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Zhai H, Li Y, Jia R, Cao J, Wei Q, Yang W, Wang J. Post-endovascular treatment, blood-brain barrier disruption, predicts patient outcomes better than pre-treatment status. Neurol Sci 2024; 45:4383-4390. [PMID: 38523206 DOI: 10.1007/s10072-024-07468-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/04/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES Blood-brain barrier (BBB) disruption is an important pathological change after cerebral infarction that exacerbates brain injury. We aimed to investigate and compare the predictive utility of pre-treatment BBB permeability (BBBP) and BBBP within 1 h after endovascular treatment (EVT) for hemorrhagic transformation (HT) and 90-day prognosis. METHODS Patients underwent preoperative computed tomography perfusion (CTP) and non-contrast CT (NCCT) within 1 h after EVT. Preoperative BBBP was determined by the relative permeability surface area product (rPS) in the hypoperfusion area. Postoperative BBBP was determined by the post-EVT Alberta Stroke Program Early CT Score (Post-ASPECTS), which is based on brain parenchymal hyperdensity on the postoperative NCCT. OUTCOMES We included 100 patients. Univariate logistic regression analysis revealed correlations of preoperative rPS with HT, poor outcomes, and death. However, these correlations were not observed in multivariate logistic regression. A Post-ASPECTS ≤7 and could independently predict poor outcomes, while Post-ASPECTS ≤6 could independently predict death and HT. The baseline National Institutes of Health Stroke Scale (NIHSS) score could independently predict poor outcomes and death but not HT. A combined model using the baseline NIHSS and Post-ASPECTS scores had better predictive performance for poor outcomes and death than baseline NIHSS score alone; however, it was not superior to the predictive performance of the Post-ASPECTS score. CONCLUSION The preoperative rPS cannot independently predict clinical outcomes in EVT-treated patients; contrastingly, the Post-ASPECTS score could independently predict poor outcomes, death, and HT. This parameter could inform prompt postoperative treatment decisions.
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Affiliation(s)
- Huazheng Zhai
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Yao Li
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Ruiqi Jia
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Jun Cao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Qiang Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Weimin Yang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
| | - Jingye Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
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Yuan G, Nguyen TN, Liu L, Li R, Xia H, Long C, Wu J, Xu J, Huang F, He B, Wu D, Wang H, Feng C, Liang Y, Zhou X, Xiao Z, Luo L, Hu Y, Liu B, Peng W, Zhang C, Cui T, Zhao G, Xu L, Ma G, Hu W. Effect of Stroke Etiology on Endovascular Treatment for Acute Basilar-Artery Occlusion: A Post Hoc Analysis of the ATTENTION Randomized Trial. Stroke 2024; 55:1973-1981. [PMID: 39038096 DOI: 10.1161/strokeaha.124.047568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND Stroke etiology could influence the outcomes in patients with basilar-artery occlusion (BAO). This study aimed to evaluate the differences in efficacy and safety of best medical treatment (BMT) plus endovascular treatment (EVT) versus BMT alone in acute BAO across different stroke etiologies. METHODS The study was a post hoc analysis of the ATTENTION trial (Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion), which was a multicenter, randomized trial at 36 centers in China from February 2021 to September 2022. Patients with acute BAO were classified into 3 groups according to stroke etiology (large-artery atherosclerosis [LAA], cardioembolism, and undetermined cause/other determined cause [UC/ODC]). The primary outcome was a favorable outcome (modified Rankin Scale score of 0-3) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and 90-day mortality. RESULTS A total of 340 patients with BAO were included, 150 (44.1%) had LAA, 72 (21.2%) had cardioembolism, and 118 (34.7%) had UC/ODC. For patients treated with BMT plus EVT and BMT alone, respectively, the rate of favorable outcome at 90 days was 49.1% and 23.8% in the LAA group (odds ratio, 3.08 [95% CI, 1.38-6.89]); 52.2% and 30.8% in the cardioembolism group (odds ratio, 2.45 [95% CI, 0.89-6.77]); and 37.5% and 17.4% in the UC/ODC group (odds ratio, 2.85 [95% CI, 1.16-7.01]), with P=0.89 for the stroke etiology×treatment interaction. The rate of symptomatic intracranial hemorrhage in EVT-treated patients with LAA, cardioembolism, and UC/ODC was 8.3%, 2.2%, and 3.2%, respectively, and none of the BMT-treated patients. Lower 90-day mortality was observed in patients with EVT compared with BMT alone across 3 etiology groups. CONCLUSIONS Among patients with acute BAO, EVT compared with BMT alone might be associated with favorable outcomes and lower 90-day mortality, regardless of cardioembolism, LAA, or UC/ODC etiologies. The influence of stroke etiology on the benefit of EVT should be explored by further trials. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04751708.
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Affiliation(s)
- Guangxiong Yuan
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Thanh N Nguyen
- Department of Neurology and Radiology, Boston Medical Center, MA (T.N.N.)
| | - Lei Liu
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Rui Li
- Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, China (R.L., C.Z., W.H.)
| | - Hong Xia
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Chen Long
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Junxiong Wu
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Jun Xu
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Feng Huang
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Bo He
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Derong Wu
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Hailing Wang
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Can Feng
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Yong Liang
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Xianghong Zhou
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Zhenhua Xiao
- Department of Emergency, Shaoshan People's Hospital, China (Z.X.)
| | - Li Luo
- Department of Head and Neck Surgery, Xiangtan Central Hospital, China (L. Luo)
| | - Yanjuan Hu
- Department of Emergency, The First People's Hospital of Xiangtan, China (Y.H.)
| | - Bin Liu
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Weibo Peng
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Chao Zhang
- Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, China (R.L., C.Z., W.H.)
| | - Tao Cui
- Department of Neurology, Taihe Country People's Hospital, Linquan, China (T.C.)
| | - Gaoshan Zhao
- Department of Neurology, Linquan Country People's Hospital, China (G.Z.)
| | - Lihua Xu
- Department of Neurology, Jiamusi Central Hospital, China (L.X.)
| | - Gaoting Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (G.M.)
| | - Wei Hu
- Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, China (R.L., C.Z., W.H.)
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Li W, Wang K, Zeng C, Huang K, Fu Y, Zhao Z. Safety and efficacy of tirofiban treatment in the endovascular treatment of patients with acute ischaemic stroke - A meta-analysis. Clin Neurol Neurosurg 2024; 243:108330. [PMID: 38936178 DOI: 10.1016/j.clineuro.2024.108330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/22/2024] [Accepted: 05/11/2024] [Indexed: 06/29/2024]
Abstract
OBJECT The use of endovascular therapy (EVT) has become a widespread strategy for the clinical management of acute ischemic stroke (AIS). However, the combination of arterial injection of tirofiban with EVT for AIS continues to be a subject of controversy. This meta-analysis was conducted to assess the safety and efficacy of this treatment approach. METHODS Relevant studies were identified through a systematic literature search in Pubmed, EMBASE, Web of Science, and Cochrane Library databases, covering articles published from January 2010 to January 2023. The efficacy outcomes included favorable functional outcomes, recanalization rates, and safety outcomes including mortality and symptomatic intracranial hemorrhage (sICH). RESULTS The meta-analysis consisted of data from 13 studies, which included 1 randomized controlled trial (RCT), 7 prospective cohort studies, and 5 retrospective cohort studies, encompassing a total of 3477 patients. The study results indicate that the intra-arterial (IA) tirofiban+EVT for AIS is associated with significant improvements in favorable functional outcomes (OR, 1.21; 95%CI, 1.05-1.40; P = 0.009) and recanalization rate (OR, 1.33; 95%CI, 1.06-1.65; P = 0.01), as well as significant reductions in mortality rates (OR, 0.65; 95%CI, 0.53-0.79; P = 0.0001). Subgroup analysis revealed that administering a maintenance dose of intravenous (IV) tirofiban post-EVT was significantly associated with improved functional outcomes and reduced mortality in patients. In addition, there was no increase in the incidence of sICH (OR, 0.92; 95%CI, 0.71-1.20; P = 0.54). CONCLUSION The administration of Intra-arterial tirofiban combined with EVT is an effective and safe treatment strategy for AIS, and postoperative maintenance doses of intravenous tirofiban may be more effective than IA only.
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Affiliation(s)
- Wei Li
- Department of Neurology,The First Affiliated Hospital of Hainan Medical University, Hainan province, China
| | - Kangmeng Wang
- Department of Neurology,The First Affiliated Hospital of Hainan Medical University, Hainan province, China
| | - Chaokun Zeng
- Department of Neurology,The First Affiliated Hospital of Hainan Medical University, Hainan province, China
| | - KaiLai Huang
- Department of Neurology,The First Affiliated Hospital of Hainan Medical University, Hainan province, China
| | - YuSi Fu
- Department of Neurology,The First Affiliated Hospital of Hainan Medical University, Hainan province, China
| | - Zhenqiang Zhao
- Department of Neurology,The First Affiliated Hospital of Hainan Medical University, Hainan province, China.
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Zheng H, Zhai Y, Cao W, Zhang Q, Bai X, Gao J, Kang M, Liu Y, Guo Y, Lu G, Xu X, Wen C. First pass effect in patients undergoing endovascular treatment for posterior circulation acute ischemic stroke. J Stroke Cerebrovasc Dis 2024; 33:107640. [PMID: 38387760 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107640] [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: 12/11/2023] [Revised: 01/12/2024] [Accepted: 02/18/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE This study aims to investigate the impact of first pass effect (FPE) on outcomes in the posterior circulation acute ischemic stroke (PC-AIS) and the independent predictors of FPE. METHODS This was a multicenter, retrospective study. PC-AIS patients who underwent endovascular treatment were reviewed. The cohort achieving complete or nearly complete reperfusion (defined as expanded treatment in cerebralischemia [eTICI] ≥ 2c) was categorized into the FPE and multiple pass effect (MPE) groups. FPE was defined as achieving eTICI ≥ 2c with a single pass and without the use of rescue therapy. Modified FPE (mFPE) was defined as meeting the criteria for FPE but with eTICI ≥ 2b. The association of FPE with 90-day clinical outcomes and predictors for FPE were both investigated. RESULTS The study included a total of 328 patients, with 69 patients (21 %) in the FPE group. For primary outcome, FPE had a significant higher favorable outcome (mRS ≤ 3) rate than MPE (65.2 % vs. 44.8 %, p = 0.003). Similar outcomes were observed in the mFPE. Furthermore, FPE was significantly associated with favorable outcome (adjusted OR 2.23, 95 % CI 1.06-4.73, p = 0.036). Positive predictors for FPE included occlusion in the distal basilar artery, the first-line aspiration or combination, and cardioembolic etiology. Negative predictors for FPE included hypertension and general anesthesia. CONCLUSION For PC-AIS patients due to large or medium vessel occlusion, FPE is associated with favorable clinical outcomes. The first-line techniques of aspiration or combination, as well as avoiding general anesthesia, contribute to a better realization of FPE.
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Affiliation(s)
- Haocun Zheng
- Nanyang Central Hospital of Xinxiang Medical University, Nanyang 473000, China
| | - Yuting Zhai
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China
| | - Wenbo Cao
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Zhang
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China
| | - Xuesong Bai
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jun Gao
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China
| | - Meijuan Kang
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China
| | - Yifeng Liu
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China
| | - Yuanzhan Guo
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China
| | - Guangdong Lu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinjuan Xu
- Department of Neurosurgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University and Shanxi Cardiovascular Hospital (Institute), Taiyuan, 030000, Shanxi, China
| | - Changming Wen
- Neurology Department, Nanyang Central Hospital, Nanyang 473000, China.
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Ayub T, Barwari A, Finsterer J. Frequency, Severity, Risk Factors, and Outcome of Hemorrhagic Transformation in Anterior and Posterior Stroke. J Clin Med 2024; 13:2010. [PMID: 38610774 PMCID: PMC11012348 DOI: 10.3390/jcm13072010] [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: 03/06/2024] [Revised: 03/18/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: There are few data on hemorrhagic transformation in posterior circulation strokes (PCS) compared to anterior circulation strokes (ACS). The aim of this study was to retrospectively analyze the incidence of hemorrhagic transformation, its different subtypes, the associations with different risk factors, and the outcome of ACS and PCS patients. Methods: A retrospective analysis of consecutive ischemic stroke patients with hemorrhagic transformation was performed. Clinical and demographic data were collected from electronic patient records. Results: Included were 186 ACS patients and 67 PCS patients. The median age was 77 years, with PCS patients being slightly younger than ACS patients. ACS patients were more likely to be treated with acetylsalicylic acid before stroke. ACS and PCS patients had comparable frequencies and severity of hemorrhagic transformation. After excluding ACS patients who received thrombectomy, PCS patients developed hemorrhagic transformation more frequently compared to ACS patients. Risk factors for hemorrhagic transformation did not differ between ACS and PCS patients and included vitamin K antagonist use before stroke and thrombectomy in ACS patients. There was no correlation between hemorrhagic transformation and stroke outcome. Conclusions: Hemorrhagic transformation occurs with similar frequency in PCS and ACS patients but is more common in PCS patients after the exclusion of ACS patients undergoing thrombectomy.
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Affiliation(s)
- Tanya Ayub
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Awini Barwari
- Neurology & Neurophysiology Center, 1180 Vienna, Austria
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Bai B, Huang S, Ning C, Wang Y, Lei W, Xi X, Zhang H, Liu T, Gao Y, Shi H, He H, Cui J, Li Y. Predictive Value of a Novel Baseline Diffusion-Weighted Imaging Posterior Circulation Score in Endovascular Treatment of Patients with Acute Vertebrobasilar Occlusion. Acad Radiol 2023; 30:2212-2221. [PMID: 37453882 DOI: 10.1016/j.acra.2023.05.037] [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: 04/26/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the predictive value of a novel posterior circulation score (novel-PC score) based on baseline posterior circulation diffusion-weighted imaging (DWI) for functional independence after endovascular treatment (EVT) in patients with acute vertebral-basilar artery occlusion (VBAO). MATERIALS AND METHODS The baseline DWI brain stem score (BSS), posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), and the novel-PC score were evaluated separately. A modified Rankin scale (mRS) ≤2 at 90 days was defined as a prognostic indicator of functional independence. Modified Thrombolysis in Cerebral Infarction grade 2b or 3 was defined as surgical success. RESULTS A total of 64 eligible patients were enrolled and divided into good and poor functional prognosis groups based on the mRS. The novel-PC score, BSS, and pc-ASPECTS (all P ≤ .001) were significantly better in the good functional prognosis group. The novel-PC score had a higher predictive value than BSS and pc-ASPECTS for 90-day functional independence (area under the receiver operating characteristic curve, 0.87 vs. 0.73 vs. 0.71; P < .05). Univariate binary logistic regression analysis showed that age (P = .006), Posterior National Institutes of Health Stroke Scale ≤18 (P < .001), BSS ≤2 (P = .008), pc-ASPECTS >7 (P = .002), and novel-PC score ≤5 (P = .001) were independently associated with function. CONCLUSION Our novel-PC score, based on DWI, can independently predict functional prognosis in patients with acute VBAO after EVT. CLINICAL RELEVANCE The novel-PC score based on baseline DWI was shown to be an independent predictor of function in patients with acute BVAO who are treated with EVT.
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Affiliation(s)
- Bofeng Bai
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Shanshan Huang
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Cong Ning
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Yannan Wang
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Wei Lei
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Xiaoyi Xi
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Haoyu Zhang
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Ting Liu
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Yifei Gao
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Hong Shi
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Hong He
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Jian Cui
- Department of Neurosurgery, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (J.C.)
| | - Yongbin Li
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.).
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Lee SJ, Hong JM, Kim JS, Lee JS. Endovascular Treatment for Posterior Circulation Stroke: Ways to Maximize Therapeutic Efficacy. J Stroke 2022; 24:207-223. [PMID: 35677976 PMCID: PMC9194547 DOI: 10.5853/jos.2022.00941] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/20/2022] [Indexed: 11/11/2022] Open
Abstract
The efficacy of endovascular treatment (EVT) in patients with posterior circulation stroke has not been proven. Two recent randomized controlled trials failed to show improved functional outcomes after EVT for posterior circulation stroke (PC-EVT). However, promising results for two additional randomized controlled trials have also been presented at a recent conference. Studies have shown that patients undergoing PC-EVT had a higher rate of futile recanalization than those undergoing EVT for anterior circulation stroke. These findings call for further identification of prognostic factors beyond recanalization. The significance of baseline clinical severity, infarct volume, collaterals, time metrics, core-penumbra mismatch, and methods to accurately measure these parameters are discussed. Furthermore, their interplay on EVT outcomes and the potential to individualize patient selection for PC-EVT are reviewed. We also discuss technical considerations for improving the treatment efficacy of PC-EVT.
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Affiliation(s)
- Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Jong S. Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
- Correspondence: Jin Soo Lee Department of Neurology, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5175 Fax: +82-31-219-5178 E-mail:
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Kim JS. Resurrection of Endovascular Thrombectomy for Posterior Circulation Stroke. J Stroke 2022; 24:177-178. [PMID: 35677973 PMCID: PMC9194535 DOI: 10.5853/jos.2022.01620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jong S. Kim
- Stroke Center and Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence: Jong S. Kim Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3442 Fax: +82-2-474-4691 E-mail:
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