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Hernandez Petzsche MR, Maegerlein C, Wunderlich S, Ikenberg B, Zimmer C, Kirschke JS, Boeckh-Behrens T, Berndt M. Impact of ischemic stroke topography on early clinical outcome of basilar artery occlusion: a retrospective study. Eur Radiol 2024:10.1007/s00330-024-10755-y. [PMID: 38662099 DOI: 10.1007/s00330-024-10755-y] [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: 11/17/2023] [Revised: 03/01/2024] [Accepted: 03/17/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Basilar artery occlusion (BAO) may be etiologically attributed to embolism or in situ thrombosis due to basilar stenosis (BS). Patients with BAO due to BS (BAOS) are known to have worse outcomes than patients with embolic occlusions (BAOE). BAOS occurs more proximally in the basilar artery (BA) than BAOE. We hypothesize that differing brain stem infarct patterns contribute to outcome differences between these stroke etiologies. METHODS This retrospective study includes 199 consecutive patients with BAO who received endovascular treatment at a single center. Final infarction in brain parenchyma dependent on the posterior circulation was graded semiquantitatively on magnetic resonance imaging (MRI). Associations to underlying stenosis and angiographic and clinical outcome variables were tested. The primary endpoint was early good clinical outcome (EGCO, mRS score ≤ 3 at discharge). RESULTS Infarct extension of the medulla oblongata (OR = 0.25; 95% CI = 0.07-0.86; p = 0.03), the inferior pons (OR = 0.328; 95% CI = 0.17-0.63; p = 0.001), the superior pons (OR = 0.57; 95% CI = 0.33-0.99; p = 0.046), and the occipital lobes (OR = 0.46; 95% CI = 0.26-0.80; p = 0.006) negatively predicted EGCO. Infarct extension for other posterior-circulation-dependent brain regions was not independently associated with unfavorable early outcomes. Patients with BAOS had more proximal occlusions and greater infarct volumes in the inferior brain stem. Successful reperfusion (mTICI 2b-3) occurred more often in patients with BAOE than in BAOS (BAOE: 131 (96.3%); BAOS: 47 (83.9%), p = 0.005). CONCLUSION Unfavorable early outcomes in patients with BAOS may be explained by a higher likelihood of inferior brain stem infarcts and lower rates of reperfusion success. CLINICAL RELEVANCE STATEMENT Basilar artery occlusion due to underlying stenosis is associated with a poorer prognosis than that caused by embolism; these results suggest that aggressive endovascular therapy, usually involving the placement of a permanent stent, may be warranted in these patients. KEY POINTS Inferior brain stem and occipital infarcts are prognostically unfavorable in basilar artery occlusion. Basilar artery occlusion due to stenosis occurs more proximally and is associated with worse outcomes. Differentiating etiologies of basilar artery occlusion may influence how aggressively treated the occlusion is.
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Affiliation(s)
- Moritz R Hernandez Petzsche
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Silke Wunderlich
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Benno Ikenberg
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tobias Boeckh-Behrens
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Maria Berndt
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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Xu Y, Huang Z, Zhang P, Zhong J, Zhang W, Hu M, Huang X, Wu Z, Xu G, Zhang M, Sun W. Effect of INR on Outcomes of Endovascular Treatment for Acute Vertebrobasilar Artery Occlusion. Transl Stroke Res 2023:10.1007/s12975-023-01176-y. [PMID: 37442918 DOI: 10.1007/s12975-023-01176-y] [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: 06/29/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/15/2023]
Abstract
Endovascular treatment (EVT) has been proven to be the standard treatment for acute vertebrobasilar artery occlusion (VBAO). This study aimed to analyze the effects of international normalized ratio (INR) indicators on outcomes in patients with acute VBAO treated with EVT. Dynamic data on INR in patients with VBAO who received endovascular treatment (EVT) at 65 stroke centers in China were retrospectively enrolled. Outcome measures included the modified Rankin Scale (mRS) score at 90 days and 1 year and symptomatic intracranial hemorrhage (sICH). The associations between elevated INR (INR > 1.1), INR variability (time-weighted variance of INR changes), and various clinical outcomes were analyzed in all patients and subgroups stratified by oral anticoagulation (OAC) by mixed logistic regression analysis. A total of 1825 patients met the study criteria, of which 1384 had normal INR and 441 had elevated INR. Multivariate analysis showed that elevated INR was significantly associated with poor functional outcomes (mRS 4-6) at 90 days (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.08-1.72) and 1 year (OR 1.32, 95% CI 1.05-1.66), but was not associated with an increased risk of sICH (OR 1.00, 95% CI 0.83-1.20). Similar associations exist between INR variability and poor functional outcomes at 90 days (OR 2.17, 95% CI 1.09-4.30), 1 year (OR 2.28, 95% CI 1.16-4.46), and sICH (OR 1.11, 95% CI 0.93-1.33). Subgroup analyses further revealed that elevated INR and INR variability remained associated with poor functional outcomes in patients not receiving oral anticoagulation (OAC) therapy, while no significant associations were observed in OAC-treated patients, regardless of whether they were on warfarin or direct oral anticoagulants. Elevated INR and INR variability in VBAO patients treated with EVT were associated with poor functional outcomes. The mechanism underlying the association between elevated INR and poor functional outcomes might be attributed to the fact that elevated INR indirectly reflects the burden of comorbidities, which could independently worsen outcomes. These findings underscore the importance of a comprehensive and dynamic evaluation of INR levels in the management of VBAO patients receiving EVT, providing valuable insights for optimizing patient outcomes.
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Affiliation(s)
- Yingjie Xu
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Zhixin Huang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Pan Zhang
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Jinghui Zhong
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Wanqiu Zhang
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Miaomiao Hu
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Xianjun Huang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, China
| | - Zongyi Wu
- Department of Neurology, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, Guangdong, China
| | - Guoqiang Xu
- Department of Neurology, The First People's Hospital of Yongkang, Yongkang, Zhejiang, China
| | - Min Zhang
- Department of Neurology, Jiangmen Central Hospital, Guangdong, Jiangmen, China.
| | - Wen Sun
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China.
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Gusler M, Razavi SM, Grossman A, Prestigiacomo C, Mowla A, Shirani P. Basilar artery recanalization by proximal balloon occlusion and aspiration in a single vessel vertebrobasilar system: A case report. Brain Circ 2023; 9:103-106. [PMID: 37576572 PMCID: PMC10419728 DOI: 10.4103/bc.bc_79_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/16/2022] [Accepted: 12/24/2022] [Indexed: 08/15/2023] Open
Abstract
The authors present a case of a patient with a hypoplastic right vertebral artery (VA) ending in the posterior inferior cerebellar artery who sustained an acute onset basilar artery occlusion. A balloon-guided catheter was used to proximally occlude the dominant left VA, and aspiration was applied until reversal of flow was achieved in the basilar artery. Thus, basilar artery reperfusion was achieved without the need for stent-retrieval thrombectomy. We believe this represents the first described case of successful thrombectomy in the vertebrobasilar system using only proximal artery occlusion and aspiration. This novel technique may decrease the time to recanalization and improve outcomes for patients with acute basilar artery occlusion in the setting of a hypoplastic contralateral VA.
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Affiliation(s)
- Matthew Gusler
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | | | - Aaron Grossman
- Department of Neurosurgery, University of Cincinnati, OH, USA
- Department of Neurology, University of Cincinnati, OH, USA
| | | | - Ashkan Mowla
- Department of Neurosurgery, University of Southern California, CA, USA
| | - Peyman Shirani
- Department of Neurosurgery, University of Cincinnati, OH, USA
- Department of Neurology, University of Cincinnati, OH, USA
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Ma W, Cheng Z, Chen X, Huang C, Yu G, Chen G. Multiphase Flow Hemodynamic Evaluation of Vertebral Artery Stenosis Lesions and Plaque Stability. Biomed Mater Eng 2023; 34:247-260. [PMID: 36245366 DOI: 10.3233/bme-221436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Atherosclerosis is one of the main causes of vertebral artery stenosis, which reduces blood supply to the posterior circulation, resulting in cerebral infarction or death. OBJECTIVE To investigate stenosis rates and locations on the development of vertebral artery plaques. METHODS Stenosis models with varying degrees and positions of stenosis were established. The stenosis area was comprehensively analyzed using multiphase flow numerical simulation. Wall shear stress (WSS), blood flow velocity, and red blood cell (RBC) volume fraction were calculated. RESULTS Blood flow velocity in 30-70% stenosis of each segment tended to increase significantly higher than normal. Downstream of 50% stenosis exhibited turbulent flow; downstream of 70% displayed reflux. Severe stenosis increases the WSS and distribution area. The mixed area of high and low WSS appeared downstream of the stenosis. The RBC volume fraction at the stenosis increased (maximum value: 0.487 at 70% stenosis in the V4), which was 1.08 times the normal volume fraction. Turbulent and backflow regions exhibited complex RBC volume fraction distributions. CONCLUSION Flow velocity, WSS, and RBC volume fraction at the stenosis increase with stenosis severity, increasing plaque shedding. Narrow downstream spoiler and reflux areas possess low WSS and high erythrocyte volume fractions, accelerating plaque growth.
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Affiliation(s)
- Wei Ma
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Zhiguo Cheng
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Xiaoqin Chen
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Chengdu Huang
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Guanghao Yu
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Guangxin Chen
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
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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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Sun W, Duan Z, Xu P, Xiao L, Wang J, Gui W, Luo G, Wu Z, Han Z, Li W, Xu G, Liu F, Yi J, Liu C, Zhang Y, Liu H. The safety and effectiveness of endovascular treatment for patients with vertebrobasilar artery occlusions: according to the BEST and BASICS criteria. Ther Adv Neurol Disord 2022; 15:17562864221114627. [PMID: 35982944 PMCID: PMC9379562 DOI: 10.1177/17562864221114627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Whether endovascular treatment (EVT) is safe and effective for vertebrobasilar artery occlusion (VBAO) is yet incompletely understood. Two RCTs, the endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST) trail and the Basilar Artery International Cooperation Study (BASICS), concentrating on this field were recently reported. Objective: We use real-world registry data of VBAO to compare the outcome of EVT inside and outside the inclusion and exclusion criteria of the BEST and BASICS study to testify the feasibility of the selection paradigms of VBAO in these trials. Methods: Consecutive patients with VBAO receiving EVT involving 21 stroke centers were retrospectively included. The safety outcomes [3-month mortality, symptomatic intracranial hemorrhage (sICH), and effectiveness outcomes (the proportion of 3-month functional independence (mRS of 0–2) and favorable outcome (mRS of 0–3)] were compared between VBAO patients who meet or failed to meet the BEST/BASICS selection criteria for EVT. Results: Our study cohort consisted of 577 VBAO patients who underwent EVT. Of them, 446 patients had pc-ASPECTS ≧8. Successful reperfusion (mTICI 2b or 3) was achieved in 85.4% (n = 493). There were 418 patients fulfilling the BEST criterion for EVT and 194 fulfilling the BASICS criterion. Regression analysis indicated that adherence to BEST or BASICS criterion for EVT was not independently related to most of the safety and effectiveness outcome except that adherence to BEST was significantly associated with the 3-month favorable outcome (ORBEST: 1.742, 95% CI: 1.087–2.790). However, when we put pc-ASPECTS into both criteria with a cut-off value of 8, meeting both BEST criterion plus pc-ASPECTS and BASICS criterion plus pc-ASPECTS was independently related to 3-month functional independence (ORBEST: 1.687, 95% CI: 1.077–2.644; ORBASIC: 1.653, 95% CI: 1.038–2.631) and favorable outcome (ORBEST: 2.280, 95% CI: 1.484–3.502; ORBASIC: 2.153, 95% CI: 1.372–3.378). Conclusion: Our study indicated that, based on real-world data of EVT, adherence to BEST or BASICS criterion for EVT was not independently associated with the safety and effectiveness outcome except that adherence to BEST was significantly related to the 3-month favorable outcome. However, the BEST or BASICS selection criterion and pc-ASPECTS ≧8 might be better paradigms for EVT patient selection.
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Affiliation(s)
- 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, China
| | - Zuowei Duan
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, 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, China
| | - Lulu Xiao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jinjing Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wei Gui
- 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, China
| | - Genpei Luo
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Zhongyi Wu
- Department of Neurology, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China
| | - Zhongkui Han
- Department of Neurology, Fuyang Tumour Hospital, Fuyang, China
| | - Wei Li
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Guoqiang Xu
- Department of Neurology, The First People's Hospital of Yongkang, Yongkang, China
| | - Fengchang Liu
- Department of Neurology, Xi'an North Hospital, Xi'an, China
| | - Jilong Yi
- Department of Neurology, The First People's Hospital of Jingmen, Jingmen, China
| | - Chaolai Liu
- Department of Neurology, The First People's Hospital of Jining, Jining, China
| | - Yan Zhang
- 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, 230000, Anhui, China
| | - Haiyan Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, 32 Coal Road, Xuzhou 221006, Jiangsu, China
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Mueck F, Hernandez Petzsche M, Boeckh-Behrens T, Maegerlein C, Linsenmaier U, Scaglione M, Zimmer C, Ikenberg B, Berndt M. CT Marker in Emergency Imaging of Acute Basilar Artery Occlusion: Thrombosis vs. Embolism. Diagnostics (Basel) 2022; 12:diagnostics12081817. [PMID: 36010168 PMCID: PMC9406658 DOI: 10.3390/diagnostics12081817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose: Acute basilar artery occlusion, a neurovascular emergency leading to high rates of morbidity and mortality, is usually diagnosed by CT imaging. The outcome is partly dependent on etiology, with a worse outcome in occlusions with underlying basilar artery stenosis. As this occlusion type requires a more complex angiographic therapy, this study aimed to develop new CT markers in emergency admission imaging to rapidly identify underlying stenosis. Methods: A total of 213 consecutive patients (female n = 91, age in years (mean/SD/range): 72/13/28−97), who received endovascular treatment at a single comprehensive stroke center for acute basilar artery occlusion, were included in this study. After applying strict inclusion criteria for imaging analyses, novel CT imaging markers, such as ‘absolute density loss’ (ADL) and relative thrombus attenuation (CTA-index), that measure perviousness, were assessed for n = 109 patients by use of CT-angiography and correlated to different occlusion patterns (thrombotic vs. embolic). Inter-observer agreement was assessed using an intraclass correlation coefficient for independent measures of a radiologist and a neuroradiologist. Associations between the imaging markers and clinical and interventional parameters were tested. Results: CT markers differ between the subgroups of basilar artery occlusions with and without underlying stenosis (for ADL: 169 vs. 227 HU (p = 0.03), for CTA-index: 0.55 vs. 0.70 (p < 0.001)), indicating a higher perviousness in the case of stenosis. A good inter-rater agreement was observed for ADL and CTA-index measures (ICC 0.92/0.88). For the case of embolic occlusions, a more pervious thrombus correlates to shorter time intervals, longer procedure times, and worse reperfusion success (p-values < 0.05, respectively). Conclusions: ADL and CTA-index are easy to assess in the emergency setting of acute basilar artery occlusion with the use of routinely acquired CT-angiography. They show a high potential to differentiate thrombotic from embolic occlusions, with an impact on therapeutic decisions and angiographic procedures. Measurements can be quickly performed with good reliability, facilitating implementation in clinical practice.
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Affiliation(s)
- Fabian Mueck
- Institute for Diagnostic and Interventional Radiology, HELIOS Clinics Munich West, Munich Perlach & Augustinum Munich, 81241 Munich, Germany; (F.M.); (U.L.)
| | - Moritz Hernandez Petzsche
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (M.H.P.); (T.B.-B.); (C.M.); (C.Z.)
| | - Tobias Boeckh-Behrens
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (M.H.P.); (T.B.-B.); (C.M.); (C.Z.)
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (M.H.P.); (T.B.-B.); (C.M.); (C.Z.)
| | - Ulrich Linsenmaier
- Institute for Diagnostic and Interventional Radiology, HELIOS Clinics Munich West, Munich Perlach & Augustinum Munich, 81241 Munich, Germany; (F.M.); (U.L.)
| | - Mariano Scaglione
- Department of Radiology, University of Sassari, 07100 Sassari SS, IT and James Cook University Hospital, Middlesbrough TS4 3BW, UK;
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (M.H.P.); (T.B.-B.); (C.M.); (C.Z.)
| | - Benno Ikenberg
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany;
| | - Maria Berndt
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (M.H.P.); (T.B.-B.); (C.M.); (C.Z.)
- Correspondence:
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8
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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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9
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Gu M, Fan J, Xu P, Xiao L, Wang J, Li M, Liu C, Luo G, Cai Q, Liu D, Ye L, Zhou J, Sun W. Effects of perioperative glycemic indicators on outcomes of endovascular treatment for vertebrobasilar artery occlusion. Front Endocrinol (Lausanne) 2022; 13:1000030. [PMID: 36277695 PMCID: PMC9581226 DOI: 10.3389/fendo.2022.1000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Endovascular treatment (EVT) is, to date, the most promising treatment of vertebrobasilar artery occlusion (VBAO). The study aimed to determine the influence of perioperative glucose levels on clinical outcomes in patients with acute VBAO treated with EVT. METHODS We retrospectively collected consecutive VBAO patients received EVT in 21 stroke centers in China. The associations between perioperative glycemic indicators (including fasting blood glucose[FBG], admission hyperglycemia, stress hyperglycemia ratio [SHR] and short-term glycemic variability [GV]) and various clinical outcomes were analyzed in all patients and subgroups stratified by diabetes mellitus (DM). RESULTS A total of 569 patients were enrolled. Admission hyperglycemia significantly correlated with increased risk of symptomatic intracranial hemorrhage (sICH) (odds ratio [OR] 3.24, 95% confidence interval [CI]: 1.40-7.46), poor functional outcomes at 90 days (OR 1.91, 95%CI: 1.15-3.18) and 1 year (OR 1.96, 95%CI: 1.20-3.22). Similar significant correlations exist between FBG, SHR, GV and all the adverse outcomes except higher levels GV was not associated with increased risk of sICH (OR 1.04, 95% CI: 0.97-1.12). Subgroup analyses showed that admission hyperglycemia, FBG and SHR were significantly associated with adverse outcomes in non-diabetic patients, but not in DM patients. While, GV was associated with poor functional outcomes regardless of diabetes history. CONCLUSIONS Admission hyperglycemia, FBG, SHR and short-term GV in VBAO patients treated with EVT were associated with adverse outcomes. The results suggested that comprehensive evaluation and appropriate management of perioperative glucose might be important for patients with VBAO and treatment with EVT.
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Affiliation(s)
- Mengmeng Gu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jin Fan
- Department of Neurology, the General Hospital of Western Theater Command, Chengdu, China
| | - Pengfei Xu
- Stroke Center & Department of Neurology, the First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Lulu Xiao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jinjing Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Min Li
- Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chaolai Liu
- Department of Neurology, The First People’s Hospital of Jining, Jining, China
| | - Genpei Luo
- Department of Neurology, Dongguan People’s Hospital, Dongguan, China
| | - Qiankun Cai
- Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Dezhi Liu
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lichao Ye
- Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Junshan Zhou, ; Wen Sun,
| | - Wen Sun
- Stroke Center & Department of Neurology, the First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- *Correspondence: Junshan Zhou, ; Wen Sun,
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10
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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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11
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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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12
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Kaiser D, Krukowski P, Hädrich K, Winzer R, Pallesen LP, Gawlitza M, Linn J, Puetz V, Gerber JC. Association of Regular Thrombus Surface Phenotype With Complete Recanalization in First-Line Contact Aspiration Thrombectomy for Basilar Artery Occlusion. Front Neurol 2021; 12:666933. [PMID: 34566832 PMCID: PMC8462661 DOI: 10.3389/fneur.2021.666933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess whether angiographic thrombus surface phenotype has an impact on efficacy of contact aspiration (CA) thrombectomy in patients with basilar artery occlusion (BAO). Methods: From January 2016 to December 2019, consecutive stroke patients with a BAO and first-line CA were analyzed in this retrospective study. We assessed baseline and imaging characteristics and treatment and clinical outcomes. We rated thrombus surface phenotype on pre-treatment digital subtraction angiography in a three-reader-consensus setting. Primary outcome was complete recanalization (modified treatment in cerebral ischemia [mTICI] 3 and arterial occlusive lesion [AOL] 3) after first-line CA without additionally stent retriever passes. Data analysis was stratified according to thrombus surface phenotype and complete first-line recanalization. Results: Seventy-eight patients met the inclusion criteria. Median age was 74 years (IQR 64-80), 64% were male, and median baseline NIHSS score was 24 (IQR 7-32). Thirty patients had a regular and 16 patients had an irregular thrombus phenotype. Thrombus surface was not assessable in 32 patients. In patients with a regular phenotype, complete recanalization was more often achieved compared to irregular and non-ratable phenotypes (50 vs. 18.8% and 21.9%; p = 0.027). Patients with a regular phenotype [odds ratio [OR] 8.3; 95% confidence interval [CI]: 1.9-35.8; p = 0.005], cardioembolic stroke (OR 12.1, 95% CI: 2.0-72.8; p = 0.007), and proximal end of the thrombus in the middle basilar artery segment (OR 5.2, 95% CI: 1.0-26.6; p = 0.046) were more likely to achieve complete recanalization after first-line CA without rescue therapy. Conclusion: The efficacy of CA may differ according to the angiographic thrombus surface phenotype in patients with BAO. A regular phenotype is associated with higher rates of complete recanalization in first-line CA. However, assessment of thrombus phenotype is frequently not feasible in BAO.
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Affiliation(s)
- Daniel Kaiser
- Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany.,Else Kröner-Fresenius Center for Digital Health, Dresden University of Technology, Dresden, Germany
| | - Pawel Krukowski
- Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Kevin Hädrich
- Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Robert Winzer
- Institute and Policlinic of Radiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Matthias Gawlitza
- Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany.,Else Kröner-Fresenius Center for Digital Health, Dresden University of Technology, Dresden, Germany
| | - Jennifer Linn
- Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes C Gerber
- Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
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13
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Meyer L, Stracke CP, Wallocha M, Broocks G, Sporns PB, Piechowiak EI, Kaesmacher J, Maegerlein C, Dorn F, Zimmermann H, Naziri W, Abdullayev N, Kabbasch C, Behme D, Jamous A, Maus V, Fischer S, Möhlenbruch M, Weyland CS, Langner S, Meila D, Miszczuk M, Siebert E, Lowens S, Krause LU, Yeo LL, Tan BY, Gopinathan A, Gory B, Arenillas JF, Navia P, Raz E, Shapiro M, Arnberg F, Zeleňák K, Martínez-Galdámez M, Kastrup A, Papanagiotou P, Kemmling A, Psychogios MN, Andersson T, Chapot R, Fiehler J, Hanning U. Thrombectomy for secondary distal, medium vessel occlusions of the posterior circulation: seeking complete reperfusion. J Neurointerv Surg 2021; 14:654-659. [PMID: 34272260 DOI: 10.1136/neurintsurg-2021-017742] [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: 05/04/2021] [Accepted: 06/26/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Whether to approach distal occlusions endovascularly or not in medium-sized vessels secondary to proximal large vessel occlusion stroke remains unanswered. OBJECTIVE To investigates the technical feasibility and safety of thrombectomy for secondary posterior circulation distal, medium vessel occlusions (DMVO). METHODS TOPMOST (Treatment fOr Primary Medium vessel Occlusion STroke) is an international, retrospective, multicenter, observational registry of patients treated for distal cerebral artery occlusions. This study subanalysis endovascularly treated occlusions of the posterior cerebral artery in the P2 and P3 segment secondary preprocedural or periprocedural thrombus migration between January 2014 and June 2020. Technical feasibility was evaluated with the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Procedural safety was assessed by the occurrence of symptomatic intracranial hemorrhage (sICH) and intervention-related serious adverse events. RESULTS Among 71 patients with secondary posterior circulation DMVO who met the inclusion criteria, occlusions were present in 80.3% (57/71) located in the P2 segment and in 19.7% (14/71) in the P3 segment. Periprocedural migration occurred in 54.9% (39/71) and preprocedural migration in 45.1% (32/71) of cases. The first reperfusion attempt led in 38% (27/71) of all cases to mTICI 3. On multivariable logistic regression analysis, increased numbers of reperfusion attempts (adjusted odds ratio (aOR)=0.39, 95% CI 0.29 to 0.88, p=0.009) and preprocedural migration (aOR=4.70, 95% CI,1.35 to 16.35, p=0.015) were significantly associated with mTICI 3. sICH occurred in 2.8% (2/71). CONCLUSION Thrombectomy for secondary posterior circulation DMVO seems to be safe and technically feasible. Even though thrombi that have migrated preprocedurally may be easier to retract, successful reperfusion can be achieved in the majority of patients with secondary DMVO of the P2 and P3 segment.
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Affiliation(s)
- Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Paul Stracke
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Endovascular Therapy, Alfred-Krupp Hospital, Essen, Germany.,Department of Interventional Neuroradiology, University Hospital Muenster, University Hospital Muenster, Muenster, Germany
| | - Marta Wallocha
- Department of Endovascular Therapy, Alfred-Krupp Hospital, Essen, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter B Sporns
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Eike I Piechowiak
- Department of Diagnostic and Interventional Neuroradiology, Inselspital - Bern University Hospital, Switzerland, Bern, Switzerland
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Inselspital - Bern University Hospital, Switzerland, Bern, Switzerland.,Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - Franziska Dorn
- Institute for Neuroradiology, Ludwig Maximilians University (LMU) Munich, Munich, Bayern, Germany
| | - Hanna Zimmermann
- Institute for Neuroradiology, Ludwig Maximilians University (LMU) Munich, Munich, Bayern, Germany
| | - Weis Naziri
- Department of Neuroradiology, Westpfalz Hospital, Kaiserslautern, Rheinland-Pfalz, Germany.,Department of Neuroradiology, University Hospital Luebeck, Luebeck, Germany
| | - Nuran Abdullayev
- Department of Neuroradiology, University Hospital Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Neuroradiology, University Hospital Cologne, Cologne, Germany
| | - Daniel Behme
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Sachsen-Anhalt, Germany.,Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Niedersachsen, Germany
| | - Ala Jamous
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Niedersachsen, Germany
| | - Volker Maus
- Department of Neuroradiology, Ruhr-Universität Bochum Medizinische Fakultät, Bochum, Nordrhein-Westfalen, Germany
| | - Sebastian Fischer
- Department of Neuroradiology, Ruhr-Universität Bochum Medizinische Fakultät, Bochum, Nordrhein-Westfalen, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | | | - Soenke Langner
- Department of Neuroradiology, Rostock University Medical Center, Rostock, Mecklenburg-Vorpommern, Germany
| | - Dan Meila
- Department of Interventional Neuroradiology, Johanna-Étienne-Hospital, Neuss, Germany
| | - Milena Miszczuk
- Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Lowens
- Department of Radiology, Klinikum Osnabrück GmbH, Osnabruck, Niedersachsen, Germany
| | - Lars Udo Krause
- Department of Neurology, Klinikum Osnabrück GmbH, Osnabruck, Niedersachsen, Germany
| | - Leonard Ll Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Benjamin Yq Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Anil Gopinathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Diagnostic Imaging, National University Health System, Singapore
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France.,Imagerie Adaptative Diagnostique et Interventionnelle, INSERM U1254, Université de Lorraine, Nancy, France
| | - Juan F Arenillas
- Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pedro Navia
- Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
| | - Eytan Raz
- Department of Radiology, NYU, New York, New York, USA
| | | | - Fabian Arnberg
- Department of Neuroradiology; Department of Clinical Neuroscience, Karolinska University Hospital; Karolinska Institutet, Stockholm, Sweden
| | - Kamil Zeleňák
- Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte gGmbH, Bremen, Germany.,Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andre Kemmling
- Department of Neuroradiology, Westpfalz Hospital, Kaiserslautern, Rheinland-Pfalz, Germany.,Department of Neuroradiology, University Hospital Luebeck, Luebeck, Germany
| | - Marios N Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Tommy Andersson
- Department of Neuroradiology; Department of Clinical Neuroscience, Karolinska University Hospital; Karolinska Institutet, Stockholm, Sweden
| | - René Chapot
- Department of Endovascular Therapy, Alfred-Krupp Hospital, Essen, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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14
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Maegerlein C, Boeckh-Behrens T, Wunderlich S, Gerber J, Pallesen LP, Puetz V. [Endovascular treatment of acute basilar artery occlusions]. DER NERVENARZT 2021; 92:752-761. [PMID: 33938960 DOI: 10.1007/s00115-021-01123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Since the publication of the large randomized controlled thrombectomy trials, endovascular treatment (EVT) has become the standard of care for acute stroke patients with anterior circulation large vessel occlusion (acLVO); however, the treatment of patients with an intracranial occlusion in the posterior circulation and in particular of the basilar artery has not been proven. Thus, there is uncertainty regarding the indications for EVT due to the poor evidence situation. OBJECTIVE This review article addresses the current data on EVT in the posterior circulation and the most recent study results. Furthermore, the pathophysiological aspects, indications and specific features in the treatment of these patients are also discussed. RESULTS Despite limited evidence for EVT, this treatment modality has gained significant clinical relevance for the treatment of stroke patients with vascular occlusions in the posterior circulation. From a technical point of view, vascular occlusions in the posterior circulation and particularly of the basilar artery are easily accessible, although the etiology of occlusions and necessary techniques differ compared to occlusions in the anterior circulation. CONCLUSION Compared to acLVO, EVT in the posterior circulation differs with respect to the current evidence, indications and technique. As current data have not proven its effectiveness for improved clinical outcome, treatment decisions must still be made individually based on institutional protocols, particularly for patients in the late time window or for patients already with signs of extensive infarction on baseline imaging.
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Affiliation(s)
- Christian Maegerlein
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Tobias Boeckh-Behrens
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Silke Wunderlich
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Johannes Gerber
- Institut und Poliklinik für diagnostische und interventionelle Neuroradiologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Lars-Peder Pallesen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Volker Puetz
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
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15
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Styczen H, Fischer S, Yeo LL, Yong-Qiang Tan B, Maurer CJ, Berlis A, Abdullayev N, Kabbasch C, Kastrup A, Papanagiotou P, Clajus C, Lobsien D, Piechowiak E, Kaesmacher J, Maus V. Approaching the Boundaries of Endovascular Treatment in Acute Ischemic Stroke : Multicenter Experience with Mechanical Thrombectomy in Vertebrobasilar Artery Branch Occlusions. Clin Neuroradiol 2020; 31:791-798. [PMID: 33108470 DOI: 10.1007/s00062-020-00970-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/01/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Little is known about catheter-based endovascular treatment of vertebrobasilar artery branch occlusion (VEBABO) in acute ischemic stroke (AIS). Nonetheless, the experience of mechanical thrombectomy (MT) in distal small sized arteries of the anterior circulation seems promising in AIS. In this multicenter study, we report the feasibility, efficacy and safety of MT in VEBABO. METHODS Retrospective analysis of consecutive AIS patients treated with MT due to VEBABO including posterior and anterior inferior cerebellar artery (PICA, AICA) and superior cerebellar artery (SCA) occlusions at seven tertiary care centers between January 2013 and May 2020. Baseline demographics and angiographic outcomes including recanalization success of the affected cerebellar arteries and procedural complications were recorded. Clinical outcomes were evaluated by the modified Rankin scale (mRS) at discharge and 90 days. RESULTS Out of 668 endovascularly treated posterior circulation strokes we identified 16 (0.02%) cases with MT for VEBABO. Most frequently, MT of the SCA was done (13/16, 81%). Most VEBABOs occurred after MT of initial basilar/posterior cerebral artery occlusion (9/16, 56%). In 10/16 (63%) procedures, the affected VEBABO was successfully recanalized. Out of four patients three (75%) with isolated VEBABO had benefited from endovascular therapy. Subarachnoid hemorrhage was observed in 3/16 (19%) procedures. The rate of favorable outcome (mRS ≤2) was 40% at discharge and 47% at 90-day follow-up. Mortality was 13% (2/15). CONCLUSION The use of MT for VEBABO is rare but appears to be feasible and effective; however, the comparatively high rate of procedure-related hemorrhage highlights that the indications for MT in these occlusion sites should be carefully weighed up.
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Affiliation(s)
- Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
| | - Sebastian Fischer
- Department of Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Langendreer, Ruhr-University Bochum, Bochum, Germany
| | - Leonard Ll Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christoph J Maurer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Nuran Abdullayev
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | | | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany.,Department of Radiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christin Clajus
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
| | - Donald Lobsien
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
| | - Eike Piechowiak
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.,University Institute of Diagnostic and Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Langendreer, Ruhr-University Bochum, Bochum, Germany
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16
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Berndt M, Poppert H, Steiger K, Pelisek J, Oberdieck P, Maegerlein C, Zimmer C, Wunderlich S, Friedrich B, Boeckh-Behrens T, Ikenberg B. Thrombus Histology of Basilar Artery Occlusions : Are There Differences to the Anterior Circulation? Clin Neuroradiol 2020; 31:753-761. [PMID: 33006654 PMCID: PMC8463366 DOI: 10.1007/s00062-020-00964-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/05/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND For patients with acute vessel occlusions of the anterior circulation histopathology of retrieved cerebral thrombi has been reported to be associated to stroke etiology. Due to the relatively small incidence of posterior circulation stroke, exclusive histopathologic analyses are missing for this subgroup. The aim of the study was to investigate thrombus histology for patients with basilar artery occlusions and uncover differences to anterior circulation clots with respect to underlying etiology. METHODS A total of 59 basilar thrombi were collected during intracranial mechanical recanalization and quantitatively analyzed in terms of their relative fractions of the main constituents, e.g. fibrin/platelets (F/P), red (RBC) and white blood cells (WBC). Data were compared to histopathological analyses of 122 thrombi of the anterior circulation with respect to underlying pathogenesis. RESULTS The composition of basilar thrombi differed significantly to thrombi of the anterior circulation with an overall higher RBC amount (median fraction in % (interquartile range):0.48 (0.37-0.69) vs. 0.37 (0.28-0.50), p < 0.001) and lower F/P count (0.45 (0.21-0.58) vs. 0.57 (0.44-0.66), p < 0.001). Basilar thrombi composition did not differ between the different etiological stroke subgroups. CONCLUSION The results depict a differing thrombus composition of basilar thrombi in comparison to anterior circulation clots with an overall higher amount of RBC. This may reflect different pathophysiologic processes between anterior and posterior circulation thrombogenesis, e.g. a larger proportion of appositional thrombus growth in the posterior circulation.
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Affiliation(s)
- M Berndt
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany.
| | - H Poppert
- Helios Klinikum München West, Munich, Germany
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - K Steiger
- Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - J Pelisek
- Department of Vascular and Endovascular Surgery, Klinikum rechts der School of Medicine, Technical University of Munich, Munich, Germany
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - C Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - C Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - S Wunderlich
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - B Friedrich
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - T Boeckh-Behrens
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - B Ikenberg
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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17
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Xu C, Wang F, Lv P, Zhang X, Tang G. Endovascular treatment combined with vertebral artery endarterectomy for patients with acute tandem vertebrobasilar artery occlusion. J Clin Neurosci 2020; 79:21-29. [PMID: 33070898 DOI: 10.1016/j.jocn.2020.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of endovascular treatment combined with vertebral artery endarterectomy in patients with acute tandem vertebrobasilar artery occlusion. METHODS From April 2017 to March 2019, three patients with acute basilar artery occlusion combined with ostial vertebral occlusion in our institution were enrolled in the study. They underwent endovascular treatment combined with vertebral artery endarterectomy. The clinical, technical and functional outcomes of the patients were retrospectively analysed. RESULTS All three patients in the study underwent complete recanalization. The modified Thrombolysis in Cerebral Infarction (mTICI) grade was 2b/3 in all patients. The modified Rankin Scale (mRS) score was 0-2 for the three patients at 3 months. Follow-up CT scans revealed no cerebral haemorrhage, and no patients died during follow-up. All patients achieved good clinical outcomes after the combined treatment. CONCLUSION Endovascular treatment combined with vertebral artery endarterectomy is a feasible method to treat patients with acute basilar artery occlusion combined with ostial vertebral occlusion, especially when the guidewire cannot pass through the ostium of the dominant vertebral artery occlusion.
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Affiliation(s)
- Chuan Xu
- Department of Radiology, Clinical Medical College of Shanghai Tenth People's Hospital of Nanjing Medical University, No. 301 Yanchang Road, Shanghai 200072, China
| | - Fuan Wang
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, Jiangsu, China
| | - Penghua Lv
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, Clinical Hospital of Nanjing Medical University, No. 98 Nantong Road, Yangzhou 225001, Jiangsu, China
| | - Xicheng Zhang
- Department of Vascular Surgery, Northern Jiangsu People's Hospital, Clinical Hospital of Nanjing Medical University, No. 98 Nantong Road, Yangzhou 225001, Jiangsu, China
| | - Guangyu Tang
- Department of Radiology, Clinical Medical College of Shanghai Tenth People's Hospital of Nanjing Medical University, No. 301 Yanchang Road, Shanghai 200072, China.
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18
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Kang K, Yang B, Gong X, Chen X, Gu W, Ma G, Miao Z, Zhao X, Ma N. Cerebral Hemodynamic Changes After Endovascular Recanalization of Symptomatic Chronic Intracranial Artery Occlusion. Front Neurol 2020; 11:318. [PMID: 32431659 PMCID: PMC7214835 DOI: 10.3389/fneur.2020.00318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/31/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: We performed this study to evaluate the hemodynamic changes over time after successful endovascular recanalization in patients with symptomatic chronic intracranial artery occlusion (CIAO). Materials and Methods: We included 20 patients with symptomatic CIAO in a high-volume stroke center from June 2014 to June 2019. All subjects were evaluated with CT perfusion (CTP) studies before and after the recanalization. The relative cerebral blood flows (rCBFs) in perforating artery territory (PAT) and cortical artery territory (CAT) of occluded arteries were compared before and after the recanalization. The patients were categorized into subgroups based on the time interval from revascularization to post-procedural CTP, occlusion sites, and restenosis status. The proportion of rCBF change (rCBFc%) was compared in variable subgroups. Results: The rCBF increased significantly from 0.52 to 0.71 in PAT (P < 0.001) and from 0.59 to 0.85 in CAT (P < 0.001) after recanalization, and there were also statistical differences in variable subgroups except for those with restenosis. The median and interquartile range (IQR) of rCBFc% were 35.2 and 18.6–56.6%. For patients with short-term follow-up (55.2%), the rCBFc% was relatively higher than that in patients with mid-term (35.4%) and long-term follow-up (32.7%), although without statistical difference (P = 0.273). For patients with restenosis, the rCBFc% was significantly lower than that in patients without restenosis (18.5 vs. 37.3%, P = 0.008). Conclusions: In patients with symptomatic CIAO, the CBF may increase and be relatively stable over time after successful recanalization except for restenosis.
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Affiliation(s)
- Kaijiang Kang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Bo Yang
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Jiangong Hospital, Beijing, China
| | - Xiping Gong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xing Chen
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Weibin Gu
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guofeng Ma
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Ning Ma
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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19
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Abstract
Background and Purpose—
Recent studies show that mechanical thrombectomy of acute basilar artery occlusions (BAO) results in high rates of successful recanalization and good outcomes, but predictors are not completely established yet. Varying occlusion types may benefit differently, and especially, an underlying basilar stenosis (BS) seems to have an impact. Aim of this study was to investigate angiographic and clinical differences in BAO subtypes and to test the potential of perviousness measures for a preinterventional identification of clinically relevant different occlusion types.
Methods—
All consecutive patients with acute BAO, endovascular treated at a single comprehensive stroke center, were included. Different occlusion patterns, especially underlying BS, were identified and analyzed in respect of angiographic and clinical (National Institutes of Health Stroke Scale/modified Rankin Scale) outcome parameters (N=115). Thrombus perviousness measures (change in thrombus attenuation Δt and corrected void fraction ε) were assessed in admission computed tomography imaging and correlated to different etiological subgroups.
Results—
Despite comparable rates of successful recanalization (87% for BAO with BS versus 95% without BS), the BS group showed worse clinical outcome with higher National Institutes of Health Stroke Scale/modified Rankin Scale values (
P
=0.002/0.003). The group of BS turned out to have lower thrombus density values in unenhanced scans (mean, 42.0 Hounsfield units) and higher perviousness measures Δt (mean, 34.6 Hounsfield units) and ε (mean, 0.23) than thrombi without an underlying BS (mean, 53.6 Hounsfield units/13.1 Hounsfield units/0.08,
P
=0.01/ 0.004/ 0.001).
Conclusions—
In agreement with previous studies, outcome of mechanical thrombectomy of BAO seems to depend on pathogenesis with less clinical benefit for underlying BS, raising the question of early identification of this subgroup. Perviousness showed a high potential to differentiate acute BAO with and without BS, possibly usable as an admission imaging marker for BS.
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20
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Maus V, Styczen H, Liman J, Maier I, Brehm A, Tsogkas I, Psychogios MN. Intracranial mechanical thrombectomy of large vessel occlusions in the posterior circulation using SAVE. BMC Neurol 2019; 19:197. [PMID: 31419959 PMCID: PMC6696671 DOI: 10.1186/s12883-019-1428-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/09/2019] [Indexed: 12/22/2022] Open
Abstract
Background Mechanical thrombectomy (MT) using stent retriever assisted vacuum-locked extraction (SAVE) is a promising method for anterior circulation strokes. We present our experience with SAVE for large vessel occlusions (LVO) of the posterior circulation. Methods We retrospectively analyzed 66 consecutive MT patients suffering from LVO of the posterior circulation. Primary endpoints were first-pass and overall complete/near complete reperfusion, defined as a modified thrombolysis in cerebral infarction (mTICI) score of 2c and 3. Secondary endpoints contained number of passes, time interval from groin puncture to reperfusion and rate of postinterventional symptomatic intracranial hemorrhage (sICH). Results Median age was 75 years (interquartile range (IQR) 54–81 years). Baseline median National Institutes of Health stroke scale (NIHSS) was 13 (IQR 8–21). Fifty-five (83%) patients had LVO of the basilar artery and 11 (17%) of the posterior cerebral artery. Eighteen (27%) patients were treated with SAVE and 21 (32%) with aspiration only. First pass mTICI2c or 3 and overall mTICI2c or 3 were documented in 11/18 (61%) and 14/18 (78%) with SAVE and in 4/21 (19%) and 13/21 (33%) with aspiration only. Median attempt was 1 (IQR 1–2) with SAVE and 2 (IQR 1–4) with aspiration (p = 0.0249). Median groin to reperfusion time did not differ significantly between groups. The rate of sICH was 5% without any complications in the SAVE cohort. Conclusion Mechanical thrombectomy of posterior large vessel occlusions with SAVE is feasible, safe, and effective with high rates of near-complete and complete reperfusion.
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Affiliation(s)
- Volker Maus
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany. .,Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Bochum, Ruhr University Bochum, In der Schornau 23-25, 44892, Bochum, Germany.
| | - Hanna Styczen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Jan Liman
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Ilko Maier
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Alex Brehm
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Ioannis Tsogkas
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Marios-Nikos Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany.,Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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21
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Meinel TR, Kaesmacher J, Chaloulos-Iakovidis P, Panos L, Mordasini P, Mosimann PJ, Michel P, Hajdu S, Ribo M, Requena M, Maegerlein C, Friedrich B, Costalat V, Benali A, Pierot L, Gawlitza M, Schaafsma J, Pereira VM, Gralla J, Fischer U. Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation. J Neurointerv Surg 2019; 11:1174-1180. [PMID: 31239331 PMCID: PMC6902072 DOI: 10.1136/neurintsurg-2018-014516] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/03/2019] [Accepted: 04/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Performing mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence-based. OBJECTIVE To compare patients' outcome, relative merits of achieving recanalization, and predictors of futile recanalization (FR) between BAO and anterior circulation large vessel occlusion (ACLVO) MT. METHODS In the multicenter BEYOND-SWIFT registry (NCT03496064), univariate and multivariate (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI) outcome comparisons between BAO (N=165) and ACLVO (N=1574) were performed. The primary outcome was favorable outcome at 90 days (modified Rankin Scale, mRS 0-2). Secondary outcome included mortality, symptomatic intracranial hemorrhage (sICH) and FR. The relative merits of achieving successful recanalization between ACLVO and BAO were evaluated with interaction terms. RESULTS MT in BAO was more often technically effective and equally safe in regards to mortality and sICH when compared to ACLVO. When adjusting for baseline differences, there was no significant difference between BAO vs ACLVO regarding rates of favorable outcome (aOR 0.986, 95%-CI 0.553 - 1.758). However, BAO were associated with increased rates of FR (aOR 2.146, 95%-CI 1.267 - 3.633). Predictors for FR were age, stroke severity, maneuver count and intracranial stenting. No significant heterogeneity on the relative merits of achieving successful recanalization on several outcome parameters were observed when comparing BAO and ACLVO. CONCLUSIONS In selected patients, similar outcomes can be achieved in BAO and ACLVO patients treated with MT. Randomized controlled trials comparing patient selection and interventional strategies seem warranted to avoid FR. TRIAL REGISTRATION NUMBER NCT03496064.
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Affiliation(s)
- Thomas Raphael Meinel
- Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | | | - Leonidas Panos
- Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Department for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal J Mosimann
- Department for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrik Michel
- Department of Neurology, CHUV Lausanne, Lausanne, Switzerland
| | - Steven Hajdu
- Department of Interventional and Diagnostic Neuroradiology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - Vincent Costalat
- Department of Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - Amel Benali
- Department of Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - Laurent Pierot
- Department of Neuroradiology, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Matthias Gawlitza
- Department of Neuroradiology, Centre Hospitalier Universitaire de Reims, Reims, France
| | | | - Vitor M Pereira
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jan Gralla
- Department for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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22
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Yeo LLL, Bhogal P, Gopinathan A, Cunli Y, Tan B, Andersson T. Why Does Mechanical Thrombectomy in Large Vessel Occlusion Sometimes Fail? Clin Neuroradiol 2019; 29:401-414. [DOI: 10.1007/s00062-019-00777-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/08/2019] [Indexed: 11/28/2022]
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23
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Aoki C, Fukuda I, Watanabe KI, Saito Y, Nomura A, Taniguchi S. Thrombectomy and reconstruction of the left vertebral artery after total arch replacement: never give up on postoperative stroke. Gen Thorac Cardiovasc Surg 2019; 68:534-537. [PMID: 30875004 DOI: 10.1007/s11748-019-01106-6] [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: 01/07/2019] [Accepted: 03/07/2019] [Indexed: 11/26/2022]
Abstract
The patient was a 64-year-old man who had aortic regurgitation, ischemic heart disease, a transverse aortic aneurysm, and an abdominal-common iliac aneurysm. Concomitant operations including aortic valve replacement, coronary artery bypass grafting, and total aortic arch replacement with elephant trunk technique were performed successfully. The patient developed postoperative cardiac tamponade on the 5th postoperative day, resulting in bulbar palsy due to occlusion of the dominant left vertebral artery. Thrombectomy of the vertebral artery with reconstruction by a saphenous vein was performed. The patient's neurological symptoms improved after the operation. Revascularization of ischemic stroke may yield neurological improvement even in patients after cardiovascular surgery.
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Affiliation(s)
- Chikashi Aoki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Ikuo Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Ken-Ichi Watanabe
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yoshiaki Saito
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Anan Nomura
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Satoshi Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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