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Elmarawany MN, El Malky I, Winklhofer S, Katan M, Kar S, Baltsavias G. Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke in Cancer Patients: A Single-Center Experience and Meta-Analysis. Neurol Clin Pract 2024; 14:e200320. [PMID: 38868837 PMCID: PMC11165561 DOI: 10.1212/cpj.0000000000200320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 03/11/2024] [Indexed: 06/14/2024]
Abstract
Background and Objectives The published data about mechanical thrombectomy (MT) in cancer patients is sparse. We present our institutional experience in this clinical scenario, and a meta-analysis. Methods The baseline data, procedural data, clinical and radiological outcomes of MT were analyzed and compared among three groups of stroke patients: controls, patients with active malignancy (AM), and patients with history of malignancy (HOM). A meta-analysis of 12 studies was conducted to address the differences between controls and AM patients regarding selected outcomes. Results The 3 groups (controls, AM, HOM) showed significant differences regarding previous history of stroke or TIA (7.8% vs 10.5% vs 38.5%, p = 0.006), alcohol consumption (0.9% vs 10.5% vs 0.0%, p = 0.04), thrombophilia (1.7% vs 15.8% vs 7.7%, p = 0.009), deep venous thrombosis (0.4 vs 26.3% vs 7.7%, p = 0.005). The AM group had significantly higher rates of sICH (3.5% [controls] vs 21.1% [AM] vs 0.0% [HOM], p = 0.007), and mortality at 3 months (27.5% [controls] vs 61.5% [AM] vs 40.0% [HOM] vs, p = 0.032). The control and HOM groups had significantly better functional independence at 3 months (52.1% [controls] vs 15.4% [AM] vs 60.0% [HOM], p = 0.032).In the meta-analysis, the AM arm showed significantly higher mortality during hospitalization (n = 6, OR 95% CI = 3.03 [1.62, 5.64]), and at 3 months (n = 10, OR 95% CI = 4.33 [2.80, 6.68]), and significantly lower rates of 3 months functional independence (mRS = 0-2) (n = 10, OR 95% CI = 0.47 [0.32, 0.70]). No significant difference was found in sICH rates (n = 6, pooled OR 95% CI = 2.03 [0.83, 4.95]). Discussion Endovascular MT is technically successful and reasonably safe in treating AIS from LVO in active malignancy patients. However, the causes and implications of sICH require further investigation. Despite technical success, these patients experience poor clinical outcomes, and the long-term benefits of MT remain uncertain.
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Affiliation(s)
- Mohamed N Elmarawany
- Department of Neuroradiology (MNE, IEM, SW, MK, GB), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Neurosurgery (MNE), Faculty of Medicine, Menoufia University; Department of Neurology (IEM), Faculty of Medicine, South valley University, Egypt; Department of Neurology (MK), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and International Neuroscience Institute (SK, GB), Hannover, Germany
| | - Islam El Malky
- Department of Neuroradiology (MNE, IEM, SW, MK, GB), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Neurosurgery (MNE), Faculty of Medicine, Menoufia University; Department of Neurology (IEM), Faculty of Medicine, South valley University, Egypt; Department of Neurology (MK), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and International Neuroscience Institute (SK, GB), Hannover, Germany
| | - Sebastian Winklhofer
- Department of Neuroradiology (MNE, IEM, SW, MK, GB), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Neurosurgery (MNE), Faculty of Medicine, Menoufia University; Department of Neurology (IEM), Faculty of Medicine, South valley University, Egypt; Department of Neurology (MK), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and International Neuroscience Institute (SK, GB), Hannover, Germany
| | - Mira Katan
- Department of Neuroradiology (MNE, IEM, SW, MK, GB), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Neurosurgery (MNE), Faculty of Medicine, Menoufia University; Department of Neurology (IEM), Faculty of Medicine, South valley University, Egypt; Department of Neurology (MK), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and International Neuroscience Institute (SK, GB), Hannover, Germany
| | - Souvik Kar
- Department of Neuroradiology (MNE, IEM, SW, MK, GB), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Neurosurgery (MNE), Faculty of Medicine, Menoufia University; Department of Neurology (IEM), Faculty of Medicine, South valley University, Egypt; Department of Neurology (MK), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and International Neuroscience Institute (SK, GB), Hannover, Germany
| | - Gerasimos Baltsavias
- Department of Neuroradiology (MNE, IEM, SW, MK, GB), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Neurosurgery (MNE), Faculty of Medicine, Menoufia University; Department of Neurology (IEM), Faculty of Medicine, South valley University, Egypt; Department of Neurology (MK), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and International Neuroscience Institute (SK, GB), Hannover, Germany
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Li J, Zhang J, Li C, Li J, Wu X, Wang S. Nomogram to predict prognosis in patients with posterior circulation acute ischemic stroke after mechanical thrombectomy. Front Neurol 2024; 15:1406882. [PMID: 38903172 PMCID: PMC11188432 DOI: 10.3389/fneur.2024.1406882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024] Open
Abstract
Purpose This study aimed to investigate the risk factors of prognosis and hemorrhagic transformation after mechanical thrombectomy (MT) in patients with posterior circulation acute ischemic stroke (PC-AIS) caused by large vessel occlusion. We sought to develop a nomogram for predicting the risk of poor prognosis and symptomatic intracerebral hemorrhage (sICH) in patients with PC-AIS. Methods A retrospective analysis was conducted on 81 patients with PC-AIS who underwent MT treatment. We collected clinical information from the patients to assessed sICH and prognosis based on CT results and National Institutes of Health Stroke Scale (NIHSS) scores. Subsequently, they were followed up for 3 months, and their prognosis was assessed using the Modified Rankin Scale. We used the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression to determine the factors affecting prognosis to construct a nomogram. The nomogram's performance was assessed through receiver operating characteristic curves, calibration curves, decision curve analysis, and clinical impact curves. Results Among the 81 patients with PC-AIS, 33 had a good prognosis, 48 had a poor prognosis, 19 presented with sICH, and 62 did not present with sICH. The results of the LASSO regression indicated that variables, including HPT, baseline NIHSS score, peak SBP, SBP CV, SBP SD, peak SBP, DBP CV, HbA1c, and BG SD, were predictors of patient prognosis. Variables such as AF, peak SBP, and peak DBP predicted the risk of sICH. Multivariate logistic regression revealed that baseline NIHSS score (OR = 1.115, 95% CI 1.002-1.184), peak SBP (OR = 1.060, 95% CI 1.012-1.111), SBP CV (OR = 1.296, 95% CI 1.036-1.621) and HbA1c (OR = 3.139, 95% CI 1.491-6.609) were independent risk factors for prognosis. AF (OR = 6.823, 95% CI 1.606-28.993), peak SBP (OR = 1.058, 95% CI 1.013-1.105), and peak DBP (OR = 1.160, 95% CI 1.036-1.298) were associated with the risk of sICH. In the following step, nomograms were developed, demonstrating good discrimination, calibration, and clinical applicability. Conclusion We constructed nomograms to predict poor prognosis and risk of sICH in patients with PC-AIS undergoing MT. The model exhibited good discrimination, calibration, and clinical applicability.
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Affiliation(s)
| | | | | | | | | | - Shaoshuai Wang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
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Ni H, Zhao L, Ma X, Lv P, Ding Y, Liu Z, Shi H, Liu S. Technical Risk Stratification Nomogram Model for 90-Day Mortality Prediction in Patients With Acute Basilar Artery Occlusion Undergoing Endovascular Thrombectomy: A Multicenter Cohort Study. J Am Heart Assoc 2024; 13:e032107. [PMID: 38471827 PMCID: PMC11010032 DOI: 10.1161/jaha.123.032107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND This study aimed to establish and validate a nomogram model for predicting 90-day mortality in patients with acute basilar artery occlusion receiving endovascular thrombectomy. METHODS AND RESULTS A total of 242 patients with basilar artery occlusion undergoing endovascular thrombectomy were enrolled in our study, in which 172 patients from 3 stroke centers were assigned to the training cohort, and 70 patients from another center were assigned to the validation cohort. Univariate and multivariate logistic regression analyses were adopted to screen prognostic predictors, and those with significance were subjected to establish a nomogram model in the training cohort. The discriminative accuracy, calibration, and clinical usefulness of the nomogram model was verified in the internal and external cohorts. Six variables, including age, baseline National Institutes of Health Stroke Scale score, Posterior Circulation-Alberta Stroke Program Early CT (Computed Tomography) score, Basilar Artery on Computed Tomography Angiography score, recanalization failure, and symptomatic intracranial hemorrhage, were identified as independent predictors of 90-day mortality of patients with basilar artery occlusion and were subjected to develop a nomogram model. The nomogram model exhibited good discrimination, calibration, and clinical usefulness in both the internal and the external cohorts. Additionally, patients were divided into low-, moderate-, and high-risk groups based on the risk-stratified nomogram model. CONCLUSIONS Our study proposed a novel nomogram model that could effectively predict 90-day mortality of patients with basilar artery occlusion after endovascular thrombectomy and stratify patients with high, moderate, or low risk, which has a potential to facilitate prognostic judgment and clinical management of stroke.
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Affiliation(s)
- Heng Ni
- Department of Interventional RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Linbo Zhao
- Department of Interventional RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Xinghua Ma
- Department of Preventive Medicine, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Penghua Lv
- Department of Interventional RadiologySubei People’s Hospital of Jiangsu ProvinceYangzhouChina
| | - Yasuo Ding
- Department of NeurosurgeryTaizhou People’s HospitalTaizhouChina
| | - Zhensheng Liu
- Department of Interventional RadiologyThe Affiliated Hospital of Yangzhou UniversityYangzhouChina
| | - Haibin Shi
- Department of Interventional RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Sheng Liu
- Department of Interventional RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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Mierzwa AT, Nelson A, Kasab SA, Ortega Gutierrez S, Vivanco-Suarez J, Farooqui M, Jadhav AP, Desai S, Toth G, Alrohimi A, Nguyen TN, Klein P, Abdalkader M, Salahuddin H, Pandey A, Wilseck Z, Koduri S, Vora N, Aladamat N, Gharaibeh K, Afreen E, Al-Hajala H, Shawver J, Zaidi S, Jumaa M. Predictors of outcome and symptomatic intracranial hemorrhage in acute basilar artery occlusions: Analysis of the PC-SEARCH thrombectomy registry. Eur Stroke J 2024:23969873241234713. [PMID: 38403924 DOI: 10.1177/23969873241234713] [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: 02/27/2024] Open
Abstract
INTRODUCTION Recent randomized controlled trials demonstrated superiority of mechanical thrombectomy compared to medical therapy in acute basilar artery occlusions, however, little data is available to guide clinicians in functional prognosis and risk stratification. PATIENTS AND METHODS Data from the retrospectively established PC-SEARCH Thrombectomy registry, which included patients with basilar artery occlusion from eight sites from January 2015 to December 2021, was interrogated. Outcomes were dichotomized into 90-day favorable (mRS ⩽ 3) and unfavorable (mRS > 3). Multivariate logistic regression analysis was performed with respect to the outcome groups and were adjusted for potential confounding baseline characteristics. RESULTS Four-hundred-forty-four patients were included in this analysis. Mean age was 66 [SD 15], with 56% male, and comprised of 76% Caucasian. Patients presented with an initial median NIHSS of 18 and 199 patients (44.8%) achieved favorable 90-day functional outcomes. Independent predictors of favorable outcomes included younger age, pc-ASPECTS > 8 (OR 2.30 p < 0.001), and TICI ⩾ 2b (OR 7.56 p < 0.001). Unfavorable outcomes were associated with increasing number of passes (OR 1.29 p = 0.004) and sICH (OR 4.19 p = 0.015). IA-tPA was an independent risk factor for sICH (OR 7.15 p = 0.002) without improving favorable functional outcomes. CONCLUSION AND DISCUSSION PC-ASPECTS > 8, successful recanalization (TICI ⩾ 2b), first-pass recanalization, and younger age are independent predictors of favorable 90-day functional outcome in thrombectomy treated patients with acute basilar artery occlusion. Conversely, sICH were independent predictors of unfavorable outcomes. IA-tPA and unsuccessful recanalization are independently associated with sICH.
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Affiliation(s)
- Adam T Mierzwa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Ashley Nelson
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Sami Al Kasab
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | - Ashutosh P Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Shashvat Desai
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gabor Toth
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Thanh N Nguyen
- Department of Neurology, Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Piers Klein
- Department of Neurology, Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Mohamad Abdalkader
- Department of Neurology, Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Hisham Salahuddin
- Department of Neurology, Antelope Valley Hospital, Los Angeles, CA, USA
| | - Aditya Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Zachary Wilseck
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Sravanthi Koduri
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Niraj Vora
- Ohio Health Riverside Methodist Hospital, Columbus, OH, USA
| | - Nameer Aladamat
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Khaled Gharaibeh
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Ehad Afreen
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Hisham Al-Hajala
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | | | - Syed Zaidi
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
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Accettone T, Personnic T, Bretzner M, Behal H, Cordonnier C, Henon H, Puy L. Impact of prodromal symptoms on the prognosis of patients with basilar artery occlusion treated with mechanical thrombectomy. Eur Stroke J 2024:23969873241234844. [PMID: 38403919 DOI: 10.1177/23969873241234844] [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: 02/27/2024] Open
Abstract
INTRODUCTION Even with reperfusion therapies, the prognosis of patients with basilar artery occlusion (BAO) related stroke remains poor. We aimed to test the hypothesis that the presence of prodromal symptoms, an easily available anamnestic data, is a key determinant of poor functional outcome. PATIENTS AND METHODS Data from patients with BAO treated in Lille, France, with mechanical thrombectomy (MT) between 2015 and 2021 were prospectively collected. The presence of prodromal symptoms was defined by previous transient neurological deficit or gradual progressive clinical worsening preceding a secondary sudden clinical worsening. We compared the characteristics of patients with and without prodromal symptoms. We built multivariate logistic regression models to study the association between the presence of prodromal symptoms and functional (mRS 0-3 and mortality), and procedural (successful recanalization and early reocclusion) outcomes. RESULTS Among the 180 patients, 63 (35%) had prodromal symptoms, most frequently a vertigo. Large artery atherosclerosis was the predominant cause of stroke (41.3%). The presence of prodromal symptoms was an independent predictor of worse 90-day functional outcome (mRS 0-3: 25.4% vs 47.0%, odds ratio (OR) 0.39; 95% confidence interval (CI) 0.16-0.86) and 90-day mortality (OR 2.17; 95% CI 1.02-4.65). Despite similar successful recanalization rate, the proportion of early basilar artery reocclusion was higher in patients with prodromal symptoms (23.8% vs 5.6%, p = 0.002). DISCUSSION AND CONCLUSION More than one third of BAO patients treated with MT had prodromal symptoms, especially patients with large-artery atherosclerosis. Clinicians should systematically screen for prodromal symptoms given the poor related functional outcome and increased risk of early basilar artery reocclusion.
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Affiliation(s)
- Thomas Accettone
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Thomas Personnic
- Department of Interventional Neuroradiology, Lille University, CHU Lille, Lille, France
| | - Martin Bretzner
- Department of Interventional Neuroradiology, Lille University, CHU Lille, Lille, France
| | - Helene Behal
- Department of Biostatistics, CHU Lille, Lille, France
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Hilde Henon
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Laurent Puy
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
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Bekri I, Finitsis S, Pizzuto S, Maier B, Piotin M, Eker OF, Marnat G, Sibon I, Dargazanli C, Bourcier R, Lapergue B, Pop R, Caroff J, Gory B, Pico F, Consoli A. Endovascular therapy of acute vertebrobasilar occlusions: influence of first-line strategy in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry. J Neurointerv Surg 2024:jnis-2023-021325. [PMID: 38302421 DOI: 10.1136/jnis-2023-021325] [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: 11/29/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The choice of the first-line technique in vertebrobasilar occlusions (VBOs) remains challenging. We aimed to report outcomes in a large cohort of patients and to compare the efficacy and safety of contact aspiration (CA) and combined technique (CoT) as a first-line endovascular technique in patients with acute VBOs. METHODS We retrospectively analyzed clinical and neuroradiological data of patients with VBOs from the prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France between January 2015 and August 2023. The primary outcome was the first pass effect (FPE) rate, whereas modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3 and 2c-3, number of passes, need for rescue strategy, modified Rankin Scale (mRS) 0-2, mortality, and symptomatic intracranial hemorrhage (sICH) were secondary outcomes. We performed univariate and multivariate analyses to investigate differences between the two groups. RESULTS Among the 583 included patients (mean age 66.2 years, median National Institutes of Health Stroke Scale (NIHSS) 13, median posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) 8), 393 were treated with CA alone and 190 with CoT. Procedures performed with CA were shorter compared with CoT (28 vs 47 min, P<0.0001); however, no differences were observed in terms of FPE (CA 43.3% vs CoT 38.4%, P=0.99), and successful final recanalization (mTICI 2b-3, CA 92.4% vs CoT 91.8%, P=0.74) did not differ between the two groups. Functional independence and sICH rates were also similar, whereas mortality was significantly lower in the CA group (34.5% vs 42.9%; OR 1.79, 95% CI 1.03 to 3.11). CONCLUSIONS We observed no differences in FPE, mTICI 2b-3, sICH, and functional independence between the two study groups. First-line CA was associated with shorter procedures and lower mortality rates than CoT.
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Affiliation(s)
- Imen Bekri
- Department of Neurology, Centre Hospitalier de Versailles, Versailles, Île-de-France, France
| | - Stefanos Finitsis
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Central Macedonia, Greece
| | - Silvia Pizzuto
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, Île-de-France, France
| | - Benjamin Maier
- Department of Neurology, Saint Anne Hospital Centre; Université Paris Cité, Paris, France
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Omer F Eker
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Igor Sibon
- Department of Neurology, Bordeaux Unviersity Hospital, Bordeaux, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, Occitanie, France
| | - Romain Bourcier
- Neuroradiology, Université de Nantes, CHU Nantes, Neuroradiologie Diagnostique et Interventionnelle, Institut du thorax, Nantes, France
| | - Bertrand Lapergue
- Department of Neurology and Stroke Center, Hospital Foch, Suresnes, Île-de-France, France
| | - Raoul Pop
- Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
| | - Fernando Pico
- Department of Vascular Neurology, Centre Hospitalier de Versailles, Versailles, France
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, Île-de-France, France
- UFR Simon Veil Santé, University of Versailles Saint-Quentine-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
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Zhu L, Liu W, Hu Z, Li Z, Duan Z, Guo Z, Huang F, Lv K, Liao J, Chen Z, Jiang H, Wang K, Wang H, Lei Y, Liao J, Li J, Wang M, Yuan H, Zi W, Wan Y, Wang P. Endovascular Therapy for Basilar Artery Occlusion in Sudden Onset to Maximal Deficit Ischemic Events. J Am Heart Assoc 2024; 13:e030713. [PMID: 38214309 PMCID: PMC10926788 DOI: 10.1161/jaha.123.030713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/17/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The presence of sudden onset to maximal deficit (SOTMD) in patients with acute basilar artery occlusion often results in more severe outcomes. However, the effect of endovascular therapy on SOTMD and whether the outcome is affected by onset-to-puncture time remain unclear. METHODS AND RESULTS This retrospective analysis was conducted using data from the prospective BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry). Consecutive patients with basilar artery occlusion receiving endovascular therapy were dichotomized into SOTMD and non-SOTMD cohorts. The primary outcomes included a favorable outcome (modified Rankin scale 0-3), recanalization, and mortality at 90 days. The outcomes of patients with SOTMD were analyzed using multivariable logistic regression. In the multivariate analysis, a favorable outcome was similar between the two cohorts (odds ratio [OR], 0.88 [95% CI, 0.58-1.34]; P=0.5), although the mortality of patients with SOTMD was higher than that of patients with non-SOTMD (OR, 1.67 [95% CI, 1.14-2.44]; P=0.008). The probability of mortality increased from 40.0% at 1 hour to 70.0% at 6 hours in the SOTMD cohort, and favorable outcomes of patients with non-SOTMD declined from 38.0% at 1 hour to 18.0% at 8 hours. CONCLUSIONS No significant difference was observed in favorable outcomes between the SOTMD and non-SOTMD groups, although mortality was higher in the SOTMD cohort. The patients with SOTMD had a stronger time dependence for endovascular therapy in terms of mortality, while the time dependency regarding favorable outcome in the NSOTMD group was even higher. REGISTRATION URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1800014759.
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Affiliation(s)
- Lina Zhu
- Department of NeurologyWeihai Municipal Hospital, Cheeloo College of Medicine, Shandong UniversityWeihaiChina
- Department of NeurologyWeifang Medical UniversityWeifangChina
| | - Wenhua Liu
- Department of NeurologyWuhan No. 1 HospitalWuhanChina
| | - Zhizhou Hu
- Department of NeurologyLongyan No. 1 HospitalLongyanChina
| | - Zhenguang Li
- Department of NeurologyWeihai Municipal Hospital, Cheeloo College of Medicine, Shandong UniversityWeihaiChina
| | - Zhenhui Duan
- Department of NeurologyWuhan No. 1 HospitalWuhanChina
| | - Zhangbao Guo
- Department of NeurologyWuhan No. 1 HospitalWuhanChina
| | - Fang Huang
- Department of NeurologyPeople’s Hospital of Yuxi CityYuxiChina
| | - Kefeng Lv
- Department of NeurologyDong Guan People’s HospitalDongguanChina
| | - Jiasheng Liao
- Department of NeurologySuining No.1 People’s HospitalSuiningChina
| | - Zhao Chen
- Department of NeurologyYaan Peoples’s HospitalYaanChina
| | - He Jiang
- Department of NeurologyThe First People’s Hospital of NeijiangNeijiangChina
| | - Kuiyun Wang
- Department of NeurologyThe Jintang First People’s HospitalChengduChina
| | - Hongjun Wang
- Department of NeurologyFengdu People’s HospitalChongqingChina
| | - Yang Lei
- Department of NeurologyWulong District People’s HospitalChongqingChina
| | - Jiachuan Liao
- Department of NeurologySantai County People’s Hospital of North Sichuan Medical CollegeMianyangChina
| | - Jing Li
- Department of NeurologyWeihai Municipal Hospital, Cheeloo College of Medicine, Shandong UniversityWeihaiChina
- Department of NeurologyWeifang Medical UniversityWeifangChina
| | - Mengmeng Wang
- Department of NeurologyWeihai Municipal Hospital, Cheeloo College of Medicine, Shandong UniversityWeihaiChina
- Department of NeurologyWeifang Medical UniversityWeifangChina
| | - Haicheng Yuan
- Department of NeurologyQingdao Central HospitalQingdaoShandongChina
| | - Wenjie Zi
- Department of NeurologyXinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University)ChongqingChina
| | - Yue Wan
- Department of NeurologyYangluo Branch of Hubei Zhongshan HospitalWuhanChina
| | - Pengfei Wang
- Department of NeurologyWeihai Municipal Hospital, Cheeloo College of Medicine, Shandong UniversityWeihaiChina
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Liang W, Kwan ATH, Ye H, Mofatteh M, Feng M, Wellington J, Fu P, Wei W, Sun Y, Huang J, Luo J, Chen Y, Yang S, Zhou S. Post-ASPECTS and Post-PC-ASPECTS Predict the Outcome of Anterior and Posterior Ischemic Stroke Following Thrombectomy. Risk Manag Healthc Policy 2023; 16:2757-2769. [PMID: 38130745 PMCID: PMC10733595 DOI: 10.2147/rmhp.s436661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose In this study, we aimed to determine whether post-Alberta Stroke Project Early CT Changes Score (post-ASPECTS) in anterior stroke and post-(posterior circulation) PC-ASPECTS in posterior stroke on CT can predict post-endovascular thrombectomy (EVT) functional outcomes among patients with acute ischemic stroke (AIS) after EVT. Patients and Methods A total of 247 consecutive patients aged 18 and over receiving EVT for LVO-related AIS were recruited into a prospective database. The data was retrospectively analyzed between March 2019 and February 2022 from two comprehensive tertiary care stroke centers: Foshan Sanshui District People's Hospital and First People's Hospital of Foshan in China. Patient parameters included EVT within 24 hr of symptom onset, premorbid modified Rankin scale (mRS) ≤2, presence of distal and terminal cerebral blood vessel occlusion, and subsequent 24-72-hr post-stroke onset CT scan. Univariate comparisons were performed using the Fisher's exact test or χ2 test for categorical variables and the Mann-Whitney U-test for continuous variables. Logistic regression analysis was performed to further analyze for adjusting for confounding factors. A p-value of ≤0.05 was statistically significant. Results Overall, 236 individuals with 196 anterior circulation ischemic strokes and 40 posterior strokes of basilar artery occlusion were examined. Post-ASPECTS in anterior stroke and post-pc-ASPECTS as strong positive markers of favorable outcome at 90 days post-EVT; and lower rates of inpatient mortality/hospice discharge, 90-day mortality, and 90-day poor outcome were observed. Moreover, patients in the post-ASPECTS ≥ 7 cohort experienced shorter door-to-recanalization time (DRT), puncture-to-recanalization time (PRT), and last known normal-to-puncture time (LKNPT). Conclusion Post-ASPECTS ≥7 in anterior circulation AIS and post-pc-ASPECTS ≥7 in posterior circulation can serve as strong prognostic markers of functional outcome after EVT.
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Affiliation(s)
- Wenjun Liang
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, People’s Republic of China
| | - Angela T H Kwan
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Huifang Ye
- Department of Pharmacy, Foshan Sanshui District People’s Hospital, Foshan, People’s Republic of China
| | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Mingzhu Feng
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, People’s Republic of China
| | - Jack Wellington
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Pingzhong Fu
- Department of Radiology, Foshan Sanshui District People’s Hospital, Foshan, Guangdong Province, People’s Republic of China
| | - Wenlong Wei
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, People’s Republic of China
| | - Yu Sun
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, People’s Republic of China
| | - Jianhui Huang
- Department of Surgery of Cerebrovascular Diseases, First People’s Hospital of Foshan, Foshan, Guangdong Province, People’s Republic of China
| | - Jie Luo
- Department of Surgery of Cerebrovascular Diseases, First People’s Hospital of Foshan, Foshan, Guangdong Province, People’s Republic of China
| | - Yimin Chen
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, People’s Republic of China
| | - Shuiquan Yang
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, People’s Republic of China
| | - Sijie Zhou
- Department of Surgery of Cerebrovascular Diseases, First People’s Hospital of Foshan, Foshan, Guangdong Province, People’s Republic of China
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Wu C, Wang J, Zhang L, Yan F, Yang Z, He L, Guo J. Effect of massive cerebellar infarction on the outcomes of patients with acute basilar artery occlusion during hospitalization after endovascular treatment: A retrospective study. Medicine (Baltimore) 2023; 102:e34154. [PMID: 37478217 PMCID: PMC10662876 DOI: 10.1097/md.0000000000034154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/09/2023] [Indexed: 07/23/2023] Open
Abstract
Acute basilar artery occlusion (ABAO) after endovascular treatment (EVT) is often associated with a poor prognosis, particularly in patients with cerebellar infarction who may develop malignant cerebellar edema. The present study aimed to investigate how massive cerebellar infarction (MCI) affects hospitalization outcomes in ABVO patients who undergo EVT. We conducted a retrospective study of ABVO patients who underwent EVT at our hospital between September 2017 and September 2022. MCI was diagnosed using imaging techniques, and various prognostic scores were assessed during hospitalization to examine the relationship between MCI and these outcomes. We identified 42 ABAO patients, of whom 22 (52.4%) had MCI. Patients with MCI had a higher modified Rankin Scale (mRS) score at discharge compared to those without MCI (4.36 ± 1.14 vs 3.05 ± 1.85, P = .042, odds ratio [OR] (95% confidence interval [CI]) = 1.093 (0.083, 2.103)), and a lower Glasgow Coma Scale score (6.59 ± 4.0 vs 10.10 ± 5.07, P = .036, OR (95% CI) = -3.444 (-6.518, -0.369)). MCI was identified as an independent risk factor for an extremely poor prognosis (mRS ≥ 5) at discharge (P = .036, OR (95% CI) = 15.531 (1.603, 313.026)) and for no improvement in mRS score compared to onset (P = .013, OR (95% CI) = 0.025 (0.001, 0.274)). Additionally, an extremely poor prognosis was independently associated with stent implantation, EVT duration, and body mass index, while mRS score improvement was correlated with EVT duration and pulmonary infection. MCI in ABAO patients is a significant independent risk factor for a poor prognosis at discharge and no improvement in function score compared to onset. Early diagnosis and intervention are necessary to improve outcomes, particularly in high-risk populations.
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Affiliation(s)
- Chuyue Wu
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Jing Wang
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Lina Zhang
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Fei Yan
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Zhenjie Yang
- Department of Radiology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Lei He
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Jing Guo
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, P.R. China
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10
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Xu W, Bao X, Jiang F, Chen F, Liu B, Yu F, He P. Factors influencing the prognosis of acute basilar artery occlusion patients treated endovascularly: the impact of treatment time window and preoperative symptoms. Front Neurol 2023; 14:1167442. [PMID: 37545731 PMCID: PMC10400006 DOI: 10.3389/fneur.2023.1167442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Objective The aim of this study was to examine the factors influencing the prognosis of patients diagnosed with acute basilar artery occlusion (BAO) who receive endovascular treatment. Our particular emphasis was on the predictive implications of the time window for treatment (from symptom onset to femoral artery puncture) and preoperative symptoms for prognosis. Methods A retrospective analysis of data collected from 51 BAO patients who received endovascular treatment at the Neurosurgery Department of Jinhua Central Hospital from April 2018 to October 2021 was undertaken. The data included immediate post-interventional recanalization rates and the 90-day clinical prognoses of the patients. We used the Modified Rankin Scale (mRs) to categorize patients into two prognosis groups: a favorable prognosis group (mRs score ≤2) and an unfavorable prognosis group (mRs score >2). Preoperative symptoms were gauged using the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) scores. A logistic regression analysis was conducted to identify risk factors affecting the prognosis of BAO patients following endovascular treatment. Results The procedure resulted in complete recanalization in all patients (100%). However, four patients (7.8%) passed away during the postoperative hospitalization period. The remaining 47 patients were followed up for 3 months. It was found that 15 patients (31.91%) had a favorable prognosis, while 32 (68.09%) had an unfavorable prognosis. It was generally observed that patients with an unfavorable prognosis had notably higher preoperative GCS and NIHSS scores (p < 0.05). Logistic regression analysis revealed that preoperative symptom severity, as indicated by NIHSS score, and treatment time window were significant prognostic risk factors for patients undergoing endovascular treatment for BAO (p < 0.05). Conclusion Endovascular intervention for BAO appears to be safe and effective, with greater likelihood of a favorable prognosis in patients treated within ≤6 h. The chances of favorable prognosis could potentially be linked to the severity of the patient's preoperative symptoms.
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Negative susceptibility vessel sign might be predictive of complete reperfusion in patients with acute basilar artery occlusion managed with thrombectomy. Eur Radiol 2023; 33:2593-2604. [PMID: 36562785 DOI: 10.1007/s00330-022-09215-2] [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: 04/01/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Negative susceptibility vessel sign (SVS) on pre-thrombectomy MRI has been linked to fibrin-rich thrombus and difficult retrieval in anterior ischemic stroke. However, its impact in posterior circulation-large vessel occlusion stroke (PC-LVOS) has not yet been elucidated. We aim to investigate the relationship of SVS parameters with stroke subtypes and their influence on angiographic and functional outcomes. METHODS Prospective thrombectomy registries at two-comprehensive stroke centers were retrospectively reviewed between January 2015 and December 2019 for consecutive MRI-selected patients with PC-LVOS. Two groups were assigned by two independent readers, based on the presence or absence of the SVS (SVS +, SVS -) on MRI-GRE sequence. Multivariate logistic regression analysis was utilized to study primarily the impact of the SVS on the rate of complete recanalization (defined as mTICI 2c/3) at the final series following endovascular thrombectomy (EVT) and whether or not it might influence the efficacy of the frontline EVT strategy. Secondarily, we studied whether the absence of the SVS was predictive of the rate of 90-day functional independence (defined as mRS score < 2). Lastly, both qualitative (SVS +, SVS-) and quantitative (SVS length and diameter) parameters of the SVS were analyzed in association with the puncture to recanalization interval and various stroke etiological subtypes based on TOAST criteria. RESULTS Among 1823 patients, 116 were qualified for final analysis (median age, 68 (59-75) years; male, 65%); SVS was detected in 62.9% (73/116) of cases. SVS length was an independent predictor of procedural duration (p = .01) whilst two-layered SVS was inversely associated with the atherosclerosis etiological subtype (aOR = 0.27, 95% CI 0.08-0.89; p = .03). Successful recanalization was achieved in 82% (60/73) vs. 86% (37/43), p = .80 of patients with SVS (+, -) respectively. Only in SVS (+), stentriever (RR 0.59 (0.4-0.88), p = .009), and contact-aspiration (RR 0.82 (0.7-0.96), p = .01) achieved a lower rate of successful recanalization compared to combined technique. SVS (-) was significantly associated with a higher rate of mTICI 2c/3 (aOR = 4.444; 95% CI 1.466-13.473; p = .008) and showed an indirect effect of 9% towards functional independence mediated by mTICI 2c/3. CONCLUSION SVS parameters in PC-LVOS might predict stroke subtype and indirectly influence the functional outcome by virtue of complete recanalization. KEY POINTS • Negative susceptibility vessel sign (SVS) in patients with basilar occlusion independently predict complete recanalization that indirectly instigated a 3-month favorable outcome following thrombectomy. • The longer the SVS, the higher likelihood of large artery atherosclerosis and the longer the thrombectomy procedure. • Two-layered SVS might be negatively associated with the presence of atherosclerosis, yet already-known limitations of TOAST classification and the absence of pathological analysis should be taken into consideration.
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12
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Abbas R, Chen CJ, Atallah E, El Naamani K, Amllay A, Sioutas G, Gooch MR, Herial NA, Jabbour P, Rosenwasser RH, Tjoumakaris S. Mechanical Thrombectomy for Stroke Due to Acute Basilar Artery Occlusion, a Safety and Efficacy Analysis. Neurosurgery 2023; 92:772-778. [PMID: 36513024 DOI: 10.1227/neu.0000000000002261] [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: 06/06/2022] [Accepted: 09/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute basilar artery occlusion accounts for 1% of all ischemic strokes but often leads to devastating neurological injury and mortality. Many institutions still opt for best medical therapy for these patients; however, there is increasing evidence that mechanical thrombectomy (MT) for these patients leads to better outcomes. OBJECTIVE To assess the safety and efficacy of MT for patients presenting with acute basilar artery occlusion (BAO). METHODS This study was a retrospective chart review of a prospectively maintained database for patients with acute BAO treated with MT from January 2014 through March 2022. RESULTS Our study included a total of 74 patients. The mean age was 62.7 years, and 55.4% were male. The most common comorbidity was hypertension (73%). The mean door to puncture time was 75 minutes, and the mean procedure time was 54 minutes. 86.5% of patients had a good modified treatment in cerebral ischemia score (≥2b). There were 4 patients who had procedural complications and 3 who had symptomatic intracerebral hemorrhage. At 90 days, 62.5% of patients had a modified Rankin Scale, 0 to 3. The mortality rate was 32.4% and 2% during hospital admission and 90 days, respectively. On univariate analysis, adjunctive angioplasty/stenting and higher presenting National Institutes of Health Stroke Scale score were associated with modified Rankin Scale 4 to 6 at 90 days ( P -value, .03 and <.001, respectively). Shorter procedure time was associated with modified treatment in cerebral ischemia score ≥ 2b ( P -value, .0015). CONCLUSION Our findings showed that MT is safe and effective for patients presenting with acute BAO and is in conjunction with previous literature. The results from upcoming trials should hopefully establish MT as gold standard for these patients.
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Affiliation(s)
- Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center, Houston, Texas, USA
| | - Elias Atallah
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Abdelaziz Amllay
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Georgios Sioutas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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13
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Guo X, Xiong Y, Huang X, Pan Z, Kang X, Chen C, Zhou J, Wang C, Lin S, Hu W, Wang L, Zheng F. Aspiration versus stent retriever for posterior circulation stroke: A meta-analysis. CNS Neurosci Ther 2022; 29:525-537. [PMID: 36513959 PMCID: PMC9873527 DOI: 10.1111/cns.14045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS New thrombectomy strategies have emerged recently. Differences between posterior circulation stroke management via aspiration and stent retriever remain to be evaluated. We compared the safety and efficacy of aspiration and stent retriever in treating posterior circulation stroke. METHODS Three databases (PubMed, Embase, and Cochrane Library) were systematically searched for studies comparing aspiration and stent retriever in patients with posterior circulation stroke. The modified Newcastle-Ottawa scale was used to assess the risk of bias. A random-effects model was used. RESULTS Fifteen cohort studies with 1451 patients were included. Pooled results showed a significant difference in total complication (odds ratio [OR] 0.48, 95% confidence interval [CI] [0.30, 0.76], p = 0.002). successful recanalization (1.85, [1.30, 2.64], p = 0.0006), favorable outcome (1.30, [1.02, 1.67], p = 0.04), procedure duration (-22.10, [-43.32, -0.88], p = 0.04), complete recanalization (4.96, [1.06, 23.16], p = 0.009), and first-pass effect (2.59, [1.55, 4.32], p = 0.0003) between the aspiration and stent retriever groups, and in favor of aspiration. There was no significant difference in the outcomes of rescue therapy (1.42, [0.66, 3.05], p = 0.37) between the two groups. CONCLUSION Patients with posterior circulation stroke receiving treatment with aspiration achieved better recanalization, first-pass effect, and shorter procedure time. Aspiration may be more secure than a stent retriever.
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Affiliation(s)
- Xiumei Guo
- Department of NeurologyThe Second Affiliated Hospital, Fujian Medical UniversityQuanzhouChina,Department of NeurosurgeryThe Second Affiliated Hospital, Fujian Medical UniversityQuanzhouChina
| | - Yu Xiong
- Department of NeurosurgeryThe Second Affiliated Hospital, Fujian Medical UniversityQuanzhouChina
| | - Xinyue Huang
- Department of NeurosurgeryThe Second Affiliated Hospital, Fujian Medical UniversityQuanzhouChina
| | - Zhigang Pan
- Department of NeurosurgeryThe Second Affiliated Hospital, Fujian Medical UniversityQuanzhouChina
| | - Xiaodong Kang
- Department of NeurosurgeryThe Second Affiliated Hospital, Fujian Medical UniversityQuanzhouChina
| | - Chunhui Chen
- Department of NeurosurgeryThe Second Affiliated Hospital, Fujian Medical UniversityQuanzhouChina
| | - Jianfeng Zhou
- Department of NeurosurgeryThe Second Affiliated Hospital, Fujian Medical UniversityQuanzhouChina
| | - Cui'e Wang
- Department of NeurosurgeryThe Second Affiliated Hospital, Fujian Medical UniversityQuanzhouChina
| | - Shu Lin
- Centre of Neurological and Metabolic ResearchThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina,Diabetes and Metabolism DivisionGarvan Institute of Medical ResearchSydneyNew South WalesAustralia
| | - Weipeng Hu
- Department of NeurosurgeryThe Second Affiliated Hospital, Fujian Medical UniversityQuanzhouChina
| | - Lingxing Wang
- Department of NeurologyThe Second Affiliated Hospital, Fujian Medical UniversityQuanzhouChina
| | - Feng Zheng
- Department of NeurosurgeryThe Second Affiliated Hospital, Fujian Medical UniversityQuanzhouChina
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14
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Yu X, Richard SA, Fuhua Y, Jianfeng J, Xinmin Z, Min W. Mechanical thrombectomy for vertebral and basilar artery occlusions: An institutional experience with 17 patients. MEDICINE INTERNATIONAL 2022; 2:32. [PMID: 36699156 PMCID: PMC9829235 DOI: 10.3892/mi.2022.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/17/2022] [Indexed: 01/27/2023]
Abstract
Acute ischemic stroke of the posterior circulation as a result of vertebrobasilar artery occlusions is often associated with severe morbidity and mortality rates. Vertebrobasilar artery occlusion retrieval via mechanical thrombectomy (MT) is a novel treatment modality for occlusive strokes. Nevertheless, factors associated with positive outcomes have not yet been adequately investigated. Thus, the present study focused on factors associated with good prognosis following this type of treatment. The present study retrospectively analyzed a series of 17 patients with acute vertebral artery occlusions (VAOs) and basilar artery occlusions (BAOs) treated with MT. In all patients, information such as sex and age, time from admission to the onset of femoral artery access, the number of thrombi removed, the time of femoral artery access to recanalization, pre- and post-operative National Institutes of Health Stroke Scale (NIHSS) scores, pre- and post-operative thrombolysis in cerebral infarction, as well as modified Rankin scale scores were documented and analyzed. The analysis comprised of 11 patients with BAOs and 6 patients with VAOs. A recanalization rate of 70.6% was achieved with an overall good functional outcome of 58.8% at 90 days. Observationally, there was a notable improvement in outcomes when comparing the NIHSS prior to surgery with NIHSS at 1 week after the surgery. A lower NIHSS score prior to MT may be a good prognostic factor. An average time of ~5.5 h from patient admittance to recanalization with a 70.6% recanalization rate with an overall good functional outcome of 58.8% at 90 days suggested that, patients for whom the surgeries were performed within 5 h of admittance may still have hope for recanalization compared to an initial 1.5-h average time for recanalization.
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Affiliation(s)
- Xu Yu
- Department of Neurosurgery, Jiangyin Hospital, Southeast University, Jiangyin, Jiangsu 214400, P.R. China
| | - Seidu A. Richard
- Department of Medicine, Princefield University, P.O. Box MA-128, Ho, Volta Region, Ghana
| | - Ye Fuhua
- Department of Neurosurgery, Jiangyin Hospital, Southeast University, Jiangyin, Jiangsu 214400, P.R. China
| | - Jiang Jianfeng
- Department of Neurosurgery, Jiangyin Hospital, Southeast University, Jiangyin, Jiangsu 214400, P.R. China
| | - Zhou Xinmin
- Department of Neurosurgery, Jiangyin Hospital, Southeast University, Jiangyin, Jiangsu 214400, P.R. China
| | - Wu Min
- Department of Neurosurgery, Jiangyin Hospital, Southeast University, Jiangyin, Jiangsu 214400, P.R. China,Correspondence to: Professor Wu Min, Department of Neurosurgery, Jiangyin Hospital, Southeast University, 16 Shou Mountain Road, Jiangyin, Jiangsu 214400, P.R. China
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15
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Terceño M, Bashir S, Cienfuegos J, Murillo A, Vera-Monge VA, Pardo L, Reina M, Gubern-Mérida C, Puigoriol-Illamola D, Carballo L, Costa A, Buxó M, Serena J, Silva Y. General anesthesia versus conscious sedation during endovascular treatment in posterior circulation large vessel occlusion: A systematic review and meta-analysis. Eur Stroke J 2022; 8:85-92. [PMID: 37021193 PMCID: PMC10069205 DOI: 10.1177/23969873221127738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/02/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose: The optimal anesthetic approach in the endovascular treatment (EVT) of patients with posterior circulation large vessel occlusion (PC-LVO) strokes is not clear. Little data has been published and no randomized clinical trials have been conducted so far. We aimed to perform an updated meta-analysis to compare clinical and procedural outcomes between conscious sedation (CS) and general anesthesia (GA). Methods: We reviewed the literature of the studies reporting CS and GA in patients with endovascularly-treated PC-LVO. The primary outcome was the functional outcome at 3 months measured using the modified Rankin Scale (mRS). A good functional outcome was defined as having a mRS 0–2. Secondary outcomes were mortality at 3 months, final successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) scale from 2b to 3) and complete recanalization (mTICI of 3) and times from stroke onset to EVT completion. Random-effects models were completed to pool the outcomes and the I2 value was calculated to assess heterogeneity. Findings: Eight studies with a total of 1351 patients were included. The pooled results reveal that CS use was associated with higher rates of good outcome (OR 2.41, 95% CI 1.58–3.64, I2 = 49.67%) and with lower mortality at 3 months (OR 0.48, 95% CI 0.28–0.82, I2 =57.11%). No significant differences were observed in the final reperfusion rates, procedural duration, and time from stroke onset to EVT completion. Conclusion: In this meta-analysis, GA was associated with significantly lower rates of functional independence at 3 months in patients with PC-LVO strokes.
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Affiliation(s)
- Mikel Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
- Mikel Terceño, Unitat d’Ictus, Servei de Neurologia, Hospital Universitari Doctor Josep Trueta de Girona, Av de França s/n, Girona 17007, Spain.
| | - Saima Bashir
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Juan Cienfuegos
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Alan Murillo
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Víctor Augusto Vera-Monge
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Laura Pardo
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Montserrat Reina
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Carme Gubern-Mérida
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Dolors Puigoriol-Illamola
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Laia Carballo
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Anna Costa
- Department of Anesthesiology and Critical Care Medicine, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
| | - Maria Buxó
- Statistical and Methodological Department, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Joaquín Serena
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Yolanda Silva
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
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16
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Altenbernd J, Forsting M, Weber W, Fischer S. Thrombectomy of symptomatic isolated occlusions of posterior cerebral arteries in segment P1 and P2 in acute stroke treatment. Acta Radiol 2022; 63:802-809. [PMID: 33940961 DOI: 10.1177/02841851211014191] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Interventional stroke treatments for occlusions of the posterior circulation are established procedures. However, there are limited data on the treatment of isolated symptomatic P1 and P2 occlusions, which we have examined in this study. PURPOSE To investigate the mechanical thrombectomy of distal posterior occlusions. MATERIAL AND METHODS Retrospectively, data from patients with isolated P1 and P2 occlusions treated with MT were evaluated. Successful reperfusions have been defined as modified thrombolysis in cerebral infarct (mTICI) Grade 2b-3. A good clinical outcome was defined as a 90-day modified Rankin score 0-2. RESULTS All 79 treated patients were primarily aspirated. Stent retrievers were used secondarily in nine patients. Successful reperfusion was achieved in 95% of patients. Of the patients, 57% had a favorable clinical outcome after 90 days. CONCLUSION Mechanical thrombectomy with first line aspiration of symptomatic P1 and P2 occlusions is a safe and effective procedure.
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Affiliation(s)
- Jens Altenbernd
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Department of Radiology and Neuroradiology, Gemeinschaftskrankenhaus Herdecke, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Werner Weber
- Department of Radiology and Neuroradiology, Knappschaftskrankenhaus Bochum, Germany
| | - Sebastian Fischer
- Department of Radiology and Neuroradiology, Knappschaftskrankenhaus Bochum, Germany
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17
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Lee SJ, Hong JM, Kim JS, Lee JS. Endovascular Treatment for Posterior Circulation Stroke: Ways to Maximize Therapeutic Efficacy. J Stroke 2022; 24:207-223. [PMID: 35677976 PMCID: PMC9194547 DOI: 10.5853/jos.2022.00941] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/20/2022] [Indexed: 11/11/2022] Open
Abstract
The efficacy of endovascular treatment (EVT) in patients with posterior circulation stroke has not been proven. Two recent randomized controlled trials failed to show improved functional outcomes after EVT for posterior circulation stroke (PC-EVT). However, promising results for two additional randomized controlled trials have also been presented at a recent conference. Studies have shown that patients undergoing PC-EVT had a higher rate of futile recanalization than those undergoing EVT for anterior circulation stroke. These findings call for further identification of prognostic factors beyond recanalization. The significance of baseline clinical severity, infarct volume, collaterals, time metrics, core-penumbra mismatch, and methods to accurately measure these parameters are discussed. Furthermore, their interplay on EVT outcomes and the potential to individualize patient selection for PC-EVT are reviewed. We also discuss technical considerations for improving the treatment efficacy of PC-EVT.
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Affiliation(s)
- Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Jong S. Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
- Correspondence: Jin Soo Lee Department of Neurology, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5175 Fax: +82-31-219-5178 E-mail:
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18
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Dong S, Li Y, Guo J, Luo Y, Fang J, Tang L, He L. Endovascular Treatment Combined With Standard Medical Treatment Improves Outcomes of Posterior Circulation Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:694418. [PMID: 35518202 PMCID: PMC9062408 DOI: 10.3389/fneur.2022.694418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 03/15/2022] [Indexed: 02/05/2023] Open
Abstract
Aims Whether endovascular treatment (EVT) can further improve the prognosis of patients with posterior circulation ischemic stroke (PCIS) is unclear. This meta-analysis aims to compare the efficacy and safety of PCIS patients treated with EVT plus standard medical treatment (SMT) and SMT alone. Methods We systematically searched for relevant randomized controlled trials (RCTs) and prospective cohort trials in MEDLINE, EMBASE, and the Cochrane Library up to February 2022. The primary outcome was favorable functional outcome of the modified Rankin Scale (mRS) with scores of 0-2 or 0-3; secondary outcomes included successful recanalization rate, intracranial hemorrhage (ICH), or symptomatic intracranial hemorrhage (sICH) after treatment and 90-day mortality. Results We identified six studies including 1, 385 PCIS patients (957 with EVT plus SMT; 428 with SMT alone). EVT plus SMT substantially improved 90-day functional outcomes compared with SMT alone [mRS score of 0-2: RR=1.95, 95% CI (1.52 - 2.51), P < 0.001; mRS score of 0-3: RR = 1.85, 95% CI (1.49 - 2.30), P < 0.001, respectively]. Moreover, compared with SMT, combined treatment significantly improved the rate of successful recanalization [RR = 5.03, 95% CI (3.96-6.40), P < 0.001] and reduced 90-day mortality [RR = 0.71, 95% CI (0.63-0.79), P < 0.001] despite a higher risk of ICH [RR = 6.13, 95% CI (2.50-15.02), P < 0.001] and sICH [RR = 10.47, 95% CI [2.79-39.32), P = 0.001]. Conclusion Low-to-moderate evidence from RCTs and non-RCTs showed that increased ICH and sICH risk of EVT plus SMT did not translate to a higher risk of unfavorable outcomes compared with SMT and could even promote independence at 90 days in a real-world cohort.
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Affiliation(s)
- Shuju Dong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbo Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Guo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yaxi Luo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinghuan Fang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Tang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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19
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Del Guerra FB, Silva GD, Perissinoti IN, Morais L, Marsolla FLD, Comerlatti LR, Puglia Junior P, Conforto AB. Outcomes of acute basilar artery occlusion-real-world experience in a middle-income country. Acta Neurol Scand 2022; 145:456-463. [PMID: 34918338 DOI: 10.1111/ane.13572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/05/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Our goal was to describe outcomes in a single-center, real-world series of patients with acute basilar artery occlusion in a middle-income country. In addition, we assessed potential outcome predictors. MATERIAL AND METHODS Data from 28 patients were retrospectively reviewed. The primary outcome was death until last follow-up. Other outcomes were rates of favorable outcome until last follow-up and rates of intracranial hemorrhage. Outcomes were compared in subgroups according to several variables, including reperfusion (REP group) or no reperfusion (NOREP group) interventions, with chi-squared, Fisher's exact test, or Mann-Whitney tests. RESULTS The rate of overall intrahospital death was 46%. Death until last follow-up occurred in 8/17 (47%) in the REP and in 7/11 (63%) of the NOREP group. Favorable outcomes were observed in 35.7% of the patients: 8/17 (47%) in REP and in 2/11 (18.1%) in NOREP. NIH stroke scale scores were significantly lower in patients with favorable outcomes. Intracranial hemorrhage was observed in 6/28 (21.4%) of the patients (all in REP group). Twenty patients were treated with anticoagulants within the first 24 h. No hemorrhage was observed in those treated with enoxaparin, while three occurred in subjects treated with unfractionated heparin. CONCLUSION Together with other series, our results underscore the relevance of NIH stroke scale at admission as a prognostic marker, the importance of reperfusion to improve outcomes, and the need of clinical trials to compare the impact of treatment with anticoagulants within first 24 h in basilar artery occlusion.
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Affiliation(s)
- Felipe Borelli Del Guerra
- Neurology Clinical Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Guilherme Diogo Silva
- Neurology Clinical Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Iago Navas Perissinoti
- Neurology Clinical Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Livia Morais
- Department of Radiology (INRAD) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | | | - Luiz Roberto Comerlatti
- Neurology Clinical Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Paulo Puglia Junior
- Neuroradiology Intervention Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Adriana Bastos Conforto
- Neurology Clinical Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
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20
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Endovascular Thrombectomy for Acute Basilar Artery Occlusion: Latest Findings and Critical Thinking on Future Study Design. Transl Stroke Res 2022; 13:913-922. [PMID: 35349051 DOI: 10.1007/s12975-022-01008-5] [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: 01/20/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Randomized controlled trials (RCTs) have demonstrated powerful efficacy of endovascular thrombectomy (EVT) for large vessel occlusion in the anterior circulation. The effect of EVT for acute basilar artery occlusion (BAO) in the posterior circulation remains unproven. Here, we highlight the latest findings of observational studies and RCTs of EVT for BAO, with a focus on the predictors of functional outcomes, the limitations of recent RCTs, and critical thinking on future study design. Pooled data from large retrospective studies showed 36.4% favorable outcome at 3 months and 4.6% symptomatic intracranial hemorrhage (sICH). Multivariate logistic regression analysis revealed that higher baseline NIHSS score, pc-ASPECTS < 8, extensive baseline infarction, large pontine infarct, and sICH were independent predictors of poor outcome. Two recent randomized trial BEST (Endovascular treatment vs. standard medical treatment for vertebrobasilar artery occlusion) and BASICS (Basilar Artery International Cooperation Study) failed to demonstrate significant benefit of EVT within 6 or 8 h after stroke symptom onset. The limitations of these studies include slow enrollment, selection bias, high crossover rate, and inclusion of patients with mild deficit. To improve enrollment and minimize risk of diluting the overall treatment effect, futile recanalization and re-occlusion, optimal inclusion/exclusion criteria, including enrollment within 24 h of last known well, NIHSS score ≥ 10, pc-ASPECTS ≥ 8, no large pontine infarct, and the use of rescue therapy for underlying atherosclerotic stenosis, should be considered for future clinical trials.
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21
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Comparative Studies of Cerebral Reperfusion Injury in the Posterior and Anterior Circulations After Mechanical Thrombectomy. Transl Stroke Res 2022; 13:556-564. [PMID: 35006533 PMCID: PMC9232466 DOI: 10.1007/s12975-021-00977-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022]
Abstract
Cerebral reperfusion injury is the major complication of mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Contrast extravasation (CE) and intracranial hemorrhage (ICH) are the key radiographical features of cerebral reperfusion injury. The aim of this study was to investigate CE and ICH after MT in the anterior and posterior circulation, and their effect on functional outcome. This is a retrospective study of all consecutive patients who were treated with MT for AIS at University of California Irvine Medical Center between January 1, 2014, and December 31, 2017. Patient characteristics, clinical features, procedural variables, contrast extravasation, ICH, and outcomes after MT were analyzed. A total of 131 patients with anterior circulation (AC) stroke and 25 patients with posterior circulation (PC) stroke underwent MT during the study period. There was no statistically significant difference in admission NIHSS score, blood pressure, rate of receiving intravenous tPA, procedural variables, contrast extravasation, and symptomatic ICH between the 2 groups. Patients with PC stroke had a similar rate of favorable outcome (mRS 0–2) but significantly higher mortality (40.0% vs. 10.7%, p < 0.01) than patients with AC stroke. Multivariate regression analysis identified initial NIHSS score (OR 1.1, CI 1.0–1.2, p = 0.01), number of passes with stent retriever (OR 2.1, CI 1.3–3.6, p < 0.01), and PC stroke (OR 9.3, CI 2.5–35.1, p < 0.01) as independent risk factors for death. There was no significant difference in functional outcomes between patients with and without evidence of cerebral reperfusion injury after MT. We demonstrated that AC and PC stroke had similar rates of cerebral reperfusion injury and favorable outcome after MT. Cerebral reperfusion injury is not a significant independent risk factor for poor functional outcome.
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22
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Kong W, Yuan J, Huang J, Song J, Zhao C, Sang H, Luo W, Xie D, Gao F, Li H, Luo J, Liu S, Xue D, Yu Y, Li F, Qiu Z, Zi W, Yang Q. Outcomes of Endovascular Therapy in Acute Basilar Artery Occlusion With Severe Symptoms. JAMA Netw Open 2021; 4:e2139550. [PMID: 34913974 PMCID: PMC8678675 DOI: 10.1001/jamanetworkopen.2021.39550] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Endovascular therapy (EVT) has been reported to be safe and effective in improving clinical outcomes among patients with acute basilar artery occlusion (ABAO). The benefits associated with EVT remain uncertain for patients with ABAO with severe symptoms (ie, National Institutes of Health Stroke Scale [NIHSS] score ≥ 21). OBJECTIVES To assess the outcomes associated with EVT and identify factors associated with outcomes among patients with ABAO and severe symptoms. DESIGN, SETTING, AND PARTICIPANTS This prospective, nationwide cohort study was conducted using data from January 2014 to May 2019 in China from the Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry (BASILAR). Included patients had ABAO and underwent EVT or standard medical treatment (SMT) alone in routine clinical practice. Patients were dichotomized into severe symptoms (ie, NIHSS score ≥ 21) and minor to moderate symptoms (NIHSS score < 21) groups. Patients were followed up for 90 days. Data were analyzed from December 2020 through June 2021. EXPOSURES EVT with SMT vs SMT alone. MAIN OUTCOMES AND MEASURES The primary outcome was improvement in modified Rankin Scale (mRS) score at 90 days, defined as a decrease by 1 grade in mRS score. Secondary outcomes included favorable functional outcome (ie, mRS score, 0-3) and mortality. RESULTS Among 542 patients with ABAO and severe symptoms (median [IQR] age, 65 [57-74] years; 147 [27.1%] women), 431 patients (79.5%) received EVT and 111 patients (20.5%) received SMT. Compared with SMT, EVT was associated with increased odds of improved mRS score (adjusted common odds ratio [OR], 3.44 [95% CI, 2.05-5.78]; P < .001), with increased odds of a favorable functional outcome (ie, mRS score, 0-3; adjusted OR, 4.52 [95% CI, 1.64-12.43]; P = .004) and decreased odds of mortality (adjusted OR, 0.27 [95% CI, 0.15-0.50]; P < .001). Among patients receiving EVT, baseline NIHSS score was associated with decreased odds of a favorable functional outcome (adjusted OR per 1-point increase in score, 0.90 [95% CI, 0.85-0.95]; P < .001) and increased odds of mortality (adjusted OR per 1-point increase in score, 1.13 [95% CI, 1.07-1.19]; P < .001), while posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS) was associated with increased odds of a favorable functional outcome (adjusted OR per 1-point increase in score, 1.71 [95% CI, 1.41-2.07]; P < .001) and decreased odds of mortality (adjusted OR per 1-point increase in score, 0.74 [95% CI, 0.64-0.85]; P < .001). Different occlusion sites, compared with distal basilar artery, were associated with decreased odds of favorable functional outcome (eg, middle basilar artery: adjusted OR vs distal basilar artery, 0.36 [95% CI, 0.17-0.80]; P = .01). CONCLUSIONS AND RELEVANCE This study found that EVT was associated with increased odds of functional favorable outcomes among patients with ABAO and severe symptoms. Baseline NIHSS score, pc-ASPECTS, and occlusion site were independent factors associated with clinical outcomes.
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Affiliation(s)
- Weilin Kong
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Junjie Yuan
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chenhao Zhao
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hongfei Sang
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Weidong Luo
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Dongjing Xie
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fei Gao
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Huagang Li
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Jun Luo
- Department of Neurology, 404th hospital of Mianyang, Mianyang, China
| | - Shudong Liu
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing Key Laboratory, Chongqing, China
| | - Dongzhang Xue
- Department of Neurology, 902nd Hospital of the People’s Liberation Army, Bengbu, China
| | - Yinquan Yu
- Department of Neurology, Bazhong Hospital of Traditional Chinese Medicine, Bazhong, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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23
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Xiao L, Gu M, Lu Y, Xu P, Wang J, Lan W, Huang Y, Xu G, Zhu S, Wang Q, Hu W, Zhu W, Sun W, Liu X. Influence of renal impairment on clinical outcomes after endovascular recanalization in vertebrobasilar artery occlusions. J Neurointerv Surg 2021; 14:1077-1083. [PMID: 34853176 DOI: 10.1136/neurintsurg-2021-018003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/31/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Renal impairment (RI) is associated with worse outcomes in the treatment of intravenous thrombolysis and emergent endovascular treatment (EVT) in anterior circulation stroke. The objective of this study was to investigate the association of RI with short-term and long-term outcomes in patients with vertebrobasilar artery occlusions (VBAO) who received EVT. METHODS Consecutive patients with VBAO receiving EVT involving 21 stroke centers were retrospectively included. Multivariate regression analyses were used to evaluate the association of RI with mortality and symptomatic intracranial hemorrhage (sICH) during the hospital stay, and also mortality, favorable functional outcome (modified Rankin Scale (mRS) score of 0-3), and functional improvement (shift in mRS score) at 3 months and 1 year follow-up. The association between RI and the risk of recurrent stroke was evaluated with multivariate competing-risk regression analyses. RESULTS After adjustment for potential confounders, RI was independently associated with sICH (OR 3.30, 95% CI 1.55 to 7.18), as well as mortality (OR 2.54, 95% CI 1.47 to 4.38; OR 3.07, 95% CI 1.72 to 8.08), favorable functional outcome (OR 0.33, 95% CI 0.17 to 0.66; OR 0.25, 95% CI 0.12 to 0.51), and functional improvement (OR 0.45, 95% CI 0.28 to 0.74; OR 0.35, 95% CI 0.21 to 0.60) at 3 months and 1 year follow-up, respectively, but RI was not associated with in-hospital mortality. Additionally, there was no significant association between RI and recurrent stroke within 1 year. CONCLUSIONS Our findings suggest that RI is associated with a higher risk of sICH in hospital and a decrease in survival, favorable functional outcome, and functional improvement at 90 days and 1 year follow-up. TRIAL REGISTRATION NUMBER URL: http://www.chictr.org.cn/; Unique identifier: ChiCTR2000033211.
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Affiliation(s)
- Lulu Xiao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Mengmeng Gu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yijiu Lu
- Department of Neurology, The First People's Hospital of Yulin, Yulin, Guangxi, 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, Hefei, Anhui, China
| | - Jinjing Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Wenya Lan
- Department of Cerebrovascular Disease Treatment Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Yong Huang
- Department of Neurosurgery, Jiangsu Provincial Corps Hospital of Chinese People's Armed Police Forces, Yangzhou, China
| | - Guoqiang Xu
- Department of Neurology, The First People's Hospital of Yongkang, Yongkang, China
| | - Shuanggen Zhu
- Department of Neurology, Affiliated to Longhua People's Hospital, Southern Medical University, Shenzhen, China
| | - Qizhang Wang
- Department of Neurology, Shenzhen Shajing People's Hospital, Shenzhen, China
| | - Wei Hu
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC,Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wusheng Zhu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 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, Hefei, Anhui, China
| | - Xinfeng Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China .,Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC,Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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24
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Luo G, Gao F, Zhang X, Jia B, Huo X, Liu R, Chi MS, Ma G, Peng G, Zhang J, Qi Z, Guo X, Han B, Tong X, Wang B, Song L, Liu L, He Z, Mo D, Ma N, Sun X, Yang M, Miao Z. Intracranial Stenting as Rescue Therapy After Failure of Mechanical Thrombectomy for Basilar Artery Occlusion: Data From the ANGEL-ACT Registry. Front Neurol 2021; 12:739213. [PMID: 34659098 PMCID: PMC8514631 DOI: 10.3389/fneur.2021.739213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background and Purpose: Studies on rescue therapy for acute posterior circulation stroke due to basilar artery occlusion (BAO) are limited in the modern era of mechanical thrombectomy (MT). The aim of this study was to evaluate the safety and efficacy of rescue stenting (RS) following MT failure in patients with BAO. Methods: Data were collected from the Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke (ANGEL-ACT) prospective registry in China. Patients who underwent MT for BAO with failure of recanalization were enrolled in this study. The patients were divided into the RS and non-RS groups. Clinical and laboratory findings, procedural details, and clinical outcomes were compared between the two groups. Results: Overall, 93 patients with acute BAO were analyzed. The RS group included 81 (87.1%) patients, and the non-RS group included 12 patients. A modified treatment in cerebral infarction (mTICI) score of 2b/3 was achieved in 75 (92.6%) patients in the RS group. Compared with the non-RS group, the RS group had a significantly higher rate of successful recanalization and favorable clinical outcomes (modified Rankin Scale score at 90 days post-procedure, 0–3: 16.7 vs. 51.9%, respectively; P = 0.023) without an increase in the rate of symptomatic intracranial hemorrhage and a significantly lower mortality rate (58.3 vs. 18.5%, respectively; P = 0.006). Furthermore, the use of a glycoprotein IIb/IIIa inhibitor improved the rate of recanalization of the target artery without increasing the rate of symptomatic intracranial hemorrhage. Conclusions: Permanent stenting appears to be a feasible rescue modality when MT fails and might provide functional benefits in patients with acute ischemic stroke due to BAO.
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Affiliation(s)
- Gang Luo
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Feng Gao
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xuelei Zhang
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Baixue Jia
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaochuan Huo
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Raynald Liu
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Man Sum Chi
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong, SAR China
| | - Gaoting Ma
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Guangge Peng
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jingyu Zhang
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhongqi Qi
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xu Guo
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Bin Han
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Interventional Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Bo Wang
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ligang Song
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lian Liu
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zijun He
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Dapeng Mo
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ning Ma
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xuan Sun
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ming Yang
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhongrong Miao
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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Liu JC, Gao BL, Li HW, Chen FW, Shi HS, Wang Z, Wang ZL, Li TX. Effects of and prognostic factors affecting endovascular mechanical thrombectomy of acute vertebrobasilar artery occlusion. J Clin Neurosci 2021; 93:221-226. [PMID: 34656251 DOI: 10.1016/j.jocn.2021.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/30/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the clinical outcome and factors affecting the prognosis of endovascular mechanical thrombectomy of acute vertebrobasilar artery occlusion. MATERIALS AND METHODS Eighty-three patients with acute vertebrobasilar artery occlusion were treated with endovascular mechanical thrombectomy, and the recanalization rate, clinical outcomes at three months, modified DWI-PC-ASPECTS, and MRA-BATMAN scores were analyzed. RESULTS Following acute mechanical thrombectomy, the TICI 2B-3 score was achieved in all patients (100%). At three-month evaluation, 56 (67.5%) patients had good prognosis with the mRS score of 0-2, including 13 (23.2%) patients who had arterial occlusion caused by emboli and 43 (76.8%) who had atherosclerotic stenosis. In analyzing factors affecting the prognosis, a significant difference (P < 0.05) existed between patients with good (mRS 0-2) and poor (mRS 3-6) prognosis in the NIHSS (17.3 vs. 31.2, P = 0.000001), modified DWI-PC-ASPECTS (10.4 vs. 7.8, P = 0.021), and MRA-BATMAN (6.3 vs. 4.6, P = 0.003) scores. Univariate Logistic regression analysis demonstrated NIHS score ≥ 21, modified DWI-PC-ASPECTS score ≤ 8.5, and MRA-BATMAN score ≤ 6.5 to be the risk factors for poor prognosis. Multivariate Logistic regression analysis revealed NIHSS score ≥ 21 as an independent risk factor for poor prognosis. CONCLUSION Endovascular mechanical thrombectomy is safe and effective in recanalizing occluded vertebrobasilar artery occlusion, and NIHS score ≥ 21, modified DWI-PC-ASPECTS score ≤ 8.5, and MRA-BATMAN score ≤ 6.5 are the risk factors for poor prognosis.
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Affiliation(s)
- Jin-Chao Liu
- Department of Intervention, Henan Puyang Oilfield General Hospital, Puyang, Henan Province 457000, China
| | - Bu-Lang Gao
- Stroke Center, Henan Provincial People's Hospital, Henan University, Zhengzhou, Henan Province 450000, China
| | - Hong-Wei Li
- Department of Intervention, Henan Puyang Oilfield General Hospital, Puyang, Henan Province 457000, China
| | - Fu-Wen Chen
- Department of Intervention, Henan Puyang Oilfield General Hospital, Puyang, Henan Province 457000, China
| | - Hong-Sheng Shi
- Department of Intervention, Henan Puyang Oilfield General Hospital, Puyang, Henan Province 457000, China
| | - Zhan Wang
- Department of Intervention, Henan Puyang Oilfield General Hospital, Puyang, Henan Province 457000, China
| | - Zi-Liang Wang
- Stroke Center, Henan Provincial People's Hospital, Henan University, Zhengzhou, Henan Province 450000, China.
| | - Tian-Xiao Li
- Stroke Center, Henan Provincial People's Hospital, Henan University, Zhengzhou, Henan Province 450000, China
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26
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Li W, Hong W, Wang E, Jiang Y. RAPID Software to the Clinical Application Value of Acute Basilar Artery Occlusion with Endovascular Treatment. J Stroke Cerebrovasc Dis 2021; 30:106147. [PMID: 34653946 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106147] [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: 07/17/2021] [Revised: 09/11/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To investigate the clinical application value of RAPID software based on computed tomography perfusion imaging (CTP) in the endovascular treatment of acute basilar artery occlusion (BAO). MATERIALS AND METHODS The data of patients with acute basilar artery occlusion who received endovascular treatment in Taizhou Hospital, Zhejiang Province, between January 2020 and April 2021 were retrospectively analysed. The patients were divided into a perfusion imaging and a no-perfusion imaging group based on whether the image analysis results were obtained by RAPID software. Age, preoperative National Institute of Health stroke scale (NIHSS) score, onset to puncture time (OPT), operation methods, good prognosis at 3 months after surgery (modified Rankin scale (mRS) score ≤3), symptomatic intracranial haemorrhage (sICH) and other clinical data were compared between the two groups. Multivariate logistic regression analysis was used to identify the independent factors affecting the prognosis of BAO patients. RESULTS In total, 61 patients with acute BAO were included: 31 patients in the perfusion imaging group and 30 patients in the no-perfusion imaging group. There were no statistically significant differences between the two groups in age, NIHSS score or operation methods (all P >0.05). However, OPT and the good prognosis rate were significantly higher in the perfusion imaging group than in the no-perfusion imaging group (χ2=8.176, 5.003, P < 0.05). SICH was significantly lower in the perfusion imaging group than in the no-perfusion imaging group (χ2=5.628, P < 0.05). Logistic regression analysis showed that the image analysis results of RAPID software influenced the prognosis of EVT in patients with acute BAO (OR=4.048, 95%CI: 1.276-12.840). CONCLUSIONS RAPID software based on CTP can be used for preoperative screening of patients with acute basilar artery occlusion to identify those suitable for endovascular treatment, which is worthy of clinical promotion.
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Affiliation(s)
- Weiling Li
- Department of Neurology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou 317000, China.
| | - Weijun Hong
- Department of Neurology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou 317000, China.
| | - En Wang
- Department of Neurology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou 317000, China.
| | - Yiqing Jiang
- Department of Neurology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou 317000, China.
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27
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Matusevicius M, Cooray C, Rand VM, Nunes AP, Moreira T, Tassi R, Egido JA, Ollikainen J, Bigliardi G, Holmin S, Ahmed N. Stroke Etiology and Outcomes after Endovascular Thrombectomy: Results from the SITS Registry and a Meta-Analysis. J Stroke 2021; 23:388-400. [PMID: 34649383 PMCID: PMC8521251 DOI: 10.5853/jos.2021.00850] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/04/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE The influence of stroke etiology on outcomes after endovascular thrombectomy (EVT) is not well understood. We aimed to investigate whether stroke etiology subgrouped as large artery atherosclerosis (LAA) and cardiac embolism (CE) influences outcomes in large artery occlusion (LAO) treated by EVT. METHODS We included EVT treated LAO stroke patients registered in the Safe Implementation of Treatment in Stroke (SITS) thrombectomy register between January 1, 2014 and September 3, 2019. Primary outcome was successful reperfusion (modified Treatment in Cerebral Infarction 2b-3). Secondary outcomes were symptomatic intracranial hemorrhage (SICH), 3-month functional independence (modified Ranking Scale 0-2) and death. Multivariable logistic regression models were used for comparisons. In addition, a meta-analysis of aggregate data from the current literature was conducted (PROSPERO, ID 167447). RESULTS Of 7,543 patients, 1,903 (25.2%) had LAA, 3,214 (42.6%) CE, and 2,426 (32.2%) unknown, other, or multiple etiologies. LAA patients were younger (66 vs. 74, P<0.001) and had lower National Institutes of Health Stroke Scale score at baseline (15 vs. 16, P<0.001) than CE patients. Multivariable analyses showed that LAA patients had lower odds of successful reperfusion (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.57 to 0.86) and functional independence (OR, 0.74; 95% CI, 0.63 to 0.85), higher risk of death (OR, 1.44; 95% CI, 1.21 to 1.71), but no difference in SICH (OR, 1.09; 95% CI, 0.71 to 1.66) compared to CE patients. The systematic review found 25 studies matching the criteria. The meta-analysis did not find any difference between etiologies. CONCLUSIONS From the SITS thrombectomy register, we observed a lower chance of reperfusion and worse outcomes after thrombectomy in patients with LAA compared to CE etiology, despite more favorable baseline characteristics. In contrast, the meta-analysis did not find any difference between etiologies with aggregate data.
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Affiliation(s)
- Marius Matusevicius
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Research and Education, Karolinska University Hospital, Stockholm, Sweden
| | - Charith Cooray
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Viiu-Marika Rand
- Department of Neurology, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Ana Paiva Nunes
- Stroke Unit, Saint Joseph's Hospital, Central Lisbon University Hospital Centre, Lisbon, Portugal
| | - Tiago Moreira
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Rossana Tassi
- Stroke Unit, University Hospital of Siena, Siena, Italy
| | - Jose Antonio Egido
- Stroke Unit, Department of Neurology, San Carlos Clinical Hospital, Madrid, Spain
| | | | - Guido Bigliardi
- Department of Neuroscience, Neurologal Clinic, Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Niaz Ahmed
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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28
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Feyen L, Schott P, Ochmann H, Katoh M, Haage P, Freyhardt P. Value of machine learning to predict functional outcome of endovascular treatment for acute ischaemic stroke of the posterior circulation. Neuroradiol J 2021; 35:363-369. [PMID: 34609913 DOI: 10.1177/19714009211049088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Clinical outcomes vary considerably among individuals with vessel occlusion of the posterior circulation. In the present study we evaluated machine learning algorithms in their ability to discriminate between favourable and unfavourable outcomes in patients with endovascular treatment of acute ischaemic stroke of the posterior circulation. METHODS This retrospective study evaluated three algorithms (generalised linear model, K-nearest neighbour and random forest) to predict functional outcomes at dismissal of 30 patients with acute occlusion of the basilar artery who were treated with thrombectomy. Input variables encompassed baseline as well as peri and postprocedural data. Favourable outcome was defined as a modified Rankin scale score of 0-2 and unfavourable outcome was defined as a modified Rankin scale score of 3-6. The performance of the algorithms was assessed with the area under the receiver operating curve and with confusion matrixes. RESULTS Successful reperfusion was achieved in 83%, with 30% of the patients having a favourable outcome. The area under the curve was 0.93 for the random forest model, 0.86 for the K-nearest neighbour model and 0.78 for the generalised linear model. The accuracy was 0.69 for the generalised linear model and 0.84 for the random forest and the K nearest neighbour models. CONCLUSION Favourable and unfavourable outcomes at dismissal of patients with acute ischaemic stroke of the posterior circulation can be predicted immediately after the follow-up non-enhanced computed tomography using machine learning.
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Affiliation(s)
- Ludger Feyen
- Department of Diagnostic and Interventional Radiology, 27664HELIOS Klinikum Krefeld, Helios Klinikum Krefeld, Germany.,University Witten/Herdecke, Faculty of Health, School of Medicine, Germany.,Department of Diagnostic and Interventional Radiology, Helios University Hospital Wuppertal, Germany
| | - Peter Schott
- Department of Diagnostic and Interventional Radiology, 27664HELIOS Klinikum Krefeld, Helios Klinikum Krefeld, Germany
| | - Hendrik Ochmann
- Department of Diagnostic and Interventional Radiology, 27664HELIOS Klinikum Krefeld, Helios Klinikum Krefeld, Germany
| | - Marcus Katoh
- Department of Diagnostic and Interventional Radiology, 27664HELIOS Klinikum Krefeld, Helios Klinikum Krefeld, Germany
| | - Patrick Haage
- University Witten/Herdecke, Faculty of Health, School of Medicine, Germany.,Department of Diagnostic and Interventional Radiology, Helios University Hospital Wuppertal, Germany
| | - Patrick Freyhardt
- Department of Diagnostic and Interventional Radiology, 27664HELIOS Klinikum Krefeld, Helios Klinikum Krefeld, Germany.,Department of Diagnostic and Interventional Radiology, Helios University Hospital Wuppertal, Germany
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29
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Wu M, Zha M, Zhang X, Yuan K, Huang K, Xie Y, Dai Q, Liu X. Predictors of mortality for acute vertebrobasilar artery occlusion receiving endovascular treatment. Acta Neurol Scand 2021; 144:433-439. [PMID: 34105145 DOI: 10.1111/ane.13477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Acute vertebrobasilar artery occlusion (VBAO) is a devastating type of stroke with a high mortality rate. This study aimed to investigate the predictors of 3-month and 1-year mortality in VBAO patients receiving endovascular treatment (EVT). MATERIALS & METHODS Consecutive acute VBAO patients undergoing EVT between January 2014 and December 2019 were retrospectively analyzed in a prospectively maintained database. Multivariate logistical regression models were used to explore the potential predictors of mortality at 3 months and 1 year, respectively. The discrimination of the final model was assessed with the area under the receiver operating characteristic curve. RESULTS A total of 100 patients were enrolled in this study (mean age 62 years; 77.0% male). After excluding patients lost to follow-up, the overall mortality rate was 34.3% (34/99) at 3 months and 45.4% (44/97) at 1 year. The Glasgow Coma Scale (GCS) score at 24 h (Odds ratio [OR], 0.676; 95% confidence interval [CI], 0.540-0.846; p = .001) and mechanical ventilation (MV) (OR, 7.356; 95% CI, 2.200-24.593; p = .001) were predictors of 3-month mortality after adjusting for potential confounders in multivariable analysis. Furthermore, the GCS score at 24 h (OR, 0.714; 95% CI, 0.590-0.864; p = .001), intracranial hemorrhage (OR, 7.330; 95% CI, 1.772-30.318; p = .006), and MV (OR, 5.804; 95% CI, 1.841-18.294; p = .003) were independently associated with mortality at 1 year. Sensitivity analyses showed similar results. CONCLUSION The 24-h GCS score and MV were common predictors of 3-month and 1-year mortality, and ICH was an additional predictor of 1-year mortality.
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Affiliation(s)
- Min Wu
- Department of Neurology Jinling HospitalThe First School of Clinical MedicineSouthern Medical University Nanjing China
| | - Mingming Zha
- Department of Neurology Jinling HospitalMedical School of Southeast University Nanjing China
| | - Xiaohao Zhang
- Department of Neurology Jinling HospitalAffiliated Medical School of Nanjing University Nanjing China
| | - Kang Yuan
- Department of Neurology Jinling HospitalNanjing Medical University Nanjing China
| | - Kangmo Huang
- Department of Neurology Jinling HospitalAffiliated Medical School of Nanjing University Nanjing China
| | - Yi Xie
- Department of Neurology Jinling HospitalAffiliated Medical School of Nanjing University Nanjing China
| | - Qiliang Dai
- Department of Neurology Jinling HospitalAffiliated Medical School of Nanjing University Nanjing China
| | - Xinfeng Liu
- Department of Neurology Jinling HospitalThe First School of Clinical MedicineSouthern Medical University Nanjing China
- Department of Neurology Jinling HospitalAffiliated Medical School of Nanjing University Nanjing China
- Stroke Center & Department of Neurology Division of Life Sciences and Medicine the First Affiliated Hospital of USTCUniversity of Science and Technology of China Hefei China
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30
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Terceño M, Silva Y, Bashir S, Vera-Monge VA, Cardona P, Molina C, Chamorro Á, de la Ossa NP, Hernández-Pérez M, Werner M, Camps-Renom P, Rodríguez-Campello A, Cánovas D, Purroy F, Serena J. Impact of general anesthesia on posterior circulation large vessel occlusions after endovascular thrombectomy. Int J Stroke 2021; 16:792-797. [DOI: 10.1177/1747493020976247] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background The impact of general anesthesia on functional outcome in patients with large vessel occlusion remains unclear. Most studies have focused on anterior circulation large vessel occlusion; however, little is known about the effect of general anesthesia in patients with posterior circulation—large vessel occlusion. Methods We performed a retrospective analysis from the prospective CICAT registry. All patients with posterior circulation—large vessel occlusion—and undergoing endovascular therapy between January 2016 and January 2020 were included. Demographics, baseline characteristics, procedural data, and anesthesia modality (general anesthesia or conscious sedation) were evaluated. The primary outcome was the proportion of patients with good clinical outcome (modified Rankin Scale score of 0–2) at three months. Results 298 patients underwent endovascular treatment with posterior circulation—large vessel occlusion—were included. Age, diabetes mellitus, renal insufficiency, baseline National Institutes of Health Stroke Scale score, puncture to recanalization length, ≥3 device passes, absent of successful recanalization (defined as treatment in cerebral ischemia of 3), and general anesthesia were statistically associated with poor outcome (mRS: 3-6). In the multivariable regression, general anesthesia and ≥3 device passes were independently associated with poor outcome (aOR: 3.11, (95% CI: 1.34–7.2); P = 0.01 and 3.77, (95% CI: 1.29–11.01); P = 0.02, respectively). Patients treated with general anesthesia were less likely to have a good outcome at three months compared to conscious sedation (19.7% vs. 45.1%, P < 0.001). Conclusions In our study population, general anesthesia use is associated with poor clinical outcome in patients with posterior circulation—large vessel occlusion—treated endovascularly.
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Affiliation(s)
- Mikel Terceño
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
- Interventional Neuroradiology Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Yolanda Silva
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
| | - Saima Bashir
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
| | - Víctor A Vera-Monge
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
| | - Pere Cardona
- Stroke Unit, Department of Neurology, Bellvitge Hospital, Barcelona, Spain
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Vall d’Hebron Hospital, Barcelona, Spain
| | - Ángel Chamorro
- Stroke Unit, Department of Neurology, Clinic Hospital, Barcelona, Spain
| | - Natalia P de la Ossa
- Stroke Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
- Stroke Program/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - María Hernández-Pérez
- Stroke Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Mariano Werner
- Interventional Neuroradiology Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Pol Camps-Renom
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - David Cánovas
- Stroke Unit, Department of Neurology, Parc Taulí Hospital, Sabadell, Spain
| | - Francisco Purroy
- Stroke Unit, Department of Neurology, Arnau de Vilanova Hospital, Lleida, Spain
| | - Joaquín Serena
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
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31
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Jahan R, Liebeskind DS, Zaidat OO, Mueller-Kronast NH, Froehler MT, Saver JL. Stent Retriever Thrombectomy for Anterior vs. Posterior Circulation Ischemic Stroke: Analysis of the STRATIS Registry. Front Neurol 2021; 12:706130. [PMID: 34504469 PMCID: PMC8421856 DOI: 10.3389/fneur.2021.706130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: The benefits of mechanical thrombectomy (MT) in vertebrobasilar artery occlusions have not been well-studied. We compared clinical, procedural, and safety outcomes of MT for posterior circulation (PC) vs. anterior circulation (AC) occlusions among patients in the STRATIS registry. Methods: Data from STRATIS including patient demographics, procedural characteristics, and outcomes including symptomatic intracranial hemorrhage (sICH) at 24 h, serious adverse events (SAE), substantial reperfusion [modified thrombolysis in cerebral infarction (mTICI) 2b/3], 90-day functional independence [modified Rankin Scale (mRS) 0–2], and 90-day mortality were analyzed. Univariate logistic regression was used to calculate predictors of good clinical outcome. Results: Of 984 STRATIS patients, 43 (4.4%) patients with PC occlusions [mean age 63.0 ± 13.6, 25.6% (11/43) female] and 932 (94.7%) with AC occlusions [mean age 68.5 ± 14.8, 46.9% (437/932) female] were included for analysis. Median National Institutes of Health Stroke Scale (NIHSS) scores at baseline were 17.0 (13.0, 12.0) for the AC group and 12.0 (11.0, 24.0) for the PC group. Time from onset to procedure end was longer for the PC group [median (IQR): 322.0 min (255.0–421.0) vs. 271.0 min (207.0–360.0); p = 0.007]. PC and AC groups had similar rates of substantial reperfusion [89.2% (33/37) vs. 87.7% (684/780)], procedure-related SAE [0.0% (0/43) vs. 1.7% (16/932)], sICH [0.0% (0/38) vs. 1.5% (12/795)], 90-day functional independence [66.7% (26/39) vs. 55.9% (480/858)] and mortality [12.8% (5/39) vs. 15.8% (136/861)]. National Institutes of Health Stroke Scale score and patient sex were significant univariate predictors of good clinical outcome (p < 0.05). Conclusions: Despite longer reperfusion times, MT in PC stroke has similar rates of 90-day functional independence with no significant difference in procedure-related SAE, sICH, or mortality, supporting the use of MT in PC acute ischemic stroke (AIS). Clinical Trial Registration:https://www.clinicaltrials.gov, Identifier: NCT02239640.
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Affiliation(s)
- Reza Jahan
- Division of Interventional Neuroradiology, Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - David S Liebeskind
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Osama O Zaidat
- Department of Neurology, Mercy Health St. Vincent Hospital, Toledo, OH, United States
| | | | - Michael T Froehler
- Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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32
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Onodera K, Kurisu K, Sakurai J, Wada H, Takebayashi S, Kobayashi T, Kobayshi R, Gotoh S, Takizawa K. A Direct Aspiration First Pass Technique for Vertebra-Basilar Occlusion: A Retrospective Comparison to Stent Retriever. J Stroke Cerebrovasc Dis 2021; 30:106069. [PMID: 34461445 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/01/2021] [Accepted: 08/14/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to assess the clinical usefulness of a direct aspiration first pass technique as a first-line strategy for mechanical thrombectomy in posterior circulation. MATERIALS AND METHODS We examined 34 consecutive patients treated with mechanical thrombectomy for acute vertebrobasilar artery occlusion. Procedural and clinical outcomes were assessed and compared between patients treated with a direct aspiration first pass technique first-line strategy (ADAPT group) and stent retriever system first-line strategy (stent retriever group). RESULTS Overall, successful reperfusion, complete reperfusion, and first-pass effects were achieved in 94.1%, 61.8%, and 50% of patients with acute ischemic stroke in vertebra-basilar artery occlusion treated with mechanical thrombectomy, respectively. The ADAPT group required a significantly shorter procedural time (p=.015) and fewer attempts (p=.0498) to achieve successful recanalization than the stent retriever group. The ADAPT group also tended to show better recanalization rates and first-pass effects than the stent retriever group. The rates of favorable outcomes seemed to be better, although insignificant, in the ADAPT group than in the stent retriever group (52.2% vs. 27.3%, p=.217). However, a significant correlation between the time required for reperfusion and clinical outcome was detected, and this will serve as the rationale for encouraging a direct aspiration first pass technique as a first-line strategy in the acute vertebra-basilar artery. CONCLUSIONS The a direct aspiration first pass technique first-line strategy for mechanical thrombectomy in posterior circulation may achieve successful recanalization with fewer attempts and shorter durations than the stent retriever first-line strategy.
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Affiliation(s)
- Koki Onodera
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan
| | - Kota Kurisu
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Juro Sakurai
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Hajime Wada
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Seiji Takebayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Tohru Kobayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Rina Kobayshi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Shuho Gotoh
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan
| | - Katsumi Takizawa
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
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Laible M, Jenetzky E, Möhlenbruch MA, Bendszus M, Ringleb PA, Rizos T. The Impact of Post-contrast Acute Kidney Injury on In-hospital Mortality After Endovascular Thrombectomy in Patients With Acute Ischemic Stroke. Front Neurol 2021; 12:665614. [PMID: 34163423 PMCID: PMC8215575 DOI: 10.3389/fneur.2021.665614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/20/2021] [Indexed: 01/22/2023] Open
Abstract
Background and Purpose: Clinical outcome and mortality after endovascular thrombectomy (EVT) in patients with ischemic stroke are commonly assessed after 3 months. In patients with acute kidney injury (AKI), unfavorable results for 3-month mortality have been reported. However, data on the in-hospital mortality after EVT in this population are sparse. In the present study, we assessed whether AKI impacts in-hospital and 3-month mortality in patients undergoing EVT. Materials and Methods: From a prospectively recruiting database, consecutive acute ischemic stroke patients receiving EVT between 2010 and 2018 due to acute large vessel occlusion were included. Post-contrast AKI (PC-AKI) was defined as an increase of baseline creatinine of ≥0.5 mg/dL or >25% within 48 h after the first measurement at admission. Adjusting for potential confounders, associations between PC-AKI and mortality after stroke were tested in univariate and multivariate logistic regression models. Results: One thousand one hundred sixty-nine patients were included; 166 of them (14.2%) died during the acute hospital stay. Criteria for PC-AKI were met by 29 patients (2.5%). Presence of PC-AKI was associated with a significantly higher risk of in-hospital mortality in multivariate analysis [odds ratio (OR) = 2.87, 95% confidence interval (CI) = 1.16–7.13, p = 0.023]. Furthermore, factors associated with in-hospital mortality encompassed higher age (OR = 1.03, 95% CI = 1.01–1.04, p = 0.002), stroke severity (OR = 1.05, 95% CI = 1.03–1.08, p < 0.001), symptomatic intracerebral hemorrhage (OR = 3.20, 95% CI = 1.69–6.04, p < 0.001), posterior circulation stroke (OR = 2.85, 95% CI = 1.72–4.71, p < 0.001), and failed recanalization (OR = 2.00, 95% CI = 1.35–3.00, p = 0.001). Conclusion: PC-AKI is rare after EVT but represents an important risk factor for in-hospital mortality and for mortality within 3 months after hospital discharge. Preventing PC-AKI after EVT may represent an important and potentially lifesaving effort in future daily clinical practice.
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Affiliation(s)
- Mona Laible
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Neurology, University of Ulm, Ulm, Germany
| | - Ekkehart Jenetzky
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany.,Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Mainz, Germany
| | | | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Timolaos Rizos
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
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34
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Wu L, Zhang D, Chen J, Sun C, Ji K, Li W, Zhao W, Li C, Wu C, Li M, Wu D, Ji X. Long-term outcome of endovascular therapy for acute basilar artery occlusion. J Cereb Blood Flow Metab 2021; 41:1210-1218. [PMID: 32955959 PMCID: PMC8142131 DOI: 10.1177/0271678x20958587] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The long-term functional outcome of acute basilar artery occlusion (BAO) patients who received modern endovascular therapy (EVT) is unclear. We sought to assess the long-term functional outcome of BAO patients treated with EVT and determine the prognostic factors associated with favorable outcome. We enrolled consecutive BAO patients who received EVT between December 2012 and December 2018 in this observational study. Baseline characteristics and outcomes were presented. Multivariable logistic regression analysis was performed to identify the prognostic factors associated with long-term outcome. Among the 177 BAO patients included in this study, 80 patients (45.2%) obtained favorable outcome and 97 patients (54.8%) had unfavorable outcome at long-term follow-up with a median observation time of 12 months (interquartile range, 3-19). A total of 67 patients (37.9%) died. National Institutes of Health Stroke Scale (NIHSS), posterior circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS), time from stroke onset to recanalization, and recanalization condition were identified as independent predictors for long-term outcome. Over 40% of BAO patients who were treated with modern EVT achieved favorable outcome at long-term follow-up. NIHSS, pc-ASPECTS, time from stroke onset to recanalization, and recanalization condition were identified as independent prognostic factors of long-term outcome.
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Affiliation(s)
- Longfei Wu
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Da Zhang
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jian Chen
- Department of Neurosurgery, Capital Medical University, Beijing, China
| | - Chenghe Sun
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Kangxiang Ji
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Weili Li
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Wenbo Zhao
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Chuanhui Li
- Department of Emergency, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Ming Li
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Di Wu
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurosurgery, Capital Medical University, Beijing, China
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35
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Jiang L, Yang JH, Ruan J, Xia WQ, Huang H, Zhang H, Chen TW, Li LF, Yin CG. A Single-Center Experience of Endovascular Treatment in Subtypes of Basilar Artery Occlusion: Embolization Caused by Tandem Vertebral Artery Stenosis May Be Associated with Better Outcomes. World Neurosurg 2021; 151:e918-e926. [PMID: 33991729 DOI: 10.1016/j.wneu.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Basilar artery occlusion (BAO) is a severe condition with high mortality. However, surgical procedures and outcomes of BAO with different pathologic subtypes have not been fully clarified. This study compared the surgical procedures and clinical outcomes of mechanical thrombectomy in different subtypes of BAO. METHODS Eighty-six patients with acute BAO receiving endovascular treatment between October 2015 and July 2019 were retrospectively analyzed and placed in 3 groups: pure embolism (group 1), arterial-arterial embolism from steno-occlusion of the tandem vertebral artery (group 2), and in situ atherosclerotic thrombosis (group 3). Recanalization rates, procedure times, surgical characteristics, and clinical outcomes were analyzed. RESULTS Groups 1, 2, and 3 included 33 (38.4%), 17 (19.8%), and 36 (41.9%) patients, respectively. The overall successful recanalization rate was 95.3%, and the good outcome rate was 61.6%. The procedure time in group 1 was shorter than the time in groups 2 and 3 (P < 0.001). The clinical good outcome rate was higher in group 2 than in group 1 (88.2% vs. 54.5%; P = 0.017). Groups 1 and 3 had similar good outcome rates (54.5% vs. 55.6%; P = 0.933). Twenty-seven patients received stent angioplasty: 10 of 17 in group 2 (58.8%) and 17 of 36 in group 3 (47.2%). CONCLUSIONS The outcome of endovascular treatment for BAO varies among patients with different pathologic mechanisms. Patients with embolism from tandem vertebral artery steno-occlusion achieved the best outcomes. Rescue treatment was more common in patients with embolic BAO with tandem vertebral artery steno-occlusion and BAO with in situ atherosclerotic thrombosis.
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Affiliation(s)
- Lin Jiang
- Department of Neurology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian-Hong Yang
- Department of Neurology, Ningbo First Hospital, Ningbo, China
| | - Jie Ruan
- Department of Neurology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen-Qing Xia
- Department of Neurology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huan Huang
- Department of Neurology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Zhang
- Department of Neurology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian-Wen Chen
- Department of Neurology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ling-Fei Li
- Department of Neurology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cong-Guo Yin
- Department of Neurology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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36
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Li H, Ye SS, Wu YL, Huang SM, Li YX, Lu K, Huang JB, Chen L, Li HZ, Wu WJ, Wu ZL, Wu JZ, Zhong WT, Xian WC, Liao F, Tung TH, Wu QL, Chen H, Yuan L, Yang Z, Huang LA. Predicting mortality in acute ischaemic stroke treated with mechanical thrombectomy: analysis of a multicentre prospective registry. BMJ Open 2021; 11:e043415. [PMID: 33795300 PMCID: PMC8021751 DOI: 10.1136/bmjopen-2020-043415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES We aimed to determine predictors of mortality within 90 days and develop a simple score for patients with mechanical thrombectomy (MT). DESIGN Analysis of a multicentre prospective registry. SETTING In six participating centres, patients who had an acute ischaemic stroke (AIS) treated by MT between March 2017 and May 2018 were documented prospectively. PARTICIPANTS 224 patients with AIS were treated by MT. RESULTS Of 224 patients, 49 (21.9%) patients died, and 87 (38.8%) were independent. Variables associated with 90-day mortality were age, previous stroke, admission National Institutes of Health Stroke Scale (NIHSS), fasting blood glucose and occlusion site. Logistic regression identified four variables independently associated with 90-day mortality: age ≥80 years (OR 3.26, 95% CI 1.45 to 7.33), previous stroke (OR 2.33, 95% CI 1.04 to 5.21), admission NIHSS ≥18 (OR 2.37, 95% CI 1.13 to 4.99) and internal carotid artery or basilar artery occlusion (OR 2.92, 95% CI 1.34 to 6.40). Using these data, we developed predicting 90-day mortality of AIS with MT (PRACTICE) score ranging from 0 to 6 points. The receiver operator curve analysis found that PRACTICE score (area under the curve (AUC)=0.744, 95% CI 0.669 to 0.820) was numerically better than iScore (AUC=0.661, 95% CI 0.577 to 0.745) and Predicting Early Mortality of Ischemic Stroke score (AUC=0.638, 95% CI 0.551 to 0.725) for predicting 90-day mortality. CONCLUSIONS We developed a simple score to estimate the 90-day mortality of patients who had an AIS treated with MT. But the score needs to be prospectively validated. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR-OOC-17013052).
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Affiliation(s)
- Hao Li
- Department of Neurology, Maoming People’s Hospital, Maoming, China
| | - Shi-sheng Ye
- Department of Neurology, Maoming People’s Hospital, Maoming, China
| | - Yuan-Ling Wu
- Department of Neurology, Longgang District People’s Hospital of Shenzhen, Shenzhen, China
| | - Sheng-Ming Huang
- Department of Neurology, Jinan University First Affiliated Hospital, Guangzhou, China
| | - Yong-Xin Li
- Department of Neurology, Shunde Hospital of Southern Medical University, Foshan, China
| | - Kui Lu
- Department of Neurology, Zhongshan City People’s Hospital, Zhongshan, China
| | - Jing-Bo Huang
- Department of Neurology, Maoming People’s Hospital, Maoming, China
| | - Lve Chen
- Department of Neurology, Shunde Hospital of Southern Medical University, Foshan, China
| | - Hong-Zhuang Li
- Department of Neurology, Shunde Hospital of Southern Medical University, Foshan, China
| | - Wen-Jun Wu
- Department of Neurology, Zhongshan City People’s Hospital, Zhongshan, China
| | - Zhi-Lin Wu
- Department of Integrated Intervention, Yunfu People’s Hospital, Yunfu, China
| | - Jian-Zhou Wu
- Department of Integrated Intervention, Yunfu People’s Hospital, Yunfu, China
| | - Wang-Tao Zhong
- Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Wen-Chuan Xian
- Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Feng Liao
- Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Tao-Hsin Tung
- Department of Enze Medical Research Center, Affiliated Taizhou Hospital of Wenzhou Medical College, Taizhou, China
| | - Qiao-Ling Wu
- Department of Neurology, Maoming People’s Hospital, Maoming, China
| | - Hai Chen
- Department of Neurology, Maoming People’s Hospital, Maoming, China
| | - Li Yuan
- Department of Neurology, Maoming People’s Hospital, Maoming, China
| | - Zhi Yang
- Department of Neurology, Maoming People’s Hospital, Maoming, China
| | - Li-An Huang
- Department of Neurology, Jinan University First Affiliated Hospital, Guangzhou, China
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Katsumata M, Ota T, Tsuruta W, Akiyama T, Sakai Y, Shigeta K, Kaneko J, Nogawa S, Ichijo M, Shiokawa Y, Hirano T. Comparisons of Characteristics and Outcomes after Mechanical Thrombectomy for Vertebrobasilar Occlusion with Cardioembolism or Atherosclerotic Brain Infarction: Data from the Tokyo-Tama-Registry of Acute Endovascular Thrombectomy (TREAT). World Neurosurg 2021; 148:e680-e688. [PMID: 33508493 DOI: 10.1016/j.wneu.2021.01.071] [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: 12/06/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Some reports suggest the efficacy of mechanical thrombectomy (MT) for acute vertebrobasilar artery (VBA) occlusion. The major causes of VBA occlusion include cardioembolism (CE) and large-artery atherosclerosis (LAA). However, the clinical characteristics of each cause remain unclear, and they might be important for decision making related to the indications and strategy of MT. OBJECTIVE This study aimed to compare functional outcomes and factors affecting outcomes between patients with CE and LAA with acute VBA occlusion. METHODS This was a retrospective and prospective observational study using data from TREAT (Tokyo-Tama-Registry of Acute Endovascular Thrombectomy), a multicenter registry of MT for acute large-vessel occlusion in the Tokyo metropolitan area. Patients with VBA occlusion classified into CE and LAA groups were analyzed. The primary outcome was a modified Rankin Scale score of 0-2 at 90 days. RESULTS Seventy-nine patients (57 with CE and 22 with LAA) were eligible from January 2015 to March 2020. Despite significantly shorter puncture-to-recanalization and onset-or-last-well-known-to-recanalization times in the CE group, the primary outcome was not significantly different between the 2 groups (CE, 31.6% vs. LAA, 45.5%; P = 0.248). In the subgroup analysis, patients with CE had worse clinical outcomes in the onset-or-last-well-known-to-door time ≥180 minutes, onset-or-last-well-known-to-door time ≥300 minutes, and low posterior circulation Alberta Stroke Program Early CT Score (≤7) subgroups. CONCLUSIONS Functional outcomes of VBA occlusion were not significantly different between CE and LAA. Based on the subgroup analysis, patients with CE might have poorer collateral status than do patients with LAA, and earlier recanalization might therefore be desired.
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Affiliation(s)
- Masahiro Katsumata
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Yu Sakai
- Department of Neurosurgery, Showa General Hospital, Tokyo, Japan
| | - Keigo Shigeta
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Shigeru Nogawa
- Department of Neurology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Masahiko Ichijo
- Department of Neurosurgery, Musashino Red Cross Hospital, Tokyo, Japan
| | | | - Teruyuki Hirano
- Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
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Wu D, Guo F, Liu D, Hu R, Shen Z, Yang Y, Wang Y, Xu Y, Li L. Characteristics and prognosis of acute basilar artery occlusion in minor to moderate stroke and severe stroke after endovascular treatment: A multicenter retrospective study. Clin Neurol Neurosurg 2021; 202:106504. [PMID: 33535127 DOI: 10.1016/j.clineuro.2021.106504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed to investigate characteristics and outcomes of patients receiving mechanical thrombectomy (MT) between minor to moderate stroke and severe stroke caused by acute basilar artery occlusion (BAO). METHODS We retrospectively reviewed the data of all patients with BAO who underwent MT from three stroke centers between January 2016 and January 2020. The patients were dichotomized as minor to moderate or severe stroke group according to their admission National Institutes of Health Stroke Scale (NIHSS) score <21and ≥21. Patient characteristics, imaging findings, and outcomes were compared between the two groups. RESULTS A total of 72 patients were included in this study. The posterior circulation Alberta Stroke Program Early CT Score (PC-ASPECTS) in the minor to moderate stroke patients were significantly higher than that of patients with severe stroke (P = 0.013). The good posterior circulation collateral scores (PC-CS) (6-10) were more commonly found in patients with minor to moderate stroke than in patients with severe stroke (58.14 % vs 10.34 %,P < 0.001). There were similar rates of successful recanalization between the two groups. Patients with minor to moderate stroke had a higher rate of favorable outcomes (mRS score 0-2, 60.47 % vs 20.69 %, P = 0.002) and a lower rate of periprocedural complications (4.65 % vs 31.03 %, P = 0.005) and mortality (4.65 % vs 24.14 %, P = 0.026) at 3 months after MT compared with the patients with severe stroke. CONCLUSIONS Acute BAO patients with minor to moderate stroke had better posterior circulation collateral and had better outcomes after MT than those patients with severe stroke.
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Affiliation(s)
- Dayu Wu
- Department of Neurology, Gongli Hospital, Shanghai, 200135, PR China
| | - Fei Guo
- Department of Neurology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, PR China
| | - Diyan Liu
- Department of Neurology, Wuchang Hospital, Wuhan, 430063, PR China
| | - Rongguo Hu
- Department of Neurology, Gongli Hospital, Shanghai, 200135, PR China
| | - Zhenkun Shen
- Department of Neurology, Gongli Hospital, Shanghai, 200135, PR China
| | - Yuwei Yang
- Department of Intervention, Gongli Hospital, Shanghai, 200135, PR China
| | - Yane Wang
- Department of Intervention, Gongli Hospital, Shanghai, 200135, PR China
| | - Yumei Xu
- Department of Neurology, Gongli Hospital, Shanghai, 200135, PR China
| | - Longxuan Li
- Department of Neurology, Gongli Hospital, Shanghai, 200135, PR China.
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Xun K, Mo J, Ruan S, Dai J, Zhang W, Lv Y, Du N, Chen S, Shen Z, Wu Y. A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy. Cerebrovasc Dis 2020; 50:185-199. [PMID: 33378751 DOI: 10.1159/000512609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Posterior circulation stroke is characterized by poor prognosis because its optimal thrombolysis "time window" is always missed. After mechanical thrombectomy (MT), the recanalization rate of posterior circulation obstruction is significantly increased, but prognosis remains poor. To best manage patients, prognostic factors are needed to inform MT triaging after posterior circulation stroke. METHODS A systematic literature search was done for the period through April 2020. Studies included those with posterior circulation stroke cases that underwent MT. The primary outcome measure in this study was the modified Rankin Scale on day 90. RESULTS No outcome differences were found in gender, atrial fibrillation, smoking, and coronary artery disease (OR = 1.07, 95% CI: 0.90-1.28; OR = 1.02, 95% CI: 0.82-1.26; OR = 1.26, 95% CI: 0.94-1.68; and OR = 0.84, 95% CI: 0.58-1.22, respectively). Hypertension, diabetes mellitus, and previous stroke correlated with poorer prognosis (OR = 0.61, 95% CI: 0.48-0.77; OR = 0.60, 95% CI: 0.50-0.73; and OR = 0.74, 95% CI: 0.55-0.99, respectively). However, hyperlipidemia correlated with better prognosis (OR = 1.28, 95% CI: 1.04-1.58). CONCLUSION Our analysis indicates that hypertension, diabetes mellitus, or previous stroke correlate with poorer outcomes. Intriguingly, hyperlipidemia correlates with better prognosis. These factors may help inform triage decisions when considering MT for posterior circulation stroke patients. However, large, multicenter, randomized controlled trials are needed to validate these observations.
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Affiliation(s)
- Kai Xun
- Department of Emergency, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Jiahang Mo
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shunyi Ruan
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jinyao Dai
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenting Zhang
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuqi Lv
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Nannan Du
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shengyue Chen
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zefeng Shen
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Yuanxi Wu
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China,
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40
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Pazuello GB, de Castro-Afonso LH, Fornazari VR, Nakiri GS, Abud TG, Monsignore LM, Dias FA, Martins-Filho RK, Camilo MR, Aléssio-Alves FF, Pontes-Neto OM, Abud DG. Thrombectomy for Posterior Circulation Stroke: Predictors of Outcomes in a Brazilian Registry. World Neurosurg 2020; 147:e363-e372. [PMID: 33346048 DOI: 10.1016/j.wneu.2020.12.060] [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: 10/26/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Acute basilar artery occlusion is a devastating life-threatening condition. Early recanalization is the therapeutic goal in patients with acute ischemic stroke. Despite the high rates of recanalization achieved with modern devices for basilar occlusions, many patients have had poor clinical outcomes. This study aimed to assess the predictors of good and poor outcomes among patients with basilar artery occlusion treated with thrombectomy. METHODS A consecutive registry of 80 patients was included in this retrospective study. The primary end point was to access variables associated with neurologic outcomes defined by a modified Rankin Scale (mRS) score of 0-2, symptomatic intracranial hemorrhage (sICH), and mortality at 3 months follow-up. RESULTS Recanalization was achieved in 86.2%, and the sICH rate was 8.7%. A good neurologic outcome (mRS score 0-2) was observed in 26.2% and a moderate outcome (mRS score 0-3) in 32.5% of patients. The mortality was 38.7% at 3 months follow-up. CONCLUSIONS After thrombectomy for posterior circulation strokes, young patients, V4-proximal basilar occlusion, (high) baseline posterior circulation Alberta Stroke Program Early CT Score, and complete recanalization were independent predictors of good neurologic outcomes. Failure to recanalize was strongly related to sICH and mortality. In addition, diabetes, atrial fibrillation, and baseline National Institutes of Health Stroke Scale scores ≥10 had an independent association with mortality. This study contributes to the knowledge required to optimize recanalization treatments for posterior circulation strokes and may help to improve future clinical studies.
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Affiliation(s)
- Guilherme Borghini Pazuello
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luís Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Vitor Rodrigues Fornazari
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Thiago Giansante Abud
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; Department of Interventional Neuroradiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Francisco Antunes Dias
- Division of Neurology, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rui Kleber Martins-Filho
- Division of Neurology, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Milene Rodrigues Camilo
- Division of Neurology, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Frederico Fernandes Aléssio-Alves
- Division of Neurology, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Octávio Marques Pontes-Neto
- Division of Neurology, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Yamamoto N, Izumi Y, Yamamoto Y, Kuroda K, Yamaguchi I, Sogabe S, Miyamoto T, Shimada K, Kanematsu Y, Morigaki R, Takagi Y. Factors associated with DWI-ASPECTS score in patients with acute ischemic stroke due to cerebral large vessel occlusion. Clin Neurol Neurosurg 2020; 199:106316. [PMID: 33161217 DOI: 10.1016/j.clineuro.2020.106316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Alberta Stroke Program Early CT score (ASPECTS) of patients with acute ischemic stroke at the time of admission varies. It is crucial to select appropriate methods of treatment, such as recombinant tissue-plasminogen activator, and/or endovascular thrombectomy. According to the recent guidelines, endovascular thrombectomy for patients with large vessel occlusion (LVO) and lesion of ischemic tissue that was not yet infarcted is effective. This result demonstrates the importance of patient selection based on neuroradiological imaging. However, there are many patients who are judged as ineligibility for recanalization therapy because of presence of large ischemic core, indicating unfavorable ASPECTS, at the time of admission. We investigated the factors associated with favorable diffusion-weighted image (DWI)-ASPECTS score at the time of admission. METHODS We studies patients with LVO within 24 h from onset who were admitted into our hospital. We divided them into two groups, with favorable DWI-ASPECTS (≥6), and unfavorable DWI-ASPECTS (<6) at the time of admission. We investigated factors associated with favorable DWI-ASPECTS by evaluation of our patients' severity of clinical symptom, etiology, and radiological findings. RESULTS This study showed that mild white matter lesion (Fazekas scale ≤1), absence of internal carotid artery (ICA) occlusion and cardioembolic stroke were independent factor of favorable DWI-ASPECTS at the time of admission. (odds ratio 12.92, p < 0.001, odds ratio 0.31, p = 0.001, odds ratio 0.16, p = 0.001, respectively) CONCLUSIONS: Absence of severe white matter lesion, cardioembolic stroke, and ICA occlusion might be associated with favorable DWI-ASPECTS at the time of admission.
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Affiliation(s)
- Nobuaki Yamamoto
- Department of Neurology, Tokushima University, Tokushima, Japan; Department of Advanced Brain Research, Tokushima University, Tokushima, Japan.
| | - Yuishin Izumi
- Department of Neurology, Tokushima University, Tokushima, Japan.
| | - Yuki Yamamoto
- Department of Neurology, Tokushima University, Tokushima, Japan.
| | - Kazutaka Kuroda
- Department of Neurology, Tokushima Prefectural Central Hospital, Tokushima, Japan.
| | - Izumi Yamaguchi
- Department of Neurosurgery, Tokushima University, Tokushima, Japan.
| | - Shu Sogabe
- Department of Neurosurgery, Tokushima University, Tokushima, Japan.
| | - Takeshi Miyamoto
- Department of Neurosurgery, Tokushima University, Tokushima, Japan.
| | - Kenji Shimada
- Department of Neurosurgery, Tokushima University, Tokushima, Japan.
| | | | - Ryoma Morigaki
- Department of Neurosurgery, Tokushima University, Tokushima, Japan; Department of Advanced Brain Research, Tokushima University, Tokushima, Japan.
| | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University, Tokushima, Japan; Department of Advanced Brain Research, Tokushima University, Tokushima, Japan.
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42
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Tajima Y, Hayasaka M, Ebihara K, Yokoyama D, Suda I. Predictors of Very Poor Outcome after Mechanical Thrombectomy for Acute Basilar Artery Occlusion. Neurol Med Chir (Tokyo) 2020; 60:507-513. [PMID: 32879183 PMCID: PMC7555156 DOI: 10.2176/nmc.oa.2020-0148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Prognosis for patients with acute basilar artery occlusion (BAO) remains poor. Successful revascularization is a main predictor of favorable clinical outcomes after mechanical thrombectomy for BAO. However, even if mechanical thrombectomy is successful, some patients have a poor clinical outcome, including vegetative state and mortality. This study investigated the factors that are predictive of extremely poor clinical outcomes despite successful revascularization after mechanical thrombectomy for BAO. We evaluated 35 consecutive patients who presented with acute ischemic stroke due to BAO and who were successfully treated with mechanical thrombectomy. A very poor outcome was defined as a modified Rankin Scale (mRS) score of 5 or 6 at 3 months after treatment. The associations between the clinical, imaging, procedural factors, and poor outcome were evaluated. Using univariate analyses, there were significant differences in the preoperative National Institute of Health Stroke Scale (NIHSS) score (22.0 ± 9.0 vs. 30.5 ± 4.3, p <0.001), and infarct volume in brain stem (0.11 ± 0.19 cc vs. 2.55 ± 1.56 cc, p <0.001) between the control and very poor outcome groups. In receiver operating characteristic (ROC) curve analysis, the area under ROC curve of infarct volume in brain stem was 0.891 to predict very poor outcome. Preoperative infarct volume in brain stem is strong predictor for very poor outcome. The infarct volume in brain stem is useful for deciding treatment indications.
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Affiliation(s)
| | | | | | | | - Izumi Suda
- Department of Neurosurgery, Kimitsu Chuo Hospital
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43
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Weyland CS, Neuberger U, Potreck A, Pfaff JAR, Nagel S, Schönenberger S, Bendszus M, Möhlenbruch MA. Reasons for Failed Mechanical Thrombectomy in Posterior Circulation Ischemic Stroke Patients. Clin Neuroradiol 2020; 31:745-752. [PMID: 32894352 PMCID: PMC8463404 DOI: 10.1007/s00062-020-00950-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/06/2020] [Indexed: 01/18/2023]
Abstract
Background and Purpose To determine reasons for failed recanalization in mechanical thrombectomy (MT) of the posterior circulation. Methods Retrospective single center analysis of reasons for MT failure in the posterior circulation. Failed MTs were categorized according to the reason for procedure failure in failed vascular access, failed passage of the target vessel occlusion and MT failure after passing the occluded target vessel. Patient characteristics were compared between failed and successful MT. Results Patients with failed MT (30/218 patients, 13.8%) were categorized into futile vascular access (13/30, 43.3%), abortive passage of the target vessel occlusion (6/30, 20.0%) and MT failure after passing the vessel occlusion (11/30, 36.7%). In 188/218 (86.2%) successful MTs alternative vascular access, local intra-arterial (i.a.) thrombolysis and emergency stent-assisted PTA prevented 65 MT failures. Patients with failed MT showed a higher NIHSS at discharge, a higher pc-ASPECTS in follow-up imaging, a higher mRS 90 days after stroke onset and a high mortality rate of 77.0% (mRS at 90 days, median (IQR): 6 (6–6) vs. 4 (2–6) for successful MT, p-value < 0.001). Co-morbidities and stroke etiology were not different compared to sufficient recanalization with atherosclerotic disease as the leading stroke etiology in both groups. Conclusion Failure of MT in posterior circulation ischemic stroke patients is associated with a high mortality rate. Reasons for MT failure are diverse with futile vascular access and MT failure after passing the vessel occlusion as the leading causes. Alternative vascular access, local i.a. thrombolysis and stent-assisted PTA can prevent MT failure.
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Affiliation(s)
- Charlotte S Weyland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ulf Neuberger
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Arne Potreck
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Johannes A R Pfaff
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Silvia Schönenberger
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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44
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Guillaume M, Lapergue B, Gory B, Labreuche J, Consoli A, Mione G, Humbertjean L, Lacour JC, Mazighi M, Piotin M, Blanc R, Richard S. Rapid Successful Reperfusion of Basilar Artery Occlusion Strokes With Pretreatment Diffusion-Weighted Imaging Posterior-Circulation ASPECTS <8 Is Associated With Good Outcome. J Am Heart Assoc 2020; 8:e010962. [PMID: 31070075 PMCID: PMC6585336 DOI: 10.1161/jaha.118.010962] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The association between time to reperfusion and clinical outcome is well known in anterior circulation strokes, whereas the impact of main time metrics remains unknown in posterior circulation strokes. We investigated the clinical effect of different time intervals from symptom onset to reperfusion on the 90‐day clinical outcome in acute ischemic stroke patients with basilar artery occlusion, and especially in the subset population presenting a low stroke volume on baseline diffusion‐weighted imaging. Methods and Results We studied patients included in the prospective, multicenter, observational ETIS (Endovascular Treatment in Ischemic Stroke) registry who had had basal artery occlusion and had achieved successful reperfusion (modified Thrombolysis In Cerebral Infarction 2b‐3). Three time intervals (onset to reperfusion, onset to imaging, and imaging to reperfusion) were considered in all patients and separately in patients with pc‐ASPECTS (posterior‐circulation Alberta Stroke Program Early Computed Tomography Score) <8 and ≥8 on baseline diffusion‐weighted imaging. The primary end point was good outcome defined as 90‐day modified Rankin Scale scores of 0 to 2. Among the 95 included patients, 38 (40%) achieved a good outcome. In all patients, no significant association was found between the different time intervals and outcome. In patients evaluated with diffusion‐weighted imaging (n=61) at baseline, a significant negative association was found between imaging‐to‐reperfusion time for patients with pc‐ASPECTS <8 (adjusted odds ratio=0.4 per 30‐minute increase; 95% CI 0.18‐0.85; P=0.02) compared with those with pc‐ASPECTS ≥8. Conclusions In patients with basilar artery occlusion and pc‐ASPECTS <8 at baseline diffusion‐weighted imaging, clinical outcome is highly dependent on the time from imaging to reperfusion, which suggests that rapid endovascular reperfusion should be performed after imaging in these patients.
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Affiliation(s)
- Morgan Guillaume
- 1 Stroke Unit Department of Neurology University Hospital of Nancy France
| | - Bertrand Lapergue
- 3 Department of Neurology Stroke Center Hôpital Foch Suresnes France
| | - Benjamin Gory
- 4 Department of Diagnostic and Therapeutic Neuroradiology University Hospital of Nancy France.,5 IADI, INSERM U1254 University of Lorraine Nancy France
| | - Julien Labreuche
- 6 CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins University of Lille Lille France
| | - Arturo Consoli
- 7 Department of Diagnostic and Therapeutic Neuroradiology Hôpital Foch Suresnes France
| | - Gioia Mione
- 1 Stroke Unit Department of Neurology University Hospital of Nancy France
| | - Lisa Humbertjean
- 1 Stroke Unit Department of Neurology University Hospital of Nancy France
| | | | - Mikael Mazighi
- 8 Department of Interventional Neuroradiology Rothschild Foundation Paris France.,9 Laboratory of Vascular Translational Science INSERM U1148 Paris France.,10 DHU NeuroVasc Paris France
| | - Michel Piotin
- 8 Department of Interventional Neuroradiology Rothschild Foundation Paris France
| | - Raphaël Blanc
- 8 Department of Interventional Neuroradiology Rothschild Foundation Paris France
| | - Sébastien Richard
- 1 Stroke Unit Department of Neurology University Hospital of Nancy France.,2 Centre d'Investigation Clinique Plurithématique CIC-P 1433, INSERM U1116 CHRU Nancy France
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45
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Mahmoudi M, Dargazanli C, Cagnazzo F, Derraz I, Arquizan C, Wacogne A, Labreuche J, Bonafe A, Sablot D, Lefevre PH, Gascou G, Gaillard N, Scott C, Costalat V, Mourand I. Predictors of Favorable Outcome after Endovascular Thrombectomy in MRI: Selected Patients with Acute Basilar Artery Occlusion. AJNR Am J Neuroradiol 2020; 41:1670-1676. [PMID: 32819893 DOI: 10.3174/ajnr.a6741] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/07/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Clinical outcomes after endovascular treatment for acute basilar artery occlusions need further investigation. Our aim was to analyze predictors of a 90-day good functional outcome defined as mRS 0-2 after endovascular treatment in MR imaging-selected patients with acute basilar artery occlusions. MATERIALS AND METHODS We analyzed consecutive MR imaging-selected patients with acute basilar artery occlusions endovascularly treated within the first 24 hours after symptom onset. Successful and complete reperfusion was defined as modified TICI scores 2b-3 and 3, respectively. Outcome at 90 days was analyzed in univariate and multivariate analysis regarding baseline patient treatment characteristics and periprocedural outcomes. RESULTS One hundred ten patients were included. In 10 patients, endovascular treatment was aborted for failed proximal/distal access. Overall, successful reperfusion was achieved in 81.8% of cases (n = 90; 95% CI, 73.3%-88.6%). At 90 days, favorable outcome was 31.8%, with a mortality rate of 40.9%; the prevalence of symptomatic intracranial hemorrhage within 24 hours was 2.7%. The median time from symptom onset to groin puncture was 410 minutes (interquartile range, 280-540 minutes). In multivariable analysis, complete reperfusion (OR = 6.59; 95% CI, 2.17-20.03), lower pretreatment NIHSS (OR = 0.77; 95% CI, 0.64-0.94), the presence of posterior communicating artery collateral flow (OR = 2.87; 95% CI, 1.05-7.84), the absence of atrial fibrillation (OR = 0.18; 95% CI, 0.03-0.99), and intravenous thrombolysis administration (OR = 2.75; 95% CI, 1.04-7.04) were associated with 90-day favorable outcome. CONCLUSIONS In our series of MR imaging-selected patients with acute basilar artery occlusions, complete reperfusion was the strongest predictor of a good outcome. Lower pretreatment NIHSS, the presence of posterior communicating artery collateral flow, the absence of atrial fibrillation, and intravenous thrombolysis administration were associated with favorable outcome.
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Affiliation(s)
- M Mahmoudi
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - C Dargazanli
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - F Cagnazzo
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - I Derraz
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - C Arquizan
- Neurology Department (C.A., N.G.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - A Wacogne
- Neurology Department (A.W.), Centre Hospitalier Universitaire Caremeau, Nimes, France
| | - J Labreuche
- Biostatistics Department (J.L.), Centre Hospitalier Universitaire Lille, Lille, France
| | - A Bonafe
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - D Sablot
- Neurology Department (D.S.), Centre Hospitalier de Perpignan, Perpignan, France
| | - P H Lefevre
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - G Gascou
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - N Gaillard
- Neurology Department (C.A., N.G.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - C Scott
- Department of Reanimation (C.S.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - V Costalat
- From the Neuroradiology Department (M.M., C.D., F.C., I.D., A.B., P.H.L., G.G., V.C.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
| | - I Mourand
- Neurology Department (C.A., N.G.), Centre Hospitalier Universitaire Gui De Chauliac, Montpellier, France
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Wan C, Wu G, Jin X, Liao S, Zhang F, Hu M, Meng M, Guo Y, You J. Predictive value on diffusion weighted imaging scores for basilar artery occlusion after endovascular treatment. Interv Neuroradiol 2020; 27:81-87. [PMID: 32640857 DOI: 10.1177/1591019920940514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To assess the predictive value of three scoring systems based on diffusion weighted imaging in basilar artery occlusion patients after endovascular treatment. METHODS We analyzed clinical and radiological data of patients with basilar artery occlusion from January 2010 to June 2019, with modified Rankin Scale of 0-2 and 3-6 defined as favorable outcome and unfavorable outcome at three months. Diffusion weighted imaging posterior circulation ASPECTS Score (DWI pc-ASPECT Score), Renard diffusion weighted imaging Score, and diffusion weighted imaging Brainstem Score were used to evaluate the early ischemic changes. RESULTS There were a total of 88 basilar artery occlusion patients enrolled in the study after endovascular treatment, with 33 of them getting a favorable outcome. According to the analysis, the time from onset to puncture within 12 h (odds ratio: 4.34; 95% confidence interval: 1.55-12.16; P = 0.01), presence of collateral flow via PCoA (odds ratio: 0.31; 95%CI: 0.12-0.79; P = 0.01) or between PICA and SCA (odds ratio: 0.18; 95%CI: 0.07-0.47; P = 0.00), equal or less than 15 points on baseline NIHSS (area under the curve 0.79, 95% CI 0.69-0.89; sensitivity = 69.1%, specificity = 81.8%; P = 0.00), and equal or less than 1.5 points on diffusion weighted imaging Renard score (area under the curve 0.63, 95% CI 0.51-0.75; sensitivity = 83.6%, specificity = 39.4%; P = 0.046) were independently associated with favorable outcome. CONCLUSIONS Renard diffusion weighted imaging score may be an independent predictor of functional outcome in basilar artery occlusion patients after endovascular treatment.
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Affiliation(s)
- Can Wan
- Second Clinical Medical School, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Guangliang Wu
- Department of Neurology, The Second Affiliated Hospital, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xing Jin
- Second Clinical Medical School, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Shaojun Liao
- Second Clinical Medical School, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Foming Zhang
- Department of Neurology, The Second Affiliated Hospital, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Mingzhe Hu
- Second Clinical Medical School, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Miaomiao Meng
- Second Clinical Medical School, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yixin Guo
- Second Clinical Medical School, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jinsong You
- Department of Neurology, The Second Affiliated Hospital, 47879Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Alawieh AM, Eid M, Anadani M, Sattur M, Maier IL, Feng W, Goyal N, Starke RM, Rai A, Fargen KM, Psychogios MN, De Leacy R, Grossberg JA, Keyrouz SG, Dumont TM, Kan P, Lena J, Liman J, Arthur AS, Elijovich L, Mccarthy DJ, Saini V, Wolfe SQ, Mocco J, Fifi JT, Nascimento FA, Giles JA, Allen M, Crosa R, Fox WC, Gory B, Spiotta AM. Thrombectomy Technique Predicts Outcome in Posterior Circulation Stroke—Insights from the STAR Collaboration. Neurosurgery 2020; 87:982-991. [DOI: 10.1093/neuros/nyaa179] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Randomized controlled trials evaluating mechanical thrombectomy (MT) for acute ischemic stroke predominantly studied anterior circulation patients. Both procedural and clinical predictors of outcome in posterior circulation patients have not been evaluated in large cohort studies.
OBJECTIVE
To investigate technical and clinical predictors of functional independence after posterior circulation MT while comparing different frontline thrombectomy techniques.
METHODS
In a retrospective multicenter international study of 3045 patients undergoing MT for stroke between 06/2014 and 12/2018, 345 patients had posterior circulation strokes. MT was performed using aspiration, stent retriever, or combined approach. Functional outcomes were assessed using the 90-d modified Rankin score dichotomized into good (0-2) and poor outcomes (3-6).
RESULTS
We included 2700 patients with anterior circulation and 345 patients with posterior circulation strokes. Posterior patients (age: 60 ± 14, 46% females) presented with mainly basilar occlusion (80%) and were treated using contact aspiration or ADAPT (39%), stent retriever (31%) or combined approach (19%). Compared to anterior strokes, posterior strokes had delayed treatment (500 vs 340 min, P < .001), higher national institute of health stroke scale (NIHSS) (17.1 vs 15.7, P < .01) and lower rates of good outcomes (31% vs 43%, P < .01). In posterior MT, diabetes (OR = 0.28, 95%CI: 0.12-0.65), admission NIHSS (OR = 0.9, 95%CI: 0.86-0.94), and use of stent retriever (OR = 0.26, 95%CI: 0.11-0.62) or combined approach (OR = 0.35, 95%CI: 0.12-1.01) vs ADAPT were associated with lower odds of good outcome. Stent retriever use was associated with lower odds of good outcomes compared to ADAPT even when including patients with only basilar occlusion or with successful recanalization only.
CONCLUSION
Despite similar safety profiles, use of ADAPT is associated with higher rates of functional independence after posterior circulation thrombectomy compared to stent retriever or combined approach in large “real-world” retrospective study.
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Affiliation(s)
- Ali M Alawieh
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Maya Eid
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Mohammad Anadani
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Mithun Sattur
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Ilko L Maier
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Wuwei Feng
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee
| | - Robert M Starke
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Ansaar Rai
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
| | - Reade De Leacy
- Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - Jonathan A Grossberg
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Salah G Keyrouz
- Department of Neurology, Washington University in Saint Louis, St. Louis, Missouri
| | - Travis M Dumont
- Department of Surgery, Division of Neurosurgery, Banner University of Arizona Medical Center, Tucson, Arizona
| | - Peter Kan
- Department of Neurology, Baylor College of medicine, Houston, Texas
| | - Jonathan Lena
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jan Liman
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Adam S Arthur
- Department of Neurology, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee
| | - Lucas Elijovich
- Department of Neurology, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee
| | - David J Mccarthy
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Vasu Saini
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - Johanna T Fifi
- Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | | | - James A Giles
- Department of Neurology, Washington University in Saint Louis, St. Louis, Missouri
| | - Michelle Allen
- Department of Neurology, Washington University in Saint Louis, St. Louis, Missouri
| | - Roberto Crosa
- Centro Endovascular Neurológico, Médica Uruguaya, Montevideo, Uruguay
| | - W Christopher Fox
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
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Awad AW, Kilburg C, Ravindra VM, Scoville J, Joyce E, Grandhi R, Taussky P. Predicting Death After Thrombectomy in the Treatment of Acute Stroke. Front Surg 2020; 7:16. [PMID: 32322587 PMCID: PMC7156540 DOI: 10.3389/fsurg.2020.00016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 03/13/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction: Treatments for acute stroke have significantly improved in the past decade, with emergent thrombectomy emerging as the standard of care. Despite these advancements, death after successful thrombectomy continues to pose a significant problem. Identifying patients least likely to benefit from thrombectomy would improve use of a limited resource and management of patient expectations. Method: We retrospectively reviewed the medical records of patients who underwent emergent thrombectomy of either anterior or posterior circulation strokes between January 2012 and January 2017. Relevant patient clinical data was collected and analyzed in a multivariable regression with a primary outcome of death at 90 days. Results: A total of 134 patients underwent emergent endovascular thrombectomy during the study period; sufficient clinical data was available in 111 of the them. Of these, 42 patients died during the 90 day post-procedural period and 69 patients survived this period. The mean NIHSS score at presentation was 14.9 in surviving patients and 19.6 in non-surviving patients (p < 0.002). Surviving patients were less likely to have a history of cancer (4.4% vs. 26.2%, p < 0.002), achieved higher rates of revascularization (78.3% vs. 50.0%, p < 0.003), had a lower rate of hemorrhagic conversion (21.7% vs. 47.6%, p < 0.004), and experienced fewer technical complications during their treatment (7.4% vs. 26.2%, p < 0.01). Overall, there were 16 intraprocedural complications and no procedural deaths. Conclusion: As emergent thrombectomy for the treatment of acute stroke becomes more prevalent, appropriate patient selection will be crucial in the utilization of a limited and costly intervention. Death within 90 days after thrombectomy appears to be more prevalent among patients with higher NIHSS at presentation, those with postprocedural hemorrhage or intraprocedural complications, and those with a history of cancer.
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Affiliation(s)
- Al-Wala Awad
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Craig Kilburg
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Jonathan Scoville
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Evan Joyce
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
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49
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Thrombectomy in acute vertebrobasilar occlusion: a single-centre experience. Neuroradiology 2020; 62:723-731. [DOI: 10.1007/s00234-020-02376-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 01/28/2020] [Indexed: 10/25/2022]
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50
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Lee SJ, Hong JM, Choi JW, Park JH, Park B, Kang DH, Kim YW, Kim YS, Hong JH, Yoo J, Kim CH, Sohn SI, Hwang YH, Lee JS. Predicting Endovascular Treatment Outcomes in Acute Vertebrobasilar Artery Occlusion: A Model to Aid Patient Selection from the ASIAN KR Registry. Radiology 2020; 294:628-637. [PMID: 31990269 DOI: 10.1148/radiol.2020191227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The decision to perform endovascular treatment (EVT) for stroke related to vertebrobasilar occlusion (VBO) remains controversial. Purpose To identify preprocedural predictors of good outcomes and to develop a model to aid patient selection for VBO. Materials and Methods For this retrospective study using a Korean multicenter registry, a predictive model for good outcomes (modified Rankin scale score, 0-2) was generated based on a derivation sample of patients with VBO (January 2011-February 2016). Preprocedural parameters, including onset-to-puncture time, infarct volume, occlusion type as a surrogate marker of intracranial atherosclerotic stenosis-related occlusion or embolic occlusion (truncal-type occlusion vs branching site occlusion), and collateral status, were analyzed. Continuous variables were dichotomized based on receiver operating characteristic analysis. Multiple logistic regression analysis was performed to generate a predictive model. The model was internally validated with the bootstrap method and was externally validated with a single-center sample (April 2016-December 2018). Results A predictive model was generated from 71 patients (mean age, 67 years ± 11 [standard deviation]; 41 [58%] men) and was externally validated in 32 patients (mean age, 72 years ± 13; 19 [59%] men). The composite of initial DW imaging volume of less than 10 mL (odds ratio [OR], 19.3; 95% confidence interval [CI]: 3.0, 126.4; P = .002), onset-to-puncture time of less than 8 hours (OR, 8.7; 95% CI: 1.8, 42.0; P = .007), and branching-site occlusion (OR, 6.1; 95% CI: 1.5, 26.0; P = .01) could be used to predict good outcomes, with a median area under the receiver operating characteristic curve of 0.86 (interquartile range [IQR], 0.77-0.95; bootstrap optimism-corrected C statistic, 0.837) in the derivation sample and 0.78 (IQR, 0.62-0.95) in the validation sample. Results failed to show an association between collateral status and outcome (P = .67). Conclusion When selecting patients with vertebrobasilar occlusion for endovascular treatment, the combination of onset-to-puncture time of less than 8 hours, initial infarct volume of less than 10 mL, and presence of branching-site occlusions is indicative of a good outcome. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Seong-Joon Lee
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Ji Man Hong
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jin Wook Choi
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Ji Hyun Park
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Bumhee Park
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Dong-Hun Kang
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yong-Won Kim
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yong-Sun Kim
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jeong-Ho Hong
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Joonsang Yoo
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Chang-Hyun Kim
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sung-Il Sohn
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yang-Ha Hwang
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jin Soo Lee
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
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