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Karimian-Jazi K, Vollherbst DF, Schwarz D, Fischer M, Schregel K, Bauer G, Kocharyan A, Sturm V, Neuberger U, Jesser J, Herweh C, Ulfert C, Hilgenfeld T, Seker F, Preisner F, Schmitt N, Charlet T, Hamelmann S, Sahm F, Heiland S, Wick W, Ringleb PA, Schirmer L, Bendszus M, Möhlenbruch MA, Breckwoldt MO. MR microscopy to assess clot composition following mechanical thrombectomy predicts recanalization and clinical outcome. J Neurointerv Surg 2024; 16:830-837. [PMID: 37527928 DOI: 10.1136/jnis-2023-020594] [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: 05/17/2023] [Accepted: 07/16/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Mechanical thrombectomy (MT) is the standard of care for patients with a stroke and large vessel occlusion. Clot composition is not routinely assessed in clinical practice as no specific diagnostic value is attributed to it, and MT is performed in a standardized 'non-personalized' approach. Whether different clot compositions are associated with intrinsic likelihoods of recanalization success or treatment outcome is unknown. METHODS We performed a prospective, non-randomized, single-center study and analyzed the clot composition in 60 consecutive patients with ischemic stroke undergoing MT. Clots were assessed by ex vivo multiparametric MRI at 9.4 T (MR microscopy), cone beam CT, and histopathology. Clot imaging was correlated with preinterventional CT and clinical data. RESULTS MR microscopy showed red blood cell (RBC)-rich (21.7%), platelet-rich (white,38.3%) or mixed clots (40.0%) as distinct morphological entities, and MR microscopy had high accuracy of 95.4% to differentiate clots. Clot composition could be further stratified on preinterventional non-contrast head CT by quantification of the hyperdense artery sign. During MT, white clots required more passes to achieve final recanalization and were not amenable to contact aspiration compared with mixed and RBC-rich clots (maneuvers: 4.7 vs 3.1 and 1.2 passes, P<0.05 and P<0.001, respectively), whereas RBC-rich clots showed higher probability of first pass recanalization (76.9%) compared with white clots (17.4%). White clots were associated with poorer clinical outcome at discharge and 90 days after MT. CONCLUSION Our study introduces MR microscopy to show that the hyperdense artery sign or MR relaxometry could guide interventional strategy. This could enable a personalized treatment approach to improve outcome of patients undergoing MT.
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Affiliation(s)
| | - Dominik F Vollherbst
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Fischer
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Schregel
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Gregor Bauer
- Neurology Clinic, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Kocharyan
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Volker Sturm
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulf Neuberger
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jessica Jesser
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Herweh
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Ulfert
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tim Hilgenfeld
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Fatih Seker
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Fabian Preisner
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Niclas Schmitt
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tobias Charlet
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Hamelmann
- Department of Neuropathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Wick
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter A Ringleb
- Neurology Clinic, University Hospital Heidelberg, Heidelberg, Germany
| | - Lucas Schirmer
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael O Breckwoldt
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
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Ji Y, Ding X, Xiao L, Li M, Wu K, Xu J, Duan Z, Sun W, Xu P, Huang X. After early mTICI 2b, stop or continue? Insights from the PERSIST Registry. Ann Clin Transl Neurol 2024; 11:1921-1929. [PMID: 38864184 PMCID: PMC11251487 DOI: 10.1002/acn3.52115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/23/2024] [Accepted: 05/23/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVES A higher reperfusion grade after endovascular thrombectomy (EVT) is associated with a good prognosis. However, the effect of the number of retrievals has not yet been investigated in vertebrobasilar occlusion (VBAO). Therefore, the aim of this study was to investigate whether to continue retrieval after early modified thrombolysis in cerebral infarction (mTICI) 2b to achieve a better reperfusion grade. METHODS We retrospectively analyzed the data of patients who underwent EVT caused by VBAO in a multicenter registry dataset. Patients who underwent successful reperfusion were included (mTICI 2b/3). Regression models were used to analyze the correlation of different reperfusion grades stratified by the number of retrieval attempts with clinical prognosis and hemorrhage transition. RESULTS We included 432 patients: 34.5% (n = 149) had a final mTICI score of 2b and 65.5% (n = 283) had a final mTICI score of 3. Patients who obtained a mTICI of 3 after the first pass had significantly increased odds of having a good prognosis. As the number of passes increases, the chances of obtaining a good prognosis decreases. After three or more passes, the odds of achieving functional independence and favorable outcomes were comparable to those of the first mTICI 2b, regardless of the 90-day (OR 1.132 95% CI 0.367-3.487 p = 0.829; OR 1.070 95% CI 0.375-3.047 p = 0.900) or 1-year follow-up (OR 1.217 95% CI 0.407-3.637 p = 0.725; OR 1.068 95% CI 0.359-3.173 p = 0.906). INTERPRETATION Within two retrieval attempts, mTICI 3 was better than the first retrieval to mTICI 2b. After early mTICI 2b, each retrieval should be undertaken with caution to pursue a higher reperfusion grade.
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Affiliation(s)
- Yachen Ji
- Department of NeurologyYijishan Hospital, Wannan Medical CollegeWuhuAnhuiChina
| | - Xianhui Ding
- Department of NeurologyYijishan Hospital, Wannan Medical CollegeWuhuAnhuiChina
| | - Lulu Xiao
- Department of Neurology, Jinling HospitalMedical School of Nanjing UniversityNanjingJiangsuChina
| | - Min Li
- Jiangsu Province Hospital of Chinese MedicineAffiliated Hospital of Nanjing University of Chinese MedicineNanjingJiangsuChina
| | - Kangfei Wu
- Department of NeurologyYijishan Hospital, Wannan Medical CollegeWuhuAnhuiChina
| | - Junfeng Xu
- Department of NeurologyYijishan Hospital, Wannan Medical CollegeWuhuAnhuiChina
| | - Zuowei Duan
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
| | - Wen Sun
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Pengfei Xu
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Xianjun Huang
- Department of NeurologyYijishan Hospital, Wannan Medical CollegeWuhuAnhuiChina
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Vandelanotte S, Staessens S, François O, De Wilde M, Desender L, De Sloovere AS, Dewaele T, Tersteeg C, Vanhoorelbeke K, Vanacker P, Andersson T, De Meyer SF. Association between thrombus composition and first-pass recanalization after thrombectomy in acute ischemic stroke. J Thromb Haemost 2024:S1538-7836(24)00357-X. [PMID: 38897388 DOI: 10.1016/j.jtha.2024.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Achieving first-pass recanalization (FPR) has become the primary procedural objective during thrombectomy in acute ischemic stroke patients as it correlates with the best clinical outcome. Understanding factors contributing to FPR failures is essential to enhance FPR success rates. As the central target of thrombectomy, the thrombus itself may be a significant factor influencing FPR. OBJECTIVES This study aimed to investigate the association between thrombus composition and FPR success rates. METHODS In total, thrombi from 267 ischemic stroke patients were collected in the AZ Groeninge Hospital (Kortrijk, Belgium). Thrombus composition was determined via detailed histologic analysis of red blood cells (RBCs), fibrin, von Willebrand factor, platelets, leukocytes, citrullinated histone 3 (marker for neutrophil extracellular traps), and intracellular and extracellular DNA. FPR was defined as obtaining a modified thrombolysis in cerebral infarction (mTICI) score of 2c/3 after the first pass. RESULTS An mTICI score of 2c/3 was obtained in 180 patients, which was achieved via a successful FPR procedure in 126 cases or after multiple passes in 54 cases. Interestingly, thrombi from FPR cases had a different composition from thrombi that needed multiple passes to obtain an mTICI score of 2c/3. FPR thrombi contained significantly more RBCs (P = .0264), less fibrin (P = .0196), and less extracellular DNA (P = .0457). CONCLUSION Our results indicate that thrombi characterized by lower RBC content, higher fibrin levels, and increased extracellular DNA are less likely to result in an FPR. These results are important to guide future research aiming at improving procedures or technologies to obtain FPR rates in RBC-poor thrombi.
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Affiliation(s)
| | - Senna Staessens
- Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium
| | | | - Maaike De Wilde
- Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium
| | - Linda Desender
- Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium
| | | | - Tom Dewaele
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium
| | | | - Peter Vanacker
- Department of Neurology, AZ Groeninge, Kortrijk, Belgium; Department of Neurology, University Hospitals Antwerp, Antwerp, Belgium; Department of Translational Neuroscience, University of Antwerp, Antwerp, Belgium
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium.
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4
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Zhang H, Polson JS, Wang Z, Nael K, Rao NM, Speier WF, Arnold CW. A Deep Learning Approach to Predict Recanalization First-Pass Effect following Mechanical Thrombectomy in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2024:ajnr.A8272. [PMID: 38871371 DOI: 10.3174/ajnr.a8272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/01/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND PURPOSE Following endovascular thrombectomy in patients with large-vessel occlusion stroke, successful recanalization from 1 attempt, known as the first-pass effect, has correlated favorably with long-term outcomes. Pretreatment imaging may contain information that can be used to predict the first-pass effect. Recently, applications of machine learning models have shown promising results in predicting recanalization outcomes, albeit requiring manual segmentation. In this study, we sought to construct completely automated methods using deep learning to predict the first-pass effect from pretreatment CT and MR imaging. MATERIALS AND METHODS Our models were developed and evaluated using a cohort of 326 patients who underwent endovascular thrombectomy at UCLA Ronald Reagan Medical Center from 2014 to 2021. We designed a hybrid transformer model with nonlocal and cross-attention modules to predict the first-pass effect on MR imaging and CT series. RESULTS The proposed method achieved a mean 0.8506 (SD, 0.0712) for cross-validation receiver operating characteristic area under the curve (ROC-AUC) on MR imaging and 0.8719 (SD, 0.0831) for cross-validation ROC-AUC on CT. When evaluated on the prospective test sets, our proposed model achieved a mean ROC-AUC of 0.7967 (SD, 0.0335) with a mean sensitivity of 0.7286 (SD, 0.1849) and specificity of 0.8462 (SD, 0.1216) for MR imaging and a mean ROC-AUC of 0.8051 (SD, 0.0377) with a mean sensitivity of 0.8615 (SD, 0.1131) and specificity 0.7500 (SD, 0.1054) for CT, respectively, representing the first classification of the first-pass effect from MR imaging alone and the first automated first-pass effect classification method in CT. CONCLUSIONS Results illustrate that both nonperfusion MR imaging and CT from admission contain signals that can predict a successful first-pass effect following endovascular thrombectomy using our deep learning methods without requiring time-intensive manual segmentation.
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Affiliation(s)
- Haoyue Zhang
- From the Computational Diagnostics Lab (H.Z., J.S.P., Z.W., W.F.S., C.W.A.), University of California, Los Angeles, California
- Department of Bioengineering (H.Z., J.S.P., Z.W., C.W.A.), University of California, Los Angeles, California
| | - Jennifer S Polson
- From the Computational Diagnostics Lab (H.Z., J.S.P., Z.W., W.F.S., C.W.A.), University of California, Los Angeles, California
- Department of Bioengineering (H.Z., J.S.P., Z.W., C.W.A.), University of California, Los Angeles, California
| | - Zichen Wang
- From the Computational Diagnostics Lab (H.Z., J.S.P., Z.W., W.F.S., C.W.A.), University of California, Los Angeles, California
- Department of Bioengineering (H.Z., J.S.P., Z.W., C.W.A.), University of California, Los Angeles, California
| | - Kambiz Nael
- Department of Radiology (K.N., W.F.S., C.W.A.), University of California, Los Angeles, California
| | - Neal M Rao
- Department of Neurology (N.M.R.), University of California, Los Angeles, California
| | - William F Speier
- From the Computational Diagnostics Lab (H.Z., J.S.P., Z.W., W.F.S., C.W.A.), University of California, Los Angeles, California
- Department of Radiology (K.N., W.F.S., C.W.A.), University of California, Los Angeles, California
| | - Corey W Arnold
- From the Computational Diagnostics Lab (H.Z., J.S.P., Z.W., W.F.S., C.W.A.), University of California, Los Angeles, California
- Department of Bioengineering (H.Z., J.S.P., Z.W., C.W.A.), University of California, Los Angeles, California
- Department of Radiology (K.N., W.F.S., C.W.A.), University of California, Los Angeles, California
- Department of Pathology (C.W.A.), University of California, Los Angeles, California
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5
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Lambrou V, Gory B, Lapergue B, Marnat G, Pop R, Calviere L, Anadani M, Blanc R, Finitsis SN. Number of passes and outcome of endovascular treatment of anterior circulation large core ischemic stroke: insights from the Endovascular Treatment in Ischemic Stroke (ETIS) registry. J Neurointerv Surg 2024:jnis-2024-021857. [PMID: 38816202 DOI: 10.1136/jnis-2024-021857] [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: 04/15/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The effect of multiple attempts on the outcome of endovascular treatment (EVT) of anterior circulation large ischemic core (LIC) stroke has not been fully explored. METHODS We analyzed data from the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a prospective, observational, multicenter study of acute ischemic stroke patients treated with EVT at 21 centers in France between January 1, 2015 and June 31, 2023. We included patients with proximal intracranial occlusion and LIC defined as Alberta Stroke Program Early CT Score (ASPECTS) of 0-5 up to 24 hours after last being seen well. We divided patients according to the number of passes with successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b) into seven groups, according to the corresponding number of passes. We compared them to the group of patients with unsuccessful reperfusion. RESULTS A total of 1235 patients with LIC constituted the study cohort. The rate of a modified Rankin Scale (mRS) score of 0 to 3 at 90 days was significantly higher for the one-pass successful recanalization category compared to no recanalization (48.1% vs 17.2%; adjusted OR (aOR) 7.99, 95% CI 4.30 to 14.8, P<0.001) and remained so even after six or more attempts (27.7% vs 17.2%; aOR 3.59, 95% CI 1.37 to 9.39, P=0.009). The rate of symptomatic intracranial hemorrhage was lower for successful recanalization up to two passes (11.1% vs 18.8%; aOR 0.36, 95% CI 0.18 to 0.69, P=0.002) without any significant differences for a higher number of passes. CONCLUSION In anterior circulation LIC patients, successful reperfusion, even after six passes, is associated with favorable clinical outcomes with no increased hemorrhagic risk when compared to unsuccessful reperfusion.
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Affiliation(s)
- Victoria Lambrou
- Neuroradiology, Aristotle University of Thessaloniki, Thessalonike, Kentrikḗ Makedonía, Greece
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
| | - Bertrand Lapergue
- Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Suresnes, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Raoul Pop
- Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France
- Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
| | | | - Mohammad Anadani
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Raphael Blanc
- Interventional Neuroradiology, Fondation Rothschild, Paris, France
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Gravino G, Jakobek W, Nayak S, Yang Y, Ranjbar J, Roffe C. Correspondence on 'Comparison of balloon guide catheter versus non-balloon guide catheter for mechanical thrombectomy in patients with distal medium vessel occlusion' by Orscelik et al. J Neurointerv Surg 2024; 16:631-632. [PMID: 38123354 DOI: 10.1136/jnis-2023-021256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Gilbert Gravino
- School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK
- Department of Neuroradiology, The Walton Centre, Liverpool, UK
| | - William Jakobek
- School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK
| | - Sanjeev Nayak
- School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK
- Royal Stoke University Hospital, Stoke on Trent, UK
| | - Ying Yang
- School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK
| | - Jacob Ranjbar
- School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK
| | - Christine Roffe
- School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK
- Royal Stoke University Hospital, Stoke on Trent, UK
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7
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Wang H, Xu C, Xiao Y, Shen P, Guo S, Shang Y, Chen X, Xu J, Li C, Tan M, Zhang S, Geng Y. A dynamic nomogram for predict individual risk of malignant brain edema after endovascular thrombectomy in acute ischemic stroke. Sci Rep 2024; 14:9529. [PMID: 38664433 PMCID: PMC11045849 DOI: 10.1038/s41598-024-60083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
The aim of this study was to develop a dynamic nomogram combining clinical and imaging data to predict malignant brain edema (MBE) after endovascular thrombectomy (EVT) in patients with large vessel occlusion stroke (LVOS). We analyzed the data of LVOS patients receiving EVT at our center from October 2018 to February 2023, and divided a 7:3 ratio into the training cohort and internal validation cohort, and we also prospectively collected patients from another stroke center for external validation. MBE was defined as a midline shift or pineal gland shift > 5 mm, as determined by computed tomography (CT) scans obtained within 7 days after EVT. A nomogram was constructed using logistic regression analysis, and its receiver operating characteristic curve (ROC) and calibration were assessed in three cohorts. A total of 432 patients were enrolled in this study, with 247 in the training cohort, 100 in the internal validation cohort, and 85 in the external validation cohort. MBE occurred in 24% (59) in the training cohort, 16% (16) in the internal validation cohort and 14% (12) in the external validation cohort. After adjusting for various confounding factors, we constructed a nomogram including the clot burden score (CBS), baseline neutrophil count, core infarct volume on CTP before EVT, collateral index, and the number of retrieval attempts. The AUCs of the training cohorts were 0.891 (95% CI 0.840-0.942), the Hosmer-Lemeshow test showed good calibration of the nomogram (P = 0.879). And our nomogram performed well in both internal and external validation data. Our nomogram demonstrates promising potential in identifying patients at elevated risk of MBE following EVT for LVOS.
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Affiliation(s)
- Huiyuan Wang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
- School of Clinical Medicine, Graduate School, Bengbu Medical College, Bengbu, China
| | - Chenghua Xu
- Department of Neurology, Taizhou First People's Hospital, Taizhou, Zhejiang, China
| | - Yu Xiao
- Department of Neurology, Taizhou First People's Hospital, Taizhou, Zhejiang, China
| | - Panpan Shen
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
- Department of the Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shunyuan Guo
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
| | - Yafei Shang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
- School of Clinical Medicine, Graduate School, Bengbu Medical College, Bengbu, China
| | - Xinyi Chen
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
- Department of the Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jie Xu
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
- Department of the Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chunrong Li
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
| | - Mingming Tan
- Department of Quality Management, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang, China
| | - Sheng Zhang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China.
| | - Yu Geng
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China.
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8
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Winkelmeier L, Heitkamp C, Faizy TD, Broocks G, Kniep H, Meyer L, Bester M, Brekenfeld C, Schell M, Hanning U, Thomalla G, Fiehler J, Flottmann F. Prognostic value of recanalization attempts in endovascular therapy for M2 segment middle cerebral artery occlusions. Int J Stroke 2024; 19:422-430. [PMID: 37935652 PMCID: PMC10964385 DOI: 10.1177/17474930231214769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND There is growing evidence suggesting efficacy of endovascular therapy for M2 occlusions of the middle cerebral artery. More than one recanalization attempt is often required to achieve successful reperfusion in M2 occlusions, associated with general concerns about the safety of multiple maneuvers in these medium vessel occlusions. AIM The aim of this study was to investigate the association between the number of recanalization attempts and functional outcomes in M2 occlusions in comparison with large vessel occlusions (LVO). METHODS Retrospective multicenter cohort study of patients who underwent endovascular therapy for primary M2 occlusions. Patients were enrolled in the German Stroke Registry at 1 of 25 comprehensive stroke centers between 2015 and 2021. The study cohort was subdivided into patients with unsuccessful reperfusion (mTICI 0-2a) and successful reperfusion (mTICI 2b-3) at first, second, third, fourth, or ⩾fifth recanalization attempt. Primary outcome was 90-day functional independence defined as modified Rankin Scale score of 0-2. Safety outcome was the occurrence of symptomatic intracranial hemorrhage. Internal carotid artery or M1 occlusions were defined as LVO and served as comparison group. RESULTS A total of 1078 patients with M2 occlusion were included. Successful reperfusion was observed in 87.1% and 90-day functional independence in 51.9%. The rate of functional independence decreased gradually with increasing number of recanalization attempts (p < 0.001). In both M2 occlusions and LVO, successful reperfusion within three attempts was associated with greater odds of functional independence, while success at ⩾fourth attempt was not. Patients with ⩾4 attempts exhibited higher rates of symptomatic intracranial hemorrhage in M2 occlusions (6.5% vs 2.7%, p = 0.02) and LVO (7.2% vs 3.5%, p < 0.001). CONCLUSION This study suggests a clinical benefit of successful reperfusion within three recanalization attempts in endovascular therapy for M2 occlusions, which was similar in LVO. Our findings reduce concerns about the risk-benefit ratio of multiple attempts in M2 medium vessel occlusions. DATA ACCESS STATEMENT The data that support the findings of this study are available on reasonable request after approval of the German Stroke Registry (GSR) steering committee. CLINICAL TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT03356392.
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Affiliation(s)
- Laurens Winkelmeier
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Heitkamp
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D Faizy
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Bester
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caspar Brekenfeld
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Khanafer A, Henkes H, Bücke P, Hennersdorf F, Bäzner H, Forsting M, von Gottberg P. Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis. BMC Neurol 2024; 24:99. [PMID: 38500074 PMCID: PMC10946095 DOI: 10.1186/s12883-024-03597-0] [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: 01/09/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Acute stroke treatment with intracranial thrombectomy and treatment of ipsilateral carotid artery stenosis/occlusion ("tandem lesion", TL) in one session is considered safe. However, the risk of stent restenosis after TL treatment is high, and antiplatelet therapy (APT) preventing restenosis must be well balanced to avoid intracranial hemorrhage. We investigated the safety and 90-day outcome of patients receiving TL treatment under triple-APT, focused on stent-patency and possible disadvantageous comorbidities. METHODS Patients receiving TL treatment in the setting of acute stroke between 2013 and 2022 were analyzed regarding peri-/postprocedural safety and stent patency after 90 days. All patients received intravenous eptifibatide and acetylsalicylic acid and one of the three drugs prasugrel, clopidogrel, or ticagrelor. Duplex imaging was performed 24 h after treatment, at discharge and 90 days, and digital subtraction angiography was performed if restenosis was suspected. RESULTS 176 patients were included. Periprocedural complications occurred in 2.3% of the patients at no periprocedural death, and in-hospital death in 13.6%. Discharge mRS score was maintained or improved at the 90-day follow-up in 86%, 4.54% had an in-stent restenosis requiring treatment at 90 days. No recorded comorbidity considered disadvantageous for stent patency showed statistical significance, the duration of the endovascular procedure had no significant effect on outcome. CONCLUSION In our data, TL treatment with triple APT resulted in a low restenosis rate, low rates of sICH and a comparably high number of patients with favorable outcome. Aggressive APT in the initial phase may therefore have the potential to prevent recurrent stroke better than restrained platelet inhibition. Comorbidities did not influence stent patency.
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Affiliation(s)
- Ali Khanafer
- Neuroradiological Clinic, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Neuroradiological Clinic, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Philipp Bücke
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Hennersdorf
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Hansjörg Bäzner
- Neurological Clinic, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Philipp von Gottberg
- Neuroradiological Clinic, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany.
- Klinik für Neuroradiologie, Klinikum Stuttgart, Kriegsbergstr. 60, 70174, Stuttgart, Germany.
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10
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Zhao ZA, Qiu J, Li W, Nguyen T, Wang S, Shi H, Wei M, Wang F, Li D, Chen HS. Intra-arterial tenecteplase during thrombectomy for acute stroke (BRETIS-TNK II): rationale and design. Stroke Vasc Neurol 2024; 9:59-65. [PMID: 37169399 PMCID: PMC10961245 DOI: 10.1136/svn-2023-002377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Our recent pilot study suggests intra-arterial tenecteplase (TNK) during the first pass of endovascular treatment (EVT) seems safe, may increase first-pass reperfusion and good outcome in acute ischaemic stroke (AIS) patients with large-vessel occlusion (LVO). AIMS To determine the efficacy and safety of intra-arterial TNK administration during EVT in AIS-LVO patients presenting up to 24 hours from symptom onset. SAMPLE SIZE ESTIMATES A maximum of 380 patients are required to test the superiority hypothesis with 80% power according to a two-side 0.05 level of significance, stratified by age, gender, baseline systolic blood pressure, prestroke modified Rankin Scale (mRS), baseline National Institute of Health stroke scale, baseline ASPECTS, time from onset to groin puncture, intravenous thrombolysis before EVT, stroke territory and stroke aetiology. DESIGN Intra-arterial TNK during thrombectomy for acute stroke (BRETIS-TNK II) study is a prospective, randomised, adaptive enrichment, open-label, blinded end point, multicentre study. Eligible AIS-LVO patients are randomly assigned into the experimental group and control group with a ratio of 1:1. The experimental group will be treated with intra-arterial infusion of TNK during EVT. The control group will be treated with standard EVT. OUTCOME The primary end point is a favourable outcome, defined as an mRS score of 0-2 at 90 days. The primary safety end point is symptomatic intracranial haemorrhage within 48 hours, which is defined as an increase in the National Institutes of Health Stroke Scale score of ≥4 points as a result of the intracranial haemorrhage. CONCLUSIONS The results of BRETIS-TNK II will provide evidence for the efficacy and safety of intra-arterial TNK administration during EVT in AIS patients with LVO.
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Affiliation(s)
- Zi-Ai Zhao
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Jing Qiu
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Wei Li
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Thanh Nguyen
- Neurology, Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Shouchun Wang
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, Jilin, China
| | - Huaizhang Shi
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ming Wei
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, Tianjin, China
| | - Feng Wang
- Department of Interventional Therapy, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Di Li
- Neurological Intervention Department, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
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11
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Wang W, Xu Y, Zhang B, Liu S, Ma Z, Wang S, Zhang P, Wei M. Mechanical thrombectomy using the retrograde semi-retrieval technique for patients with underlying intracranial atherosclerotic stenosis. Front Neurol 2024; 14:1280181. [PMID: 38283684 PMCID: PMC10811598 DOI: 10.3389/fneur.2023.1280181] [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: 08/19/2023] [Accepted: 11/13/2023] [Indexed: 01/30/2024] Open
Abstract
Background The retrograde semi-retrieval technique (RESET) has been described as a modified technique for endovascular thrombectomy (EVT) whose safety and efficacy for intracranial atherosclerosis stenosis (ICAS) patients remain uncertain. This article presents our single-center experience, comparing RESET vs. non-RESET in ICAS patients. Materials and methods We analyzed 327 consecutive ICAS patients who underwent EVT at Tianjin Huanhu Hospital from January 2018 and December 2022. Patients were categorized into two groups: RESET and non-RESET. The primary outcome was the first-pass effect (FPE). Secondary outcomes included successful reperfusion, functional independence at 90 days, mortality, and symptomatic intracranial hemorrhage (sICH). Results RESET was significantly associated with FPE [adjusted odds ratio (aOR) 2.00, 95% confidence interval (CI) 1.03-3.87, p = 0.040]. RESET was not significantly associated with successful reperfusion (aOR 1.5, CI 0.55-4.06, p = 0.425), an mRS of 0-2 at 90 days (aOR 1.36, CI 0.83-2.21, p = 0.223), sICH (aOR 0.39, CI 0.12-1.23, p = 0.108), and mortality (aOR 0.49, CI 0.16-1.44, p = 0.193). After propensity score matching, the results were consistent with the primary analysis. Conclusion Compared to non-RESET, patients treated with RESET showed increased FPE incidence and significantly decreased puncture-to-reperfusion time. RESET was proven to be safe and effective in enhancing reperfusion for LVO patients receiving EVT with underlying ICAS.
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Affiliation(s)
- Wei Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Yongbo Xu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Bohao Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Shuling Liu
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhenjian Ma
- Department of Neurosurgery, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Sifei Wang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Pinyuan Zhang
- Department of Neurosurgery (Cerebrovascular Disease), The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ming Wei
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
- Department of Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
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12
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Kniep H, Meyer L, Broocks G, Bechstein M, Guerreiro H, Winkelmeier L, Brekenfeld C, Flottmann F, Deb-Chatterji M, Alegiani A, Hanning U, Thomalla G, Fiehler J, Gellißen S. Predictors of functional outcome after thrombectomy for M2 occlusions: a large scale experience from clinical practice. Sci Rep 2023; 13:18740. [PMID: 37907482 PMCID: PMC10618211 DOI: 10.1038/s41598-023-45232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
Mechanical thrombectomy (MT) for acute ischemic stroke with medium vessel occlusions is still a matter of debate. We sought to identify factors associated with clinical outcome after MT for M2-occlusions based on data from the German Stroke Registry-Endovascular Treatment (GSR-ET). All patients prospectively enrolled in the GSR-ET from 05/2015 to 12/2021 were analyzed (NCT03356392). Inclusion criteria were primary M2-occlusions and availability of relevant clinical data. Factors associated with excellent/good outcome (modified Rankin scale mRS 0-1/0-2), poor outcome/death (mRS 5-6) and mRS-increase pre-stroke to day 90 were determined in multivariable logistic regression. 1348 patients were included. 1128(84%) had successful recanalization, 595(44%) achieved good outcome, 402 (30%) had poor outcome. Successful recanalization (odds ratio [OR] 4.27 [95% confidence interval 3.12-5.91], p < 0.001), higher Alberta stroke program early CT score (OR 1.25 [1.18-1.32], p < 0.001) and i.v. thrombolysis (OR 1.28 [1.07-1.54], p < 0.01) increased probability of good outcome, while age (OR 0.95 [0.94-0.95], p < 0.001), higher pre-stroke-mRS (OR 0.36 [0.31-0.40], p < 0.001), higher baseline NIHSS (OR 0.89 [0.88-0.91], p < 0.001), diabetes (OR 0.52 [0.42-0.64], p < 0.001), higher number of passes (OR 0.75 [0.70-0.80], p < 0.001) and intracranial hemorrhage (OR 0.26 [0.14-0.46], p < 0.001) decreased the probability of good outcome. Additional predictors of mRS-increase pre-stroke to 90d were dissections, perforations (OR 1.59 [1.11-2.29], p < 0.05) and clot migration, embolization (OR 1.67 [1.21-2.30], p < 0.01). Corresponding to large-vessel-occlusions, younger age, low pre-stroke-mRS, low severity of acute clinical disability, i.v. thrombolysis and successful recanalization were associated with good outcome while diabetes and higher number of passes decreased probability of good outcome after MT in M2 occlusions. Treatment related complications increased probability of mRS increase pre-stroke to 90d.
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Affiliation(s)
- Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Helena Guerreiro
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Laurens Winkelmeier
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Caspar Brekenfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Milani Deb-Chatterji
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Alegiani
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Susanne Gellißen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Kobeissi H, Adusumilli G, Ghozy S, Dmytriw AA, Senol YC, Orscelik A, Bilgin C, Kadirvel R, Brinjikji W, Kallmes DF. First-pass effect in posterior acute ischemic stroke undergoing endovascular thrombectomy: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2023; 32:107304. [PMID: 37579638 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107304] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVES First-pass effect (FPE) has been shown to be a predictor of favorable clinical outcomes following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) in the anterior circulation. Literature regarding FPE for posterior circulation AIS is sparse; we conducted a systematic review and meta-analysis to explore FPE in posterior circulation stroke undergoing EVT. MATERIALS AND METHODS We conducted a systematic review of the English literature in PubMed, Embase, Scopus, and Web of Science. FPE was defined as thrombolysis in cerebral infarction (TICI) 2c-3 and modified FPE (mFPE) was defined as TICI 2b-3 in one pass. Definitions of non-FPE and non-mFPE varied among studies. The primary outcome of interest was modified Rankin Scale (mRS) 0-2. Secondary outcomes of interest were mRS 0-3, symptomatic intracranial hemorrhage (sICH), and mortality. We calculated odds ratios (OR) and corresponding 95% confidence intervals (CI). Heterogeneity was assessed with Q statistic and I2 test. RESULTS Seven studies with 417 patients in the mFPE group, 942 in the non-mFPE group, 545 in the FPE group, and 1023 in the non-FPE group were included. Overall, FPE was associated with greater rates of 90-day mRS 0-2 (OR= 2.78, 95% CI= 2.11-3.65; P-value< 0.001) and mRS 0-3 (OR= 2.67, 95% CI= 1.98-3.60; P-value< 0.001); however, there was significant heterogeneity among studies for both mRS 0-2 (I2= 69%; P-value< 0.001) and mRS 0-3 (I2= 69%; P-value< 0.001). FPE and non-FPE were associated with similar rates of sICH (OR= 0.65, 95% CI= 0.40-1.07; P-value= 0.09), and no heterogeneity was observed (I2= 0%; P-value= 0.95). FPE was associated with lower rates of mortality (OR= 0.44, 95% CI= 0.33-0.58; P-value< 0.001), although heterogeneity was observed (I2= 58%; P-value= 0.01). CONCLUSIONS FPE is associated with favorable clinical outcomes in patients undergoing EVT for posterior circulation AIS. Future studies should work to further quantify the impact of FPE on outcomes in the posterior circulation.
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Affiliation(s)
- Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; College of Medicine, Central Michigan University, Mount Pleasant, MI, USA.
| | - Gautam Adusumilli
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Yigit Can Senol
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Jakobek W, Gravino G, Nayak S, Yang Y, Ranjbar J, Roffe C. The effect of distal aspiration catheter position on collateral flow in mechanical thrombectomy - an in vitro study. Interv Neuroradiol 2023:15910199231201518. [PMID: 37769320 DOI: 10.1177/15910199231201518] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Endovascular mechanical thrombectomy for ischaemic stroke is one of the most effective treatments. Despite the devices and techniques that have been developed, thrombi are not always successfully retrieved. The incidence of futile reperfusion after successful clot retrieval also remains a major concern. We hypothesise that simply placing an aspiration catheter in the system compromises collateral flow which may have an impact on functional outcomes. METHODS An in vitro study was conducted using a physical pulsatile flow model designed in glass to mimic the anterior cerebral circulation with middle cerebral artery M1 segment occlusion. A 5Fr aspiration catheter was positioned at the supra-clinoid internal carotid (SC-ICA), carotid terminus (T-ICA) and M1. For each catheter position, the flow rate through the model's anterior cerebral (ACA) and posterior communicating (PCOM) arteries was measured (no aspiration applied). RESULTS Our results showed significant mean percentage flow reductions in the ACA and PCOM with the catheter positioned at the SC-ICA (PCOM 59.14% ± 0.93, ACA 59.52% ± 0.82, p < 0.001), T-ICA (PCOM 81.54% ± 0.55, ACA 85.65% ± 1.54) and M1 (PCOM 75.79% ± 0.98, ACA 84.20% ± 0.43) (Mann-Whitney U Test, p < 0.001). CONCLUSION These results indicate a significant reduction in collateral flow following the insertion of a wide bore catheter in an in vitro model. In a clinical setting, this could have an impact on patient outcome, particularly in prolonged procedures and those requiring several passes to achieve recanalisation.
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Affiliation(s)
- William Jakobek
- School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK
| | - Gilbert Gravino
- School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK
- Department of Neuroradiology, The Walton Centre, Liverpool, UK
| | - Sanjeev Nayak
- School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK
- Royal Stoke University Hospital, Stoke on Trent, UK
| | - Ying Yang
- School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK
| | - Jacob Ranjbar
- School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK
| | - Christine Roffe
- School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK
- Royal Stoke University Hospital, Stoke on Trent, UK
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15
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Jeong HY, Nam TM, Lee SH, Jang JH, Kim YZ, Kim KH, Ryu KH, Kim DH, Kwan BS, Bak H, Kim SH. Impact on Endovascular Thrombectomy for Acute Ischemic Stroke of Aortic Arch Calcification on Chest X-ray. J Clin Med 2023; 12:6115. [PMID: 37834759 PMCID: PMC10573594 DOI: 10.3390/jcm12196115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Vascular conditions can affect the recanalization rates after endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). Chest radiography can assess the conditions of the aortic arch based on the presence or absence of aortic arch calcification (AoAC). The aim of this study was to investigate the relationship between AoAC on chest radiography and first-pass successful recanalization (modified thrombolysis in cerebral infarction 2b/3 after the first-pass). METHODS We compared the rate of first-pass successful recanalization between patients with and without AoAC. A total of 193 patients with anterior circulation occlusion who underwent EVT between January 2017 and December 2021 were included. RESULTS AoAC was observed in 80 (41.5%) patients. Patients with AoAC were older (74.5 ± 7.78 vs. 63.9 ± 12.4 years, p < 0.001), had more EVT attempts (3.04 ± 1.95 vs. 2.01 ± 1.34 times, p < 0.001), and a longer procedural time (71.7 ± 31.2 vs. 48.7 ± 23.1 min, p < 0.001) than those without AoAC. Moreover, Patients with AoAC showed a lower incidence of first-pass successful recanalization (18.8% vs. 47.8%, p < 0.001) and a higher incidence of postprocedural hemorrhage (45.0% vs. 27.7%, p = 0.015) than those without AoAC. On multivariate analysis, AoAC was independently associated with first-pass successful recanalization (odds ratio: 0.239 [0.121-0.475], p < 0.001). CONCLUSIONS AoAC on chest radiography can be used as a preoperative predictor of successful first-pass recanalization in patients undergoing EVT for AIS.
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Affiliation(s)
- Hyeon Yeong Jeong
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea; (H.Y.J.); (T.M.N.); (S.H.L.); (J.H.J.); (Y.Z.K.); (K.H.K.)
| | - Taek Min Nam
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea; (H.Y.J.); (T.M.N.); (S.H.L.); (J.H.J.); (Y.Z.K.); (K.H.K.)
| | - Sang Hyuk Lee
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea; (H.Y.J.); (T.M.N.); (S.H.L.); (J.H.J.); (Y.Z.K.); (K.H.K.)
| | - Ji Hwan Jang
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea; (H.Y.J.); (T.M.N.); (S.H.L.); (J.H.J.); (Y.Z.K.); (K.H.K.)
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea; (H.Y.J.); (T.M.N.); (S.H.L.); (J.H.J.); (Y.Z.K.); (K.H.K.)
| | - Kyu Hong Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea; (H.Y.J.); (T.M.N.); (S.H.L.); (J.H.J.); (Y.Z.K.); (K.H.K.)
| | - Kyeong Hwa Ryu
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea;
| | - Do-Hyung Kim
- Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea;
| | - Byung Soo Kwan
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea;
| | - Hyerang Bak
- Department of Family Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea;
| | - Seung Hwan Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea; (H.Y.J.); (T.M.N.); (S.H.L.); (J.H.J.); (Y.Z.K.); (K.H.K.)
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Remollo S, Werner M, Blasco J, López-Rueda A, San Roman L, Jimenez-Gomez E, Bravo Rey I, Vega P, Murias E, Rosati S, Pérez-García C, González E, Manso X, Aixut S, Chirife Chaparro O, Terceño M, Bashir S, Pumar JM, Ruiz-González E, Méndez JC, Aguilar Tejedor Y, Zamarro J, Castaño M, Daunis-I-Estadella P, Puig J. First-Pass Effect in M1-Occlusion Stroke Patients Treated with Combined Stent-Retriever/Large-Bore Distal Aspiration Catheter Thrombectomy. Clin Neuroradiol 2023; 33:701-708. [PMID: 36856786 DOI: 10.1007/s00062-023-01264-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/17/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers. METHODS We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″-0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″-0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device. RESULTS We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004). CONCLUSION Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.
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Affiliation(s)
- S Remollo
- Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - M Werner
- Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - J Blasco
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A López-Rueda
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - L San Roman
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - E Jimenez-Gomez
- Diagnostic and Therapeutical Neuroradiology Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - I Bravo Rey
- Neuroradiology Department, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - P Vega
- Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - E Murias
- Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - S Rosati
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - C Pérez-García
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - E González
- Interventional Neuroradiology, Radiology Department, Cruces University Hospital, Barakaldo, Spain
| | - X Manso
- Interventional Neuroradiology, Radiology Department, Cruces University Hospital, Barakaldo, Spain
| | - S Aixut
- Neuroradiology Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Llobregat, Spain
| | - O Chirife Chaparro
- Neuroradiology Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Llobregat, Spain
| | - M Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - S Bashir
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - J M Pumar
- Neuroradiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - E Ruiz-González
- Interventional Neuroradiology, Hospital General Universitario de Alicante, Alicante, Spain
| | - J C Méndez
- Interventional Neuroradiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Y Aguilar Tejedor
- Radiology Department, Hospital Universitario Insular de Gran Canaria, Gran Canaria, Spain
| | - J Zamarro
- Interventional Neuroradiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M Castaño
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - P Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - J Puig
- Department of Radiology (IDI) and Institut d'Investigació Biomèdica de Girona, Hospital Universitari Doctor Josep Trueta, Girona, Spain.
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Winkelmeier L, Faizy TD, Broocks G, Meyer L, Heitkamp C, Brekenfeld C, Thaler C, Steffen P, Schell M, Deb-Chatterji M, Hanning U, Kniep H, Maros ME, Thomalla G, Fiehler J, Flottmann FA. Association Between Recanalization Attempts and Functional Outcome After Thrombectomy for Large Ischemic Stroke. Stroke 2023; 54:2304-2312. [PMID: 37492970 PMCID: PMC10464881 DOI: 10.1161/strokeaha.123.042794] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Recently, 3 randomized controlled trials provided high-level evidence that patients with large ischemic stroke achieved better functional outcomes after endovascular therapy than with medical care alone. We aimed to investigate whether the clinical benefit of endovascular therapy is associated with the number of recanalization attempts in extensive baseline infarction. METHODS This retrospective multicenter study enrolled patients from the German Stroke Registry who underwent endovascular therapy for anterior circulation large vessel occlusion between 2015 and 2021. Large ischemic stroke was defined as an Alberta Stroke Program Early Computed Tomography Score of 3 to 5. The study cohort was divided into patients with unsuccessful reperfusion (Thrombolysis in Cerebral Infarction score, 0-2a) and successful reperfusion (Thrombolysis in Cerebral Infarction score, 2b/3) at attempts 1, 2, 3, or ≥4. The primary outcome was favorable functional outcome defined as modified Rankin Scale score of 0 to 3 at 90 days. Safety outcomes were symptomatic intracranial hemorrhage after 24 hours and death within 90 days. Multivariable logistic regression was used to identify independent determinants of primary and secondary outcomes. RESULTS A total of 348 patients met the inclusion criteria. Successful reperfusion was observed in 83.3% and favorable functional outcomes in 36.2%. Successful reperfusion at attempts 1 (adjusted odds ratio, 5.97 [95% CI, 1.71-24.43]; P=0.008) and 2 (adjusted odds ratio, 6.32 [95% CI, 1.73-26.92]; P=0.008) increased the odds of favorable functional outcome, whereas success at attempts 3 or ≥4 did not. Patients with >2 attempts showed higher rates of symptomatic intracranial hemorrhage (12.8% versus 6.5%; P=0.046). Successful reperfusion at any attempt lowered the odds of death compared with unsuccessful reperfusion. CONCLUSIONS In patients with large vessel occlusion and Alberta Stroke Program Early Computed Tomography Score of 3 to 5, the clinical benefit of endovascular therapy was linked to the number of recanalization attempts required for successful reperfusion. Our findings encourage to perform at least 2 recanalization attempts to seek for successful reperfusion in large ischemic strokes, while >2 attempts should follow a careful risk-benefit assessment in these highly affected patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03356392.
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Affiliation(s)
- Laurens Winkelmeier
- Departments of Neuroradiology (L.W., T.D.F., G.B., L.M., C.H., C.B., C.T., P.S., U.H., H.K., J.F., F.F.)
| | - Tobias D. Faizy
- Departments of Neuroradiology (L.W., T.D.F., G.B., L.M., C.H., C.B., C.T., P.S., U.H., H.K., J.F., F.F.)
| | - Gabriel Broocks
- Departments of Neuroradiology (L.W., T.D.F., G.B., L.M., C.H., C.B., C.T., P.S., U.H., H.K., J.F., F.F.)
| | - Lukas Meyer
- Departments of Neuroradiology (L.W., T.D.F., G.B., L.M., C.H., C.B., C.T., P.S., U.H., H.K., J.F., F.F.)
| | - Christian Heitkamp
- Departments of Neuroradiology (L.W., T.D.F., G.B., L.M., C.H., C.B., C.T., P.S., U.H., H.K., J.F., F.F.)
| | - Caspar Brekenfeld
- Departments of Neuroradiology (L.W., T.D.F., G.B., L.M., C.H., C.B., C.T., P.S., U.H., H.K., J.F., F.F.)
| | - Christian Thaler
- Departments of Neuroradiology (L.W., T.D.F., G.B., L.M., C.H., C.B., C.T., P.S., U.H., H.K., J.F., F.F.)
| | - Paul Steffen
- Departments of Neuroradiology (L.W., T.D.F., G.B., L.M., C.H., C.B., C.T., P.S., U.H., H.K., J.F., F.F.)
| | - Maximilian Schell
- Neurology (M.S., M.D.-C., G.T.), University Medical Center Hamburg-Eppendorf, Germany
| | - Milani Deb-Chatterji
- Neurology (M.S., M.D.-C., G.T.), University Medical Center Hamburg-Eppendorf, Germany
| | - Uta Hanning
- Departments of Neuroradiology (L.W., T.D.F., G.B., L.M., C.H., C.B., C.T., P.S., U.H., H.K., J.F., F.F.)
| | - Helge Kniep
- Departments of Neuroradiology (L.W., T.D.F., G.B., L.M., C.H., C.B., C.T., P.S., U.H., H.K., J.F., F.F.)
| | - Máté E. Maros
- Department of Neuroradiology, Medical Faculty Mannheim, Heidelberg University, Germany (M.E.M.)
| | - Götz Thomalla
- Neurology (M.S., M.D.-C., G.T.), University Medical Center Hamburg-Eppendorf, Germany
| | - Jens Fiehler
- Departments of Neuroradiology (L.W., T.D.F., G.B., L.M., C.H., C.B., C.T., P.S., U.H., H.K., J.F., F.F.)
| | - Fabian Alexander Flottmann
- Departments of Neuroradiology (L.W., T.D.F., G.B., L.M., C.H., C.B., C.T., P.S., U.H., H.K., J.F., F.F.)
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18
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van Voorst H, Bruggeman AAE, Yang W, Andriessen J, Welberg E, Dutra BG, Konduri PR, Arrarte Terreros N, Hoving JW, Tolhuisen ML, Kappelhof M, Brouwer J, Boodt N, van Kranendonk KR, Koopman MS, Hund HM, Krietemeijer M, van Zwam WH, van Beusekom HMM, van der Lugt A, Emmer BJ, Marquering HA, Roos YBWEM, Caan MWA, Majoie CBLM. Thrombus radiomics in patients with anterior circulation acute ischemic stroke undergoing endovascular treatment. J Neurointerv Surg 2023; 15:e79-e85. [PMID: 35882552 DOI: 10.1136/jnis-2022-019085] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/10/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Thrombus radiomics (TR) describe complex shape and textural thrombus imaging features. We aimed to study the relationship of TR extracted from non-contrast CT with procedural and functional outcome in endovascular-treated patients with acute ischemic stroke. METHODS Thrombi were segmented on thin-slice non-contrast CT (≤1 mm) from 699 patients included in the MR CLEAN Registry. In a pilot study, we selected 51 TR with consistent values across two raters' segmentations (ICC >0.75). Random forest models using TR in addition or as a substitute to baseline clinical variables (CV) and manual thrombus measurements (MTM) were trained with 499 patients and evaluated on 200 patients for predicting successful reperfusion (extended Thrombolysis in Cerebral Ischemia (eTICI) ≥2B), first attempt reperfusion, reperfusion within three attempts, and functional independence (modified Rankin Scale (mRS) ≤2). Three texture and shape features were selected based on feature importance and related to eTICI ≥2B, number of attempts to eTICI ≥2B, and 90-day mRS with ordinal logistic regression. RESULTS Random forest models using TR, CV or MTM had comparable predictive performance. Thrombus texture (inverse difference moment normalized) was independently associated with reperfusion (adjusted common OR (acOR) 0.85, 95% CI 0.72 to 0.99). Thrombus volume and texture were also independently associated with the number of attempts to successful reperfusion (acOR 1.36, 95% CI 1.03 to 1.88 and acOR 1.24, 95% CI 1.04 to 1.49). CONCLUSIONS TR describing thrombus volume and texture were associated with more attempts to successful reperfusion. Compared with models using CV and MTM, TR had no added value for predicting procedural and functional outcome.
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Affiliation(s)
- Henk van Voorst
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Agnetha A E Bruggeman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Wenjin Yang
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Neurosurgery, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Jurr Andriessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Elise Welberg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Bruna G Dutra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Praneeta R Konduri
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Nerea Arrarte Terreros
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Jan W Hoving
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Manon L Tolhuisen
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Manon Kappelhof
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Josje Brouwer
- Department of Neurology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Nikki Boodt
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Katinka R van Kranendonk
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Miou S Koopman
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Hajo M Hund
- Department of Radiology and Nuclear Medicine, Haaglanden Medical Center Bronovo, Den Haag, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Menno Krietemeijer
- Department of Radiology and Nuclear Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Matthan W A Caan
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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19
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Bala F, Cimflova P, Singh N, Zhang J, Kappelhof M, Kim BJ, Najm M, Golan R, Elebute I, Benali F, Terreros NA, Marquering H, Majoie C, Almekhlafi M, Goyal M, Hill MD, Qiu W, Menon BK. Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy: Results from the ESCAPE-NA1 trial. Eur Stroke J 2023; 8:675-683. [PMID: 37345551 PMCID: PMC10472967 DOI: 10.1177/23969873231183766] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Despite improvements in device technology, only one-third of stroke patients undergoing endovascular thrombectomy (EVT) achieve first-pass effect (FPE). We investigated the effect of arterial tortuosity and thrombus characteristics on the relationship between first-line EVT strategy and angiographic outcomes. PATIENTS AND METHODS Patients with thin-slice baseline CT-angiography from the ESCAPE-NA1 trial (Efficacy and safety of nerinetide for the treatment of acute ischemic stroke) were included. Tortuosity was estimated using the tortuosity index extracted from catheter pathway, and radiological thrombus characteristics were length, non-contrast density, perviousness and hyperdense artery sign. We assessed the association of first-line EVT strategy (stent-retriever [SR] versus contact aspiration [CA] versus combined SR+CA) with FPE (eTICI score 2c/3 after one pass), final eTICI 2b/3, number of passes and procedure duration using multivariable regression. Interaction of tortuosity and thrombus characteristics with first-line technique were assessed using interaction terms. RESULTS Among 520 included patients, SR as a first-line modality was used in 165 (31.7%) patients, CA in 132 (25.4%), and combined SR+CA in 223 (42.9%). FPE was observed in 166 patients (31.9%). First-line strategy was not associated with FPE. Tortuosity had a significant effect on FPE only in the CA group (aOR = 0.90 [95% CI 0.83-0.98]) compared with stent-retrievers and combined first-line approach (p interaction = 0.03). There was an interaction between thrombus length and first-line strategy for number of passes (p interaction = 0.04). Longer thrombi were associated with higher number of passes only in the CA group (acOR 1.03 [95% CI 1.00-1.06]). CONCLUSION Our study suggests that vessel tortuosity and longer thrombi may negatively affect the performance of first-line contact aspiration catheters in acute stroke patients undergoing EVT.
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Affiliation(s)
- Fouzi Bala
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, France
| | - Petra Cimflova
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Medical Imaging, St Anne’s University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Nishita Singh
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Jianhai Zhang
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Mohamed Najm
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Rotem Golan
- Circle Neurovascular Imaging Inc., Calgary, AB, Canada
| | | | - Faysal Benali
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ MUMC+, Maastricht, The Netherlands
| | - Nerea Arrarte Terreros
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Henk Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Mohammed Almekhlafi
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Mayank Goyal
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Wu Qiu
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bijoy K Menon
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
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20
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Rex N, Ospel JM, Brown SB, McDonough RV, Kashani N, Hill MD, Dippel DWJ, Campbell B, Muir KW, Demchuk AM, Bracard S, Guillemin F, Jovin TG, Mitchell PJ, White P, Majoie CBLM, Saver JL, Goyal M. Endovascular therapy in acute ischemic stroke with poor reperfusion is associated with worse outcomes compared with best medical management: a HERMES substudy. J Neurointerv Surg 2023:jnis-2023-020411. [PMID: 37532454 DOI: 10.1136/jnis-2023-020411] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Functional outcomes in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) undergoing endovascular treatment (EVT) with poor reperfusion were compared with patients with AIS-LVO treated with best medical management only. METHODS Data are from the HERMES collaboration, a patient-level meta-analysis of seven randomized EVT trials. Baseline characteristics and functional outcomes (modified Rankin Scale (mRS) score at 90 days) were compared between patients with poor reperfusion (defined as modified Thrombolysis in Cerebral Infarction Score 0-1 on the final intracranial angiography run as assessed by the central imaging core laboratory) and patients in the control arm with multivariable logistic ordinal logistic regression adjusted for pre-specified baseline variables. RESULTS 972 of 1764 patients from the HERMES collaboration were included in the analysis: 893 in the control arm and 79 in the EVT arm with final mTICI 0-1. Patients with poor reperfusion who underwent EVT had higher baseline National Institutes of Health Stroke Scale than controls (median 19 (IQR 15.5-21) vs 17 (13-21), P=0.011). They also had worse mRS at 90 days compared with those in the control arm in adjusted analysis (median 4 (IQR 3-6) vs median 4 (IQR 2-5), adjusted common OR 0.59 (95% CI 0.38 to 0.91)). Symptomatic intracranial hemorrhage was not different between the two groups (3.9% vs 3.5%, P=0.75, adjusted OR 0.94 (95% CI 0.23 to 3.88)). CONCLUSION Poor reperfusion after EVT was associated with worse outcomes than best medical management, although no difference in symptomatic intracranial hemorrhage was seen. These results emphasize the need for additional efforts to further improve technical EVT success rates.
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Affiliation(s)
- Nathaniel Rex
- Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Johanna M Ospel
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Rosalie V McDonough
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nima Kashani
- Neuroradiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Michael D Hill
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Bruce Campbell
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Keith W Muir
- Department of Neurology, University of Glasgow, Glasgow, UK
| | - Andrew M Demchuk
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Serge Bracard
- Neuroradiology, Université de Lorraine, Nancy, France
| | - Francis Guillemin
- Clinical Investigation Centre-Clinical Epidemiology INSERM 1433, University of Lorraine, Nancy, France
| | - Tudor G Jovin
- Neurology, Cooper University Hospital, Camden, New Jersey, USA
| | - Peter J Mitchell
- Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Phil White
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Charles B L M Majoie
- Radiology and Nuclear Medicine, Amsterdam UMC - Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Jeffrey L Saver
- Comprehensive Stroke Center and Neurology, David Geffen School of Medicine, Los Angeles, California, USA
| | - Mayank Goyal
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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21
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Namitome S, Uchida K, Shindo S, Yoshimura S, Sakai N, Yamagami H, Toyoda K, Matsumaru Y, Matsumoto Y, Kimura K, Ishikura R, Inoue M, Beppu M, Sakakibara F, Shirakawa M, Ueda M, Morimoto T. Number of Passes of Endovascular Therapy for Stroke With a Large Ischemic Core: Secondary Analysis of RESCUE-Japan LIMIT. Stroke 2023; 54:1985-1992. [PMID: 37417239 DOI: 10.1161/strokeaha.123.042552] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The increased risk of intracranial hemorrhage with multiple passes in endovascular therapy (EVT) for large vessel occlusion with a large ischemic core is a concern. We explored the effect of the number of EVT passes on patients in a randomized clinical trial. METHODS This post hoc study was the secondary analysis of RESCUE-Japan LIMIT, which was a randomized clinical trial comparing EVT and medical treatment alone for large vessel occlusion with large ischemic core. We grouped patients according to the number of passes with successful reperfusion (modified Thrombolysis in Cerebral Infarction score, ≥2b) in 1, 2, and 3 to 7 passes and failed reperfusion (modified Thrombolysis in Cerebral Infarction score, 0-2a) after any pass in the EVT group, and these groups were compared with medical treatment group. The primary outcome was modified Rankin Scale score of 0 to 3 at 90 days. Secondary outcomes were improvement in National Institutes of Health Stroke Scale score of ≥8 at 48 hours, mortality at 90 days, symptomatic intracranial hemorrhage, and any intracranial hemorrhage within 48 hours. RESULTS The number of patients who received EVT with successful reperfusion after 1, 2, and 3 to 7 passes and failed reperfusion were 44, 23, 19, and 14, respectively, and 102 received medical treatment alone. The adjusted odds ratios (95% CIs) for the primary outcome relative to medical treatment were 5.52 (2.23-14.28) after 1 pass, 6.45 (2.22-19.30) after 2 passes, 1.03 (0.15-4.48) after 3 to 7 passes, and 1.17 (0.16-5.37) if reperfusion failed. The adjusted odds ratios (95% CIs) for any intracranial hemorrhage within 48 hours relative to medical treatment were 1.88 (0.90-3.93) after 1 pass, 5.14 (1.97-14.72) after 2 passes, 3.00 (1.09-8.58) after 3 to 7 passes, and 6.16 (1.87-24.27) if reperfusion failed. CONCLUSIONS The successful reperfusion within 2 passes was associated with better clinical outcomes. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03702413.
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Affiliation(s)
- Satoshi Namitome
- Department of Neurology, Japanese Red Cross Kumamoto Hospital, Japan (S.N.)
| | - Kazutaka Uchida
- Department of Neurosurgery (K.U., S.Y., M.B., F.S., M.S.), Hyogo Medical University, Nishinomiya, Japan
- Department of Clinical Epidemiology (K.U., F.S., T.M.), Hyogo Medical University, Nishinomiya, Japan
| | - Seigo Shindo
- Department of Neurology, Kumamoto University, Japan (S.S., M.U.)
| | - Shinichi Yoshimura
- Department of Neurosurgery (K.U., S.Y., M.B., F.S., M.S.), Hyogo Medical University, Nishinomiya, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery (N.S.), Kobe City Medical Center General Hospital, Japan
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Japan (H.Y.)
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., M.I.)
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan (Y. Matsumaru)
| | - Yasushi Matsumoto
- Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y. Matsumoto)
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (K.K.)
| | - Reiichi Ishikura
- Department of Diagnostic Radiology (R.I.), Kobe City Medical Center General Hospital, Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., M.I.)
| | - Mikiya Beppu
- Department of Neurosurgery (K.U., S.Y., M.B., F.S., M.S.), Hyogo Medical University, Nishinomiya, Japan
| | - Fumihiro Sakakibara
- Department of Neurosurgery (K.U., S.Y., M.B., F.S., M.S.), Hyogo Medical University, Nishinomiya, Japan
- Department of Clinical Epidemiology (K.U., F.S., T.M.), Hyogo Medical University, Nishinomiya, Japan
| | - Manabu Shirakawa
- Department of Neurosurgery (K.U., S.Y., M.B., F.S., M.S.), Hyogo Medical University, Nishinomiya, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Kumamoto University, Japan (S.S., M.U.)
| | - Takeshi Morimoto
- Department of Clinical Epidemiology (K.U., F.S., T.M.), Hyogo Medical University, Nishinomiya, Japan
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Guo C, Song J, Li L, Yang J, Huang J, Xie D, Yue C, Kong W, Luo W, Liu S, Wang X, Peng Z, Fan S, Xie Y, Alawieh AM, Spiotta AM, Li F, Zi W. Association of Procedure Time With Clinical and Procedural Outcome in Patients With Basilar Occlusion Undergoing Embolectomy. Neurology 2023; 101:e253-e266. [PMID: 37202165 PMCID: PMC10382271 DOI: 10.1212/wnl.0000000000207395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/23/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previous studies have demonstrated the association between the procedure time (PT) and outcomes for patients with proximal large vessel occlusion; however, whether the relationship remains for patients with acute basilar artery occlusion (ABAO) was not clear. We aimed to characterize the association between PT and other procedure-related variables on clinical outcomes among patients with ABAO who underwent endovascular treatment (EVT). METHODS Patients with ABAO who underwent EVT with a documented PT in the EVT for Acute Basilar Artery Occlusion (BASILAR) study from January 2014 to May 2019 among 47 comprehensive centers in China were included. Multivariable analysis was performed to reveal the association between PT and 90-day modified Rankin Scale score, mortality, complications, and all-cause death at 1 year. RESULTS Of the 829 patients from the BASILAR registry, 633 eligible patients were included. Longer PT were associated with a lower rate of favorable outcome (by 30 minutes, adjusted OR 0.82 [95% CI 0.72-0.93], p = 0.01). In addition, a PT ≤ 75 minutes was associated with a favorable outcome (adjusted OR 2.03 [95% CI 1.26-3.28]). The risk of complications and mortality increased by 0.5% and 1.5% with every 10 minutes increase in PT, respectively (R2 = 0.64 and R2 = 0.68, p < 0.01). The cumulative rates of favorable outcomes and successful recanalization plateaued after 120 minutes (2 attempts). Restricted cubic spline regression analysis for the probability of favorable outcomes had an L-shape association (p nonlinearity = 0.01) with PT with significant benefit loss before 120 minutes and then appeared relatively flat. DISCUSSION For patients with ABAO, procedures that exceeded 75 minutes were associated with an increased risk of mortality and lower odds of a favorable outcome. A careful assessment of futility and the risks of continuing the procedure should be made after 120 minutes.
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Affiliation(s)
- Changwei Guo
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Jiaxing Song
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Linyu Li
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Jie Yang
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Jiacheng Huang
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Dongjing Xie
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Chengsong Yue
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Weilin Kong
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Weidong Luo
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Shuai Liu
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Xiaoman Wang
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Zhouzhou Peng
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Shitao Fan
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Yuqian Xie
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Ali Mostafa Alawieh
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Alejandro M Spiotta
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Fengli Li
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston
| | - Wenjie Zi
- From the Department of Neurology (C.G., J.S., L.L., J.Y., J.H., D.X., C.Y., W.K., W.L., S.L., X.W., Z.P., S.F., F.L., W.Z.), Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology (Y.X.), The Second Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Neurosurgery (A.M.A.), Emory University School of Medicine, Atlanta, GA; and Department of Neurosurgery (A.M.S.), Medical University of South Carolina, Charleston.
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Grieb D, Meila D, Sommer CM, Schulz K, Abu-Fares O, Donnerstag F, Schlunz-Hendann M, Lanfermann H, Boxberg F. Feasibility and safety of ADAPT in acute distal posterior cerebral artery occlusions. Eur J Radiol 2023; 165:110936. [PMID: 37354767 DOI: 10.1016/j.ejrad.2023.110936] [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: 04/25/2023] [Revised: 05/25/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The direct aspiration first pass technique (ADAPT) is an effective and safe endovascular treatment for distal medium vessel occlusions (DMVO) of the anterior circulation. Clinical experience with ADAPT in the distal posterior circulation, however, is still limited and published data is scarce. In this original work, feasibility, safety and efficacy of ADAPT with distal access catheters (DAC) for treatment of acute distal posterior cerebral artery occlusions (DPCAOs) is evaluated. METHOD All acute ischemic stroke patients between 2017 and 2022 with primary or secondary DPCAOs in the P2 or P3 segment, that underwent thrombectomy of the DPACO using ADAPT with DACs as frontline therapy, were identified. Demographic data, recanalization rates, procedural safety, and clinical outcome were assessed. RESULTS Twenty-four patients with primary (n = 6) or secondary (n = 18) DPCAOs (P2: 21/24; P3: 3/24) were included. Median NIHSS score at admission was 14.5 (IQR 9.5). In all cases, the DPCAO could be reached with the DAC. Successful revascularization (DMVO-p-TICI ≥ 2b) with ADAPT was achieved in 79.2% (19/24), including a first pass effect of 62.5% (15/24), leading to complete recanalization (DMVO-p-TICI 3). Median number of passes was 1 (range 1-2). No complications related to distal PCA aspiration thrombectomy occurred. Median NIHSS and mRS scores at discharge were 4 (IQR 8) and 3 (IQR 2), respectively. CONCLUSIONS ADAPT appears to be feasible, safe and effective for the treatment of acute DPCAOs in the setting of different occlusion patterns. High revascularization rates without procedural complications can be achieved. Further studies are needed to consolidate these results.
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Affiliation(s)
- Dominik Grieb
- Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany; Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany.
| | - Dan Meila
- Department of Interventional Neuroradiology, Johanna-Étienne-Hospital, Neuss, Germany; Department of Diagnostic and Interventional Radiology, Helios Klinikum Krefeld, Krefeld, Germany
| | - Christof-Matthias Sommer
- Clinic of Neuroradiology, Stuttgart Clinics, Stuttgart, Germany; Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Schulz
- Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany
| | - Omar Abu-Fares
- Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany
| | - Frank Donnerstag
- Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany
| | | | - Heinrich Lanfermann
- Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany
| | - Frederik Boxberg
- Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany
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24
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Nordmeyer H, Belachew NF, Phung TH, Gralla J, Molina Gil S, Douglas A, Neuhaus S, Haage P, Doyle K, Mordasini P. NIMBUS geometric clot extractor for challenging clots: Real-world clinical experience and clot composition. Interv Neuroradiol 2023:15910199231167912. [PMID: 37011914 DOI: 10.1177/15910199231167912] [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: 04/05/2023] Open
Abstract
PURPOSE Revascularization rates following mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remain suboptimal for patients with fibrin-rich, recalcitrant clots. The NIMBUS Geometric Clot Extractor has demonstrated promising in vitro revascularization rates using fibrin-rich clot analogs. This study assessed the retrieval rate and composition of clot using NIMBUS in a clinical setting. METHODS This retrospective study included patients who underwent MT with NIMBUS at two high-volume stroke centers between December 2019 and May 2021. NIMBUS was used for clots deemed challenging to remove at the interventionalist's discretion. At one of the centers, per pass clot was collected for histological analysis by an independent lab. RESULTS A total of 37 patients (mean age 76.87 ± 11.73 years; 18 female; mean time from stroke onset 11.70 ± 6.41 h) were included. NIMBUS was used as first and second-line device in 5 and 32 patients, respectively. The main reason for using NIMBUS (32/37) was the failure of standard MT techniques after a mean 2.86 ± 1.48 number of passes. Substantial reperfusion (mTICI ≥2b) was achieved in 29/37 patients (78.4%) with a mean of 1.81 ± 1.00 NIMBUS passes (mean 4.68 ± 1.68 passes with all devices), and NIMBUS was the final device used in 79.3% (23/29) of those cases. Clot specimens from 18 cases underwent composition analysis. Fibrin and platelets represented 31.4 ± 13.7% and 28.8 ± 18.8% of clot components; 34.4 ± 19.5% were red blood cells. CONCLUSIONS In this series, NIMBUS was effective in removing tough clots rich in fibrin and platelets in challenging real-world situations.
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Affiliation(s)
- Hannes Nordmeyer
- Diagnostic and Interventional Neuroradiology, radprax Neurocenter, St Lukas Hospital, Solingen, Germany
- Department of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Nebiyat Filate Belachew
- Department of Neuroradiology, Faculty of Medicine, 14879Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Timo Huan Phung
- Diagnostic and Interventional Neuroradiology, radprax Neurocenter, St Lukas Hospital, Solingen, Germany
| | - Jan Gralla
- Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Sara Molina Gil
- Department of Physiology, Galway Neuroscience Centre, CURAM-SFI Research Centre in Medical Devices, 8799National University of Ireland Galway, Galway, Ireland
| | - Andrew Douglas
- Department of Physiology, Galway Neuroscience Centre, CURAM-SFI Research Centre in Medical Devices, 8799National University of Ireland Galway, Galway, Ireland
| | - Stephanie Neuhaus
- Diagnostic and Interventional Neuroradiology, radprax Neurocenter, St Lukas Hospital, Solingen, Germany
| | - Patrick Haage
- Department of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- Diagnostic and Interventional Radiology and Neuroradiology, 60865Helios University Hospital, Wuppertal, Germany
| | - Karen Doyle
- Department of Physiology, Galway Neuroscience Centre, CURAM-SFI Research Centre in Medical Devices, 8799National University of Ireland Galway, Galway, Ireland
| | - Pasquale Mordasini
- Netzwerk Radiologie, 30883Kantosspital St Gallen, St Gallen, Switzerland
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25
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Liu H, Zhang Y, Fan H, Wen C. Risk Factors and Functional Outcomes with Early Neurological Deterioration after Mechanical Thrombectomy for Acute Large Vessel Occlusion Stroke. J Neurol Surg B Skull Base 2023; 84:183-191. [PMID: 36895817 PMCID: PMC9991527 DOI: 10.1055/a-1762-0167] [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: 07/31/2021] [Accepted: 02/03/2022] [Indexed: 10/19/2022] Open
Abstract
Early neurological deterioration (END) is associated with a poor survival after mechanical thrombectomy (MT) in acute ischemic stroke (AIS). To assess risk factors and functional outcomes of END after MT in patients, we analyzed data from 79 patients who received MT with large-vessel occlusion. END after MT in patients is defined as an increase of two points or more in the National Institute of Health Stroke Scale (NIHSS) score, compared with the best neurological status within 7 days. The mechanism of END can be classified into: AIS progression, sICH, and encephaledema. A total of 32 AIS patients (40.5%) had END after MT. Risk factors for END after MT included: history of oral antiplatelet and/or anticoagulation drugs before MT (OR = 9.56,95% CI = 1.02-89.57), higher NIHSS score when admitted to hospital (OR = 1.24, 95% CI = 1.04-1.48), under the subtype of atherosclerotic stroke (OR = 17.36, 95% CI = 1.51-199.56), ASITN/SIR< 2 (OR = 15.78, 95% CI = 1.65-151.26), and prolonged period from AIS onset to the first revascularization (OR = 1.01, 95% CI = 1.00-1.02). AIS patients who had END at early stages were more likely to experience poor outcomes (Modified Rankin Scale [mRS] >2) at 90 days after MT (OR = 6.829, 95% CI = 1.573-29.655). Thus, AIS patients who had experienced END at early stages were more likely to have poor outcomes (mRS >2) at 90 days after MT, and the risk factors of END were connected to the mechanism of END.
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Affiliation(s)
- Hongwei Liu
- Department of Neurology, Shanxi Medical University, Taiyuan Central Hospital, Shanxi Province, China
| | - Yi Zhang
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Haixia Fan
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chao Wen
- Department of Neurology, Shanxi Medical University, Taiyuan Central Hospital, Shanxi Province, China
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Hashimoto H, Maruo T, Kimoto Y, Nakamura M, Fujinaga T, Nakamura H, Ushio Y. The association between diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score and the outcome following mechanical thrombectomy of anterior circulation occlusion. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Baek JH, Kim BM, Suh SH, Jeon HJ, Ihm EH, Park H, Kim CH, Cha SH, Choi CH, Yi KS, Kim JH, Suh S, Kim B, Chang Y, Kim SY, Oh JS, Heo JH, Kim DJ, Nam HS, Kim YD. First-Pass Recanalization with EmboTrap II in Acute Ischemic Stroke (FREE-AIS): A Multicenter Prospective Study. Korean J Radiol 2023; 24:145-154. [PMID: 36725355 PMCID: PMC9892223 DOI: 10.3348/kjr.2022.0618] [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: 08/25/2022] [Revised: 11/18/2022] [Accepted: 12/11/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the efficacy of EmboTrap II in terms of first-pass recanalization and to determine whether it could yield favorable outcomes. MATERIALS AND METHODS In this multicenter, prospective study, we consecutively enrolled patients who underwent mechanical thrombectomy using EmboTrap II as a front-line device. The primary outcome was the first pass effect (FPE) rate defined by modified Thrombolysis In Cerebral Infarction (mTICI) grade 2c or 3 by the first pass of EmboTrap II. In addition, modified FPE (mFPE; mTICI grade 2b-3 by the first pass of EmboTrap II), successful recanalization (final mTICI grade 2b-3), and clinical outcomes were assessed. We also analyzed the effect of FPE on a modified Rankin Scale (mRS) score of 0-2 at 3 months. RESULTS Two hundred-ten patients (mean age ± standard deviation, 73.3 ± 11.4 years; male, 55.7%) were included. Ninety-nine patients (47.1%) had FPE, and mFPE was achieved in 150 (71.4%) patients. Successful recanalization was achieved in 191 (91.0%) patients. Among them, 164 (85.9%) patients underwent successful recanalization by exclusively using EmboTrap II. The time from groin puncture to FPE was 25.0 minutes (interquartile range, 17.0-35.0 minutes). Procedure-related complications were observed in seven (3.3%) patients. Symptomatic intracranial hemorrhage developed in 14 (6.7%) patients. One hundred twenty-three (58.9% of 209 completely followed) patients had an mRS score of 0-2. Sixteen (7.7% of 209) patients died during the follow-up period. Patients who had successful recanalization with FPE were four times more likely to have an mRS score of 0-2 than those who had successful recanalization without FPE (adjusted odds ratio, 4.13; 95% confidence interval, 1.59-10.8; p = 0.004). CONCLUSION Mechanical thrombectomy using the front-line EmboTrap II is effective and safe. In particular, FPE rates were high. Achieving FPE was important for an mRS score of 0-2, even in patients with successful recanalization.
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Affiliation(s)
- Jang-Hyun Baek
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Moon Kim
- Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hong-Jun Jeon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eun Hyun Ihm
- Department of Neurosurgery, Andong Hospital, Andong, Korea
| | - Hyungjong Park
- Department of Neurology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Hoon Cha
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea.,College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| | - Chi-Hoon Choi
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea.,College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| | - Kyung Sik Yi
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Jun-Hwee Kim
- Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Sangil Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byungjun Kim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Neurosurgery, International St. Mary’s Hospital, Catholic Kwandong University, Incheon, Korea
| | - Jae Sang Oh
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Korea
| | - Ji Hoe Heo
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Joon Kim
- Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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He G, Deng J, Lu H, Wei L, Zhao Y, Zhu Y, Li Y. Thrombus enhancement sign on CT angiography is associated with the first pass effect of stent retrievers. J Neurointerv Surg 2023; 15:146-152. [PMID: 35110399 DOI: 10.1136/neurintsurg-2021-018447] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/13/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The thrombus enhancement sign (TES) is thought to be associated with the source of the stroke and thrombus composition. We investigated whether this imaging sign along with other thrombus characteristics could be used to predict the successful first pass effect (FPE) of mechanical thrombectomy. METHODS 246 consecutive patients with acute ischemic stroke in the anterior circulation with large vessel occlusion who underwent thrombectomy with a stent retriever and clot collection were included. Patients were divided into FPE (modified Thrombolysis in Cerebral Infarction (mTICI) grade 2c or 3)/non-FPE (mTICI 0-2b) and modified FPE (mFPE) (mTICI 2b-3)/non-mFPE (mTICI 0-2a) groups based on flow restoration after the first pass. TES presence, thrombus density, thrombus length, clot burden score, and thrombus composition were compared. The association between FPE and imaging biomarkers, along with clinical and interventional parameters, was investigated by univariate and multivariate analysis. RESULTS FPE was achieved in 85 (34.6%) patients. TES presence was significantly lower in the FPE group (64.7% vs 80.7% in the non-FPE group, p=0.008) and mFPE group (69.1% vs 81.0% in the non-mFPE group, p=0.039). Histopathological examination revealed that TES (+) thrombi contained a higher fibrin/platelet proportion (50.9% vs 46.9% in TES (-) thrombi, p=0.029) and fewer erythrocytes (43.3% vs 47.3% in TES (-) thrombi, p=0.030). Thrombus characteristics, namely shorter thrombus length (p=0.032), higher erythrocyte proportions (p=0.026), and less fibrin/platelets (p=0.014), were confirmed in patients with FPE. In multivariable analysis, TES was the only independent predictor of FPE failure (OR 0.51, 95% CI 0.28 to 0.94; p=0.031). CONCLUSIONS TES was independently associated with first pass angiographic failure in patients treated with a stent retriever.
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Affiliation(s)
- Guangchen He
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiangshan Deng
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haitao Lu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Liming Wei
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuwu Zhao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yueqi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuehua Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Terceño M, Silva Y, Bashir S, Chamorro Á, Pérez de la Ossa N, Hernandez-Pérez M, Castaño C, Camps-Renom P, Wenger D, Cardona P, Molina C, Rodríguez-Campello A, Cánovas D, Purroy F, Salvat-Plana M, Serena J, On Behalf Of The Catalan Stroke Code And Reperfusion Consortium Cat-Scr. First pass effect in posterior circulation occlusions: Analysis from the CICAT registry. Int J Stroke 2023; 18:221-228. [PMID: 35272563 DOI: 10.1177/17474930221089772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The first pass effect (FPE) is an independent predictor of functional independence in patients with large vessel occlusion in anterior circulation ischemic strokes. However, whether it predicts outcome in posterior circulation large vessel occlusion (PC-LVO) is uncertain. We aimed to study the frequency, characteristics, and predictors of FPE and its association with clinical outcomes in PC-LVO. METHOD We performed an analysis from the prospective CICAT Registry. All patients with PC-LVO who underwent endovascular therapy between January 2016 and January 2020 were included. A centrally assessed clinical follow-up was performed at 3 months by blinded investigators. FPE was defined as the achievement of modified Thrombolysis In Cerebral Infarction 3 in a single pass of the endovascular thrombectomy device, and multi-pass effect (MPE) if it was achieved in more than one pass. A multivariable analysis was performed to identify whether FPE is an independent predictor of functional independence defined as a modified Rankin Score of 0-2. RESULTS We analyzed data from 265 patients in who FPE was achieved in 105 (39.6%). Patients with FPE were more likely to achieve functional independence compared to the non-FPE group (52.4% vs 25.1%, p < .001) and the MPE group (52.4% vs 26.7%, p < .001). FPE was independently associated with functional independence (adjusted odds ratio (aOR): 2.10, 95% confidence interval (CI) 1.01-4.37) but MPE was not (aOR: 0.92, 95% CI 0.40-2.13). Independent predictors of FPE were the use of direct aspiration, embolic mechanism of stroke, and the absence of general anesthesia (GA) use. CONCLUSIONS FPE is an independent predictor of functional independence in PC-LVO and was associated with a significantly better outcome than MPE.
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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
| | - Ángel Chamorro
- Stroke Unit, Department of Neurology, Clinic Hospital, Barcelona, Spain
| | - Natalia Pérez 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 Hernandez-Pérez
- Stroke Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Carlos Castaño
- 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
| | - Denisse Wenger
- Stroke Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, 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
| | | | - David Cánovas
- Stroke Unit, Department of Neurology, Parc Taulí Hospital, Sabadell, Spain
| | - Francisco Purroy
- Stroke Unit, Department of Neurology, Arnau de Vilanova Hospital, IRBLleida, University of Lleida, Lleida, Spain
| | - Mercè Salvat-Plana
- Catalan Stroke Programme, Catalan Public Health Department, Barcelona, Spain
| | - Joaquín Serena
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
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Zhao ZA, Qiu J, Wang L, Zhao YG, Sun XH, Li W, Liu X, Li XL, Liu L, Chen MR, Chen HS. Intra-arterial tenecteplase is safe and may improve the first-pass recanalization for acute ischemic stroke with large-artery atherosclerosis: the BRETIS-TNK trial. Front Neurol 2023; 14:1155269. [PMID: 37143999 PMCID: PMC10151652 DOI: 10.3389/fneur.2023.1155269] [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: 01/31/2023] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
Background and purpose The first-pass recanalization of endovascular treatment (EVT) is closely correlated with clinical outcome of patients with large vessel occlusion (LVO) stroke. The aim of the study was to explore whether intra-arterial tenecteplase (TNK) during the first pass of EVT can increase first-pass successful reperfusion and improve the neurological outcome in AIS-LVO patients. Materials and methods The BRETIS-TNK trial (ClinicalTrials.gov Identifier: NCT04202458) was a prospective, single-arm, single center study. Twenty-six eligible AIS-LVO patients with large-artery atherosclerosis etiology were consecutively enrolled from December 2019 to November 2021. Intra-arterial TNK (4 mg) after microcatheter navigation through the clot was administered, followed by TNK (0.4 mg/min) given continuously for 20 min after the first retrieval attempt of EVT without confirmation of the reperfusion status by DSA. The 50 control patients comprised of a historical cohort before the BRETIS-TNK trial (from March 2015 to November 2019). Successful reperfusion was defined as modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b. Results The first-pass successful reperfusion rate was higher in the BRETIS-TNK vs. control group (53.8% vs. 36%, p = 0.14), and the difference became statistically significant after propensity score matching (53.8% vs. 23.1%, p = 0.03). There was no difference in symptomatic intracranial hemorrhage between the BRETIS-TNK and control groups (7.7% vs. 10.0%, p = 0.92). There was a trend toward higher proportion of functional independence at 90 days in the BRETIS-TNK comparing with the control group (50% vs. 32%, p = 0.11). Conclusion This is the first study to report that intra-arterial TNK during the first pass of EVT seems safe and feasible in AIS-LVO patients.
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Bui TA, Jickling GC, Winship IR. Neutrophil dynamics and inflammaging in acute ischemic stroke: A transcriptomic review. Front Aging Neurosci 2022; 14:1041333. [PMID: 36620775 PMCID: PMC9813499 DOI: 10.3389/fnagi.2022.1041333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Stroke is among the leading causes of death and disability worldwide. Restoring blood flow through recanalization is currently the only acute treatment for cerebral ischemia. Unfortunately, many patients that achieve a complete recanalization fail to regain functional independence. Recent studies indicate that activation of peripheral immune cells, particularly neutrophils, may contribute to microcirculatory failure and futile recanalization. Stroke primarily affects the elderly population, and mortality after endovascular therapies is associated with advanced age. Previous analyses of differential gene expression across injury status and age identify ischemic stroke as a complex age-related disease. It also suggests robust interactions between stroke injury, aging, and inflammation on a cellular and molecular level. Understanding such interactions is crucial in developing effective protective treatments. The global stroke burden will continue to increase with a rapidly aging human population. Unfortunately, the mechanisms of age-dependent vulnerability are poorly defined. In this review, we will discuss how neutrophil-specific gene expression patterns may contribute to poor treatment responses in stroke patients. We will also discuss age-related transcriptional changes that may contribute to poor clinical outcomes and greater susceptibility to cerebrovascular diseases.
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Affiliation(s)
- Truong An Bui
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Glen C. Jickling
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada,Department of Medicine, Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ian R. Winship
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada,*Correspondence: Ian R. Winship,
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Zhang J, Bala F, Cimflova P, Singh N, Benali F, Hill MD, Menon BK, Qiu W. SPD matrices representing artery anatomy for first-pass effect prediction by aggregated networks with multi-scale attentions. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2022. [DOI: 10.1080/21681163.2022.2155577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jianhai Zhang
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Fouzi Bala
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Petra Cimflova
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Faysal Benali
- Cumming School of Medicine, University of Calgary, Calgary, Canada
- Maastricht University Medical Center+, Maastricht, Netherlands
| | - Michael D. Hill
- Cumming School of Medicine, University of Calgary, Calgary, Canada
- Foothills Medical Centre, Calgary, Canada
| | - Bijoy K. Menon
- Cumming School of Medicine, University of Calgary, Calgary, Canada
- Foothills Medical Centre, Calgary, Canada
| | - Wu Qiu
- Huazhong University of Science and Technology, Wuhan, China
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Zhang Y, Hong L, Ling Y, Yang L, Li S, Cheng X, Dong Q. Association of time to groin puncture with patient outcome after endovascular therapy stratified by etiology. Front Aging Neurosci 2022; 14:884087. [PMID: 36299609 PMCID: PMC9590449 DOI: 10.3389/fnagi.2022.884087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Randomized clinical trials and large stroke registries have demonstrated a time-dependent benefit of endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). The aim of this study was to investigate whether this could be applied to different stroke subtypes in a real-world single-center cohort. Materials and methods Consecutive ischemic stroke patients with LVOs presenting within 24 h after symptom onset were prospectively registered and retrospectively assessed. Baseline multimodal imaging was conducted before EVT. Independent predictors of functional independence [90-day modified Rankin scale (mRS), 0–2] and any incidence of intracranial hemorrhage (ICH) were explored using a stepwise logistic regression model in the entire cohort and in stroke subtypes. Results From 2015 to 2020, 140 eligible patients received EVT, of whom 59 (42%) were classified as large artery atherosclerosis (LAA)-related. Time from last known normal to groin puncture was identified as an independent predictor for functional independence in patients of cardioembolic (CE) subtype [odds ratio (OR) 0.90 per 10 min; 95% CI 0.82–0.98; P = 0.013] but not in the LAA subtype and the whole cohort. Groin puncture within 6 h after the time of last known normal was associated with a lower risk of any ICH in the whole cohort (OR 0.36, 95% CI 0.17–0.75, P = 0.007). Sensitivity analysis of patients with complete imaging profiles also confirmed the above findings. Besides, compared with patients of the CE subtype, the LAA subtype had a smaller baseline ischemic core volume, a better collateral status, a slower core growth rate, and a numerically smaller final infarct volume. Conclusion Faster groin puncture has a more pronounced effect on the functional outcome in patients of CE subtype than those of LAA subtype. Reducing time to groin puncture is of great importance in improving the prognosis of patients after EVT, especially those of CE subtype, and reducing the incidence of any ICH in all patients.
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Affiliation(s)
- Yiran Zhang
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Lan Hong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yifeng Ling
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Lumeng Yang
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Siyuan Li
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Cheng
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xin Cheng,
| | - Qiang Dong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
- Qiang Dong,
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Steffen P, Van Horn N, McDonough R, Deb-Chatterji M, Alegiani AC, Thomalla G, Fiehler J, Flottmann F. Continuing early mTICI 2b recanalization may improve functional outcome but is associated with a higher risk of intracranial hemorrhage. Front Neurol 2022; 13:955242. [PMID: 36226091 PMCID: PMC9549059 DOI: 10.3389/fneur.2022.955242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSuccessful reperfusion (mTICI 2c/3) and low number of passes are key determinants for good clinical outcome in acute large vessel occlusion. While final mTICI 2c/3 reperfusion is superior to partial reperfusion (mTICI 2b) it remains unclear if this is also true for the subgroup of patients with early mTICI 2b (achieved in ≤2 retrieval attempts) reperfusion who are secondarily improved to mTICI 2c/3. This study was designed to examine if early mTICI2b should be continued or stopped during mechanical thrombectomy (MT).MethodsNine hundred and thirteen ischemic stroke patients who received MT were retrospectively analyzed. Angiography runs following each recanalization attempt were scored for mTICI. The patients with early mTICI 2b reperfusions were dichotomized in “TICI2b-stopped” (MT withdrawal after mTICI 2b was achieved with first or second retrieval) and “TICI2b-continued” (MT was continued after mTICI 2b was achieved with first or second retrieval). Functional outcome was obtained after 90 days using the modified Rankin scale (mRS90).ResultsOf 362 Patients with a M1-occlusion, 100 patients fulfilled the inclusion criteria with an early mTICI 2b. 78/100 patients were included in the “TICI2b-stopped” group and 22/100 patients were in the “TICI2b-continued” group. Of these 22 patients, none had a final mTICI score lower than 2b and 11 patients had a final mTICI score of 2c/3. Regarding good functional outcome at mRS90, “TICI2b-continued” showed by trend a slight advantage of 40.1 vs. 35.6% in “TICI2b-stopped” but in multivariate logistic regression analysis adjusted for confounders, no significant difference was found between the two groups (OR 0.75, 95% CI 0.19–2.87, p = 0.67). Symptomatic intracranial hemorrhage was significantly higher in “TICI2b-continued” compared to “TICI2b-stopped” (31.8 vs. 10.3%, p = 0.031).ConclusionSuccessfully improving an early mTICI 2b to mTICI 2c/3 reperfusion is possible in a substantial number of patients and might improve functional outcome. However, an increase in symptomatic intracranial hemorrhage (SICH) due to further retrieval attempts may diminish the potential functional benefit to continue early mTICI 2b. To support this finding, further investigation with more power is needed to account for the low number of events regarding SICH.
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Affiliation(s)
- Paul Steffen
- Department for Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- *Correspondence: Paul Steffen
| | - Noel Van Horn
- Department for Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rosalie McDonough
- Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Milani Deb-Chatterji
- Department for Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Christina Alegiani
- Department for Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department for Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department for Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department for Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Marnat G, Gory B, Sibon I, Kyheng M, Labreuche J, Boulouis G, Liegey JS, Caroff J, Eugène F, Naggara O, Consoli A, Mazighi M, Maier B, Richard S, Denier C, Turc G, Lapergue B, Bourcier R. Mechanical thrombectomy failure in anterior circulation strokes: Outcomes and predictors of favorable outcome. Eur J Neurol 2022; 29:2701-2707. [PMID: 35648445 PMCID: PMC9541042 DOI: 10.1111/ene.15429] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2022]
Abstract
Background and purpose Despite continuous improvement and growing knowledge in the endovascular therapy of large vessel occlusion stroke (LVOS), mechanical thrombectomy (MT) still fails to obtain satisfying intracranial recanalization in 10% to 15% of cases. However, little is known regarding clinical and radiological outcomes among this singularly underexplored subpopulation undergoing failed MT. We aimed to investigate the outcome after failed MT and identify predictive factors of favorable outcome despite recanalization failure. Methods We conducted a retrospective analysis of consecutive patients prospectively included in the ongoing observational multicenter Endovascular Treatment in Ischemic Stroke registry from January 2015 to September 2020. Patients presenting with anterior circulation LVOS treated with MT but experiencing failed intracranial recanalization defined as final modified Thrombolysis In Cerebral Infarction (mTICI) score of 0, 1 and 2a were included. Clinical and radiological outcomes were assessed along with the exploration of predictive factors of Day‐90 favorable outcome. Results The study population comprised 533 patients. Mean age was 68.8 ± 16 years, and median admission National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were 17 (IQR 12–21) and 7 (IQR 5–8), respectively. Favorable outcomes were observed in 85 patients (18.2%) and 186 died (39.0%). The rate of symptomatic intracranial hemorrhage was 14.1%. In multivariable analysis, younger age (odds ratio [OR] 0.96, 95% CI 0.94–0.98, p < 0.001), a lower admission NIHSS (OR 0.87, 95% CI 0.83–0.91, p < 0.001), a lower number of MT passes (OR 0.77, 95% CI 0.77–0.87, p < 0.001), a lower delta ASPECTS between initial and Day‐1 imaging (OR 0.83, 95% CI 0.71–0.98, p = 0.026) and stroke etiology [significant difference among etiological subtypes (p = 0.024) with a tendency toward more favorable outcomes for dissection (OR 2.01, 95% CI 0.71–5.67)] were significantly associated with a 90‐day favorable outcome. Conclusions In this large retrospective analysis of a multicenter registry, we quantified the poor outcome after MT failure. We also identified factors associated with favorable outcome despite recanalization failure that might influence therapeutic management.
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Affiliation(s)
- Gaultier Marnat
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Gory
- CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, Nancy, France.,IADI, INSERM-U1254, Université de Lorraine, Nancy, France
| | - Igor Sibon
- Neurology Department, Bordeaux University Hospital, Bordeaux, France
| | - Maeva Kyheng
- CHU Lille, Department of Biostatistics, Lille, France
| | | | | | | | - Jildaz Caroff
- Neuroradiolology Department, CHU Kremlin Bicêtre, Paris, France
| | - François Eugène
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Rennes, Rennes, France
| | - Olivier Naggara
- Department of Neuroradiology, GHU Paris, Centre Hospitalier Sainte-Anne, Université de Paris, INSERM-UMR-894, Paris, France
| | - Arturo Consoli
- Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin-en-Yvelines, Foch Hospital, Suresnes, France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, University of Paris, FHU-NeuroVASC, Paris, INSERM-1148, France
| | - Benjamin Maier
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, University of Paris, FHU-NeuroVASC, Paris, INSERM-1148, France
| | | | | | - Guillaume Turc
- Department of Neurology, GHU Paris, Centre Hospitalier Sainte-Anne, Paris, France
| | - Bertrand Lapergue
- Department of Neurology, University of Versailles and Saint-Quentin-en-Yvelines, Foch Hospital, Suresnes, France
| | - Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nantes, Nantes, France
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de Havenon A, Elhorany M, Boulouis G, Naggara O, Darcourt J, Clarençon F, Richard S, Marnat G, Bourcier R, Sibon I, Arquizan C, Dargazanli C, Maïer B, Seners P, Lapergue B, Consoli A, Eugene F, Vannier S, Caroff J, Denier C, Boulanger M, Gauberti M, Rouchaud A, Macian F, Rosso C, Turc G, Ozkul-Wermester O, Papagiannaki C, Albucher JF, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Fahed R, Finitsis SN, Gory B. Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion. J Neurointerv Surg 2022; 15:422-427. [PMID: 35450929 DOI: 10.1136/neurintsurg-2022-018715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/05/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The number of mechanical thrombectomy (MT) passes is strongly associated with angiographic reperfusion as well as clinical outcomes in patients with anterior circulation ischemic stroke. However, these associations have not been analyzed in patients with basilar artery occlusion (BAO). We investigated the influence of the number of MT passes on the degree of reperfusion and clinical outcomes, and compared outcome after ≤3 passes versus >3 passes. METHODS We used data from the prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry at 18 sites in France. Patients with BAO treated with MT were included. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0-3 at 90 days. We fit mixed multiple regression models, with center as a random effect. RESULTS We included 275 patients. Successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) was achieved in 88.4%, and 41.8% had a favorable outcome. The odds ratio for favorable outcome with each pass above 1 was 0.41 (95% CI 0.23 to 0.73) and for recanalization (mTICI 2b-3) it was 0.70 (95% CI 0.57 to 0.87). In patients with ≤3 passes, the rate of favorable outcome in recanalized versus non-recanalized patients was 50.5% versus 10.0% (p=0.001), while in those with >3 passes it was 16.7% versus 15.2% (p=0.901). CONCLUSIONS We found that BAO patients had a significant relationship between the number of MT passes and both recanalization and favorable functional outcome. We further found that the benefit of recanalization in BAO patients was significant only when recanalization was achieved within three passes, encouraging at least three passes before stopping the procedure.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Mahmoud Elhorany
- Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | | | | | - Frédéric Clarençon
- Sorbonne Université, Paris, France.,Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | | | | | | | - Cyril Dargazanli
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Benjamin Maïer
- Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France
| | - Pierre Seners
- Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France
| | - Bertrand Lapergue
- Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France.,Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | | | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | | | | | | | - Aymeric Rouchaud
- Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France.,Univ. Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | | | - Charlotte Rosso
- Urgences Cérébro-Vasculaires, Pitié-Salpétrière Hospital, Paris, France
| | - Guillaume Turc
- Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | | | | | - Anthony Le Bras
- Department of Radiology, CH Bretagne Atlantique, Vannes, France.,CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
| | - Sarah Evain
- Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
| | - Valerie Wolff
- Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
| | - Raoul Pop
- Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France.,Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
| | - Serge Timsit
- Department of Neurology, CHU Brest, Brest, France
| | | | | | - Louis Veunac
- Department of Radiology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
| | - Robert Fahed
- Medicine - Neurology, Ottawa Hospital, Ottawa, Ontario, Canada.,Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Stephanos Nikolaos Finitsis
- Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Québec, Canada.,Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Québec, Canada
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
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Meyer L, Stracke P, Wallocha M, Broocks G, Sporns P, Piechowiak EI, Kaesmacher J, Maegerlein C, Hernandez Petzsche MR, 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 L, Tan B, Gopinathan A, Gory B, Galván-Fernández J, Schüller M, Navia P, Raz E, Shapiro M, Arnberg F, Zeleňák K, Martínez-Galdámez M, Kastrup A, Papanagiotou P, Kemmling A, Psychogios M, Andersson T, Chapot R, Fiehler J, Hanning U. Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study. Stroke 2022; 53:2449-2457. [PMID: 35443785 DOI: 10.1161/strokeaha.121.037792] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The optimal endovascular strategy for reperfusing distal medium-vessel occlusions (DMVO) remains unknown. This study evaluates angiographic and clinical outcomes of thrombectomy strategies in DMVO stroke of the posterior circulation. METHODS TOPMOST (Treatment for Primary Medium Vessel Occlusion Stroke) is an international, retrospective, multicenter, observational registry of patients treated for DMVO between January 2014 and June 2020. This study analyzed endovascularly treated isolated primary DMVO of the posterior cerebral artery in the P2 and P3 segment. Technical feasibility was evaluated with the first-pass effect defined as a modified Thrombolysis in Cerebral Infarction Scale score of 3. Rates of early neurological improvement and functional modified Rankin Scale scores at 90 days were compared. Safety was assessed by the occurrence of symptomatic intracranial hemorrhage and intervention-related serious adverse events. RESULTS A total of 141 patients met the inclusion criteria and were treated endovascularly for primary isolated DMVO in the P2 (84.4%, 119) or P3 segment (15.6%, 22) of the posterior cerebral artery. The median age was 75 (IQR, 62-81), and 45.4% (64) were female. The initial reperfusion strategy was aspiration only in 29% (41) and stent retriever in 71% (100), both achieving similar first-pass effect rates of 53.7% (22) and 44% (44; P=0.297), respectively. There were no significant differences in early neurological improvement (aspiration: 64.7% versus stent retriever: 52.2%; P=0.933) and modified Rankin Scale rates (modified Rankin Scale score 0-1, aspiration: 60.5% versus stent retriever 68.6%; P=0.4). In multivariable logistic regression analysis, the time from groin puncture to recanalization was associated with the first-pass effect (adjusted odds ratio, 0.97 [95% CI, 0.95-0.99]; P<0.001) that in turn was associated with early neurological improvement (aOR, 3.27 [95% CI, 1.16-9.21]; P<0.025). Symptomatic intracranial hemorrhage occurred in 2.8% (4) of all cases. CONCLUSIONS Both first-pass aspiration and stent retriever thrombectomy for primary isolated posterior circulation DMVO seem to be safe and technically feasible leading to similar favorable rates of angiographic and clinical outcome.
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Affiliation(s)
- Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
| | - Paul Stracke
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.).,Department of Interventional Neuroradiology, University Hospital Muenster, Germany (P.S.).,Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland (P.S., M.P.)
| | - Marta Wallocha
- Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Germany (M.W., R.C.)
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
| | - Peter Sporns
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
| | - Eike I Piechowiak
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (E.I.P., J.K.)
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (E.I.P., J.K.).,Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (J.K.)
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.)
| | - Moritz Roman Hernandez Petzsche
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.)
| | - Franziska Dorn
- Institute of Neuroradiology, University Hospitals, LMU Munich, Germany (F.D., H.Z.)
| | - Hanna Zimmermann
- Institute of Neuroradiology, University Hospitals, LMU Munich, Germany (F.D., H.Z.)
| | - Weis Naziri
- Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.).,Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.)
| | - Nuran Abdullayev
- Department of Neuroradiology, University of Cologne, Germany (N.A., C.K.)
| | - Christoph Kabbasch
- Department of Neuroradiology, University of Cologne, Germany (N.A., C.K.)
| | - Daniel Behme
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Goettingen, Germany (D.B., A.J.)
| | - Ala Jamous
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Goettingen, Germany (D.B., A.J.)
| | - Volker Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Germany (V.M., S.F.)
| | - Sebastian Fischer
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Germany (V.M., S.F.)
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Germany (M.M., C.S.W.)
| | - Charlotte S Weyland
- Department of Neuroradiology, Heidelberg University Hospital, Germany (M.M., C.S.W.)
| | - Sönke Langner
- Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, University Hospital Rostock, Germany (S.L.)
| | - Dan Meila
- Department of Interventional Neuroradiology, Johanna-Étienne-Hospital, Neuss, Germany (D.M.)
| | - Milena Miszczuk
- Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Germany (M.M., E.S.)
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Germany (M.M., E.S.)
| | - Stephan Lowens
- Department of Radiology, Klinikum Osnabrück, Germany. (S.L.)
| | - Lars Udo Krause
- Department of Neurology, Klinikum Osnabrück, Germany. (L.U.K.)
| | - Leonard Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore. (L.Y., B.T.).,Yong Loo Lin School of Medicine, National University of Singapore (L.Y., B.T., A.G.)
| | - Benjamin Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore. (L.Y., B.T.).,Yong Loo Lin School of Medicine, National University of Singapore (L.Y., B.T., A.G.)
| | - Anil Gopinathan
- Department of Diagnostic imaging, National University Health System, Singapore. (A.G.)
| | - Benjamin Gory
- Yong Loo Lin School of Medicine, National University of Singapore (L.Y., B.T., A.G.).,Université de Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, France (B.G.).,Université de Lorraine, IADI, INSERM U1254, F-54000 Nancy, France (B.G.)
| | - Jorge Galván-Fernández
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Spain (J.G.-F., M.S., M.M.-G.)
| | - Miguel Schüller
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Spain (J.G.-F., M.S., M.M.-G.)
| | - Pedro Navia
- Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.)
| | - Eytan Raz
- Department of Radiology, New York Langone Medical Center (E.R., M.S.)
| | - Maksim Shapiro
- Department of Radiology, New York Langone Medical Center (E.R., M.S.)
| | - Fabian Arnberg
- Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.)
| | - Kamil Zeleňák
- Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.)
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Spain (J.G.-F., M.S., M.M.-G.)
| | - Andreas Kastrup
- Department of Neurology, Hospital Bremen-Mitte, Germany (A.K.)
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (P.P.).,Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Greece (P.P.)
| | - André Kemmling
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.).,Department of Neuroradiology, University Hospital Marburg, Germany (A.K.)
| | - Marios Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland (P.S., M.P.)
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.).,Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.)
| | - Rene Chapot
- Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Germany (M.W., R.C.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
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Koge J, Tanaka K, Yoshimoto T, Shiozawa M, Kushi Y, Ohta T, Satow T, Kataoka H, Ihara M, Koga M, Isobe N, Toyoda K. Internal Carotid Artery Tortuosity: Impact on Mechanical Thrombectomy. Stroke 2022; 53:2458-2467. [PMID: 35400203 PMCID: PMC9311296 DOI: 10.1161/strokeaha.121.037904] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Although tortuosity of the internal carotid artery (ICA) can pose a significant challenge when performing mechanical thrombectomy, few studies have examined the impact of ICA tortuosity on mechanical thrombectomy outcomes. Methods: In a registry-based hospital cohort, consecutive patients with anterior circulation stroke in whom mechanical thrombectomy was attempted were divided into 2 groups: those with tortuosity in the extracranial or cavernous ICA (tortuous group) and those without (nontortuous group). The extracranial ICA tortuosity was defined as the presence of coiling or kinking. The cavernous ICA tortuosity was defined by the posterior deflection of the posterior genu or the shape resembling Simmons-type catheter. Outcomes included first pass effect (FPE; extended Thrombolysis in Cerebral Infarction score 2c/3 after first pass), favorable outcome (3-month modified Rankin Scale score of 0–2), and intracranial hemorrhage. Results: Of 370 patients, 124 were in the tortuous group (extracranial ICA tortuosity, 35; cavernous ICA tortuosity, 70; tortuosity at both sites, 19). The tortuous group showed a higher proportion of women and atrial fibrillation than the nontortuous group. FPE was less frequently achieved in the tortuous group than the nontortuous group (21% versus 39%; adjusted odds ratio, 0.45 [95% CI, 0.26–0.77]). ICA tortuosity was independently associated with the longer time from puncture to extended Thrombolysis in Cerebral Infarction ≥2b reperfusion (β=23.19 [95% CI, 13.44–32.94]). Favorable outcome was similar between groups (46% versus 48%; P=0.87). Frequencies of any intracranial hemorrhage (54% versus 42%; adjusted odds ratio, 1.61 [95% CI, 1.02–2.53]) and parenchymal hematoma (11% versus 6%; adjusted odds ratio, 2.41 [95% CI, 1.04–5.58]) were higher in the tortuous group. In the tortuous group, the FPE rate was similar in patients who underwent combined stent retriever and contact aspiration thrombectomy and in those who underwent either procedure alone (22% versus 19%; P=0.80). However, in the nontortuous group, the FPE rate was significantly higher in patients who underwent combined stent retriever and contact aspiration (52% versus 35%; P=0.02). Conclusions: ICA tortuosity was independently associated with reduced likelihood of FPE and increased risk of postmechanical thrombectomy intracranial hemorrhage. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02251665.
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Affiliation(s)
- Junpei Koge
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. (J.K., M.S., M.K., K. Toyoda)
| | - Kanta Tanaka
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan. (K. Tanaka)
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan. (T.Y., M.I.)
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. (J.K., M.S., M.K., K. Toyoda)
| | - Yuji Kushi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan. (Y.K., T.O., T.S., H.K.)
| | - Tsuyoshi Ohta
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan. (Y.K., T.O., T.S., H.K.)
| | - Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan. (Y.K., T.O., T.S., H.K.)
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan. (Y.K., T.O., T.S., H.K.)
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan. (T.Y., M.I.)
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. (J.K., M.S., M.K., K. Toyoda)
| | - Noriko Isobe
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (N.I.)
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. (J.K., M.S., M.K., K. Toyoda)
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Zhang J, Jia B, Pan Y, Yu Z, Deng Y, Mo D, Ma N, Gao F, Miao Z. A comparison between different endovascular treatment strategies for acute large vessel occlusion due to intracranial artery atherosclerosis: data from ANGEL-ACT Registry. Neuroradiology 2022; 64:1627-1638. [PMID: 35348815 DOI: 10.1007/s00234-022-02933-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of our study is to compare the characteristics and clinical outcomes among the different endovascular treatment (EVT) strategies for large vessel occlusion underlying intracranial atherosclerosis (ICAS-LVO) in a recent nationwide registry. METHODS Patients with isolated ICAS-LVO were enrolled in our analysis and were categorized into three groups: first-line mechanical thrombectomy (MT) with rescue angioplasty and/or stenting (MT + RS), direct angioplasty and/or stenting without thrombectomy (DA), and MT alone. Baseline and periprocedural characteristics, successful recanalization, and 90-day functional outcomes were compared. RESULTS Of 396 patients with isolated ICAS-LVO in our study, successful recanalization was achieved in 94.5%, 100%, and 90.9% of patients in the MT + RS, DA, and MT groups, respectively. The 90-day functional independence in the three groups was 50.8%, 59.0%, and 45.1%. The main efficacy and safety outcomes showed no significant differences among the groups. First-pass recanalization (FPR) was more observed in the MT group (43.4%), the recanalization rate per attempt in the MT group gradually decreased until the fourth attempt, and further maneuvers showed recanalization rates of ≈0% per attempt. MT + RS (adjusted odds ratio [aOR] 0.10, p < 0.0001) and DA (aOR 0.18, p = 0.0013) were associated with lower FPR rate than MT alone in the multivariable logistic regression. CONCLUSIONS The technical feasibility and favorable outcomes of several EVT strategies for ICAS-LVO were established in our study. First-line MT with a bailout angioplasty is a reasonable option for ICAS-LVO, and DA is an effective option for the cases when ICAS-LVO is strongly suspected before EVT procedure.
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Affiliation(s)
- Jingyu Zhang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zequan Yu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yiming Deng
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
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Vogt ML, Kollikowski AM, Weidner F, Strinitz M, Feick J, Essig F, Neugebauer H, Haeusler KG, Pham M, Maerz A. Safety and Effectiveness of the New Generation APERIO® Hybrid Stent-retriever Device in Large Vessel Occlusion Stroke. Clin Neuroradiol 2021; 32:141-151. [PMID: 34936016 PMCID: PMC8894307 DOI: 10.1007/s00062-021-01122-1] [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: 05/22/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
Background It is unknown whether technological advancement of stent-retriever devices influences typical observational indicators of safety or effectiveness. Methods Observational retrospective study of APERIO® (AP) vs. new generation APERIO® Hybrid (APH) (Acandis®, Pforzheim, Germany) stent-retriever device (01/2019–09/2020) for mechanical thrombectomy (MT) in large vessel occlusion (LVO) stroke. Primary effectiveness endpoint was successful recanalization eTICI (expanded Thrombolysis In Cerebral Ischemia) ≥ 2b67, primary safety endpoint was occurrence of hemorrhagic complications after MT. Secondary outcome measures were time from groin puncture to first pass and successful reperfusion, and the total number of passes needed to achieve the final recanalization result. Results A total of 298 patients with LVO stroke who were treated by MT matched the inclusion criteria: 148 patients (49.7%) treated with AP vs. 150 patients (50.3%) treated with new generation APH. Successful recanalization was not statistically different between both groups: 75.7% for AP vs. 79.3% for APH; p = 0.450. Postinterventional hemorrhagic complications and particularly subarachnoid hemorrhage as the entity possibly associated with stent-retriever device type was significantly less frequent in the group treated with the APH: 29.7% for AP and 16.0% for APH; p = 0.005; however, rates of symptomatic hemorrhage with clinical deterioration and in domo mortality were not statistically different. Neither the median number of stent-retriever passages needed to achieve final recanalization, time from groin puncture to first pass, time from groin puncture to final recanalization nor the number of cases in which successful recanalization could only be achieved by using a different stent-retriever as bail-out device differed between both groups. Conclusion In the specific example of the APERIO® stent-retriever device, we observed that further technological developments of the new generation device were not associated with disadvantages with respect to typical observational indicators of safety or effectiveness.
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Affiliation(s)
- Marius L Vogt
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany.
| | - Alexander M Kollikowski
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Franziska Weidner
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Marc Strinitz
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Jörn Feick
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Fabian Essig
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Hermann Neugebauer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | | | - Mirko Pham
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Maerz
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
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41
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Yang S, Zhao K, Xi H, Xiao Z, Li W, Zhang Y, Fan Z, Li C, Chai E. Nomogram to Predict the Number of Thrombectomy Device Passes for Acute Ischemic Stroke with Endovascular Thrombectomy. Risk Manag Healthc Policy 2021; 14:4439-4446. [PMID: 34744465 PMCID: PMC8565981 DOI: 10.2147/rmhp.s317834] [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: 04/28/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to determine the risk factors associated with the number of thrombectomy device passes and establish a nomogram for predicting the number of device pass attempts in patients with successful endovascular thrombectomy (EVT). Methods We enrolled patients from a signal comprehensive stroke center (CSC) who underwent EVT because of large vessel occlusion stroke. Multivariate logistic regression analysis was used to develop the best-fit nomogram for predicting the number of thrombectomy device passes. The discrimination and calibration of the nomogram were estimated using the area under the receiver operating characteristic curve (AUC-ROC) and a calibration plot with a bootstrap of 1000 resamples. A decision curve analysis (DCA) was used to measure the availability and effect of this predictive tool. Results In total, 130 patients (mean age 64.9 ± 11.1 years; 83 males) were included in the final analysis. Age (odds ratio [OR], 1.085; 95% confidence interval [CI], 1.005-1.172; p = 0.036), baseline Alberta Stroke Program Early computed tomography (ASPECTS) score (OR, 0.237; 95% CI, 0.115-0.486; p < 0.001), and homocysteine level (OR, 1.090; 95% CI, 1.028-1.155; p = 0.004) were independent predictors of device pass number and were thus incorporated into the nomogram. The AUC-ROC determined the discrimination ability of the nomogram, which was 0.921 (95% CI, 0.860-0.980), which indicated good predictive power. Moreover, the calibration plot revealed good predictive accuracy of the nomogram. The DCA demonstrated that when the threshold probabilities of the cohort ranged between 5.0% and 98.0%, the use of the nomogram to predict a device pass number > 3 provided greater net benefit than did "treat all" or "treat none" strategies. Conclusion The nomogram comprised age, baseline ASPECTS score, and homocysteine level, can predict a device pass number >3 in acute ischemic stroke (AIS) patients who are undergoing EVT.
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Affiliation(s)
- Shijie Yang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China
| | - Kaixuan Zhao
- Clinical Medical College, Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China
| | - Huan Xi
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China
| | - Zaixing Xiao
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China
| | - Wei Li
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China
| | - Yichuan Zhang
- Clinical Medical College, Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China
| | - Zhiqiang Fan
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China
| | - Changqing Li
- Cerebrovascular Disease Center, Gansu Provincial Hospital, Lanzhou, Gansu, People's Republic of China.,Key Laboratory of Cerebrovascular Disease of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, People's Republic of China
| | - Erqing Chai
- Cerebrovascular Disease Center, Gansu Provincial Hospital, Lanzhou, Gansu, People's Republic of China.,Key Laboratory of Cerebrovascular Disease of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, People's Republic of China
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van Horn N, Heit JJ, Kabiri R, Mader MM, Christensen S, Mlynash M, Broocks G, Meyer L, Nawabi J, Lansberg MG, Albers GW, Wintermark M, Fiehler J, Faizy TD. Cerebral venous outflow profiles are associated with the first pass effect in endovascular thrombectomy. J Neurointerv Surg 2021; 14:1056-1061. [PMID: 34750110 PMCID: PMC9606492 DOI: 10.1136/neurintsurg-2021-018078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/24/2021] [Indexed: 12/26/2022]
Abstract
Background Recent studies found that favorable venous outflow (VO) profiles are associated with higher reperfusion rates after mechanical thrombectomy (MT) in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Fewer retrieval attempts and first-pass revascularization during MT lead to better functional outcomes. Objective To examine the hypothesis that favorable VO profiles assessed on baseline CT angiography (CTA) images correlate with successful vessel reperfusion after the first retrieval attempt and fewer retrieval attempts. Methods A multicenter retrospective cohort study of patients with AIS-LVO treated by MT. Baseline CTA was used to determine the cortical vein opacification score (COVES). Favorable VO was defined as COVES ≥3. Primary outcomes were successful with excellent vessel reperfusion status, defined as Thrombolysis in Cerebral Infarction (TICI) 2b/3 and 2c/3 after first retrieval attempt. Results 617 patients were included in this study, of whom 205 (33.2%) had first pass reperfusion. In univariate analysis, ordinal COVES (p=0.011) values were significantly higher in patients with first pass than in those with non-first pass reperfusion, while the number of patients exhibiting favorable pial arterial collaterals using the Maas scale on CTA did not differ (p=0.243). In multivariable logistic regression analysis, higher COVES were independently associated with TICI 2b/3 (OR=1.25, 95% CI 1.1 to 1.42; p=0.001) and TICI 2c/3 (OR=1.2, 95% CI 1.04 to 1.36; p=0.011) reperfusion after one retrieval attempt, controlling for penumbra volume and time from symptom onset to vessel reperfusion. Conclusions Favorable VO, classified as higher COVES, is independently associated with successful and excellent first pass reperfusion in patients with AIS-LVO treated by endovascular thrombectomy.
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Affiliation(s)
- Noel van Horn
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Reza Kabiri
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marius M Mader
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Soren Christensen
- Department of Neurology and Neurological Sciences, Stanford, Stanford, California, USA
| | - Michael Mlynash
- Department of Neurology and Neurological Sciences, Stanford, Stanford, California, USA
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jawed Nawabi
- Department of Radiology, Charité School of Medicine and University Hospital Berlin, Berlin, Germany
| | - Maarten G Lansberg
- Department of Neurology and Neurological Sciences, Stanford, Stanford, California, USA
| | - Gregory W Albers
- Department of Neurology and Neurological Sciences, Stanford, Stanford, California, USA
| | - Max Wintermark
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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Cimflova P, McDonough R, Kappelhof M, Singh N, Kashani N, Ospel JM, Demchuk AM, Menon BK, Chen M, Sakai N, Fiehler J, Goyal M. Perceived Limits of Endovascular Treatment for Secondary Medium-Vessel-Occlusion Stroke. AJNR Am J Neuroradiol 2021; 42:2188-2193. [PMID: 34711552 DOI: 10.3174/ajnr.a7327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Thrombus embolization during mechanical thrombectomy occurs in up to 9% of cases, making secondary medium vessel occlusions of particular interest to neurointerventionalists. We sought to gain insight into the current endovascular treatment approaches for secondary medium vessel occlusion stroke in an international case-based survey because there are currently no clear recommendations for endovascular treatment in these patients. MATERIALS AND METHODS Survey participants were presented with 3 cases involving secondary medium vessel occlusions, each consisting of 3 case vignettes with changes in the patient's neurologic status (improvement, no change, unable to assess). Multivariable logistic regression analyses clustered by the respondent's identity were used to assess factors influencing the decision to treat. RESULTS In total, 366 physicians (56 women, 308 men, 2 undisclosed) from 44 countries provided 3294 responses to 9 scenarios. Most (54.1%, 1782/3294) were in favor of endovascular treatment. Participants were more likely to treat occlusions in the anterior M2/3 (74.3%; risk ratio = 2.62; 95% CI, 2.27-3.03) or A3 (59.7%; risk ratio = 2.11; 95% CI, 1.83-2.42) segment compared with the M3/4 segment (28.3%; reference). Physicians were less likely to pursue endovascular treatment in patients who showed neurologic improvement than in patients with an unchanged neurologic deficit (49.9% versus 57.0% responses in favor of endovascular treatment, respectively; risk ratio = 0.88, 95% CI, 0.83-0.92). Interventionalists and more experienced physicians were more likely to treat secondary medium vessel occlusions. CONCLUSIONS Physicians' willingness to treat secondary medium vessel occlusions endovascularly is limited and varies per occlusion location and change in neurologic status. More evidence on the safety and efficacy of endovascular treatment for secondary medium vessel occlusion stroke is needed.
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Affiliation(s)
- P Cimflova
- From the Departments of Clinical Neurosciences (P.C., N.S., A.M.D., B.K.M., M.G.).,Department of Medical Imaging (P.C.), St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - R McDonough
- Diagnostic Imaging (R.M., M.K., N.K., M.G.), Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada.,Department of Diagnostic and Interventional Neuroradiology (R.M., J.F.), University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Kappelhof
- Diagnostic Imaging (R.M., M.K., N.K., M.G.), Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology and Nuclear Medicine (M.K.), University of Amsterdam, Amsterdam, the Netherlands
| | - N Singh
- From the Departments of Clinical Neurosciences (P.C., N.S., A.M.D., B.K.M., M.G.)
| | - N Kashani
- Diagnostic Imaging (R.M., M.K., N.K., M.G.), Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - J M Ospel
- Division of Neuroradiology (J.M.O.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - A M Demchuk
- From the Departments of Clinical Neurosciences (P.C., N.S., A.M.D., B.K.M., M.G.).,Hotchkiss Brain Institute (A.M.D.), Cumming School of Medicine, University of Calgary, Canada
| | - B K Menon
- From the Departments of Clinical Neurosciences (P.C., N.S., A.M.D., B.K.M., M.G.)
| | - M Chen
- Department of Neurological Sciences (M.C.), Rush University Medical Center, Chicago, Illinois
| | - N Sakai
- Department of Neurosurgery (N.S.), Kobe City Medical Centre General Hospital, Kobe, Japan
| | - J Fiehler
- Department of Diagnostic and Interventional Neuroradiology (R.M., J.F.), University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Goyal
- From the Departments of Clinical Neurosciences (P.C., N.S., A.M.D., B.K.M., M.G.) .,Diagnostic Imaging (R.M., M.K., N.K., M.G.), Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
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More Retrieval Attempts are Associated with Poorer Functional Outcome After Unsuccessful Thrombectomy. Clin Neuroradiol 2021; 32:361-368. [PMID: 34236443 PMCID: PMC9187527 DOI: 10.1007/s00062-021-01054-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/10/2021] [Indexed: 12/25/2022]
Abstract
Purpose In mechanical thrombectomy, it has been hypothesized that multiple retrieval attempts might the improve reperfusion rate but not the clinical outcome. In order to assess a potential harmful effect of a mechanical thrombectomy on patient outcome, the number of retrieval attempts was analyzed. Only patients with a thrombolysis in cerebral infarction (TICI) score of 0 were reviewed to exclude the impact of eventual successful reperfusion on the mechanical hazardousness of repeated retrievals. Methods In this study 6635 patients who underwent endovascular thrombectomy (EVT) for acute large vessel occlusion (LVO) from the prospectively administered multicenter German Stroke Registry were screened. Insufficient reperfusion was defined as no reperfusion (TICI score of 0), whereas a primary outcome was defined as functional independence (modified Rankin scale [mRS] 0–2 at day 90). Propensity score matching and multivariable logistic regressions were then performed to adjust for confounders. Results A total of 377 patients (7.8%) had a final TICI score of 0 and were included in the study. After propensity score matching functional independence was found to be significantly more frequent in patients who underwent ≤ 2 retrieval attempts (14%), compared to patients with > 2 retrieval attempts (3.9%, OR 0.29, 95% CI 0.07–0.73, p = 0.009). After adjusting for age, sex, admission NIHSS score, and location of occlusion, more than two retrieval attempts remained significantly associated with lower odds of functional independence at 90 days (OR 0.2, 95% CI 0.07–0.52, p = 0.002). Conclusion In patients with failure of reperfusion, more than two retrieval attempts were associated with a worse clinical outcome, therefore indicating a possible harmful effect of multiple retrieval attempts. Supplementary Information The online version of this article (10.1007/s00062-021-01054-w) contains supplementary material, which is available to authorized users.
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Arturo Larco J, Abbasi M, Liu Y, Madhani SI, Shahid AH, Kadirvel R, Brinjikji W, Savastano LE. Per-pass analysis of recanalization and good neurological outcome in thrombectomy for stroke: Systematic review and meta-analysis. Interv Neuroradiol 2021; 28:358-363. [PMID: 34229523 DOI: 10.1177/15910199211028342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIM First pass effect (FPE) is defined as achieving a complete recanalization with a single thrombectomy device pass. Although clinically desired, FPE is reached in less than 30% of thrombectomy procedures. Multiple device passes are often necessary to achieve successful or complete recanalization. We performed a systematic review and meta-analysis to determine the recanalization rate after each pass of mechanical thrombectomy and its association with good neurological outcome. METHODS A literature search was performed for studies reporting the number of device passes required for either successful (mTICI 2b or higher) or complete (mTICI 2c or higher) recanalization. Using random-effect meta-analysis, we evaluated the likelihood of recanalization and good neurological outcome (measured with the modified Rankin Score <2 at 90 days) after each device pass. RESULTS Thirteen studies comprising 4197 patients were included. Among cases with failed first pass, 24% of them achieved final complete recanalization and 45% of them achieved final successful recanalization. Independently to the total number of previously failed attempts, the likelihood of achieving successful recanalization was 30% per pass, and the likelihood to achieve complete recanalization was about 20% per pass. The likelihood of good neurological outcome in patients with final successful recanalization decreased after each device pass: 55% after the first pass, 48% after the second pass, 42% after the third pass, 36% after the fourth pass, and 26% for 5 passes or more. CONCLUSION Each pass is associated with a stable likelihood of recanalization but a decreased likelihood of good neurological outcome.
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Affiliation(s)
| | - Mehdi Abbasi
- Department of Neurosurgery, Mayo Clinic, Rochester, USA.,Department of Radiology, Mayo Clinic, Rochester, USA
| | - Yang Liu
- Department of Neurosurgery, Mayo Clinic, Rochester, USA.,Department of Radiology, Mayo Clinic, Rochester, USA
| | | | | | | | - Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic, Rochester, USA.,Department of Radiology, Mayo Clinic, Rochester, USA
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