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Li J, Yang J, Gao X, Han Q, Wu Y, Shang Q, Huang Y, Xu Y, Huang Y, Lin L. Clot patterns determined by DSA and CTA can help predict intracranial atherosclerotic stenosis in acute ischemic stroke patients. Front Neurol 2024; 15:1395764. [PMID: 39114532 PMCID: PMC11303227 DOI: 10.3389/fneur.2024.1395764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/28/2024] [Indexed: 08/10/2024] Open
Abstract
Background This study examines whether clot patterns at large artery occlusion sites, as observed using digital subtraction angiography (DSA) and computed tomography angiography (CTA), can reliably indicate intracranial atherosclerotic stenosis (ICAS) in acute ischemic stroke (AIS) patients. Methods We conducted a retrospective analysis of patients treated with stent retriever thrombectomy for intracranial occlusions at our institute since 2017, with follow-up assessments conducted at 3 months. The patients were grouped based on the initial angiography clot topographies (i.e., cut-off or tapered signs). We assessed the potential of these topographies in predicting ICAS, including a clinical outcome analysis based on clot pattern, age, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and onset-to-door time. Results Among 131 patients (with a mean age of 66.6 years), the clot pattern emerged as a significant predictor of ICAS. The DSA-based model had a predictive area under the curve (AUC) of 0.745, with 55.1% sensitivity and 94.0% specificity. A multivariate model including age, onset-to-door time, TOAST classification as large artery atherosclerosis (LAA), and the presence of the tapered sign in clot patterns had an AUC of 0.916. In patients over 65 years of age with an onset-to-door time of >5 h and exhibiting a tapered sign in the clot pattern, the AUC reached 0.897. The predictive ability of the tapered sign was similar in DSA and CTA, showing 73.4% agreement between modalities. Conclusion The clot pattern with the tapered sign as observed using DSA is significantly associated with ICAS. Incorporating this clot pattern with age, TOAST classification as LAA, and onset-to-door time enhances the prediction of ICAS. The clot pattern identified by CTA is also a reliable predictor, highlighting the importance of assessing clot patterns in ICAS identification.
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Affiliation(s)
- Jichuan Li
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- Department of Neurology, The First People's Hospital of Yuexi County, Liangshan, China
| | - Jianhong Yang
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Xiang Gao
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Qing Han
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Yuefei Wu
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Qing Shang
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Yueshi Huang
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Yao Xu
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Yi Huang
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, China
| | - Longting Lin
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- Sydney Brain Center, University of New South Wales, Sydney, NSW, Australia
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Han B, Tong X, Raynald, Jia B, Wang A, Mo D, Gao F, Ma N, Miao Z. Thrombectomy Plus Intra-Arterial Thrombolysis Versus Thrombectomy for Acute Large Vessel Occlusions: a Matched-Control Study. Clin Neuroradiol 2024:10.1007/s00062-024-01431-1. [PMID: 38953962 DOI: 10.1007/s00062-024-01431-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/26/2024] [Indexed: 07/04/2024]
Abstract
AIM We conducted a matched-control analysis to compare the outcomes of large vessel occlusion (LVO) patients treated with mechanical thrombectomy (MT) plus Intra-arterial thrombolysis (IAT) versus those treated with MT alone. METHODS The subjects of this study were chosen from ANGEL-ACT registry. All patients who received MT were identified and categorized into two groups: "MT + IAT" and "MT," based on whether or not they received additional intra-arterial medication IAT during the MT procedure. After being subjected to 1:1 propensity score matching, the outcome measures, including modified Rankin Scale (mRS) score at 90 days, successful recanalization at the final angiogram, symptomatic intracranial hemorrhage (sICH) within 36 h, and death within 90 days, were compared. RESULTS The study encompassed a total of 1607 patients, with 641 individuals assigned to the MT + IAT group and 966 to the MT group. After applying propensity score matching, a total of 524 pairs were identified for comparison. The results indicated that there were no significant differences between the two groups with regard to the modified Rankin Scale (mRS) score (median: 3 vs. 3 points; P = 0.83), successful recanalization (89.9 vs. 88.9%; P = 0.62), sICH (8.3 vs. 8.7%; P = 0.79), and death (15.5 vs. 16.4%; P = 0.70). CONCLUSIONS IAT during MT does not confer an elevated risk of sICH or mortality. Furthermore, the combination of MT and IAT may produce comparable functional outcomes in comparison to MT alone, when treating acute LVO patients.
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Affiliation(s)
- Bin Han
- Shanxi Key Laboratory of Brain Disease Control, Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, 100050, Fengtai district Beijing, China
| | - Raynald
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, 100050, Fengtai district Beijing, China
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, 100050, Fengtai district Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, 100050, Fengtai district Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, 100050, Fengtai district Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, 100050, Fengtai district Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, 100050, Fengtai district Beijing, China.
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Ito Y, Sugiyama T, Terasaka S, Matsuzawa H, Harada K, Nakayama N, Ito M, Maruichi K, Fujimura M. Differences between Acute Embolic and Atherosclerotic Middle Cerebral Artery Occlusion in Multiphase Arterial Spin-labeling Imaging. Neurol Med Chir (Tokyo) 2024; 64:197-204. [PMID: 38432944 PMCID: PMC11153842 DOI: 10.2176/jns-nmc.2023-0237] [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: 10/13/2023] [Accepted: 01/10/2024] [Indexed: 03/05/2024] Open
Abstract
Arterial spin-labeling magnetic resonance imaging (ASL-MRI) is widely used for evaluating collateral development in patients with acute ischemic stroke (AIS). This study aimed to characterize the findings of multiphase ASL-MRI between embolic and atherosclerotic large vessel occlusion (LVO) to aid in the differential diagnosis. Among 982 patients with AIS, 44 who were diagnosed with acute, symptomatic, and unilateral occlusion of the horizontal segment of the middle cerebral artery (MCA) were selected and categorized into embolic stroke (ES) and atherosclerosis (AT) groups. Using ASL-MRI (postlabeling delay [PLD] of 1.5, 2.0, and 2.5 s) at admission, the ipsilateral to contralateral ratio (ICR) of the signal intensity and its time-course increasing rate (from PLD 1.5 to 2.0 and 2.5, ΔICR) were measured and compared between the two groups. The mean ICR was significantly higher in the AT group than in the ES group (AT vs. ES: 0.49 vs. 0.27 for ICR1.5, 0.73 vs. 0.32 for ICR2.0, and 0.92 vs. 0.37 for ICR2.5). The ΔICR of PLD 1.5-2.0 (ΔICR2.0) and 2.5 (ΔICR2.5) were also significantly higher in the AT group than in the ES group (AT vs. ES: 50.9% vs. 26.3% for ΔICR2.0, and 92.6% vs. 42.9% for ΔICR2.5). Receiver operating characteristic curves showed moderate-to-strong discriminative abilities of each ASL-MRI parameter in predicting MCA occlusion etiology. In conclusion, multiphase ASL-MRI parameters may aid in differentiating intracranial LVO etiology during the acute phase. Thus, it is applicable to AIS management.
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Affiliation(s)
- Yasuhiro Ito
- Department of Neurosurgery, Kashiwaba Neurosurgical Hospital
| | - Taku Sugiyama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | | | | | - Kuniaki Harada
- Department of Neurosurgery, Kashiwaba Neurosurgical Hospital
| | - Naoki Nakayama
- Department of Neurosurgery, Kashiwaba Neurosurgical Hospital
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | | | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
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Sen S, Nagao Y, Inatomi Y, Nakajima M, Yonehara T. Stent Retriever Angioplasty for Acute Restenosis of the Middle Cerebral Artery: A Case Report. Cureus 2024; 16:e59696. [PMID: 38841041 PMCID: PMC11150170 DOI: 10.7759/cureus.59696] [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] [Accepted: 05/05/2024] [Indexed: 06/07/2024] Open
Abstract
We present a case of ischemic stroke treated by stent retriever angioplasty for restenosis during mechanical thrombectomy. An 85-year-old man was admitted to our hospital because of left hemiplegia and left-sided hemispatial neglect caused by an occlusion at the origin of the right middle cerebral artery. Although mechanical thrombectomy transiently resulted in recanalization of the occluded lesion, restenosis immediately occurred and recurred repeatedly. On an angiogram, the stent retriever appeared poorly dilated at the stenosis and showed a contrast deficit. We concluded that restenosis was due to a secondary thrombus resulting from a ruptured atherosclerotic plaque. The stent retriever was kept deployed for 15 minutes. After the stent was retrieved, restenosis did not occur. Stent retriever angioplasty may be effective for determining the cause of restenosis after mechanical thrombectomy as well as for the treatment of restenosis.
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Affiliation(s)
- Shoei Sen
- Neurology, Saiseikai Kumamoto Hospital, Kumamoto, JPN
- Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, JPN
| | | | | | - Makoto Nakajima
- Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, JPN
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Koo AB, Reeves BC, Renedo D, Maier IL, Al Kasab S, Jabbour P, Kim JT, Wolfe SQ, Rai A, Starke RM, Psychogios MN, Shaban A, Arthur A, Yoshimura S, Cuellar H, Grossberg JA, Alawieh A, Romano DG, Tanweer O, Mascitelli J, Fragata I, Polifka A, Osbun J, Crosa R, Park MS, Levitt MR, Brinjikji W, Moss M, Dumont T, Williamson R, Navia P, Kan P, Spiotta AM, Sheth KN, de Havenon A, Matouk CC. Impact of Procedure Time on First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke. Neurosurgery 2024:00006123-990000000-01086. [PMID: 38483158 DOI: 10.1227/neu.0000000000002900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/13/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES First pass effect (FPE) is a metric increasingly used to determine the success of mechanical thrombectomy (MT) procedures. However, few studies have investigated whether the duration of the procedure can modify the clinical benefit of FPE. We sought to determine whether FPE after MT for anterior circulation large vessel occlusion acute ischemic stroke is modified by procedural time (PT). METHODS A multicenter, international data set was retrospectively analyzed for anterior circulation large vessel occlusion acute ischemic stroke treated by MT who achieved excellent reperfusion (thrombolysis in cerebral infarction 2c/3). The primary outcome was good functional outcome defined by 90-day modified Rankin scale scores of 0-2. The primary study exposure was first pass success (FPS, 1 pass vs ≥2 passes) and the secondary exposure was PT. We fit-adjusted logistic regression models and used marginal effects to assess the interaction between PT (≤30 vs >30 minutes) and FPS, adjusting for potential confounders including time from stroke presentation. RESULTS A total of 1310 patients had excellent reperfusion. These patients were divided into 2 cohorts based on PT: ≤30 minutes (777 patients, 59.3%) and >30 minutes (533 patients, 40.7%). Good functional outcome was observed in 658 patients (50.2%). The interaction term between FPS and PT was significant ( P = .018). Individuals with FPS in ≤30 minutes had 11.5% higher adjusted predicted probability of good outcome compared with those who required ≥2 passes (58.2% vs 46.7%, P = .001). However, there was no significant difference in the adjusted predicted probability of good outcome in individuals with PT >30 minutes. This relationship appeared identical in models with PT treated as a continuous variable. CONCLUSION FPE is modified by PT, with the added clinical benefit lost in longer procedures greater than 30 minutes. A comprehensive metric for MT procedures, namely, FPE 30 , may better represent the ideal of fast, complete reperfusion with a single pass of a thrombectomy device.
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Affiliation(s)
- Andrew B Koo
- Department of Neurosurgery, Yale University, New Haven , Connecticut , USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University, New Haven , Connecticut , USA
| | - Daniela Renedo
- Department of Neurosurgery, Yale University, New Haven , Connecticut , USA
| | - Ilko L Maier
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen , Germany
| | - Sami Al Kasab
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston , South Carolina , USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju , Korea
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem , North Carolina , USA
| | - Ansaar Rai
- Department of Neuroradiology, West Virginia School of Medicine, Morgantown , West Virginia , USA
| | - Robert M Starke
- Department of Neurosurgery, University of Miami Health System, Miami , Florida , USA
| | - Marios-Nikos Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University of Basel, Basel , Switzerland
| | - Amir Shaban
- Department of Neurology, The University of Iowa, Iowa City , Iowa , USA
| | - Adam Arthur
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya , Hyogo , Japan
| | - Hugo Cuellar
- Department of Neurosurgery, Louisiana State University Health Shreveport, Shreveport , Louisiana , USA
| | | | - Ali Alawieh
- Department of Neurosurgery, Emory University, Atlanta , Georgia , USA
| | - Daniele G Romano
- Department of Radiology, Aou S. Giovanni di Dio e Ruggi d'Aragona, Salerno , Italy
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA
| | - Justin Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio , Texas , USA
| | - Isabel Fragata
- Department of Neuroradiology, Centro Hospitalar Universitario de Lisboa Central, Lisbon , Portugal
| | - Adam Polifka
- Department of Neurosurgery, University of Florida, Gainesville , Florida , USA
| | - Joshua Osbun
- Department of Neurosurgery, Washington University, St. Louis , Missouri , USA
| | - Roberto Crosa
- Department of Neurosurgery, Medica Uruguaya, Montevideo , Uruguay
| | - Min S Park
- Department of Neurosurgery, University of Virginia, Charlottesville , Virginia , USA
| | - Michael R Levitt
- Department of Neurosurgery, University of Washington, Seattle , Washington , USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic in Minnesota, Rochester , Minnesota , USA
| | - Mark Moss
- Department of Interventional Neuroradiology, Washington Regional Medical Center, Fayetteville , Arkansas , USA
| | - Travis Dumont
- Department of Neurosurgery, University of Arizona, Tucson , Arizona , USA
| | - Richard Williamson
- Department of Neurosurgery, Allegheny Hospital, Pittsburgh , Pennsylvania , USA
| | - Pedro Navia
- Department of Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid , Spain
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston , Texas , USA
| | - Alejandro M Spiotta
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston , South Carolina , USA
| | - Kevin N Sheth
- Department of Neurology, Yale University, New Haven , Connecticut , USA
| | - Adam de Havenon
- Department of Neurology, Yale University, New Haven , Connecticut , USA
| | - Charles C Matouk
- Department of Neurosurgery, Yale University, New Haven , Connecticut , USA
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Liu C, Li F, Chen L, Huang J, Sang H, Nguyen TN, Saver JL, Abdalkader M, Kong W, Yang J, Guo C, Gong C, Huang L, Pan Y, Wang X, Chen Y, Qiu Z, Zi W. Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function. Ann Clin Transl Neurol 2024; 11:618-628. [PMID: 38156359 DOI: 10.1002/acn3.51982] [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: 11/09/2023] [Revised: 12/05/2023] [Accepted: 12/16/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVE Renal function can modify the outcomes of large vessel occlusion (LVO) stroke across stroke etiologies in disparate degrees. The presence of renal function deficit can also impair the pharmacokinetics of tirofiban. Hence, this study aimed to investigate the roles of renal function in determining efficacy and safety of intravenous tirofiban before endovascular treatment (EVT) for acute ischemic stroke patients with large vessel occlusion (LVO). METHODS This study was a post hoc exploratory analysis of the RESCUE-BT trial. The primary outcome was the proportion of patients achieving functional independence (modified Rankin scale 0-2) at 90 days, and the primary safety outcome was the rate of symptomatic intracranial hemorrhage (sICH). RESULTS Among 908 individuals with available serum creatinine, decreased estimated glomerular filtration rate (eGFR) status was noted more commonly in patients with cardioembolic stroke (CE), while large artery atherosclerosis (LAA) was predominant in patients with normal renal function. In LAA with normal renal function, tirofiban was associated with higher rates of functional independence at 90 days (41.67% vs 59.80%, p = 0.003). However, for LVO patients with renal dysfunction, tirofiban did not improve functional outcomes for any of the etiologies (LAA, p = 0.876; CE, p = 0.662; others, p = 0.894) and significantly increased the risk of sICH among non-LAA patients (p = 0.020). Mediation analysis showed tirofiban reduced thrombectomy passes (12.27%) and drug/placebo to recanalization time (14.25%) mediated its effects on functional independence. CONCLUSION This present study demonstrated the importance of evaluating renal function before administering intravenous tirofiban among patients with LVO who are planned to undergo EVT.
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Affiliation(s)
- Chang Liu
- Department of Neurology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Liyuan Chen
- Department of Neurology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jiacheng Huang
- Department of Neurology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hongfei Sang
- Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Jeffrey L Saver
- Neurology, University of California in Los Angeles, Los Angeles, California, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Weiling Kong
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Changwei Guo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chen Gong
- Department of Neurology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Liping Huang
- Department of Neurology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yanzhu Pan
- Department of Neurology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xinxin Wang
- Department of Neurology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Zhongming Qiu
- Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Ojeda DJ, Ghannam M, Sanchez S, Almajali M, Koul P, Saver JL, Gupta R, Ortega-Gutierrez S, Liebeskind DS, Samaniego EA. Tigertriever in the treatment of acute ischemic stroke with underlying intracranial atherosclerotic disease. J Neurointerv Surg 2024:jnis-2023-020796. [PMID: 37777257 DOI: 10.1136/jnis-2023-020796] [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: 07/12/2023] [Accepted: 09/10/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND The Tigertriever device offers a unique feature that enables gradual control of the radial expansion. We sought to evaluate the safety and efficacy of the Tigertriever device in patients with large vessel occlusion (LVO) and underlying intracranial atherosclerotic disease (ICAD). The patients were part of the TIGER trial. METHODS The presence of underlying ICAD was determined by a core imaging laboratory using CT angiography and digital subtraction angiography. The primary outcomes included successful reperfusion, puncture to reperfusion time, and complications associated with the use of the Tigertriever device. Patients underwent mechanical thrombectomy with the Tigertriever device for up to three passes, and alternative devices were employed for subsequent passes. RESULTS A total of 160 patients were enrolled in the TIGER trial, and 32 patients had ICAD. Among the patients with ICAD, 78% achieved successful reperfusion within three passes of the Tigertriever device, without requiring rescue therapy. Additionally, a first pass effect was observed in 46.8%. The median time from puncture to reperfusion was 22 minutes. There were no device-related complications. The National Institutes of Health Stroke Scale (NIHSS) score at 24 hours was significantly reduced, from an average of 17 at baseline to 8. At the 3 month follow-up, 50% of patients achieved a modified Rankin Scale score of ≤2. CONCLUSION Endovascular therapy (EVT) with the Tigertriever device for LVO in patients with underlying ICAD is effective and safe. When compared with historical data from other devices employed in similar cases, we observed a high rate of successful reperfusion, along with a shorter puncture to reperfusion time.
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Affiliation(s)
- Diego J Ojeda
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Malik Ghannam
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Sebastian Sanchez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mohammad Almajali
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Prateeka Koul
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jeffrey L Saver
- Neurology and Comprehensive Stroke Center, University of California Los Angeles, Los Angeles, California, USA
| | - Rishi Gupta
- Neurosurgery, WellStar Medical Group, Marietta, Georgia, USA
| | | | - David S Liebeskind
- Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - Edgar A Samaniego
- Departments of Neurology, Neurosurgery and Radiology, University of Iowa, Iowa City, Iowa, USA
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8
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Koh S, Park SY, Liebeskind DS, Choi JW, Kim HK, Choi JY, Kim M, Lee S, Hong JM, Lee JS. Prediction of Intracranial Atherosclerotic Disease-Related Large-Vessel Occlusion Stroke on the Basis of Novel Cerebral Blood Volume Parameters. J Am Heart Assoc 2024; 13:e030936. [PMID: 38214247 PMCID: PMC10926804 DOI: 10.1161/jaha.123.030936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/23/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Mechanical thrombectomy is an effective treatment method for large-vessel occlusion stroke (LVOS); however, it has limited efficacy for intracranial atherosclerotic disease (ICAD)-related LVOS. We investigated the use of cerebral blood volume (CBV) maps for identifying ICAD as the underlying cause of LVOS before the initiation of endovascular treatment (EVT). METHODS AND RESULTS We reviewed clinical and imaging data from patients who presented with LVOS and underwent endovascular treatment between January 2011 and May 2021. The CBV patterns were analyzed to identify an increase in CBV within the hypoperfused area and estimate infarct patterns within the area of decreased CBV. Comparisons were made between the patients with an increase in CBV and those without, and among the estimated infarct patterns: territorial, cortical wedge, basal ganglia-only, subcortical, and normal CBV. Overall, 243 patients were included. CBV increase in the hypoperfused area was observed in 23.5% of patients. A significantly higher proportion of ICAD was observed in those with increased CBV than in those without (56.4% versus 19.8%; P<0.001). Regarding the estimated infarct patterns on the CBV, ICAD was most frequently observed in the normal CBV group (territorial, 14.9%; cortical wedge, 10.0%; basal ganglia-only, 43.8%; subcortical, 35.7%; normal, 61.7%). CBV parameters, including "an increase in CBV," "normal CBV infarct pattern," and "an increase in CBV or normal CBV infarct pattern composite," were independently associated with ICAD. CONCLUSIONS An increased CBV or normal CBV pattern may be associated with ICAD LVOS on the pretreatment perfusion imaging.
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Affiliation(s)
- Seungyon Koh
- Department of Brain ScienceAjou University School of MedicineSuwonRepublic of Korea
- Department of NeurologyAjou University School of Medicine, Ajou University HospitalSuwonRepublic of Korea
| | - So Young Park
- Department of NeurologyAjou University School of Medicine, Ajou University HospitalSuwonRepublic of Korea
| | | | - Jin Wook Choi
- Department of Radiology, Ajou University School of MedicineAjou University HospitalSuwonRepublic of Korea
| | - Han Ki Kim
- Department of Brain ScienceAjou University School of MedicineSuwonRepublic of Korea
| | - Jun Young Choi
- Department of Brain ScienceAjou University School of MedicineSuwonRepublic of Korea
- Department of NeurologyAjou University School of Medicine, Ajou University HospitalSuwonRepublic of Korea
| | - Min Kim
- Department of NeurologyAjou University School of Medicine, Ajou University HospitalSuwonRepublic of Korea
| | - Seong‐Joon Lee
- Department of NeurologyAjou University School of Medicine, Ajou University HospitalSuwonRepublic of Korea
| | - Ji Man Hong
- Department of NeurologyAjou University School of Medicine, Ajou University HospitalSuwonRepublic of Korea
| | - Jin Soo Lee
- Department of NeurologyAjou University School of Medicine, Ajou University HospitalSuwonRepublic of Korea
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9
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Cho KC, Son NH, Choi JW, Jung WS. Angiographic tapering sign as a surrogate marker for large vessel occlusion due to intracranial atherosclerotic stenosis and its clinical implication: a retrospective matched case-control study. J Neurointerv Surg 2023; 15:e204-e208. [PMID: 36223997 DOI: 10.1136/jnis-2022-019311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The purpose of this study was to investigate whether the initial DSA appearance of the occlusion during mechanical thrombectomy (MT) can help distinguish the nature of the underlying lesion and predict radiological and clinical outcomes. METHODS We retrospectively reviewed cases of patients with acute ischemic stroke who underwent MT for anterior circulation occlusion between March 2017 and February 2020. Underlying intracranial atherosclerotic stenosis (ICAS) was determined based on the presence of fixed stenosis after endovascular treatment. Patients were categorized based on the appearance of the occlusion observed in the initial DSA as tapering sign (+) or (-) groups. We performed 1:2 propensity score matching to establish a proper control group among the tapering sign (-) group. We analyzed and compared baseline characteristics and clinical outcomes between the two groups. RESULTS A total of 293 patients (tapering sign (+), n=47; tapering sign (-), n=246) were included in the analysis. The procedure time of MT was significantly longer for the tapering sign (+) group, and the successful recanalization rate after MT was significantly lower in the tapering sign (+) group than in the tapering sign (-) group. Logistic regression showed that ICAS-related occlusion was strongly associated with a positive angiographic tapering sign, and the angiographic tapering sign was a negative factor for the first-pass effect during MT. However, a 3-month good functional outcome was not significantly associated with the angiographic tapering sign. CONCLUSIONS The tapering sign on the initial DSA could be a surrogate marker for ICAS-related occlusion and procedural difficulty. However, its clinical significance remains unclear.
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Affiliation(s)
| | | | - Jin Wook Choi
- Radiology, Ajou University Hospital, Suwon, Gyeonggi-do, Korea
| | - Woo Sang Jung
- Radiology, Ajou University Hospital, Suwon, Gyeonggi-do, Korea
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10
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Sogabe S, Haboshi T, Yamaguchi I, Korai M, Yamamoto N, Shimada K, Kanematsu Y, Takagi Y. Experience of using coronary perfusion balloon catheter for acute middle cerebral artery occlusion. Surg Neurol Int 2023; 14:365. [PMID: 37941628 PMCID: PMC10629293 DOI: 10.25259/sni_608_2023] [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: 07/20/2023] [Accepted: 09/21/2023] [Indexed: 11/10/2023] Open
Abstract
Background We present the case of an individual with acute occlusion of the middle cerebral artery caused by atherosclerosis. The patient underwent angioplasty using a coronary perfusion balloon, which resulted in a favorable clinical outcome. Case Description A 66-year-old male patient presented with an acute onset of right hemiplegia and dysarthria. Magnetic resonance imaging revealed an occlusion of the left middle cerebral artery, and alteplase was administered, followed by a mechanical thrombectomy and intracranial balloon catheter angioplasty. Due to restenosis, a coronary perfusion balloon catheter was used for a 15-minute angioplasty procedure while maintaining the perfusion. This treatment approach led to the recanalization of the artery and favorable clinical outcomes. Conclusion The coronary perfusion balloon may represent a viable therapeutic alternative for the management of refractory intracranial atherosclerotic large vessel occlusion.
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Affiliation(s)
- Shu Sogabe
- Department of Neurosurgery, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tatsuya Haboshi
- Department of Neurosurgery, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Izumi Yamaguchi
- Department of Neurosurgery, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Masaaki Korai
- Department of Neurosurgery, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Nobuaki Yamamoto
- Department of Clinical Neurosciences, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kenji Shimada
- Department of Neurosurgery, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yasuhisa Kanematsu
- Department of Neurosurgery, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
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11
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Memon MZ, Ezzeldin M, Biswas A, Ahmad R, Nisar T, Singla A, Muhammad N, Shaltoni H, Kan P, Zaidat OO, Khandelwal P. Novel technique of stent placement via gateway balloon in intracranial atherosclerosis-associated large vessel occlusion. J Neuroimaging 2023; 33:773-780. [PMID: 37391866 DOI: 10.1111/jon.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Neuroform Atlas stent can be deployed directly via gateway balloon for angioplasty and stent placement without the need for exchange maneuver required for Wingspan stent use. We present our initial experience of this strategy in intracranial atherosclerosis-associated large vessel occlusions. METHODS Patients were identified through mechanical thrombectomy (MT) database from January 2020 to June 2022 at our institutions. Due to reocclusion or impending occlusion, rescue angioplasty with stent placement was performed after initial standard MT. Primary outcomes were good angiographic recanalization with modified thrombolysis in cerebral infarction (mTICI) score of 2b-3, rate of intracranial hemorrhage (ICH), and favorable functional outcome at 3 months, that is, modified Rankin Scale (mRS) score of 0-3. RESULTS We identified 22 patients treated using this technique. Among those, 11 were females with their average age at 66 years (range: 52-85). Initial median National Institute of Health Stroke Scale score was 11 (range: 5-30) and all patients received loading doses of aspirin and P2Y₁₂ inhibitor. After performing submaximal angioplasty and Neuroform Atlas stent deployment through the gateway balloon, we achieved final mTICI of 2b-3 in 20 (90%) patients. One patient had ICH post-op that was asymptomatic. Eight (36%) patients had mRS of 0-3 at 90 days. CONCLUSION Our preliminary experience suggests possible safety and feasibility of deploying Neuroform Atlas stent through a compatible Gateway balloon microcatheter without the need for ICH-associated microcatheter exchange. Further studies with long-term clinical and angiographic follow-up are warranted to corroborate our initial findings.
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Affiliation(s)
- Muhammad Zeeshan Memon
- Department of Neurosurgery Rutgers, The State University of New Jersey, Newark, New Jersey, USA
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mohamad Ezzeldin
- Department of Clinical Sciences, College of Medicine, University of Houston, Houston, Texas, USA
| | - Arundhati Biswas
- Department of Neurosurgery Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Rowaid Ahmad
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Taha Nisar
- Department of Neurology, University of South Alabama
| | - Amit Singla
- Department of Neurosurgery Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Nazar Muhammad
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Hashem Shaltoni
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Peter Kan
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Osama O Zaidat
- Departments of Endovascular Neurosurgery and Stroke, St. Vincent Mercy Medical Center, Toledo, Ohio, USA
| | - Priyank Khandelwal
- Department of Neurosurgery Rutgers, The State University of New Jersey, Newark, New Jersey, USA
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12
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Thut MZ, Rhiner N, Thurner P, Madjidyar J, Schubert T, Wegener S, Globas C, Luft AR, Kulcsar Z. Stent reconstruction in intracranial atherosclerotic disease related acute ischemic stroke results in high revascularization rates. J Stroke Cerebrovasc Dis 2023; 32:107232. [PMID: 37453214 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107232] [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: 02/02/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES Intracranial atherosclerotic disease (ICAD) is a major cause of large vessel occlusion (LVO) in acute ischemic stroke (AIS). Our study aimed to analyze the effect of percutaneous transluminal angioplasty and stenting (PTAS) in patients with ICAD undergoing rescue treatment in terms of functional outcome and mortality rate at 90 days and compare the results to LVO with thromboembolic origins. MATERIALS AND METHODS A retrospective review of a mechanical thrombectomy (MT) single center database from 01/2019 to 09/2021 was carried out using chart review and angiogram analysis. From 469 acute stroke patients, 361 patients were enroled in the study, of whom twenty-four (6.6%) were diagnosed with underlying ICAD and treated with angioplasty and stent reconstruction (PTAS) with a standardized medication protocol. Successful reperfusion, peri-procedural complications, and functional independence at 90 days were collected as outcomes. RESULTS There was no difference in age or admission National Institutes of Health Stroke Scale (NIHSS). Onset to groin puncture (median 460 vs 277 min, P = 0.019) was significantly longer in the ICAD group. The procedure time (median 73 vs 60 min, P = 0.137) did not differ. Successful reperfusion was achieved in 95.8% of ICAD and 91.1% of the remaining patients (P = 0.445). Functional independence (mRS ≤ 2) at 90 days was achieved in 45.8% (11/24) and 42.7% (144/337, (P = 0.767)). The mortality rates (mRS 6) at 90 days were similar (29.2% vs 29.4% (P = 0.983)). CONCLUSION Despite significantly longer treatment delays, the outcome and revascularization rates of ICAD patients were similar to the thromboembolic cohort. Our proposed protocol of PTAS and medication protocol in ICAD was effective with a similar safety profile as MT in general.
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Affiliation(s)
- Mara Z Thut
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Nadine Rhiner
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Patrick Thurner
- Department of Neuroradiology, Clinical Neurocenter, University Hospital Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland
| | - Jawid Madjidyar
- Department of Neuroradiology, Clinical Neurocenter, University Hospital Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland
| | - Tilman Schubert
- Department of Neuroradiology, Clinical Neurocenter, University Hospital Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland
| | - Susanne Wegener
- Department of Neurology, Clinical Neurocenter, University Hospital Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland
| | - Christoph Globas
- Department of Neurology, Clinical Neurocenter, University Hospital Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland
| | - Andreas R Luft
- Department of Neurology, Clinical Neurocenter, University Hospital Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland; Cerneo Center for Neurology and Rehabilitation, Seestrasse 18, Vitznau 6354, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neurocenter, University Hospital Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland.
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13
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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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14
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Yoshimoto T. Imaging diagnosis of intracranial atherosclerosis stenosis-related large vessel occlusion before and during endovascular therapy. Front Neurol 2023; 14:1168004. [PMID: 37416315 PMCID: PMC10320000 DOI: 10.3389/fneur.2023.1168004] [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: 02/17/2023] [Accepted: 05/26/2023] [Indexed: 07/08/2023] Open
Abstract
It is becoming increasingly important to identify the type of stroke, especially the mechanism of occlusion, before and during its treatment. In the case of intracranial atherosclerotic stenosis-related large vessel occlusion, it is necessary to develop a treatment strategy that includes not only mechanical thrombectomy but also adjunctive therapies such as primary or rescue therapy (percutaneous angioplasty, intracranial/carotid stenting, local fibrinolysis) and perioperative antithrombotic therapy. However, in clinical practice we often encounter cases where it is difficult to identify the occlusive mechanism before endovascular treatment because of insufficient information in the minimal circumstances of the hyperacute phase of stroke. Here we focus on the imaging diagnosis before and during treatment of intracranial atherosclerotic stenosis-related large vessel occlusion with in situ thrombotic occlusion as the mechanism of thrombotic occlusion, based on previous reports. We describe the diagnosis of intracranial atherosclerotic stenosis-related large vessel occlusion from the perspectives of "thrombus imaging," "perfusion," and "occlusion margin."
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15
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Huo X, Sun D, Chen W, Han H, Abdalkader M, Puetz V, Yi T, Wang H, Liu R, Tong X, Jia B, Ma N, Gao F, Mo D, Yan B, Mitchell PJ, Leung TW, Yavagal DR, Albers GW, Costalat V, Fiehler J, Zaidat OO, Jovin TG, Liebeskind DS, Nguyen TN, Miao Z. Endovascular Treatment for Acute Large Vessel Occlusion Due to Underlying Intracranial Atherosclerotic Disease. Semin Neurol 2023; 43:337-344. [PMID: 37549690 DOI: 10.1055/s-0043-1771207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Intracranial atherosclerotic disease (ICAD) is one of the most common causes of acute ischemic stroke worldwide. Patients with acute large vessel occlusion due to underlying ICAD (ICAD-LVO) often do not achieve successful recanalization when undergoing mechanical thrombectomy (MT) alone, requiring rescue treatment, including intra-arterial thrombolysis, balloon angioplasty, and stenting. Therefore, early detection of ICAD-LVO before the procedure is important to enable physicians to select the optimal treatment strategy for ICAD-LVO to improve clinical outcomes. Early diagnosis of ICAD-LVO is challenging in the absence of consensus diagnostic criteria on noninvasive imaging and early digital subtraction angiography. In this review, we summarize the clinical and diagnostic criteria, prediction of ICAD-LVO prior to the procedure, and EVT strategy of ICAD-LVO and provide recommendations according to the current literature.
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Affiliation(s)
- Xiaochuan Huo
- Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dapeng Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenhuo Chen
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Hongxing Han
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | | | - Volker Puetz
- Department of Neurology, University Clinics Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Tingyu Yi
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Hao Wang
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Raynald Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bernard Yan
- Department of Medicine and Neurology, Melbourne Brain Centre, Melbourne, Australia
| | - Peter J Mitchell
- Department of Radiology, Melbourne Brain Centre, Melbourne, Australia
| | - Thomas W Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Dileep R Yavagal
- Departments of Neurology and Neurosurgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida
| | - Gregory W Albers
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Osama O Zaidat
- Department of Neuroscience, Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Tudor G Jovin
- Department of Neurology, Cooper University Hospital, Camden, New Jersey
| | - David S Liebeskind
- Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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16
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Abdelrady M, Rodriguez J, Dargazanli C, Lefevre PH, Ognard J, Murias E, Chaviano J, Gentric JC, Ben Salem D, Mourand I, Arquizan C, Derraz I, Vega P, Costalat V. Angioplasty, stenting, or both - rescue maneuvers and reperfusion after endovascular therapy for intracranial atherosclerosis-related occlusion. Neuroradiology 2023; 65:775-784. [PMID: 36609714 DOI: 10.1007/s00234-022-03108-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/18/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE Data concerning reperfusion strategies of intracranial atherosclerosis-related occlusion (ICARO) and clinico-angiographic outcomes remain scarce, particularly in Caucasians. We aim to compare the reperfusion rate and functional outcome between reperfusion strategies in the setting of the ICARO. METHODS Retrospective analysis of prospectively maintained endovascular thrombectomy (EVT) registries at three high-volume stroke centers were retrospectively analyzed for consecutive ICARO patients from January 2015 to December 2019. We defined ICARO as any fixed high-degree (> 70%) focal narrowing or stenosis of any degree with a perpetual tendency for reocclusion. We categorized reperfusion strategies into four groups: EVT [group 1], balloon angioplasty [(BAp), group 2], placement of self-expandable stents [(SES), group 3], and BAp combined with implantation of SES; or direct placement of balloon mounted stents (BMS) [(BAp-SES/BMS), group 4]. We evaluated the association with the successful reperfusion [mTICI 2b - 3] and favorable outcome [mRS 0-2] with logistic regression analysis. RESULTS Out of 2550 EVT, 124 patients (median age, 70 (61-80) years; 76 men) with ICARO and 130 reperfusion attempts [36 EVT, 38 BAp, 17 SES, and 39 BAp + SES/BMS] were analyzed. SES implantation showed the highest frequency of post-procedural symptomatic intracranial hemorrhage [(18%, 3/17), p = .03]; however, we observed no significant differences in the mortality rate. Overall, we achieved successful reperfusion in 71% (92/130) and favorable outcomes in 42% (52/124) of the patients. BAp + SES/BMS was the only independent predictor of the final successful reperfusion [aOR, 4.488 (95% CI, 1.364-14.773); p = .01], which was significantly associated with the 90-day favorable outcome [aOR, 10.837 (95% CI, 3.609-32.541); p = < .001] after adjustment for confounding variables between the reperfusion strategies. CONCLUSION Among patients with ICARO, the rescue angioplasty stenting effectively contributed to higher odds of successful reperfusion with no increased risk for intracranial hemorrhage.
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Affiliation(s)
- Mohamed Abdelrady
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Hospital, Montpellier, France.
- Department of Neuroradiology, Hôpital Cavale Blanche, Brest University Hospital, Bd Tanguy Prigent, 29200, Brest, France.
- Department of Neuroradiology, El-Demerdash University Hospital, Cairo, Egypt.
| | - José Rodriguez
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Spain
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Hospital, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Hospital, Montpellier, France
| | - Julien Ognard
- Department of Neuroradiology, Hôpital Cavale Blanche, Brest University Hospital, Bd Tanguy Prigent, 29200, Brest, France
| | - Eduardo Murias
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Spain
| | - Juan Chaviano
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Spain
| | - Jean-Christophe Gentric
- Department of Neuroradiology, Hôpital Cavale Blanche, Brest University Hospital, Bd Tanguy Prigent, 29200, Brest, France
| | - Douraied Ben Salem
- Department of Neuroradiology, Hôpital Cavale Blanche, Brest University Hospital, Bd Tanguy Prigent, 29200, Brest, France
| | - Isabelle Mourand
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Hospital, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Hospital, Montpellier, France
| | - Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Hospital, Montpellier, France
| | - Pedro Vega
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Spain
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Hospital, Montpellier, France
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Zhao C, Hu T, Kong W, Yang D, Wan J, Lv K, Liao J, Chen Z, Jiang H, Wu D, Yang P, Zi W, Li F, Yang Q. First-pass effect in patients with acute basilar artery occlusions undergoing stent retriever thrombectomy. J Neurosurg 2023; 138:693-700. [PMID: 35901699 DOI: 10.3171/2022.5.jns22751] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE First-pass effect (FPE), defined as successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2b-3) with a single stent retriever attempt without salvage treatment, has not been fully identified in patients with acute basilar artery occlusion (BAO). The authors' aim was to assess the impact of FPE on efficacy and safety for patients with BAO. METHODS The authors included data from the Acute Basilar Artery Occlusion Study (BASILAR) about patients who underwent mechanical thrombectomy within 24 hours after symptom onset and compared the clinical outcomes of patients who achieved FPE with those who did not. In addition, the authors further compared outcomes between patients with FPE and those with final successful reperfusion achieved with salvage treatment. The primary clinical outcome was favorable outcome (modified Rankin Scale score ≤ 3). RESULTS Among 471 enrolled patients, FPE was achieved in 83 (17.6%) who underwent acute BAO thrombectomy. FPE was strongly associated with favorable outcome (adjusted OR 2.84, 95% CI 1.56-5.16, p = 0.001), lower rate of mortality (28.9% of FPE patients vs 48.2% of non-FPE patients, p = 0.001), and shorter median time from groin puncture to recanalization (65 minutes vs 110 minutes, p < 0.001). Occlusion site of the distal basilar artery, cardioembolism, and undetermined etiology were positive predictors of FPE, whereas baseline National Institutes of Health Stroke Scale score was a negative predictor. Compared with final successful reperfusion, FPE also contributed independently to favorable outcomes (adjusted OR 2.25, 95% CI 1.23-4.10, p = 0.008). CONCLUSIONS FPE was associated with 90-day favorable outcome in patients with acute BAO who underwent stent retriever thrombectomy within 24 hours. Clinical trial registration no.: ChiCTR1800014759 (www.chictr.org.cn).
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Affiliation(s)
- Chenhao Zhao
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ting Hu
- 2Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Weilin Kong
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - De Yang
- 3Department of Neurology, Chongqing University Fuling Hospital, Chongqing, China
| | - Junfang Wan
- 4Department of Anesthesiology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Kefeng Lv
- 5Department of Neurology, Affiliated Dongguan People's Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong, China
| | - Jiasheng Liao
- 6Department of Neurology, Suining No. 1 People's Hospital, Suining, Sichuan, China
| | - Zhao Chen
- 7Department of Neurology, Yaan People's Hospital, Yaan, Sichuan, China
| | - He Jiang
- 8Department of Neurology, The First People's Hospital of Neijiang, Neijiang, Sichuan, China; and
| | - Deping Wu
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ping Yang
- 9No. 923 Hospital of PLA Joint Logistics Support Force, Nanning, Guangxi, China
| | - Wenjie Zi
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengli Li
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qingwu Yang
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Comparison of Safety and Efficacy after Emergency Stenting in Patients Exhibiting Intracranial Atherosclerotic Stenosis Associated with Large-vessel Occlusion with and without Intravenous Infusion of Tirofiban. Cardiovasc Intervent Radiol 2023; 46:377-384. [PMID: 36797426 PMCID: PMC10014670 DOI: 10.1007/s00270-023-03372-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/23/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE Intracranial rescue stent angioplasty is a bailout strategy for acute stroke patients in cases of unsuccessful endovascular thrombectomy due to underlying atherosclerotic stenosis. However, there is no consensus on a preprocedural and intraprocedural antiplatelet regimen. The aim of this single-centre study was to compare the safety and efficacy of emergency stenting in patients exhibiting intracranial atherosclerotic stenosis-related acute large-vessel occlusion with or without peri-interventional intravenous infusion of tirofiban. MATERIALS AND METHODS We performed a retrospective analysis of 78 patients who were treated with rescuestent angioplasty between 2010 and 2019 due to acute ischaemic stroke. The patients were divided into 2 groups: those who received peri-interventional intravenous tirofiban and those who did not receive tirofiban. We compared clinical safety and functional outcomes in both treatment groups with symptomatic haemorrhage as the primary endpoint. Bivariate and multivariable logistic regression was performed to investigate the association between tirofiban and outcome measures. RESULTS Thirty-seven patients were treated with intravenous tirofiban (47.4%), and 41 patients did not receive intravenous tirofiban (52.6%). Statistical analysis revealed no significant difference between the two groups in the rate of symptomatic haemorrhage (16.2% in the tirofiban group versus 14.6% in the control group, p = 0.847). The 3-month mortality (21.6% in the tirofiban group versus 17.1% in the control group, p = 0.611) and good functional outcomes according to the modified Rankin scale (45.9% versus 34.1%, p = 0.289) were comparable. CONCLUSION The results of our study suggest that the application of tirofiban for rescue stenting after failed mechanical thrombectomy is safe.
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Xu X, Yang K, Xu J, Yang Q, Guo Y, Xu Y, Wang H, Ge L, Zhou Z, Huang X. Endovascular treatment in patients with middle cerebral artery occlusion of different aetiologies. Neuroradiology 2023; 65:609-618. [PMID: 36333556 DOI: 10.1007/s00234-022-03078-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The purpose of this study was to evaluate differences in endovascular treatment (EVT) outcomes in M1 segment middle cerebral artery occlusion (MCAO) patients with different pathologic subtypes. METHODS Patients with MCAO who received EVT from July 2014 to December 2020 were categorized into three groups: embolism without internal carotid artery steno-occlusion (MCAO-E), in situ atherosclerotic thrombosis (MCAO-AS) and embolism from tandem ICA steno-occlusion (MCAO-T). Baseline characteristics, EVT-related factors and clinical outcomes were compared between groups. Multivariable regression analyses were performed to evaluate the relationship between aetiologic classification and outcomes at 90 days after stroke. RESULTS Among eligible patients (n = 220), MCAO-E (n = 129, 58.6%) was the most common aetiology, followed by MCAO-AS (n = 47, 21.4%) and MCAO-T (n = 44, 20.0%). Patients with MCAO-E were significantly older but had a lower rate of dyslipidaemia and smoking history than those with MCAO-AS. Although patients with MCAO-AS and MCAO-T more often required rescue balloon angioplasty and stenting (p < 0.001), no significant difference in the rate of final recanalization was found. Patients in the MCAO-AS group obtained better functional outcomes (90-day modified Rankin Scale score, 0-2) (p = 0.002) and lower mortality than in the MCAO-E group (p = 0.009). On multivariable logistic regression, we failed to find that stroke subtype was an independent predictor of functional outcomes and mortality. CONCLUSIONS Patients with acute MCA M1 occlusion stroke due to different pathogeneses had comparable successful recanalization rates and functional independence at 90 days. The optimal management for MCAO patients with different aetiologies requires further research.
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Affiliation(s)
- Xiangjun Xu
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Ke Yang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Junfeng Xu
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Qian Yang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Yapeng Guo
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Youqing Xu
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Hao Wang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Liang Ge
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China.
| | - Xianjun Huang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China.
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20
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Li W, Sui X, Li C, Zhao W, Yuan S, Dou S, Han G, Ji K, Ma Q, Ji X. Emergency Angioplasty or Stenting for Stroke Patients with Intracranial Atherosclerotic Large Vessel Occlusion. J Atheroscler Thromb 2023; 30:160-169. [PMID: 35466122 PMCID: PMC9925205 DOI: 10.5551/jat.63381] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIM Mechanical thrombectomy (MT) has become the gold standard for the treatment of large vessel occlusion (LVO) in acute ischemic stroke. However, it remains controversial whether emergency angioplasty or stenting in patients with intracranial atherosclerotic stenosis (ICAS) should be adopted. Thus, we performed a retrospective analysis of clinical data to determine whether emergency angioplasty or stenting is necessary. METHODS We retrospectively analyzed data from patients undergoing MT with ICAS-related LVO of the acute anterior circulation between 2017 and 2019. Eligible patients were divided into two treatment groups: those who received rescue angioplasty or stenting [Patients treated with rescue angioplasty or stenting (PTAS) group] and those who received thrombectomy alone (non-PTAS group). The primary outcomes were good prognosis at 90 days (mRS: 0-2). Mortality, symptomatic intracranial hemorrhage, and reocclusion rate were evaluated as secondary outcomes. RESULTS A total of 184 patients with severe stenosis after MT were enrolled, including 64 patients receiving rescue angioplasty or stenting and 120 patients without rescue angioplasty or stenting. Compared with the non-PTAS group, a better functional outcome (mRS0-2) (51.6% vs. 35.0%, adjusted odds ratio: 2.11, 95% confidence interval [CI]: 1.22-4.29; P=0.02), lower 7-day National Institutes of Health Stroke Scale [6 (3-12.75) vs. 10 (4-16); P=0.04], lower 24-h neurological deterioration rate (7.8% vs. 21.7%, P=0.02), and lower 24-h reocclusion rate were observed in the PTAS group (6.3% vs. 17.5%, P=0.03). There were no significant differences in mortality or incidence of symptomatic intracerebral hemorrhage. CONCLUSION Emergency angioplasty or stenting could be a safe and feasible therapeutic option with better outcomes for stroke patients with ICAS-related LVO.
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Affiliation(s)
- Weili Li
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China,Cerebrovascular Diseases Research Institute, Xuanwu Hospital, Capital Medical University, Beijing, China,Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xueqin Sui
- Department of General Medicine, Affiliated Hospital of Weifang Medical University, Shandong province, China
| | - Cong Li
- Department of Neurology, Weifang People’s Hospital, Shandong province, China
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Shuhua Yuan
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital, Capital Medical University, Beijing, China,Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Shoutan Dou
- Department of Neurology, Affiliated Hospital of Weifang Medical University, Shandong province, China
| | - Guosheng Han
- Department of Neurology, Affiliated Hospital of Weifang Medical University, Shandong province, China
| | - Kangxiang Ji
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xunming Ji
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China,Cerebrovascular Diseases Research Institute, Xuanwu Hospital, Capital Medical University, Beijing, China,Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
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21
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Ma C, Cao W, Huang Y, Tian Q, Chen Y, Wang Y, Chen J, Gao P, Dmytriw AA, Regenhardt RW, Chen F, Ma Q, Jiao L, Yang B. Outcome after endovascular treatment for acute ischemic stroke by underlying etiology: Tertiary experience and meta-analysis. Front Neurol 2023; 14:1065484. [PMID: 37122311 PMCID: PMC10140423 DOI: 10.3389/fneur.2023.1065484] [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: 10/09/2022] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Objective To investigate the effect of two major etiologies [intracranial atherosclerotic stenosis (ICAS) and cardioembolism (CE])] on outcomes of acute ischemic stroke (AIS) patients due to large vessel occlusion (LVO) after endovascular thrombectomy (EVT). Methods Anterior circulation AIS patients receiving EVT were retrospectively analyzed. Clinical and laboratory data were collected. Clinical outcomes including favorable outcome (90-day modified Rankin Scale 0-2), mortality, intracranial hemorrhage (ICH) and symptomatic ICH (sICH) were compared. A systematic review and meta-analysis was also performed. Results A total of 302 AIS patients were included and divided into the ICAS group (86 patients) and the CE group (216 patients). Patients in the ICAS group were younger (62[18.0] vs. 68[19.0] years, p < 0.001), more likely to have smoking (52.3% vs. 26.9%, p < 0.001) and drinking (52.3% vs. 23.1%, p < 0.001) history, and more frequently required rescue therapy (80.2% vs. 4.6%, p < 0.001) compared to the CE group. However, favorable outcome (aOR 0.722, 95%CI 0.372-1.402, p = 0.336) and mortality (aOR 1.522, 95%CI 0.606-3.831, p = 0.371) were not significantly different between the two groups before and after adjustment. The incidence of sICH and ICH were comparable between the two groups before and after adjustment. Systematic review and meta-analysis consisted of 8 eligible studies (7 previous studies and this current study), incorporating 552 ICAS patients and 1,402 CE patients. Favorable outcome was slightly more likely in the ICAS group compared to the CE group (54.2% vs. 46.3%, OR 1.40, 95%CI 1.00-1.96, I 2 = 53.2%). Moreover, the ICAS group had a lower rate of mortality (14.3% vs. 22.2%, OR 0.63, 95%CI 0.46-0.87, I 2 = 0.0%) and ICH (19.5% vs. 31.9%, OR 0.60, 95%CI 0.42-0.84, I 2 = 0.0%) than the CE group, while the two groups were similar in sICH rate (5.9% vs. 6.7%, OR 0.94, 95%CI 0.55-1.60, I 2 = 6.3%). Conclusion Etiology was not considered as an important factor in functional outcome, despite the differences in baseline characteristics and technical EVT approach. The current study of anterior circulation AIS-LVO patients supports that outcomes for those with ICAS are not significantly different from those with CE.
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Affiliation(s)
- Chunlin Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, The First Hospital of Shanxi Medical University, Shanxi, Taiyuan, China
| | - Wenbo Cao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Yang Huang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Yankuang Xinlicheng General Hospital, Jining, Shandong, China
| | - Qiuyue Tian
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Adam A. Dmytriw
- Neurointerventional Program, Departments of Medical Imaging and Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert W. Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Fei Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
- *Correspondence: Bin Yang,
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22
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Safety and Efficacy of Tirofiban in Severe Ischemic Stroke Patients Undergoing Mechanical Thrombectomy. J Cardiovasc Dev Dis 2022; 9:jcdd9110408. [PMID: 36421943 PMCID: PMC9699197 DOI: 10.3390/jcdd9110408] [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: 09/02/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
Tirofiban has recently shown encouraging efficacy and safety among acute ischemic stroke (AIS) patients with mechanical thrombectomy (MT). However, the benefits of tirofiban varied among studies depending on the patient’s condition, which was often not well analyzed. This study aimed to identify the characteristics of patients who may obtain the largest benefits from tirofiban. The efficacy endpoint was a favorable outcome defined as a modified Rankin Scale (mRS) score of 0~2 at 90 days. The safety endpoints were intracranial hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH) and mortality at 90 days. Adjusted logistic regression analysis and subgroup analyses were utilized to investigate the factors associated with tirofiban and the outcome. All of 285 patients fit the inclusion criteria. Tirofiban was associated with a higher rate of favorable outcome (aOR 2.033, 95% CI, 1.002~4.123, p = 0.043) but not with an increased risk of ICH, sICH or mortality (p > 0.05). Moreover, subgroup analyses revealed that tirofiban was associated with favorable outcomes in patients with NIHSS > 14 (aOR 2.778, 95% CI 1.056~7.356, p = 0.038) but not in patients with NIHSS ≤ 14 (aOR 1.719, 95% CI 0.646~4.578, p = 0.278). No significant heterogeneity was found in the effect of tirofiban across the subgroups of age, sex, ASPECTS, time from onset to puncture, use of t-PA or stroke etiology (p for interaction > 0.05). The administration of tirofiban was associated with favorable outcomes in severe ischemic stroke patients, and further studies are needed to confirm this finding.
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Sun D, Huo X, Raynald, Ma N, Gao F, Mo D, Han H, Albers GW, Miao Z. Prediction of intracranial atherosclerotic acute large vessel occlusion by severe hypoperfusion volume growth rate. J Stroke Cerebrovasc Dis 2022; 31:106799. [PMID: 36174326 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106799] [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: 07/15/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND PURPOSE We aimed to investigate whether the time elapsed from stroke onset to imaging (OTI) combined with the parameters generated by automated computed tomography perfusion (CTP) could predict large vessel occlusion (LVO) patients with underlying intracranial atherosclerotic disease (ICAD) before endovascular treatment (EVT). METHODS We performed a prospective cohort of LVO patients with automated CTP before EVT from two comprehensive stroke centers. Severe hypoperfusion volume growth rate was defined as the Time-to-Maximum (Tmax) > 10s divided by OTI. We performed receiver operating characteristic analyses to assess the ICAD prediction performance of all the automated CTP parameters, Delong test to compare the area under the curve (AUC) of severe hypoperfusion volume growth rate with the AUC of the other parameters, and logistic regression analysis to find the independent predictors of LVO with underlying ICAD. RESULTS Of the 204 enrolled LVO patients, 95 ICAD patients and 109 non-ICAD patients were identified. The AUC of severe hypoperfusion volume growth rate was 0.86 (95% confidence interval [CI] 0.81 - 0.91, P < 0.001), the cut-off value with the highest Youden Index was ≤ 11.2 mL/h (sensitivity, 78.95%; specificity, 77.06%; accuracy 77.94%), which was larger than the other parameters except for hypoperfusion intensity ratio (HIR) (All P for Delong test < 0.05). Atrial fibrillation (odds ratio [OR]: 0.09, 95%CI: 0.03 - 0.26, P < 0.001), admission ASPECTS (1-point increased OR: 1.25, 95%CI: 1.03 - 1.53, P = 0.024), and severe hypoperfusion volume growth rate (1 mL/h increased OR: 0.94, 95%CI: 0.90 - 0.98, P = 0.003) were associated with underlying ICAD independently. CONCLUSIONS Severe hypoperfusion volume growth rate showed the best performance for LVO with underlying ICAD prediction. Future larger studies for external validation are needed.
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Affiliation(s)
- Dapeng Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Raynald
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongxing Han
- Department of Neurology, Linyi people's Hospital, Linyi, Shandong Province, China.
| | - Gregory W Albers
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, California, USA.
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Siddiqui AH, Waqas M, Andersson T, Saver JL, Mattle HP, Bozorgchami H, Ribó M, Zaidat OO. Predictors of unfavorable outcomes despite substantial reperfusion: Insights from Analysis of Revascularization in Ischemic Stroke With EmboTrap II Study. Interv Neuroradiol 2022; 28:556-561. [PMID: 34719305 PMCID: PMC9511624 DOI: 10.1177/15910199211051553] [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: 03/20/2021] [Accepted: 09/18/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A considerable proportion of stroke patients have unfavorable outcomes despite substantial reperfusion during mechanical thrombectomy for large vessel occlusion. This study aimed to determine predictors of unfavorable outcomes despite substantial reperfusion (modified thrombolysis in cerebral infarction score of ≥2b). METHODS We conducted a post hoc analysis of Analysis of Revascularization in Ischemic Stroke With EmboTrap, a prospective, multicenter study on the efficacy of the EmboTrap revascularization device. We included patients with anterior large vessel occlusion, substantial reperfusion within three passes, and 3-month follow-up. Univariate and multivariate logistic regression analyses were performed to determine independent predictors of dependency or death (modified Rankin Score 3-6) at 90 days. RESULTS Of the 176 patients included in the study, 124 (70.45%) achieved modified Rankin Score of 0-2 at 90 days and 52 (29.6%) had modified Rankin Score of 3-6. On univariate analysis, patient age and initial National Institutes of Health Stroke Scale score were significantly higher in the modified Rankin Score of 3-6 groups (71.4 ± 11.3 years vs. 66.0 ± 13.1 years, 0.01; 18.9 ± 4.13 vs. 14.6 ± 4.36, p < 0.01, respectively). Mean number of passes and symptomatic intracranial hemorrhage were also higher in patients with modified Rankin Score of 3-6 (2.46 ± 1.42 vs. 1.65 ± 0.9, p < 0.01; 13.5% vs. 2.4%, p = 0.008). On multivariate analysis, initial National Institutes of Health Stroke Scale score and mean number of passes and were independent predictors of modified Rankin Score of 3-6 at 90 days. CONCLUSION More severe initial neurologic deficit and higher number of passes in patients with substantial reperfusion were independent predictors of dependency or death. These findings highlight a reduction in the number of passes required to achieve reperfusion as a therapeutic target to improve the outcome after thrombectomy.
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Affiliation(s)
- Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Muhammad Waqas
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Tommy Andersson
- Karolinska University Hospital and Clinical Neuroscience Karolinska Institute, Stockholm, Sweden
- Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Jeffrey L Saver
- Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Marc Ribó
- Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain
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Kim JH, Jung YJ. Should we always retrieve? Endovascular treatment outcomes in emergent large-vessel occlusion due to underlying intracranial atherosclerotic stenosis. Clin Neurol Neurosurg 2022; 222:107464. [DOI: 10.1016/j.clineuro.2022.107464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 09/19/2022] [Accepted: 09/28/2022] [Indexed: 11/03/2022]
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Qiu Z, Li F, Sang H, Luo W, Liu S, Liu W, Guo Z, Li H, Sun D, Huang W, Zhang M, Zhang M, Dai W, Zhou P, Deng W, Zhou Z, Huang X, Lei B, Li J, Yuan Z, Song B, Miao J, Liu S, Jin Z, Zeng G, Zeng H, Yuan J, Wen C, Yu Y, Yuan G, Wu J, Long C, Luo J, Tian Z, Zheng C, Hu Z, Wang S, Wang T, Qi L, Li R, Wan Y, Ke Y, Wu Y, Zhu X, Kong W, Huang J, Peng D, Chang M, Ge H, Shi Z, Yan Z, Du J, Jin Y, Ju D, Huang C, Hong Y, Liu T, Zhao W, Wang J, Zheng B, Wang L, Liu S, Luo X, Luo S, Xu X, Hu J, Pu J, Chen S, Sun Y, Jiang S, Wei L, Fu X, Bai Y, Yang S, Hu W, Zhang G, Pan C, Zhang S, Wang Y, Cao W, Yang S, Zhang J, Guo F, Wen H, Zhang J, Song J, Yue C, Li L, Wu D, Tian Y, Yang J, Lu M, Saver JL, Nogueira RG, Zi W, Yang Q. Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke: The RESCUE BT Randomized Clinical Trial. JAMA 2022; 328:543-553. [PMID: 35943471 PMCID: PMC9364124 DOI: 10.1001/jama.2022.12584] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Tirofiban is a highly selective nonpeptide antagonist of glycoprotein IIb/IIIa receptor, which reversibly inhibits platelet aggregation. It remains uncertain whether intravenous tirofiban is effective to improve functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy. OBJECTIVE To assess the efficacy and adverse events of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke secondary to large vessel occlusion. DESIGN, SETTING, AND PARTICIPANTS This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 55 hospitals in China, enrolling 948 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of time last known well. Recruitment took place between October 10, 2018, and October 31, 2021, with final follow-up on January 15, 2022. INTERVENTIONS Participants received intravenous tirofiban (n = 463) or placebo (n = 485) prior to endovascular thrombectomy. MAIN OUTCOMES AND MEASURES The primary outcome was disability level at 90 days as measured by overall distribution of the modified Rankin Scale scores from 0 (no symptoms) to 6 (death). The primary safety outcome was the incidence of symptomatic intracranial hemorrhage within 48 hours. RESULTS Among 948 patients randomized (mean age, 67 years; 391 [41.2%] women), 948 (100%) completed the trial. The median (IQR) 90-day modified Rankin Scale score in the tirofiban group vs placebo group was 3 (1-4) vs 3 (1-4). The adjusted common odds ratio for a lower level of disability with tirofiban vs placebo was 1.08 (95% CI, 0.86-1.36). Incidence of symptomatic intracranial hemorrhage was 9.7% in the tirofiban group vs 6.4% in the placebo group (difference, 3.3% [95% CI, -0.2% to 6.8%]). CONCLUSIONS AND RELEVANCE Among patients with large vessel occlusion acute ischemic stroke undergoing endovascular thrombectomy, treatment with intravenous tirofiban, compared with placebo, before endovascular therapy resulted in no significant difference in disability severity at 90 days. The findings do not support use of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke. TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier: ChiCTR-IOR-17014167.
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Affiliation(s)
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
- Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Hongfei Sang
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weidong Luo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
- Department of Cardiovascular diseases, The General Hospital of Tibet Military Area Command, Lhasa, China
| | - Shuai Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Wenhua Liu
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China
| | - Zhangbao Guo
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China
| | - Huagang Li
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Dong Sun
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Wenguo Huang
- Department of Neurology, Chinese Medical Hospital of Maoming, Maoming, China
| | - Min Zhang
- Department of Neurology, Chinese Medical Hospital of Maoming, Maoming, China
| | - Min Zhang
- Department of Neurology, Jiangmen Central Hospital, Jiangmen, China
| | - Weipeng Dai
- Department of Neurology, Jiangmen Central Hospital, Jiangmen, China
| | - Peiyang Zhou
- Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Wei Deng
- Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Xianjun Huang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Bo Lei
- Department of Cerebrovascular Diseases, Leshan People's Hospital, Leshan, China
| | - Jinglun Li
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhengzhou Yuan
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Bo Song
- Department of Neurosurgery, Xianyang Hospital of Yan'an University, Xianyang, China
| | - Jian Miao
- Department of Neurology, Xianyang Hospital of Yan'an University, Xianyang, China
| | - Shudong Liu
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan, China
| | - Zhenglong Jin
- Department of Neurology, Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, China
| | - Hongliang Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, China
| | - Junjie Yuan
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Changming Wen
- Department of Neurology, Nanyang Central Hospital, Nanyang, China
| | - Yang Yu
- Department of Neurology, Nanyang Central Hospital, Nanyang, China
| | - Guangxiong Yuan
- Department of Emergency, Xiangtan Central Hospital, Xiangtan, China
| | - Junxiong Wu
- Department of Emergency, Xiangtan Central Hospital, Xiangtan, China
| | - Chen Long
- Department of Emergency, Xiangtan Central Hospital, Xiangtan, China
| | - Jun Luo
- Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Zhenxuan Tian
- Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Chong Zheng
- Department of Neurology, Longyan First Affliated Hospital of Fujian Medical University, Longyan, China
| | - Zhizhou Hu
- Department of Neurology, Longyan First Affliated Hospital of Fujian Medical University, Longyan, China
| | - Shouchun Wang
- Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China
| | - Tao Wang
- Department of Neurology, Huainan First People's Hospital, Huainan, China
| | - Li Qi
- Department of Neurology, The 924th Hospital of The People's Liberation Army, Guilin, China
| | - Rongzong Li
- Department of Neurology, The 924th Hospital of The People's Liberation Army, Guilin, China
| | - Yue Wan
- Department of Neurology, The Third People's Hospital of Hubei Province, Wuhan, China
| | - Yingbing Ke
- Department of Neurology, The Third People's Hospital of Hubei Province, Wuhan, China
| | - Youlin Wu
- Department of Neurology, Chongzhou People's Hospital, Chongzhou, China
| | - Xiurong Zhu
- Department of Neurology, Chongzhou People's Hospital, Chongzhou, China
| | - Weilin Kong
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Daizhou Peng
- Department of Neurology, Qianxinan People's Hospital, Xingyi, China
| | - Mingze Chang
- Department of Neurology, Xi'an Third Hospital, Xi'an, China
| | - Hanming Ge
- Department of Neurology, Xi'an Third Hospital, Xi'an, China
| | - Zhonghua Shi
- Department of Neurosurgery, The 904th Hospital of The People's Liberation Army, Wuxi, China
| | - Zhizhong Yan
- Department of Neurosurgery, The 904th Hospital of The People's Liberation Army, Wuxi, China
| | - Jie Du
- Department of Neurology, Kaizhou District People's Hospital, Kaizhou, China
| | - Ying Jin
- Department of Neurology, Songyuan Jilin Oilfield Hospital, Songyuan, China
| | - Dongsheng Ju
- Department of Neurology, Songyuan Jilin Oilfield Hospital, Songyuan, China
| | - Chuming Huang
- Department of Neurology, Shantou Central Hospital, Shantou, China
| | - Yifan Hong
- Department of Neurology, Shantou Central Hospital, Shantou, China
| | - Tianzhu Liu
- Department of Neurology, Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, China
| | - Wenlong Zhao
- Department of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jian Wang
- Department of Neurology, Ya'an People's Hospital, Ya'an, China
| | - Bo Zheng
- Department of Neurology, Ya'an People's Hospital, Ya'an, China
| | - Li Wang
- Department of Neurology, The Third People's Hospital of Zigong, Zigong, China
| | - Shugai Liu
- Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan, China
| | - Xiaojun Luo
- Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan, China
| | - Shiwei Luo
- Department of Neurology, Jieyang People's Hospital, Jieyang, China
| | - Xinwei Xu
- Department of Neurology, Jieyang People's Hospital, Jieyang, China
| | - Jinrong Hu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Jie Pu
- Department of Neurology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Department of Neurology, People's Hospital of Wuhan University, Hubei General Hospital, Wuhan, China
| | - Shengli Chen
- Department of Neurology, Chongqing University Three Gorges Central Hospital, Wanzhou, China
| | - Yaxuan Sun
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Shunfu Jiang
- Department of Neurology, Jingdezhen First People's Hospital, Jingdezhen, China
| | - Liping Wei
- Department of Neurointervention, Luoyang Central Hospital, Luoyang, China
| | - Xinmin Fu
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, China
| | - Yongjie Bai
- Department of Neurology, The First Affiliated Hospital of Henan Science and Technology University, Luoyang, China
| | - Shunyu Yang
- Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Wei Hu
- Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Guling Zhang
- Department of Neurology, Danzhai County People's Hospital, Danzhai, China
| | - Chengde Pan
- Department of Neurology, Banan District People's Hospital, Banan, China
| | - Shuai Zhang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Yan Wang
- Department of Neurology, The Fifth People's Hospital of Chengdu, Chengdu, China
| | - Wenfeng Cao
- Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Shiquan Yang
- Department of Neurology, The 902nd Hospital of The People's Liberation Army, Bengbu, China
| | - Jun Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Fuqiang Guo
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Hongbin Wen
- Department of Neurology, Xiangyang Central Hospital, Hubei Arts and Science University, Xiangyang, China
| | - Jinhua Zhang
- Department of Neurology, Sir Run Run Shaw Hospital affiliated to Zhejiang University, Hangzhou, China
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Chengsong Yue
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Linyu Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Deping Wu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Yan Tian
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Jie Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Mengjie Lu
- School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Raul G Nogueira
- Department of Neurology, Marcus Stroke & Neuroscience Centre, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
- Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing 400064, China
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27
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Mohammaden MH, Haussen DC, Al-Bayati AR, Hassan A, Tekle W, Fifi J, Matsoukas S, Kuybu O, Gross BA, Lang MJ, Narayanan S, Cortez GM, Hanel RA, Aghaebrahim A, Sauvageau E, Farooqui M, Ortega-Gutierrez S, Zevallos C, Galecio-Castillo M, Sheth SA, Nahhas M, Salazar-Marioni S, Nguyen TN, Abdalkader M, Klein P, Hafeez M, Kan P, Tanweer O, Khaldi A, Li H, Jumaa M, Zaidi S, Oliver M, Salem MM, Burkhardt JK, Pukenas BA, Alaraj A, Peng S, Kumar R, Lai M, Siegler J, Nogueira RG. Stenting and Angioplasty in Neurothrombectomy: Matched Analysis of Rescue Intracranial Stenting Versus Failed Thrombectomy. Stroke 2022; 53:2779-2788. [DOI: 10.1161/strokeaha.121.038248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
Successful reperfusion is one of the strongest predictors of functional outcomes after mechanical thrombectomy (MT). Despite continuous advancements in MT technology and techniques, reperfusion failure still occurs in ≈15% to 30% of patients with large vessel occlusion strokes undergoing MT. We aim to evaluate the safety and efficacy of rescue intracranial stenting for large vessel occlusion stroke after failed MT.
METHODS:
The SAINT (Stenting and Angioplasty in Neurothrombectomy) Study is a retrospective analysis of prospectively collected data from 14 comprehensive stroke centers through January 2015 to December 2020. Patients were included if they had anterior circulation large vessel occlusion stroke due to intracranial internal carotid artery and middle cerebral artery-M1/M2 segments and failed MT. The cohort was divided into 2 groups: rescue intracranial stenting and failed recanalization (modified Thrombolysis in Cerebral Ischemia score 0–1). Propensity score matching was used to balance the 2 groups. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale at 90 days. Secondary outcomes included functional independence (90-day modified Rankin Scale score 0–2). Safety measures included symptomatic intracranial hemorrhage and 90-day mortality.
RESULTS:
A total of 499 patients were included in the analysis. Compared with the failed reperfusion group, rescue intracranial stenting had a favorable shift in the overall modified Rankin Scale score distribution (acOR, 2.31 [95% CI, 1.61–3.32];
P
<0.001), higher rates of functional independence (35.1% versus 7%; adjusted odds ratio [aOR], 6.33 [95% CI, 3.14–12.76];
P
<0.001), and lower mortality (28% versus 46.5%; aOR, 0.55 [95% CI, 0.31–0.96];
P
=0.04) at 90 days. Rates of symptomatic intracerebral hemorrhage were comparable across both groups (7.1% versus 10.2%; aOR, 0.99 [95% CI, 0.42–2.34];
P
=0.98). The matched cohort analysis demonstrated similar results. Specifically, rescue intracranial stenting (n=107) had a favorable shift in the overall modified Rankin Scale score distribution (acOR, 3.74 [95% CI, 2.16–6.57];
P
<0.001), higher rates of functional independence (34.6% versus 6.5%; aOR, 10.91 [95% CI, 4.11–28.92];
P
<0.001), and lower mortality (29.9% versus 43%; aOR, 0.49 [95% CI, 0.25–0.94];
P
=0.03) at 90 days with similar rates of symptomatic intracerebral hemorrhage (7.5% versus 11.2%; aOR, 0.87 [95% CI, 0.31–2.42];
P
=0.79) compared with patients who failed to reperfuse (n=107). There was no heterogeneity of treatment effect across the prespecified subgroups for improvement in functional outcomes.
CONCLUSIONS:
Acute intracranial stenting appears to be a safe and effective rescue strategy in patients with large vessel occlusion stroke who failed MT. Randomized multicenter trials are warranted.
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Affiliation(s)
- Mahmoud H. Mohammaden
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine-Atlanta, GA (M.H.M., D.C.H.)
| | - Diogo C. Haussen
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine-Atlanta, GA (M.H.M., D.C.H.)
| | - Alhamza R. Al-Bayati
- UPMC Stroke Institute, Departments of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, PA (A.R.A.-B., O.K., B.A.G., M.J.L., S.N., R.G.N.)
| | - Ameer Hassan
- Department of Neurology, Valley Baptist Medical Center, Harlingen, TX (A.H., W.T.)
| | - Wondwossen Tekle
- Department of Neurology, Valley Baptist Medical Center, Harlingen, TX (A.H., W.T.)
| | - Johanna Fifi
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.F., S.M.)
| | - Stavros Matsoukas
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.F., S.M.)
| | - Okkes Kuybu
- UPMC Stroke Institute, Departments of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, PA (A.R.A.-B., O.K., B.A.G., M.J.L., S.N., R.G.N.)
| | - Bradley A. Gross
- UPMC Stroke Institute, Departments of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, PA (A.R.A.-B., O.K., B.A.G., M.J.L., S.N., R.G.N.)
| | - Michael J. Lang
- UPMC Stroke Institute, Departments of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, PA (A.R.A.-B., O.K., B.A.G., M.J.L., S.N., R.G.N.)
| | - Sandra Narayanan
- UPMC Stroke Institute, Departments of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, PA (A.R.A.-B., O.K., B.A.G., M.J.L., S.N., R.G.N.)
| | - Gustavo M. Cortez
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, FL (G.M.C., R.A.H., A.A., E.S.)
| | - Ricardo A. Hanel
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, FL (G.M.C., R.A.H., A.A., E.S.)
| | - Amin Aghaebrahim
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, FL (G.M.C., R.A.H., A.A., E.S.)
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, FL (G.M.C., R.A.H., A.A., E.S.)
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.F., S.O.-G., C.Z., M.G.-C.)
| | - Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.F., S.O.-G., C.Z., M.G.-C.)
| | - Cynthia Zevallos
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.F., S.O.-G., C.Z., M.G.-C.)
| | - Milagros Galecio-Castillo
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.F., S.O.-G., C.Z., M.G.-C.)
| | - Sunil A. Sheth
- Department of Neurology, University of Texas, Houston (S.A.S., M.N., S.S.-M.)
| | - Michael Nahhas
- Department of Neurology, University of Texas, Houston (S.A.S., M.N., S.S.-M.)
| | | | - Thanh N. Nguyen
- Department of Neurology, Radiology, Boston University School of Medicine, MA (T.N.N., M.A., P.K.)
| | - Mohamad Abdalkader
- Department of Neurology, Radiology, Boston University School of Medicine, MA (T.N.N., M.A., P.K.)
| | - Piers Klein
- Department of Neurology, Radiology, Boston University School of Medicine, MA (T.N.N., M.A., P.K.)
| | - Muhammad Hafeez
- Department of Neurosurgery, Baylor School of Medicine, Houston, TX (M.H., P.K., O.T.)
| | - Peter Kan
- Department of Neurosurgery, Baylor School of Medicine, Houston, TX (M.H., P.K., O.T.)
| | - Omar Tanweer
- Department of Neurosurgery, Baylor School of Medicine, Houston, TX (M.H., P.K., O.T.)
| | - Ahmad Khaldi
- Department of Neurosciences, WellStar Health System, Atlanta, GA (A.K., H.L.)
| | - Hanzhou Li
- Department of Neurosciences, WellStar Health System, Atlanta, GA (A.K., H.L.)
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo, OH (M.J., S.Z., M.O.)
| | - Syed Zaidi
- Department of Neurology, University of Toledo, OH (M.J., S.Z., M.O.)
| | - Marion Oliver
- Department of Neurology, University of Toledo, OH (M.J., S.Z., M.O.)
| | - Mohamed M. Salem
- Department of Neurosurgery, University of Pennsylvania, Philadelphia (M.M.S., J.-K.B., B.A.P.)
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University of Pennsylvania, Philadelphia (M.M.S., J.-K.B., B.A.P.)
| | - Bryan A. Pukenas
- Department of Neurosurgery, University of Pennsylvania, Philadelphia (M.M.S., J.-K.B., B.A.P.)
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago (A.A., S.P.)
| | - Sophia Peng
- Department of Neurosurgery, University of Illinois at Chicago (A.A., S.P.)
| | - Rahul Kumar
- Department of Neurology, Cooper University Medical Center, Camden, NJ (R.K., M.L., J.S.)
| | - Michael Lai
- Department of Neurology, Cooper University Medical Center, Camden, NJ (R.K., M.L., J.S.)
| | - James Siegler
- Department of Neurology, Cooper University Medical Center, Camden, NJ (R.K., M.L., J.S.)
| | - Raul G. Nogueira
- UPMC Stroke Institute, Departments of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, PA (A.R.A.-B., O.K., B.A.G., M.J.L., S.N., R.G.N.)
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28
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Tong X, Burgin WS, Ren Z, Jia B, Zhang X, Huo X, Luo G, Wang A, Zhang Y, Ma N, Gao F, Song L, Sun X, Liu L, Deng Y, Li X, Wang B, Ma G, Wang Y, Wang Y, Miao Z, Mo D. Association of Stroke Subtype With Hemorrhagic Transformation Mediated by Thrombectomy Pass: Data From the ANGEL-ACT Registry. Stroke 2022; 53:1984-1992. [PMID: 35354298 DOI: 10.1161/strokeaha.121.037411] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The role of stroke etiology subtype in patients with acute large vessel occlusion on the occurrence of hemorrhagic transformation (HT) after endovascular treatment is poorly studied, and which factors mediate their relationship remains largely unknown. We utilized nationwide registry data to explore the association of stroke subtype (cardioembolism versus large artery atherosclerosis) with HT and to identify the possible mediators. METHODS A total of 1015 subjects were selected from the ANGEL-ACT registry (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke)-a prospective consecutive cohort of acute large vessel occlusion patients undergoing endovascular treatment at 111 hospitals in China between November 2017 and March 2019-and divided into large artery atherosclerosis (n=538) and cardioembolism (n=477) according to the Trial of ORG 10172 in Acute Stroke Treatment criteria. The types of HT included any intracerebral hemorrhage (ICH), parenchymal hematoma, and symptomatic ICH within 24 hours after endovascular treatment. The association between stroke subtype and HT was analyzed using a logistic regression model. Mediation analysis was done to assess how much of the effect of stroke subtype on HT was mediated through the identified mediators. RESULTS Stroke subtype (cardioembolism versus large artery atherosclerosis) was associated with increased risk of any ICH (29.8% versus 16.5%; odds ratio, 2.03 [95% CI, 1.22-3.36]), parenchymal hematoma (14.3% versus 5.4%; odds ratio, 2.90 [95% CI, 1.38-6.13]), and symptomatic ICH (9.9% versus 4.7%; odds ratio, 2.59 [95% CI, 1.09-6.16]) after adjustment for potential confounders. The more thrombectomy passes in cardioembolism patients had a significant mediation effect on the association of stroke subtype with increased risk of HT (any ICH, 15.9%; parenchymal hematoma, 13.4%; symptomatic ICH, 14.2%, respectively). CONCLUSIONS Stroke subtype is an independent risk factor for HT within 24 hours following endovascular treatment among acute large vessel occlusion patients. Mediation analyses propose that stroke subtype contributes to HT partly through thrombectomy pass, suggesting a possible pathomechanistic link.
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Affiliation(s)
- Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - W Scott Burgin
- Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa. (W.S.B.).,Comprehensive Stroke Center, Tampa General Hospital, FL (W.S.B.)
| | - Zeguang Ren
- Department of Neurosurgery, University of South Florida, Tampa. (Z.R.)
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - Xuelei Zhang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - Gang Luo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., Y.Z., Yongjun Wang)
| | - Yijun Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., Y.Z., Yongjun Wang)
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - Ligang Song
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - Xuan Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - Lian Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - Yiming Deng
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - Xiaoqing Li
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - Bo Wang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - Gaoting Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | | | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China. (Yilong Wang)
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.)
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Lee JS, Lee SJ, Hong JM, Alverne FJAM, Lima FO, Nogueira RG. Endovascular Treatment of Large Vessel Occlusion Strokes Due to Intracranial Atherosclerotic Disease. J Stroke 2022; 24:3-20. [PMID: 35135056 PMCID: PMC8829471 DOI: 10.5853/jos.2021.01375] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Mechanical thrombectomy (MT) has become the gold-standard for patients with acute large vessel occlusion strokes (LVOS). MT is highly effective in the treatment of embolic occlusions; however, underlying intracranial atherosclerotic disease (ICAD) represents a therapeutic challenge, often requiring pharmacological and/or mechanical rescue treatment. Glycoprotein IIb/IIIa inhibitors have been suggested as the best initial approach, if reperfusion can be achieved after thrombectomy, with angioplasty and/or stenting being reserved for the more refractory cases. In this review, we focus on the therapeutic considerations surrounding the endovascular treatment of ICAD-related acute LVOS.
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Affiliation(s)
- Jin Soo Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Seong-Joon Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | | | | | - Raul G. Nogueira
- Department of Neurology and Neurosurgery, University of Pittsburg Medical Center, UPMC Stroke Institute, Pittsburg, PA, USA
- Correspondence: Raul G. Nogueira Department of Neurology and Neurosurgery, University of Pittsburg Medical Center, UPMC Stroke Institute, C-400 PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA Tel: +1-412-647-8080 Fax: +1-412-647-8445 E-mail:
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30
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Nguyen L, Maingard J, Jhamb A, Brooks M, Barras C, Kok HK, Asadi H. Intracranial atherosclerotic disease and acute ischaemic stroke: A review of diagnosis and management. J Med Imaging Radiat Oncol 2021; 66:391-403. [PMID: 34894071 DOI: 10.1111/1754-9485.13366] [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: 04/14/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
Intracranial atherosclerotic disease is highly prevalent and a common cause of ischaemic stroke globally. With the increasing use of endovascular treatment for acute stroke management, computed tomography and magnetic resonance imaging have become an essential part of patient selection. In this review, we present the typical imaging findings of intracranial atherosclerosis and an overview of management as relevant to diagnostic and interventional radiologists.
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Affiliation(s)
- Lauren Nguyen
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Victoria, Australia
| | - Julian Maingard
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Victoria, Australia.,Department of Imaging, Monash Health, Melbourne, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Ashu Jhamb
- Interventional Neuroradiology Service, Austin Health, Melbourne, Victoria, Australia
| | - Mark Brooks
- School of Medicine, Deakin University, Geelong, Victoria, Australia.,Interventional Neuroradiology Service, Austin Health, Melbourne, Victoria, Australia
| | - Christen Barras
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,The University of Adelaide, Adelaide, South Australia, Australia
| | - Hong Kuan Kok
- Department of Radiology, Northern Health, Melbourne, Victoria, Australia
| | - Hamed Asadi
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Victoria, Australia.,Department of Imaging, Monash Health, Melbourne, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia.,Interventional Neuroradiology Service, Austin Health, Melbourne, Victoria, Australia
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31
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Chen W, Gong J, Song R, Liu J, Wang M, Zhang T, Sun H, Zhao Z, Liu Y, Zhu Q, Wang X. Efficacy and safety of direct balloon angioplasty in the treatment of large atherosclerotic stroke. Clin Neurol Neurosurg 2021; 211:107035. [PMID: 34826756 DOI: 10.1016/j.clineuro.2021.107035] [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: 09/25/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Based on the unclear safety and effectiveness of direct balloon angioplasty as a first-line treatment for patients with acute ischemic stroke caused by large artery atherosclerosis (LAA), our paper would center on investigating the safety and effectiveness of this novel strategy. PATIENTS AND METHODS A consecutive series of acute ischemic stroke patients due to intracranial atherosclerosis and short thrombus who underwent thorough direct balloon angioplasty from October 2019 to March 2021 were enrolled. The primary end point included arterial recanalization (modified Thrombolysis in Cerebral Infarction [mTICI]: 2b-3), and 90-day functional independence (modified Rankin Scale[mRS]: 0-2). The secondary end point was symptomatic intracerebral hemorrhage (sICH) and perioperative restenosis and re-occlusion of offending vessel. RESULTS 68 patients were included. Mean time from onset to groin puncture was 342.5 min and 50 min for groin puncture to successful recanalization. 61 (89.7%) patients achieved successful recanalization and 41 (60.3%) acquired functional independence. 11 (16.0%) patients experienced ICH and only 3 (4.4%) for sICH. 8 (11.8%) patients developed symptomatic restenosis or re-occlusion within seven days after the operation. In addition, 16 (23.5%) patients received rescue stenting and 3 (18.8%) of this subgroup appeared immediate intra-stent thrombosis. CONCLUSION Direct balloon angioplasty may be a safe and effective method for the treatment of stroke caused by intracranial large arteriosclerosis occlusion.
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Affiliation(s)
- Wang Chen
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Jian Gong
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Rao Song
- Department of Cardiology, Linyi People's Hospital, Linyi, Shandong, China
| | - Ji Liu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Mengen Wang
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Tongtong Zhang
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Hongyang Sun
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Zhenyu Zhao
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Yan Liu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Qiyi Zhu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Xianjun Wang
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China.
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Endovascular Treatment in Acute Ischemic Stroke with Large Vessel Occlusion According to Different Stroke Subtypes: Data from ANGEL-ACT Registry. Neurol Ther 2021; 11:151-165. [PMID: 34800279 PMCID: PMC8857367 DOI: 10.1007/s40120-021-00301-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/03/2021] [Indexed: 12/08/2022] Open
Abstract
Introduction Endovascular treatment’s (EVT) safety and efficacy have been proven in treating acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, limited data exist in different stroke subtypes. We aimed to investigate the differences in efficacy and safety of EVT for acute LVO according to different stroke subtypes. Methods A total of 1635 AIS patients with LVO undergoing EVT from a prospective cohort of the Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke (ANGEL-ACT) registry were classified into three types according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. We compared the primary outcome: 90-day modified Rankin Scale (mRS) score, the secondary outcomes: 90-day mRS (0–1, 0–2, and 0–3), successful recanalization (mTICI 2b/3), and complete recanalization (mTICI 3), and the safety outcomes: death within 90 days, parenchymal hemorrhage (PH), and symptomatic intracranial hemorrhage (SICH) among the three subtypes of stroke patients. Then, multivariable logistic regression models adjusting for potential baseline-confounding variables to determine the associations between stroke subtypes and safety and efficacy endpoints were performed. Finally, we performed subgroup analyses to explore discrepancies in the relationships. Results EVT of cardioembolic LVO (CE-LVO) had a higher rate of mTICI 3 (71.7% vs. 65.9% and 63.2%; P = 0.024) and a higher rate of PH (13.8% vs. 5.4% and 6.7%; P < 0.001) when compared to other stroke subtypes. Even multivariable analysis demonstrated that CE-LVO was associated with mTICI 3 [adjusted odds ratio (OR), 1.50 (95% CI 1.04–2.17)] and PH [adjusted OR, 1.97 (95% CI 1.09–3.55)]. However, the 90-day mRS distribution and 90-day mRS (0–1, 0–2, and 0–3) did not differ among the stroke subtypes, and nor did the SICH (P > 0.05). Conclusions Functional outcomes were similar among different stroke subtypes. Despite a higher rate of complete recanalization, there is an increased risk of parenchymal hemorrhage in CE-LVO. Trial Registration Clinical trial registration number: NCT03370939.
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Kim JH, Jung YJ, Chang CH. Feasibility and safety of the strategy of first stenting without retrieval using Solitaire FR as a treatment for emergent large-vessel occlusion due to underlying intracranial atherosclerosis. J Neurosurg 2021; 135:1091-1099. [PMID: 33513579 DOI: 10.3171/2020.8.jns202504] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 08/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The optimal treatment for underlying intracranial atherosclerosis (ICAS) in patients with emergent large-vessel occlusion (ELVO) remains unclear. Reocclusion during endovascular treatment (EVT) occurs frequently (57.1%-77.3%) after initial recanalization with stent retriever (SR) thrombectomy in ICAS-related ELVO. This study aimed to compare treatment outcomes of the strategy of first stenting without retrieval (FRESH) using the Solitaire FR versus SR thrombectomy in patients with ICAS-related ELVO. METHODS The authors retrospectively reviewed consecutive patients with acute ischemic stroke and intracranial ELVO of the anterior circulation who underwent EVT between January 2017 and December 2019 at Yeungnam University Medical Center. Large-vessel occlusion (LVO) of the anterior circulation was classified by etiology as follows: 1) no significant stenosis after recanalization (embolic group) and 2) remnant stenosis > 70% or lesser degree of stenosis with a tendency toward reocclusion and/or flow impairment during EVT (ICAS group). The ICAS group was divided into the SR thrombectomy group (SR thrombectomy) and the FRESH group. RESULTS A total of 105 patients (62 men and 43 women; median age 71 years, IQR 62.5-79 years) were included. The embolic, SR thrombectomy, and FRESH groups comprised 66 (62.9%), 26 (24.7%), and 13 (12.4%) patients, respectively. There were no significant differences between the SR thrombectomy and FRESH groups in symptom onset-to-door time, but puncture-to-recanalization time was significantly shorter in the latter group (39 vs 54 minutes, p = 0.032). There were fewer stent retrieval passes but more first-pass recanalizations in the FRESH group (p < 0.001). Favorable functional outcomes were significantly more frequent in the FRESH group (84.6% vs 42.3%, p = 0.017). CONCLUSIONS This study's findings suggest that FRESH, rather than rescue stenting, could be a treatment option for ICAS-related ELVO.
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Ni CF, Cheng SJ, Chen CY, Yeh TH, Hsieh KLC. Added Value of Rescue Devices in Intra-Arterial Thrombectomy: When Should We Apply Them? Front Neurol 2021; 12:689606. [PMID: 34421793 PMCID: PMC8375030 DOI: 10.3389/fneur.2021.689606] [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: 04/01/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Recent trials have demonstrated the superior efficacy of mechanical thrombectomy over other medical treatments for acute ischemic stroke; however, not every large vessel occlusion (LVO) can be recanalized using a single thrombectomy device. Rescue devices were proved to increase the reperfusion rate, but the efficacy is unclear. Objective: In this retrospective study, we evaluated the efficacy of rescue therapy in different locations of LVO. Methods: We analyzed the outcomes of mechanical thrombectomy from a prospective registry of consecutive 82 patients in Taipei Medical University Hospital. The reperfusion rate and the functional outcome were compared in patients who received first-line therapy only and patients who need rescue therapy. Results: An 84.1% reperfusion rate was achieved in our cohort. We applied first-line stent retriever (SR) treatment in 6 patients, among which 4 (66.6%) achieved successful reperfusion. We applied a direct-aspiration first-pass technique (ADAPT) as the first-line treatment in 76 patients, among which 46 (60.5%) achieved successful reperfusion. Successful reperfusion could not be achieved in 30 cases (39.5%); therefore, we applied a second-line rescue SR for 28 patients, and reperfusion was established in 18 (64.3%) of them. These results revealed that the LVO in anterior circulation has a higher chance to respond to SR rescue therapy than posterior circulation lesions (68 vs. 33.3%, P < 0.001). Patients who received only first-line therapy exhibited significantly better functional outcomes than those who were also treated with rescue SR therapy (41.2 vs. 16.7%, P = 0.001). In addition, patients with LVO in the anterior circulation were found to have a higher probability of achieving functional independence than patients with posterior circulation lesions (10.7 vs. 0.0%, P < 0.001). The adjusted multivariate analysis revealed that successful reperfusion and treatment type (first-line or rescue therapy) were significantly related to a modified Rankin Scale (mRS) score at 90 days. Conclusion: This study reveals that rescue SR therapy improves the reperfusion rate. Patients who require rescue SR therapy have a lower likelihood of functional independence. LVO in the anterior circulation responds better to rescue SR therapy and results in better functional outcomes than posterior circulation lesions.
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Affiliation(s)
- Cheng-Fu Ni
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sho-Jen Cheng
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
| | - Cheng-Yu Chen
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.,Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tu-Hsueh Yeh
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Kevin Li-Chun Hsieh
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.,Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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35
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Jang SH, Sohn SI, Park H, Lee SJ, Kim YW, Hong JM, Kim CH, Choi JW, Kang DH, Kim YS, Hwang YH, Lee JS, Hong JH. The Safety of Intra-arterial Tirofiban during Endovascular Therapy after Intravenous Thrombolysis. AJNR Am J Neuroradiol 2021; 42:1633-1637. [PMID: 34301637 DOI: 10.3174/ajnr.a7203] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/07/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The safety and efficacy of tirofiban during endovascular therapy in patients undergoing intravenous thrombolysis with recombinant IV tPA remain unclear. This study aimed to investigate the safety and efficacy of intra-arterial tirofiban use during endovascular therapy in patients treated with IV tPA. MATERIALS AND METHODS Using a multicenter registry, we enrolled patients with acute ischemic stroke who underwent endovascular therapy. Safety outcomes included postprocedural parenchymal hematoma type 2 and/or thick subarachnoid hemorrhage, intraventricular hemorrhage, and 3-month mortality. Efficacy outcomes included the successful reperfusion rate, postprocedural reocclusion, and good outcomes at 3 months (mRS scores of 0-2). The tirofiban effect on the outcomes was evaluated using a multivariable analysis while adjusting for potential confounders. RESULTS Among enrolled patients, we identified 314 patients with stroke (279 and 35 patients in the no tirofiban and tirofiban groups, respectively) due to an intracranial artery occlusion who underwent endovascular therapy with intravenous thrombolysis. A multivariable analysis revealed no association of intra-arterial tirofiban with postprocedural parenchymal hematoma type and/or thick subarachnoid hemorrhage (adjusted OR, 1.07; 95% CI, 0.20-4.10; P = .918), intraventricular hemorrhage (adjusted OR, 0.43; 95% CI, 0.02-2.85; P = .467), and 3-month mortality (adjusted OR, 0.38; 95% CI, 0.04-1.87; P = .299). Intra-arterial tirofiban was not associated with good outcome (adjusted OR, 2.22; 95% CI, 0.89 -6.12; P = .099). CONCLUSIONS Using intra-arterial tirofiban during endovascular therapy after IV tPA could be safe.
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Affiliation(s)
- S H Jang
- From the Departments of Neurology (S.H.J., S.-I.S., H.P., J.-H.H.)
| | - S-I Sohn
- From the Departments of Neurology (S.H.J., S.-I.S., H.P., J.-H.H.)
| | - H Park
- From the Departments of Neurology (S.H.J., S.-I.S., H.P., J.-H.H.)
| | - S-J Lee
- Department of Neurology (S.-J.L., J.M.H., J.S.L.)
| | - Y-W Kim
- Department of Neurology (Y.-W.K., Y.-H.H.)
| | - J M Hong
- Department of Neurology (S.-J.L., J.M.H., J.S.L.)
| | - C-H Kim
- Neurosurgery (C.-H.K.), School of Medicine Keimyung University, Daegu, South Korea
| | - J W Choi
- Radiology (J.W.C.), School of Medicine, Ajou University, Suwon, South Korea
| | | | - Y-S Kim
- Radiology (Y.-S.K.), School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Y-H Hwang
- Department of Neurology (Y.-W.K., Y.-H.H.)
| | - J S Lee
- Department of Neurology (S.-J.L., J.M.H., J.S.L.)
| | - J-H Hong
- From the Departments of Neurology (S.H.J., S.-I.S., H.P., J.-H.H.)
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Baek JH, Jung C, Kim BM, Heo JH, Kim DJ, Nam HS, Kim YD, Lim EH, Kim JH, Kim JY, Kim JH. Combination of Rescue Stenting and Antiplatelet Infusion Improved Outcomes for Acute Intracranial Atherosclerosis-Related Large-Vessel Occlusion. Front Neurol 2021; 12:608270. [PMID: 34290659 PMCID: PMC8287123 DOI: 10.3389/fneur.2021.608270] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 05/11/2021] [Indexed: 11/20/2022] Open
Abstract
Background and Purpose: Intracranial atherosclerosis-related large-vessel occlusion caused by in situ thrombo-occlusion (ICAS-LVO) has been regarded an important reason for refractoriness to mechanical thrombectomy (MT). To achieve better outcomes for ICAS-LVO, different endovascular strategies should be explored. We aimed to investigate an optimal endovascular strategy for ICAS-LVO. Methods: We retrospectively reviewed three prospective registries of acute stroke underwent endovascular treatment. Among them, patients with ICAS-LVO were assigned to four groups based on their endovascular strategy: (1) MT alone, (2) rescue intracranial stenting after MT failure (MT-RS), (3) glycoprotein IIb/IIIa inhibitor infusion after MT failure (MT-GPI), and (4) a combination of MT-RS and MT-GPI (MT-RS+GPI). Baseline characteristics and outcomes were compared among the groups. To evaluate whether the endovascular strategy resulted in favorable outcome, multivariable analysis was also performed. Results: A total of 184 patients with ICAS-LVO were included. Twenty-four patients (13.0%) were treated with MT alone, 25 (13.6%) with MT-RS, 84 (45.7%) with MT-GPI, and 51 (27.7%) with MT-RS+GPI. The MT-RS+GPI group showed the highest recanalization efficiency (98.0%). Frequency of patent arteries on follow-up (98.0%, p < 0.001) and favorable outcome (84.3%, p < 0.001) were higher in the MT-RS+GPI group than other groups. The MT-RS+GPI strategy remained an independent factor for favorable outcome (odds ratio, 20.4; 95% confidence interval, 1.97–211.4; p = 0.012). Conclusion: Endovascular strategy was significantly associated with procedural and clinical outcomes in acute stroke by ICAS-LVO. A combination of RS and GPI infusion might be an optimal rescue modality when frontline MT fails.
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Affiliation(s)
- Jang-Hyun Baek
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byung Moon Kim
- Interventional Neuroradiology, Department of Radiology, Severance Hospital, Severance Stroke Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Joon Kim
- Interventional Neuroradiology, Department of Radiology, Severance Hospital, Severance Stroke Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Hyun Lim
- Department of Neurosurgery, Andong Hospital, Andong, South Korea
| | - Jun-Hwee Kim
- Interventional Neuroradiology, Department of Radiology, Severance Hospital, Severance Stroke Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Yup Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
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Weinberg JH, Sweid A, Asada A, Abbas R, Piper K, Joffe D, Gooch MR, Tjoumakaris S, Jabbour P, Rosenwasser RH, Zarzour H. Risk of mechanical thrombectomy recanalization failure: Intraoperative nuances and the role of intracranial atherosclerotic disease. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Memon MZ, Daniel D, Chaudhry MRA, Grewal M, Saini V, Lukas J, Siddu M, Algahtani R, Nisar T, Majidi S, Leon Guerrero CR, Burger KM, Greenberg E, Khandelwal P, Malik AM, Starke RM, Koch S, Yavagal DR. Clinical impact of the first pass effect on clinical outcomes in patients with near or complete recanalization during mechanical thrombectomy for large vessel ischemic stroke. J Neuroimaging 2021; 31:743-750. [PMID: 33930218 DOI: 10.1111/jon.12864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND PURPOSE The first pass effect has been reported as a mechanical thrombectomy (MT) success metric in patients with large vessel occlusive stroke. We aimed to compare the clinical and neuroimagign outcomes of patients who had favorable recanalization (mTICI 2c or mTICI 3) achieved in one pass versus those requiring multiple passes. METHODS In this "real-world" multicenter study, patients with mTICI 2c or 3 recanalization were identified from three prospectively collected stroke databases from January 2016 to December 2019. Clinical outcomes were a favorable functional outcome at 90 days (modified Rankin Scale score 0-2), and the rate of symptomatic intracranial hemorrhage (ICH) any ICH, and 90-day mortality. RESULTS Favorable recanalization was achieved in 390/664 (59%) of consecutive patients who underwent MT (age 71.2 ± 13.2 years, 188 [48.2%] women). This was achieved after a single thrombectomy pass (n = 290) or multiple thrombectomy passes (n = 100). The rate of favorable clinical outcome was higher (41% vs. 28 %, p = .02) in the first pass group with a continued trend on multivariate analysis that did not reaching statistical significance (OR 1.68 95% confidence interval [CI] 1.0-2.95, p = .07). Similarly, the odds of any ICH were significantly lower (OR 0.56 CI 0.32-0.97, p = .03). A similar trend of favorable clinical outcomes was noticed on subgroup analysis of patients with M1 occlusion (OR 1.81 CI 1.01-3.61, p = .08). CONCLUSION The first-pass reperfusion was associated with a trend toward favorable clinical outcome and lower rates of ICH. These data suggest that the first-pass effect should be the mechanical thrombectomy procedure goal.
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Affiliation(s)
- Muhammad Zeeshan Memon
- Department of Neurology, University of Miami, Miami, Florida, USA.,Department of Neurosurgery Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - David Daniel
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neurology, George Washington University, Washington, DC, USA
| | | | - Manjot Grewal
- Department of Neurology, George Washington University, Washington, DC, USA
| | - Vasu Saini
- Department of Neurology, University of Miami, Miami, Florida, USA.,Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Joshua Lukas
- Department of Neurology, University of Miami, Miami, Florida, USA
| | - Mithilesh Siddu
- Department of Neurology, University of Miami, Miami, Florida, USA.,Department of Neurology, George Washington University, Washington, DC, USA
| | - Rami Algahtani
- Department of Neurology, University of Miami, Miami, Florida, USA.,Department of Neurology, George Washington University, Washington, DC, USA.,Department of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Taha Nisar
- Department of Neurosurgery Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Shahram Majidi
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neurology, George Washington University, Washington, DC, USA
| | | | - Kathleen M Burger
- Department of Neurology, George Washington University, Washington, DC, USA
| | | | - Priyank Khandelwal
- Department of Neurology, University of Miami, Miami, Florida, USA.,Department of Neurosurgery Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Amer M Malik
- Department of Neurology, University of Miami, Miami, Florida, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Sebastian Koch
- Department of Neurology, University of Miami, Miami, Florida, USA
| | - Dileep R Yavagal
- Department of Neurology, University of Miami, Miami, Florida, USA.,Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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Liang W, Wang Y, Du Z, Mang J, Wang J. Intraprocedural Angiographic Signs Observed During Endovascular Thrombectomy in Patients With Acute Ischemic Stroke: A Systematic Review. Neurology 2021; 96:1080-1090. [PMID: 33893205 DOI: 10.1212/wnl.0000000000012069] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the real-world practice of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), the analysis of intraprocedural angiographic signs (IPASs) still challenges neurointerventionists. This review provides insights into the significance of these subtle changes for predicting underlying etiology, technical feasibility, and patient prognosis, thus promoting the potential real-time application of these signs. METHODS A systematic literature search was conducted using PubMed, Ovid Medline/Embase, and Cochrane. The search focused on studies published between January 1995 and August 2020 that reported findings related to intraprocedural angiographic manifestations in endovascular recanalization therapy for AIS. RESULTS We identified 12 IPASs in 22 studies involving 1,683 patients. The IPASs were assigned into 3 subsets according to their clinical meanings. CONCLUSION The systematic analysis of IPAS in clinical trials and practice will lead to a better understanding of treatment effects, responses, and mechanisms during EVT. Studies of larger cohorts using more robust statistical methods are needed.
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Affiliation(s)
- Wenzhao Liang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Yimeng Wang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Zhihua Du
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Jing Mang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China.
| | - Jun Wang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
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Abdalla RN, Cantrell DR, Shaibani A, Hurley MC, Jahromi BS, Potts MB, Ansari SA. Refractory Stroke Thrombectomy: Prevalence, Etiology, and Adjunctive Treatment in a North American Cohort. AJNR Am J Neuroradiol 2021; 42:1258-1263. [PMID: 33888454 DOI: 10.3174/ajnr.a7124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/26/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Acute stroke intervention refractory to mechanical thrombectomy may be due to underlying vessel wall pathology including intracranial atherosclerotic disease and intracranial arterial dissection or recalcitrant emboli. We studied the prevalence and etiology of refractory thrombectomy, the safety and efficacy of adjunctive interventions in a North American-based cohort. MATERIALS AND METHODS We performed a multicenter, retrospective study of refractory thrombectomy, defined as unsuccessful recanalization, vessel reocclusion in <72 hours, or required adjunctive antiplatelet glycoprotein IIb/IIIa inhibitors, intracranial angioplasty and/or stenting to achieve and maintain reperfusion. Clinical and imaging criteria differentiated etiologies for refractory thrombectomy. Baseline demographics, cerebrovascular risk factors, technical/clinical outcomes, and procedural safety/complications were compared between refractory and standard thrombectomy groups. Multivariable logistic regression analysis was performed to determine independent predictors of refractory thrombectomy. RESULTS Refractory thrombectomy was identified in 25/302 cases (8.3%), correlated with diabetes (44% versus 22%, P = .02) as an independent predictor with OR = 2.72 (95% CI, 1.05-7.09; P = .04) and inversely correlated with atrial fibrillation (16% versus 45.7%, P = .005). Refractory etiologies were secondary to recalcitrant emboli (20%), intracranial atherosclerotic disease (60%), and/or intracranial arterial dissection (44%). Four (16%) patients were diagnosed with early vessel reocclusion, and 21 patients underwent adjunctive salvage interventions with glycoprotein IIb/IIIa inhibitor infusion alone (32%) or intracranial angioplasty and/or stenting (52%). There were no significant differences in TICI 2b/3 reperfusion efficacy (85.7% versus 90.9%, P = .48), symptomatic intracranial hemorrhage rates (0% versus 9%, P = .24), favorable clinical outcomes (39.1% versus 48.3%, P = .51), or mortality (13% versus 28.3%, P = .14) versus standard thrombectomy. CONCLUSIONS Refractory stroke thrombectomy is encountered in <10% of cases, independently associated with diabetes, and related to underlying vessel wall pathology (intracranial atherosclerotic disease and/or intracranial arterial dissection) or, less commonly, recalcitrant emboli. Emergent salvage interventions with glycoprotein IIb/IIIa inhibitors or intracranial angioplasty and/or stenting are safe and effective adjunctive treatments.
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Affiliation(s)
- R N Abdalla
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois.,Department of Radiology (R.N.A.), Ain Shams University, Cairo, Egypt
| | - D R Cantrell
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - A Shaibani
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - M C Hurley
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - B S Jahromi
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - M B Potts
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - S A Ansari
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.) .,Neurology (S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Zha M, Wu M, Huang X, Zhang X, Huang K, Yang Q, Cai H, Ji Y, Lv Q, Yang D, Dai Q, Liu R, Liu X. A Pre-Interventional Scale to Predict in situ Atherosclerotic Thrombosis in Acute Vertebrobasilar Artery Occlusion Patients. Front Neurol 2021; 12:648081. [PMID: 33897603 PMCID: PMC8058399 DOI: 10.3389/fneur.2021.648081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Determining the occlusion mechanism before endovascular treatment (EVT) is of great significance for acute large vessel occlusion patients. We aimed to develop and validate a simple pre-EVT scale with readily available variables for predicting in situ atherosclerotic thrombosis (ISAT) in acute vertebrobasilar artery occlusion (VBAO) patients. Materials and Methods: Consecutive patients were retrieved from Nanjing Stroke Registry Program between January 2014 and December 2019 as a derivation cohort. Anonymous data of consecutive patients between January 2014 and December 2019 were collected from another comprehensive stroke center as an external validation cohort. Demographics, medical histories, and clinical characteristics were collected. ISAT was defined according to the following criteria: (a) detection of moderate to severe (≥50%) stenosis or stenosis with significant distal flow impairment at the occluded segment when successful reperfusion was achieved; (b) transient visualization of eccentric plaque contour or a recurrent re-occlusion tendency when reperfusion was unsuccessful. Logistic regression was taken to develop a predictive scale. The performance of the scale was assessed by area under the receiver operating characteristic curve (AUC) and Hosmer–Lemeshow test. Results: ISAT was observed in 41 of 95 (43.2%) patients included in the derivation cohort. The ISAT predictive scale consisted of three pre-interventional predictors, including the history of hypertension, atrial fibrillation rhythm, and baseline serum glucose level ≥7.55 mmol/L. The model depicted acceptable calibration (Hosmer–Lemeshow test, P = 0.554) and good discrimination (AUC, 0.853; 95% confidence interval, 0.775–0.930). The optimal cutoff value of the ISAT scale was 1 point with 95.1% sensitivity, 64.8% specificity, and 77.9% accuracy. In the validation cohort, the discrimination ability was still promising with an AUC value of 0.800 (0.682–0.918). Conclusion: The three-item scale comprised of the history of hypertension, atrial fibrillation rhythm, and dichotomous serum glucose level had a promising predictive value for ISAT before EVT in acute VBAO patients.
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Affiliation(s)
- Mingming Zha
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Min Wu
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Xianjun Huang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Xiaohao Zhang
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, China
| | - Kangmo Huang
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, China
| | - Qingwen Yang
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Haodi Cai
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Yachen Ji
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Qiushi Lv
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, China
| | - Dong Yang
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, China
| | - Qiliang Dai
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, China
| | - Rui Liu
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.,Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, China
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Jia B, Ren Z, Mokin M, Burgin WS, Bauer CT, Fiehler J, Mo D, Ma N, Gao F, Huo X, Luo G, Wang A, Pan Y, Song L, Sun X, Zhang X, Gui L, Song C, Peng Y, Wu J, Zhao S, Zhao J, Zhou Z, Li Y, Jing P, Yang L, Liu Y, Zhao Q, Liu Y, Peng X, Gao Q, Guo Z, Chen W, Li W, Cheng X, Xu Y, Zhang Y, Zhang G, Lu Y, Lu X, Wang D, Wang Y, Li H, Ling L, Peng G, Zhang J, Zhang K, Li S, Qi Z, Xu H, Tong X, Ma G, Liu R, Guo X, Deng Y, Leng X, Leung TW, Liebeskind DS, Wang Y, Wang Y, Miao Z. Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China: A Real-World Nationwide Registry. Stroke 2021; 52:1203-1212. [PMID: 33596674 DOI: 10.1161/strokeaha.120.031869] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE The benefit of endovascular treatment (EVT) for large vessel occlusion in clinical practice in developing countries like China needs to be confirmed. The aim of the study was to determine whether the benefit of EVT for acute ischemic stroke in randomized trials could be generalized to clinical practice in Chinese population. METHODS We conducted a prospective registry of EVT at 111 centers in China. Patients with acute ischemic stroke caused by imaging-confirmed intracranial large vessel occlusion and receiving EVT were included. The primary outcome was functional independence at 90 days defined as a modified Rankin Scale score of 0 to 2. Outcomes of specific subgroups in the anterior circulation were reported and logistic regression was performed to predict the primary outcome. RESULTS Among the 1793 enrolled patients, 1396 (77.9%) had anterior circulation large vessel occlusion (median age, 66 [56-73] years) and 397 (22.1%) had posterior circulation large vessel occlusion (median age, 64 [55-72] years). Functional independence at 90 days was reached in 45% and 44% in anterior and posterior circulation groups, respectively. For anterior circulation population, underlying intracranial atherosclerotic disease was identified in 29% of patients, with higher functional independence at 90 days (52% versus 44%; P=0.0122) than patients without intracranial atherosclerotic disease. In the anterior circulation population, after adjusting for baseline characteristics, procedure details, and early outcomes, the independent predictors for functional independence at 90 days were age <66 years (odds ratio [OR], 1.733 [95% CI, 1.213-2.476]), time from onset to puncture >6 hours (OR, 1.536 [95% CI, 1.065-2.216]), local anesthesia (OR, 2.194 [95% CI, 1.325-3.633]), final modified Thrombolysis in Cerebral Infarction 2b/3 (OR, 2.052 [95% CI, 1.085-3.878]), puncture-to-reperfusion time ≤1.5 hours (OR, 1.628 [95% CI, 1.098-2.413]), and National Institutes of Health Stroke Scale score 24 hours after the procedure <11 (OR, 9.126 [95% CI, 6.222-13.385]). CONCLUSIONS Despite distinct characteristics in the Chinese population, favorable outcome of EVT can be achieved in clinical practice in China. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939.
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Affiliation(s)
- Baixue Jia
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Zeguang Ren
- Department of Neurosurgery, University of South Florida (Z.R., M.M., W.S.B., C.T.B.)
| | - Maxim Mokin
- Department of Neurosurgery, University of South Florida (Z.R., M.M., W.S.B., C.T.B.)
| | - W Scott Burgin
- Department of Neurosurgery, University of South Florida (Z.R., M.M., W.S.B., C.T.B.)
| | - Clayton T Bauer
- Department of Neurosurgery, University of South Florida (Z.R., M.M., W.S.B., C.T.B.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (J.F.)
| | - Dapeng Mo
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Ning Ma
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Feng Gao
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Xiaochuan Huo
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Gang Luo
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases (A.W., Y. Pan), Beijing Tiantan Hospital, Capital Medical University
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases (A.W., Y. Pan), Beijing Tiantan Hospital, Capital Medical University
| | - Ligang Song
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Xuan Sun
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Xuelei Zhang
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Liqiang Gui
- Department of Interventional Neuroradiology, Langfang Changzheng Hospital, China (L.G.)
| | - Cunfeng Song
- Department of Interventional Neuroradiology, Liaocheng Third People's Hospital, China (C.S.)
| | - Ya Peng
- Department of Neurosurgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, China (Y. Peng)
| | - Jin Wu
- Department of Neurology, Second Affiliated Hospital of Nanjing Medical University, China (J.W.)
| | - Shijun Zhao
- Department of Interventional Radiology, Fengrun District People's Hospital of Tangshan City, China (S.Z.)
| | - Junfeng Zhao
- Department of Neurology, SiPing Central People's Hospital, China (J. Zhao)
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, China (Z.Z.)
| | - Yongli Li
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, China (Y. Li)
| | - Ping Jing
- Department of Neurology, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, China (P.J.)
| | - Lei Yang
- Department of Neurosurgery, The First Hospital of Shijiazhuang, China (L.Y.)
| | - Yajie Liu
- Department of Neurology, Shenzhen Hospital of Southern Medical University, China (Yajie Liu)
| | - Qingshi Zhao
- Department of Neurology, The People's Hospital of Longhua, China (Q.Z.)
| | - Yan Liu
- Department of Neurology, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, China (Yan Liu)
| | - Xiaoxiang Peng
- Department of Neurology, Hubei Third People's Hospital, China (X.P.)
| | - Qingchun Gao
- Department of Neurology, Institute of Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, China (Q.G.)
| | - Zaiyu Guo
- Department of Neurosurgery, Tianjin TEDA Hospital, China (Z.G.)
| | - Wenhuo Chen
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, China (W.C.)
| | - Weirong Li
- Department of Neurology, Taiyuan Central Hospital, China (W.L.)
| | - Xiaojiang Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical University, China (X.C.)
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, China (Y.X.)
| | - Yongqiang Zhang
- Department of Neurosurgery, Wenling First People's Hospital, China (Y.Z.)
| | - Guilian Zhang
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, China (G.Z.)
| | - Yijiu Lu
- Department of Internal Neurology, The First People's Hospital of Yulin, China (Y. Lu)
| | - Xinyu Lu
- Department of Neurosurgery, Zhenjiang First People's Hospital, China (X. Lu)
| | - Dengxiang Wang
- Department of Neurology, Qitaihe Coal General Hospital, China (D.W.)
| | - Yan Wang
- Stroke Center, People's Hospital of Tangshan City, China (Yan Wang)
| | - Hao Li
- Department of Neurology, Affiliated Hospital Guilin Medical University, China (H.L.)
| | - Li Ling
- Department of Neurology, The Affiliated Hospital of Hebei University, China (L.L.)
| | - Guangge Peng
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Jingyu Zhang
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Kai Zhang
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Shuo Li
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Zhongqi Qi
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Haifeng Xu
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Xu Tong
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Gaoting Ma
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Raynald Liu
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Xu Guo
- Department of Neurointervetion, Beijing Anzhen Hospital, Capital Medical University, China (X.G.)
| | - Yiming Deng
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Xinyi Leng
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, China (X. Leng, T.W.L.)
| | - Thomas W Leung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, China (X. Leng, T.W.L.)
| | | | - Yilong Wang
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Tiantan Clinical Trial and Research Center for Stroke (Yilong Wang), Beijing Tiantan Hospital, Capital Medical University
- Beijing Tiantan Hospital, Capital Medical University, China (Yongjun Wang)
| | | | - Zhongrong Miao
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
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Lee JS, Hwang YH, Sohn SI. Factors Contributing to an Efficacious Endovascular Treatment for Acute Ischemic Stroke in Asian Population. Neurointervention 2021; 16:91-110. [PMID: 33765729 PMCID: PMC8261106 DOI: 10.5469/neuroint.2020.00339] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
Although randomized control trials about endovascular treatment (EVT) of emergent large vessel occlusion (LVO) have demonstrated the success of mechanical thrombectomy as the choice of treatment, a wide range of caveats remain unaddressed. Asian patients were rarely included in the trials, thereby raising the question of whether the treatment could be generalized. In addition, there remains a concern on the feasibility of the method with respect to its application against intracranial atherosclerosis (ICAS)-related LVO, frequently observed in the Asian population. It is important to include evidence on ICAS LVO from Asian countries in the future for a comprehensive understanding of LVO etiology. Besides the issues with EVT, prognostic concerns in diabetes patients, acute kidney injury following EVT, neuroprotective management against reperfusion injury, and other peri-EVT issues should be considered in clinical practice. In the current article, we present an in-depth review of the literature that revises information pertaining to such concerns.
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Affiliation(s)
- Jin Soo Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Hospital, Kyemyung University School of Medicine, Daegu, Korea
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Li ZS, Zhou TF, Li Q, Guan M, Liu H, Zhu LF, Wang ZL, Li TX, Gao BL. Endovascular Management of Intracranial Atherosclerosis-Related Large Vessel Occlusion With the A Direct Aspiration First-Pass Thrombectomy Compared With Solumbra Technique. Front Neurol 2021; 12:643633. [PMID: 33737905 PMCID: PMC7960763 DOI: 10.3389/fneur.2021.643633] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/26/2021] [Indexed: 01/01/2023] Open
Abstract
Background: To investigate the effect of the A Direct Aspiration First-Pass Thrombectomy (ADAPT) vs. Solumbra technique in the treatment of acute intracranial atherosclerosis-related large vessel occlusion (LVO). Methods: Patients with acute atherosclerosis-related LVO who had undergone endovascular treatment were retrospectively enrolled into two groups: The Solumbra and ADAPT groups. The clinical data were analyzed. Results: Patients (104) were enrolled with 48 in the Solumbra and 56 in the ADAPT group. The mean time from femoral access to recanalization was significantly (P < 0.05) shorter in the ADAPT than in the Solumbra group. The recanalization time at the first line was significantly shorter in the ADAPT group than in the Solumbra group (17 ± 10.21 vs. 26 ± 15.55 min, P = 0.02). However, the rate of switching to the alternative was significantly higher in the ADAPT group than that in the Solumbra group (46.42 vs. 33.33%, P = 0.01). Eighty-two patients had eventual recanalization, resulting in a final recanalization rate of 78.85%. At 3-month clinical follow-up for all patients, the good prognosis rate reached 51.92% with good prognosis in 24 patients (50%) in the Solumbra and 30 (53.57%) in the ADAPT group. The rate of symptomatic intracranial hemorrhage was 18.75% (n = 9) in the Solumbra and 19.64% (n = 11) in the ADAPT group. The mortality rate was 21.15% (22/104). Among 80 (76.92%) patients who had angiographic follow-up (3–30 months), five (6.25%) patients experienced in-stent stenosis, and two (2.5%) experienced asymptomatic stent occlusion. Conclusion: In patients with acute intracranial atherosclerosis-related LVO, clinical outcomes treated using the ADAPT technique are comparable with those using the Solumbra technique, and more patients need additional remedial measures if treated with the ADAPT technique.
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Affiliation(s)
- Zhao-Shuo Li
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Teng-Fei Zhou
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Qiang Li
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Min Guan
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Huan Liu
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Liang-Fu Zhu
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Zi-Liang Wang
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Tian-Xiao Li
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Bu-Lang Gao
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
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Huo X, Raynald, Wang A, Mo D, Gao F, Ma N, Wang Y, Wang Y, Miao Z. Safety and Efficacy of Tirofiban for Acute Ischemic Stroke Patients With Large Artery Atherosclerosis Stroke Etiology Undergoing Endovascular Therapy. Front Neurol 2021; 12:630301. [PMID: 33643207 PMCID: PMC7905208 DOI: 10.3389/fneur.2021.630301] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the safety and efficacy of tirofiban in acute ischemic stroke (AIS) patients with large artery atherosclerosis (LAA) stroke etiology receiving endovascular therapy (EVT). Methods: In this multi-center prospective study, patients who were considered to have an indication received a low dose intra-arterial bolus (0.25–1 mg) of tirofiban. The safety and efficacy outcomes at 90-day follow-ups included symptomatic intracranial hemorrhage (sICH), recanalization rate, functional outcome, and mortality. Results: Among the 649 AIS patients with LAA, those in the tirofiban group (n = 244) showed higher systolic blood pressure (BP) and NIHSS score on admission, puncture-to-recanalization time, lower frequency of intravenous thrombolysis and intra-arterial thrombolysis, higher frequency of antiplatelet, heparinization, mechanical stent retrieval, aspiration, balloon angioplasty, and more retrieval times compared with those in the non-tirofiban group (n = 405) (all P < 0.05). Tirofiban was found to be associated with superior clinical outcomes in anterior circulation stroke and major stroke patients [adjusted odds ratio (OR) = 2.163, 95% confidence interval (CI) = 1.130–4.140, P = 0.02 and adjusted OR = 2.361, 95% CI = 1.326–4.202, P = 0.004, respectively] and a lower risk of mortality at 90-day follow-ups (adjusted OR = 0.159, 95% CI = 0.042–0.599, P = 0.007 and adjusted OR = 0.252, 95% CI = 0.103–0.621, P = 0.003, respectively). There was no significant difference in sICH between the two groups. Conclusions: Tirofiban in AIS patients with LAA undergoing EVT is safe and may benefit the functional outcomes in anterior circulation and major stroke patients and showed a trend for reduced mortality.
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Affiliation(s)
- Xiaochuan Huo
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Raynald
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Dapeng Mo
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhongrong Miao
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Zhang P, Xing Y, Li H, Yao Q, Shen J, Liu Y, Wei Y, Guo Y. Efficacy and safety of rescue angioplasty and/or stenting for acute large artery occlusion with underlying intracranial atherosclerosis: A systematic review and meta-analysis. Clin Neurol Neurosurg 2021; 203:106538. [PMID: 33607582 DOI: 10.1016/j.clineuro.2021.106538] [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] [Received: 11/02/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Intracranial angioplasty and/or stenting implantation is an important rescue treatment for the management of intracranial atherosclerosis-related occlusion (ICAS-O) after mechanical thrombectomy failure, but its safety and efficacy remain unclear. We investigated the safety and efficacy of rescue intracranial angioplasty and/or stenting for emergent large artery occlusion (LAO) with underlying ICAS. METHODS We searched for relevant full-text articles in EMBASE, PubMed and the Cochrane Central Register of Controlled Trials from inception to March 1, 2020. We calculated the odds ratios (ORs) using random-effects models for symptomatic intracranial hemorrhage (sICH), mortality, recanalization rate and favorable clinical outcome at 90 days between ICAS-O group treated by rescue therapy and Non ICAS-O group. RStudio software 1.3.959 was used to perform this meta-analysis. RESULTS Ten studies were included with a total of 1639 patients, of which 450 (27.5 %) were in the ICAS-O group treated with intracranial angioplasty and/or stenting, and 1189 (72.5 %) were in the Non ICAS-O group. Overall, intracranial angioplasty and/or stenting did not improve the recanalization rate (OR, 0.67 [0.26-1.76]; p = 0.419) or favorable functional outcome (OR, 1.01 [0.64-1.58]; p = 0.97) in patients with underlying ICAS-O, and the risk of sICH (OR, 0.99 [0.59-1.68]; p = 0.983) and mortality (OR, 1.26 [0.87-1.83]; p = 0.225) did not significantly differ between ICAS-O and Non ICAS-O. CONCLUSIONS From these observational study results, rescue intracranial angioplasty and/or stenting seems safe in patients with emergent LAO after attempted thrombectomy, but further rigorous studies are warranted to confirm its efficacy.
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Affiliation(s)
- Pengfei Zhang
- Department of Neurosurgery, Beichen Traditional Chinese Medical Hospital Tianjin, Tianjin, 300400, China
| | - Yongguo Xing
- Department of Neurosurgery, Beichen Traditional Chinese Medical Hospital Tianjin, Tianjin, 300400, China
| | - Hongbin Li
- Department of Neurology, Beichen Traditional Chinese Medical Hospital Tianjin, Tianjin, 300400, China
| | - Qingping Yao
- Department of Neurology, Beichen Traditional Chinese Medical Hospital Tianjin, Tianjin, 300400, China
| | - Jie Shen
- Department of Neurology, Beichen Traditional Chinese Medical Hospital Tianjin, Tianjin, 300400, China
| | - Yi Liu
- Department of Neurology, Beichen Traditional Chinese Medical Hospital Tianjin, Tianjin, 300400, China
| | - Ying Wei
- Department of Neurology, Beichen Traditional Chinese Medical Hospital Tianjin, Tianjin, 300400, China
| | - Yanting Guo
- Department of Pediatrics, Tianjin First Central Hospital, Tianjin, 300192, China.
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Lee SJ, Park SY, Hong JM, Choi JW, Kang DH, Kim YW, Kim YS, Hong JH, Kim CH, Yoo J, Nogueira RG, Hwang YH, Sohn SI, Lee JS. Etiological Approach to Understanding Recanalization Failure in Intracranial Large Vessel Occlusion and Thrombectomy: Close to Embolism but Distant From Atherosclerosis. Front Neurol 2021; 11:598216. [PMID: 33536994 PMCID: PMC7848124 DOI: 10.3389/fneur.2020.598216] [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: 08/24/2020] [Accepted: 12/10/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction: In patients with intracranial large vessel occlusion (LVO) who undergo endovascular treatment (EVT), recanalization failure may be related to intracranial atherosclerotic stenosis (ICAS). We evaluated whether the risk factors of recanalization failure could possibly be a marker of ICAS among various types of LVO. Methods: From a multicenter registry, patients with middle cerebral artery M1 segment occlusions who underwent thrombectomy within 24 h were included. Based on the on-procedure and post-procedure angiographic findings, patients were classified into embolic, ICAS-related, tandem occlusion, and recanalization failure groups. Recanalization failure was defined if the occluded vessel could not be recanalized by stent retrieval, contact aspiration, or local lytics treatment. Risk factors, imaging markers, and EVT methods were compared between groups. Results: Among 326 patients, 214 were classified as embolism, 76 as ICAS, 16 as tandem, and 20 as recanalization failure. The group with recanalization failure showed higher scores on the National Institutes of Health Stroke Scale (NIHSS) (median, 16.0 vs. 14.5 vs. 14.0 vs. 17.0, p = 0.097), frequent atrial fibrillation (59.3 vs. 18.4 vs. 0 vs. 40.0% p < 0.001), and elevation in erythrocyte sedimentation rate (ESR) (14.5 ± 15.7 vs. 15.0 ± 14.1 vs. 21.2 ± 19.5 vs. 36.0 ± 32.9, p < 0.001) among the groups. The rate of computed tomography angiography-based truncal-type occlusion in recanalization failure group was not as high as that in the ICAS group (8.1 vs. 37.5 vs. 0 vs. 16.7%, p < 0.001). Balloon guide catheters (BGC) were less frequently utilized in the recanalization failure group as compared to their use in the other groups (72.0 vs. 72.4 vs. 62.5 vs. 30.0%, p = 0.001). In the multivariable analysis, initial higher NIHSS [odds ratio (OR), 1.11 95% confidence interval (CI), 1.01–1.22 p = 0.027], higher ESR (OR, 1.03 CI, 1.01–1.05 p = 0.006), and non-use of BGCs (OR, 3.41 CI, 1.14–10.17 p = 0.028) were associated with recanalization failure. In M1 occlusions, the predominant mechanism of recanalization failure was presumed to be embolic in 80% and due to ICAS in 20%. Conclusion: The analysis of recanalization failures does not suggest an underlying predominant ICAS mechanism. Sufficient utilization of thrombectomy devices and procedures may improve the rates of recanalization.
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Affiliation(s)
- Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - So Young Park
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Dong-Hun Kang
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yong-Won Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yong-Sun Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Joonsang Yoo
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea.,Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Raul G Nogueira
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, United States
| | - Yang-Ha Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
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Tang L, Tang X, Yang Q. The Application of Tirofiban in the Endovascular Treatment of Acute Ischemic Stroke: A Meta-Analysis. Cerebrovasc Dis 2021; 50:121-131. [PMID: 33401276 DOI: 10.1159/000512601] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 10/21/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this meta-analysis is to evaluate the safety and efficacy of tirofiban during endovascular treatment (EVT) for acute ischemic stroke (AIS) patients. METHODS We systematically searched PubMed, Embase, Web of Science, and CENTRAL (Cochrane Central Register of Controlled Trials) databases for randomized controlled trials and cohort studies (published before May 1, 2020; no language restrictions) comparing tirofiban administration to blank control during EVT in patients with AIS. Our primary end points were the 3-month functional outcome, recanalization rate, symptomatic intracerebral hemorrhage, and 3-month mortality. RESULTS The incidence of 3-month modified Rankin Scale (mRS) 0-2 score of the tirofiban group was higher than that of the control group (odds ratio [OR] = 1.27, 95% CI [1.09, 1.48], p = 0.002) with heterogeneity (I2 = 34%, p = 0.11). Data pooled from the 6 studies describing the details of retriever stent in EVT revealed that tirofiban was associated with higher incidence of 3-month mRS 0-2 score (OR = 1.48, 95% CI [1.11, 1.96], p = 0.007). The recanalization rate was higher in the tirofiban group compared to the control group (OR = 1.66, 95% CI [1.16, 2.39], p = 0.006). There were no statistically significant differences in the incidence of symptomatic intracranial hemorrhage (OR = 0.97, 95% CI [0.73, 1.31], p = 0.86) and intracranial hemorrhage (OR = 1.08, 95% CI [0.59, 1.97], p = 0.80) between tirofiban and non-tirofiban group. Besides, the tirofiban administration was associated with lower mortality (OR = 0.75, 95% CI [0.62, 0.91], p = 0.003). CONCLUSIONS The application of tirofiban in EVT of AIS may improve functional outcomes and reduce mortality at 3 months. Besides, tirofiban does not seem to increase the risk of symptomatic intracranial hemorrhage and intracranial hemorrhage, either in the anterior or posterior circulation stroke.
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Affiliation(s)
- Lisha Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiangqi Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China,
| | - Qianwen Yang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
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Chien C, Lin CJ, Chang FC, Chung CP, Lin CJ, Liu HY, Chi NF, Hsu LC, Tang CW, Guo WY, Luo CB, Lai YJ, Lee IH. Quantitative CT angiography predicts large artery occlusion types and successful thrombectomy in acute ischemic stroke. J Chin Med Assoc 2021; 84:61-67. [PMID: 32956106 DOI: 10.1097/jcma.0000000000000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Clinical and radiological outcomes of endovascular thrombectomy (EVT) are related to etiologies of large vessel occlusion (LVO) in acute stroke. However, preprocedural computed tomography angiography (CTA) or CT perfusion imaging can hardly distinguish embolic occlusion from atherosclerotic occlusion. We hypothesized that quantitative multiphase CTA (mCTA) of LVO may predict occlusion types and thrombectomy outcome. METHODS We retrospectively evaluated the consecutive stroke patients who had undergone mCTA and EVT <6 hours of onset at two independent medical centers. The intra-arterial radiodensities of Hounsfield unit (HU) were measured to examine the HUdistal/proximal ratio using receiver operating characteristic curve analysis. The derived cut-off value was re-examined in an independent cohort. RESULTS In the derivation cohort (n = 102), 81 patients (79.4%) were embolic occlusion without severe residual intracranial atherosclerotic stenosis (ICAS[-]) and 21 patients were atherosclerosis-related occlusion (ICAS[+]) based on digital subtraction angiography (DSA). The optimal cut-off to predict embolic occlusion was HU ratio <0.6 measured at 2 mm from the occlusion site (maximum area under the curve = 0.87; sensitivity 96%; specificity 81%). This cut-off also independently predicted successful recanalization using stent-retrievers and/or contact aspiration (modified Treatment in Cerebral Ischemia score ≥2b; p = 0.002) after adjusting for age, atrial fibrillation, and collateral circulation score, but not predicted favorable outcome at 3 months post stroke. Importantly, in the validation cohort (n = 95, 80% embolic occlusion), this HU ratio cut-off similarly predicted occlusion types and recanalization outcome, respectively. CONCLUSION The mCTA-based quantitative radiodensities of acute LVO provides preprocedural predictive values of DSA-determined occlusion types and thrombectomy outcomes.
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Affiliation(s)
- Chun Chien
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chun-Jen Lin
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Ping Chung
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chung-Jung Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hung-Yu Liu
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Nai-Fang Chi
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Li-Chi Hsu
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chih-Wei Tang
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Wan-Yuo Guo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yen-Jun Lai
- Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - I-Hui Lee
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
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Usefulness of stent strut deformity during thrombectomy for predicting the stroke etiology in acute large artery occlusion. Clin Neurol Neurosurg 2020; 198:106130. [DOI: 10.1016/j.clineuro.2020.106130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/22/2022]
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