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Brissette V, Roy DC, Jamal M, Fahmy M, Guenego A, Fahed J, Shamy M, Dowlatshahi D, Fahed R. Benefits of First Pass Recanalization in Basilar Strokes Based on Initial Clinical Severity. Clin Neuroradiol 2024; 34:555-562. [PMID: 38386052 DOI: 10.1007/s00062-024-01392-5] [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: 10/11/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Randomized trials demonstrating the benefits of thrombectomy for basilar artery occlusions have enrolled an insufficient number of patients with a National Institutes for Health Stroke Scale (NIHSS) score < 10 and shown discrepant results for patients with an NIHSS > 20. Achieving a first pass recanalization (FPR) improves clinical outcomes in stroke. We aimed to evaluate the effect of the FPR on outcomes among basilar artery occlusion patients, characterized by prethrombectomy initial NIHSS score. METHODS We retrospectively analyzed the Endovascular Treatment in Ischemic Stroke (ETIS) registry of 279 basilar artery occlusion patients treated with thrombectomy from 6 participating centers. We compared the 90-day clinical outcomes of achieving a FPR versus no FPR, categorized by initial clinical severity: mild (NIHSS < 10), moderate (NIHSS 10-20) and severe (NIHSS > 20). We used Poisson regression with robust error variance to determine the effect of the NIHSS score on the association between FPR and outcomes. RESULTS The FPR patients with NIHSS < 10 or NIHSS 10-20 were more likely to have a favorable clinical outcome (modified Rankin scale, mRS 0-3) than non-FPR patients (relative risk, RR = 1.32, 95% confidence interval, CI: 1.04, 1.66, p-value = 0.0213, and RR = 1.79, 95% CI: 1.26, 2.53, p-value = 0.0011, respectively). A similar benefit was not found in patients with severe symptoms. We found a significantly lower risk of poor clinical outcome (mRS 4-6) in FPR patients with NIHSS 10-20, but not among patients with an NIHSS > 20. CONCLUSION Achieving a FPR in basilar artery occlusion patients with mild (NIHSS < 10) or moderate (NIHSS 10-20) symptoms is associated with better clinical outcomes, but not in patients with severe symptoms. These results support the importance of further clinical trials on the benefits of thrombectomy in severe strokes.
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Affiliation(s)
- Vincent Brissette
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Danielle Carole Roy
- School of Epidemiology and Public Health, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Mobin Jamal
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Maria Fahmy
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Adrien Guenego
- Interventional Neuroradiology, Erasme Hospital, Brussels, Belgium
| | - Joud Fahed
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michel Shamy
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Robert Fahed
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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Vandelanotte S, Staessens S, François O, De Wilde M, Desender L, De Sloovere AS, Dewaele T, Tersteeg C, Vanhoorelbeke K, Vanacker P, Andersson T, De Meyer SF. Association between thrombus composition and first-pass recanalization after thrombectomy in acute ischemic stroke. J Thromb Haemost 2024; 22:2555-2561. [PMID: 38897388 DOI: 10.1016/j.jtha.2024.05.034] [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: 04/10/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Achieving first-pass recanalization (FPR) has become the primary procedural objective during thrombectomy in acute ischemic stroke patients as it correlates with the best clinical outcome. Understanding factors contributing to FPR failures is essential to enhance FPR success rates. As the central target of thrombectomy, the thrombus itself may be a significant factor influencing FPR. OBJECTIVES This study aimed to investigate the association between thrombus composition and FPR success rates. METHODS In total, thrombi from 267 ischemic stroke patients were collected in the AZ Groeninge Hospital (Kortrijk, Belgium). Thrombus composition was determined via detailed histologic analysis of red blood cells (RBCs), fibrin, von Willebrand factor, platelets, leukocytes, citrullinated histone 3 (marker for neutrophil extracellular traps), and intracellular and extracellular DNA. FPR was defined as obtaining a modified thrombolysis in cerebral infarction (mTICI) score of 2c/3 after the first pass. RESULTS An mTICI score of 2c/3 was obtained in 180 patients, which was achieved via a successful FPR procedure in 126 cases or after multiple passes in 54 cases. Interestingly, thrombi from FPR cases had a different composition from thrombi that needed multiple passes to obtain an mTICI score of 2c/3. FPR thrombi contained significantly more RBCs (P = .0264), less fibrin (P = .0196), and less extracellular DNA (P = .0457). CONCLUSION Our results indicate that thrombi characterized by lower RBC content, higher fibrin levels, and increased extracellular DNA are less likely to result in an FPR. These results are important to guide future research aiming at improving procedures or technologies to obtain FPR rates in RBC-poor thrombi.
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Affiliation(s)
| | - Senna Staessens
- Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium
| | | | - Maaike De Wilde
- Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium
| | - Linda Desender
- Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium
| | | | - Tom Dewaele
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium
| | | | - Peter Vanacker
- Department of Neurology, AZ Groeninge, Kortrijk, Belgium; Department of Neurology, University Hospitals Antwerp, Antwerp, Belgium; Department of Translational Neuroscience, University of Antwerp, Antwerp, Belgium
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium.
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McKenzie ED, Chaturvedi S, Peters SR. Basilar artery stenting in hyperacute stroke: A systematic review of published cases. Clin Neurol Neurosurg 2024; 242:108327. [PMID: 38761504 DOI: 10.1016/j.clineuro.2024.108327] [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: 07/13/2023] [Revised: 04/10/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND AND PURPOSE Basilar artery stenting is a rescue therapy in the management of hyperacute stroke. Published data on efficacy and safety are limited. METHODS A systematic review of published studies was performed in accordance with PRISMA guidelines. Inclusion criteria were adult patients with ischemic stroke with permanent basilar artery stent placement within 48 h of onset. Data were extracted by two independent reviewers. Additional cases from our institution were identified via a local stroke registry. RESULTS Of 212 screened articles, patient-level data was reported in 35 studies (87 individuals) and six additional patients were included from our registry. Patients (n = 93, 63 % male; median age 64) most often presented with mid-basilar occlusion (52 %) and 76 % received treatment within 12 hours of onset. Favorable angiographic results occurred in 67 %. The final modified Rankin Scale score (mRS) was 0-3 for 56 % of patients; mortality was 29 %. Those with complete flow post-procedure were more likely to have a final mRS of 0-3 (p = 0.05). CONCLUSIONS In 93 cases of basilar stenting in hyperacute stroke, favourable angiographic and functional outcomes were reported in 67 % and 56 % of patients, respectively. International multicenter registries are required to establish benefit and identify patient and technical factors that predict favorable outcomes.
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Affiliation(s)
- Erica D McKenzie
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Surbhi Chaturvedi
- Department of Neuroscience, Specialist Hospital, Bengaluru, Karnataka, India
| | - Steven R Peters
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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4
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Zheng H, Zhai Y, Cao W, Zhang Q, Bai X, Gao J, Kang M, Liu Y, Guo Y, Lu G, Xu X, Wen C. First pass effect in patients undergoing endovascular treatment for posterior circulation acute ischemic stroke. J Stroke Cerebrovasc Dis 2024; 33:107640. [PMID: 38387760 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107640] [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: 12/11/2023] [Revised: 01/12/2024] [Accepted: 02/18/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE This study aims to investigate the impact of first pass effect (FPE) on outcomes in the posterior circulation acute ischemic stroke (PC-AIS) and the independent predictors of FPE. METHODS This was a multicenter, retrospective study. PC-AIS patients who underwent endovascular treatment were reviewed. The cohort achieving complete or nearly complete reperfusion (defined as expanded treatment in cerebralischemia [eTICI] ≥ 2c) was categorized into the FPE and multiple pass effect (MPE) groups. FPE was defined as achieving eTICI ≥ 2c with a single pass and without the use of rescue therapy. Modified FPE (mFPE) was defined as meeting the criteria for FPE but with eTICI ≥ 2b. The association of FPE with 90-day clinical outcomes and predictors for FPE were both investigated. RESULTS The study included a total of 328 patients, with 69 patients (21 %) in the FPE group. For primary outcome, FPE had a significant higher favorable outcome (mRS ≤ 3) rate than MPE (65.2 % vs. 44.8 %, p = 0.003). Similar outcomes were observed in the mFPE. Furthermore, FPE was significantly associated with favorable outcome (adjusted OR 2.23, 95 % CI 1.06-4.73, p = 0.036). Positive predictors for FPE included occlusion in the distal basilar artery, the first-line aspiration or combination, and cardioembolic etiology. Negative predictors for FPE included hypertension and general anesthesia. CONCLUSION For PC-AIS patients due to large or medium vessel occlusion, FPE is associated with favorable clinical outcomes. The first-line techniques of aspiration or combination, as well as avoiding general anesthesia, contribute to a better realization of FPE.
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Affiliation(s)
- Haocun Zheng
- Nanyang Central Hospital of Xinxiang Medical University, Nanyang 473000, China
| | - Yuting Zhai
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China
| | - Wenbo Cao
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Zhang
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China
| | - Xuesong Bai
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jun Gao
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China
| | - Meijuan Kang
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China
| | - Yifeng Liu
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China
| | - Yuanzhan Guo
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China
| | - Guangdong Lu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinjuan Xu
- Department of Neurosurgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University and Shanxi Cardiovascular Hospital (Institute), Taiyuan, 030000, Shanxi, China
| | - Changming Wen
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China.
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5
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Sun D, Huo X, Raynald, Jia B, Tong X, Wang A, Ma N, Gao F, Mo D, Miao Z. First pass effect of mechanical thrombectomy for acute vertebrobasilar artery occlusion: data from the ANGEL-ACT registry. J Neurointerv Surg 2023; 15:1201-1206. [PMID: 36725361 DOI: 10.1136/jnis-2023-020065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND To explore the incidence, predictors, and association of first pass effect (FPE) on clinical outcomes of mechanical thrombectomy (MT) for acute vertebrobasilar artery occlusion (VBAO) in the Asian population. METHODS We selected patients from the ANGEL-ACT registry. We defined FPE as complete recanalization after one MT attempt without rescue treatment, multiple pass effect (MPE) as complete recanalization after >1 MT attempt or after one MT attempt with rescue treatment, and incomplete recanalization (ICR) as a modified Thrombolysis in Cerebral Ischemia score of 2b, independent of the number of MT attempts. We conducted multivariable logistic analyses to identify the independent predictors of FPE and to compare the outcomes, including favorable outcome, mortality within 90 days, and intracranial hemorrhage (ICH) among the FPE, MPE, and ICR groups. RESULTS Two hundred and seventy-nine patients, 68 with FPE (24.4%), 114 with MPE (40.9%), and 83 with ICR (29.7%), were included. Underlying intracranial atherosclerosis disease (ICAD) (adjusted OR (aOR) 0.16, 95% CI 0.08 to 0.34, P<0.001) was independently associated with a low chance of FPE. Furthermore, FPE was associated with a favorable outcome compared with MPE and ICR (MPE vs FPE, aOR 0.49, 95% CI 0.25 to 0.97, P=0.040; ICR vs FPE, aOR 0.38, 95% CI 0.18 to 0.81, P=0.012), and decreased mortality (MPE vs FPE, aOR 2.57, 95% CI 1.04 to 6.36, P=0.041) compared with MPE but similar mortality to ICR (P=0.374). No difference was found for ICH among the three groups (P>0.05). CONCLUSIONS FPE occurred in 24.4% of patients with VBAO in our cohort, which was associated with improved clinical outcomes compared with MPE and ICR. VBAO with underlying ICAD was less likely to achieve FPE. TRIAL REGISTRATION NUMBER NCT03370939.
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Affiliation(s)
- Dapeng Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Raynald
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - BaiXue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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6
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van Voorst H, Bruggeman AAE, Yang W, Andriessen J, Welberg E, Dutra BG, Konduri PR, Arrarte Terreros N, Hoving JW, Tolhuisen ML, Kappelhof M, Brouwer J, Boodt N, van Kranendonk KR, Koopman MS, Hund HM, Krietemeijer M, van Zwam WH, van Beusekom HMM, van der Lugt A, Emmer BJ, Marquering HA, Roos YBWEM, Caan MWA, Majoie CBLM. Thrombus radiomics in patients with anterior circulation acute ischemic stroke undergoing endovascular treatment. J Neurointerv Surg 2023; 15:e79-e85. [PMID: 35882552 DOI: 10.1136/jnis-2022-019085] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/10/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Thrombus radiomics (TR) describe complex shape and textural thrombus imaging features. We aimed to study the relationship of TR extracted from non-contrast CT with procedural and functional outcome in endovascular-treated patients with acute ischemic stroke. METHODS Thrombi were segmented on thin-slice non-contrast CT (≤1 mm) from 699 patients included in the MR CLEAN Registry. In a pilot study, we selected 51 TR with consistent values across two raters' segmentations (ICC >0.75). Random forest models using TR in addition or as a substitute to baseline clinical variables (CV) and manual thrombus measurements (MTM) were trained with 499 patients and evaluated on 200 patients for predicting successful reperfusion (extended Thrombolysis in Cerebral Ischemia (eTICI) ≥2B), first attempt reperfusion, reperfusion within three attempts, and functional independence (modified Rankin Scale (mRS) ≤2). Three texture and shape features were selected based on feature importance and related to eTICI ≥2B, number of attempts to eTICI ≥2B, and 90-day mRS with ordinal logistic regression. RESULTS Random forest models using TR, CV or MTM had comparable predictive performance. Thrombus texture (inverse difference moment normalized) was independently associated with reperfusion (adjusted common OR (acOR) 0.85, 95% CI 0.72 to 0.99). Thrombus volume and texture were also independently associated with the number of attempts to successful reperfusion (acOR 1.36, 95% CI 1.03 to 1.88 and acOR 1.24, 95% CI 1.04 to 1.49). CONCLUSIONS TR describing thrombus volume and texture were associated with more attempts to successful reperfusion. Compared with models using CV and MTM, TR had no added value for predicting procedural and functional outcome.
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Affiliation(s)
- Henk van Voorst
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Agnetha A E Bruggeman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Wenjin Yang
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Neurosurgery, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Jurr Andriessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Elise Welberg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Bruna G Dutra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Praneeta R Konduri
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Nerea Arrarte Terreros
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Jan W Hoving
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Manon L Tolhuisen
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Manon Kappelhof
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Josje Brouwer
- Department of Neurology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Nikki Boodt
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Katinka R van Kranendonk
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Miou S Koopman
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Hajo M Hund
- Department of Radiology and Nuclear Medicine, Haaglanden Medical Center Bronovo, Den Haag, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Menno Krietemeijer
- Department of Radiology and Nuclear Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Matthan W A Caan
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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7
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Guo C, Song J, Li L, Yang J, Huang J, Xie D, Yue C, Kong W, Luo W, Liu S, Wang X, Peng Z, Fan S, Xie Y, Alawieh AM, Spiotta AM, Li F, Zi W. Association of Procedure Time With Clinical and Procedural Outcome in Patients With Basilar Occlusion Undergoing Embolectomy. Neurology 2023; 101:e253-e266. [PMID: 37202165 PMCID: PMC10382271 DOI: 10.1212/wnl.0000000000207395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/23/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previous studies have demonstrated the association between the procedure time (PT) and outcomes for patients with proximal large vessel occlusion; however, whether the relationship remains for patients with acute basilar artery occlusion (ABAO) was not clear. We aimed to characterize the association between PT and other procedure-related variables on clinical outcomes among patients with ABAO who underwent endovascular treatment (EVT). METHODS Patients with ABAO who underwent EVT with a documented PT in the EVT for Acute Basilar Artery Occlusion (BASILAR) study from January 2014 to May 2019 among 47 comprehensive centers in China were included. Multivariable analysis was performed to reveal the association between PT and 90-day modified Rankin Scale score, mortality, complications, and all-cause death at 1 year. RESULTS Of the 829 patients from the BASILAR registry, 633 eligible patients were included. Longer PT were associated with a lower rate of favorable outcome (by 30 minutes, adjusted OR 0.82 [95% CI 0.72-0.93], p = 0.01). In addition, a PT ≤ 75 minutes was associated with a favorable outcome (adjusted OR 2.03 [95% CI 1.26-3.28]). The risk of complications and mortality increased by 0.5% and 1.5% with every 10 minutes increase in PT, respectively (R2 = 0.64 and R2 = 0.68, p < 0.01). The cumulative rates of favorable outcomes and successful recanalization plateaued after 120 minutes (2 attempts). Restricted cubic spline regression analysis for the probability of favorable outcomes had an L-shape association (p nonlinearity = 0.01) with PT with significant benefit loss before 120 minutes and then appeared relatively flat. DISCUSSION For patients with ABAO, procedures that exceeded 75 minutes were associated with an increased risk of mortality and lower odds of a favorable outcome. A careful assessment of futility and the risks of continuing the procedure should be made after 120 minutes.
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Affiliation(s)
- Changwei Guo
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Jiaxing Song
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Linyu Li
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Jie Yang
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Jiacheng Huang
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Dongjing Xie
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Chengsong Yue
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Weilin Kong
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Weidong Luo
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Shuai Liu
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Xiaoman Wang
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Zhouzhou Peng
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Shitao Fan
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Yuqian Xie
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Ali Mostafa Alawieh
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Alejandro M Spiotta
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Fengli Li
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Wenjie Zi
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston.
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8
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Bruggeman AAE, Kappelhof M, den Hartog SJ, Burke JF, Berkhemer OA, van Es ACGM, van Zwam WH, Dippel DWJ, Coutinho JM, Marquering HA, Majoie CBLM, Emmer BJ. Successful reperfusion in relation to the number of passes: comparing outcomes of first pass expanded Treatment In Cerebral Ischemia (eTICI) 2B with multiple-pass eTICI 3. J Neurointerv Surg 2023; 15:120-126. [PMID: 35086964 DOI: 10.1136/neurintsurg-2021-018465] [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: 11/18/2021] [Accepted: 01/13/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Higher expanded Treatment In Cerebral Ischemia (eTICI) reperfusion scores after endovascular treatment (EVT) are associated with better outcomes. However, the influence of the number of passes on this association is unclear. We aimed to compare outcomes of single-pass good reperfusion (eTICI 2B) with multiple-pass excellent/complete reperfusion (eTICI 2C/3) in daily clinical practice. METHODS We compared outcomes of patients in the MR CLEAN Registry with good reperfusion (eTICI 2B) in a single pass to those with excellent/complete reperfusion (eTICI 2C/3) in multiple passes. Regression models were used to investigate the association of single-pass eTICI 2B versus multiple-pass eTICI 2C/3 reperfusion with 90-day functional outcome (modified Rankin Scale (mRS)), functional independence (mRS 0-2), per-procedural complications and safety outcomes. RESULTS We included 699 patients: 178 patients with single-pass eTICI 2B, and 242 and 279 patients with eTICI 2C/3 after 2 and ≥3 passes, respectively. Patients with eTICI 2C/3 after 2 or ≥3 passes did not achieve significantly better functional outcomes compared with patients with single-pass eTICI 2B (adjusted common OR (acOR) 1.06, 95% CI 0.75 to 1.50 and acOR 0.88, 95% CI 0.74 to 1.05 for 90-day mRS, and adjusted OR (aOR) 1.24, 95% CI 0.78 to 1.97 and aOR 0.79, 95% CI 0.52 to 1.22 for functional independence). CONCLUSIONS Our results did not show better outcomes for patients who achieved eTICI 2C/3 in multiple, that is, two or more, passes when compared with patients with single-pass eTICI 2B. However, this concerns observational data. Further research is necessary to investigate the per-pass effect in relation to reperfusion and functional outcome.
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Affiliation(s)
- Agnetha A E Bruggeman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne J den Hartog
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - James F Burke
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Olvert A Berkhemer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Adriaan C G M van Es
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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9
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Hafeez MU, Essibayi MA, Raper D, Tanweer O, Sattur M, Al-Kasab S, Burks J, Townsend R, Alsbrook D, Dumont T, Park MS, Goyal N, Arthur AS, Maier I, Mascitelli J, Starke R, Wolfe S, Fargen K, Spiotta A, Kan PT. Predictors and outcomes of first pass efficacy in posterior circulation strokes: Insights from STAR collaboration. Interv Neuroradiol 2022:15910199221149080. [PMID: 36579794 DOI: 10.1177/15910199221149080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: First-pass efficacy (FPE) has been established as an important predictor of favorable functional outcomes after endovascular thrombectomy (ET) in anterior circulation strokes. In this retrospective cohort study, we investigate predictors and clinical outcomes of FPE in posterior circulation strokes (pcAIS). Methods: The Stroke Thrombectomy and Aneurysm Registry database was used to identify pcAIS patients who achieved FPE. Their baseline characteristics and outcomes were compared with the non-FPE group. The primary outcome was a 90-day modified Rankin Scale (mRS) of 0-3. Univariate (UVA) and multivariate (MVA) analyses were done to evaluate predictors of FPE. Safety outcomes included distal emboli, vessel rupture, symptomatic intracranial hemorrhage, and mortality. Results: Of 359 patients, 179 (50%) achieved FPE. Clot burden, occlusion site, and ET technique-related variables were similar between the two groups except for shorter procedure time with FPE. The primary outcome was significantly better with FPE (56.4% vs. 32.8%, p < 0.001). Complications were similar except for a higher rate of distal emboli in non-FPE group (11.1% vs. 3.2%, p = 0.032). Atrial fibrillation (Afib) had increased odds (aOR: 2.06, 95% CI; 1.24, 3.4, p = 0.005) and prior ischemic stroke had decreased odds (aOR: 0.524, 95% CI; 0.28, 0.97, p = 0.04) of FPE. Afib was the only independent predictor of FPE on MVA (1.94, 95% CI; 1.1, 3.43, p = 0.022). Conclusions: Higher rate of FPE in Afib-related pcAIS could possibly be explained by the differences in clot composition and degree of in-situ atherosclerotic disease burden. Future studies are warranted to explore the relationship of clot composition with ET outcomes.
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Affiliation(s)
- Muhammad U Hafeez
- Department of Neurology, 3989Baylor College of Medicine, Houston, TX, USA
| | - Muhammed A Essibayi
- Department of Neurosurgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Daniel Raper
- Department of Neurosurgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Omar Tanweer
- Department of Neurosurgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Mithun Sattur
- Department of Neurosurgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Sami Al-Kasab
- Department of Neurosurgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Joshua Burks
- Department of Neurosurgery, University of Miami Health System, Miami, FL, USA
| | - Robert Townsend
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Diana Alsbrook
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Travis Dumont
- Department of Neurosurgery, University of Arizona, Tuscon, AZ, USA
| | - Min S Park
- Department of Neurosurgery, 2358University of Virginia, Charlottesville, VA, USA
| | - Nitin Goyal
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ilko Maier
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Justin Mascitelli
- Department of Neurosurgery, 14742University of Texas Health Science Center, San Antonio, TX, USA
| | - Robert Starke
- Department of Neurosurgery, University of Miami Health System, Miami, FL, USA
| | - Stacey Wolfe
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kyle Fargen
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alejandro Spiotta
- Department of Neurosurgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Peter T Kan
- Department of Neurosurgery, 12338University of Texas Medical Branch, Galveston, TX, USA
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10
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Huang X, Chen C, Li M, Duan Z, Ji Y, Wu K, Xu J, Xiao L, Xu P, Sun W. First-pass effect in patients with acute vertebrobasilar artery occlusion undergoing thrombectomy: insights from the PERSIST registry. Ther Adv Neurol Disord 2022; 15:17562864221139595. [PMID: 36452411 PMCID: PMC9703483 DOI: 10.1177/17562864221139595] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/01/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Achieving rapid and complete vascular recanalization in patients with acute large vessel occlusion can significantly improve patients' prognosis. OBJECTIVE We aimed to investigate the potential contribution of the first-pass effect (FPE) to the clinical outcome of patients with acute vertebrobasilar artery occlusion (VBAO). METHODS We retrospectively analyzed the data of patients who underwent endovascular thrombectomy (EVT) caused by VBAO in a multicentered retrospective registry dataset. FPE was defined as successful recanalization [modified thrombolysis in cerebral infarction (mTICI) 2b/3 as modified FPE (mFPE); mTICI 3 as true FPE (tFPE)] after one pass of the device without rescue therapy. The baseline characteristics and procedural and clinical outcomes were analyzed. Multivariate analysis was used to explore the predictors of FPE and the relationship between FPE and 90-day prognosis. RESULTS A total of 508 patients (age, 63.7 ± 13.1 years, male, 71.6%) were finally included, 29.9% (152/508) of whom achieved mFPE, and 21.1% (107/508) of whom achieved tFPE. FPE was significantly associated with improved clinical outcomes, regardless of mFPE [odds ratio (OR): 0.601, 95% confidence interval (CI): 0.370-0.977, p = 0.040] and tFPE (OR: 0.547, 95% CI: 0.318-0.940, p = 0.029). The use of contact aspiration, favorable collateral status, cardioembolic etiology, and basilar artery occlusion were statistically significant predictors of mFPE and tFPE, whereas hypertension was a negative predictor. Intravenous (IV) recombinant tissue plasminogen activator (rt-PA) prior to EVT was a positive predictor of mFPE but not of tFPE. CONCLUSION FPE was associated with significantly favorable outcomes in EVT patients with VBAO. The predictors of FPE include infarct etiology, the site of occlusion, collateral status, EVT strategies, and IV rt-PA bridging strategies. TRIAL REGISTRATION NUMBER URL: http://www.chictr.org.cn/; Unique identifier: ChiCTR2000033211.
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Affiliation(s)
- Xianjun Huang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Chu Chen
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Min Li
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zuowei Duan
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yachen Ji
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Kangfei Wu
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Junfeng Xu
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Lulu Xiao
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Pengfei Xu
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 26# Jinzhai Road, Hefei 230026, Anhui Province, China
| | - Wen Sun
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 26# Jinzhai Road, Hefei 230026, Anhui Province, China
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11
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de Havenon A, Elhorany M, Boulouis G, Naggara O, Darcourt J, Clarençon F, Richard S, Marnat G, Bourcier R, Sibon I, Arquizan C, Dargazanli C, Maïer B, Seners P, Lapergue B, Consoli A, Eugene F, Vannier S, Caroff J, Denier C, Boulanger M, Gauberti M, Rouchaud A, Macian F, Rosso C, Turc G, Ozkul-Wermester O, Papagiannaki C, Albucher JF, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Fahed R, Finitsis SN, Gory B. Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion. J Neurointerv Surg 2022; 15:422-427. [PMID: 35450929 DOI: 10.1136/neurintsurg-2022-018715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/05/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The number of mechanical thrombectomy (MT) passes is strongly associated with angiographic reperfusion as well as clinical outcomes in patients with anterior circulation ischemic stroke. However, these associations have not been analyzed in patients with basilar artery occlusion (BAO). We investigated the influence of the number of MT passes on the degree of reperfusion and clinical outcomes, and compared outcome after ≤3 passes versus >3 passes. METHODS We used data from the prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry at 18 sites in France. Patients with BAO treated with MT were included. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0-3 at 90 days. We fit mixed multiple regression models, with center as a random effect. RESULTS We included 275 patients. Successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) was achieved in 88.4%, and 41.8% had a favorable outcome. The odds ratio for favorable outcome with each pass above 1 was 0.41 (95% CI 0.23 to 0.73) and for recanalization (mTICI 2b-3) it was 0.70 (95% CI 0.57 to 0.87). In patients with ≤3 passes, the rate of favorable outcome in recanalized versus non-recanalized patients was 50.5% versus 10.0% (p=0.001), while in those with >3 passes it was 16.7% versus 15.2% (p=0.901). CONCLUSIONS We found that BAO patients had a significant relationship between the number of MT passes and both recanalization and favorable functional outcome. We further found that the benefit of recanalization in BAO patients was significant only when recanalization was achieved within three passes, encouraging at least three passes before stopping the procedure.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Mahmoud Elhorany
- Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | | | | | - Frédéric Clarençon
- Sorbonne Université, Paris, France.,Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | | | | | | | - Cyril Dargazanli
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Benjamin Maïer
- Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France
| | - Pierre Seners
- Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France
| | - Bertrand Lapergue
- Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France.,Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | | | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | | | | | | | - Aymeric Rouchaud
- Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France.,Univ. Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | | | - Charlotte Rosso
- Urgences Cérébro-Vasculaires, Pitié-Salpétrière Hospital, Paris, France
| | - Guillaume Turc
- Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | | | | | - Anthony Le Bras
- Department of Radiology, CH Bretagne Atlantique, Vannes, France.,CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
| | - Sarah Evain
- Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
| | - Valerie Wolff
- Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
| | - Raoul Pop
- Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France.,Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
| | - Serge Timsit
- Department of Neurology, CHU Brest, Brest, France
| | | | | | - Louis Veunac
- Department of Radiology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
| | - Robert Fahed
- Medicine - Neurology, Ottawa Hospital, Ottawa, Ontario, Canada.,Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Stephanos Nikolaos Finitsis
- Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Québec, Canada.,Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Québec, Canada
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
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12
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Baik SH, Jung C, Kim BM, Kim DJ. Mechanical thrombectomy for acute posterior cerebral artery stroke; Feasibility and predictors of outcome. Neuroradiology 2022; 64:1419-1427. [PMID: 35133483 DOI: 10.1007/s00234-022-02910-3] [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: 10/05/2021] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE The territorial involvement and the clinical benefit of endovascular therapy (EVT) of the posterior cerebral artery (PCA) occlusion may vary between patients. The purpose of this study was to investigate the feasibility of mechanical thrombectomy (MT) in isolated posterior cerebral artery occlusions (IPCAOs) and the prognostic factors of EVT. METHODS Forty-eight patients with acute PCA occlusion who underwent EVT between Mar 2008 and Apr 2021 from 2 tertiary centers were retrospectively analyzed. Clinical characteristics, imaging and perfusion abnormalities, and angiographic and clinical outcomes were analyzed. Ischemic changes were assessed with the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS). Perfusion abnormalities were assessed using automated software for Tmax volume measurement and identification of Tmax involved in PCA eloquent areas. RESULTS The IPCAO sites were P1 (n = 17) and P2 (n = 31). Overall successful recanalization (mTICI 2b/3) was achieved in 68.8% (33/48) and excellent outcome (90-day mRS 0-1) in 52.1% (25/48) of the patients. Excellent/non-excellent outcome was associated with male sex (p = 0.036), admission NIHSS (p = 0.002), pc-ASPECTS (p = 0.035), Tmax > 6 s involvement of the midbrain-thalamus (p = 0.008), first-line stent-retriever thrombectomy (p = 0.036), complete recanalization (p = 0.009), and modified first pass effect (FPE, p = 0.047). Tmax>6 s involvement of the midbrain-thalamus was an independent predictor for non-excellent outcome on multivariable analysis. CONCLUSION Acute stroke from IPCAO may be successfully treated with EVT. Tmax > 6 s involvement of the midbrain-thalamus on perfusion imaging may be a predictor for clinical outcome.
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Affiliation(s)
- Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Byung Moon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
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Fiehler J, Nawka MT, Meyer L. Persistent challenges in endovascular treatment decision-making for acute ischaemic stroke. Curr Opin Neurol 2022; 35:18-23. [PMID: 34812746 DOI: 10.1097/wco.0000000000001006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Although endovascular treatment (EVT) is the gold standard for treating acute stroke patients with large vessel occlusion (LVO), multiple challenges in decision-making for specific conditions persist. Recent evidence on a selection of patient subgroups will be discussed in this narrative review. RECENT FINDINGS Two randomized controlled trials (RCTs) have been published in EVT of basilar artery occlusion (BAO). Large single arm studies showed promising results in Patients with low Alberta stroke program early CT score (ASPECTS) and more distal vessel occlusions. Recent data confirm patients with low National Institutes of Health Stroke Scale (NIHSS) despite LVO to represent a heterogeneous and challenging patient group. SUMMARY The current evidence does not justify withholding EVT from BAO patients as none of the RCTs showed any signal of superiority of BMT alone vs. EVT. Patients with low ASPECTS, more distal vessel occlusions and patients with low NIHSS scores should be included into RCTs if possible. Without participation in a RCT, patients should be selected for EVT based on age, severity and type of neurological impairment, time since symptom onset, location of the ischaemic lesion and perhaps also results of advanced imaging.
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Affiliation(s)
- Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10. Life (Basel) 2021; 11:life11121423. [PMID: 34947955 PMCID: PMC8703711 DOI: 10.3390/life11121423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Mechanical thrombectomy (MT) is currently the gold standard treatment for ischemic stroke due to large vessel occlusion (LVO). However, the evidence of clinical usefulness of MT in posterior circulation LVO (pc-LVO) is still doubtful compared to the anterior circulation, especially in patients with mild neurological symptoms. The database of 10 high-volume stroke centers in Europe, including a period of three year and a half, was screened for patients with an acute basilar artery occlusion or a single dominant vertebral artery occlusion ("functional" BAO) presenting with a NIHSS ≤10, and with at least 3 months follow-up. A total of 63 patients were included. Multivariate analysis demonstrated that female gender (adjusted OR 0.04; 95% CI 0-0.84; p = 0.04) and combined technique (adj OR 0.001; 95% CI 0-0.81; p = 0.04) were predictors of worse outcome. Higher pc-ASPECTS (adj OR 4.75; 95% CI 1.33-16.94; p = 0.02) and higher Delta NIHSS (adj OR 2.06; 95% CI 1.16-3.65; p = 0.01) were predictors of better outcome. Delta NIHSS was the main predictor of good outcome at 90 days in patients with posterior circulation LVO presenting with NIHSS score ≤ 10.
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