rankin scale (mRS) score 0 to 2 at 90 days. Secondary endpoints were functional outcome, early neurological improvement, symptomatic intracranial hemorrhage and 90-day mortality. RESULTS Among the 794 included patients with LVO who underwent MT, 122 (15.4%) were managed by a SC, 403 (50.8%) were first admitted to a PSC, and 269 (33.9%) were first admitted to the CSC. The overall median NIHSS and ASPECTS score were 16 and 8, respectively. Multivariate analysis did not find any significant difference for the primary endpoint between patients managed by PSC versus CSC (OR 1.06 [95% CI 0.64;1.76], P=0.82) and between patient managed by SC versus CSC (OR 0.69 [0.34;1.40], P=0.30). No difference between the three groups was found except for the parenchymal hematoma rate between PSC and CSC (15.7 versus 7.4%, OR 2.25 [1.07;4.74], P=0.032). CONCLUSIONS Compared with a first admission to a CSC, the clinical outcomes of stroke patients with LVO eligible for MT first admitted to a SC or a PSC are similar.
Collapse
Affiliation(s)
- W Abou Loukoul
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Central, CHRU-Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - S Richard
- Department of Neurology, Stroke Unit, CHRU-Nancy, Nancy, France; Université de Lorraine, Inserm U1116, Nancy, France
| | - G Mione
- Department of Neurology, Stroke Unit, CHRU-Nancy, Nancy, France
| | - S Finitsis
- Aristotle University of Thessaloniki, Ahepa Hospital, Thessaloniki, Greece
| | - A-L Derelle
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Central, CHRU-Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - F Zhu
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Central, CHRU-Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France; Université de Lorraine, Inserm U1254, Nancy, France
| | - L Liao
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Central, CHRU-Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - R Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Central, CHRU-Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France; Université de Lorraine, Inserm U1254, Nancy, France
| | - M Douarinou
- Department of Neurology, Stroke Unit, CHRU-Nancy, Nancy, France
| | - L Humbertjean
- Department of Neurology, Stroke Unit, CHRU-Nancy, Nancy, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Central, CHRU-Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France; Université de Lorraine, Inserm U1254, Nancy, France.
| |
Collapse
|
2
|
Candefjord S, Andersson Hagiwara M, Sjöqvist BA, Karlsson JE, Nordanstig A, Rosengren L, Söderholm HM. Video support for prehospital stroke consultation: implications for system design and clinical implementation from prehospital simulations. BMC Med Inform Decis Mak 2024; 24:146. [PMID: 38811986 PMCID: PMC11138054 DOI: 10.1186/s12911-024-02539-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 05/17/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Video consultations between hospital-based neurologists and Emergency Medical Services (EMS) have potential to increase precision of decisions regarding stroke patient assessment, management and transport. In this study we explored the use of real-time video streaming for neurologist-EMS consultation from the ambulance, using highly realistic full-scale prehospital simulations including role-play between on-scene EMS teams, simulated patients (actors), and neurologists specialized in stroke and reperfusion located at the remote regional stroke center. METHODS Video streams from three angles were used for collaborative assessment of stroke using the National Institutes of Health Stroke Scale (NIHSS) to assess symptoms affecting patient's legs, arms, language, and facial expressions. The aim of the assessment was to determine appropriate management and transport destination based on the combination of geographical location and severity of stroke symptoms. Two realistic patient scenarios were created, with severe and moderate stroke symptoms, respectively. Each scenario was simulated using a neurologist acting as stroke patient and an ambulance team performing patient assessment. Four ambulance teams with two nurses each all performed both scenarios, for a total of eight cases. All scenarios were video recorded using handheld and fixed cameras. The audio from the video consultations was transcribed. Each team participated in a semi-structured interview, and neurologists and actors were also interviewed. Interviews were audio recorded and transcribed. RESULTS Analysis of video-recordings and post-interviews (n = 7) show a more thorough prehospital patient assessment, but longer total on-scene time, compared to a baseline scenario not using video consultation. Both ambulance nurses and neurologists deem that video consultation has potential to provide improved precision of assessment of stroke patients. Interviews verify the system design effectiveness and suggest minor modifications. CONCLUSIONS The results indicate potential patient benefit based on a more effective assessment of the patient's condition, which could lead to increased precision in decisions and more patients receiving optimal care. The findings outline requirements for pilot implementation and future clinical tests.
Collapse
Affiliation(s)
- Stefan Candefjord
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, 412 96, Sweden.
| | - Magnus Andersson Hagiwara
- Center for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, 501 90, Sweden
| | - Bengt Arne Sjöqvist
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, 412 96, Sweden
| | - Jan-Erik Karlsson
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Nordanstig
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Simulation Center West, Sahlgrenska University Hospital and University of Gothenburg, , Gothenburg, Sweden
| | - Lars Rosengren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | |
Collapse
|
3
|
Lan XY, Li D, Cui Y, Nguyen TN, Li S, Chen HS. Proteomic analysis of jugular venous blood in acute large vessel occlusion stroke with futile recanalization. J Cereb Blood Flow Metab 2024; 44:702-711. [PMID: 38000017 PMCID: PMC11197136 DOI: 10.1177/0271678x231216767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/13/2023] [Accepted: 10/17/2023] [Indexed: 11/26/2023]
Abstract
Futile recanalization (FR) after endovascular treatment (EVT) remains a significant challenge for acute ischemic stroke (AIS) with large vessel occlusion (LVO). The pathogenesis of FR has not been well elucidated. We prospectively enrolled anterior circulation LVO-AIS patients who achieved successful recanalization after EVT. The jugular venous blood ipsilateral to stroke was collected before and immediately after recanalization. Plasma proteomic analysis based on liquid chromatography-mass spectrometry was performed using data-independent acquisition method. Differentially expressed proteins (DEPs) among patients with or without FR in the whole or propensity score matching (PSM) cohorts were screened according to the absolute value of fold change ≥1.5 and P value <0.05. We identified 104 and 34 DEPs between patients with or without FR in the whole cohort and PSM cohort, respectively. Bioinformatic analysis indicated that the identified proteins were primarily related to specific biological processes including immune response, complement activation, oxidative stress, lipid metabolism, protein ubiquitylation as well as autophagy, suggesting that these may be mechanisms in FR pathogenesis. Collectively, we discovered proteins that may be potential research targets for FR. The combination of proteomic and bioinformatic analysis could provide a better understanding of the pathogenesis of FR in a comprehensive manner.
Collapse
Affiliation(s)
- Xiao-Yan Lan
- Graduate School, Dalian Medical University, Dalian, China
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
- Department of Neurointervention, Dalian Municipal Central Hospital, Dalian, China
| | - Di Li
- Department of Neurointervention, Dalian Municipal Central Hospital, Dalian, China
| | - Yu Cui
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Thanh N Nguyen
- Department of Neurology, Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Shen Li
- Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Beijing, China
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Hui-Sheng Chen
- Graduate School, Dalian Medical University, Dalian, China
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| |
Collapse
|
4
|
Aljuwaiser S, Abdel-Fattah AR, Brown C, Kane L, Cooper J, Mostafa A. Evaluating the effects of simulation training on stroke thrombolysis: a systematic review and meta-analysis. Adv Simul (Lond) 2024; 9:11. [PMID: 38424568 PMCID: PMC10905914 DOI: 10.1186/s41077-024-00283-6] [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: 11/01/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Ischaemic strokes are medical emergencies, and reperfusion treatment, most commonly intravenous thrombolysis, is time-critical. Thrombolysis administration relies on well-organised pathways of care with highly skilled and efficient clinicians. Simulation training is a widespread teaching modality, but results from studies on the impact of this intervention have yet to be synthesised. This systematic review and meta-analysis aimed to synthesise the evidence and provide a recommendation regarding the effects of simulation training for healthcare professionals on door-to-needle time in the emergency thrombolysis of patients with ischaemic stroke. METHODS Seven electronic databases were systematically searched (last updated 12th July 2023) for eligible full-text articles and conference abstracts. Results were screened for relevance by two independent reviewers. The primary outcome was door-to-needle time for recombinant tissue plasminogen activator administration in emergency patients with ischaemic stroke. The secondary outcomes were learner-centred, improvements in knowledge and communication, self-perceived usefulness of training, and feeling 'safe' in thrombolysis-related decision-making. Data were extracted, risk of study bias assessed, and analysis was performed using RevMan™ software (Web version 5.6.0, The Cochrane Collaboration). The quality of the evidence was assessed using the Medical Education Research Study Quality Instrument. RESULTS Eleven studies were included in the meta-analysis and nineteen in the qualitative synthesis (n = 20,189 total patients). There were statistically significant effects of simulation training in reducing door-to-needle time; mean difference of 15 min [95% confidence intervals (CI) 8 to 21 min]; in improving healthcare professionals' acute stroke care knowledge; risk ratio (RR) 0.42 (95% CI 0.30 to 0.60); and in feeling 'safe' in thrombolysis-related decision-making; RR 0.46 (95% CI 0.36 to 0.59). Furthermore, simulation training improved healthcare professionals' communication and was self-perceived as useful training. CONCLUSION This meta-analysis showed that simulation training improves door-to-needle times for the delivery of thrombolysis in ischaemic stroke. However, results should be interpreted with caution due to the heterogeneity of the included studies.
Collapse
Affiliation(s)
- Sameera Aljuwaiser
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | | | - Craig Brown
- Emergency Medicine, NHS Grampian, Aberdeen, Scotland
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Leia Kane
- Emergency Medicine, NHS Grampian, Aberdeen, Scotland
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Jamie Cooper
- Emergency Medicine, NHS Grampian, Aberdeen, Scotland
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Alyaa Mostafa
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| |
Collapse
|
5
|
Minchell E, Rumbach A, Farrell A, Burns CL, Wong A, Finch E. Acute Dysphagia Following Reperfusion Therapies: A Prospective Pilot Cohort Study. Dysphagia 2024; 39:119-128. [PMID: 37380703 PMCID: PMC10781886 DOI: 10.1007/s00455-023-10599-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/04/2023] [Indexed: 06/30/2023]
Abstract
Dysphagia is a well-documented sequela of stroke. Recent advancements in medical treatments for stroke include reperfusion therapies (endovascular thrombectomy (EVT) and thrombolysis). As outcomes following reperfusion therapies are typically measured via general functional scales, the pattern and progression of acute dysphagia following reperfusion therapies is less known. To determine the progression of acute dysphagia (0-72 h) following reperfusion therapies and relationships between various stroke parameters and dysphagia, twenty-six patients were prospectively recruited across two EVT and thrombolysis centres in Brisbane, Australia. Dysphagia was screened via the Gugging Swallowing Screen (GUSS) at the bedside at three timepoints: 0-24 h, 24-48 h, and 48-72 h post-reperfusion therapies. Across three groups (EVT only, thrombolysis only, or both), the incidence of any dysphagia within the first 24 h of reperfusion therapy was 92.31% (n = 24/26), 91.30% (n = 21/23) by 48 h, and 90.91% (n = 20/22) by 72 h. Fifteen patients presented with severe dysphagia at 0-24 h, 10 at 24-48 h, and 10 at 48-72 h. Whilst dysphagia was not significantly correlated to infarct penumbra/core size, dysphagia severity was significantly related to the number of passes required during EVT (p = 0.009).Dysphagia continues to persist in the acute stroke population despite recent advancements in technology aimed to reduce morbidity and mortality post-stroke. Further research is required to establish protocols for management of dysphagia post-reperfusion therapies.
Collapse
Affiliation(s)
- Ellie Minchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
- Royal Brisbane and Women's Hospital, Metro North Health, Queensland Health, Brisbane, Australia.
- Centre for Functioning and Health Research, Metro South Health, Queensland Health, Brisbane, Australia.
| | - Anna Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Anna Farrell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Princess Alexandra Hospital, Metro South Health, Queensland Health, Brisbane, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Metro North Health, Queensland Health, Brisbane, Australia
| | - Andrew Wong
- Royal Brisbane and Women's Hospital, Metro North Health, Queensland Health, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Research and Innovation, West Moreton Health, Queensland Health, Ipswich, Australia
- Princess Alexandra Hospital, Metro South Health, Queensland Health, Brisbane, Australia
| |
Collapse
|
6
|
Wang Y, Yuan X, Kang Y, Yu L, Chen W, Fan G. Clinical predictors of prognosis in stroke patients after endovascular therapy. Sci Rep 2024; 14:667. [PMID: 38182739 PMCID: PMC10770320 DOI: 10.1038/s41598-024-51356-5] [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: 06/29/2023] [Accepted: 01/03/2024] [Indexed: 01/07/2024] Open
Abstract
Endovascular therapy (EVT) is effective in the treatment of large vascular occlusive stroke. However, many factors are associated with the outcomes of acute ischemic stroke (AIS) after EVT. This study aimed to identify the main factors related to the prognosis of AIS patients after EVT. We analyzed the clinical data of AIS patients in the neurology department of our medical center from June 2017 to August 2021 following treatment with EVT. The data included the patients' blood pressure upon admission, blood glucose concentration, National Institutes of Health Stroke Scale (NIHSS) score, 90-day modified Rankin scale (mRs) score follow-up data, and time from LKN to the successful groin puncture (GP). A good outcome was defined as a 90-day mRs score of 0-2, and a poor outcome was defined as a 90-day mRs score of 3-6. A total of 144 patients were included in the study. Admission, smoking, and LKN-to-GP time, NIHSS score of 6-12 was found to be relevant to the prognosis. The results of multivariate analysis showed that prognosis was significantly influenced by baseline NIHSS (odds ratio = 3.02; 95% confidence interval, 2.878-4.252; P = 0.001), LKN-to-GP time (odds ratio = 2.17; 95% confidence interval, 1.341-2.625; P = 0.003), and time stratification (6-12 h) (odds ratio = 4.22; 95% confidence interval, 2.519-5.561; P = 0.001). Our study indicated that smoking, baseline NIHSS score, and LKN-to-GP time were the risk factors for a poor outcome in stroke patients following an EVT. Quitting smoking and shortening LKN time to GP should improve the outcome of AIS after EVT.
Collapse
Affiliation(s)
- Yugang Wang
- Department of Neurology, The First People's Hospital of Xian Yang City, Xian Yang, Sha'anxi, China.
| | - Xingyun Yuan
- Department of Neurology, The First People's Hospital of Xian Yang City, Xian Yang, Sha'anxi, China.
| | - Yonggang Kang
- Department of Neurology, The First People's Hospital of Xian Yang City, Xian Yang, Sha'anxi, China
| | - Liping Yu
- Department of Neurology, The First People's Hospital of Xian Yang City, Xian Yang, Sha'anxi, China
| | - Wanhong Chen
- Department of Neurology, The First People's Hospital of Xian Yang City, Xian Yang, Sha'anxi, China
| | - Gang Fan
- Department of Neurology, The First People's Hospital of Xian Yang City, Xian Yang, Sha'anxi, China
| |
Collapse
|
7
|
Ran L, Wang P, Chen H, Li N, Zhou F, Zhao W, Ma Q, Xing Y. Compromised dynamic cerebral autoregulation is a hemodynamic marker for predicting poor prognosis even with good recanalization after endovascular thrombectomy. Brain Circ 2024; 10:77-84. [PMID: 38655440 PMCID: PMC11034450 DOI: 10.4103/bc.bc_83_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/30/2023] [Accepted: 12/22/2023] [Indexed: 04/26/2024] Open
Abstract
PURPOSE In patients undergoing endovascular thrombectomy (EVT) with acute ischemic stroke (AIS), dynamic cerebral autoregulation (dCA) may minimize neurological injury from blood pressure fluctuations. This study set out to investigate the function of dCA in predicting clinical outcomes following EVT. METHODS 43 AIS of the middle cerebral or internal carotid artery patients underwent with EVT, and 43 healthy individuals (controls) were enrolled in this case control research. The dCA was evaluated using transcranial Doppler 12 h and five days after EVT. The transfer function analysis was used to derive the dCA parameters, such as phase, gain, and coherence. The modified Rankin scale (mRS) at 3 months after EVT was used to assess the clinical outcomes. Thefavorable outcome group was defined with mRS ≤2 and the unfavorable outcome group was defined with mRS score of 3-6. Logistic regression analysis was performed to determine the risk factors of clinical outcomes. RESULTS A significant impairment in dCA was observed on the ipsilateral side after EVT, particularly in patients with unfavorable outcomes. After 5 days, the ipsilateral phase was associated with poor functional outcomes (adjusted odds ratio [OR] = 0.911, 95% confidence interval [CI]: 0.854-0.972; P = 0.005) and the area under the curve (AUC) (AUC, 0.878, [95% CI: 0.756-1.000] P < 0.001) (optimal cutoff, 35.0°). Phase change was an independent predictor of clinical outcomes from 12 h to 5 days after EVT (adjusted OR = 1.061, 95% CI: 1.016-1.109, P = 0.008). CONCLUSIONS dCA is impaired in patients with AIS after EVT. Change in dCA could be an independent factor related to the clinical outcomes.
Collapse
Affiliation(s)
- Liu Ran
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Xicheng, Beijing, China
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Xicheng, Beijing, China
| | - Pingping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Xicheng, Beijing, China
| | - Hongxiu Chen
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Xicheng, Beijing, China
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Xicheng, Beijing, China
| | - Na Li
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Xicheng, Beijing, China
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Xicheng, Beijing, China
| | - Fubo Zhou
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Xicheng, Beijing, China
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Xicheng, Beijing, China
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Xicheng, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Xicheng, Beijing, China
| | - Yingqi Xing
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Xicheng, Beijing, China
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Xicheng, Beijing, China
| |
Collapse
|
8
|
Liang W, Yin J, Lu C, Yang J, Ma X, Zhang X, Turhon M, Yang X. Endovascular re-canalization for symptomatic non-acute intracranial large artery occlusion: a single-center retrospective study. Quant Imaging Med Surg 2023; 13:8031-8041. [PMID: 38106254 PMCID: PMC10722064 DOI: 10.21037/qims-23-643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/24/2023] [Indexed: 12/19/2023]
Abstract
Background Managing patients with symptomatic non-acute intracranial large artery occlusion (SNA-ILAO) poses a significant challenge due to the high morbidity and risk of recurrent critical ischemic events, even with standard medical therapy. This unique subgroup of patients requires specialized attention. The aim of this study is to evaluate the feasibility and safety of endovascular interventional recanalization for SNA-ILAO. Methods We retrospectively collected data of patients with SNA-ILAO who underwent endovascular interventional therapy at the Fourth Affiliated Hospital of Xinjiang Medical University from 2018 to 2021. The collected data included clinical demography, imaging data, treatment details, and prognosis. Follow-up imaging assessments were conducted for the patients, and descriptive statistics were performed. Results A total of 24 patients were enrolled, with a majority being male (58.3%) and a mean age of 62.0±9.3 years. The pre-treatment median modified Rankin scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS) scores at baseline were 3 and 1, respectively. The most common occlusion location was the middle cerebral artery (MCA), including M1 (70.8%), M2 (20.8%), and M3 (4.7%). Successful recanalization was achieved in all 24 patients, with 21 cases (87.5%) achieving thrombolysis in cerebral infarction (TICI) 3 reperfusion and the remaining 3 cases (12.5%) achieving TICI 2b reperfusion. Asymptomatic intracranial hemorrhage (ICH) occurred in 2 patients (8.3%). During the first 30-day clinical follow-up, none of these patients experienced any recurrent cerebral ischemic events. During the 29.5-month follow-up period for vessel imaging, only 12.5% (3/24) of patients who had follow-up imaging experienced re-stenosis. Conclusions Endovascular recanalization is a potentially safe and effective procedure for patients with SNA-ILAO. However, it is important to note that there is still a non-negligible rate of complications associated with this treatment. Therefore, exercising caution and implementing strict controls when administering this procedure is crucial.
Collapse
Affiliation(s)
- Wenbao Liang
- Department of Neurology, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Neurology, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
- Department of Neurosurgery, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
| | - Jiaqi Yin
- Department of Cardiology Three, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
| | - Chenyu Lu
- Department of Neurosurgery, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
| | - Jianbo Yang
- Department of Neurology, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
| | - Xiaoqiang Ma
- Department of Neurosurgery, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
| | - Xin Zhang
- Department of Neurosurgery, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
| | - Mirzat Turhon
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xinling Yang
- Department of Neurology, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Neurology, Xinjiang Medical University, Urumqi, China
| |
Collapse
|
9
|
Wang Y, Wan F, Hu P, He B, Hu Y, Liu Y. Efficacy and safety of anisodine hydrobromide injection for acute ischemic stroke: a systematic review and meta-analysis. Front Pharmacol 2023; 14:1290755. [PMID: 38034985 PMCID: PMC10684921 DOI: 10.3389/fphar.2023.1290755] [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: 09/08/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Background: Acute ischemic stroke (AIS) is a leading cause of death and disability worldwide. This study aimed to evaluate the efficacy and safety of anisodine hydrobromide (Ani) injection in the treatment of AIS. Methods: Randomized controlled trials (RCTs) based on Ani injection for the treatment of AIS were retrieved from both Chinese and English databases. The retrieval period was from the databases' inception to May 2023. The Cochrane Collaboration Risk of Bias Tool was used to assess the methodological quality. The outcome indicators were analyzed using RevMan 5.3 software. Results: We included the findings of 11 RCTs encompassing 1,337 patients with AIS. Our meta-analysis revealed that Ani injection supplementation significantly reduced the National Institutes of Health Stroke Scale [MD = -1.53, 95%CI = (-1.94, -1.12), p < 0.00001], modified Rankin Scale [MD = -0.89, 95%CI = (-0.97, -0.81), p < 0.00001], and the relative time to peak [SMD = -0.81, 95%CI = (-1.08, -0.55), p < 0.00001] significantly. Additionally, Ani injection significantly increased the Barthel Index [MD = 10.65, 95%CI = (4.30, 17.00), p = 0.001], relative cerebral blood volume [SMD = 0.28, 95%CI = (0.02, 0.53), p = 0.03], and clinical efficacy [RR = 1.2, 95%CI = (1.08, 1.34), p = 0.001]. No statistically significant difference in the rate of adverse events was observed between the Ani injection supplemental group and the control group. Conclusion: Based on currently published evidence, Ani injection was found to be effective and safe in improving AIS outcome. Nevertheless, limitations of the included RCTs still exist, and thus, more multi-center, large-sample, high-quality RCTs are required to further verify the efficacy and safety of Ani injection in patients with AIS. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023427591], identifier [PROSPERO 2023 CRD42023427591].
Collapse
Affiliation(s)
- Yang Wang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
- Postdoctoral Workstation, Affiliated Sport Hospital of Chengdu Sport University, Chengdu, Sichuan, China
| | - Feng Wan
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Peiqun Hu
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
| | - Benxiang He
- Sichuan Academy of Chinese Medicine Science, Chengdu, Sichuan, China
| | - Yushi Hu
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
| | - Yunlu Liu
- Institute of Laboratory Animal Sciences, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| |
Collapse
|
10
|
Hernandez S, Mill C, Irvine D, Clarke K, Granger CL, Da Silva A, Bower W. Can gait outcomes be predicted early after a stroke? Physiother Theory Pract 2023; 39:2154-2162. [PMID: 35437107 DOI: 10.1080/09593985.2022.2064379] [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: 08/24/2020] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the ability of clinical measures collected within 72 hours of neurological insult to predict independent gait 6 and 12 months after a stroke. METHODS Patients with a confirmed stroke diagnosis were eligible for inclusion in this prospective cohort study. Sitting balance, National Institutes of Health Stroke Scale (NIHSS) motor leg, NIHSS motor arm, and Motricity Index (MI) were measured within 72 hours post-stroke. Follow-up assessments were conducted at 6 and 12 months post-stroke to measure gait recovery. RESULTS A total of 78 patients were included at baseline for analysis. At 6 and 12 months, 38% (n = 38) and 35% (n = 42) of patients used a gait aid, and 80% and 87% were independently ambulant, respectively. Sitting balance, NIHSS motor leg, and NIHSS motor arm were not significantly associated with ambulation at 6 or 12 months or with the use of a gait aid. Thrombolysis was significantly associated with independent outdoors ambulation at 6 months (p = .011). A worse MI score was significantly associated with a higher number of falls at 6 months (p < .010) but not with the need for a gait aid. The number of falls at 6 months was independently predicted by urinary incontinence post-stroke (p < .001), NIHSS leg score (p < .005), and depression and anxiety while in acute care (p < .005). CONCLUSIONS Clinical bedside assessments may be less important in predicting safe, independent gait than previously thought. Urinary incontinence and poor mental health should be addressed in the hospital. Increased utilization of reperfusion techniques may alter functional recovery patterns.
Collapse
Affiliation(s)
- Sabrina Hernandez
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Chloe Mill
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Damon Irvine
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Katherine Clarke
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Catherine L Granger
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Alisha Da Silva
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Bower
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| |
Collapse
|
11
|
Bai X, Zhang X, Gong H, Wang T, Wang X, Wang W, Yang K, Yang W, Feng Y, Ma Y, Yang B, Lopez-Rueda A, Tomasello A, Jadhav V, Jiao L. Different types of percutaneous endovascular interventions for acute ischemic stroke. Cochrane Database Syst Rev 2023; 5:CD014676. [PMID: 37249304 PMCID: PMC10228464 DOI: 10.1002/14651858.cd014676.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Acute ischemic stroke (AIS) is the abrupt reduction of blood flow to a certain area of the brain which causes neurologic dysfunction. Different types of percutaneous arterial endovascular interventions have been developed, but as yet there is no consensus on the optimal therapy for people with AIS. OBJECTIVES To compare the safety and efficacy of different types of percutaneous arterial endovascular interventions for treating people with AIS. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 4 of 12, 2022), MEDLINE Ovid (1946 to 13 May 2022), Embase (1947 to 15 May 2022), Science Citation Index Web of Science (1900 to 15 May 2022), Scopus (1960 to 15 May 2022), and China Biological Medicine Database (CBM; 1978 to 16 May 2022). We also searched the ClinicalTrials.gov trials register and the World Health Organization (WHO) International Clinical Trials Registry Platform to 16 May 2022. SELECTION CRITERIA Randomized controlled trials (RCTs) comparing one percutaneous arterial endovascular intervention with another in treating adult patients who have a clinical diagnosis of AIS due to large vessel occlusion and confirmed by imaging evidence, including thrombo-aspiration, stent-retrieval thrombectomy, aspiration-retriever combined technique, and thrombus mechanical fragmentation. DATA COLLECTION AND ANALYSIS Two review authors independently performed the literature searches, identified eligible trials, and extracted data. A third review author participated in discussions to reach consensus decisions when any disputes occurred. We assessed risk of bias and applied the GRADE approach to evaluate the quality of the evidence. The primary outcome was rate of modified Rankin Scale (mRS) of 0 to 2 at three months. Secondary outcomes included the rate of modified Thrombolysis In Cerebral Infarction (mTICI) of 2b to 3 postprocedure, all-cause mortality within three months, rate of intracranial hemorrhage on imaging at 24 hours, rate of symptomatic intracranial hemorrhage at 24 hours, and rate of procedure-related adverse events within three months. MAIN RESULTS Four RCTs were eligible. The current meta-analysis included two trials with 651 participants comparing thrombo-aspiration with stent-retrieval thrombectomy. We judged the quality of evidence to be high in both trials according to Cochrane's risk of bias tool RoB 2. There were no significant differences between thrombo-aspiration and stent-retrieval thrombectomy in rate of mRS of 0 to 2 at three months (risk ratio [RR] 0.97, 95% confidence interval [CI] 0.82 to 1.13; P = 0.68; 633 participants; 2 RCTs); rate of mTICI of 2b to 3 postprocedure (RR 1.01, 95% CI 0.95 to 1.07; P = 0.77; 650 participants; 2 RCTs); all-cause mortality within three months (RR 1.01, 95% CI 0.74 to 1.37; P = 0.95; 633 participants; 2 RCTs); rate of intracranial hemorrhage on imaging at 24 hours (RR 1.03, 95% CI 0.86 to 1.24; P = 0.73; 645 participants; 2 RCTs); rate of symptomatic intracranial hemorrhage at 24 hours (RR 0.90, 95% CI 0.49 to 1.68; P = 0.75; 645 participants; 2 RCTs); and rate of procedure-related adverse events within three months (RR 0.98, 95% CI 0.68 to 1.41; P = 0.90; 651 participants; 2 RCTs). Another two included studies reported no differences for the comparisons of combined therapy versus stent-retrieval thrombectomy or thrombo-aspiration. One RCT is ongoing. AUTHORS' CONCLUSIONS This review did not establish any difference in safety and effectiveness between the thrombo-aspiration approach and stent-retrieval thrombectomy for treating people with AIS. Furthermore, the combined group did not show any obvious advantage over either intervention applied alone.
Collapse
Affiliation(s)
- Xuesong Bai
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiao Zhang
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haozhi Gong
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Wang
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xue Wang
- Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenjiao Wang
- Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kun Yang
- Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yao Feng
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Ma
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bin Yang
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Antonio Lopez-Rueda
- Department of Radiology, Hospital Clinic I Provincial de Barcelona, Barcelona, Spain
| | - Alejandro Tomasello
- Department of Neurointerventional Radiology, Vall d'Hebron Hospital, Barcelona, Spain
| | - Vikram Jadhav
- Neurosciences - Stroke and Cerebrovascular, CentraCare Health System, St Cloud, Minnesota, USA
| | - Liqun Jiao
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
12
|
The prognostic value of caveolin-1 levels in ischemic stroke patients after mechanical thrombectomy. Neurol Sci 2023; 44:2081-2086. [PMID: 36746844 DOI: 10.1007/s10072-023-06606-1] [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: 12/05/2022] [Accepted: 01/05/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE The impact of serum caveolin-1 (Cav-1) on clinical outcomes in patients after mechanical thrombectomy (MT) is unclear. We aimed to investigate the association between serum cav-1 levels and the 3-month functional outcome. METHODS We prospectively enrolled and analyzed patients with an anterior circulation large vessel occlusion who underwent MT. Serum cav-1 concentrations were tested after admission. The primary outcome was a 90-day modified Rankin Scale score of 3-6. RESULTS Of the 237 recruited patients (mean age, 69.7 ± 12.1 years; 152 male), 131 (55.3%) experienced a 90-day poor outcome. After adjustment for demographic characteristics and other covariates, patients with higher serum Cav-1 levels had a reduced risk of poor outcome at 3 months (Per 1-standard deviation increase; odd ratios [OR], 0.59; 95% confidence interval [CI], 0.39 - 0.89, P = 0.013). Elevated Cav-1 concentrations (Per 1-standard deviation increase; OR, 0.59; 95% CI, 0.40 - 0.88, P = 0.011) were significantly associated with a favorable shift in modified Rankin Scale score distribution. Similar results were confirmed when the Cav-1 levels were analyzed as a categorical variable. Furthermore, the restricted cubic spline showed a linear association between Cav-1 levels and 90-day poor outcome (P = 0.032 for linearity). CONCLUSIONS Increased serum Cav-1 levels were associated with improved prognosis at 3 months in ischemic stroke patients after MT, suggesting that Cav-1 may be a potential prognostic biomarker for ischemic stroke after reperfusion therapy.
Collapse
|
13
|
Venketasubramanian N. Advances in Neurological Diseases and Stroke. J Cardiovasc Dev Dis 2023; 10:jcdd10020066. [PMID: 36826562 PMCID: PMC9966626 DOI: 10.3390/jcdd10020066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Neurological diseases are a major cause of death and disability worldwide [...].
Collapse
|
14
|
Collateral-Core Ratio as a Novel Predictor of Clinical Outcomes in Acute Ischemic Stroke. Transl Stroke Res 2023; 14:73-82. [PMID: 35877061 DOI: 10.1007/s12975-022-01066-9] [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: 03/16/2022] [Revised: 06/26/2022] [Accepted: 07/13/2022] [Indexed: 01/31/2023]
Abstract
The interaction effect between collateral circulation and ischemic core size on stroke outcomes has been highlighted in acute ischemic stroke (AIS). However, biomarkers that assess the magnitude of this interaction are still lacking. We aimed to present a new imaging marker, the collateral-core ratio (CCR), to quantify the interaction effect between these factors and evaluate its ability to predict functional outcomes using machine learning (ML) in AIS. Patients with AIS caused by anterior circulation large vessel occlusion (LVO) were recruited from a prospective multicenter study. CCR was calculated as collateral perfusion volume/ischemic core volume. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days. An ML model was built and tested with a tenfold cross-validation using nine clinical and four imaging variables with mRS score 3-6 as unfavorable outcomes. Among 129 patients, CCR was identified as the most important variable. The prediction model incorporating clinical factors, ischemic core volume, collateral perfusion volume, and CCR showed better discriminatory power in predicting unfavorable outcomes than the model without CCR (mean C index 0.853 ± 0.108 versus 0.793 ± 0.133, P = 0.70; mean net reclassification index 52.7% ± 32.7%, P < 0.05). When patients were divided into two groups based on their CCR value with a threshold of 0.73, unfavorable outcomes were significantly more prevalent in patients with CCR ≤ 0.73 than in those with CCR > 0.73. CCR is a robust predictor of functional outcomes, as identified by ML, in patients with acute LVO. The prediction model that incorporated CCR improved the model's ability to identify unfavorable outcomes. ClinicalTrials.gov Identifier: NCT02580097.
Collapse
|
15
|
Zacà S, Ramundo RM, Desantis C, Di Stefano L, Pulli R, Angiletta D. Endovascular Bailout Repair After Intraprocedural Thrombosis of a Bifurcated Unimodular Stent-graft During Aorto-iliac Revascularization in a Patient with Sars CoV-2 Infection. Vasc Endovascular Surg 2023:15385744231154333. [PMID: 36704834 DOI: 10.1177/15385744231154333] [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: 01/28/2023]
Abstract
To describe a case of endovascular bailout strategy during stent-graft thrombotic complication in an endovascular procedure for complex TASC II D aortoiliac lesion. A 77-year-old patient was admitted at our institution with bilateral lower limb rest pain due to aortoiliac obstructive disease in a previous aortobifemoral bypass grafting with an asymptomatic Sars-CoV-2 infection. We planned an anatomic reconstruction of the aortoiliac segment with an unimodular bifurcated stent-graft. During the procedure, we observed a preocclusive thrombosis of the aortic portion requiring endovascular thrombectomy with vacuum assisted system followed by a successfully kissing-stent endolining. The post-operative period was uneventful and patient was discharged on the 14th post-operative day. Endovascular thrombectomy may be a helpful strategy during thrombotic complication of complex reconstructions of obstructive aortoiliac disease avoiding surgical conversion to laparotomy.
Collapse
Affiliation(s)
- Sergio Zacà
- Vascular and Endovascular Surgery, Department of Emergency and Organs Transplantation (DETO), 579980"Aldo Moro" University of Bari School of Medicine, Bari, Italy
| | - Roberto Maria Ramundo
- Vascular and Endovascular Surgery, Department of Emergency and Organs Transplantation (DETO), 579980"Aldo Moro" University of Bari School of Medicine, Bari, Italy
| | - Claudio Desantis
- Vascular and Endovascular Surgery, Department of Emergency and Organs Transplantation (DETO), 579980"Aldo Moro" University of Bari School of Medicine, Bari, Italy
| | - Lucia Di Stefano
- Vascular and Endovascular Surgery, Department of Emergency and Organs Transplantation (DETO), 579980"Aldo Moro" University of Bari School of Medicine, Bari, Italy
| | - Raffaele Pulli
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Domenico Angiletta
- Vascular and Endovascular Surgery, Department of Emergency and Organs Transplantation (DETO), 579980"Aldo Moro" University of Bari School of Medicine, Bari, Italy
| |
Collapse
|
16
|
Chen Y, Zhou S, Yang S, Mofatteh M, Hu Y, Wei H, Lai Y, Zeng Z, Yang Y, Yu J, Chen J, Sun X, Wei W, Nguyen TN, Baizabal-Carvallo JF, Liao X. Developing and predicting of early mortality after endovascular thrombectomy in patients with acute ischemic stroke. Front Neurosci 2022; 16:1034472. [PMID: 36605548 PMCID: PMC9810273 DOI: 10.3389/fnins.2022.1034472] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Stroke is one of the leading causes of mortality across the world. However, there is a paucity of information regarding mortality rates and associated risk factors in patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy (EVT). In this study, we aimed to clarify these issues and analyzed previous publications related to mortality in patients treated with EVT. Methods We analyzed the survival of 245 consecutive patients treated with mechanical thrombectomy for AIS for which mortality information was obtained. Early mortality was defined as death occurring during hospitalization after EVT or within 7 days following hospital discharge from the stroke event. Results Early mortality occurred in 22.8% of cases in this cohort. Recanalization status (modified thrombolysis in cerebral infarction, mTICI) (p = 0.002), National Institute of Health Stroke Scale Score (NIHSS) score 24-h after EVT (p < 0.001) and symptomatic intracerebral hemorrhage (sICH) (p < 0.001) were independently associated with early mortality. Age, sex, cardiovascular risk factors, NIHSS score pre-treatment, Alberta Stroke Program Early CT Score (ASPECTS), stroke subtype, site of arterial occlusion and timing form onset to recanalization did not have an independent influence on survival. Non-survivors had a shorter hospitalization (p < 0.001) but higher costs related to their hospitalization and outpatient care. Conclusion The recanalization status, NIHSS score 24-h after EVT and sICH were predictors of early mortality in AIS patients treated with EVT.
Collapse
Affiliation(s)
- Yimin Chen
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Sijie Zhou
- Department of Surgery of Cerebrovascular Diseases, The First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Shuiquan Yang
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Yuqian Hu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Hongquan Wei
- Department of 120 Emergency Command Center, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Yuzheng Lai
- Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanhai District Hospital of Traditional Chinese Medicine of Foshan City, Foshan, Guangdong, China
| | - Zhiyi Zeng
- Department of Scientific Research and Education, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Yajie Yang
- The First School of Clinical Medicine, Southern Medical University, Foshan, China
| | - Junlin Yu
- School of Laboratory Medicine and Biotechnology, Southern Medical University, Foshan, China
| | - Juanmei Chen
- Second Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Xi Sun
- School of Medicine, Shaoguan University, Shaoguan, Guangdong, China,Medical Intern, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Wenlong Wei
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Thanh N. Nguyen
- Department of Neurology, Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - José Fidel Baizabal-Carvallo
- Department of Neurology, Baylor College of Medicine, Parkinson’s Disease Center and Movement Disorders Clinic, Houston, TX, United States,Department of Sciences and Engineering, University of Guanajuato, León, Mexico,José Fidel Baizabal-Carvallo,
| | - Xuxing Liao
- Department of Surgery of Cerebrovascular Diseases, The First People’s Hospital of Foshan, Foshan, Guangdong, China,Department of Neurosurgery and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China,*Correspondence: Xuxing Liao,
| |
Collapse
|
17
|
Li Z, Bi R, Sun S, Chen S, Chen J, Hu B, Jin H. The Role of Oxidative Stress in Acute Ischemic Stroke-Related Thrombosis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:8418820. [PMID: 36439687 PMCID: PMC9683973 DOI: 10.1155/2022/8418820] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/13/2022] [Accepted: 11/02/2022] [Indexed: 09/22/2023]
Abstract
Acute ischemic stroke is a serious life-threatening disease that affects almost 600 million people each year throughout the world with a mortality of more than 10%, while two-thirds of survivors remain disabled. However, the available treatments for ischemic stroke are still limited to thrombolysis and/or mechanical thrombectomy, and there is an urgent need for developing new therapeutic target. Recently, intravascular oxidative stress, derived from endothelial cells, platelets, and leukocytes, has been found to be tightly associated with stroke-related thrombosis. It not only promotes primary thrombus formation by damaging endothelial cells and platelets but also affects thrombus maturation and stability by modifying fibrin components. Thus, oxidative stress is expected to be a novel target for the prevention and treatment of ischemic stroke. In this review, we first discuss the mechanisms by which oxidative stress promotes stroke-related thrombosis, then summarize the oxidative stress biomarkers of stroke-related thrombosis, and finally put forward an antithrombotic therapy targeting oxidative stress in ischemic stroke.
Collapse
Affiliation(s)
- Zhifang Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Rentang Bi
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shuai Sun
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shengcai Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jiefang Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Huijuan Jin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| |
Collapse
|
18
|
Zhang T, Han H, Zhou Y, Liu Z, Ma T, Cao X. MicroRNA-454 modulates the oxidative stress and neuronal apoptosis after cerebral ischemia/reperfusion injury via targeting NADPH oxidase 4 (NOX4). J Biochem Mol Toxicol 2022; 36:e23153. [PMID: 36043333 PMCID: PMC9786265 DOI: 10.1002/jbt.23153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/06/2022] [Accepted: 05/29/2022] [Indexed: 12/30/2022]
Abstract
To investigate the function of miR-454 in ischemic stroke, this study was carried out. Cerebral ischemia/reperfusion (I/R) injury animal model and a SHSY5Y cell culture model of oxygen-glucose deprivation/reoxygenation (OGD/R) were constructed. The effects of miR-454 were detected by evaluating the levels of biochemical markers, gene expression, and pathophysiological markers. The results showed that NOX4 level was elevated, while miR-454 expression was reduced in I/R brain samples and in OGD/R-treated cells. The miR-454 agomir declined NOX4 level and reactive oxygen species (ROS) production in rats suffering from I/R. Furthermore, microRNA-145 (miR-454) overexpression inhibited NOX4 level and ROS production in cells treated by OGD/R and decreased luciferase activity in cells transfected with NOX4-wild type (WT) reporter plasmid. Meanwhile, our results proved that the protected effects of miR-454 on SH-SY5Y cells treated by OGD/R were reversed by pcDNA-NOX4 transfection. MiR-454 protected animals from brain injury induced by cerebral I/R via directly regulating its target gene NOX4, illustrating a curatively potential target for treating ischemic stroke.
Collapse
Affiliation(s)
- Tao Zhang
- Department of NeurologyBaoan District Central HospitalShenzhen CityGuangdong ProvinceP.R. China
| | - Haiping Han
- Department of NeurologyNingxia Hui Autonomous Region People's HospitalYinchuan CityNingxia Hui Autonomous RegionP.R. China
| | - Yan Zhou
- Department of Thoracic SurgeryNingxia Hui Autonomous Region People's HospitalYinchuan CityNingxia Hui Autonomous RegionP.R. China
| | - Zhimei Liu
- Department of NeurologyNingxia Hui Autonomous Region People's HospitalYinchuan CityNingxia Hui Autonomous RegionP.R. China
| | - Tingjie Ma
- Department of NeurologyNingxia Hui Autonomous Region People's HospitalYinchuan CityNingxia Hui Autonomous RegionP.R. China
| | - Xuqing Cao
- Department of NeurologyNingxia Hui Autonomous Region People's HospitalYinchuan CityNingxia Hui Autonomous RegionP.R. China
| |
Collapse
|
19
|
Intravenous thrombolysis prior to endovascular treatment for acute ischemic stroke: a meta-analysis. Neurol Sci 2022; 43:5993-6002. [DOI: 10.1007/s10072-022-06233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
|
20
|
Association of CHA2DS2-VASc score with successful recanalization in acute ischemic stroke patients undergoing endovascular thrombectomy. Adv Cardiol 2022; 18:269-275. [PMID: 36751289 PMCID: PMC9885239 DOI: 10.5114/aic.2022.122027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Introduction The CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease and sex) score is a simple risk stratification algorithm to estimate stroke/thromboembolic risk in patients with non-valvular atrial fibrillation (AF). Higher pre-stroke CHA2DS2-VASc score is known to be associated with greater stroke severity and poorer outcomes. AF patients generally have higher CHA2DS2-VASc scores than non-AF patients. The Modified Thrombolysis in Cerebral Infarction (mTICI) score is the most widely used grading system to assess the result of recanalizing therapies in acute ischemic stroke (AIS). mTICI 2c and mTICI 3 are conventionally accepted as successful recanalization. Aim We investigated whether pre-stroke CHA2DS2-VASc score is associated with mTICI recanalization score in AIS patients with and without AF undergoing percutaneous thrombectomy. Material and methods One hundred fifty-nine patients with the diagnosis of AIS who were admitted within 6 h from symptom onset were included in the study (mean age: 65.7 ±12.9). All subjects underwent endovascular treatment. CHA2DS2-VASc scores of the participants were calculated. Subjects were grouped according to mTICI scores achieved after endovascular treatment. mTICI 2c and mTICI 3 were accepted as successful recanalization. Results Successful reperfusion was observed in 130 (81.8%) of all patients who underwent endovascular treatment (mTICI flow ≥ 2c) and first-pass reperfusion was observed in 107 (67.3%) patients. When the patients with successful (mTICI flow ≥ 2c) and unsuccessful (mTICI flow ≤ 2b) reperfusion were divided into groups, no significant difference was observed between the patients in terms of comorbidities such as AF, hypertension, hyperlipidemia, coronary artery disease and cerebrovascular accident history. Patients with unsuccessful reperfusion were older than patients with successful reperfusion (71.4 ±11.2 vs. 64.5 ±13.01, p = 0.006), with a higher CHA2DS2-VASc score (4.1 ±1.5 vs. 3.04 ±1.6, p = 0.002). In addition, the duration of the procedure was longer in the unsuccessful reperfusion group (92.4 ±27.2 min vs. 65.0 ±25.1 min, p < 0.001). CHA2DS2-VASc score significantly correlated with successful recanalization (correlation coefficient; 0.243, p = 0.002). Multivariate logistic regression analysis revealed that only CHA2DS2-VASc score (OR = 1.43, 95% CI: 1.09-1.87, p = 0.006) and procedure time (OR = 1.03, 95% CI: 1.01-1.05, p < 0.001) were independent predictors of successful reperfusion. The receiver-operating characteristic (ROC) curve was used to determine the cut-off value for the CHA2DS2-VASc score that best predicts successful reperfusion. The optimal threshold was 3.5, with a sensitivity of 58.6% and specificity of 59.2% (area under the curve (AUC): 0.669, p = 0.005). Conclusions For the first time in the literature, we investigated and demonstrated that pre-stroke CHA2DS2-VASc score was associated with success of recanalization as assessed with mTICI 2c and mTICI 3 in a cohort of AIS patients regardless of AF presence who underwent endovascular treatment. Our findings deserve to be tested with large scale long term studies.
Collapse
|
21
|
Scopelliti G, Pero G, Macera A, Quilici L, Cervo A, Platania G, Tadeo CS, Prelle AC, Muscia F, Riggio MG, Zilioli A, Agostoni EC, Piano M, Pantoni L. Outcome of a Real-World Cohort of Patients Subjected to Endovascular Treatment for Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2022; 31:106511. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022] Open
|
22
|
Grand T, Dargazanli C, Papagiannaki C, Bruggeman A, Maurer C, Gascou G, Fauche C, Bourcier R, Tessier G, Blanc R, Machaa MB, Marnat G, Barreau X, Ognard J, Gentric JC, Barbier C, Gory B, Rodriguez C, Boulouis G, Eugène F, Thouant P, Ricolfi F, Janot K, Herbreteau D, Eker OF, Cappucci M, Dobrocky T, Möhlenbruch M, Demerath T, Psychogios M, Fischer S, Cianfoni A, Majoie C, Emmer B, Marquering H, Valter R, Lenck S, Premat K, Cortese J, Dormont D, Sourour NA, Shotar E, Samson Y, Clarençon F. Benefit of mechanical thrombectomy in acute ischemic stroke related to calcified cerebral embolus. J Neuroradiol 2022; 49:317-323. [PMID: 35183595 DOI: 10.1016/j.neurad.2022.02.006] [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: 12/22/2021] [Revised: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Mechanical thrombectomies (MT) in patients with large vessel occlusion (LVO) related to calcified cerebral embolus (CCE) have been reported, through small case series, being associated with low reperfusion rate and worse outcome, compared to regular MT. The purpose of the MASC (Mechanical Thrombectomy in Acute Ischemic Stroke Related to Calcified Cerebral Embolus) study was to evaluate the incidence of CCEs treated by MT and the effectiveness of MT in this indication. METHODS The MASC study is a retrospective multicentric (n = 37) national study gathering the cases of adult patients who underwent MT for acute ischemic stroke with LVO related to a CCE in France from January 2015 to November 2019. Reperfusion rate (mTICI ≥ 2B), complication rate and 90-day mRS were systematically collected. We then conducted a systematic review by searching for articles in PubMed, Cochrane Library, Embase and Google Scholar from January 2015 to March 2020. A meta-analysis was performed to estimate clinical outcome at 90 days, reperfusion rate and complications. RESULTS We gathered data from 35 patients. Reperfusion was obtained in 57% of the cases. Good clinical outcome was observed in 28% of the patients. The meta-analysis retrieved 136 patients. Reperfusion and good clinical outcome were obtained in 50% and 29% of the cases, respectively. CONCLUSION The MASC study found worse angiographic and clinical outcomes compared to regular thrombectomies. Individual patient-based meta-analysis including the MASC findings shows a 50% reperfusion rate and a 29% of good clinical outcome.
Collapse
Affiliation(s)
- Téodor Grand
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | | | | | - Agnetha Bruggeman
- Departments of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NETHERLANDS
| | - Christoph Maurer
- Department of Neuroradiology, Klinikum Augsburg, Augsburg, GERMANY
| | | | - Cédric Fauche
- Department of Neuroradiology, CHU de Poitiers, FRANCE
| | - Romain Bourcier
- Department of Neuroradiology, Hôpital Nord Laennec, Nantes, FRANCE
| | | | - Raphaël Blanc
- Department of Neuroradiology, Fondation Rothschild, Paris, FRANCE
| | - Malek Ben Machaa
- Department of Neuroradiology, Fondation Rothschild, Paris, FRANCE
| | | | | | | | | | | | - Benjamin Gory
- Department of Neuroradiology, Centre Hospitalier Régional et Universitaire, Nancy, FRANCE
| | | | | | | | | | | | - Kevin Janot
- Department of Neuroradiology, CHU de Tours, France
| | | | | | | | - Tomas Dobrocky
- Department of Neuroradiology, Universitätsspital Bern, Bern, SWITZERLAND
| | - Markus Möhlenbruch
- Department of Neurology, University Heidelberg Medical Center, Heidelberg, GERMANY
| | - Theo Demerath
- Department of Neurology, University Freiburg Medical Center, Freiburg, GERMANY
| | - Marios Psychogios
- Department of Neurology, University Basel Medical Center, Basel, SWITZERLAND
| | - Sebastian Fischer
- Department of Neurology, University Bochum Medical Center, Bochum, GERMANY
| | - Alessandro Cianfoni
- Department of Neurology, University Lugano Medical Center, Lugano, SWITZERLAND
| | - Charles Majoie
- Departments of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NETHERLANDS
| | - Bart Emmer
- Departments of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NETHERLANDS
| | - Henk Marquering
- Departments of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NETHERLANDS
| | - Rémi Valter
- Department of Public Health, Hôpital Henri Mondor, Créteil, FRANCE
| | - Stéphanie Lenck
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Kévin Premat
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Jonathan Cortese
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Didier Dormont
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, Paris, FRANCE
| | | | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Yves Samson
- Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, FRANCE
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, Paris, FRANCE; GRC Biofast, Paris, FRANCE.
| |
Collapse
|
23
|
Cai X, Chen X, Xiang Y, Chen L, Sun J. Balloon-Assisted Angioplasty for the Treatment of In-Stent Restenosis After Vertebral Artery Ostium Stenting: Experiences From One Single Center. Neurologist 2022; 27:106-110. [PMID: 34842576 PMCID: PMC9067090 DOI: 10.1097/nrl.0000000000000383] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stenting appears to be a safe means of treatment for vertebral artery ostium stenosis with low complication rates and positive long-term effects, but the incidence of in-stent restenosis (ISR) after stenting is high. Different treatment strategies are applied for the revascularization of ISR; however, currently the optional approach is not recommended. The study was designed to investigate the feasibility, safety, and effectiveness of balloon-assisted angioplasty for the treatment of ISR after vertebral artery ostium stenosis. METHODS In this study, we included patients from the Department of Neurology, Lishui Hospital of Zhejiang University, who were treated with balloon-assisted angioplasty as a result of suffering from ISR after previously undergoing vertebral artery ostium stenting. We retrospectively analyzed the clinical and functional outcomes of the patients. RESULTS From January 2015 to December 2019, 11 patients were included in the study. The technical success rate reached 100% and the average operation time was 73 minutes. The Thrombolysis in Cerebral Infarction Score 2b-3 was acquired in all patients except 1 patient, who was presented with symptoms of hypoperfusion syndrome. The remaining 10 patients did not experience any intraoperative or postoperative complications. No restenosis, new cerebral infarction or transient ischemic attack were reported within 6 months of follow-up. CONCLUSION Balloon-assisted angioplasty could be feasible for the treatment of ISR after vertebral artery ostium stenting, however, more research is needed to confirm this.
Collapse
Affiliation(s)
- Xueli Cai
- Department of Neurology, Lishui Hospital of Zhejiang University (The Central Hospital of Lishui)
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang Province, China
| | - Xueping Chen
- Department of Neurology, Lishui Hospital of Zhejiang University (The Central Hospital of Lishui)
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang Province, China
| | - Yian Xiang
- Department of Neurology, Lishui Hospital of Zhejiang University (The Central Hospital of Lishui)
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang Province, China
| | - Liujing Chen
- Department of Neurology, Lishui Hospital of Zhejiang University (The Central Hospital of Lishui)
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang Province, China
| | - Jingping Sun
- Department of Neurology, Lishui Hospital of Zhejiang University (The Central Hospital of Lishui)
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang Province, China
| |
Collapse
|
24
|
Xu Z, Chen N, Sun H, Jiang T, Deng Q, Zhou J, Zhang Y. Dual Antiplatelet Therapy in Patients With Minor Stroke Receiving Intravenous Thrombolysis. Front Neurol 2022; 13:819896. [PMID: 35185771 PMCID: PMC8854355 DOI: 10.3389/fneur.2022.819896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionConcern over the potential severe bleeding risk of dual antiplatelet therapy for patients with minor stroke after intravenous thrombolysis (IVT) leads to different antiplatelet strategies in the secondary prevention of stroke. Our aim was to investigate the effect of dual antiplatelet therapy on patients with minor ischemic stroke receiving IVT.MethodsFrom November 2016 to April 2021, a total of 855 consecutive patients who received IVT were observed. We collected and analyzed demographic characteristics, medical history, clinical information, and important time metrics of patients with minor ischemic stroke. Comparative and multivariate logistic regression analyses were used to explore the clinical significance of single or dual antiplatelet therapy after IVT. Propensity score matching analyses (1:1 matching including baseline characteristics of patients) were also performed.ResultsA total of 245 patients were enrolled in the study (118 patients in the single antiplatelet therapy group and 127 patients in the dual antiplatelet group). No significant difference was found in baseline characteristics except stroke etiology (p < 0.001) for patients with minor stroke. The dual antiplatelet group showed a higher proportion of 90-day modified Rankin Scale (mRS) (0–1) than the single antiplatelet group (p = 0.030). Furthermore, patients receiving dual antiplatelet therapy had excellent outcomes (90-day mRS 0–1) after adjustment (odds ratio [OR] 2.76, 95% CI 1.27–6.01, p = 0.010). Other secondary outcomes (recurrent stroke within 90 days, symptomatic intracerebral hemorrhage, and early neurological deterioration) were not significantly different between the two groups. These findings were generally consistent in propensity score analyses.ConclusionsDual antiplatelet therapy may be a potential therapeutic approach in patients with minor stroke receiving IVT. Further randomized controlled trials are required to confirm this finding.
Collapse
Affiliation(s)
- Zhaohan Xu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nihong Chen
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Neurology, Nanjing Yuhua Hospital, Yuhua Branch of Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huiling Sun
- General Clinical Research Centre, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Teng Jiang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qiwen Deng
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Qiwen Deng
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Junshan Zhou
| | - Yingdong Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Yingdong Zhang ;
| |
Collapse
|
25
|
Point-of-care ultrasound for stroke patients in the emergency room. J Med Ultrason (2001) 2022; 49:581-592. [PMID: 35112168 DOI: 10.1007/s10396-021-01185-0] [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: 08/12/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
Stroke requires rapid determination of the cause to provide timely and appropriate initial management. Various ultrasonographic techniques have been evaluated as ways to determine the cause of stroke; among them, carotid artery ultrasonography is particularly useful since it provides considerable information within a short time period when used to evaluate a specific site. In the emergency room, carotid artery ultrasonography can be used to diagnose internal carotid artery stenosis, predict an occluded vessel, and infer the cause of ischemic stroke. Additionally, carotid artery ultrasonography can diagnose different conditions including subclavian artery steal syndrome, bow hunter's stroke, Takayasu's arteritis, moyamoya disease, and dural arteriovenous fistula. Furthermore, patients with ischemic stroke with a pulse deficit or hypotension must be differentiated from acute type A aortic dissection, which requires emergency surgery; carotid artery ultrasonography can immediately differentiate between the two conditions by identifying the intimal flap of the common carotid artery. The following article provides an overview of carotid artery ultrasonography performed as point-of-care ultrasound in the emergency room in patients with suspected stroke.
Collapse
|
26
|
Li L, Yasmen N, Hou R, Yang S, Lee JY, Hao J, Yu Y, Jiang J. Inducible Prostaglandin E Synthase as a Pharmacological Target for Ischemic Stroke. Neurotherapeutics 2022; 19:366-385. [PMID: 35099767 PMCID: PMC9130433 DOI: 10.1007/s13311-022-01191-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 01/03/2023] Open
Abstract
As the inducible terminal enzyme for prostaglandin E2 (PGE2) synthesis, microsomal PGE synthase-1 (mPGES-1) contributes to neuroinflammation and secondary brain injury after cerebral ischemia via producing excessive PGE2. However, a proof of concept that mPGES-1 is a therapeutic target for ischemic stroke has not been established by a pharmacological strategy mainly due to the lack of drug-like mPGES-1 inhibitors that can be used in relevant rodent models. To this end, we recently developed a series of novel small-molecule compounds that can inhibit both human and rodent mPGES-1. In this study, blockade of mPGES-1 by our several novel compounds abolished the lipopolysaccharide (LPS)-induced PGE2 and pro-inflammatory cytokines interleukin 1β (IL-1β), IL-6, and tumor necrosis factor α (TNF-α) in mouse primary brain microglia. Inhibition of mPGES-1 also decreased PGE2 produced by neuronal cells under oxygen-glucose deprivation (OGD) stress. Among the five enzymes for PGE2 biosynthesis, mPGES-1 was the most induced one in cerebral ischemic lesions. Systemic treatment with our lead compound MPO-0063 (5 or 10 mg/kg, i.p.) in mice after transient middle cerebral artery occlusion (MCAO) improved post-stroke well-being, decreased infarction and edema, suppressed induction of brain cytokines (IL-1β, IL-6, and TNF-α), alleviated locomotor dysfunction and anxiety-like behavior, and reduced the long-term cognitive impairments. The therapeutic effects of MPO-0063 in this proof-of-concept study provide the first pharmacological evidence that mPGES-1 represents a feasible target for delayed, adjunct treatment - along with reperfusion therapies - for acute brain ischemia.
Collapse
Affiliation(s)
- Lexiao Li
- Department of Pharmaceutical Sciences and Drug Discovery Center, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Nelufar Yasmen
- Department of Pharmaceutical Sciences and Drug Discovery Center, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Ruida Hou
- Department of Pharmaceutical Sciences and Drug Discovery Center, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Seyoung Yang
- Research Institute for Basic Sciences and Department of Chemistry, College of Sciences, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Jae Yeol Lee
- Research Institute for Basic Sciences and Department of Chemistry, College of Sciences, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Jiukuan Hao
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX, 77204, USA
| | - Ying Yu
- Department of Pharmaceutical Sciences and Drug Discovery Center, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Jianxiong Jiang
- Department of Pharmaceutical Sciences and Drug Discovery Center, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
| |
Collapse
|
27
|
Du H, Lei H, Ambler G, Fang S, He R, Yuan Q, Werring DJ, Liu N. Intravenous Thrombolysis Before Mechanical Thrombectomy for Acute Ischemic Stroke: A Meta-Analysis. J Am Heart Assoc 2021; 10:e022303. [PMID: 34779235 PMCID: PMC9075352 DOI: 10.1161/jaha.121.022303] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Whether intravenous thrombolysis before mechanical thrombectomy provides additional benefit for functional outcome in acute ischemic stroke remains uncertain. We performed a meta‐analysis to compare the outcomes of direct mechanical thrombectomy (dMT) to mechanical thrombectomy with bridging using intravenous thrombolysis (bridging therapy [BT]) in patients with acute ischemic stroke. Methods and Results We performed a literature search in the PubMed, Excerpta Medica database, and Cochrane Central Register of Controlled Trials from January 1, 2003, to April 26, 2021. We included randomized clinical trials and observational studies that reported the 90‐day functional outcome in patients with acute ischemic stroke undergoing dMT compared with BT. The 12 included studies (3 randomized controlled trials and 9 observational studies) yielded 3924 participants (mean age, 68.0 years [SD, 13.1 years]; women, 44.2%; 1887 participants who received dMT and 2037 participants who received BT). A meta‐analysis of randomized controlled trial and observational data revealed similar 90‐day functional independence (odds ratio [OR], 1.04; 95% CI, 0.90–1.19), mortality (OR, 1.03; 95% CI, 0.78–1.36), and successful recanalization (OR, 0.93; 95% CI, 0.76–1.14) for patients treated with dMT or BT. Compared with those in the BT group, patients in the dMT group were less likely to experience symptomatic intracranial hemorrhage (OR, 0.68; 95% CI, 0.51–0.91; P=0.008) or any intracranial hemorrhage (OR, 0.71; 95% CI, 0.61–0.84; P<0.001). Conclusions In this meta‐analysis of patients with acute ischemic stroke, we found no significant differences in 90‐day functional outcome or mortality between dMT and BT, but a lower rate of symptomatic intracranial hemorrhage for dMT. These findings support the use of dMT without intravenous thrombolysis bridging therapy. Registration URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: 42021234664.
Collapse
Affiliation(s)
- Houwei Du
- Department of Neurology Stroke Research Center Fujian Medical University Union Hospital Fuzhou China.,Institute of Clinical Neurology Fujian Medical University Fuzhou China
| | - Hanhan Lei
- Department of Neurology Stroke Research Center Fujian Medical University Union Hospital Fuzhou China.,Institute of Clinical Neurology Fujian Medical University Fuzhou China
| | - Gareth Ambler
- Statistical Science University College London London United Kingdom
| | - Shuangfang Fang
- Department of Neurology Stroke Research Center Fujian Medical University Union Hospital Fuzhou China.,Institute of Clinical Neurology Fujian Medical University Fuzhou China
| | - Raoli He
- Department of Neurology Stroke Research Center Fujian Medical University Union Hospital Fuzhou China.,Institute of Clinical Neurology Fujian Medical University Fuzhou China
| | - Qilin Yuan
- Department of Neurology Stroke Research Center Fujian Medical University Union Hospital Fuzhou China.,Institute of Clinical Neurology Fujian Medical University Fuzhou China
| | - David J Werring
- University College London Queen Square Institute of Neurology London United Kingdom
| | - Nan Liu
- Department of Neurology Stroke Research Center Fujian Medical University Union Hospital Fuzhou China.,Department of Rehabilitation Fujian Medical University Union Hospital Fuzhou China
| |
Collapse
|
28
|
Li H, Yang S, Zhong Y, Wang J, Li X, Gao H, Chen G. Mechanical Thrombectomy with or without Intravenous Thrombolysis in Acute Ischemic Stroke: A Meta-Analysis for Randomized Controlled Trials. Eur Neurol 2021; 85:85-94. [PMID: 34818658 DOI: 10.1159/000520085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The combination of mechanical thrombectomy (MT) and intravenous thrombolysis (IVT) is more effective than IVT alone in patients with large vessel occlusion, which has been proven in recent studies. However, there are still debates over whether IVT benefits patients treated with only direct mechanical thrombectomy (dMT). METHODS PubMed, Embase, and Cochrane Library were searched on June 15, 2021, for randomized controlled trials (RCTs). Seven RCTs with 2,143 patients were enrolled in our study. RESULTS MT combined with IVT had comparable efficacy and safety outcome compared with dMT in proximal anterior circulation occlusion at 90 days. For the primary outcome, pooled data showed no significant difference in the modified Rankin Scale (mRS) 0-2 at 90 days between the dMT and MT+IVT groups (pooled odds ratio 0.96, 95% confidence interval, 0.79, 1.17, p = 0.39). As for the mRS score 0-1 at 90 days, the degree of benefit conferred by dMT was substantial: for every 100 patients treated, the number of patients which had an excellent outcome in the dMT group was 10 higher than that of the MT+IVT group. CONCLUSION In this meta-analysis including 7 RCTs, MT had comparable consequences to bridging treatment in efficacy and safety outcomes for patients with ischemic stroke caused by the occlusion of proximal anterior circulation, irrespective of geographical location. These findings support the adoption of dMT in acute ischemic stroke treatments and have higher cost-effectiveness in global applications.
Collapse
Affiliation(s)
- Hang Li
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Siyuan Yang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Zhong
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiahe Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiang Li
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Heng Gao
- Department of Neurosurgery, The Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, China
| | - Gang Chen
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
29
|
Tao C, Xu P, Yao Y, Zhu Y, Li R, Li J, Luo W, Hu W. A Prospective Study to Investigate Controlling Blood Pressure Under Transcranial Doppler After Endovascular Treatment in Patients With Occlusion of Anterior Circulation. Front Neurol 2021; 12:735758. [PMID: 34659095 PMCID: PMC8511455 DOI: 10.3389/fneur.2021.735758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/26/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: The objective of this study was to evaluate the effect of blood pressure (BP) management with transcranial Doppler (TCD) guidance in patients with large-vessel occlusion in the anterior circulation after endovascular thrombectomy (EVT) on the long-term prognosis. Methods: This was a prospective study; 232 patients were nonrandomized assigned to TCD-guided BP management (TBM) group or non-TCD-guided BP management (NBM) group. In the TBM group, BP was controlled according to TCD showing cerebral blood flow fluctuation. In the NBM group, BP was controlled according to the guidelines. The primary endpoint was a modified Rankin scale (mRS) score of 2 or lower at 90 days. The safety outcomes were the rates of symptomatic or any intracerebral hemorrhage (ICH) and mortality at 90 days. Results: One hundred sixty-three patients were assigned to the TBM group, and 69 were assigned to the NBM group. In the propensity score-matched cohort (65 matches in both groups), there was significant difference in the proportion of participants with mRS 0–2 at 90 days according to BP management (adjusted odds ratio 3.34, 95% CI 1.36 to 8.22). There was no difference in the rates of symptomatic or any ICH and mortality between two groups. In inverse probability-weighted regression adjustment analysis, mortality decreased significantly in the TBM group than in the NBM group (adjusted odds ratio 0.86, 95% CI 0.76–0.99, p = 0.03). Conclusion: In patients with acute ischemic stroke from large-vessel occlusion in the anterior circulation, BP management under TCD was superior to NBM in improving the clinical outcomes at 90 days. Clinical Trial Registration: (URL: https://www.chictr.org.cn/showproj.aspx?proj=55484; Identifier: ChiCTR2000034443.
Collapse
Affiliation(s)
- Chunrong Tao
- Division of Life Sciences and Medicine, Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Pengfei Xu
- Division of Life Sciences and Medicine, Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Yang Yao
- Division of Life Sciences and Medicine, Department of Neurosurgery, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Yajuan Zhu
- Division of Life Sciences and Medicine, Department of Ultrasound, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Rui Li
- Division of Life Sciences and Medicine, Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Jie Li
- Division of Life Sciences and Medicine, Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Wenwu Luo
- Department of pathology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Hu
- Division of Life Sciences and Medicine, Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| |
Collapse
|
30
|
Ajmi SC, Kurz MW, Ersdal H, Lindner T, Goyal M, Issenberg SB, Vossius C. Cost-effectiveness of a quality improvement project, including simulation-based training, on reducing door-to-needle times in stroke thrombolysis. BMJ Qual Saf 2021; 31:569-578. [PMID: 34599087 DOI: 10.1136/bmjqs-2021-013398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 09/23/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Rapid revascularisation in acute ischaemic stroke is crucial to reduce its total burden including societal costs. A quality improvement (QI) project that included streamlining the stroke care pathway and simulation-based training was followed by a significant reduction in median door-to-needle time (27 to 13 min) and improved patient outcomes after stroke thrombolysis at our centre. Here, we present a retrospective cost-effectiveness analysis of the QI project. METHODS Costs for implementing and sustaining QI were assessed using recognised frameworks for economic evaluations. Effectiveness was calculated from previously published outcome measures. Cost-effectiveness was presented as incremental cost-effectiveness ratios including costs per minute door-to-needle time reduction per patient, and costs per averted death in the 13-month post-intervention period. We also estimated incremental cost-effectiveness ratios for a projected 5-year post-intervention period and for varying numbers of patients treated with thrombolysis. Furthermore, we performed a sensitivity analysis including and excluding costs of unpaid time. RESULTS All costs including fixed costs for implementing the QI project totalled US$44 802, while monthly costs were US$2141. We calculated a mean reduction in door-to-needle time of 13.1 min per patient and 6.36 annual averted deaths. Across different scenarios, the estimated costs per minute reduction in door-to-needle time per patient ranged from US$13 to US$29, and the estimated costs per averted death ranged from US$4679 to US$10 543. CONCLUSIONS We have shown that a QI project aiming to improve stroke thrombolysis treatment at our centre can be implemented and sustained at a relatively low cost with increasing cost-effectiveness over time. Our work builds on the emerging theory and practice for economic evaluations in QI projects and simulation-based training. The presented cost-effectiveness data might help guide healthcare leaders planning similar interventions.
Collapse
Affiliation(s)
- Soffien Chadli Ajmi
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway .,Faculty of Health Sciences, Universitetet i Stavanger, Stavanger, Norway
| | - Martin W Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hege Ersdal
- Faculty of Health Sciences, Universitetet i Stavanger, Stavanger, Norway.,Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Thomas Lindner
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.,The Regional Centre for Emergency Medical Research and Development, Stavanger, Norway
| | - Mayank Goyal
- Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - S Barry Issenberg
- The Gordon Centre for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Corinna Vossius
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| |
Collapse
|
31
|
Crosby L, Davis M. Anesthesia for Acute Ischemic Stroke: Updates and Ongoing Debates. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00447-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Karakus A, Girerd N, Sanchez JC, Sabben C, Wietrich A, Lavandier K, Marchal S, Aubertin A, Humbertjean L, Mione G, Bouali S, Duarte K, Reymond S, Gory B, Richard S. Identifying patients with cerebral infarction within the time window compatible with reperfusion therapy, diagnostic performance of glutathione S-transferase-π (GST-π) and peroxiredoxin 1 (PRDX1): exploratory prospective multicentre study FLAG-1 protocol. BMJ Open 2021; 11:e046167. [PMID: 34417212 PMCID: PMC8381327 DOI: 10.1136/bmjopen-2020-046167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Plasma biomarkers may be useful in diagnosing acute cerebral infarction requiring urgent reperfusion, but their performance remains to be confirmed. If confirmed, these molecules could be used to develop rapid and reliable decentralised measurement methods, making it possible to initiate reperfusion therapy before hospital admission. The FLAG-1 large prospective study will constitute a plasma bank to assess the diagnostic performance of two biomarkers: glutathione S-transferase-π and peroxiredoxin 1. These molecules are involved in the oxidative stress response and could identify cerebral infarction within a therapeutic window of less than 4.5 hours following the onset of symptoms. Secondary objectives include assessing performance of these biomarkers within 3-hour and 6-hour windows; identifying additional biomarkers diagnosing cerebral infarction and significant criteria guiding therapeutic decisions: ischaemic features of stroke, presence of diffusion/fluid-attenuated inversion recovery mismatch, volume of cerebral infarction and penumbra on cerebral MRI. METHODS AND ANALYSIS The exploratory, prospective, multicentre FLAG-1 Study will include 945 patients with acute stroke symptoms (onset ≤12 hours, National Institute of Health Stroke Scale score ≥3). Each patient's 25 mL blood sample will be associated with cerebral MRI data. Two patient groups will be defined based on the time of blood collection (before and after 4.5 hours following onset). Receiver operating characteristic analysis will determine the diagnostic performance of each biomarker, alone or in combination, for the identification of cerebral infarction <4.5 hours. ETHICS AND DISSEMINATION The protocol has been approved by an independent ethics committee. Biological samples are retained in line with best practices and procedures, in accordance with French legislation. Anonymised data and cerebral imaging records are stored using electronic case report forms and a secure server, respectively, registered with the French Data Protection Authority (Commission Nationale de l'Informatique et des Libertés (CNIL)). Results will be disseminated through scientific meetings and publication in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03364296).
Collapse
Affiliation(s)
- Arif Karakus
- Department of Neurology, Stroke Unit, University Hospital Centre Nancy, 54035 Nancy, France
- University of Lorraine, Nancy, France
| | - Nicolas Girerd
- University of Lorraine, Nancy, France
- Plurithematic Clinical Investigation Center, CIC-P 1433, INSERM U1116, University Hospital Centre Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Jean-Charles Sanchez
- Department of Human Protein Sciences, University of Geneva Medical Centre, 1206 Geneva, Switzerland
| | | | - Anthony Wietrich
- Stroke Unit, Bar-le-Duc Hospital Centre, 55000 Bar-le-Duc, France
| | - Karine Lavandier
- Stroke Unit, Bar-le-Duc Hospital Centre, 55000 Bar-le-Duc, France
| | - Sophie Marchal
- Stroke Unit, Verdun Hospital Centre, 55100 Verdun, France
| | - Anne Aubertin
- Stroke Unit, Hospital Centre Troyes, CS 20718, 10003 Troyes, France
| | - Lisa Humbertjean
- Department of Neurology, Stroke Unit, University Hospital Centre Nancy, 54035 Nancy, France
| | - Gioia Mione
- Department of Neurology, Stroke Unit, University Hospital Centre Nancy, 54035 Nancy, France
| | - Sanae Bouali
- Plurithematic Clinical Investigation Center, CIC-P 1433, INSERM U1116, University Hospital Centre Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Kevin Duarte
- Plurithematic Clinical Investigation Center, CIC-P 1433, INSERM U1116, University Hospital Centre Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Sandrine Reymond
- Department of Human Protein Sciences, University of Geneva Medical Centre, 1206 Geneva, Switzerland
| | - Benjamin Gory
- University of Lorraine, Nancy, France
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, University Hospital Centre Nancy, 54035 Nancy, France
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, University Hospital Centre Nancy, 54035 Nancy, France
- University of Lorraine, Nancy, France
- Plurithematic Clinical Investigation Center, CIC-P 1433, INSERM U1116, University Hospital Centre Nancy, 54500 Vandoeuvre-lès-Nancy, France
| |
Collapse
|
33
|
Du AL, Robbins K, Waterman RS, Urman RD, Gabriel RA. National trends in nonoperating room anesthesia: procedures, facilities, and patient characteristics. Curr Opin Anaesthesiol 2021; 34:464-469. [PMID: 34074883 DOI: 10.1097/aco.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Nonoperating room anesthesia (NORA) continues to increase in popularity and scope. This article reviews current and new trends in NORA, trends in anesthesia management in nonoperating room settings, and the evolving debates surrounding these trends. RECENT FINDINGS National data suggests that NORA cases will continue to rise relative to operating room (OR) anesthesia and there will continue to be a shift towards performing more interventional procedures outside of the OR. These trends have important implications for the safety of interventional procedures as they become increasingly more complex and patients continue to be older and more frail. In order for anesthesia providers and proceduralists to be prepared for this future, rigorous standards must be set for safe anesthetic care outside of the OR.Although the overall association between NORA and patient morbidity and mortality remains unclear, focused studies point toward trends specific to each non-OR procedure type. Given increasing patient and procedure complexity, anesthesiology teams may see a larger role in the interventional suite. However, the ideal setting and placement of anesthesia staff for interventional procedures remain controversial. Also, the impact of COVID-19 on the growth and utilization of non-OR anesthesia remains unclear, and it remains to be seen how the pandemic will influence the delivery of NORA procedures in postpandemic settings. SUMMARY NORA is a rapidly growing field of anesthesia. Continuing discussions of complication rates and mortality in different subspecialty areas will determine the need for anesthesia care and quality improvement efforts in each setting. As new noninvasive procedures are developed, new data will continue to shape debates surrounding anesthesia care outside of the operating room.
Collapse
Affiliation(s)
| | - Kimberly Robbins
- Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
| | - Ruth S Waterman
- Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA
| |
Collapse
|
34
|
Hankey GJ. Evolution of Evidence-Based Medicine in Stroke. Cerebrovasc Dis 2021; 50:644-655. [PMID: 34315156 DOI: 10.1159/000517679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022] Open
Abstract
The introduction and evolution of evidence-based stroke medicine has realized major advances in our knowledge about stroke, methods of medical research, and patient outcomes that continue to complement traditional individual patient care. It is humbling to recall the state of knowledge and scientific endeavour of our forebears who were unaware of what we know now and yet pursued the highest standards for evaluating and delivering effective stroke care. The science of stroke medicine has evolved from pathophysiological theory to empirical testing. Progress has been steady, despite inevitable disappointments and cul-de-sacs, and has occasionally been punctuated by sensational breakthroughs, such as the advent of reperfusion therapies guided by imaging.
Collapse
Affiliation(s)
- Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Washington, Australia.,Department of Neurology, Sir Charles Gairdner Hospital, Perth, Washington, Australia
| |
Collapse
|
35
|
Savello AV, Voznyuk IA, Babichev KN, Kandyba DV, Shenderov SV, Vlasenko SV, Saraev GB. [A prognosis scale for functional outcome at discharge after endovascular thrombectomy in the carotid artery territory]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:34-39. [PMID: 34283527 DOI: 10.17116/jnevro202112106134] [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: 11/18/2022]
Abstract
OBJECTIVE To develop a method for early (24 hrs after intervention) prognosis of functional outcome at discharge in patients after endovascular thrombectomy (EVT) in anterior cerebral circulation based on NIHSS. MATERIAL AND METHODS A retrospective analysis of endovascular treatment in 362 acute stroke patients (189 men, 173 women, median age 69 years) with anterior circulation large vessel occlusion was performed in the regional vascular centers of St. Petersburg. RESULTS The original scale (S10-10) developed for prognosis of functional outcome at discharge is based on total scores on 3 patterns: NIHSS 24 hrs after EVT (10 and less - 1, greater than 10 - 2), NIHSS improvement 24 hrs (greater than 10 - 0, 1-10 - 1, 0 and less - 2), older than 78 yr - 1. According to the total score, 5 grades are determined: 1 (good, mRs 0-2 75%, mRs 3-5 25%, mRs 6 0%), 2 (favorable, mRs 0-2 66%, mRs 3-5 26%, mRs 6 8%), 3 (unfavorable, mRs 0-2 14%, mRs 3-5 68%, mRs 6 18%), 4 (unfavorable with high mortality, mRs 0-2 1%, mRs 3-5 52%, mRs 6 47%), 5 (highly negative, mRs 0-2 0%, mRs 3-5 16%, mRs 6 84%). S10-10 greater than 2 indicates unfavorable prognosis. The scale allows accurate prognosis of functional outcome at discharge (AUC 0.89; AUC 0.84 in a validation cohort) and length of in-patient staying and time to death for S10-10 greater than 2. CONCLUSION Accurate prognosis of functional outcome at discharge can be done 24 hrs after EVT in anterior cerebral circulation based on the widely used neurological scale (NIHSS) taking into account patient age.
Collapse
Affiliation(s)
- A V Savello
- Kirov Medical Military Academy St. Petersburg, Russi, Kirov Medical Military Academy, St. Petersburg, Russia.,Almazov National Medical Research Centre, St. Petersburg, Russia
| | - I A Voznyuk
- Dzhanelidze Saint-Petersburg Research Institute of Emergency Medicine, St. Petersburg, Russia
| | - K N Babichev
- Kirov Medical Military Academy St. Petersburg, Russi, Kirov Medical Military Academy, St. Petersburg, Russia.,Dzhanelidze Saint-Petersburg Research Institute of Emergency Medicine, St. Petersburg, Russia
| | - D V Kandyba
- Dzhanelidze Saint-Petersburg Research Institute of Emergency Medicine, St. Petersburg, Russia
| | - S V Shenderov
- City Multi-Field Hospital No. 26, St. Petersburg, Russia
| | - S V Vlasenko
- City Multi-Field Hospital No. 40, Sestroretsk, Russia
| | - G B Saraev
- City Multi-Field Hospital «Elizavetinskaya bolnitsa», St. Petersburg, Russia
| |
Collapse
|
36
|
StrokeWatch: An Instrument for Objective Standardized Real-Time Measurement of Door-to-Needle Times in Acute Ischemic Stroke Treatment. J Stroke Cerebrovasc Dis 2021; 30:105962. [PMID: 34265596 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Monitoring critical time intervals in acute ischemic stroke treatment delivers metrics for quality of performance - the door-to-needle time being well-established. To resolve the conflict of self-reporting bias a "StrokeWatch" was designed - an instrument for objective standardized real-time measurement of procedural times. MATERIALS AND METHODS An observational, monocentric analysis of patients receiving intravenous thrombolysis for acute ischemic stroke between January 2018 and September 2019 was performed based on an ongoing investigator-initiated, prospective, and blinded endpoint registry. Patient data and treatment intervals before and after introduction of "StrokeWatch" were compared. RESULTS "StrokeWatch" was designed as a mobile board equipped with three digital stopwatches tracking door-to-needle, door-to-groin, and door-to-recanalization intervals as well as a form for standardized documentation. 118 patients before introduction of "StrokeWatch" (subgroup A) and 53 patients after introduction of "StrokeWatch" (subgroup B) were compared. There were no significant differences in baseline characteristics, procedural times, or clinical outcome. A non-significant increase in patients with door-to-needle intervals of 60 min or faster (93.2 vs 98.1%, p = 0.243) and good functional outcome (mRS d90 ≤ 2, 47.5 vs 58.5%, p = 0.218) as well as a significant increase in reports of delayed arrival of intra-hospital patient transport service (0.8 vs 13.2%, p = 0.001) were observed in subgroup B. CONCLUSIONS The implementation of StrokeWatch for objective standardized real-time measurement of door-to-needle times is feasible in a real-life setting without negative impact on procedural times or outcome. It helped to reassure a high-quality treatment standard and reveal factors associated with procedural delays.
Collapse
|
37
|
Liu M, Pu Y, Gu J, He Q, Liu Y, Zeng Y, Li J, Long X, Yang S, Wu Q, Zhou H. Evaluation of Zhilong Huoxue Tongyu capsule in the treatment of acute cerebral infarction: A systematic review and meta-analysis of randomized controlled trials. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 86:153566. [PMID: 33940333 DOI: 10.1016/j.phymed.2021.153566] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/24/2021] [Accepted: 04/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Zhilong Huoxue Tongyu capsule (ZL) is a Chinese patent medicine and used for the treatment of acute cerebral infarction (ACI) and its clinical application has gradually been widely recognized in China. However, the effects of ZL for patients with ACI have never been systematically evaluated. PURPOSE A systematic review and meta-analysis was performed to evaluate the efficacy of ZL in ACI. STUDY DESIGN A systematic review and meta-analysis of randomized clinical trials (RCTs). MATERIALS AND METHODS A systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The comprehensive literature search was accomplished in 6 electronic databases to find relevant randomized controlled trials from their inception until October 31, 2020. The Cochrane Handbook for Systematic Reviews of Interventions was used for methodological quality and independent evaluation. Review Manager 5.3 was used to analyze all the data obtained. The Clinical Effective Rate (CER) was the primary outcome, and the National Institutes of Health Stroke Score (NIHSS), Barthel Index (BI), and Modified Rankin Scale (MRS) were the secondary outcomes. RESULTS Seven clinical studies recruiting 571 eligible patients were included in this meta-analysis. The results of meta-analysis suggested that compared with conventional treatment alone, ZL combined with conventional treatment significantly improved CER (RR = 1.20, 95% CI: 1.12-1.29, p < 0.00001), decrease National Institutes of Health Stroke Scale Score (NIHSS) (MD = -2.60, 95% CI: -3.41-1.79, p < 0.00001), Barthel Index (BI) (MD = -9.75, 95% CI: 7.15-12.36, p < 0.00001) and Modified Rankin Scale (MRS) (MD = -0.57, 95% CI: -0.84-0.30, p < 0.00001). There were no reported adverse events in the studies. Most results were robust and the quality of evidence was from moderate to low. CONCLUSION ZL combined with conventional treatment can improve the short-term outcomes of ACI patients, indicating ZL is a promising treatment choice for ACI and may be used as adjunctive treatment to the conventional treatment of ACI. However, due to the limitations of included clinical trials, high-quality clinical trials with longer follow-ups are still needed to further assess the effectiveness and safety of ZL for ACI patients.
Collapse
Affiliation(s)
- Mengnan Liu
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, China; National Traditional Chinese Medicine Clinical Research Base and Department of Cardiovascular, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, Sichuan, China
| | - Yuting Pu
- Department of Neurology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, Sichuan, China
| | - Juan Gu
- Department of Neurology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, Sichuan, China
| | - Qida He
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, China
| | - Yan Liu
- National Traditional Chinese Medicine Clinical Research Base and Department of Cardiovascular, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, Sichuan, China
| | - Yiwei Zeng
- Acupuncture and Tuina College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jingchi Li
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese, and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, China
| | - Xingru Long
- Medical Imaging Department, Southwest Medical University, Luzhou, Sichuan, China
| | - Sijin Yang
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, China; National Traditional Chinese Medicine Clinical Research Base and Department of Cardiovascular, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, Sichuan, China.
| | - Qibiao Wu
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, China.
| | - Hua Zhou
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, China.
| |
Collapse
|
38
|
Vidale S, Romoli M, Clemente Agostoni E. Mechanical thrombectomy with or without thrombolysis: A meta-analysis of RCTs. Acta Neurol Scand 2021; 143:554-557. [PMID: 33523458 DOI: 10.1111/ane.13390] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/02/2020] [Accepted: 11/18/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Mechanical thrombectomy (MT) is effective in treating ischemic strokes due to large vessel occlusion. However, the risk-benefit ratio of intravenous thrombolysis (IVT) prior to MT is still unclear. Aim of the study was to provide a pooled analysis of only randomized controlled trials (RCTs) comparing direct MT (dMT) vs bridging treatment (IVT+MT). METHODS PubMed, EMBASE and Cochrane Central were searched only for RCTs comparing IVT+MT vs dMT in ischemic stroke patients. Primary endpoint was functional independence at 90 days (mRS<3), while secondary endpoints were represented by successful recanalization (TICI>2a), mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Odds ratios for endpoints were pooled with meta-analysis and compared between reperfusion strategies. RESULTS The pooled analysis comprised 5 studies (n. patients = 1657). The rates for the primary endpoint were 39% and 34.5% for dMT and IVT+MT, respectively (OR 1.06; 95%CI 0.80-1.40). For the secondary endpoints, we did not observe significant differences between groups, even if the rate of successful recanalization was higher in IVT+MT treated patients (OR: 0.58; 95%CI 0.26-1.30;pheterogeneity = 0.002), without a significant increase in sICH rates (4.3% vs 5.5%; OR: 0.96; 95%CI 0.43-2.13;pheterogeneity = 0.26). Finally, mortality rates were 19.8% and 15.9% for dMT and IVT+MT, respectively. CONCLUSIONS In this meta-analysis including only RCTs, dMT and bridging treatment were substantially equivalent for good functional outcome. IVT+MT was associated to higher rates of successful recanalization, even if not significant. Therefore, further adequately powered RCTs comparing dMT vs IVT+MT are warranted.
Collapse
Affiliation(s)
- Simone Vidale
- Department of Neurology Ospedale degli Infermi Rimini Italy
| | - Michele Romoli
- Department of Neurology Ospedale degli Infermi Rimini Italy
| | | |
Collapse
|
39
|
Zhang B, Huo X, Yuan F, Song G, Liu L, Ma G, Mo D, Wu Z, Miao Z, Liu A. Design and validation of a recognition instrument-the stroke aid for emergency scale-to predict large vessel occlusion stroke. Aging (Albany NY) 2021; 13:13680-13692. [PMID: 33902003 PMCID: PMC8202851 DOI: 10.18632/aging.202910] [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: 10/06/2020] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
Background and purpose: Rapidly recognizing patients with large-vessel occlusion stroke (LVOS) and transferring them to a center offering recanalization therapy is crucial of maximizing the benefits of early treatment. We therefore aimed to design an easy-to-use recognition instrument for identifying LVOS. Methods: Prospective data were collected from emergency departments of 12 stroke-center hospitals in China during a 17-month study period. The Stroke Aid for Emergency (SAFE) scale is based on consciousness commands, facial palsy, gaze, and arm motor ability. Receiver operating characteristic analysis was used to obtain the area under the curve for the SAFE scale and previously established scales to predict LVOS. Results: The SAFE scale could accurately predict LVOS at an accuracy rate comparable to that of the National Institutes of Health Stroke Scale (c-statistics: 0.823 versus 0.831, p = 0.4798). The sensitivity, specificity, positive predictive value, and negative predictive value for the SAFE scale were 0.6875, 0.8577, 0.6937, and 0.8542, respectively, with a cutoff point of 4. The SAFE scale also performed well in a subgroup analysis based on the patients’ ages, occluded vessel locations, and the onset-to-door times. Conclusions: The SAFE scale can accurately recognize LVOS at a rate comparable to those of other, similar scales.
Collapse
Affiliation(s)
- Baorui Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Xiaochuan Huo
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Fei Yuan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Guangrong Song
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Lang Liu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha 410011, Hunan, China
| | - Gaoting Ma
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Dapeng Mo
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Zhongxue Wu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Zhongrong Miao
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| |
Collapse
|
40
|
Wu X, Wira CR, Matouk CC, Forman HP, Gandhi D, Sanelli P, Schindler J, Malhotra A. Drip-and-ship versus mothership for endovascular treatment of acute stroke: A comparative effectiveness analysis. Int J Stroke 2021; 17:315-322. [PMID: 33759645 DOI: 10.1177/17474930211008701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Triage for suspected acute stroke has two main options: (1) transport to the closest primary stroke center (PSC) and then to the nearest comprehensive stroke center (CSC) (Drip-and-Ship) or (2) transport the patient to the nearest CSC, bypassing a closer PSC (mothership). The purpose was to evaluate the effectiveness of drip-and-ship versus mothership models for acute stroke patients. METHODS A Markov decision-analytic model was constructed. All model parameters were derived from recent medical literature. Our target population was adult patient with sudden onset of acute stroke within 8 h of onset over a one-year horizon. The primary outcome was quantified in terms of quality-adjusted-life-years (QALYs). RESULTS The base case scenario show that the drip-and-ship strategy has a slightly higher expected health benefit, 0.591 QALY, as compared to 0.586 QALY in the mothership strategy when the time to PSC is 30 min and to CSC is 65 min, although the difference in health benefit becomes minimal as the time to PSC increases towards 60 min. Multiple sensitivity analyses show that when both PSC and CSC are far from place of onset (>1.5 h away), drip-and-ship becomes the better strategy. Mothership strategy is favored by smaller difference between distances to PSC and CSC, shorter transfer time from PSC to CSC, and longer delay in reperfusion in CSC for transferred patients. Drip-and-ship is favored by the reverse. CONCLUSION Drip-and-ship has a slightly higher utility than mothership. This study assesses the complex issue of prehospital triage of acute stroke patients and can provide a framework for real-world data input.
Collapse
Affiliation(s)
- Xiao Wu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Charles R Wira
- Department of Emergency Medicine, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Charles C Matouk
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Dheeraj Gandhi
- Radiology, Neurology and Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pina Sanelli
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joseph Schindler
- Department of Neurology, 12228Yale School of Medicine, New Haven, CT, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| |
Collapse
|
41
|
Hernandez S, Kittelty K, Hodgson CL. Rehabilitating the neurological patient in the ICU: what is important? Curr Opin Crit Care 2021; 27:120-130. [PMID: 33395083 DOI: 10.1097/mcc.0000000000000804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe recent literature evaluating the effectiveness of early rehabilitation in neurocritical care patients. RECENT FINDINGS There is a drive for early rehabilitation within the ICU; however, there are unique considerations for the neurocritically ill patient that include hemiplegia, cognitive impairments and impaired conscious state that can complicate rehabilitation. Additionally, neurological complications, such as hemorrhage expansion and cerebral edema can lead to the risk of further neurological damage. It is, therefore, important to consider the effect of exercise and position changes on cerebral hemodynamics in patients with impaired cerebral autoregulation. There is a paucity of evidence to provide recommendations on timing of early rehabilitation postneurological insult. There are also mixed findings on the effectiveness of early mobilization with one large, multicenter RCT demonstrating the potential harm of early and intensive mobilization in stroke patients. Conversely, observational trials have found early rehabilitation to be well tolerated and feasible, reduce hospital length of stay and improve functional outcomes in neurological patients admitted to ICU. SUMMARY Further research is warranted to determine the benefits and harm of early rehabilitation in neurological patients. As current evidence is limited, and given recent findings in stroke studies, careful consideration should be taken when prescribing exercises in neurocritically ill patients.
Collapse
Affiliation(s)
- Sabrina Hernandez
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital
| | - Katherine Kittelty
- Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne
- Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
42
|
Hu G, Shi Z, Li B, Shao W, Xu B. General anesthesia versus monitored anesthesia care during endovascular therapy for vertebrobasilar stroke. Am J Transl Res 2021; 13:1558-1567. [PMID: 33841679 PMCID: PMC8014376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The objective is to compare the effect of general anesthesia (GA) and monitored anesthesia care (MAC) on clinical outcomes in patients with endovascular therapy for vertebrobasilar occlusion stroke. METHODS 139 patients undergoing endovascular therapy for vertebrobasilar stroke, were recruited. The patients were randomized into GA group and MAC group (about 1:1 ratio). GA group received general anesthesia and MAC group received monitored anesthesia care during endovascular therapy. The primary outcome measure was the shift in the degree of disability among the 2 groups as measured by the modified Rankin scale score (mRS) at 90 days (80-100 days). Secondary end points included infarct volume and related complications. RESULTS The patients were assigned randomly (about 1:1 allocation) to GA group (n=72) and MAC group (n=67). The primary outcome of functional independence measured by 90-day mRS score was not significantly different between the 2 groups (median (IQR), 2 (1-3) vs. 3 (1-4); P=0.316). Final infarct volume was smaller in the GA group than in the MAC group (median (IQR), 27.60 (13.75-83.52) vs. 33.60 (26.85-92.95); P=0.045). There were no differences with statistical significance in rates of successful reperfusion (modified Thrombolysis in Cerebral Ischemia (mTICI) 2b-3) between 2 groups (73.61% vs. 76.12%; P=0.734). Early neurological outcomes measured by the 24-hour National Institutes of Health Stroke Scale scores (NIHSS) showed that 11 (interquartile range (IQR), 3-22) in GA group and 11 (interquartile range (IQR), 7-25) in MAC group, but were not statistically significant. There was no statistical difference in postoperative complications between the two groups. CONCLUSION For patients who underwent endovascular therapy for vertebrobasilar occlusion strok caused by occlusions in the posterior circulation, MAC appears to be as effective as GA. However, MAC is associated with bigger final infarct volume. Future studies are warranted to confirm our findings.
Collapse
Affiliation(s)
- Guangjun Hu
- The First Clinical College of Southern Medical UniversityGuangzhou, Guangdong Province, China
- Department of Anesthesiology, General Hospital of The Southern Theater Command of The Chinese PLAGuangzhou, Guangdong Province, China
- Department of Anesthesiology, Wuhan Third Hospital/Tongren Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Zhen Shi
- Department of Pain Treatment, Hubei Provincial Hospital of Traditional Chinese MedicineWuhan, Hubei Province, China
- Hubei Provincial Academy of Traditional Chinese MedicineWuhan, Hubei Province, China
| | - Bixi Li
- Department of Anesthesiology, General Hospital of The Central Theater Command of The Chinese PLAWuhan, Hubei Province, China
| | - Weidong Shao
- Department of Anesthesiology, General Hospital of The Southern Theater Command of The Chinese PLAGuangzhou, Guangdong Province, China
| | - Bo Xu
- The First Clinical College of Southern Medical UniversityGuangzhou, Guangdong Province, China
- Department of Anesthesiology, General Hospital of The Southern Theater Command of The Chinese PLAGuangzhou, Guangdong Province, China
| |
Collapse
|
43
|
Zotter M, Piechowiak EI, Balasubramaniam R, Von Martial R, Genceviciute K, Blanquet M, Slavova N, Sarikaya H, Arnold M, Gralla J, Jung S, Fischer U, El-Koussy M, Heldner MR. Endovascular therapy in patients with large vessel occlusion due to cardioembolism versus large-artery atherosclerosis. Ther Adv Neurol Disord 2021; 14:1756286421999017. [PMID: 33786067 PMCID: PMC7958159 DOI: 10.1177/1756286421999017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background and aims: To investigate whether stroke aetiology affects outcome in patients with
acute ischaemic stroke who undergo endovascular therapy. Methods: We retrospectively analysed patients from the Bernese Stroke Centre Registry
(January 2010–September 2018), with acute large vessel occlusion in the
anterior circulation due to cardioembolism or large-artery atherosclerosis,
treated with endovascular therapy (±intravenous thrombolysis). Results: The study included 850 patients (median age 77.4 years, 49.3% female, 80.1%
with cardioembolism). Compared with those with large-artery atherosclerosis,
patients with cardioembolism were older, more often female, and more likely
to have a history of hypercholesterolaemia, atrial fibrillation, current
smoking (each p < 0.0001) and higher median National
Institutes of Health Stroke Scale (NIHSS) scores on admission
(p = 0.030). They were more frequently treated with
stent retrievers (p = 0.007), but the median number of
stent retriever attempts was lower (p = 0.016) and fewer
had permanent stent placements (p ⩽ 0.004). Univariable
analysis showed that patients with cardioembolism had worse 3-month survival
[72.7% versus 84%, odds ratio (OR) = 0.51;
p = 0.004] and modified Rankin scale (mRS) score shift
(p = 0.043) and higher rates of post-interventional
heart failure (33.5% versus 18.5%, OR = 2.22;
p < 0.0001), but better modified thrombolysis in
cerebral infarction (mTICI) score shift (p = 0.025).
Excellent (mRS = 0–1) 3-month outcome, successful reperfusion
(mTICI = 2b–3), symptomatic intracranial haemorrhage and Updated Charlson
Comorbidity Index were similar between groups. Propensity-matched analysis
found no statistically significant difference in outcome between stroke
aetiology groups. Stroke aetiology was not an independent predictor of
favourable mRS score shift, but lower admission NIHSS score, younger age and
independence pre-stroke were (each p < 0.0001). Stroke
aetiology was not an independent predictor of heart failure, but older age,
admission antithrombotics and dependence pre-stroke were (each ⩽0.027).
Stroke aetiology was not an independent predictor of favourable mTICI score
shift, but application of stent retriever and no permanent intracranial
stent placement were (each ⩽0.044). Conclusion: We suggest prospective studies to further elucidate differences in
reperfusion and outcome between patients with cardioembolism and
large-artery atherosclerosis.
Collapse
Affiliation(s)
- Meredeth Zotter
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Eike I Piechowiak
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | | | - Rascha Von Martial
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Kotryna Genceviciute
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marisa Blanquet
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Nedelina Slavova
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Hakan Sarikaya
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marwan El-Koussy
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Freiburgstrasse, Bern, 3010, Switzerland
| |
Collapse
|
44
|
Vidale S, Romoli M, Agostoni EC. Endovascular treatment versus intravenous thrombolysis alone in isolated M2 occlusion: a meta-analysis. Neurol Sci 2021; 42:4221-4224. [PMID: 33586082 DOI: 10.1007/s10072-021-05124-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Optimal reperfusion strategies for M2 occlusion are still uncertain, with previous studies questioning benefit of mechanical thrombectomy (MT) over intravenous thrombolysis alone (IVT). Here we systematically reviewed and meta-analyzed data from studies comparing IVT alone vs MT with/without previous IVT, to define risk/benefit profile of each paradigm. METHODS The study followed PRISMA guidelines. PubMed, EMBASE, and Cochrane Central were searched only for RCTs comparing MT with or without IVT vs IVT alone in adults with acute ischemic stroke and M2 occlusion. Primary endpoint was functional independence at 90 days (modified Rankin Scale<3); secondary endpoints were represented by symptomatic intracranial hemorrhage (sICH) and good recanalization (TICI>2a). Odds ratios for endpoints were pooled with meta-analysis and compared between reperfusion strategies. RESULTS Seven studies (n=779) were included, all of high quality. Rate of good functional outcome was similar for MT and IVT (62.4% vs 66.3%; OR=0.73; 95%CI: 0.38-1.41; pheterogeneity=0.008) (Fig. 1).sICH was significantly more frequent in the MT group (8.5%) vs IVT group (3%) (OR 2.76, 95%CI 1.19-6.36, pheterogeneity=0.14). Good recanalization (TICI>2a) rate was higher in MT group vs IVT alone group (81.2% vs 51.4%; OR 3.99; 95%CI: 1.98-8.94; pheterogeneity=0.80). CONCLUSIONS IVT alone provides similar clinical benefit compared to MT with/without IVT in cases of M2 occlusion. MT quadruplicates rates of good recanalization, but triplicates risk of sICH. Further trials are needed to define if MT confers any advantage over IVT for M2 occlusion.
Collapse
Affiliation(s)
- Simone Vidale
- Department of Neurology, Infermi Hospital - Rimini, Viale Luigi Settembrini, 2, 47923, Rimini, Italy. .,Department of Neuroscience, Ospedale Generale di Zona "Moriggia Pelascini", Gravedona, Italy.
| | - Michele Romoli
- Department of Neurology, Infermi Hospital - Rimini, Viale Luigi Settembrini, 2, 47923, Rimini, Italy
| | | |
Collapse
|
45
|
Matei N, Camara J, Zhang JH. The Next Step in the Treatment of Stroke. Front Neurol 2021; 11:582605. [PMID: 33551950 PMCID: PMC7862333 DOI: 10.3389/fneur.2020.582605] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022] Open
Abstract
Although many patients do not receive reperfusion therapy because of delayed presentation and/or severity and location of infarct, new reperfusion approaches are expanding the window of intervention. Novel application of neuroprotective agents in combination with the latest methods of reperfusion provide a path to improved stroke intervention outcomes. We examine why neuroprotective agents have failed to translate to the clinic and provide suggestions for new approaches. New developments in recanalization therapy in combination with therapeutics evaluated in parallel animal models of disease will allow for novel, intra-arterial deployment of therapeutic agents over a vastly expanded therapeutic time window and with greater likelihood success. Although the field of neuronal, endothelial, and glial protective therapies has seen numerous large trials, the application of therapies in the context of newly developed reperfusion strategies is still in its infancy. Given modern imaging developments, evaluation of the penumbra will likely play a larger role in the evolving management of stroke. Increasingly more patients will be screened with neuroimaging to identify patients with adequate collateral blood supply allowing for delayed rescue of the penumbra. These patients will be ideal candidates for therapies such as reperfusion dependent therapeutic agents that pair optimally with cutting-edge reperfusion techniques.
Collapse
Affiliation(s)
- Nathanael Matei
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, United States
| | - Justin Camara
- Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, United States
| | - John H Zhang
- Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, United States.,Department of Anesthesiology, Loma Linda University, Loma Linda, CA, United States.,Department of Neurosurgery, Loma Linda University, Loma Linda, CA, United States
| |
Collapse
|
46
|
Acute ischemic stroke & emergency mechanical thrombectomy: The effect of type of anesthesia on early outcome. Clin Neurol Neurosurg 2021; 202:106494. [PMID: 33493885 DOI: 10.1016/j.clineuro.2021.106494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Endovascular mechanical thrombectomy (EMT) is the standard of care for acute ischemic stroke (AIS) caused by proximal large vessel occlusions. There is conflicting evidence on outcome of patients undergoing EMT under procedural sedation (PS) or general anesthesia (GA). In this retrospective study we analyze the effect of GA and PS on the functional outcome of patients undergoing EMT. METHODS Patients who have been admitted at our institute AIS and were treated with EMT under GA or PS between January 2015 and September 2018 were included in the study. Primary end point was the proportion of patients with good functional outcome as defined by a modified Rankin score (mRS) 0-2 at discharge. RESULTS A total of 155 patients were analyzed in this study including 45 (29.03 %) patients who received 97 GA, 110 (70.9 %) PS and 31 of these received Dexmedetomidine/Remifentanil. The median (IQR) 98 mRS at discharge was 4.0 (1.0-4.0) in the GA group Vs 3.00, (1.00-4.00) in the PS group. Among the secondary outcomes the lowest MAP recorded was significantly less in GA group (64.56 100 ± 18.70) compared to PS group (70.86 ± 16.30); p = 0.03. The PS group had a lower odd of mRS 3-5 (after adjustment), however, this finding was statistically not significant (OR 0.52 [0.07-3.5] 102 p = 0.5). CONCLUSIONS Our retrospective analysis did not find any influence of GA compared to PS whenever this was delivered by target controlled infusion (TCI) of propofol or by remifentanil/dexmedetomidine (REX) on early functional outcome.
Collapse
|
47
|
de Oliveira MMR, Nicolato A, Malheiros JA, Vieira Costa PH, Fidelis AC, Tibães Oliveira MA, Ramos TM, Lima Junior GM, Avellar L. Stroke Microsurgical Thrombectomy Human Placenta Simulator. World Neurosurg 2021; 148:e115-e120. [PMID: 33444832 DOI: 10.1016/j.wneu.2020.12.177] [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: 10/30/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Stroke microsurgical cerebrovascular thrombectomy reports are limited, although this technique could be used in many centers as a primary treatment or a salvage intervention option. It requires great ability, so our aim is to describe and validate a stroke microsurgical thrombectomy ex vivo simulator with operative nuances analysis. METHODS Human placenta (HP) models simulated middle cerebral artery vessels with intraluminal thrombus to be microsurgically excised. Six neurosurgeons performed 1-mm and 2-mm longitudinal and transverse arteriotomy in different arteries to remove a 1.5-cm length thrombus. Validation through construct validity compared time to complete the task, complete vessel cleaning, vessel manipulation, vessel stenosis, and leakage in both techniques. RESULTS All 6 HP models reproduced with fidelity stroke microsurgical thrombectomy, so participants completed 24 sessions, 4 for each neurosurgeon on the same model in different arteries. Construct validity highlighted microsurgical technical difficulties with positive results obtained by parameters variation during performance. Transverse arteriotomy with 1-mm length had best results (P < 0.05) allowing complete thrombus removal, less stenosis, and minor leakage in abbreviated time. CONCLUSIONS A HP simulator can reproduce with high fidelity all stroke microsurgical thrombectomy part tasks. Transverse 1-mm arteriotomy followed by thrombectomy and 2 simple sutures can fulfill all quality assurance aspects in such intervention accordingly to training model, due to easier vessel opening, complete thrombus removal, no stenosis, and faster microsuture.
Collapse
Affiliation(s)
| | - Arthur Nicolato
- Placentarium, Federal University of Minas Gerais and Felicio Rocho Hospital, Belo Horizonte, Brazil
| | - Jose Augusto Malheiros
- Placentarium, Federal University of Minas Gerais and Felicio Rocho Hospital, Belo Horizonte, Brazil
| | | | - Ana Clara Fidelis
- Placentarium, Federal University of Minas Gerais and Felicio Rocho Hospital, Belo Horizonte, Brazil
| | | | - Taise Mosso Ramos
- Placentarium, Federal University of Minas Gerais and Felicio Rocho Hospital, Belo Horizonte, Brazil
| | | | - Leonardo Avellar
- Department of Neurosurgery, Hospital Geral Roberto Santos, Salvador, Bahia, Brazil
| |
Collapse
|
48
|
Geisler F, Wesirow M, Ebinger M, Kunz A, Rozanski M, Waldschmidt C, Weber JE, Wendt M, Winter B, Audebert HJ. Probability assessment of intracerebral hemorrhage in prehospital emergency patients. Neurol Res Pract 2021; 3:1. [PMID: 33499926 PMCID: PMC7786495 DOI: 10.1186/s42466-020-00100-1] [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: 11/04/2020] [Accepted: 12/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Routing of patients with intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) to the most appropriate hospital is challenging for emergency medical services particularly when specific treatment options are only provided by specialized hospitals and determination of the exact diagnosis is difficult. We aimed to develop a prehospital score - called prehospital-intracerebral hemorrhage score (ph-ICH score) - to assist in discriminating between both conditions. METHODS The ph-ICH score was developed with data from patients treated aboard a mobile stroke unit in Berlin, Germany, between 2011 and 2013 (derivation cohort) and in 2018 (validation cohort). Diagnosis of ICH or AIS was established using clinical data and neuroradiological cerebral imaging. Diagnostic accuracy was measured with significance testing, Cohen's d and receiver-operating-characteristics. RESULTS We analyzed 416 patients (32 ICH, 224 AIS, 41 transient ischemic attack, 119 stroke mimic) in the derivation cohort and 285 patients (33 ICH and 252 AIS) in the validation cohort. Systolic blood pressure, level of consciousness and severity of neurological deficits (i. e. certain items of the National Institutes of Health Stroke Scale) were used to calculate the ph-ICH score that showed higher values in the ICH compared to the AIS group (derivation cohort: 1.8 ± 1.2 vs. 1.0 ± 0.9 points; validation cohort: 1.8 ± 0.9 vs. 0.8 ± 0.7 points; d = 0.9 and 1.4, both p < 0.01). Receiver-operating-characteristics showed fair and good accuracy with an area under the curve of 0.71 for the derivation and 0.81 for the validation cohort. CONCLUSIONS The ph-ICH score can assist medical personnel in the field to assess the likelihood of ICH and AIS in emergency patients.
Collapse
Affiliation(s)
- Frederik Geisler
- Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Medschid Wesirow
- Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Martin Ebinger
- Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Alexander Kunz
- Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Michal Rozanski
- Department of Neurology, Auguste-Viktoria-Klinikum, Berlin, Germany
| | | | - Joachim E Weber
- Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Matthias Wendt
- Department of Neurology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Benjamin Winter
- Department of Neurology, St. Josefs-Krankenhaus, Potsdam, Germany
| | - Heinrich J Audebert
- Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.,Center for Stroke Research Berlin, Berlin, Germany
| |
Collapse
|
49
|
Fan L, Han W, Zhang Y, Zhou M, Ye H, Chen W, Su Y. Risk factors for ineffective recanalization after endovascular treatment in acute ischemic stroke. Clin Neurol Neurosurg 2020; 200:106362. [PMID: 33243698 DOI: 10.1016/j.clineuro.2020.106362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 10/13/2020] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the risk factors of early ineffective recanalization, defined as a modified Rankin scale (mRS) score of 4∼6 at two weeks after symptom onset, in acute ischemic stroke (AIS) patients receiving endovascular treatment (EVT). METHOD One hundred eighty-four AIS patients who received EVT in 01/2016-12/2018 were analyzed. The recanalization rate was 81.5 % (150/184). Patients were divided into effective (mRS 0-3) and ineffective (mRS 4-6) recanalization groups. The independent risk factors for ineffective recanalization were analyzed. RESULT The ineffective recanalization rate was 67.3 % (101/150 cases) at 14 days after symptom onset. Twenty-five patients (24.8 %) in the ineffective recanalization group had coronary heart disease, higher than that in the effective group (4 patients, 8.2 %, P = 0.016). Infratentorial pathology accounted for 34.7 % (35 cases) of the ineffective group and only 14.3 % (7 cases) of the control group (P = 0.011). Systolic blood pressure (SBP) was higher in the ineffective group than in the effective group (146 mmHg vs 140 mmHg, P = 0.038). General anesthesia was more common in the ineffective group than in the control group (49 cases, 48.5 %, vs 9 cases, 18.4 %; P = 0.000). Logistic regression showed that coronary heart disease (odds ratio (OR) = 3.399, 95 % confidence interval (CI) 1.013-11.401, P = 0.048), unconsciousness before EVT (OR = 4.292, 95 % CI 1.963-9.386, P = 0.000), SBP (OR = 1.016, 95 % CI 0.997-1.035, P = 0.090) and general anesthesia (OR = 3.378, 95 % CI 1.395-8.180, P = 0.007) were independent risk factors for ineffective recanalization. CONCLUSION Patients with coronary heart disease, unconsciousness before EVT, elevated SBP and general anesthesia need precise assessment to benefit from EVT.
Collapse
Affiliation(s)
- Linlin Fan
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wei Han
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China; Department of Neurology, Affiliated Hospital of Jiang Su University, Zhejiang, China
| | - Yan Zhang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China.
| | - Meijun Zhou
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China; Department of Neurology, The Fourth Hospital of Changsha, Changsha, China
| | - Hong Ye
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Weibi Chen
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yingying Su
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| |
Collapse
|
50
|
Nayak S. Mechanical Thrombectomy using Distal Access Catheters: Current Status and Future Prospects. J Neuroimaging 2020; 30:754-761. [PMID: 33142040 DOI: 10.1111/jon.12793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Mechanical Thrombectomy (MT) using modern devices has proved to be efficacious in re-establishing intracranial circulation and reduced procedural times. We outline a number of endovascular techniques utilizing the distal access catheter, the circumstances where they are applicable, and the outcomes achieved. METHODS In this review, we describe a variety of endovascular techniques with distal access catheter, deployed with and without the stent retriever device gained from our experience of performing over 700 procedures in 10 years of providing a 24/7 service within the national framework of a hyperacute stroke centre. RESULTS We used distal access catheter techniques for intracranial support during a stent-retriever thrombectomy or thrombo-suction on its own. When used as a sole suction device, or combined with a stent-retriever, we have been able to provide a rapid route to successful reperfusion, with minimal complications related to our endovascular procedures. We can report distal access catheter techniques works well when access to thrombi involves navigation through tortuous vessel anatomy, notably when convoluted loops in the cervical internal carotid artery are encountered. We suggest use of the distal access catheter techniques in thrombectomy procedures for steep-angle Middle Cerebral Artery occlusions, M2/M3 occlusion, and for basilar occlusion, where thrombectomy via suction alone proved to be adequate. CONCLUSION In this pictorial review, we have demonstrated techniques where distal access catheter when used as a sole suction device, or combined with a stent-retriever, has been able to provide a rapid route to successful reperfusion, with minimal complications related to our endovascular procedures.
Collapse
Affiliation(s)
- Sanjeev Nayak
- Department of Clinical Radiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| |
Collapse
|