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Masouris I, Wischmann J, Schniepp R, Müller R, Fuhry L, Hamann GF, Trumm C, Liebig T, Kellert L, Schöberl F. Basilar artery occlusion: drip-and-ship versus direct-to-center for mechanical thrombectomy within the Neurovascular Network of Southwest Bavaria (NEVAS). J Neurol 2024; 271:1885-1892. [PMID: 38095722 DOI: 10.1007/s00415-023-12126-x] [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: 09/20/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Recent clinical trials revealed a substantial clinical benefit for mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO). While urban areas are sufficiently covered with comprehensive stroke centers and MT expertise, rural areas lack such resources. Structured telemedical stroke networks offer rural hospitals instant consultation by stroke experts, enabling swift administration of intravenous thrombolysis (IVT) on-site and transportation for MT. For BAO patients, data on performance and clinical outcomes in telemedical stroke networks are lacking. METHODS We retrospectively analyzed data from patients with acute BAO eligible for MT: those treated directly in our comprehensive stroke center (direct-to-center/DC) and those treated in rural hospitals that were telemedically consulted by the Neurovascular Network of Southwest Bavaria (NEVAS) and transferred to our center for MT (drip-and-ship, DS). Key time intervals, stroke management performance and functional outcome after 90 days were compared. RESULTS Baseline characteristics, including premorbid status and stroke severity, were comparable. Time from symptom onset to IVT was identical in both groups (118 min). There was a delay of 180 min until recanalization in DS patients, mainly due to patient transport for MT. Procedural treatment time intervals, success of recanalization and complications were comparable. Clinical outcome at 3 months follow-up of DS patients was not inferior to DC patients. CONCLUSION We show for the first time that patients with BAO in rural areas benefit from a structured telemedicine network such as NEVAS, regarding both on-site processing and drip-and-ship for MT. Clinical outcomes are comparable among DS and DC patients.
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Affiliation(s)
- Ilias Masouris
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany.
| | - J Wischmann
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - R Schniepp
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - R Müller
- Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Guenzburg, Günzburg, Germany
| | - L Fuhry
- Department of Neurology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - G F Hamann
- Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Guenzburg, Günzburg, Germany
| | - C Trumm
- Institute of Neuroradiology, LMU University Hospital, LMU, Munich, Germany
| | - T Liebig
- Institute of Neuroradiology, LMU University Hospital, LMU, Munich, Germany
| | - L Kellert
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - F Schöberl
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
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Phungsoonthorn T, Charoensukmongkol P. How does mindfulness help university employees cope with emotional exhaustion during the
COVID
‐19 crisis? The mediating role of psychological hardiness and the moderating effect of workload. Scand J Psychol 2022; 63:449-461. [DOI: 10.1111/sjop.12826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 12/22/2022]
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Liu Y, Hong Z, Li Y, Li S, Liu Q, Xie S, Wang J, Wang J, Zheng M. Effect of intravenous thrombolysis combined with mechanical thrombectomy on neurological function and short-term prognosis of patients with acute cerebral infarction. Am J Transl Res 2022; 14:2376-2382. [PMID: 35559387 PMCID: PMC9091080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/09/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study was to assess the effect of intravenous thrombolysis combined with mechanical thrombectomy on neurological function and the short-term prognosis of patients with acute cerebral infarction (ACI). METHODS A total of 120 patients with ACI admitted to our hospital from January 2019 to January 2020 were selected as research objects, and randomized into Group A (n=60) or Group B (n=60). Patients in both groups were treated with intravenous thrombolysis. Group B received ACI conventional treatment and intravenous thrombolysis, while Group A was additionally given mechanical thrombectomy. Then the neurological function scores, serum factor levels, vascular recanalization rate, incidence of adverse reactions, Thrombolysis in Myocardial Infarction (TIMI) grade flow, and effective rate of treatment were compared between the two groups. The clinical trial is available at https://clinicaltrials.gov/, ClinicalTrials.gov Identifier: NCT03502411. RESULTS The neurological function scores of Group A were apparently lower than those of Group B one month after treatment (P<0.001). After treatment, Group A yielded a superior serum factor level compared to Group B (P<0.001), and also showed a higher recanalization rate of blood vessels and a notably lower adverse reaction rate (all P<0.05). CONCLUSION Intravenous thrombolysis combined with mechanical thrombectomy can accelerate the recovery of neurological function in patients with ACI, and yield a more promising outcome in terms of the patient's vascular recanalization rate compared with the monotherapy. It can also reduce the adverse reaction rate of patients to ensure a better short-term prognosis.
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Affiliation(s)
- Yongchang Liu
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Zhen Hong
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Yan Li
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Shaoquan Li
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Qingran Liu
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Songwang Xie
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Junyong Wang
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Jian Wang
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Mingming Zheng
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
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Del Guerra FB, Silva GD, Perissinoti IN, Morais L, Marsolla FLD, Comerlatti LR, Puglia Junior P, Conforto AB. Outcomes of acute basilar artery occlusion-real-world experience in a middle-income country. Acta Neurol Scand 2022; 145:456-463. [PMID: 34918338 DOI: 10.1111/ane.13572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/05/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Our goal was to describe outcomes in a single-center, real-world series of patients with acute basilar artery occlusion in a middle-income country. In addition, we assessed potential outcome predictors. MATERIAL AND METHODS Data from 28 patients were retrospectively reviewed. The primary outcome was death until last follow-up. Other outcomes were rates of favorable outcome until last follow-up and rates of intracranial hemorrhage. Outcomes were compared in subgroups according to several variables, including reperfusion (REP group) or no reperfusion (NOREP group) interventions, with chi-squared, Fisher's exact test, or Mann-Whitney tests. RESULTS The rate of overall intrahospital death was 46%. Death until last follow-up occurred in 8/17 (47%) in the REP and in 7/11 (63%) of the NOREP group. Favorable outcomes were observed in 35.7% of the patients: 8/17 (47%) in REP and in 2/11 (18.1%) in NOREP. NIH stroke scale scores were significantly lower in patients with favorable outcomes. Intracranial hemorrhage was observed in 6/28 (21.4%) of the patients (all in REP group). Twenty patients were treated with anticoagulants within the first 24 h. No hemorrhage was observed in those treated with enoxaparin, while three occurred in subjects treated with unfractionated heparin. CONCLUSION Together with other series, our results underscore the relevance of NIH stroke scale at admission as a prognostic marker, the importance of reperfusion to improve outcomes, and the need of clinical trials to compare the impact of treatment with anticoagulants within first 24 h in basilar artery occlusion.
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Affiliation(s)
- Felipe Borelli Del Guerra
- Neurology Clinical Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Guilherme Diogo Silva
- Neurology Clinical Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Iago Navas Perissinoti
- Neurology Clinical Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Livia Morais
- Department of Radiology (INRAD) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | | | - Luiz Roberto Comerlatti
- Neurology Clinical Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Paulo Puglia Junior
- Neuroradiology Intervention Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Adriana Bastos Conforto
- Neurology Clinical Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
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Zhang C, Dou W, Jiang S, Dong D, Wang X. High-Resolution Vessel Wall MR Imaging in Diagnosis and Length Measurement of Cerebral Arterial Thrombosis: A Feasibility Study. J Magn Reson Imaging 2022; 56:1267-1274. [PMID: 35315157 DOI: 10.1002/jmri.28170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Detecting and measuring intraluminal thrombus has prognostic and therapeutic implications for stroke patients. PURPOSE To investigate the feasibility of 3D isotropic high-resolution T1w-CUBE imaging to detect and measure intraluminal thrombus in stroke patients. STUDY TYPE Retrospective. SUBJECTS A total of 93 patients with acute (N = 39) and subacute (N = 54) stroke. FIELD STRENGTH/SEQUENCE A 3.0 T/spin-echo echo-planar diffusion-weighted imaging (DWI), high-resolution T1w-CUBE imaging and 3D flow compensated gradient-echo susceptibility-weighted imaging (SWI). ASSESSMENT Data assessment was performed by three neuroradiologists with 11, 13, and 20 years of clinical experience. The accuracy of T1W-CUBE and SWI in diagnosing thrombosis was compared by using digital subtraction angiography (DSA) as the reference. For thrombus length measurement, the image quality of proximal and distal thrombus of T1w-CUBE images was first evaluated with a 4-point rating system. Then, the proximal and distal positions to lesions were determined on T1w-CUBE images and compared with those from DSA acquired during endovascular reperfusion therapy. If comparable both locations were found between CUBE and DSA, CUBE imaging can thus be considered for accurate measurement of thrombus length. STATISTICAL TESTS Fleiss' Kappa; the area under the receiver operating characteristic (ROC) curve (AUC); Pearson's chi-squared test with Yates' continuity correction. RESULTS Moderate-to-good interobserver agreements were validated with all Kappa coefficients higher than 0.40 in thrombus diagnosis and measurement. CUBE imaging showed higher clinical efficacy than SWI (AUC: 0.966 vs. 0.850) in thrombus diagnosis. Additionally, high quality of CUBE imaging was confirmed with 3 or 4 points rated by all three observers. Compared to intraoperative DSA, T1w CUBE showed consistent proximal and distal positions of thrombi in 16 of the 18 patients, validating the accuracy of T1w-CUBE in measuring thrombus length. DATA CONCLUSION T1w-CUBE imaging has potential to facilitate diagnosis and measurement of intraluminal thrombus. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Chao Zhang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, 250014, China
| | - Weiqiang Dou
- MR Research, GE Healthcare, Beijing, 10076, China
| | - Shu Jiang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, 250014, China
| | - Dong Dong
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, 250014, China
| | - Xinyi Wang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, 250014, China
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Dose-Response Relationship and Threshold Drug Dosage Identification for a Novel Hybrid Mechanical-Thrombolytic System with an Ultra-Low Dose Patch. Cell Mol Bioeng 2021; 14:627-637. [PMID: 34900015 DOI: 10.1007/s12195-021-00683-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/31/2021] [Indexed: 10/21/2022] Open
Abstract
Introduction Ischemic stroke treatment has advanced in the last two decades and intravenous thrombolysis is now considered the standard of care for selected patients. Recanalization can also be achieved by mechanical endovascular treatment for patients with large vessel occlusions. Complicating treatment-related symptomatic intracerebral hemorrhage and prolonged needle-to-recanalization times have been identified as major determinants of poor three-month functional outcomes. A hybrid mechanical-thrombolytic system with a patch imbued with an ultra-low dose of thrombolytic agents loaded onto a stent-retriever has been developed. Methods In this study, the in situ dose-response relationship of the thrombolytic patch imbued with up to 1000 IU of urokinase plasminogen activator (uPA) was quantified using Raman spectroscopy. Results Thrombi of up to 400 μm thickness dissolved within 15 min when patches imbued with < 1% of the conventional thrombolysis therapy dosage were applied. The results demonstrated that low-dose thrombolytic patches can dissolve normal clots compressed in the blood vessel in a short time. 500 IU is the threshold uPA dosage in the thrombolytic patch that most effectively dissolves the clots. Conclusion This study suggests that a novel endovascular stent-retriever loaded with an ultra-low drug dose fibrinolytic patch may be a suitable treatment for patients who are ineligible for conventional thrombolytic therapy.
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Suen CG, Goldstein ED, de Havenon AH, McNally JS. Intracranial high-resolution vessel wall imaging in differentiating intraluminal basilar artery thrombus from arterial dissection. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ravindren J, Aguilar Pérez M, Hellstern V, Bhogal P, Bäzner H, Henkes H. Predictors of Outcome After Endovascular Thrombectomy in Acute Basilar Artery Occlusion and the 6hr Time Window to Recanalization. Front Neurol 2019; 10:923. [PMID: 31608001 PMCID: PMC6773802 DOI: 10.3389/fneur.2019.00923] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/09/2019] [Indexed: 12/20/2022] Open
Abstract
Background and Purpose: Decision algorithms for large vessel occlusions in the anterior circulation remain unconfirmed for acute basilar artery occlusion (aBAO). The aim of this study was to investigate procedural parameters, patient characteristics, functional outcome, and survival in dependency of the time window to recanalization from symptom onset. Furthermore predictors of outcome were identified. Materials and Methods: Retrospectively 231 patients with aBAO treated with endovascular treatment (EVT) between November 2008 and February 2019 were identified in a prospectively maintained single center stroke database. Baseline characteristics such as age, cardiovascular risk factors, NIHSS at admission, pre-interventional PC-ASPECTS, periprocedural parameters such as time to recanalization, duration of treatment, extent of reperfusion, collateral status, and occlusion patterns, as well as post-interventional 24 h NIHSS and post-interventional ICH were evaluated. Target variables were mRS at 90 days and mortality over 90 days. Results: Good outcome (mRS 0–2) was attained in 29.5% (n = 68) of patients, overall mortality was 36.8% (n = 85). In mulitivariate analyses patients with time to reperfusion beyond 6 h had a more than half fold decreased chance of good outcome [OR 0.47 95% CI (0.23–0.95) p < 0.05]. The odds for good outcome were reduced by almost 2/3 if post-interventional imaging revealed intracerebral hemorrhage [OR 0.28 95% CI (0.08–0.98)]. Unfavorable outcome was noted in 100% (n = 14) of patients with symptomatic ICH. Risk for death was reduced by more than 80% if collaterals were present [0.16 95% CI (0.03–0.87)] and if recanalization was successful (TICI 2b-3) [OR 0.19 95% CI (0.05–0.78)]. The odds for survival were 5-fold higher in patients with no post-interventional hemorrhages present [OR 5.35 95% CI (2.2–1.58)]. Conclusion: This study might contribute to explaining the ambiguous findings regarding the validity of the 6 h time window in aBAO, suggesting that collateral status impacts the odds of survival in the time window to recanalization beyond 6 h. In our study recanalization within 6 h from symptom onset was associated with good outcome. Successful recanalization (TICI 2b-3a) was necessary for good outcome and survival, post-interventional ICH was highly associated with unfavorable outcome. This might ease the decision making for EVT.
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Affiliation(s)
- Johannes Ravindren
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany.,Neurological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - Marta Aguilar Pérez
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - Victoria Hellstern
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - Pervinder Bhogal
- Department of Neuroradiology, St Bartholomew's Hospital, London, United Kingdom
| | - Hansjörg Bäzner
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany.,Medical Faculty, University Duisburg-Essen, Essen, Germany
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