1
|
Sadeh-Gonik U, Budylev A, Krivitzky D, Molad J, Halevi H, Jonas-Kimchi T, Yashar H, Ben Assayag E, Seyman E. Circle of Willis integrity in acute middle cerebral artery occlusion: does the posterior communicating artery matter? J Neurointerv Surg 2024; 16:801-808. [PMID: 37527929 DOI: 10.1136/jnis-2023-020326] [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: 03/17/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Collateral circulation is an important determinant of outcome in people with acute ischemic stroke due to large vessel occlusion (LVO). OBJECTIVE To explore the impact of the circle of Willis (CW) anatomical characteristics ipsilateral to the occlusion site, particularly the posterior communicating artery (PComA) and the A1-portion of the anterior cerebral artery (A1-ACA), on stroke outcomes in a cohort of patients with LVO and middle cerebral artery (MCA) occlusion, undergoing endovascular thrombectomy (EVT). METHODS This is a retrospective cohort study performed in a comprehensive tertiary stroke center. The study population consisted of consecutive patients with LVO with proximal MCA occlusion (M1) between June 2016 and April 2021, undergoing EVT. Demographic, clinical, and imaging information was extracted from patient files. Patency and diameters of ipsilateral A1-ACA and PComA were manually measured on admission CT angiography images in the core laboratory. RESULTS One hundred and five patients with LVO comprised the study cohort, mean age 72.3 years, 43.8% were male, mean National Institutes of Health Stroke Scale score at admission 15.2. The cohort was grouped according to CW vessel characteristics. On univariate analysis, a well-developed PComA was associated with lower rates of hemorrhagic transformation (1.8% vs 14.3%, P=0.01) and a trend towards lower mortality rates (8.9% vs 20.4%, P=0.08).On multivariable regression analysis a well-developed PComA emerged as an independent predictor for survival (aOR=0.09, 95% CI 0.01 to 0.4 for survival at discharge, P=0.009, aOR=0.22, 95% CI 0.05 to 0.8 for survival at 90 days, P=0.02). CONCLUSIONS In a cohort of patients with LVO due to M1 occlusion undergoing EVT, a well-developed PComA was associated with significantly lower hemorrhagic transformation rates, a trend towards better functional outcomes, and independently predicted survival. Larger studies are needed to understand the differential effect of CW collateral conduits on stroke outcome and evaluate the practicality of incorporating such factors in the clinical decision-making process prior to EVT.
Collapse
Affiliation(s)
- Udi Sadeh-Gonik
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anatoly Budylev
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David Krivitzky
- Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jeremy Molad
- Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hen Halevi
- Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience Tel Aviv University, Tel-Aviv, Israel
- The Faculty of Medicine,Tel Aviv University, Tel-Aviv, Israel
| | - Tali Jonas-Kimchi
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hila Yashar
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einor Ben Assayag
- Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience Tel Aviv University, Tel-Aviv, Israel
- The Faculty of Medicine,Tel Aviv University, Tel-Aviv, Israel
| | - Estelle Seyman
- Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Faculty of Medicine,Tel Aviv University, Tel-Aviv, Israel
| |
Collapse
|
2
|
Yamada S, Kawano H, Otani T, Ii S, Ito H, Okada K, Iseki C, Tanikawa M, Yoshida K, Watanabe Y, Wada S, Oshima M, Mase M. Higher cerebral blood flow on four-dimensional flow magnetic resonance imaging in young women. Sci Prog 2024; 107:368504241266371. [PMID: 39051513 DOI: 10.1177/00368504241266371] [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] [Indexed: 07/27/2024]
Abstract
We investigated the reduction in regional brain volume and cerebral blood flow (CBF) with aging and explored potential sex differences in healthy brains. Three-dimensional (3D) T1-weighted magnetic resonance imaging (MRI), time-of-flight magnetic resonance angiography, and four-dimensional (4D) flow MRI were performed on 129 healthy volunteers aged 22-92 years. The brains of healthy volunteers were segmented into 21 subregions using 3D T1-weighted MRI and CBFs in 16 major intracranial arteries were measured using 4D flow MRI. The cortical gray matter volume decreased linearly with aging, whereas the cerebral white matter volume increased until the 40s and then decreased, and the subcortical gray matter volume changed little with aging. The cortical gray matter volume was significantly associated with the total CBF of the major intracranial arteries distal to the circle of Willis; however, the cerebral white matter and subcortical gray matter volumes were not. Generally, women have higher total CBF than men, particularly in their 40s and younger, despite the smaller intracranial volume and smaller diameters of intracranial arteries than men. This may contribute to the higher incidence of subarachnoid hemorrhage due to cerebral aneurysms and migraine in women.
Collapse
Affiliation(s)
- Shigeki Yamada
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Science, Aichi, Japan
- Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Hiroto Kawano
- Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan
| | - Tomohiro Otani
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Osaka, Japan
| | - Satoshi Ii
- Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
- Department of Mechanical Engineering, School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Hirotaka Ito
- Medical System Research & Development Center, FUJIFILM Corporation, Tokyo, Japan
| | - Ko Okada
- Medical System Research & Development Center, FUJIFILM Corporation, Tokyo, Japan
| | - Chifumi Iseki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata, Japan
| | - Motoki Tanikawa
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Science, Aichi, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Shigeo Wada
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Osaka, Japan
| | - Marie Oshima
- Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Mitsuhito Mase
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Science, Aichi, Japan
| |
Collapse
|
3
|
Del Brutto VJ, Khasiyev F, Liu M, Spagnolo-Allende A, Qiao Y, Melgarejo Arias JD, Guzman VA, Igwe KC, Sanchez DL, Andrews H, Morales CD, Farrell MT, Bassil DT, Seshadri S, Wagner RG, Mngomezulu V, Manly J, Elkind MSV, Berkman L, Romero JR, Maestre GE, Del Brutto OH, Brickman AM, Venketasubramanian N, Chen C, Robert C, Hilal S, Rundek T, Wasserman BA, Gutierrez J. Association of brain arterial diameters with demographic and anatomical factors in a multi-national pooled analysis of cohort studies. Neuroradiol J 2024; 37:304-313. [PMID: 38148489 PMCID: PMC11138338 DOI: 10.1177/19714009231224429] [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] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND AND PURPOSE Brain arterial diameters are markers of cerebrovascular disease. Demographic and anatomical factors may influence arterial diameters. We hypothesize that age, sex, height, total cranial volume (TCV), and persistent fetal posterior cerebral artery (fPCA) correlate with brain arterial diameters across populations. METHODS Participants had a time-of-flight MRA from nine international cohorts. Arterial diameters of the cavernous internal carotid arteries (ICA), middle cerebral arteries (MCA), and basilar artery (BA) were measured using LAVA software. Regression models assessed the association between exposures and brain arterial diameters. RESULTS We included 6,518 participants (mean age: 70 ± 9 years; 41% men). Unilateral fPCA was present in 13.2% and bilateral in 3.2%. Larger ICA, MCA, and BA diameters correlated with older age (Weighted average [WA] per 10 years: 0.18 mm, 0.11 mm, and 0.12 mm), male sex (WA: 0.24 mm, 0.13 mm, and 0.21 mm), and TCV (WA: for one TCV standard deviation: 0.24 mm, 0.29 mm, and 0.18 mm). Unilateral and bilateral fPCAs showed a positive correlation with ICA diameters (WA: 0.39 mm and 0.73 mm) and negative correlation with BA diameters (WA: -0.88 mm and -1.73 mm). Regression models including age, sex, TCV, and fPCA explained on average 15%, 13%, and 25% of the ICA, MCA, and BA diameter interindividual variation, respectively. Using height instead of TCV as a surrogate of head size decreased the R-squared by 3% on average. CONCLUSION Brain arterial diameters correlated with age, sex, TCV, and fPCA. These factors should be considered when defining abnormal diameter cutoffs across populations.
Collapse
Affiliation(s)
| | | | | | | | - Ye Qiao
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | | | - Meagan T Farrell
- Harvard University, Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - Darina T Bassil
- Harvard University, Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | | | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Mngomezulu
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Lisa Berkman
- Harvard University, Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | | | - Gladys E Maestre
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela
- Institute of Neuroscience, University of Texas Rio Grande Valley, Harlingen, TX, USA
| | | | | | | | - Christopher Chen
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Center, National University Health System, Singapore
| | - Caroline Robert
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Center, National University Health System, Singapore
| | - Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Center, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Bruce A Wasserman
- Johns Hopkins University, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | |
Collapse
|
4
|
Xue J, Zhang XG, Zhang D, Hu L, Xu XS, Li YM, Yue YH. Predictors of Very Poor Outcome After Mechanical Thrombectomy in Older Patients with Acute Ischemic Stroke. World Neurosurg 2024; 185:e1224-e1229. [PMID: 38514033 DOI: 10.1016/j.wneu.2024.03.060] [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: 02/25/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Mechanical thrombectomy (MT) is an effective treatment for patients with acute ischemic stroke due to large vessel occlusion. However, some elderly patients with recanalization have a very poor outcome, including vegetative state and mortality. This study evaluated predictors of very poor outcome at 3 months in older patients with stroke undergoing MT treatment. METHODS We retrospectively collected data from consecutive stroke patients ≥80 years old undergoing MT between April 2018 and January 2021. A very poor outcome was defined as a modified Rankin Scale (mRS) score of 5 or 6 at 3-month follow-up. Multiple logistic regression analysis was performed to identify the predictors of very poor outcome at 3 months. RESULTS The study enrolled 62 patients with a median age of 85.5 years (interquartile range: 82.0-89.0). Of patients, 35 (56.5%) had a very poor outcome at 3-month follow-up. Multiple logistic regression analysis identified female sex (odds ratio = 3.592, 95% confidence interval 1.047-12.319, P = 0.042) and stroke-associated pneumonia (odds ratio = 6.103, 95% CI 1.541-24.174, P = 0.010) as independent predictors of very poor outcome. CONCLUSIONS In elderly stroke patients undergoing MT treatment, female sex and stroke-associated pneumonia were independent predictors of very poor outcome at 3 months.
Collapse
Affiliation(s)
- Jie Xue
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China
| | - Xiao-Guang Zhang
- Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China
| | - Dong Zhang
- Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China
| | - Liang Hu
- Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China
| | - Xu-Shen Xu
- Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China
| | - You-Mei Li
- Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China
| | - Yun-Hua Yue
- Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China.
| |
Collapse
|
5
|
van der Meij A, Holswilder G, Bernsen MLE, van Os HJ, Hofmeijer J, Spaander FH, Martens JM, van den Wijngaard IR, Lingsma HF, Konduri PR, Blm Majoie C, Schonewille WJ, Dippel DW, Kruyt ND, Nederkoorn PJ, van Walderveen MA, Wermer MJ. Sex differences in clot, vessel and tissue characteristics in patients with a large vessel occlusion treated with endovascular thrombectomy. Eur Stroke J 2024:23969873241231125. [PMID: 38420950 DOI: 10.1177/23969873241231125] [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: 03/02/2024] Open
Abstract
INTRODUCTION To improve our understanding of the relatively poor outcome after endovascular treatment (EVT) in women we assessed possible sex differences in baseline neuroimaging characteristics of acute ischemic stroke patients with large anterior vessel occlusion (LVO). PATIENTS AND METHODS We included all consecutive patients from the MR CLEAN Registry who underwent EVT between 2014 and 2017. On baseline non-contrast CT and CT angiography, we assessed clot location and clot burden score (CBS), vessel characteristics (presence of atherosclerosis, tortuosity, size, and collateral status), and tissue characteristics with the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). Radiological outcome was assessed with the extended thrombolysis in cerebral infarction score (eTICI) and functional outcome with the modified Rankin Scale score (mRS) at 90 days. Sex-differences were assessed with multivariable regression analyses with adjustments for possible confounders. RESULTS 3180 patients were included (median age 72 years, 48% women). Clots in women were less often located in the intracranial internal carotid artery (ICA) (25%vs 28%, odds ratio (OR) 0.85;95% confidence interval: 0.73-1.00). CBS was similar between sexes (median 6, IQR 4-8). Intracranial (aOR 0.73;95% CI:0.62-0.87) and extracranial (aOR 0.64;95% CI:0.43-0.95) atherosclerosis was less prevalent in women. Vessel tortuosity was more frequent in women in the cervical ICA (aOR 1.89;95% CI:1.39-2.57) and women more often had severe elongation of the aortic arch (aOR 1.38;95% CI:1.00-1.91). ICA radius was smaller in women (2.3vs 2.5 mm, mean difference 0.22;95% CI:0.09-0.35) while M1 radius was essentially equal (1.6vs 1.7 mm, mean difference 0.09;95% CI:-0.02-0.21). Women had better collateral status (⩾50% filling in 62%vs 53% in men, aOR 1.48;95% CI:1.29-1.70). Finally, ASPECT scores were equal between women and men (median 9 in both sexes, IQR 8-10vs 9-10). Reperfusion rates were similar between women and men (acOR 0.94;95% CI:0.83-1.07). However, women less often reached functional independence than men (34%vs 46%, aOR 0.68;95% CI:0.53-0.86). DISCUSSION AND CONCLUSION On baseline imaging of this Dutch Registry, men and women with LVO mainly differ in vessel characteristics such as atherosclerotic burden, extracranial vessel tortuosity, and collateral status. These sex differences do not result in different reperfusion rates and are, therefore, not likely to explain the worse functional outcome in women after EVT.
Collapse
Affiliation(s)
- Anne van der Meij
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Ghislaine Holswilder
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie Louise E Bernsen
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Hendrikus Ja van Os
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeannette Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
| | | | - Jasper M Martens
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Ido R van den Wijngaard
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, Den Haag, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Praneeta R Konduri
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Blm Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Diederik Wj Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nyika D Kruyt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marieke Jh Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
6
|
Kim DJ, Singh N, Catanese L, Yu AYX, Demchuk AM, Lloret-Villas MI, Deschaintre Y, Coutts SB, Khosravani H, Appireddy R, Moreau F, Gubitz G, Tkach A, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar J, Williams H, Manosalva H, Siddiqui M, Zafar A, Imoukhuede O, Hunter G, Phillips S, Hill MD, Poppe AY, Ademola A, Shamy M, Bala F, Sajobi TT, Swartz RH, Almekhlafi MA, Menon BK, Field TS. Sex-Based Analysis of Workflow and Outcomes in Acute Ischemic Stroke Patients Treated With Alteplase Versus Tenecteplase. Stroke 2024; 55:288-295. [PMID: 38174568 DOI: 10.1161/strokeaha.123.045320] [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: 08/14/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Understanding sex differences in stroke care is important in reducing potential disparities. Our objective was to explore sex differences in workflow efficiency, treatment efficacy, and safety in the AcT trial (Alteplase Compared to Tenecteplase). METHODS AcT was a multicenter, registry-linked randomized noninferiority trial comparing tenecteplase (0.25 mg/kg) with alteplase (0.9 mg/kg) in acute ischemic stroke within 4.5 hours of onset. In this post hoc analysis, baseline characteristics, workflow times, successful reperfusion (extended Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracerebral hemorrhage, 90-day functional independence (modified Rankin Scale score, 0-1), and 90-day mortality were compared by sex. Mixed-effects regression analysis was used adjusting for age, stroke severity, and occlusion site for outcomes. RESULTS Of 1577 patients treated with intravenous thrombolysis (2019-2022), 755 (47.9%) were women. Women were older (median, 77 [68-86] years in women versus 70 [59-79] years in men) and had a higher proportion of severe strokes (National Institutes of Health Stroke Scale score >15; 32.4% versus 24.9%) and large vessel occlusions (28.7% versus 21.5%) compared with men. All workflow times were comparable between sexes. Women were less likely to achieve functional independence (31.7% versus 39.8%; unadjusted relative risk, 0.80 [95% CI, 0.70-0.91]) and had higher mortality (17.7% versus 13.3%; unadjusted relative risk, 1.33 [95% CI, 1.06-1.69]). Adjusted analysis showed no difference in outcomes between sexes. CONCLUSIONS Differences in prognostic factors of age, stroke severity, and occlusion site largely accounted for higher functional dependence and mortality in women. No sex disparities were apparent in workflow quality indicators. Given the integration of the AcT trial into clinical practice, these results provide reassurance that no major sex biases are apparent in acute stroke management throughout participating Canadian centers. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03889249.
Collapse
Affiliation(s)
- Diana J Kim
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Nishita Singh
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., J.S.)
| | - Luciana Catanese
- Hamilton Health Sciences Centre, McMaster University, Hamilton, ON, Canada (L.C.)
| | - Amy Y X Yu
- Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | | | - Yan Deschaintre
- Department of Neurosciences, Université de Montréal, QC, Canada (Y.D.)
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Houman Khosravani
- Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada
| | - Ramana Appireddy
- Division of Neurology, Queen's University, Kingston, ON, Canada (R.A.)
| | | | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (G.G., S.P.)
| | | | - Dar Dowlatshahi
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - George Medvedev
- Royal Columbian Hospital, New Westminster, BC, Canada (G.M.)
| | - Jennifer Mandzia
- London Health Sciences Centre, Western University, London, ON, Canada (J.M.)
| | | | - Jai Shankar
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., J.S.)
| | | | | | | | - Atif Zafar
- St Michael's Hospital, Toronto, ON, Canada (A.Z.)
| | | | - Gary Hunter
- University of Saskatchewan, Saskatoon, Canada (G.H.)
| | - Stephen Phillips
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (G.G., S.P.)
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | | | - Ayoola Ademola
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Michel Shamy
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - Fouzi Bala
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Richard H Swartz
- Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, The University of British Columbia, Vancouver, Canada (T.S.F.)
| |
Collapse
|
7
|
Kato S, Ban Y, Ota T, Miki N. Microfabricated Nitinol Stent Retrievers with a Micro-Patterned Surface. MICROMACHINES 2024; 15:213. [PMID: 38398942 PMCID: PMC10893500 DOI: 10.3390/mi15020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Stent retrievers are medical devices that are designed to physically remove blood clots from within the blood vessels of the brain. This paper focuses on microfabricated nitinol (nickel-titanium alloy) stent retrievers, which feature micro-patterns on their surface to enhance the effectiveness of mechanical thrombectomy. A thick film of nitinol, which was 20 µm in thickness, was sputtered onto a substrate with a micro-patterned surface, using electroplated copper as the sacrificial layer. The nitinol film was released from the substrate and then thermally treated while folded into a cylindrical shape. In vitro experiments with pig blood clots demonstrated that the micro-patterns on the surface improved the efficacy of blood clot retrieval.
Collapse
Affiliation(s)
| | | | | | - Norihisa Miki
- Department of Mechanical Engineering, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522, Japan; (S.K.); (Y.B.); (T.O.)
| |
Collapse
|
8
|
Fauzi AA, Thamrin AMH, Permana AT, Ranuh IGMAR, Hidayati HB, Hamdan M, Wahyuhadi J, Suroto NS, Lestari P, Chandra PS. Comparison of the Administration Route of Stem Cell Therapy for Ischemic Stroke: A Systematic Review and Meta-Analysis of the Clinical Outcomes and Safety. J Clin Med 2023; 12:jcm12072735. [PMID: 37048818 PMCID: PMC10094955 DOI: 10.3390/jcm12072735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/06/2023] [Accepted: 04/04/2023] [Indexed: 04/09/2023] Open
Abstract
Stem cell treatment is emerging as an appealing alternative for stroke patients, but there still needs to be an agreement on the protocols in place, including the route of administration. This systematic review aimed to assess the efficacy and safety of the administration routes of stem cell treatment for ischemic stroke. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was undertaken using the PubMed, Scopus, and Cochrane databases. A total of 21 publications on stem cell therapy for ischemic stroke were included. Efficacy outcomes were measured using the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and the Barthel index (BI). Intracerebral administration showed a better outcome than other routes, but a greater number of adverse events followed due to its invasiveness. Adverse events were shown to be related to the natural history of stroke not to the treatment. However, further investigation is required, since studies have yet to compare the different administration methods directly.
Collapse
Affiliation(s)
- Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia
| | - Ahmad Muslim Hidayat Thamrin
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia
| | - Andhika Tomy Permana
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia
| | - I. G. M. Aswin R. Ranuh
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia
| | - Hanik Badriyah Hidayati
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia
| | - Muhammad Hamdan
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia
| | - Joni Wahyuhadi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia
| | - Nur Setiawan Suroto
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia
| | - Pudji Lestari
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia
| | - Poodipedi Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110608, India
| |
Collapse
|
9
|
Fifi JT, Nguyen TN, Song S, Sharrief A, Pujara DK, Shaker F, Fournier LE, Jones EM, Lechtenberg CG, Slavin SJ, Ifejika NL, Diaz MV, Martin-Schild S, Schaafsma J, Tsai JP, Alexandrov AW, Tjoumakaris SI, Sarraj A. Sex differences in endovascular thrombectomy outcomes in large vessel occlusion: a propensity-matched analysis from the SELECT study. J Neurointerv Surg 2023; 15:105-112. [PMID: 35232756 DOI: 10.1136/neurintsurg-2021-018348] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/06/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sex disparities in acute ischemic stroke outcomes are well reported with IV thrombolysis. Despite several studies, there is still a lack of consensus on whether endovascular thrombectomy (EVT) outcomes differ between men and women. OBJECTIVE To compare sex differences in EVT outcomes at 90-day follow-up and assess whether progression in functional status from discharge to 90-day follow-up differs between men and women. METHODS From the Selection for Endovascular Treatment in Acute Ischemic Stroke (SELECT) prospective cohort study (2016-2018), adult men and women (≥18 years) with anterior circulation large vessel occlusion (internal carotid artery, middle cerebral artery M1/M2) treated with EVT up to 24 hours from last known well were matched using propensity scores. Discharge and 90-day modified Rankin Scale (mRS) scores were compared between men and women. Furthermore, we evaluated the improvement in mRS scores from discharge to 90 days in men and women using a repeated-measures, mixed-effects regression model. RESULTS Of 285 patients, 139 (48.8%) were women. Women were older with median (IQR) age 69 (57-81) years vs 64.5 (56-75), p=0.044, had smaller median perfusion deficits (Tmax >6 s) 109 vs 154 mL (p<0.001), and had better collaterals on CT angiography and CT perfusion but similar ischemic core size (relative cerebral blood flow <30%: 7.6 (0-25.2) vs 11.4 (0-38) mL, p=0.22). In 65 propensity-matched pairs, despite similar discharge functional independence rates (women: 42% vs men: 48%, aOR=0.55, 95% CI 0.18 to 1.69, p=0.30), women exhibited worse 90-day functional independence rates (women: 46% vs men: 60%, aOR=0.41, 95% CI 0.16 to 1.00, p=0.05). The reduction in mRS scores from discharge to 90 days also demonstrated a significantly larger improvement in men (discharge 2.49 and 90 days 1.88, improvement 0.61) than in women (discharge 2.52 and 90 days 2.44, improvement 0.08, p=0.036). CONCLUSION In a propensity-matched cohort from the SELECT study, women had similar discharge outcomes as men following EVT, but the improvement from discharge to 90 days was significantly worse in women, suggesting the influence of post-discharge factors. Further exploration of this phenomenon to identify target interventions is warranted. TRIAL REGISTRATION NUMBER NCT02446587.
Collapse
Affiliation(s)
- Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
| | - Sarah Song
- Department of Neurology, Rush University Medical Center, Chicago, Illinois, USA
| | - Anjail Sharrief
- Department of Neurology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Deep Kiritbhai Pujara
- Department of Neurology, University Hospitals Neurological Institute, Cleveland, Ohio, USA
| | - Faris Shaker
- Department of Neurology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Lauren E Fournier
- Department of Neurology, Baylor Scott & White Health, Dallas, Texas, USA
| | - Erica M Jones
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Colleen G Lechtenberg
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sabreena J Slavin
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nneka L Ifejika
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Physical Medicine and Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Maria V Diaz
- Department of Neurology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Sheryl Martin-Schild
- Department of Neurology, Infirmary and New Orleans East Hospital, Metairie, Louisiana, USA.,Dr. Brain Inc, New Orleans, Louisiana, USA
| | - Joanna Schaafsma
- Medicine - Division Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jenny P Tsai
- Department of Neurological Surgery, Spectrum Health Medical Group, Grand Rapids, Michigan, USA
| | - Anne W Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Amrou Sarraj
- Department of Neurology, University Hospitals Neurological Institute, Cleveland, Ohio, USA .,Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | |
Collapse
|
10
|
Luraghi G, Bridio S, Migliavacca F, Rodriguez Matas JF. Self-expandable stent for thrombus removal modeling: Solid or beam finite elements? Med Eng Phys 2022; 106:103836. [PMID: 35926960 DOI: 10.1016/j.medengphy.2022.103836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The performance of self-expandable stents is being increasingly studied by means of finite-element analysis. As for peripheral stents, transcatheter valves and stent-grafts, there are numerous computational studies for setting up a proper model, this information is missing for stent-retrievers used in the procedure of thrombus removal in cerebral arteries. It is well known that the selection of the appropriate finite-element dimensions (topology) and formulations (typology) is a fundamental step to set up accurate and reliable computational simulations. In this context, a thorough verification analysis is here proposed, aimed at investigating how the different element typologies and topologies - available to model a stent-retriever - affect simulation results. METHOD Hexahedral and beam element formulations were analyzed first individually by virtually replicating a crimping test on the device, and then by replicating the thrombectomy procedure aiming at removing a thrombus from a cerebral vessel. In particular, three discretization refinements for each element type and different element formulations including both full and reduced integration were investigated and compared in terms of the resultant radial force of the stent and the stress field generated in the thrombus. RESULTS The sensitivity analysis on the element formulation performed with the crimping simulations allowed the identification of the optimal setting for each element family. Both setting lead to similar results in terms of stent performance in the virtual thrombectomy and should be used in future studies simulating the mechanical thrombectomy with stent-retrievers. CONCLUSIONS The carried out virtual thrombectomy procedures confirmed that the beam element formulation results were sufficiently accurate to model the radial force and the performance of the stent-retriever during the procedure. For different self-expandable stents, hexahedral formulation could be essential in stress analysis.
Collapse
Affiliation(s)
- Giulia Luraghi
- Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano, Piazza L. da Vinci 32, 20133 Milan, Italy.
| | - Sara Bridio
- Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano, Piazza L. da Vinci 32, 20133 Milan, Italy
| | - Francesco Migliavacca
- Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano, Piazza L. da Vinci 32, 20133 Milan, Italy
| | - Jose Felix Rodriguez Matas
- Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano, Piazza L. da Vinci 32, 20133 Milan, Italy
| |
Collapse
|
11
|
Ospel JM, Schaafsma JD, Leslie-Mazwi TM, Amin-Hanjani S, Asdaghi N, Gordon-Perue GL, Couillard P, Hadidi NN, Bushnell C, McCullough LD, Goyal M. Toward a Better Understanding of Sex- and Gender-Related Differences in Endovascular Stroke Treatment: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2022; 53:e396-e406. [PMID: 35695016 DOI: 10.1161/str.0000000000000411] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are many unknowns when it comes to the role of sex in the pathophysiology and management of acute ischemic stroke. This is particularly true for endovascular treatment (EVT). It has only recently been established as standard of care; therefore, data are even more scarce and conflicting compared with other areas of acute stroke. Assessing the role of sex and gender as isolated variables is challenging because they are closely intertwined with each other, as well as with patients' cultural, ethnic, and social backgrounds. Nevertheless, a better understanding of sex- and gender-related differences in EVT is important to develop strategies that can ultimately improve individualized outcome for both men and women. Disregarding patient sex and gender and pursuing a one-size-fits-all strategy may lead to suboptimal or even harmful treatment practices. This scientific statement is meant to outline knowledge gaps and unmet needs for future research on the role of sex and gender in EVT for acute ischemic stroke. It also provides a pragmatic road map for researchers who aim to investigate sex- and gender-related differences in EVT and for clinicians who wish to improve clinical care of their patients undergoing EVT by accounting for sex- and gender-specific factors. Although most EVT studies, including those that form the basis of this scientific statement, report patient sex rather than gender, open questions on gender-specific EVT differences are also discussed.
Collapse
|
12
|
Zhang XG, Wang JH, Yang WH, Zhu XQ, Xue J, Li ZZ, Kong YM, Hu L, Jiang SS, Xu XS, Yue YH. Nomogram to predict 3-month unfavorable outcome after thrombectomy for stroke. BMC Neurol 2022; 22:111. [PMID: 35321686 PMCID: PMC8941794 DOI: 10.1186/s12883-022-02633-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 03/14/2022] [Indexed: 01/01/2023] Open
Abstract
Background Mechanical thrombectomy (MT) is an effective treatment for large-vessel occlusion in acute ischemic stroke, however, only some revascularized patients have a good prognosis. For stroke patients undergoing MT, predicting the risk of unfavorable outcomes and adjusting the treatment strategies accordingly can greatly improve prognosis. Therefore, we aimed to develop and validate a nomogram that can predict 3-month unfavorable outcomes for individual stroke patient treated with MT. Methods We analyzed 258 patients with acute ischemic stroke who underwent MT from January 2018 to February 2021. The primary outcome was a 3-month unfavorable outcome, assessed using the modified Rankin Scale (mRS), 3–6. A nomogram was generated based on a multivariable logistic model. We used the area under the receiver-operating characteristic curve to evaluate the discriminative performance and used the calibration curve and Spiegelhalter’s Z-test to assess the calibration performance of the risk prediction model. Results In our visual nomogram, gender (odds ratio [OR], 3.40; 95%CI, 1.54–7.54), collateral circulation (OR, 0.46; 95%CI, 0.28–0.76), postoperative mTICI (OR, 0.06; 95%CI, 0.01–0.50), stroke-associated pneumonia (OR, 5.76; 95%CI, 2.79–11.87), preoperative Na (OR, 0.82; 95%CI, 0.72–0.92) and creatinine (OR, 1.02; 95%CI, 1.01–1.03) remained independent predictors of 3-month unfavorable outcomes in stroke patients treated with MT. The area under the nomogram curve was 0.8791 with good calibration performance (P = 0.873 for the Spiegelhalter’s Z-test). Conclusions A novel nomogram consisting of gender, collateral circulation, postoperative mTICI, stroke-associated pneumonia, preoperative Na and creatinine can predict the 3-month unfavorable outcomes in stroke patients treated with MT. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02633-1.
Collapse
Affiliation(s)
- Xiao-Guang Zhang
- Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Jia-Hui Wang
- Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Wen-Hao Yang
- Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Xiao-Qiong Zhu
- Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Jie Xue
- Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Zhi-Zhang Li
- Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Yu-Ming Kong
- Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Liang Hu
- Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Shan-Shan Jiang
- Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Xu-Shen Xu
- Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University, 200092, Shanghai, China.
| | - Yun-Hua Yue
- Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University, 200092, Shanghai, China.
| |
Collapse
|
13
|
Mehta AM, Fifi JT, Shoirah H, Shigematsu T, Oxley TJ, Kellner CP, Leacy RD, Mocco J, Majidi S. Racial and Socioeconomic Disparities in the Use and Outcomes of Endovascular Thrombectomy for Acute Ischemic Stroke. AJNR Am J Neuroradiol 2021; 42:1576-1583. [PMID: 34353781 DOI: 10.3174/ajnr.a7217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/26/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Racial and socioeconomic disparities in the incidence, treatment, and outcomes of acute ischemic stroke exist and have been described. We aimed to characterize disparities in the use of endovascular thrombectomy in a nationally representative analysis. MATERIALS AND METHODS Discharge data from the Nationwide Inpatient Sample between 2006 and 2016 were queried using validated International Classification of Disease codes. Patients admitted to US hospitals with acute ischemic stroke were included and stratified on the basis of race, income, and primary payer. Trends in endovascular thrombectomy use, good outcome (discharge to home/acute rehabilitation), and poor outcome (discharge to skilled nursing facility, hospice, in-hospital mortality) were studied using univariate and multivariable analyses. RESULTS In this analysis of 1,322,162 patients, endovascular thrombectomy use increased from 53/111,829 (0.05%) to 3054/146,650 (2.08%) between 2006 and 2016, respectively. Less increase was observed in black patients from 4/12,733 (0.03%) to 401/23,836 (1.68%) and those in the lowest income quartile from 10/819 (0.03%) to 819/44,984 (1.49%). Greater increase was observed in the highest income quartile from 18/22,138 (0.08%) to 669/27,991 (2.39%). Black race predicted less endovascular thrombectomy use (OR = 0.79; 95% CI, 0.72-0.86). The highest income group predicted endovascular thrombectomy use (OR = 1.24; 95% CI, 1.13-1.36) as did private insurance (OR = 1.30; 95% CI, 1.23-1.38). High income predicted good outcome (OR = 1.10; 95% CI. 1.06-1.14), as did private insurance (OR = 1.36; 95% CI, 1.31-1.39). Black race predicted poor outcome (OR = 1.33; 95% CI, 1.30-1.36). All results were statistically significant (P < .01). CONCLUSIONS Despite a widespread increase in endovascular thrombectomy use, black and low-income patients may be less likely to receive endovascular thrombectomy. Future effort should attempt to better understand the causes of these disparities and develop strategies to ensure equitable access to potentially life-saving treatment.
Collapse
Affiliation(s)
- A M Mehta
- From the Department of Neurosurgery (A.M.M., J.T.F., H.S., T.S., T.J.O., C.P.K., R.D.L., J.M., S.M.), Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Neurology (A.M.M.), Columbia University, New York, New York
| | - J T Fifi
- From the Department of Neurosurgery (A.M.M., J.T.F., H.S., T.S., T.J.O., C.P.K., R.D.L., J.M., S.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - H Shoirah
- From the Department of Neurosurgery (A.M.M., J.T.F., H.S., T.S., T.J.O., C.P.K., R.D.L., J.M., S.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - T Shigematsu
- From the Department of Neurosurgery (A.M.M., J.T.F., H.S., T.S., T.J.O., C.P.K., R.D.L., J.M., S.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - T J Oxley
- From the Department of Neurosurgery (A.M.M., J.T.F., H.S., T.S., T.J.O., C.P.K., R.D.L., J.M., S.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - C P Kellner
- From the Department of Neurosurgery (A.M.M., J.T.F., H.S., T.S., T.J.O., C.P.K., R.D.L., J.M., S.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - R De Leacy
- From the Department of Neurosurgery (A.M.M., J.T.F., H.S., T.S., T.J.O., C.P.K., R.D.L., J.M., S.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - J Mocco
- From the Department of Neurosurgery (A.M.M., J.T.F., H.S., T.S., T.J.O., C.P.K., R.D.L., J.M., S.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - S Majidi
- From the Department of Neurosurgery (A.M.M., J.T.F., H.S., T.S., T.J.O., C.P.K., R.D.L., J.M., S.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
14
|
Branyan TE, Sohrabji F. Sex differences in stroke co-morbidities. Exp Neurol 2020; 332:113384. [PMID: 32585156 PMCID: PMC7418167 DOI: 10.1016/j.expneurol.2020.113384] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/06/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022]
Abstract
Males and females possess distinct biological differences that manifest in diverse risk profiles for acute and chronic diseases. A well-documented example of this is ischemic stroke. It has been demonstrated that older females have greater prevalence of, and worse outcome after, ischemic stroke than do males and younger females. Loss of estrogen after menopause is heavily implicated as a contributing factor for this phenomenon; however, there is mounting evidence to suggest that certain risk factors tend to occur more often in older females, such as hypertension and atrial fibrillation, while others more adversely affect females than they do males, such as diabetes and smoking. Sex-specific risk factors, such as oral contraceptive use and menopause, could also contribute to the discrepancy in stroke prevalence and outcome. Additionally, there is evidence to suggest that females tend to present with more nontraditional symptoms of acute stroke than do males, making it more difficult for clinicians to correctly identify the occurrence of a stroke, which may delay the administration of thrombolytic intervention. Finally, certain sociodemographic factors, such as the fact that females were more likely to live alone prior to stroke, may contribute to poorer recovery in females. This review will explore the various co-morbidities and sociodemographic factors that contribute to the greater prevalence of and poorer outcome after stroke in older females and will highlight the critical need for considering sex as a predisposing biological variable in stroke studies.
Collapse
Affiliation(s)
- Taylor E Branyan
- Women's Health in Neuroscience Program, Department of Neuroscience and Experimental Therapeutics, Texas A&M HSC College of Medicine, Bryan, TX 77807, USA; Texas A&M Institute for Neuroscience, College Station, TX 77840, USA
| | - Farida Sohrabji
- Women's Health in Neuroscience Program, Department of Neuroscience and Experimental Therapeutics, Texas A&M HSC College of Medicine, Bryan, TX 77807, USA; Texas A&M Institute for Neuroscience, College Station, TX 77840, USA.
| |
Collapse
|
15
|
Arrarte Terreros N, Tolhuisen ML, Bennink E, de Jong HW, Beenen LF, Majoie CB, van Bavel E, Marquering HA. From perviousness to permeability, modelling and measuring intra-thrombus flow in acute ischemic stroke. J Biomech 2020; 111:110001. [DOI: 10.1016/j.jbiomech.2020.110001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
|
16
|
Mönch S, Boeckh-Behrens T, Maegerlein C, Berndt M, Wunderlich S, Zimmer C, Friedrich B. Mechanical Thrombectomy of the Middle Cerebral Artery - Neither Segment nor Diameter Matter. J Stroke Cerebrovasc Dis 2019; 29:104542. [PMID: 31836359 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/08/2019] [Accepted: 11/15/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore the role of the vessel diameter at the site of middle cerebral artery (MCA) occlusion in acute ischemic stroke patients who underwent mechanical thrombectomy (MT) regarding technical aspects, safety, and clinical outcomes. METHODS In a retrospective analysis, cerebral artery diameters were measured using digital subtraction angiography in patients with isolated M1 or M2 occlusions undergoing MT. Associations between occluded vessel, occlusion diameter and outcomes were analyzed using logistic regression models adjusting for prespecified prognostic factors. RESULTS 168 patients with M1 occlusions and 98 patients with M2 occlusions who underwent MT were included. Mean vessel diameters at M1 and M2 occlusion sites differed significantly (2.15 +/- .36 1.55 +/- .38, P < .001). Vessel diameters at the occlusion site and occluded vessel segment did not predict good functional outcome (aOR 1.2 CI .28-5.26, P = .659; aOR .84 CI .35-2.03, P = .841) or mortality (aOR .21 CI .04-1.01, P = .215; aOR 1.36 CI .55-3.37, P = .676). No significant differences in successful recanalization, good functional outcome, mortality, procedural complications, and intracranial hemorrhages between M1 and M2 occlusions was observed. CONCLUSIONS In this study no significant effect of the MCA vessel diameter on successful recanalization, good functional outcome, or mortality of acute ischemic stroke patients treated with MT could be detected. However, these findings need to be confirmed in further studies.
Collapse
Affiliation(s)
- Sebastian Mönch
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany.
| | - Tobias Boeckh-Behrens
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany
| | - Maria Berndt
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany
| | - Silke Wunderlich
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany
| |
Collapse
|
17
|
Mönch S, Boeckh-Behrens T, Berndt M, Maegerlein C, Wunderlich S, Zimmer C, Friedrich B. Angiographic Baseline Proximal Thrombus Appearance of M1/M2 Occlusions in Mechanical Thrombectomy. Clin Neuroradiol 2019; 31:189-196. [PMID: 31807811 DOI: 10.1007/s00062-019-00863-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/19/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Analyzing stroke thrombi has proven to be valuable in prognostication and risk stratification of stroke etiology, reperfusion success and outcomes. The aim of this study was to test if the baseline appearance of the proximal thrombus on digital subtraction angiography (DSA) can predict these parameters in acute ischemic stroke patients treated with mechanical thrombectomy. METHODS The appearance of the most proximal part of the thrombus was determined based on DSA. Thrombus perviousness, density, and histology were measured beforehand as described previously. Baseline, technical, and outcome variables were compared using the χ2-test, analysis of variance and the Kruskal-Wallis test. RESULTS A total of 144 stroke patients with M1 and M2 occlusions could be included in this present study. Of the patients 60.4% had a cutoff, 27.1% a tapered, and 12.5% a meniscus/tram-track appearance of the thrombus on baseline DSA. The number of maneuvers was higher in the cutoff cohort (P = 0.003). Age (P = 0.777), female sex (P = 0.936), administration of intravenous thrombolysis (P = 0.364), percentage of M1 occlusions (P = 0.194), Alberta Stroke Program early computed tomography score (ASPECTS, P = 0.256), usage of balloon guide catheters (P = 0.367), general anesthesia (P = 0.184), procedure time (P = 0.214) and symptom onset to groin puncture time (P = 0.114) did not significantly differ. Alongside a lower National Institutes of Health scale (NIHSS) score on admission (P = 0.085), good functional outcome was favorable for the meniscus/tram-track cohort (P = 0.030). Stroke etiology according to the trial of Org 10172 in acute stroke treatment (TOAST) criteria as well as thrombus perviousness, density, and histology showed no association with the thrombus appearance. CONCLUSION Baseline cut off thrombus appearance predicts a higher number of thrombectomy maneuvers. In day to day practice this may prepare the neurointerventionalist for a more challenging endovascular procedure ahead. Stroke etiology, clinical outcomes and thrombus-specific characteristics did not show any associations with the thrombus appearance.
Collapse
Affiliation(s)
- Sebastian Mönch
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Tobias Boeckh-Behrens
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Maria Berndt
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Silke Wunderlich
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
| |
Collapse
|
18
|
Madsen TE, DeCroce-Movson E, Hemendinger M, McTaggart RA, Yaghi S, Cutting S, Furie KL, Saad A, Siket MS, Jayaraman MV. Sex differences in 90-day outcomes after mechanical thrombectomy for acute ischemic stroke. J Neurointerv Surg 2018; 11:221-225. [DOI: 10.1136/neurintsurg-2018-014050] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 11/03/2022]
Abstract
BackgroundIt is largely unknown whether functional outcomes after mechanical thrombectomy for large vessel occlusion (LVO) ischemic strokes differ by sex in non-clinical trial populations. We investigated sex differences in 90-day outcomes among ischemic stroke patients receiving mechanical thrombectomy.MethodsThis was a prospective cohort of adults treated with mechanical thrombectomy for LVO at a single academic comprehensive stroke center from July 2015 to April 2017. Data on independence (mRS ≤2) at hospital discharge and 90 days were collected prospectively. Multiple logistic regression was used to determine the association between sex and 90-day independence, first adjusting for demographics, pre-stroke mRS, and NIHSS, then by co-morbidities and time to thrombectomy, and finally by vessel recanalization and use of intravenous thrombolysis.ResultsWe included 279 patients, 52% of whom were female. Compared with males, females were older (median years (IQR) 81 (75–88) vs. 71.5 (60–81), P<0.001) and had higher baseline NIHSS (mean SD 18.2±7.5 vs . 16.0±7.1, P=0.02). Similar proportions of males and females had pre-stroke mRS ≤2 (73.3% vs.67.1%, P=0.27). In multivariate analyses, males and females had a similar likelihood of being independent at discharge (aOR 0.71 (95%CI 0.32 to 1.58)), but females were less likely to be independent at 90 days (aOR 0.37 95% CI 0.16 to 0.87).ConclusionsIn patients treated with mechanical thrombectomy for LVOs at a large comprehensive stroke center, females were less likely to be independent at 90 days. Future research should investigate contributors to poor outcomes post-discharge in females with LVOs, along with potential interventions to improve outcomes.
Collapse
|