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Gharaibeh K, Aladamat N, Mierzwa AT, Rao R, Alhajala H, Al Kasab S, Anadani M, Burgess R, Zaidi S, Jumaa M. Blood Pressure after Successful Endovascular Therapy: A Systematic Review and Meta-Analysis of Randomized Control Trials. Ann Neurol 2024; 95:858-865. [PMID: 38481016 DOI: 10.1002/ana.26907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE There are limited data evaluating the optimum blood pressure (BP) goal post mechanical thrombectomy (MT) and its effect on outcomes of patients with large vessel occlusions (LVO). The objective of this study was to compare the efficacy and safety of intensive versus conventional BP control after reperfusion with MT via a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS We searched PubMed and Embase to obtain articles related to BP control post MT through September 2023. The primary outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 3 months, while secondary outcomes included excellent outcome (mRS 0-1), symptomatic intracranial hemorrhage (sICH), and mortality. RESULTS Four RCTs with 1,566 patients (762 randomized into intensive BP control vs. 806 randomized into conventional BP control) were included. Analysis showed that there was a lower likelihood of functional independence (mRS 0-2: odds ratio [OR]: 0.68, 95% confidence interval [CI] 0.51-0.91, p = 0.009) in the more intensive treatment group compared with the conventional treatment group. There was no statistically significant difference in achieving excellent outcome (mRS0-1: OR: 0.82, 95% CI: 0.63-1.07; p = 0.15), risk of sICH or mortality. INTERPRETATION This systematic review and meta- analysis Indicates that in patients who achieved successful MT for acute ischemic stroke with LVO, intensive BP control was associated with a lower likelihood of functional independence at 3 months without significant difference in likelihood of achieving excellent outcome, sICH risk, or mortality. ANN NEUROL 2024;95:858-865.
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Affiliation(s)
- Khaled Gharaibeh
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Nameer Aladamat
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Adam T Mierzwa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Rahul Rao
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Hisham Alhajala
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Sami Al Kasab
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Mohammad Anadani
- Department of Neurosciences, Intent Medical Group, Northshore University Neurosciences Institute, Arlington Heights, IL, USA
| | - Richard Burgess
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Syed Zaidi
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
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Katsanos AH, Joundi RA, Palaiodimou L, Ahmed N, Kim JT, Goyal N, Maier IL, de Havenon A, Anadani M, Matusevicius M, Mistry EA, Khatri P, Arthur AS, Sarraj A, Yaghi S, Shoamanesh A, Catanese L, Psychogios MN, Tsioufis K, Malhotra K, Spiotta AM, Sandset EC, Alexandrov AV, Petersen NH, Tsivgoulis G. Blood Pressure Trajectories and Outcomes After Endovascular Thrombectomy for Acute Ischemic Stroke. Hypertension 2024; 81:629-635. [PMID: 38164751 DOI: 10.1161/hypertensionaha.123.22164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Data on systolic blood pressure (SBP) trajectories in the first 24 hours after endovascular thrombectomy (EVT) in acute ischemic stroke are limited. We sought to identify these trajectories and their relationship to outcomes. METHODS We combined individual-level data from 5 studies of patients with acute ischemic stroke who underwent EVT and had individual blood pressure values after the end of the procedure. We used group-based trajectory analysis to identify the number and shape of SBP trajectories post-EVT. We used mixed effects regression models to identify associations between trajectory groups and outcomes adjusting for potential confounders and reported the respective adjusted odds ratios (aORs) and common odds ratios. RESULTS There were 2640 total patients with acute ischemic stroke included in the analysis. The most parsimonious model identified 4 distinct SBP trajectories, that is, general directional patterns after repeated SBP measurements: high, moderate-high, moderate, and low. Patients in the higher blood pressure trajectory groups were older, had a higher prevalence of vascular risk factors, presented with more severe stroke syndromes, and were less likely to achieve successful recanalization after the EVT. In the adjusted analyses, only patients in the high-SBP trajectory were found to have significantly higher odds of early neurological deterioration (aOR, 1.84 [95% CI, 1.20-2.82]), intracranial hemorrhage (aOR, 1.84 [95% CI, 1.31-2.59]), mortality (aOR, 1.75 [95% CI, 1.21-2.53), death or disability (aOR, 1.63 [95% CI, 1.15-2.31]), and worse functional outcomes (adjusted common odds ratio,1.92 [95% CI, 1.47-2.50]). CONCLUSIONS Patients follow distinct SBP trajectories in the first 24 hours after an EVT. Persistently elevated SBP after the procedure is associated with unfavorable short-term and long-term outcomes.
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Affiliation(s)
- Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., R.A.J., A.S., L.C.)
| | - Raed A Joundi
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., R.A.J., A.S., L.C.)
| | - Lina Palaiodimou
- Second Department of Neurology, Attikon University Hospital, School of Medicine (L.P., G.T.), National and Kapodistrian University of Athens, Greece
| | - Niaz Ahmed
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A., M.M.)
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A., M.M.)
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea (J.-T.K.)
| | - Nitin Goyal
- Department of Neurology (N.G., G.T., A.V.A.), University of Tennessee Health Science Center, Memphis
- Department of Neurosurgery (N.G., A.S.A.), University of Tennessee Health Science Center, Memphis
| | - Ilko L Maier
- Department of Neurology, University Medical Center Goettingen, Germany (I.L.M.)
| | - Adam de Havenon
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City (A.d.H.)
| | - Mohammad Anadani
- Department of Neurology, (M.A.), Medical University of South Carolina, Charleston
- Department of Neurosurgery (MA., A.M.S.), Medical University of South Carolina, Charleston
| | - Marius Matusevicius
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A., M.M.)
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A., M.M.)
| | - Eva A Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee (E.A.M.)
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati, Ohio (P.K.)
| | - Adam S Arthur
- Department of Neurosurgery (N.G., A.S.A.), University of Tennessee Health Science Center, Memphis
| | - Amrou Sarraj
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., R.A.J., A.S., L.C.)
| | - Shadi Yaghi
- Department of Neurology, NYU Langone Health, New York, NY (S.Y.)
| | - Ashkan Shoamanesh
- Department of Neurology, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (A.S.)
| | - Luciana Catanese
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., R.A.J., A.S., L.C.)
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland (M.-N.P.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokration Hospital (K.T.), National and Kapodistrian University of Athens, Greece
| | - Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania (K.M.)
| | - Alejandro M Spiotta
- Department of Neurosurgery (MA., A.M.S.), Medical University of South Carolina, Charleston
| | | | - Andrei V Alexandrov
- Department of Neurology (N.G., G.T., A.V.A.), University of Tennessee Health Science Center, Memphis
| | - Nils H Petersen
- Department of Neurology, Yale University, New Haven (N.H.P.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine (L.P., G.T.), National and Kapodistrian University of Athens, Greece
- Department of Neurology (N.G., G.T., A.V.A.), University of Tennessee Health Science Center, Memphis
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Palaiodimou L, Joundi RA, Katsanos AH, Ahmed N, Kim JT, Goyal N, Maier IL, de Havenon A, Anadani M, Matusevicius M, Mistry EA, Khatri P, Arthur AS, Sarraj A, Yaghi S, Shoamanesh A, Catanese L, Psychogios MN, Malhotra K, Spiotta AM, Vassilopoulou S, Tsioufis K, Sandset EC, Alexandrov AV, Petersen N, Tsivgoulis G. Association between blood pressure variability and outcomes after endovascular thrombectomy for acute ischemic stroke: An individual patient data meta-analysis. Eur Stroke J 2024; 9:88-96. [PMID: 37921233 PMCID: PMC10916831 DOI: 10.1177/23969873231211157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Data on the association between blood pressure variability (BPV) after endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) and outcomes are limited. We sought to identify whether BPV within the first 24 hours post EVT was associated with key stroke outcomes. METHODS We combined individual patient-data from five studies among AIS-patients who underwent EVT, that provided individual BP measurements after the end of the procedure. BPV was estimated as either systolic-BP (SBP) standard deviation (SD) or coefficient of variation (CV) over 24 h post-EVT. We used a logistic mixed-effects model to estimate the association [expressed as adjusted odds ratios (aOR)] between tertiles of BPV and outcomes of 90-day mortality, 90-day death or disability [modified Rankin Scale-score (mRS) > 2], 90-day functional impairment (⩾1-point increase across all mRS-scores), and symptomatic intracranial hemorrhage (sICH), adjusting for age, sex, stroke severity, co-morbidities, pretreatment with intravenous thrombolysis, successful recanalization, and mean SBP and diastolic-BP levels within the first 24 hours post EVT. RESULTS There were 2640 AIS-patients included in the analysis. The highest tertile of SBP-SD was associated with higher 90-day mortality (aOR:1.44;95% CI:1.08-1.92), 90-day death or disability (aOR:1.49;95% CI:1.18-1.89), and 90-day functional impairment (adjusted common OR:1.42;95% CI:1.18-1.72), but not with sICH (aOR:1.22;95% CI:0.76-1.98). Similarly, the highest tertile of SBP-CV was associated with higher 90-day mortality (aOR:1.33;95% CI:1.01-1.74), 90-day death or disability (aOR:1.50;95% CI:1.19-1.89), and 90-day functional impairment (adjusted common OR:1.38;95% CI:1.15-1.65), but not with sICH (aOR:1.33;95% CI:0.83-2.14). CONCLUSIONS BPV after EVT appears to be associated with higher mortality and disability, independently of mean BP levels within the first 24 h post EVT. BPV in the first 24 h may be a novel target to improve outcomes after EVT for AIS.
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Affiliation(s)
- Lina Palaiodimou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Raed A Joundi
- Department of Medicine (Neurology), McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Aristeidis H Katsanos
- Department of Medicine (Neurology), McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Niaz Ahmed
- Department of Neurology, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ilko L Maier
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Adam de Havenon
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Mohammad Anadani
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Marius Matusevicius
- Department of Neurology, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eva A Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Amrou Sarraj
- Department of Neurology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Shadi Yaghi
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Ashkan Shoamanesh
- Department of Medicine (Neurology), McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Luciana Catanese
- Department of Medicine (Neurology), McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Sofia Vassilopoulou
- First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nils Petersen
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
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4
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Yaghi S, Shu L, Mandel DM, Leon Guerrero CR, Henninger N, Muppa J, Affan M, Ul Haq Lodhi O, Heldner MR, Antonenko K, Seiffge DJ, Arnold M, Salehi Omran S, Crandall RC, Lester E, Lopez Mena D, Arauz A, Nehme A, Boulanger M, Touzé E, Sousa JA, Sargento-Freitas J, Barata V, Castro-Chaves P, Brito MTÁP, Khan M, Mallick D, Rothstein A, Khazaal O, Kaufmann J, Engelter ST, Traenka C, Aguiar de Sousa D, Soares M, Rosa SD, Zhou LW, Gandhi P, Field TS, Mancini S, Metanis I, Leker RR, Pan K, Dantu V, Baumgartner KV, Burton TM, Freiin von Rennenberg R, Nolte CH, Choi RK, MacDonald JA, Bavarsad Shahripour R, Guo X, Ghannam M, AlMajali M, Samaniego EA, Sanchez S, Rioux B, Zine-Eddine F, Poppe AY, Fonseca AC, Baptista M, Cruz D, Romoli M, De Marco G, Longoni M, Keser Z, Griffin KJ, Kuohn L, Frontera JA, Amar J, Giles JA, Zedde M, Pascarella R, Grisendi I, Nzwalo H, Liebeskind DS, Molaie AM, Cavalier A, Kam W, Mac Grory B, Al Kasab S, Anadani M, Kicielinski KP, Eltatawy AR, Chervak LM, Chulluncuy-Rivas R, Aziz YN, Bakradze E, Tran TL, Rodrigo-Gisbert M, Requena M, Saleh Velez FG, Ortiz Garcia JG, Muddasani V, de Havenon A, Vishnu VY, Yaddanapudi SS, Adams L, Browngoehl A, Ranasinghe T, Dunston R, Lynch Z, Penckofer M, Siegler JE, Mayer SV, Willey JZ, Zubair AS, Cheng YK, Sharma R, Marto JP, Mendes Ferreira V, Klein P, Nguyen TN, Asad SD, Sarwat Z, Balabhadra A, Patel S, Secchi TL, Martins SC, Mantovani GP, Kim YD, Krishnaiah B, Elangovan C, Lingam S, Qureshi AY, Fridman S, Alvarado-Bolaños A, Khasiyev F, Linares G, Mannino M, Terruso V, Vassilopoulou S, Tentolouris-Piperas V, Martínez-Marino M, Carrasco Wall VA, Indraswari F, El Jamal S, Liu S, Alvi M, Ali F, Sarvath MM, Morsi RZ, Kass-Hout T, Shi F, Zhang J, Sokhi D, Said J, Simpkins AN, Gomez R, Sen S, Ghani MR, Elnazeir M, Xiao H, Kala NS, Khan F, Stretz C, Mohammadzadeh N, Goldstein ED, Furie KL. Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study. Stroke 2024. [PMID: 38335240 DOI: 10.1161/strokeaha.123.045731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Background: Small, randomized trials of cervical artery dissection (CAD) patients showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with CAD treated with antiplatelets versus anticoagulation. Methods: This is a multi-center observational retrospective international study (16 countries, 63 sites) that included CAD patients without major trauma. The exposure was antithrombotic treatment type (anticoagulation vs. antiplatelets) and outcomes were subsequent ischemic stroke and major hemorrhage (intracranial or extracranial hemorrhage). We used adjusted Cox regression with Inverse Probability of Treatment Weighting (IPTW) to determine associations between anticoagulation and study outcomes within 30 and 180 days. The main analysis used an "as treated" cross-over approach and only included outcomes occurring on the above treatments. Results: The study included 3,636 patients [402 (11.1%) received exclusively anticoagulation and 2,453 (67.5%) received exclusively antiplatelets]. By day 180, there were 162 new ischemic strokes (4.4%) and 28 major hemorrhages (0.8%); 87.0% of ischemic strokes occurred by day 30. In adjusted Cox regression with IPTW, compared to antiplatelet therapy, anticoagulation was associated with a non-significantly lower risk of subsequent ischemic stroke by day 30 (adjusted HR 0.71 95% CI 0.45-1.12, p=0.145) and by day 180 (adjusted HR 0.80 95% CI 0.28-2.24, p=0.670). Anticoagulation therapy was not associated with a higher risk of major hemorrhage by day 30 (adjusted HR 1.39 95% CI 0.35-5.45, p=0.637) but was by day 180 (adjusted HR 5.56 95% CI 1.53-20.13, p=0.009). In interaction analyses, patients with occlusive dissection had significantly lower ischemic stroke risk with anticoagulation (adjusted HR 0.40 95% CI 0.18-0.88) (Pinteraction=0.009). Conclusions: Our study does not rule out a benefit of anticoagulation in reducing ischemic stroke risk, particularly in patients with occlusive dissection. If anticoagulation is chosen, it seems reasonable to switch to antiplatelet therapy before 180 days to lower the risk of major bleeding. Large prospective studies are needed to validate our findings.
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Affiliation(s)
- Shadi Yaghi
- Neurology, Alpert Medical School at Brown University, UNITED STATES
| | - Liqi Shu
- Neurology, Alpert Medical School of Brown University, UNITED STATES
| | - Daniel M Mandel
- Neurology, University of Miami Miller School of Medicine, UNITED STATES
| | | | - Nils Henninger
- Departments of Neurology and Psychiatry, University of Massachusetts Medical School, UNITED STATES
| | | | | | | | - Mirjam R Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, SWITZERLAND
| | - Kateryna Antonenko
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland, SWITZERLAND
| | - David J Seiffge
- Neurology, Inselspital, Bern University Hospital, University of Bern, SWITZERLAND
| | - Marcel Arnold
- Department of Neurology, University hospital of Bern, SWITZERLAND
| | | | | | | | - Diego Lopez Mena
- National Institute of Neurology and Neurosurgery of Mexico, MEXICO
| | - Antonio Arauz
- stroke clinic, Instituto Nacional de Neurologia, MEXICO
| | | | - Marion Boulanger
- Service de neurologie,, Universite Caen Normandie, CHU Caen Normandie, INSERM U1237, CYCERON, boulevard Henri Becquerel, Caen, France, Blood and Brain @ Caen-Normandie Institute (BB@C), Caen, France, FRANCE
| | | | | | | | | | | | | | - Muhib Khan
- Department of Neurology, Mayo Clinic, UNITED STATES
| | | | - Aaron Rothstein
- Department of Neurology, University of Pennsylvania, UNITED STATES
| | - Ossama Khazaal
- Department of Neurology, University of Pennsylvania, UNITED STATES
| | | | | | - Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel, SWITZERLAND
| | | | - Mafalda Soares
- Lisbon Central University Hospital, University of Lisbon, PORTUGAL
| | - Sara Db Rosa
- Neuroradiology, Lisbon Central University Hospital, PORTUGAL
| | - Lily W Zhou
- Neurology, The University of British Columbia, CANADA
| | | | - Thalia S Field
- Centre for Brain Health, Division of Neurology, Vancouver Stroke Program, University of British Columbia, CANADA
| | | | - Issa Metanis
- Hebrew University-Hadassah Medical Center, ISRAEL
| | - Ronen R Leker
- Neurology, Hadassah-Hebrew University Medical Center, ISRAEL
| | - Kelly Pan
- Rhode Island Hospital, UNITED STATES
| | - Vishnu Dantu
- Barrow Neurological Institute - St. Joseph's Hospital and Medical Center, UNITED STATES
| | | | - Tina M Burton
- Neurology, The Warren Alpert Medical School of Brown University, UNITED STATES
| | - Regina Freiin von Rennenberg
- Department of Neurology (Klinik und Hochschulambulanz für Neurologie), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | | | | | | | - Reza Bavarsad Shahripour
- University of California San Diego Comprehensive Stroke Center, Department of Neurosciences, University of California, San Diego, USA., UNITED STATES
| | - Xiaofan Guo
- Neurology, Department of Neurology, Loma Linda University Health, UNITED STATES
| | - Malik Ghannam
- Neurology, University of Iowa Hospitals and Clinics, UNITED STATES
| | | | - Edgar A Samaniego
- Neurology, Neurosurgery & Radiology, University of Iowa, UNITED STATES
| | | | | | | | | | - Ana Catarina Fonseca
- Department of Neurosciences and Mental Health (Neurology), University of Lisbon, PORTUGAL
| | - Maria Baptista
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto
| | - Diana Cruz
- Neurology, Hospital Santa Maria - CHULN, PORTUGAL
| | | | - Giovanna De Marco
- Neurology and Stroke Unit, Department of Neuroscience,, Bufalini Hospital, ITALY
| | | | | | | | - Lindsey Kuohn
- Department of Neurology, NYU Langone Health, UNITED STATES
| | | | - Jordan Amar
- Keck School of Medicine of the University of Southern California, UNITED STATES
| | - James A Giles
- Neurology, Yale University School of Medicine, UNITED STATES
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia
| | | | - Ilaria Grisendi
- Neuromotor physiology, Azienda USL-IRCCS di Reggio Emilia, ITALY
| | - Hipólito Nzwalo
- Ageing and Cerebrovascular Research Group, Algarve Biomedical Research Institute, PORTUGAL
| | - David S Liebeskind
- Neurovascular Imaging Research Core & Neurology, University of California, Los Angeles, UNITED STATES
| | - Amir M Molaie
- Neurology, University of California at Los Angeles Medical Center, UNITED STATES
| | - Annie Cavalier
- Neurology, Duke University School of Medicine, UNITED STATES
| | - Wayneho Kam
- Duke University Hospital; UNC Health Rex Comprehensive Stroke Center, UNITED STATES
| | - Brian Mac Grory
- Neurology, Duke University School of Medicine, UNITED STATES
| | - Sami Al Kasab
- Neurosurgery and Neurology, Medical University of south Carolina, UNITED STATES
| | - Mohammad Anadani
- Neurology, Medical University of South Carolina, College of Medicine, UNITED STATES
| | | | | | - Lina M Chervak
- Department of Neurology, University of Cincinnati Medical Center, UNITED STATES
| | | | - Yasmin Ninette Aziz
- Neurology and Rehabilitation Medicine, University of Cincinnati, UNITED STATES
| | | | | | - Marc Rodrigo-Gisbert
- Hospital Universitari Vall d'Hebron. Departament de Medicina, Universitat Autònoma de Barcelona. Barcelona. Spain
| | - Manuel Requena
- Neurology. Universitat Autònoma de Barcelona, Univ Hosp Vall d'Hebron, SPAIN
| | - Faddi Ghassan Saleh Velez
- Department of Neurology, Vascular Division, The University of Oklahoma Health Sciences Center, UNITED STATES
| | - Jorge G Ortiz Garcia
- Department of Neurology, Division of Critical Care Neurology, Division of Stroke and Cerebrovascular Disorders, The University of Oklahoma Health Sciences Center, UNITED STATES
| | | | - Adam de Havenon
- Department of Neurology, Yale University School of Medicine, UNITED STATES
| | | | | | | | | | | | - Randy Dunston
- Wake Forest University Baptist Medical Center, UNITED STATES
| | | | - Mary Penckofer
- Cooper Medical School of Rowan University, UNITED STATES
| | - James E Siegler
- Department of Neurology, University of Chicago, UNITED STATES
| | | | | | | | | | | | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, PORTUGAL
| | | | - Piers Klein
- Neurology, Boston University Chobanian & Avedisian School of Medicine, UNITED STATES
| | - Thanh N Nguyen
- Neurology, Radiology, Boston University Chobanian and Avedisian School of Medicine, UNITED STATES
| | | | | | - Anvesh Balabhadra
- Neurology, Hartford Hospital & University of Connecticut, UNITED STATES
| | - Shivam Patel
- Neurology, UConn School of Medicine, UNITED STATES
| | | | - Sheila Co Martins
- Stroke Unit, Neurology Service, Hospital de Clinicas de Porto Alegre, BRAZIL
| | | | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, KOREA, REPUBLIC OF
| | - Balaji Krishnaiah
- Neurology, University of Tennnessee Health Science Center, UNITED STATES
| | | | | | - Abid Y Qureshi
- Department of Neurology, University of Kansas Medical Center, UNITED STATES
| | - Sebastian Fridman
- Department of Clinical Neurological Sciences, University of Western Ontario - London Health Science Centre, CANADA
| | | | - Farid Khasiyev
- Neurology, Saint Louis University School of Medicine, UNITED STATES
| | - Guillermo Linares
- Souers Stroke Institute, Saint Louis University School of Medicine, UNITED STATES
| | | | | | - Sofia Vassilopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, GREECE
| | | | | | | | | | - Sleiman El Jamal
- Neurology, Rhode Island Hospital & Alpert Medical School of Brown University, UNITED STATES
| | - Shilin Liu
- University of Science and Technology, CHINA
| | | | | | | | - Rami Z Morsi
- Department of Neurology, University of Chicago, UNITED STATES
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, UNITED STATES
| | - Feina Shi
- Department of Neurology, Sir Run Run Shaw Hospital of Zhejiang University, School of Medicine, CHINA
| | - Jinhua Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, CHINA
| | | | | | | | | | - Shayak Sen
- Cedars Sinai Medical Center, UNITED STATES
| | | | - Marwa Elnazeir
- Department of Neurology, University of Louisville, UNITED STATES
| | - Han Xiao
- Economics, University of California Santa Barbara, UNITED STATES
| | | | - Farhan Khan
- Neurology, Alpert Medical School, Brown University, UNITED STATES
| | - Christoph Stretz
- Neurology, Warren Alpert Medical School of Brown University, UNITED STATES
| | | | - Eric D Goldstein
- Neurology, Warren Alpert Medical School of Brown University, UNITED STATES
| | - Karen L Furie
- Department of Neurology, Rhode Island Hospital, UNITED STATES
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5
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Anadani M, Almallouhi E, Maier I, Al Kasab S, Jabbour P, Kim JT, Wolfe SQ, Rai A, Starke RM, Psychogios MN, Samaniego EA, Arthur AS, Yoshimura S, Cuellar H, Howard BM, Alawieh A, Fragata I, Polifka AJ, Mascitelli JR, Osbun JW, Matouk C, Park MS, Levitt MR, Dumont TM, Williamson R, Spiotta AM. Effect of intravenous thrombolysis before endovascular therapy on outcomes in patients with large core infarct. J Neurointerv Surg 2023; 15:e414-e418. [PMID: 36990690 DOI: 10.1136/jnis-2022-019537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/17/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND The safety and efficacy of bridging therapy with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in patients with large core infarct has not been sufficiently studied. In this study, we compared the efficacy and safety outcomes between patients who received IVT+MT and those treated with MT alone. METHODS This is a retrospective analysis of the Stroke Thrombectomy Aneurysm Registry (STAR). Patients with Alberta Stroke Program Early CT Score (ASPECTS) ≤5 treated with MT were included in this study. Patients were divided into two groups based on pre-treatment IVT (IVT, no IVT). Propensity score matched analysis were used to compare outcomes between groups. RESULTS A total of 398 patients were included; 113 pairs were generated using propensity score matching analyses. Baseline characteristics were well balanced in the matched cohort. The rate of any intracerebral hemorrhage (ICH) was similar between groups in both the full cohort (41.4% vs 42.3%, P=0.85) and matched cohort (38.55% vs 42.1%, P=0.593). Similarly, the rate of significant ICH was similar between the groups (full cohort: 13.1% vs 16.9%, P=0.306; matched cohort: 15.6% vs 18.95, P=0.52). There was no difference in favorable outcome (90-day modified Rankin Scale 0-2) or successful reperfusion between groups. In an adjusted analysis, IVT was not associated with any of the outcomes. CONCLUSION Pretreatment IVT was not associated with an increased risk of hemorrhage in patients with large core infarct treated with MT. Future studies are needed to assess the safety and efficacy of bridging therapy in patients with large core infarct.
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Affiliation(s)
- Mohammad Anadani
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eyad Almallouhi
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ilko Maier
- Neurology, University Medicine Goettingen, Goettingen, Germany
| | - Sami Al Kasab
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pascal Jabbour
- Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joon-Tae Kim
- Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Ansaar Rai
- Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Robert M Starke
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Edgar A Samaniego
- Neurology, Radiology and Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hugo Cuellar
- Neurosurgery, LSUHSC, Shreveport, Louisiana, USA
| | - Brian M Howard
- Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ali Alawieh
- Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Isabel Fragata
- Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Adam J Polifka
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Justin R Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Joshua W Osbun
- Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Charles Matouk
- Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Min S Park
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Michael R Levitt
- Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Travis M Dumont
- Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
| | | | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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6
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Almallouhi E, Zandpazandi S, Anadani M, Cunningham C, Sowlat MM, Matsukawa H, Orscelik A, Elawady SS, Maier I, Al Kasab S, Jabbour P, Kim JT, Wolfe SQ, Rai A, Starke RM, Psychogios MN, Samaniego EA, Arthur AS, Yoshimura S, Cuellar H, Grossberg JA, Alawieh A, Romano DG, Tanweer O, Mascitelli J, Fragata I, Polifka AJ, Osbun JW, Crosa RJ, Matouk C, Park MS, Levitt MR, Brinjikji W, Moss M, Dumont TM, Williamson R, Navia P, Kan P, De Leacy R, Chowdhry SA, Ezzeldin M, Spiotta AM. Outcomes of mechanical thrombectomy in stroke patients with extreme large infarction core. J Neurointerv Surg 2023:jnis-2023-021046. [PMID: 38041671 DOI: 10.1136/jnis-2023-021046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/04/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Recent clinical trials have demonstrated that patients with large vessel occlusion (LVO) and large infarction core may still benefit from mechanical thrombectomy (MT). In this study, we evaluate outcomes of MT in LVO patients presenting with extremely large infarction core Alberta Stroke Program Early CT Score (ASPECTS 0-2). METHODS Data from the Stroke Thrombectomy and Aneurysm Registry (STAR) was interrogated. We identified thrombectomy patients presenting with an occlusion in the intracranial internal carotid artery (ICA) or M1 segment of the middle cerebral artery and extremely large infarction core (ASPECTS 0-2). A favorable outcome was defined by achieving a modified Rankin scale of 0-3 at 90 days post-MT. Successful recanalization was defined by achieving a modified Thrombolysis In Cerebral Ischemia (mTICI) score ≥2B. RESULTS We identified 58 patients who presented with ASPECTS 0-2 and underwent MT . Median age was 70.0 (59.0-78.0) years, 45.1% were females, and 202 (36.3%) patients received intravenous tissue plasminogen activator. There was no difference regarding the location of the occlusion (p=0.57). Aspiration thrombectomy was performed in 268 (54.6%) patients and stent retriever was used in 70 (14.3%) patients. In patients presenting with ASPECTS 0-2 the mortality rate was 4.5%, 27.9% had mRS 0-3 at day 90, 66.67% ≥70 years of age had mRS of 5-6 at day 90. On multivariable analysis, age, National Institutes of Health Stroke Scale on admission, and successful recanalization (mTICI ≥2B) were independently associated with favorable outcomes. CONCLUSIONS This multicentered, retrospective cohort study suggests that MT may be beneficial in a select group of patients with ASPECTS 0-2.
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Affiliation(s)
- Eyad Almallouhi
- Neuro Interventional Surgery, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Sara Zandpazandi
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohammad Anadani
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Conor Cunningham
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohammad-Mahdi Sowlat
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Hidetoshi Matsukawa
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Atakan Orscelik
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Sameh Samir Elawady
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ilko Maier
- Neurology, University Medicine Goettingen, Goettingen, Germany
| | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pascal Jabbour
- Neurological surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joon-Tae Kim
- Chonnam National University Hospital, Gwangju, Korea (the Republic of)
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Ansaar Rai
- Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Robert M Starke
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- University of Miami School of Medicine, Miami, Florida, USA
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Edgar A Samaniego
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hugo Cuellar
- Neurosurgery, LSUHSC, Shreveport, Louisiana, USA
| | - Jonathan A Grossberg
- Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ali Alawieh
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Daniele G Romano
- Neurordiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | | | - Justin Mascitelli
- Deparment of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Isabel Fragata
- Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Adam J Polifka
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Joshua W Osbun
- Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | | | - Charles Matouk
- Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Min S Park
- University of Virginia, Charlottesville, Virginia, USA
| | - Michael R Levitt
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Mark Moss
- Washington Regional Medical Center, Fayetteville, Arkansas, USA
| | - Travis M Dumont
- Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
| | | | - Pedro Navia
- Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
| | - Peter Kan
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shakeel A Chowdhry
- Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Mohamad Ezzeldin
- Department of Clinical Sciences, University of Houston, HCA Houston Healthcare Kingwood, University of Houston, Houston, Texas, USA
- Neuroendovascular surgery, HCA Houston, Houston, Texas, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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7
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Stulberg EL, Harris BRE, Zheutlin AR, Delic A, Sheibani N, Anadani M, Yaghi S, Petersen NH, de Havenon A. Association of Blood Pressure Variability With Death and Discharge Destination Among Critically Ill Patients With and Without Stroke. Neurology 2023; 101:e1145-e1157. [PMID: 37487742 PMCID: PMC10513881 DOI: 10.1212/wnl.0000000000207599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/15/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES It is unclear whether blood pressure variability's (BPV) association with worse outcomes is unique to patients with stroke or a risk factor among all critically ill patients. We (1) determined whether BPV differed between patients with stroke and nonstroke patients, (2) examined BPV's associations with in-hospital death and favorable discharge destination in patients with stroke and nonstroke patients, and (3) assessed how minimum mean arterial pressure (MAP)-a correlate of illness severity and cerebral perfusion-affects these associations. METHODS This is a retrospective analysis of adult intensive care unit patients hospitalized between 2001 and 2012 from the Medical Information Mart for Intensive Care III database. Confounder-adjusted logistic regressions determined associations between BPV, measured as SD and average real variability (ARV), and (1) in-hospital death and (2) favorable discharge, with testing of minimum MAP for effect modification. RESULTS BPV was higher in patients with stroke (N = 2,248) compared with nonstroke patients (N = 9,085) (SD mean difference 2.3, 95% CI 2.1-2.6, p < 0.01). After adjusting for minimum tertile of MAP and other confounders, higher SD remained significantly associated (p < 0.05) with higher odds of in-hospital death for patients with acute ischemic strokes (AISs, odds ratio [OR] 2.7, 95% CI 1.5-4.8), intracerebral hemorrhage (ICH, OR 2.6, 95% CI 1.6-4.3), subarachnoid hemorrhage (SAH, OR 3.4, 95% CI 1.2-9.3), and pneumonia (OR 1.9, 95% CI 1.1-3.3) and lower odds of favorable discharge destination in patients with ischemic stroke (OR 0.3, 95% CI 0.2-0.6) and ICH (OR 0.4, 95% CI 0.3-0.6). No interaction was found between minimum MAP tertile with SD (p > 0.05). Higher ARV was not significantly associated with increased risk of death in any condition when adjusting for illness severity but portended worse discharge destination in those with AIS (OR favorable discharge 0.4, 95% CI 0.3-0.7), ICH (OR favorable discharge 0.5, 95% CI 0.3-0.7), sepsis (OR favorable discharge 0.8, 95% CI 0.6-1.0), and pneumonia (OR favorable discharge 0.5, 95% CI 0.4-0.8). DISCUSSION BPV is higher and generally associated with worse outcomes among patients with stroke compared with nonstroke patients. BPV in patients with AIS and patients with ICH may be a marker of central autonomic network injury, although clinician-driven blood pressure goals likely contribute to the association between BPV and outcomes.
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Affiliation(s)
- Eric Lee Stulberg
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT.
| | - Benjamin Robert Edward Harris
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Alexander Robert Zheutlin
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Alen Delic
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Nazanin Sheibani
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Mohammad Anadani
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Shadi Yaghi
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Nils H Petersen
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Adam de Havenon
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
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8
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Anadani M, Finitsis S, Pop R, Darcourt J, Clarençon F, Richard S, de Havenon A, Liebeskind D, Marnat G, Bourcier R, Sibon I, Dargazanli C, Arquizan C, Blanc R, Lapergue B, Consoli A, Eugène F, Vannier S, Caroff J, Denier C, Boulanger M, Gauberti M, Saleme S, Macian F, Rosso C, Turc G, Ozkul-Wermester O, Papagiannaki C, Olivot JM, Le Bras A, Evain S, Wolff V, Timsit S, Gentric JC, Bourdain F, Veunac L, Maïer B, Ben Hassen W, Gory B. ASPECTS evolution after endovascular successful reperfusion in the early and extended time window. Interv Neuroradiol 2023:15910199231196953. [PMID: 37671452 DOI: 10.1177/15910199231196953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND The Alberta Stroke Program Early CT scan Score (ASPECTS) is a reliable imaging biomarker of infarct extent on admission but the value of 24-hour ASPECTS evolution in day-to-day practice is not well studied, especially after successful reperfusion. We aimed to assess the association between ASPECTS evolution after successful reperfusion with functional and safety outcomes, as well as to identify the predictors of ASPECTS evolution. METHODS We used data from an ongoing prospective multicenter registry. Stroke patients with anterior circulation large vessel occlusion treated with endovascular therapy (EVT) and achieved successful reperfusion (modified thrombolysis in cerebral ischemia (mTICI) 2b-3) were included. ASPECTS evolution was defined as one or more point decrease in ASPECTS at 24 hours. RESULTS A total of 2366 patients were enrolled. In a fully adjusted model, ASPECTS evolution was associated with lower odds of favorable outcome (modified Rankin Scale (mRS) score 0-2) at 90 days (adjusted odds ratio (aOR) = 0.46; 95% confidence interval (CI) = 0.37-0.57). In addition, ASPECTS evolution was a predictor of excellent outcome (90-day mRS 0-1) (aOR = 0.52; 95% CI = 0.49-0.57), early neurological improvement (aOR = 0.42; 95% CI = 0.35-0.51), and parenchymal hemorrhage (aOR = 2.64; 95% CI, 2.03-3.44). Stroke severity, admission ASPECTS, total number of passes, complete reperfusion (mTICI 3 vs. mTICI 2b-2c) and good collaterals emerged as predictors of ASPECTS evolution. CONCLUSION ASPECTS evolution is a strong predictor of functional and safety outcomes after successful endovascular therapy. Higher number of EVT attempts and incomplete reperfusion are associated with ASPECTS evolution at day 1.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Stephanos Finitsis
- Aristotle University of Thessaloniki, Ahepa Hospital, Thessaoniki, Greece
| | - Raoul Pop
- Department of Neuroradiolology, CHU Strasbourg, France
| | - Jean Darcourt
- Department of Neuroradiolology, CHU Toulouse, France
| | | | - Sébastien Richard
- Department of Neurology, Université de Lorraine, CHRU-Nancy, Nancy, France
- CIC-P 1433, INSERM U1116, CHRU-Nancy, Nancy, France
| | - Adam de Havenon
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - David Liebeskind
- Department of Neurology, Neurovascular Imaging Research Core & UCLA Stroke Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, France
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Igor Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, France
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | | | - Raphaël Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - François Eugène
- Department of Neuroradiology, University Hospital of Rennes, France
| | | | - Jildaz Caroff
- Department of Neuroradiolology, CHU Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Christian Denier
- Department of Neurology, CHU Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | | | | | - Suzana Saleme
- Department of Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Francisco Macian
- Department of Neurology, University Hospital of Limoges, Limoges, France
| | - Charlotte Rosso
- Department of Neurology, CHU Pitié-Salpêtrière, Paris, France
| | - Guillaume Turc
- Department of Neurology, Hôpital Saint-Anne, Paris, France
| | | | | | | | - Anthony Le Bras
- Department of Neurology, CH Bretagne Atlantique, Vannes, France
| | - Sarah Evain
- Department of Neuroradiolology, CH Bretagne Atlantique, Vannes, France
| | | | | | | | | | - Louis Veunac
- Department of Neuroradiolology, CH Côte Basque, Bayonne, France
| | - Benjamin Maïer
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Wagih Ben Hassen
- Department of Neuroradiolology, Hôpital Saint-Anne, Paris, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France
- Université de Lorraine, IADI, INSERM U1254, Nancy, France
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9
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Anadani M, Maier B, Escalard S, Labreuche J, de Havenon A, Sabben C, Lapergue B, Mistry EA, Gory B, Spiotta AM, Richard S, Sibon I, Desilles JP, Blanc R, Piotin M, Mazighi M. Safety and efficacy of intensive systolic blood pressure lowering after successful endovascular therapy: a post hoc analysis of the BP TARGET trial. J Neurointerv Surg 2023; 15:e142-e147. [PMID: 36220337 DOI: 10.1136/jnis-2022-019130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Safety and Efficacy of Intensive Blood Pressure Lowering after Successful Endovascular Therapy in Acute Ischaemic Stroke (BP TARGET) trial demonstrated no benefit from intensive systolic blood pressure (SBP) treatment after successful reperfusion with endovascular therapy. However, it remains unknown if the response to blood pressure treatment is modified by other factors. OBJECTIVE To carry out a post hoc analysis of the BP TARGET trial data to determine if the response to blood pressure treatment is modified by factors such as age, history of hypertension, recanalization status, location of occlusion, diabetes, hyperglycemia, or pretreatment with intravenous thrombolysis. METHODS This is a post hoc analysis of the BP TARGET trial. Patients were divided into groups based on age, diabetes, blood glucose, site of occlusion, history of hypertension, and pretreatment with intravenous thrombolysis. The primary outcome was any intraparenchymal hemorrhage. RESULTS 318 patients were included. Diabetes modified the treatment effect on favorable functional outcome (Pheteogenity=0.041). There was a trend towards benefit from intensive SBP treatment in diabetic patients (OR=2.81; 95% CI 0.88 to 8.88; p=0.08) but not in non-diabetic patients (OR=0.75; 95% 0.45 to 126; p 0.28). Age, location of occlusion, admission SBP, pretreatment with intravenous thrombolysis, and history of hypertension did not modify the effect of intensive SBP treatment on any of the outcomes. CONCLUSION The effect of SBP lowering treatment was not modified by age, location of occlusion history of hypertension, intravenous thrombolysis, and admission SBP. Diabetes modified the effect of intensive SBP lowering treatment, and there was a trend towards benefit from intensive SBP treatment in diabetic patients. This finding is hypothesis generating and requires further validation.
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Affiliation(s)
- Mohammad Anadani
- Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Benjamin Maier
- Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
| | - Simon Escalard
- Departement of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | | | - Adam de Havenon
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Candice Sabben
- Department of Neurology, Fondation Rothschild Hospital, paris, France
| | | | - Eva A Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | | | | | - Raphael Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
| | - Michel Piotin
- Departement of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Mikaël Mazighi
- Departement of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
- Department of Neurology, GH Lariboisiere Fernand-Widal, Paris, France
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10
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de Havenon A, Zhou LW, Johnston KC, Dangayach NS, Ney J, Yaghi S, Sharma R, Abbasi M, Delic A, Majersik JJ, Anadani M, Tirschwell DL, Sheth KN. Twenty-Year Disparity Trends in United States Stroke Death Rate by Age, Race/Ethnicity, Geography, and Socioeconomic Status. Neurology 2023; 101:e464-e474. [PMID: 37258298 PMCID: PMC10401675 DOI: 10.1212/wnl.0000000000207446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/07/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In 2017, the Centers for Disease Control and Prevention (CDC) issued an alert that, after decades of consistent decline, the stroke death rate levelled off in 2013, particularly in younger individuals and without clear origin. The objective of this analysis was to understand whether social determinants of health have influenced trends in stroke mortality. METHODS We performed a longitudinal analysis of county-level ischemic and hemorrhagic stroke death rate per 100,000 adults from 1999 to 2018 using a Bayesian spatiotemporally smoothed CDC dataset stratified by age (35-64 years [younger] and 65 years or older [older]) and then by county-level social determinants of health. We reported stroke death rate by county and the percentage change in stroke death rate during 2014-2018 compared with that during 2009-2013. RESULTS We included data from 3,082 counties for younger individuals and 3,019 counties for older individuals. The stroke death rate began to increase for younger individuals in 2013 (p < 0.001), and the slope of the decrease in stroke death rate tapered for older individuals (p < 0.001). During the 20-year period of our study, counties with a high social deprivation index and ≥10% Black residents consistently had the highest rates of stroke death in both age groups. Comparing stroke death rate during 2014-2018 with that during 2009-2013, larger increases in younger individuals' stroke death rate were seen in counties with ≥90% (vs <90%) non-Hispanic White individuals (3.2% mean death rate change vs 1.7%, p < 0.001), rural (vs urban) populations (2.6% vs 2.0%, p = 0.019), low (vs high) proportion of medical insurance coverage (2.9% vs 1.9%, p = 0.002), and high (vs low) substance abuse and suicide mortality (2.8 vs 1.9%, p = 0.008; 3.3% vs 1.5%, p < 0.001). In contrast to the younger individuals, in older individuals, the associations with increased death rates were with more traditional social determinants of health such as the social deprivation index, urban location, unemployment rate, and proportion of Black race and Hispanic ethnicity residents. DISCUSSION Improvements in the stroke death rate in the United States are slowing and even reversing in younger individuals and many US counties. County-level increases in stroke death rate were associated with distinct social determinants of health for younger vs older individuals. These findings may inform targeted public health strategies.
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Affiliation(s)
- Adam de Havenon
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle.
| | - Lily W Zhou
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Karen C Johnston
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Neha S Dangayach
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - John Ney
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Shadi Yaghi
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Richa Sharma
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Mehdi Abbasi
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Alen Delic
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Jennifer Juhl Majersik
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Mohammad Anadani
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - David L Tirschwell
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
| | - Kevin Navin Sheth
- From the Department of Neurology (A.H., R.S., M. Abbasi, K.N.S.), Yale University, New Haven, CT; Department of Neurology (L.Z.), The University of British Columbia, Vancouver; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Department of Neurology (N.S.D.), Mount Sinai, New York, NY; Department of Neurology (J.N.), Boston University, MA; Department of Neurology (S.Y.), Brown University, Providence, RI; Department of Neurology (A.D., J.J.M.), University of Utah; Department of Neurology (M. Anadani), Medical University of South Carolina, Charleston; and Department of Neurology (D.L.T.), University of Washington, Seattle
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11
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Muszynski P, Anadani M, Richard S, Gory B. Treatment of Sub-Acute Intracranial Stent Occlusion with Rescue Stenting After Failed Aspiration and Stent Retriever Thrombectomy. Cardiovasc Revasc Med 2023; 53S:S250-S252. [PMID: 36754772 DOI: 10.1016/j.carrev.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
We report a case of middle age man presented a subacute balloon-mounted stent occlusion placed for M1 segment occlusion stroke due to intracranial atherosclerotic stenosis after thrombectomy failure and treated with a second balloon-mounted stent within the first one. Successful recanalization and complete clinical recovery were achieved. The coronary balloon-mounted stent is s a useful tool as a rescue treatment in case of intracranial stent occlusion.
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Affiliation(s)
- Patricio Muszynski
- Université de Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, F-54000 Nancy, France
| | - Mohammad Anadani
- Department of Neurology, Washington University School of Medicine, St Louis, United States of America
| | - Sébastien Richard
- Université de Lorraine, CHRU-Nancy, Department of Neurology, Stroke Unit, F-54000 Nancy, France
| | - Benjamin Gory
- Université de Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, F-54000 Nancy, France.
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12
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de Havenon A, Zaidat OO, Amin-Hanjani S, Nguyen TN, Bangad A, Abassi M, Anadani M, Almallouhi E, Chatterjee R, Mazighi M, Mistry E, Yaghi S, Derdeyn C, Hong KS, Kvernland A, Leslie-Mazwi T, Al Kasab S. Large Vessel Occlusion Stroke due to Intracranial Atherosclerotic Disease: Identification, Medical and Interventional Treatment, and Outcomes. Stroke 2023; 54:1695-1705. [PMID: 36938708 PMCID: PMC10202848 DOI: 10.1161/strokeaha.122.040008] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Large vessel occlusion stroke due to underlying intracranial atherosclerotic disease (ICAD-LVO) is prevalent in 10 to 30% of LVOs depending on patient factors such as vascular risk factors, race and ethnicity, and age. Patients with ICAD-LVO derive similar functional outcome benefit from endovascular thrombectomy as other mechanisms of LVO, but up to half of ICAD-LVO patients reocclude after revascularization. Therefore, early identification and treatment planning for ICAD-LVO are important given the unique considerations before, during, and after endovascular thrombectomy. In this review of ICAD-LVO, we propose a multistep approach to ICAD-LVO identification, pretreatment and endovascular thrombectomy considerations, adjunctive medications, and medical management. There have been no large-scale randomized controlled trials dedicated to studying ICAD-LVO, therefore this review focuses on observational studies.
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Affiliation(s)
| | | | | | | | | | | | | | - Eyad Almallouhi
- Neurology, Medical University of South Carolina, Charleston, SC
| | | | - Mikael Mazighi
- Neurology, Lariboisière hospital-APHP NORD, FHU Neurovasc, Paris Cité University, INSERM 1144, France
| | - Eva Mistry
- Neurology and Rehabilitation Medicine, University of Cincinnati, OH
| | - Shadi Yaghi
- Neurology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Colin Derdeyn
- Neurosurgery, Carver College of Medicine, Iowa City, Iowa
| | - Keun-Sik Hong
- Neurology, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | | | | | - Sami Al Kasab
- Neurology, Medical University of South Carolina, Charleston, SC
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13
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Yahia MI, Marnat G, Finitsis S, Sibon I, Olivot JM, Pop R, Anadani M, Richard S, Gory B. Acute carotid stenting plus aspirin during thrombectomy of tandem occlusions: A matched case-control study. Interv Neuroradiol 2023:15910199231175375. [PMID: 37229632 DOI: 10.1177/15910199231175375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND AND PURPOSE Acute carotid artery stenting (CAS) for ischemic stroke patients with anterior circulation tandem occlusion requires periprocedural antiplatelet therapy to prevent stent thrombosis. However, due to the lack of randomized trials and inconsistent published results, there is no reliable information regarding the safety of additional antiplatelet treatment. Therefore, we compared the safety and functional outcomes of patients treated with acute CAS plus Aspirin during tandem occlusions thrombectomy with isolated intracranial occlusions patients treated with thrombectomy alone. METHODS Two prospectively acquired mechanical databases from August 2017 to December 2021 were reviewed. Patients were included if they had carotid atherosclerotic tandem occlusions treated with acute CAS and Aspirin (intravenous bolus 250 mg) during thrombectomy. Any antiplatelet agent was added after thrombectomy and before the 24-h control imaging. This group was compared with a matched group of isolated intracranial occlusions treated with thrombectomy alone. RESULTS A total of 1557 patients were included and 70 (4.5%) had an atherosclerotic tandem occlusion treated with acute CAS plus Aspirin during thrombectomy. In exact coarse matched weight adjusted analysis, the rate of symptomatic intracerebral hemorrhage was similar in both groups (OR, 3.06; 95% CI, 0.66-14.04; P = 0.150), parenchymal hematoma type 2 (OR, 1.15; 95% CI, 0.24-5.39; P = 0.856), any intracerebral hemorrhage (OR, 1.84; 95% CI, 0.75-4.53; P = 0.182), and 90-day mortality (OR, 0.79; 95% CI, 0.24-2.60; P = 0.708). Rates of early neurological improvement and 90-day modified Rankin Scale score 0-2 were comparable. CONCLUSIONS Acute CAS plus Aspirin during thrombectomy for tandem occlusion stroke appears safe. Randomized trials are warranted to confirm these findings.
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Affiliation(s)
- Mohamed-Ismaël Yahia
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, CHU Bordeaux, France
| | - Stephanos Finitsis
- Aristotle University of Thessaloniki, Ahepa Hospital, Thessaoniki, Greece
| | - Igor Sibon
- Department of Neurology, Stroke Center, CHU Bordeaux, France
| | | | - Raoul Pop
- Department of Interventional Neuroradiology, CHRU Strasbourg, France
| | - Mohammad Anadani
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Sébastien Richard
- Department of Neurology, Université de Lorraine, CHRU-Nancy, Nancy, France
- CIC-P 1433, INSERM U1116, CHRU-Nancy, Nancy, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France
- Université de Lorraine, IADI, Nancy, France
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14
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Anadani M, Turan TN, Yaghi S, Spiotta AM, Gory B, Sharma R, Kevin N, de Havenon A. Change in Smoking Behavior and Outcome After Ischemic Stroke: Post-Hoc Analysis of the SPS3 Trial. Stroke 2023; 54:921-927. [PMID: 36876480 PMCID: PMC10050138 DOI: 10.1161/strokeaha.121.038202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 11/10/2022] [Indexed: 03/07/2023]
Abstract
BACKGROUND Cigarette smoking is a known risk factor for cardiovascular disease, including ischemic stroke. The literature regarding the rate of persistent smoking after acute ischemic stroke and its effect on subsequent cardiovascular events is scarce. With this study, we aimed to report the rate of persistent smoking after ischemic stroke and the association between smoking status and major cardiovascular outcomes. METHODS This is a post-hoc analysis of the SPS3 trial (Secondary Prevention of Small Subcortical Strokes). Patients were divided into 4 groups based on smoking status at trial enrollment: (1) never smokers, (2) former smokers, (3) smokers who quit at 3 months, and (4) persistent smokers. The primary outcome is a major adverse cardiovascular events composite of stroke (ischemic and hemorrhagic), myocardial infarction, and mortality. Outcomes were adjudicated after month 3 of enrollment until an outcome event or the end of study follow-up. RESULTS A total of 2874 patients were included in the study. Of the total cohort, 570 patients (20%) were smokers at enrollment, of whom 408 (71.5%) patients continued to smoke and 162 (28.4%) quit smoking by 3 months. The major adverse cardiovascular events outcome occurred in 18.4%, 12.4%, 16.2%, and 14.4%, respectively, in persistent smokers, smokers who quit, prior smokers, and never smokers. In a model adjusted for age, sex, race, ethnicity, education, employment status, history of hypertension, diabetes, hyperlipidemia, myocardial infarction, and intensive blood pressure randomization arm, the risk of major adverse cardiovascular events, and death were higher in the persistent smokers compared with never smokers (HR for major adverse cardiovascular events: 1.56 [95% CI, 1.16-2.09]; HR for death: 2.0 [95% CI, 2.18-3.12]). The risk of stroke, and MI did not differ according to smoking status Conclusions: Compared with never smoking, persistent smoking after acute ischemic stroke was associated with an increased risk of cardiovascular events and death. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT00059306.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurosurgery, Medical University of South Carolina
| | - Tanya N Turan
- Department of Neurology, Medical University of South Carolina
| | - Shadi Yaghi
- Department of Neurology, Warren Alpert Medical School of Brown University
| | | | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, CHRU-Nancy, Nancy, France
| | - Richa Sharma
- Department of Neurology, Yale University School of Medicine
| | - N. Kevin
- Department of Neurology, Yale University School of Medicine
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15
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Essibayi MA, Anadani M, Almallouhi E, Yaghi S, Maier I, Jabbour PM, Kim JT, Wolfe SQ, Rai A, Starke R, Psychogios M, Shaban A, Arthur AS, Yoshimura S, Howard B, Alawieh A, Fragata I, Cuellar H, Polifka A, Mascitelli J, Osbun J, Matouk C, Park MS, Levitt M, Dumont T, Williamson R, Altschul D, Spiotta AM, Al Kasab S. Abstract WP164: Acute Carotid Stenting Versus Conservative Management For Tandem Carotid Occlusions: Insights From STAR. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Management of anterior circulation emergent large vessel occlusion with tandem carotid occlusion (TCO) remains a challenge during mechanical thrombectomy (MT). To day, there is no consensus regarding emergent carotid stenting (ECS) in the setting of MT with TCO. We aimed to compare the outcomes of ECS versus conservative management (MT alone) among patients with TCO.
Methods:
Data from the Stroke Thrombectomy and Aneurysm Registry between 2010 and 2022 was interrogated. Only patients with concomitant occlusions of cervical carotid and proximal ipsilateral intracranial segments of the ICA or MCA were included in the analyses. We compared baseline, procedural charecteristics, successful reperfusion (mTICI 2b-3), favorable 90-day good outcomes (mRS 0-2), intravenous tPA administration and symptomatic ICH between patients who did or did not undergo ECS. Multivariate regression was performed adjusting for variables of clinical importance. Propensity score matching for IV tPA use was performed to explore its safety with stenting.
Results:
Among 9812 thrombectomy patients, 688 patients had TCO; 132 underwent emergent stenting and 444 had MT alone. Patients who did not undergo ECS had a higher prevalence of atrial fibrillation (33.9% Vs 9.2%, P<.001), higher admission NIHSS scores (18 Vs 14, P<.001), shorter time from symptom onset to puncture (275 minutes Vs 333 minutes, P=0.029), and were predominantly women (59.2% Vs 33.6%, P<0.001).Patients with stenting had lower mortality rates ( 17.5% Vs 29.6%, P=0.009), and higher rates of successful reperfusion (83% Vs 95%, P=0.001). No difference in mRS 0-2 (37.5% Vs 30.4%, P=0.178) or sICH were seen (11.1% Vs 15.4%, P=0.219). Propensity score matching analysis (n=129 in each group) demonstrated better rates of reperfusion (94.8 Vs 84.4%, P=0.011) in the stenting group. Advanced age, higher admission NIHSS and lower ASPECT scores were associated with worse clinical outcomes.
Conclusion:
ECS during MT for TCO appears to be safe and is associated with better clinical and angiographic outcomes compared to conservative management.
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Affiliation(s)
| | | | | | | | | | | | - Joon-Tae Kim
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | | | | | | | | | | | | | | | | | | | - Isabel Fragata
- Cntr Hospar Universitário de Lisboa Central, Lisbon, Portugal
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16
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Almallouhi E, Anadani M, Al Kasab S, Maier I, Jabbour PM, Kim JT, Quintero Wolfe SC, rai A, Starke R, Psychogios M, Samaniego EA, Arthur AS, Yoshimura S, Grossberg JA, Alawieh A, Fragata I, Cuellar H, Polifka A, Mascitelli J, Osbun J, Matouk C, Park MS, Levitt M, Dumont T, Williamson R, Spiotta AM. Abstract 98: The Impact Of Aspiration Catheter Size On Thrombectomy Outcomes Using Adapt Technique-analysis From The STAR Registry. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introductions:
Clinical trials have shown that aspiration thrombectomy is as safe and effective as stent-retriever thrombectomy. Multiple improvements have been made to the aspiration technique over the last few years. In this study, we aim to assess the effect of aspiration catheter bore size on the outcomes of A direct aspiration first pass technique (ADAPT) thrombectomy.
Methods:
We included patients who underwent ADAPT thrombectomy for M1 or internal carotid artery terminus (ICA-T) occlusions in the Stroke Thrombectomy and Aneurysm (STAR) database. Patients included between July 2016 and July 2022. We compared baseline characteristics, procedural metrics and outcomes between patients who underwent thrombectomy using small bore (0.035”-0.060”), medium bore (0.062”-0.068”) and large bore (0.070”-0.074”) catheters.
Results:
A total of 1158 patients were included; 576 (49.7%) females, 645 (70%) White, and 464 (40.6%) received IV-tPA. No difference was noticed in age, sex, and vascular risk factors between the 3 different groups. There was higher rate of IV-tPA in the small-bore catheter group (48.8%) compared to the medium and large bore catheter groups (38.4% and 36.7%, respectively) (P=0.03). Procedure duration was shorter when using medium (20 min) and large (18 min) compared to small bore catheters (30 min) (P=0.01). Both medium and large bore catheters were associated with higher rate of successful recanalization (88.9% and 87.9%, respectively) compared to small bore catheters (81.6%) (P=0.010). However, the difference in successful recanalization or procedure duration between medium and large bore catheters was not significant. No difference was noted in the rate of symptomatic hemorrhagic transformation (sICH) (4.7%, 5.3%, and 7.1%; P=0.345), 90-day favorable outcome (modified Rankin Scale 0-2) (41.8%, 39.3%, 40.8%; P=0.766) or 90-day mortality (18.1%, 23.5%, 24.4%; P=0.111) between the groups.
Conclusions:
Higher rate of successful recanalization and shorter procedure duration were observed when using medium and large bore aspiration catheters compared with small bore catheters in ADAPT technique. However, these procedural benefits were not observed when comparing large bore to medium bore catheters.
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Affiliation(s)
| | | | | | | | | | - Joon-Tae Kim
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
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17
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Essibayi MA, Anadani M, Almallouhi E, Yaghi S, Lajthia O, Maier I, Jabbour PM, Kim JT, Quintero Wolfe S, rai A, Starke R, Psychogios M, Shaban A, Arthur AS, Yoshimura S, Howard B, Alawieh A, Fragata I, Cuellar H, Polifka A, Mascitelli J, Osbun J, Matouk C, Park MS, Levitt M, Dumont T, Williamson R, Altschul D, Spiotta AM, Al Kasab S. Abstract TP154: Outcomes Of Acute Carotid Stenting With Or Without Intravenous Thrombolysis Among Patients With Acute Tandem Occlusion: Insights From STAR. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tp154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Emergency carotid artery stenting during mechanical thrombectomy has emerged as an effective emergent treatment for tandem carotid occlusions. Nevertheless, scarce evidence is available about the safety of this procedure in patients who received intravenous tPA before thrombectomy. Herein, we investigate the safety of acute carotid stenting among patients who received intravenous tPA in a large international multicenter registry.
Methods:
Patients from the Stroke Thrombectomy and Aneurysm Registry between 2010 and 2022 were analyzed. Only patients with concomitant occlusions of cervical carotid and proximal ipsilateral intracranial segments of the internal carotid or middle cerebral artery were included in the final analyses. Patients were divided into two groups, depending on tPA administration. The primary outcome was 90-day good clinical outcome (mRS 0-2), and the primary safety outcome was symptomatic intracranial hemorrhage. Univariate and multivariate regressions were performed adjusting for variables of clinical importance.
Results:
Among 9812 with acute ischemic stroke in the registry, 132 patients had acute tandem occlusion and underwent carotid stenting; of those, 60 patients received IV tPA. Compared to non-intravenous thrombolytics, patients with IV tPA had a higher male prevalence (78.3% Vs 54.4%, P=0.005) and better ASPECT scores (9 Vs 8, P=0.022) with a shorter time from onset to puncture (241 Vs 672 minutes, P<0.001). There was no difference in rates of successful revascularization (94% Vs 95.5%, P=NS), good clinical outcome (50.8% Vs 61.4%, P=NS), symptomatic intracranial hemorrhage (15.3% Vs 14.5%, P=NS) or procedural complications (15% Vs 11.6%, P=NS) between the tPA and non-tPA groups.
Conclusion:
The use of IV tPA did not affect the safety or efficacy of emergent carotid stenting in the setting of acute tandem occlusion.
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Affiliation(s)
| | | | | | | | | | | | | | - Joon-Tae Kim
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | | | | | | | | | | | | | | | | | | | - Isabel Fragata
- Cntr Hospar Universitário de Lisboa Central, Lisbon, Portugal
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18
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Anadani M, Lena J. Transvenous embolization of conus spinal arteriovenous malformation: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22382. [PMID: 36647251 PMCID: PMC9844523 DOI: 10.3171/case22382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Spinal arteriovenous malformations (AVMs) are the most challenging spinal vascular malformations. Endovascular transarterial embolization of spinal AVM has been well described. However, transvenous embolization has not been previously reported. In this case report, the authors describe transvenous embolization of a recurrent intramedullary/conus spinal AVM that was previously deemed unamenable to endovascular therapy. OBSERVATIONS A 30-year-old female presented with debilitating lumbar back pain and was found to have an intramedullary spinal AVM at the level of the conus medullaris. Initially, the AVM was treated with endovascular arterial embolization and subsequently with microsurgical resection. However, on follow-up angiography, the AVM had recurred. Further arterial embolization was deemed not possible because of anatomical challenges. After careful consideration, endovascular transvenous embolization was performed with successful occlusion of the AVM nidus. LESSONS Transvenous embolization is an alternative route for endovascular treatment of spinal AVMs that have an accessible single draining vein.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jonathan Lena
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
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19
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Anadani M, Januel AC, Finitsis S, Clarençon F, Richard S, Marnat G, Bourcier R, Sibon I, Dargazanli C, Arquizan C, Blanc R, Lapergue B, Consoli A, Eugene F, Vannier S, Caroff J, Denier C, Boulanger M, Gauberti M, Rouchaud A, Macian Montoro F, Rosso C, Ben Hassen W, Turc G, Ozkul-Wermester O, Papagiannaki C, Albucher JF, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, de Havenon A, Liebeskind DS, Maier B, Gory B. Effect of intravenous thrombolysis before endovascular therapy on outcome according to collateral status: insight from the ETIS Registry. J Neurointerv Surg 2023; 15:14-19. [PMID: 35115393 DOI: 10.1136/neurintsurg-2021-018170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is unknown whether collateral status modifies the effect of pretreatment intravenous thrombolysis (IVT) on the outcomes of patients with large vessel occlusions treated with endovascular therapy (EVT). We aimed to assess whether collateral status modifies the effect of IVT on the outcomes of EVT in clinical practice. METHODS We used data from the ongoing prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France. Patients with anterior circulation proximal large vessel occlusions treated with EVT within 6 hours of symptom onset were enrolled. Patients were divided into two groups based on pretreatment with IVT. The two groups were matched based on baseline characteristics. We tested the interaction between collateral status and IVT in unadjusted and adjusted models. RESULTS A total of 1589 patients were enrolled in the study, of whom 55% received IVT. Using a propensity score matching method, 724 no IVT patients were matched to 549 IVT patients. In propensity score weighted analysis, IVT was associated with higher odds of early neurological improvement (OR 1.74; 95% CI 1.33 to 2.26), favorable functional outcome (OR 1.66; 95% CI 1.23 to 2.24), excellent functional outcome (OR 2.04; 95% CI 1.47 to 2.83), and successful reperfusion (OR 2.18; 95% CI 1.51 to 3.16). IVT was not associated with mortality or hemorrhagic complications. There was no interaction between collateral status and IVT association with any of the outcomes. CONCLUSIONS Collateral status does not modify the effect of pretreatment IVT on the efficacy and safety outcomes of EVT.
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Affiliation(s)
- Mohammad Anadani
- Neurosurgery, Medical University of South Carolina - College of Medicine, Charleston, South Carolina, USA
| | | | - Stephanos Finitsis
- Neuroradiolology, University General Hospital of Thessaloniki AHEPA, Thessaoniki, Greece
| | - Frédéric Clarençon
- Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | | | | | - Cyril Dargazanli
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
| | | | - Raphael Blanc
- Interventional Neuroradiology, Fondation Rothschild, Paris, France
| | | | | | | | | | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Christian Denier
- Neurology, Hôpital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
| | | | - Maxime Gauberti
- Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Aymeric Rouchaud
- Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France.,Department of Neurology, CHU Limoges, Limoges, France
| | | | - Charlotte Rosso
- Urgences Cérébro-Vasculaires, Pitié-Salpétrière Hospital, Paris, France
| | - Wagih Ben Hassen
- Interventional Neuroradiology, Saint Anne Hospital Centre, Paris, France.,INSERM U1166, Paris, France
| | - Guillaume Turc
- Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | | | | | | | - Anthony Le Bras
- Department of Radiology, CH Bretagne Atlantique, Vannes, France.,CHU Rennes Service de Radiologie et d'Imagerie Médicale, Rennes, France
| | - Sarah Evain
- Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Valerie Wolff
- Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
| | - Raoul Pop
- Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France.,Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
| | - Serge Timsit
- Department of Neurology, CHU Brest, Brest, France
| | | | - Frederic Bourdain
- Neurology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
| | - Louis Veunac
- Department of Radiology and Interventional Neuroradiology, CHU de Bordeaux, Bordeaux, France
| | - Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | | | - Benjamin Maier
- Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
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20
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Prasad A, Kobsa J, Kodali S, Bartolome D, Begunova L, Quispe-Orozco D, Farooqui M, Zevallos C, Ortega-Gutiérrez S, Anadani M, Almallouhi E, Spiotta AM, Giles JA, Keyrouz SG, Kim JT, Maier IL, Liman J, Psychogios MN, Riou-Comte N, Richard S, Gory B, Quintero Wolfe S, Brown PA, Fargen KM, Mistry EA, Fakhri H, Mistry A, Wong KH, Nascimento FA, Kan P, de Havenon A, Sheth KN, Petersen NH. Temporal profiles of systolic blood pressure variability and neurologic outcomes after endovascular thrombectomy. Eur Stroke J 2022; 7:365-375. [PMID: 36478756 PMCID: PMC9720854 DOI: 10.1177/23969873221106907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Observational studies have found an increased risk of hemorrhagic transformation and worse functional outcomes in patients with higher systolic blood pressure variability (BPV). However, the time-varying behavior of BPV after endovascular thrombectomy (EVT) and its effects on functional outcome have not been well characterized. Patients and methods We analyzed data from an international cohort of patients with large-vessel occlusion stroke who underwent EVT at 11 centers across North America, Europe, and Asia. Repeated time-stamped blood pressure data were recorded for the first 72 h after thrombectomy. Parameters of BPV were calculated in 12-h epochs using five established methodologies. Systolic BPV trajectories were generated using group-based trajectory modeling, which separates heterogeneous longitudinal data into groups with similar patterns. Results Of the 2041 patients (age 69 ± 14, 51.4% male, NIHSS 15 ± 7, mean number of BP measurements 50 ± 28) included in our analysis, 1293 (63.4%) had a poor 90-day outcome (mRS ⩾ 3) or a poor discharge outcome (mRS ⩾ 3). We identified three distinct SBP trajectories: low (25%), moderate (64%), and high (11%). Compared to patients with low BPV, those in the highest trajectory group had a significantly greater risk of a poor functional outcome after adjusting for relevant confounders (OR 2.2; 95% CI 1.2-3.9; p = 0.008). In addition, patients with poor outcomes had significantly higher systolic BPV during the epochs that define the first 24 h after EVT (p < 0.001). Discussion and conclusions Acute ischemic stroke patients demonstrate three unique systolic BPV trajectories that differ in their association with functional outcome. Further research is needed to rapidly identify individuals with high-risk BPV trajectories and to develop treatment strategies for targeting high BPV.
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Affiliation(s)
- Ayush Prasad
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - Jessica Kobsa
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - Sreeja Kodali
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - David Bartolome
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - Liza Begunova
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - Darko Quispe-Orozco
- Department of Neurology, University of
Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mudassir Farooqui
- Department of Neurology, University of
Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Cynthia Zevallos
- Department of Neurology, University of
Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Mohammad Anadani
- Departments of Neurology, Medical
University of South Carolina, Charleston, SC, USA
| | - Eyad Almallouhi
- Departments of Neurology, Medical
University of South Carolina, Charleston, SC, USA
| | - Alejandro M Spiotta
- Departments of Neurosurgery, Medical
University of South Carolina, Charleston, SC, USA
| | - James A Giles
- Department of Neurology, Washington
University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Salah G Keyrouz
- Department of Neurology, Washington
University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Joon-Tae Kim
- Department of Neurology, Chonnam
National University Medical School, Gwangju, South Korea
| | - Ilko L Maier
- Department of Neurology, University
Medical Center Göttingen, Göttingen, Germany
| | - Jan Liman
- Department of Neurology, University
Medical Center Göttingen, Göttingen, Germany
| | - Marios-Nikos Psychogios
- Department of Diagnostic and
Interventional Neuroradiology, University Clinic Basel, Basel, Switzerland
| | | | - Sébastien Richard
- Department of Neurology, University
Hospital of Nancy, Nancy, France
- Centre d’Investigation Clinique
Plurithématique, INSERM U1116, University Hospital of Nancy, Vandoeuvre-lès-Nancy,
France
| | - Benjamin Gory
- Department of Diagnostic and
Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France
- IADI, INSERM U1254, University of
Lorraine, Nancy, France
| | | | - Patrick A Brown
- Departments of Radiology, Wake Forest
School of Medicine, Winston-Salem, NC, USA
| | - Kyle M Fargen
- Departments of Neurosurgery, Wake
Forest School of Medicine, Winston-Salem, NC, USA
| | - Eva A Mistry
- Department of Neurology and
Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Hiba Fakhri
- Department of Neurology, Vanderbilt
University Medical Center, Nashville, TN
| | - Akshitkumar Mistry
- Department of Neurosurgery,
University of Louisville, Louisville, KY, USA
| | - Ka-Ho Wong
- Department of Neurology, University
of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Peter Kan
- Department of Neurology, Baylor
College of Medicine, Houston, TX, USA
| | - Adam de Havenon
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - Kevin N Sheth
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - Nils H Petersen
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
- Nils H Petersen, Division of Neurocritical
Care and Emergency Neurology, Department of Neurology, Yale Medical School, 15
York Street, LCI 1003, New Haven, CT 06510, USA.
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21
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de Havenon A, Petersen N, Stulberg E, Anadani M, Biffi A, Sheth KN. Interaction of Mean Arterial Pressure and Blood Pressure Variability in Critically Ill Brain Injured Patients. Stroke 2022; 53:e512-e514. [PMID: 36367101 PMCID: PMC9712254 DOI: 10.1161/strokeaha.122.041274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Petersen NH, Kodali S, Meng C, Li F, Nguyen CK, Peshwe KU, Strander S, Silverman A, Kimmel A, Wang A, Anadani M, Almallouhi E, Spiotta AM, Kim JT, Giles JA, Keyrouz SG, Farooqui M, Zevallos C, Maier IL, Psychogios MN, Liman J, Riou-Comte N, Richard S, Gory B, Wolfe SQ, Brown PA, Fargen KM, Mistry EA, Fakhri H, Mistry AM, Wong KH, de Havenon A, Nascimento FA, Kan P, Matouk C, Ortega-Gutiérrez S, Sheth KN. Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study. Stroke 2022; 53:1216-1225. [PMID: 34781705 PMCID: PMC8960326 DOI: 10.1161/strokeaha.121.034408] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Elevated blood pressure after endovascular thrombectomy (EVT) has been associated with an increased risk of hemorrhagic transformation and poor functional outcomes. However, the optimal hemodynamic management after EVT remains unknown, and the blood pressure course in the acute phase of ischemic stroke has not been well characterized. This study aimed to identify patient subgroups with distinct blood pressure trajectories after EVT and study their association with radiographic and functional outcomes. METHODS This multicenter retrospective cohort study included consecutive patients with anterior circulation large-vessel occlusion ischemic stroke who underwent EVT. Repeated time-stamped blood pressure data were recorded for the first 72 hours after thrombectomy. Latent variable mixture modeling was used to separate subjects into five groups with distinct postprocedural systolic blood pressure (SBP) trajectories. The primary outcome was functional status, measured on the modified Rankin Scale 90 days after stroke. Secondary outcomes included hemorrhagic transformation, symptomatic intracranial hemorrhage, and death. RESULTS Two thousand two hundred sixty-eight patients (mean age [±SD] 69±15, mean National Institutes of Health Stroke Scale 15±7) were included in the analysis. Five distinct SBP trajectories were observed: low (18%), moderate (37%), moderate-to-high (20%), high-to-moderate (18%), and high (6%). SBP trajectory group was independently associated with functional outcome at 90 days (P<0.0001) after adjusting for potential confounders. Patients with high and high-to-moderate SBP trajectories had significantly greater odds of an unfavorable outcome (adjusted odds ratio, 3.5 [95% CI, 1.8-6.7], P=0.0003 and adjusted odds ratio, 2.2 [95% CI, 1.5-3.2], P<0.0001, respectively). Subjects in the high-to-moderate group had an increased risk of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.82 [95% CI, 1-3.2]; P=0.04). No significant association was found between trajectory group and hemorrhagic transformation. CONCLUSIONS Patients with acute ischemic stroke demonstrate distinct SBP trajectories during the first 72 hours after EVT that have differing associations with functional outcome. These findings may help identify potential candidates for future blood pressure modulation trials.
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Affiliation(s)
- Nils H Petersen
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Sreeja Kodali
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Can Meng
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT
| | - Fangyong Li
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT
| | - Cindy Khanh Nguyen
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Krithika U. Peshwe
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Sumita Strander
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Andrew Silverman
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Alexandra Kimmel
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Anson Wang
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Mohammad Anadani
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | - Eyad Almallouhi
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | - Alejandro M. Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
| | - James A. Giles
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Salah G. Keyrouz
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Cynthia Zevallos
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ilko L. Maier
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Marios-Nikos Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Clinic Basel, Switzerland
| | - Jan Liman
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Sébastien Richard
- Department of Neurology, University Hospital of Nancy, Nancy, France,,Centre d’Investigation Clinique Plurithématique, INSERM U1116, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Benjamin Gory
- Department of Neuroradiology, University Hospital of Nancy, Nancy, France,,IADI, INSERM U1254, University of Lorraine, Nancy, France
| | | | - Patrick A. Brown
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kyle M. Fargen
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Eva A. Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Hiba Fakhri
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Ka-Ho Wong
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT
| | - Adam de Havenon
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT
| | | | - Peter Kan
- Department of Neurology, Baylor College of Medicine, Houston, TX
| | - Charles Matouk
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
| | | | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, CT
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23
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Anadani M, Qureshi AI, Menacho S, Grandhi R, Yaghi S, Jumaa MA, de Havenon A. Race/ethnicity and response to blood pressure lowering treatment after intracerebral hemorrhage. Eur Stroke J 2022; 6:343-348. [PMID: 35342813 DOI: 10.1177/23969873211046116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It is unknown if race/ethnicity modifies the response to blood pressure (BP) lowering treatment after intracerebral hemorrhage (ICH). We aimed to examine the race/ethnicity differences in the response to BP lowering treatment after ICH. METHODS This is a post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) trial. The primary outcome is good outcome, defined as 90-day modified Rankin Scale 0-3. The primary predictor is race/ethnicity for which we included non-Hispanic categories of White, Black, Asian, and the category of Hispanic. We fit adjusted logistic regression models with the predictor of race/ethnicity and models with the interaction term of treatment*race/ethnicity. RESULTS We included a total of 953 patients in our analysis (White = 213, Black = 112, Asian = 554, and Hispanic = 74). In the models with the interaction between race/ethnicity and treatment, we found that White patients assigned to the intensive treatment arm had lower predicted probability of good outcome than those assigned to the standard treatment arm (Model 1: 56.2% vs. 68.1%, p = .027; Model 2: 53.4% vs. 68.3%, p = .009). When divided into White and non-White groups, intensive treatment was associated with higher odds of serious adverse events in White group but not in the non-White group. In addition, there was an association between intensive treatment and higher risk of hematoma expansion in White patients and lower risk of hematoma expansion in non-White patients. CONCLUSIONS In the ATACH-2, there was an interaction between race/ethnicity and response to BP lowering treatment after ICH, with White patients having an association between intensive blood pressure reduction and worse outcome.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Sarah Menacho
- Department of Neurosurgery, University of Utah, Salt Lake, UT, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, University of Utah, Salt Lake, UT, USA
| | - Shadi Yaghi
- Department of Neurology, New York University, New York, NY, USA
| | | | - Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake, UT, USA
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de Havenon A, Petersen N, Wolcott Z, Goldstein E, Delic A, Sheibani N, Anadani M, Sheth KN, Lansberg M, Turan T, Prabhakaran S. Effect of dihydropyridine calcium channel blockers on blood pressure variability in the SPRINT trial: a treatment effects approach. J Hypertens 2022; 40:462-469. [PMID: 34694261 DOI: 10.1097/hjh.0000000000003033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Increased visit-to-visit blood pressure variability (vvBPV) has negative effects on multiple organ systems. Prior research has suggested that dihydropyridine calcium channel blockers (CCB) may reduce vvBPV, which we attempted to verify in a high-quality dataset with robust statistical methodology. METHODS We performed a post hoc analysis of the SPRINT trial and included participants who were on a dihydropyridine CCB either 0 or 100% of follow-up study visits. The primary outcome was vvBPV, defined as residual standard deviation (rSD) of SBP from month 6 until study completion. We estimated the average treatment effect of the treated (ATET) after augmented inverse-probability-weighting (AIPW) matching. RESULTS Of the 9361 participants enrolled in SPRINT, we included 5020, of whom 1959 were on a dihydropyridine CCB and 3061 were not; mean age was 67.4 ± 9.2 years, 34.5% were men, 65.9% were white, 49.4% were randomized to intensive blood pressure control, and the rSD was 10.1 ± 4.0 mmHg. Amlodipine represented greater than 95% of dihydropyridine CCB use. After AIPW matching of demographics and other antihypertensive medications, the ATET estimation for participants on a dihydropyridine CCB was an rSD that was 2.05 mmHg lower (95% CI -3.19 to -0.91). We did not find that other antihypertensive medications classes decreased vvBPV, and several increased it. CONCLUSION In the SPRINT trial, consistent use of a dihydropyridine CCB was associated with a 2 mmHg reduction in vvBPV. The implication of this hypothesis-generating finding in a high-quality dataset is that future trials to reduce vvBPV could consider using dihydropyridine CCBs.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, Utah
| | - Nils Petersen
- Department of Neurology, Yale University, New Haven, Connecticut
| | - Zoe Wolcott
- Department of Neurology, University of Utah, Salt Lake City, Utah
| | - Eric Goldstein
- Department of Neurology, University of Utah, Salt Lake City, Utah
| | - Alen Delic
- Department of Neurology, University of Utah, Salt Lake City, Utah
| | - Nazanin Sheibani
- Department of Neurology, University of Utah, Salt Lake City, Utah
| | - Mohammad Anadani
- Department of Neurology, Washington University, St Louis, Missouri
| | - Kevin N Sheth
- Department of Neurology, Yale University, New Haven, Connecticut
| | - Maarten Lansberg
- Department of Neurology, Stanford University, Stanford, California
| | - Tanya Turan
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
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25
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Anadani M, Maïer B, Escalard S, Labreuche J, de Havenon A, Sabben C, Lapergue B, Gory B, Richard S, Sibon I, Desilles JP, Blanc R, Piotin M, Mazighi M. Magnitude of Blood Pressure Change After Endovascular Therapy and Outcomes: Insight From the BP-TARGET Trial. Stroke 2022; 53:719-727. [PMID: 35109685 DOI: 10.1161/strokeaha.121.036701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To assess the association between systolic blood pressure change (ΔSBP) at different time intervals after successful reperfusion with radiographic and clinical outcomes. METHODS This is a post hoc analysis of the BP-TARGET multicenter trial (Blood Pressure Target in Acute Stroke to Reduce Hemorrhage After Endovascular Therapy). ΔSBP was defined as end of procedure SBP minus mean SBP at different time intervals (15-60 minutes, 1-6 hours, and 6-24 hours postprocedure). The primary outcome was the poor functional outcome (90-day modified Rankin Scale score 3-6). RESULTS We included a total of 267 patients (130 in the intensive treatment group). Compared with patients with favorable outcome, patients with poor outcome had lower ΔSBP (less SBP reduction) at all times intervals. After adjusting for potential confounders including baseline SBP, both ΔSBP15-60M and ΔSBP6-24H were associated with lower odds of poor outcome (adjusted odds ratio per 5 mm Hg SBP reduction, 0.89 [95% CI, 0.81-0.99], and adjusted odds ratio 0.82 [95% CI, 0.73-0.92], respectively). Concerning safety outcomes, patients with intraparenchymal hemorrhage had lower ΔSBP at all time intervals. ΔSBP15-60M was associated with lower odds of any intraparenchymal hemorrhage (adjusted odds ratio per 5 mm Hg SBP reduction 0.91 [95% CI, 0.83-0.99]). Conversely, ΔSBP was not associated with mortality or neurological deterioration at any time interval. CONCLUSIONS After successful reperfusion, ΔSBP had a linear relationship with poor outcome and the risk of poor outcome was higher with less reduction from the baseline SBP. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03160677.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurology, Washington University, St Louis, MO (M.A.).,Department of Neurosurgery, Medical University of South Carolina, Charleston (M.A.)
| | - Benjamin Maïer
- Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M.).,University of Paris, France (B.M., J.-P.D., M.M.).,FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | - Simon Escalard
- Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M.)
| | - Julien Labreuche
- University of Lille, CHU Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, France (J.L.).,CHU Lille, Department of Biostatistics, France (J.L.)
| | - Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City (A.d.H.)
| | | | - Bertrand Lapergue
- Division of Neurology, Department of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France (B.L.)
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Nancy, France (B.G.).,Université de Lorraine, IADI, INSERM U1254, Nancy, France (B.G.)
| | | | | | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M.).,University of Paris, France (B.M., J.-P.D., M.M.).,FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M.).,FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | - Michel Piotin
- Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M.).,FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M.).,University of Paris, France (B.M., J.-P.D., M.M.).,FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M.)
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Anadani M, Maier B, Escalard S, Labreuche J, de Havenon AH, Sabben C, LAPERGUE B, Gory B, Richard S, Sibon I, Desilles JP, BLANC RAPHAEL, Piotin M, Mazighi M. Abstract 38: Magnitude Of Blood Pressure Change After Endovascular Therapy And Outcomes: Insight From Bp Target Trial. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
To assess the association between systolic blood pressure change (ΔSBP) at different time intervals after successful reperfusion with radiographic and clinical outcomes.
Methods:
This is a post hoc analysis of the Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke (BP TARGET) multicenter trial. ΔSBP was defined as end of procedure SBP minus mean SBP at different time intervals (15-60 minutes, 1-6 hours, 6-24 hours post-procedure). The primary outcome was the poor functional outcome (90-day modified Rankin Scale 3-6).
Results:
We included a total of 267 patients (130 in the intensive treatment group). Compared to patients with favorable outcome, patients with poor outcome had lower ΔSBP (less SBP reduction) at all times intervals. After adjusting for potential confounders including baseline SBP, both ΔSBP
15-60M
and ΔSBP
6-24H
were associated with lower odds of poor outcome (adjusted odds ratio [aOR] per 5mmHg SBP reduction, 0.89; 95% confidence interval [CI] 0.81 to 0.99, and aOR 0.82; 95% CI 0.73 to 0.92, respectively). Concerning safety outcomes, patients with intraparenchymal hemorrhage (IPH) had lower ΔSBP at all time intervals. ΔSBP
15-60M
was associated with lower odds of any IPH (aOR per 5mmHg SBP reduction 0.91, 95% CI 0.83 to 0.99). Conversely, ΔSBP was not associated with mortality or neurological deterioration at any time interval.
Conclusion:
After successful reperfusion, ΔSBP had a linear relationship with poor outcome and the risk of poor outcome was higher with less reduction from the baseline SBP.
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Anadani M, Qureshi AI, Sheth KN, Yaghi S, de Havenon AH. Abstract TP142: Platelet Count And Intracerebral Hemorrhage Expansion In The ATACH 2 Trial. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The effect of platelet count on hematoma expansion in patients with intracerebral hemorrhage (ICH) has not been sufficiently studied. We performed a secondary analysis of the ATACH 2 trial to examine the association between platelet count and hematoma expansion.
Methods:
We included patients with a baseline platelet count, volumetric measurement of ICH hematoma volume in mL on a baseline and 24-hour follow-up CT, and excluded those who had surgical evacuation in the first 24 hours. To address the right skew of ICH volume, the primary outcome was the log difference in ICH volume from baseline to 24-hour follow-up. The exposure was baseline platelet count and secondary exposure was the mean of the baseline and a 24-hour platelet count value. We fit unadjusted linear regression models and models adjusted for patient age, sex, race/ethnicity, smoking, baseline ICH volume, GCS, ICH location/side, and randomization arm.
Results:
We included 945 patients in our primary analysis (mean age 62.3, 62% male, 22.7% white, 57.1% Asian). The mean baseline platelet count was 220.7±61.9 with a standard distribution (Figure 1). There was no association between log difference in ICH volume and baseline platelet count (unadjusted p value=0.616, adjusted p value=0.730) or the mean platelet count over 24 hours (unadjusted p value=0.509, adjusted p value=0.853). The relationships are shown graphically in Figure 2.
Conclusion:
In patients with supratentorial ICH enrolled in the ATACH-II trial, there was not a significant association between platelet count and hematoma expansion.
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Stulberg EL, Zheutlin A, Harris B, Delic A, Sheibani N, Anadani M, yaghi S, Petersen NH, de Havenon AH. Abstract TMP60: Association Of Blood Pressure Variability With Death And Discharge Destination Among Stroke And Non-stroke Critical Illness Patients. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tmp60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
High blood pressure variability (BPV) is associated with worse prognoses among critically ill stroke and non-stroke patients. It is unclear if higher BPV’s association with worse outcomes is a unique sequela of stroke or a modifiable risk factor among all critically-ill patients.
Methods:
Using data from 7,939 ICU patients hospitalized between 2001 and 2012 in the Medical Information Mart for Intensive Care III (MIMIC-III) database, we examined (1) differences in BPV between stroke and non-stroke patients, (2) BPV’s associations with in-hospital death and favorable discharge destination in stroke and non-stroke patients after adjusting for confounders, and (3) how minimum systolic blood pressure (SBP) - a correlate of illness severity and cerebral perfusion - affected these associations.
Results:
BPV was higher in stroke patients compared to non-stroke patients. In regression analyses, higher BPV was significantly associated with higher odds of in-hospital death and unfavorable discharge amongst stroke and non-stroke patients. After adjusting for minimum tertile of SBP to account for illness severity and cerebral perfusion, higher BPV was significantly associated with higher odds of in-hospital death and lower odds of favorable discharge destination only in patients with ischemic stroke (OR
in-hospital death
2.1, 95% CI: 1.0-4.1; OR
favorable discharge
0.6, 95% CI: 0.4-0.9) or intracerebral hemorrhage (OR
in-hospital death
3.3, 95% CI: 1.8-6.1; OR
unfavorable discharge
0.4, 95% CI: 0.3-0.7).
Conclusion:
Among critically ill stroke patients, BPV seems to represent both generalized critical illness as well as a specific feature of stroke. BPV in critically ill stroke patients may be in part a function of injury to the central autonomic network or modulation of sympathetic outflow.
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de Havenon AH, Yaghi S, Stulberg E, Delic A, Anadani M, Sheth KN, Majersik JJ. Abstract TMP21: Impact Of COVID-19 State-level Hospital Capacity On Overall Stroke Mortality In 2020 In The United States. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tmp21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Although hospital admissions for stroke declined in 2020 during the COVID-19 pandemic, patients with comorbid COVID-19 and stroke had increased mortality. We explored stroke mortality in 2020 and its association with COVID-19 prevalence and state-level hospital capacities.
Methods:
We analyzed CDC National Vital Statistics System and COVID Data Tracker data from 2017-2020. The primary outcome was age-adjusted stroke (ischemic and hemorrhagic) mortality rate per 100,000. The secondary outcome was % change in state-level stroke mortality rates in 2020 (vs. 2017-19); we report its correlation with state-level 1) prevalence of confirmed COVID-19 infections by 12/31/2021, 2) total COVID mortality by 12/31/20, and the 2020 average state-level % of 3) hospital and 4) ICU beds occupied by COVID-19 patients.
Results:
Figure 1A shows the typical seasonal decline in stroke mortality in quarters 2/3 was attenuated in 2020. The % change in state-level stroke mortality in 2020 (Figure 1B) was not correlated with prevalence of COVID-19 infection (rho=0.05, p=0.74), mortality (rho=0.10, p=0.49), or the % of ICU beds occupied by COVID-19 patients (rho=0.24, p=0.09). There was a correlation with % of hospital beds occupied by COVID-19 patients (rho=0.35, p=0.01) (Figure 2).
Conclusion:
Overall stroke mortality increased in 2020, particularly in Q2/3, the early-to-mid phase of the COVID-19 pandemic. At the state level, the average % of all hospital beds occupied by COVID-19 patients in 2020 was the only COVID-19 metric associated with change in stroke mortality. Future work should determine if this association was due to decreased hospital capacity to deliver standard stroke care.
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de Havenon AH, Yaghi S, Anadani M, Mistry E, Petersen NH, Prabhakaran S, Lansberg MG, Sheth KN. Abstract WP218: Midlife Blood Pressure Trajectory And Later Life Risk Of Ischemic Stroke: A Post-hoc Analysis Of ARIC. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wp218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Midlife hypertension is associated with an increased later-life ischemic stroke risk. However, temporal trends of blood pressure have not been fully explored.
Methods:
We performed a post hoc analysis of the ARIC study and included participants with four systolic blood pressures (SBP) at Visits 1-4 (1987-1999). Patients who had an ischemic stroke, died, or were lost to follow-up before 1999 were excluded from the analysis. We used group-based trajectory modeling to define six distinct SBP trajectories during Visits 1-4 (Figure 1). We report unadjusted and adjusted hazard ratios from Cox models fit to the primary outcome of ischemic stroke during follow-up from 1999-2017. We confirmed the proportional hazards assumptions of our models.
Results:
We included 9,689 participants, of which 758 (7.8%) had an ischemic stroke during follow-up. The mean±SD age at Visit 1 was 54±6 years and at Visit 4 was 63±6 years. The adjusted Cox models, Table 1, show the highest risk of ischemic stroke with increasing hypertension or stable severe hypertension. Comparing trajectories with similar baseline hypertension confirmed that increasing hypertension and stable severe hypertension had a higher risk than decreasing trajectories with the same starting point.
Conclusion:
Midlife blood pressure trajectory is associated with later-life ischemic stroke risk. Patients with hypertension who achieved a midlife reduction in systolic blood pressure were less likely to have a later-life stroke than those who did not.
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Anadani M, Maier B, Escalard S, Labreuche J, de Havenon AH, Sabben C, LAPERGUE B, Gory B, Richard S, Sibon I, Desilles JP, Mazighi M. Abstract WMP87: Effect Of Intensive Blood Pressure Treatment After Successful Reperfusion On Outcome According To End Of Procedure Blood Pressure: Insight From The Bp Target Trial. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wmp87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Backgroup:
The Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke (BP TARGET) trial demonstrated no benefit of systolic blood pressure (SBP) intensive lowering treatment after successful reperfusion. However, it is still unknown whether end of procedure SBP modifies the treatment effect of SBP intensive lowering treatment after successful reperfusion.
Methods:
This is a post hoc analysis of the BP TARGET multicenter trial. Patients were enrolled in the BP TARGET trial if they achieved successful reperfusion with EVT and had systolic blood pressure (SBP) ≥130 mmHg at the end of procedure. Patients were randomized in 1:1 fashion to intensive SBP treatment (SBP target 100-129 mmHg to be achieved within 1 hour of randomization) or standard SBP treatment (SBP target 130-185 mmHg). In this study, patients were divided into two groups based on end of procedure SBP (<160 mmHg, ≥ 160 mmHg). Primary outcome was any intracerebral hemorrhage and secondary outcome was favorable outcome ( modified Rankin Scale 0-2 ) at 90 days.
Results:
A total of 290 patients were included in the present study (141 patients in the intensive treatment arm and 149 patients in the standard arm). A total of 105 patients had end of procedure SBP≥160 mmHg (53 in the intensive arm and 52 in the standard arm) and 185 patients had SBP<160mmHg (88 in the intensive arm and 97 in the standard arm). Intensive SBP treatment was not associated with any intracerebral hemorrhage or favorable outcome in both <160 mmHg and ≥160mmHg groups (Table 1). Moreover, there was no heterogeneity of treatment effect according to end of procedure SBP.
Conclusion:
End of procedure SBP did not modify the treatment effect of SBP lowering treatment after successful reperfusion.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sébastien Richard
- Dept of Diagnostic and Therapeutic Neuroradiology, F-54000 Nancy, France; Université de Lorraine, IADI, INSERM U1254, F-54000 Nancy, France, Nancy, France
| | | | - Jean-philippe Desilles
- Dept of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France, Paris, France
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Anadani M, JANUEL ANNECHRISTINE, Finitsis SN, Clarençon F, Richard S, Marnat G, bourcier R, Sibon I, Dargazanli C, Arquizan C, BLANC RAPHAEL, LAPERGUE B, Consoli A, Eugène F, vannier S, Caroff J, denier C, BOULANGER M, Gauberti M, Rouchaud A, Macian F, Rosso C, ben Hassen W, TURC G, ozkul-wermester O, PAPAGIANNAKI CHRYSANTHI, Albucher JF, LE BRAS A, Evain S, wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, de Havenon AH, Maier B, Gory B. Abstract TMP63: Predictors And Clinical Impact Of ASPECTS Evolution After Successful Reperfusion With Endovascular Therapy: Insight From The ETIS Registry. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tmp63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Alberta Stroke Program Early CT scan Score (ASPECTS) is a reliable imaging biomarker of infarct extension in patients with large vessel occlusions. ASPECTS evolution, a surrogate of infarct expansion, is an important predictor of functional and safety outcomes after endovascular therapy (EVT). In this study, we aimed to identify the predictors of ASPECTS evolution after successful reperfusion and the association between ASPECTS evolution and outcomes of EVT.
Methods:
We used data from the ongoing prospective multicenter Endovascular Treatment in Ischemic Stroke (ETIS) registry (NCT03776877). For the purpose of this study, we enrolled patients with anterior circulation LVO treated with EVT and achieved successful reperfusion (mTICI 2b-3). Additional inclusion criteria included 1) the availability of ASPECTS score on admission and at 24 hours after EVT 2) ASPECTS was assessed on the same imaging technique (i.e MRI or CT) on admission and at 24 hours. We considered 2 or more points decrease in ASPECTS as a significant ASPECTS change. Multivariable logistic regression analyses were used to identify the predictors of ASPECT evolution and to study the association between ASPECTS evolution and outcomes.
Results:
We included a total of 1161 patients, of whom 978 (84%) patients had at least 2 points decrease in ASPECTS score. Worsening ASPECTS score was associated with higher odds of poor functional outcome (90-day mRS 3-6), mortality, and symptomatic intracerebral hemorrhage. Admission ASPECTS, NIHSS, blood glucose, location of occlusion, final mTICI score, total number of attempts and procedure time emerged as predictors of ASPECTS evolution.
Conclusion:
ASPECTS evolution is a strong predictor of clinical and safety outcomes after successful reperfusion with EVT.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Arturo Consoli
- Foch Hosp, Versailles Saint-Quentin en Yvelines Univ, Suresnes, Suresnes, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sarah Evain
- CH Bretagne Atlantique, Vannes, Vannes, France
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de Havenon AH, Yaghi S, Anadani M, Petersen NH. Abstract TMP50: Increased Systolic Blood Pressure In The Subacute, But Not Acute, Period After Ischemic Stroke Is Associated With Good Functional Outcome At 90 Days. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tmp50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Prior research has shown that increased blood pressure variability (BPV) after ischemic stroke is associated with lower odds of good functional outcome, but the number, intervals between, and epochs of blood pressure measurements have not been standardized.
Methods:
We include patients enrolled in the FAST-MAG trial with a final diagnosis of ischemic stroke, premorbid modified Rankin Scale (mRS) of 0, 4 “early” blood pressure measurements (prehospital and 3 in the hour after arrival), and 9 “later” measurements (q4 hours from hours 4-24 and q8 hours from hours 24-48). The primary outcome was 90-day mRS of 0-1 (good outcome). The BPV exposure was the top tertile (highest level) of systolic standard deviation (SD). We fit logistic regression models adjusted for patient age, race, sex, baseline NIH Stroke Scale, tPA, endovascular therapy, mean systolic blood pressure, smoking, atrial fibrillation, hypertension, and diabetes.
Results:
We included 455 patients, with a mean age of 70.8 years, 46.8% female, 50.8% had tPA, 6.4% had endovascular therapy, the median baseline NIH Stroke Scale was 12 (5-19) and good outcome occurred in 152/455 (33.4%). The mean early SD was not significantly lower in patients with good outcome (p=0.12), but later SD was lower in patients with good outcome (13.5±5.6 vs. 15.1±5.6, p<0.01). The adjusted odds ratio for good outcome in the top tertile of early BPV was 1.09 (95% CI 0.63-1.89), while for the top tertile of later BPV it was 0.54 (95% CI 0.30-0.95). The predicted probability of good outcome for a range of later BPV values is seen in Figure 1.
Conclusion:
Increased BPV in the hours after ischemic stroke onset was not associated with 90-day good outcome, but increased BPV during hours 4-48 after hospital arrival had a significant association with lower odds of good outcome. While these results are hypothesis-generating, the rigor of outcome adjudication and standardization of blood pressure measurements strengthens the findings.
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de Havenon A, Sheth K, Johnston KC, Delic A, Stulberg E, Majersik J, Anadani M, Yaghi S, Tirschwell D, Ney J. Acute Ischemic Stroke Interventions in the United States and Racial, Socioeconomic, and Geographic Disparities. Neurology 2021; 97:e2292-e2303. [PMID: 34649872 PMCID: PMC8665433 DOI: 10.1212/wnl.0000000000012943] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/27/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In patients with ischemic stroke (IS), IV alteplase (tissue plasminogen activator [tPA]) and endovascular thrombectomy (EVT) reduce long-term disability, but their utilization has not been fully optimized. Prior research has also demonstrated disparities in the use of tPA and EVT specific to sex, race/ethnicity, socioeconomic status, and geographic location. We sought to determine the utilization of tPA and EVT in the United States from 2016-2018 and if disparities in utilization persist. METHODS This is a retrospective, longitudinal analysis of the 2016-2018 National Inpatient Sample. We included adult patients who had a primary discharge diagnosis of IS. The primary study outcomes were the proportions who received tPA or EVT. We fit a multivariate logistic regression model to our outcomes in the full cohort and also in the subset of patients who had an available baseline National Institutes of Health Stroke Scale (NIHSS) score. RESULTS The full cohort after weighting included 1,439,295 patients with IS. The proportion who received tPA increased from 8.8% in 2016 to 10.2% in 2018 (p < 0.001) and who had EVT from 2.8% in 2016 to 4.9% in 2018 (p < 0.001). Comparing Black to White patients, the odds ratio (OR) of receiving tPA was 0.82 (95% confidence interval [CI] 0.79-0.86) and for having EVT was 0.75 (95% CI 0.70-0.81). Comparing patients with a median income in their zip code of ≤$37,999 to >$64,000, the OR of receiving tPA was 0.81 (95% CI 0.78-0.85) and for having EVT was 0.84 (95% CI 0.77-0.91). Comparing patients living in a rural area to a large metro area, the OR of receiving tPA was 0.48 (95% CI 0.44-0.52) and for having EVT was 0.92 (95% CI 0.81-1.05). These associations were largely maintained after adjustment for NIHSS, although the effect size changed for many of them. Contrary to prior reports with older datasets, sex was not consistently associated with tPA or EVT. DISCUSSION Utilization of tPA and EVT for IS in the United States increased from 2016 to 2018. There are racial, socioeconomic, and geographic disparities in the accessibility of tPA and EVT for patients with IS, with important public health implications that require further study.
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Affiliation(s)
- Adam de Havenon
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA.
| | - Kevin Sheth
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - Karen C Johnston
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - Alen Delic
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - Eric Stulberg
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - Jennifer Majersik
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - Mohammad Anadani
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - Shadi Yaghi
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - David Tirschwell
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - John Ney
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
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de Havenon A, Muddasani V, Anadani M, Prabhakaran S. Impact of mean blood pressure and blood pressure variability after diagnosis of mild cognitive impairment and risk of dementia. J Clin Hypertens (Greenwich) 2021; 23:2124-2128. [PMID: 34862714 PMCID: PMC8696239 DOI: 10.1111/jch.14391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/25/2021] [Accepted: 10/10/2021] [Indexed: 11/30/2022]
Abstract
Hypertension and increased blood pressure variability (BPV) are associated with the development of dementia. However, previous studies did not focus on the risk of dementia among participants with mild cognitive impairment (MCI) and controlled blood pressure level. To address this limitation, the authors performed a post‐hoc analysis of SPRINT MIND participants diagnosed with MCI (mean Montreal Cognitive Assessment score at diagnosis 16.1±3.1). The primary outcome was subsequent diagnosis of probable dementia. The exposure was mean blood pressure and BPV following MCI diagnosis until the end of follow‐up or a dementia event (mean follow‐up 2.6±1.2 years). The primary outcome occurred in 76/516 (14.7%) patients. The mean blood pressure was not significantly higher in participants who developed dementia. In the lowest quartile of BPV (systolic standard deviation), the rate of dementia was 8.5% (11/129), while in the highest quartile it was 21.7% (28/129). The highest quartile of systolic BPV had an adjusted hazard ratio for dementia of 2.73 (95% CI, 1.31–5.69) and for diastolic BPV it was 2.62 (95% CI, 1.26–5.47). In SPRINT MIND participants, the authors found that increased BPV after MCI diagnosis was associated with incident probable dementia during subsequent follow‐up.
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Affiliation(s)
- Adam de Havenon
- University of Utah, Department of Neurology, Salt Lake City, Utah, USA
| | - Varsha Muddasani
- University of Utah, Department of Neurology, Salt Lake City, Utah, USA
| | - Mohammad Anadani
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, St Louis, Missouri, USA
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de Havenon A, Delic A, Yaghi S, Wong KH, Majersik JJ, Stulberg E, Tirschwell D, Anadani M. Midlife Blood Pressure Variability and Risk of All-Cause Mortality and Cardiovascular Events During Extended Follow-up. Am J Hypertens 2021; 34:1269-1275. [PMID: 34240111 PMCID: PMC8643578 DOI: 10.1093/ajh/hpab106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/08/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Studies demonstrate an association between visit-to-visit blood pressure variability (BPV) and cardiovascular events and death. We aimed to determine the long-term cardiovascular and mortality effects of BPV in midlife in participants with and without cardiovascular risk factors. METHODS This is a post-hoc analysis of the Atherosclerosis Risk in the Community study. Long-term BPV was derived utilizing mean systolic blood pressure at Visits 1-4 (Visit 1: 1987-1989, Visit 2: 1990-1992, Visit 3: 1993-1995, Visit 4: 1996-1998). The primary outcome was mortality from Visit 4 to 2016 and secondary outcome was cardiovascular events (fatal coronary heart disease, myocardial infarction, cardiac procedure, or stroke). We fit Cox proportional hazards models and also performed the analysis in a subgroup of cardiovascular disease-free patients without prior stroke, myocardial infarction, congestive heart failure, hypertension, or diabetes. RESULTS We included 9,578 participants. The mean age at the beginning of follow-up was 62.9 ± 5.7 years, and mean follow-up was 14.2 ± 4.5 years. During follow-up, 3,712 (38.8%) participants died and 1,721 (n = 8,771, 19.6%) had cardiovascular events. For every SD higher in systolic residual SD (range 0-60.5 mm Hg, SD = 5.6 mm Hg), the hazard ratio for death was 1.09 (95% confidence interval [CI] 1.05-1.12) and for cardiovascular events was 1.00 (95% CI 0.95-1.05). In cardiovascular disease-free participants (n = 4,452), the corresponding hazard ratio for death was 1.12 (95% CI 1.03-1.21) and for cardiovascular events was 1.01 (95% CI 0.89-1.14). CONCLUSION Long-term BPV during midlife is an independent predictor of later life mortality but not cardiovascular events.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Alen Delic
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Shadi Yaghi
- Department of Neurology, New York University, New York, New York, USA
| | - Ka-Ho Wong
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | | | - Eric Stulberg
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - David Tirschwell
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Mohammad Anadani
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
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Anadani M, de Havenon A, Henninger N, Kuohn L, Grory BM, Furie KL, Kim AS, Donald Easton J, Claiborne Johnston S, Yaghi S. Antiplatelet Use and Ischemic Stroke Risk in Minor Stroke or Transient Ischemic Attack: A Post Hoc Analysis of the POINT Trial. Stroke 2021; 52:e773-e776. [PMID: 34634925 PMCID: PMC10615349 DOI: 10.1161/strokeaha.121.035354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Dual antiplatelet therapy has been shown to reduce the risk of recurrent stroke in patients with minor stroke or transient ischemic attack. However, whether the effect of dual antiplatelet therapy is modified by pretreatment antiplatelet status is unclear. METHODS This is a post hoc analysis of the POINT trial (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke). Patients were divided into 2 groups based on pretreatment antiplatelet use. The primary outcome was ischemic stroke within 90 days of randomization. RESULTS We included 4881 patients of whom 41% belonged to the no pretreatment antiplatelet. Ischemic stroke occurred in 6% and 5% in the antiplatelet pretreatment and no antiplatelet pretreatment, respectively. Antiplatelet pretreatment was not associated with the risk of ischemic stroke (adjusted hazard ratio, 1.05 [95% CI, 0.81-137]) or risk of major hemorrhage (hazard ratio, 1.10 [95% CI, 0.55-2.21]; P=0.794). The effect of dual antiplatelet therapy on recurrent ischemic stroke risk was not different in patients who were on antiplatelet before randomization (adjusted hazard ratio, 0.69 [95% CI, 0.50-0.94]) as opposed to those who were not (adjusted hazard ratio, 0.75 [95% CI, 0.50-1.12]), P for interaction = 0.685. CONCLUSIONS In patients with minor stroke and high-risk transient ischemic attack, dual antiplatelet therapy reduces the risk of ischemic stroke regardless of premorbid antiplatelet use.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO
| | - Adam de Havenon
- Departments of Neurology, University of Utah Medical Center, Salt Lake City, UT
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical Center, Worcester, MA
- Department of Psychiatry, University of Massachusetts Medical Center, Worcester, MA
| | | | | | - Karen L. Furie
- Department of Neurology, Brown University, Providence, RI
| | - Anthony S. Kim
- Department of Neurology, University of California, San Francisco, CA
| | - J. Donald Easton
- Department of Neurology, University of California, San Francisco, CA
| | | | - Shadi Yaghi
- Department of Neurology, Brown University, Providence, RI
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Maïer B, Gory B, Lapergue B, Sibon I, Escalard S, Kyheng M, Labreuche J, de Havenon A, Petersen N, Anadani M, Gayat E, Boursin P, Ben Maacha M, Desilles JP, Blanc R, Piotin M, Halimi JM, Mazighi M. Effect of blood pressure variability in the randomized controlled BP TARGET trial. Eur J Neurol 2021; 29:771-781. [PMID: 34821437 DOI: 10.1111/ene.15194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The Blood Pressure Target in Acute Ischemic Stroke to Reduce Hemorrhage After Endovascular Therapy (BP TARGET) trial evaluated whether an intensive systolic blood pressure (SBP) target resulted in reduced rates of intracranial hemorrhage (ICH) after successful endovascular therapy (EVT) but did not assess the effect of blood pressure variability (BPV) on functional outcomes and ICH occurrence. We sought to evaluate this question in the BP TARGET trial. METHODS We performed a post hoc analysis of the BP TARGET trial and included patients with at least 50% of blood pressure (BP) recordings during the first 24 h after EVT. BPV parameters were SBP and diastolic BP (DBP) coefficient of variation (CV), standard deviation (SD), maximum-minimum (max-min), successive variation (SV), and time rate. The primary outcome was favorable functional outcome (3-month modified Rankin Scale between 0 and 2); the secondary outcome was the rate of ICH at 24 h. RESULTS We included 290 patients (mean number of BP measures = 30.4, SD = 8.0). BPV parameters (SBPSD , SBPmax-min , SBPCV ) were higher in the intensive SBP target group. Only DBP BPV parameters were associated with worse functional outcomes in the unadjusted model (DBPSD , DBPmax-min , DBPCV , and DBPSV ), but not after adjustment. Higher SBPmax-min was associated with worse functional outcomes in Thrombolysis in Cerebral Infarction 2B patients (odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.38-1.02), but not in patients with complete reperfusion (OR = 1.27, 95% CI = 0.80-2.02, p for heterogeneity (phet =0.037). None of the BPV parameters was associated with ICH, regardless of the randomization group or the reperfusion grade. CONCLUSIONS BPV was significantly higher in the intensive SBP target group but was not associated with functional outcome or ICH.
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Affiliation(s)
- Benjamin Maïer
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,University of Paris, Paris, France.,FHU NeuroVasc, Paris, France.,EA4245-Transplantation, Immunology, and Inflammation, University of Tours, Tours, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, University of Lorraine, Nancy, France.,IADI, INSERM U1254, University of Lorraine, Nancy, France
| | - Bertrand Lapergue
- Division of Neurology, Department of Neurology, Stroke Center, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - Igor Sibon
- Stroke Unit, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France
| | - Maeva Kyheng
- University of Lille, Lille University Hospital Center, EA 2694-Public Health: Epidemiology and Quality of Care, Lille, France
| | - Julien Labreuche
- University of Lille, Lille University Hospital Center, EA 2694-Public Health: Epidemiology and Quality of Care, Lille, France
| | - Adam de Havenon
- Neurology Department, University of Utah, Salt Lake City, Utah, USA
| | - Nils Petersen
- Neurocritical Care and Emergency Neurology, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Mohammad Anadani
- Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Etienne Gayat
- University of Paris, Paris, France.,Department of Anesthesiology, Critical Care and Burn Center, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, Paris, France.,INSERM UMR-S 942, Cardiovascular Makers in Stress Conditions, Paris, France
| | - Perrine Boursin
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France
| | - Malek Ben Maacha
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,University of Paris, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Raphael Blanc
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Jean-Michel Halimi
- EA4245-Transplantation, Immunology, and Inflammation, University of Tours, Tours, France.,Nephrology Department, Tours Hospital, Tours, France.,University of Tours, Tours, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,University of Paris, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
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Alawieh AM, Eid M, Anadani M, Sattur M, Maier IL, Feng W, Goyal N, Starke RM, Rai A, Fargen KM, Psychogios MN, De Leacy R, Grossberg JA, Keyrouz SG, Dumont TM, Kan P, Lena J, Liman J, Arthur AS, Elijovich L, Mccarthy DJ, Saini V, Wolfe SQ, Mocco J, Fifi JT, Nascimento FA, Giles JA, Allen M, Crosa R, Fox WC, Gory B, Spiotta AM. Thrombectomy Technique Predicts Outcome in Posterior Circulation Stroke—Insights from the STAR Collaboration. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa179_s037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Katsanos AH, Malhotra K, Ahmed N, Seitidis G, Mistry EA, Mavridis D, Kim JT, Veroniki A, Maier I, Matusevicius M, Khatri P, Anadani M, Goyal N, Arthur AS, Sarraj A, Yaghi S, Shoamanesh A, Catanese L, Kantzanou M, Psaltopoulou T, Rentzos A, Psychogios M, Van Adel B, Spiotta AM, Sandset EC, de Havenon A, Alexandrov AV, Petersen NH, Tsivgoulis G. Blood Pressure After Endovascular Thrombectomy and Outcomes in Patients With Acute Ischemic Stroke: An Individual Patient Data Meta-analysis. Neurology 2021; 98:e291-e301. [PMID: 34772799 DOI: 10.1212/wnl.0000000000013049] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore the association between blood pressure (BP) levels after endovascular thrombectomy (EVT) and the clinical outcomes of acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). METHODS A study was eligible if it enrolled AIS patients older than 18 years, with an LVO treated with either successful or unsuccessful EVT, and provided either individual or mean 24-hour systolic BP values after the end of the EVT procedure. Individual patient data from all studies were analyzed using a generalized linear mixed-effects model. RESULTS A total of 5874 patients (mean age: 69±14 years, 50% women, median NIHSS on admission: 16) from 7 published studies were included. Increasing mean systolic BP levels per 10 mm Hg during the first 24 hours after the end of the EVT were associated with a lower odds of functional improvement (unadjusted common OR=0.82, 95%CI:0.80-0.85; adjusted common OR=0.88, 95%CI:0.84-0.93) and modified Ranking Scale score≤2 (unadjusted OR=0.82, 95%CI:0.79-0.85; adjusted OR=0.87, 95%CI:0.82-0.93), and a higher odds of all-cause mortality (unadjusted OR=1.18, 95%CI:1.13-1.24; adjusted OR=1.15, 95%CI:1.06-1.23) at 3 months. Higher 24-hour mean systolic BP levels were also associated with an increased likelihood of early neurological deterioration (unadjusted OR=1.14, 95%CI:1.07-1.21; adjusted OR=1.14, 95%CI:1.03-1.24) and a higher odds of symptomatic intracranial hemorrhage (unadjusted OR=1.20, 95%CI:1.09-1.29; adjusted OR=1.20, 95%CI:1.03-1.38) after EVT. CONCLUSION Increased mean systolic BP levels in the first 24 hours after EVT are independently associated with a higher odds of symptomatic intracranial hemorrhage, early neurological deterioration, three-month mortality, and worse three-month functional outcomes.
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Affiliation(s)
- Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada .,Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Niaz Ahmed
- Department of Neurology, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Georgios Seitidis
- Department of Primary Education, University of Ioannina, Ioannina, Greece
| | - Eva A Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dimitris Mavridis
- Department of Primary Education, University of Ioannina, Ioannina, Greece.,Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Argie Veroniki
- Department of Primary Education, University of Ioannina, Ioannina, Greece.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Ilko Maier
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Marius Matusevicius
- Department of Neurology, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Mohammad Anadani
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Amrou Sarraj
- Department of Neurology, UT Houston, Houston, Texas, USA
| | - Shadi Yaghi
- Department of Neurology, NYU Langone Health, New York, NY
| | - Ashkan Shoamanesh
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada
| | - Luciana Catanese
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Rentzos
- Diagnostic and Interventional Neuroradiology, Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marios Psychogios
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Brian Van Adel
- Division of Neurology, Neurosurgery, and Diagnostic Imaging, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Else Charlotte Sandset
- Department of Neurology, Stroke Unit, Oslo University Hospital, Oslo, Norway.,The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Adam de Havenon
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Douarinou M, Gory B, Consoli A, Lapergue B, Kyheng M, Labreuche J, Anadani M, Blanc R, Marnat G, Bourcier R, Sibon I, Eugène F, Vannier S, Audibert G, Mione G, Richard S. Impact of Strategy on Clinical Outcome in Large Vessel Occlusion Stroke Successfully Reperfused: ETIS Registry Results. Stroke 2021; 53:e1-e4. [PMID: 34727741 DOI: 10.1161/strokeaha.121.034422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Approximately half of the patients with acute ischemic stroke due to anterior circulation large vessel occlusion do not achieve functional independence despite successful reperfusion. We aimed to determine influence of reperfusion strategy (bridging therapy, intravenous thrombolysis alone, or mechanical thrombectomy alone) on clinical outcomes in this population. METHODS From ongoing, prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke registry in France, all patients with anterior circulation large vessel occlusion who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3) following reperfusion therapy were included. Primary end point was favorable outcome, defined as 90-day modified Rankin Scale score ≤2. Patient groups were compared using those treated with bridging therapy as reference. Differences in baseline characteristics were reduced after propensity score-matching, with a maximum absolute standardized difference of 14% for occlusion site. RESULTS Among 1872 patients included, 970 (51.8%) received bridging therapy, 128 (6.8%) received intravenous thrombolysis alone, and the remaining 774 (41.4%) received MT alone. The rate of favorable outcome was comparable between groups. Excellent outcome (90-day modified Rankin Scale score 0-1) was achieved more frequently in the bridging therapy group compared with the MT alone (odds ratio after propensity score-matching, 0.70 [95% CI, 0.50-0.96]). Regarding safety outcomes, hemorrhagic complications were similar between the groups, but 90-day mortality was significantly higher in the MT alone group compared with the bridging therapy group (odds ratio, 1.60 [95% CI, 1.09-2.37]). CONCLUSIONS This real-world observational study of patients with anterior circulation large vessel occlusion demonstrated a similar rate of favorable outcome following successful reperfusion with different therapeutic strategies. However, our results suggest that bridging therapy compared with MT alone is significantly associated with excellent clinical outcome and lower mortality. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03776877.
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Affiliation(s)
- Marian Douarinou
- Université de Lorraine, CHRU-Nancy, Stroke Unit, CIC-P 1433, INSERM U1116, France (M.D., G.M., S.R.)
| | - Benjamin Gory
- Department of Neuroradiology, Université de Lorraine, CHRU-Nancy, INSERM U1254, France (B.G.)
| | - Arturo Consoli
- Department of Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France. (A.C.)
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France. (B.L.)
| | - Maeva Kyheng
- Université de Lille, CHU Lille, EA 2694, France (M.K., J.L.)
| | | | - Mohammad Anadani
- Department of Neurology, Washington University School of Medicine, St Louis, MO (M.A.)
| | - Raphael Blanc
- Department of Neuroradiology, Rothschild Foundation, Paris, France (R.B.).,Department of Neuroradiology, University Hospital of Nantes, INSERM 1087, UNIV Nantes, France (R.B.)
| | - Gaultier Marnat
- Université de Lorraine, CHRU-Nancy, Stroke Unit, CIC-P 1433, INSERM U1116, France (M.D., G.M., S.R.).,Department of Neuroradiology, University Hospital of Bordeaux, France. (G.M.)
| | | | - Igor Sibon
- Department of Neurology, University Hospital of Bordeaux, France. (I.S.)
| | - François Eugène
- Department of Neuroradiology, University Hospital of Rennes, France. (F.E.)
| | - Stéphane Vannier
- Department of Neurology, University Hospital of Rennes, France. (S.V.)
| | - Gérard Audibert
- Department of Anesthesiology and Surgical Intensive Care, Université de Lorraine, CHRU-Nancy, France (G.A.)
| | | | - Sébastien Richard
- Université de Lorraine, CHRU-Nancy, Stroke Unit, CIC-P 1433, INSERM U1116, France (M.D., G.M., S.R.)
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de Havenon A, Anadani M, Stulberg E, Rost N, Prabhakaran S, Sheth KN. Hispanic Ethnicity and Risk of Incident Cognitive Impairment in Relation to Systolic Blood Pressure. Hypertension 2021; 78:1665-1666. [PMID: 34365813 PMCID: PMC8516701 DOI: 10.1161/hypertensionaha.121.17599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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de Havenon A, Sheth KN, Johnston KC, Anadani M, Yaghi S, Tirschwell D, Ney J. Effect of Adjusting for Baseline Stroke Severity in the National Inpatient Sample. Stroke 2021; 52:e739-e741. [PMID: 34455821 PMCID: PMC8545762 DOI: 10.1161/strokeaha.121.035112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
| | | | | | | | | | | | - John Ney
- Departments of Neurology, Boston University
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Marnat G, Sibon I, Bourcier R, Anadani M, Gariel F, Labreuche J, Kyheng M, Mazighi M, Dargazanli C, Piotin M, Consoli A, Blanc R, Anxionnat R, Audibert G, Richard S, Lapergue B, Gory B. Thrombolysis Improves Reperfusion and the Clinical Outcome in Tandem Occlusion Stroke Related to Cervical Dissection: TITAN and ETIS Pooled Analysis. J Stroke 2021; 23:411-419. [PMID: 34649385 PMCID: PMC8521253 DOI: 10.5853/jos.2020.04889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Despite the widespread adoption of mechanical thrombectomy (MT) for the treatment of large vessel occlusion stroke (LVOS) in the anterior circulation, the optimal strategy for the treatment tandem occlusion related to cervical internal carotid artery (ICA) dissection is still debated. This individual patient pooled analysis investigated the safety and efficacy of prior intravenous thrombolysis (IVT) in anterior circulation tandem occlusion related to cervical ICA dissection treated with MT.
Methods We performed a retrospective analysis of two merged prospective multicenter international real-world observational registries: Endovascular Treatment in Ischemic Stroke (ETIS) and Thrombectomy In TANdem occlusions (TITAN) registries. Data from MT performed in the treatment of tandem LVOS related to cervical ICA dissection between January 2012 and December 2019 at 24 comprehensive stroke centers were analyzed. The primary endpoint was a favorable outcome defined as 90-day modified Rankin Scale (mRS) score of 0–2.
Results The study included 144 patients with tandem occlusion LVOS due to cervical ICA dissection, of whom 94 (65.3%) received IVT before MT. Prior IVT was significantly associated with a better clinical outcome considering the mRS shift analysis (common odds ratio, 2.59; 95% confidence interval [CI], 1.35 to 4.93; P=0.004 for a 1-point improvement) and excellent outcome (90-day mRS 0–1) (adjusted odds ratio [aOR], 4.23; 95% CI, 1.60 to 11.18). IVT was also associated with a higher rate of intracranial successful reperfusion (83.0% vs. 64.0%; aOR, 2.70; 95% CI, 1.21 to 6.03) and a lower rate of symptomatic intracranial hemorrhage (4.3% vs. 14.8%; aOR, 0.21; 95% CI, 0.05 to 0.80).
Conclusions Prior IVT before MT for the treatment of tandem occlusion related to cervical ICA dissection was safe and associated with an improved 90-day functional outcome.
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Affiliation(s)
- Gaultier Marnat
- Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Igor Sibon
- Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Mohammad Anadani
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Florent Gariel
- Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | | | - Maeva Kyheng
- Department of Biostatistics, University of Lille, Lille, France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Cyril Dargazanli
- Department of Neuroradiology, CHRU Gui-de-Chauliac, Montpellier, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Arturo Consoli
- Department of Neuroradiology, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - René Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, CHRU-Nancy, Nancy, France.,Université de Lorraine, IADI, INSERM U1254, Nancy, France
| | - Gérard Audibert
- Department of Anesthesiology and Intensive Care, University of Lorraine, University Hospital of Nancy, Nancy, France
| | - Sébastien Richard
- Stroke Unit, Department of Neurology, University of Lorraine, University Hospital of Nancy, and INSERM U1116, Nancy, France
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, CHRU-Nancy, Nancy, France.,Université de Lorraine, IADI, INSERM U1254, Nancy, France
| | -
- Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
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de Havenon A, Anadani M, Prabhakaran S, Wong KH, Yaghi S, Rost N. Increased Blood Pressure Variability and the Risk of Probable Dementia or Mild Cognitive Impairment: A Post Hoc Analysis of the SPRINT MIND Trial. J Am Heart Assoc 2021; 10:e022206. [PMID: 34533059 PMCID: PMC8649507 DOI: 10.1161/jaha.121.022206] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Increased systolic blood pressure variability (BPV) is associated with stroke, cardiovascular disease, and dementia and mild cognitive impairment. However, prior studies assessing the relationship between BPV and dementia or mild cognitive impairment had infrequent measurement of blood pressure or suboptimal blood pressure control. Methods and Results We performed a post hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) MIND (Memory and Cognition in Decreased Hypertension) trial. The primary outcome was probable dementia during follow‐up. We defined our exposure period, during which blood pressures were collected, as the first 600 days of the trial, and outcomes were ascertained during the subsequent follow‐up. BPV was measured as tertiles of systolic blood pressure standard deviation. We fit Cox proportional hazards models to our outcome. We included 8379 patients. The mean follow‐up was 3.2±1.4 years, during which 316 (3.8%) patients developed dementia. The mean number of blood pressure measurements was 7.8, and in the tertiles of BPV, the SD was 6.3±1.6, 10.3±1.1, and 16.3±3.6 mm Hg, respectively. The rate of dementia was 2.4%, 3.6%, and 5.4% by ascending tertile, respectively (P<0.001). In the Cox models, compared with the lowest tertile of BPV, the highest tertile of BPV increased the risk of dementia in both unadjusted (hazard ratio [HR], 2.36; 95% CI, 1.77–3.15) and adjusted (HR, 1.69; 95% CI, 1.25–2.28) models. Conclusions In a post hoc analysis of the SPRINT MIND trial, we found that higher BPV was associated with the development of probable dementia despite excellent blood pressure control. Additional research is needed to understand how to reduce BPV and if its reduction lowers the risk of cognitive impairment and dementia.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology University of Utah Salt Lake City UT
| | | | | | - Ka-Ho Wong
- Department of Neurology University of Utah Salt Lake City UT
| | - Shadi Yaghi
- Department of Neurology New York University New York NY
| | - Natalia Rost
- Department of Neurology Harvard University Boston MA
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Anadani M, Marnat G, Consoli A, Papanagiotou P, Nogueira RG, Siddiqui A, Ribo M, Spiotta AM, Bourcier R, Kyheng M, Labreuche J, de Havenon A, Sibon I, Dargazanli C, Arquizan C, Cognard C, Olivot JM, Anxionnat R, Audibert G, Mazighi M, Blanc R, Lapergue B, Richard S, Gory B. Endovascular Therapy of Anterior Circulation Tandem Occlusions: Pooled Analysis From the TITAN and ETIS Registries. Stroke 2021; 52:3097-3105. [PMID: 34372671 DOI: 10.1161/strokeaha.120.033032] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular therapy for tandem occlusion strokes of the anterior circulation is an effective and safe treatment. The best treatment approach for the cervical internal carotid artery (ICA) lesion is still unknown. In this study, we aimed to compare the functional and safety outcomes between different treatment approaches for the cervical ICA lesion during endovascular therapy for acute ischemic strokes due to tandem occlusion in current clinical practice. METHODS Individual patients' data were pooled from the French prospective multicenter observational ETIS (Endovascular Treatment in Ischemic Stroke) and the international TITAN (Thrombectomy in Tandem Lesions) registries. TITAN enrolled patients from January 2012 to September 2016, and ETIS from January 2013 to July 2019. Patients with acute ischemic stroke due to anterior circulation tandem occlusion who were treated with endovascular therapy were included. Patients were divided based on the cervical ICA lesion treatment into stent and no-stent groups. Outcomes were compared between the two treatment groups using propensity score methods. RESULTS A total of 603 patients were included, of whom 341 were treated with acute cervical ICA stenting. In unadjusted analysis, the stent group had higher rate of favorable outcome (90-day modified Rankin Scale score, 0-2; 57% versus 45%) and excellent outcome (90-day modified Rankin Scale score, 0-1; 40% versus 27%) compared with the no-stent group. In inverse probability of treatment weighting propensity score-adjusted analyses, stent group had higher odds of favorable outcome (adjusted odds ratio, 1.09 [95% CI, 1.01-1.19]; P=0.036) and successful reperfusion (modified Thrombolysis in Cerebral Ischemia score, 2b-3; adjusted odds ratio, 1.19 [95% CI, 1.11-1.27]; P<0.001). However, stent group had higher odds of any intracerebral hemorrhage (adjusted odds ratio, 1.10 [95%, 1.02-1.19]; P=0.017) but not higher rate of symptomatic intracerebral hemorrhage or parenchymal hemorrhage type 2. Subgroup analysis demonstrated heterogeneity according to the lesion type (atherosclerosis versus dissection; P for heterogeneity, 0.01), and the benefit from acute carotid stenting was only observed for patients with atherosclerosis. CONCLUSIONS Patients treated with acute cervical ICA stenting for tandem occlusion strokes had higher odds of 90-day favorable outcome, despite higher odds of intracerebral hemorrhage; however, most of the intracerebral hemorrhages were asymptomatic.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurology, Washington University School of Medicine, St. Louis (M.A., A.d.H.).,Department of Neurosurgery, Medical University of South Carolina, Charleston (A.M.S., M.A.)
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, France. (G.M.)
| | - Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France. (A.C.)
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (P.P.)
| | - Raul G Nogueira
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta (R.G.N.)
| | - Adnan Siddiqui
- Department of Neurosurgery, State University of New York, Buffalo (A.S.)
| | - Marc Ribo
- Department of Neurology, Hospital Vall D'Hebron, Barcelona, Spain (M.R.)
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston (A.M.S., M.A.)
| | - Romain Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, INSERM 1087, CNRS, Université de Nantes, France (R.B.)
| | - Maeva Kyheng
- University Lille, CHU Lille, EA 2694, Santé Publique: épidémiologie et Qualité des Soins, France (M.K., J.L.)
| | - Julien Labreuche
- University Lille, CHU Lille, EA 2694, Santé Publique: épidémiologie et Qualité des Soins, France (M.K., J.L.)
| | - Adam de Havenon
- Department of Neurology, Washington University School of Medicine, St. Louis (M.A., A.d.H.)
| | - Igor Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, France. (I.S.)
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France. (C.D.)
| | - Caroline Arquizan
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France. (C.A.)
| | - Christophe Cognard
- Department of Neuroradiology, University Hospital of Toulouse, France. (C.C.)
| | - Jean-Marc Olivot
- Department of Stroke Unit, Department of Neurology, University Hospital of Toulouse, France. (J.-M.O.)
| | - René Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, France. (R.A., B.G.).,IADI, INSERM U1254, Université de Lorraine, Nancy, France (R.A., B.G.)
| | - Gérard Audibert
- Department of Anesthesiology and Surgical Intensive Care, Université de Lorraine, CHRU-Nancy, France. (G.A.)
| | - Mikaël Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, University of Paris, INSERM U1148, France (M.M., R.B.)
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, University of Paris, INSERM U1148, France (M.M., R.B.)
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France. (B.L.)
| | - Sébastien Richard
- Stroke Unit, Department of Neurology, Université de Lorraine, CHRU-Nancy, France. (S.R.).,INSERM U1116, CHRU-Nancy, France. (S.R.)
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, France. (R.A., B.G.).,IADI, INSERM U1254, Université de Lorraine, Nancy, France (R.A., B.G.)
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Anadani M, Finitsis S, Clarençon F, Richard S, Marnat G, Bourcier R, Sibon I, Dargazanli C, Arquizan C, Blanc R, Lapergue B, Consoli A, Eugene F, Vannier S, Spelle L, Denier C, Boulanger M, Gauberti M, Liebeskind DS, de Havenon A, Saleme S, Macian F, Rosso C, Naggara O, Turc G, Ozkul-Wermester O, Papagiannaki C, Viguier A, Cognard C, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Maier B, Gory B. Collateral status reperfusion and outcomes after endovascular therapy: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) Registry. J Neurointerv Surg 2021; 14:551-557. [PMID: 34140288 DOI: 10.1136/neurintsurg-2021-017553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/31/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Studies have suggested that collateral status modifies the effect of successful reperfusion on functional outcome after endovascular therapy (EVT). We aimed to assess the association between collateral status and EVT outcomes and to investigate whether collateral status modified the effect of successful reperfusion on EVT outcomes. METHODS We used data from the ongoing, prospective, multicenter Endovascular Treatment in Ischemic Stroke (ETIS) Registry. Collaterals were graded according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) guidelines. Patients were divided into two groups based on angiographic collateral status: poor (grade 0-2) versus good (grade 3-4) collaterals. RESULTS Among 2020 patients included in the study, 959 (47%) had good collaterals. Good collaterals were associated with favorable outcome (90-day modified Rankin Scale (mRS) 0-2) (OR 1.5, 95% CI 1.19 to 1.88). Probability of good outcome decreased with increased time from onset to reperfusion in both good and poor collateral groups. Successful reperfusion was associated with higher odds of favorable outcome in good collaterals (OR 6.01, 95% CI 3.27 to 11.04) and poor collaterals (OR 5.65, 95% CI 3.32 to 9.63) with no significant interaction. Similarly, successful reperfusion was associated with higher odds of excellent outcome (90-day mRS 0-1) and lower odds of mortality in both groups with no significant interaction. The benefit of successful reperfusion decreased with time from onset in both groups, but the curve was steeper in the poor collateral group. CONCLUSIONS Collateral status predicted functional outcome after EVT. However, collateral status on the pretreatment angiogram did not decrease the clinical benefit of successful reperfusion.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA .,Neurology, Neurosurgery, Medical University of South Carolina,College of Medicine, Charleston, South Carolina, USA
| | - Stephanos Finitsis
- Neuroradiolology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Frédéric Clarençon
- Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.,Neuroradiology, Sorbonne Université, Paris, Paris, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Romain Bourcier
- Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Igor Sibon
- Neuroradiology, CHU de Bordeaux, Bordeaux, France
| | - Cyril Dargazanli
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | | | - Raphael Blanc
- Interventional Neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
| | | | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France.,Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | | | - Laurent Spelle
- Department of Neuroradiolology, CHU Kremlin Bicêtre, Paris, France
| | | | | | | | - David S Liebeskind
- Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | | | | | - Charlotte Rosso
- Department of Neurology, CHU Pitié-Salpétrière, Paris, France
| | | | - Guillaume Turc
- Neurology, Stroke Unit, Hôpital Saint Anne, Paris, France
| | | | | | - Alain Viguier
- Department of Neurology, CHU Toulouse, Toulouse, France
| | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Anthony Le Bras
- Department of Radiology, CH Bretagne Atlantique, Vannes, France.,Department of Neurology, CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
| | - Sarah Evain
- Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
| | - Valerie Wolff
- Stroke unit, Strasbourg University Hospitals, Strasbourg, France
| | - Raoul Pop
- Department of Neuroradiolology, CHU Strasbourg, Strasbourg, France
| | - Serge Timsit
- Department of Neurology, CHU Brest, Brest, France
| | | | | | - Louis Veunac
- Department of Neuroradiolology, CH Côte Basque, Bayonne, France
| | - Benjamin Maier
- Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
| | - Benjamin Gory
- Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
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Muszynski P, Anadani M, Richard S, Marnat G, Bourcier R, Sibon I, Dargazanli C, Arquizan C, Maïer B, Blanc R, Lapergue B, Consoli A, Eugene F, Vannier S, Spelle L, Denier C, Boulanger M, Gauberti M, Saleme S, Macian F, Clarençon F, Rosso C, Naggara O, Turc G, Ozkul-Wermester O, Papagiannaki C, Viguier A, Cognard C, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Gory B, Finitsis SN. Endovascular reperfusion of M2 occlusions in acute ischemic stroke reduced disability and mortality: ETIS Registry results. J Neurointerv Surg 2021; 14:neurintsurg-2021-017380. [PMID: 34045317 DOI: 10.1136/neurintsurg-2021-017380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/13/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The predictors of successful reperfusion and the effect of reperfusion after endovascular treatment (EVT) for M2 occlusions have not been well studied. We aimed to identify predictors of successful reperfusion and the effect of reperfusion on outcomes of EVT for M2 occlusions in current practice. METHODS Patients with acute ischemic stroke due to isolated M2 occlusions who were enrolled in the prospective multicenter Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France between January 2015 and March 2020 were included. The primary outcome was a favorable outcome, defined as modified Rankin Scale (mRS) score of 0-2 at 90 days. Successful reperfusion was defined as an improvement of ≥1 points in the modified Thrombolysis In Cerebral Infarction score between the first and the last intracranial angiogram. RESULTS A total of 458 patients were included (median National Institutes of Health Stroke Scale (NIHSS) score 14; 61.4% received prior intravenous thrombolysis). Compared with the non-reperfused patients, reperfused patients had an increased rate of excellent outcome (OR 2.3, 95% CI 0.98 to 5.36; p=0.053), favorable outcome (OR 2.79, 95% CI 1.31 to 5.93; p=0.007), and reduced 90-day mortality (OR 0.39, 95% CI 0.19 to 0.79; p<0.01). Admission NIHSS score was the only predictor of successful reperfusion. First-line strategy was not a predictor of successful reperfusion or favorable outcome, but the use of a stent retriever, alone or with an aspiration catheter, was associated with higher rates of procedural complications and 90-day mortality. CONCLUSIONS Successful reperfusion of M2 occlusions reduced disability and mortality. However, safety is a concern, especially if the procedure failed.
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Affiliation(s)
- Patricio Muszynski
- Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Mohammad Anadani
- Washington University School of Medicine in St Louis, St Louis, Missouri, USA.,Neurology, Medical University of South Carolina - College of Medicine, Charleston, South Carolina, USA
| | - Sébastien Richard
- Neurology, Stroke Unit, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, CHU Bordeaux, Bordeaux, France
| | - Romain Bourcier
- Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Igor Sibon
- Neurology, Stroke Unit, CHU Bordeaux, Bordeaux, France
| | | | | | - Benjamin Maïer
- Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Raphaël Blanc
- Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | | | - Arturo Consoli
- Diagnostic and Therapeutic Neuroradiology, Foch Hospital, Suresnes, France
| | | | | | - Laurent Spelle
- Interventional Neuroradiolology, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | | | | | | | - Frédéric Clarençon
- Sorbonne Université, Paris, France.,Neuroradiology, CHU Pitié-Salpêtrière, Paris, France
| | - Charlotte Rosso
- Neurology, Stroke Unit, CHU Pitié-Salpêtrière, Paris, France
| | | | - Guillaume Turc
- Neurology, Stroke Unit, Hôpital Saint Anne, Paris, France
| | | | | | - Alain Viguier
- Neurology, Stroke Unit, CHU Toulouse, Toulouse, France
| | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Toulouse, France
| | | | - Sarah Evain
- Neurology, Stroke Unit, CH Bretagne Atlantique, Vannes, France
| | | | - Raoul Pop
- Interventional Neuroradiolology, CHU Strasbourg, Strasbourg, France
| | - Serge Timsit
- Neurology, Stroke Unit, CHU Brest, Brest, France
| | | | | | | | - Benjamin Gory
- Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France .,IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - Stephanos Nikolaos Finitsis
- Neuroradiolology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece.,Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
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Affiliation(s)
- Mohammad Anadani
- Department of Neurology, Washington University in St. Louis School of Medicine, MO (M.A.)
| | | | - Eva Mistry
- Vanderbilt University Medical Center, TN (E.M.)
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (C.S.A.)
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de Havenon A, Ney JP, Callaghan B, Hohmann S, Shippey E, Yaghi S, Anadani M, Majersik JJ. Characteristics and Outcomes Among US Patients Hospitalized for Ischemic Stroke Before vs During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2110314. [PMID: 33999162 PMCID: PMC8129817 DOI: 10.1001/jamanetworkopen.2021.10314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE After the emergence of COVID-19, studies reported a decrease in hospitalizations of patients with ischemic stroke (IS), but there are little to no data regarding hospitalizations for the remainder of 2020, including outcome data from a large cohort of patients with IS and comorbid COVID-19. OBJECTIVE To assess hospital discharge rates, demographic factors, and outcomes of hospitalization associated with the COVID-19 pandemic among US patients with IS before vs during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the Vizient Clinical Data Base on 324 013 patients with IS at 478 nonfederal hospitals in 43 US states between January 1, 2019, and December 31, 2020. Patients were eligible if they were admitted to the hospital on a nonelective basis and were not receiving hospice care at the time of admission. A total of 41 166 discharged between January and March 2020 were excluded from the analysis because they had unreliable data on COVID-19 status, leaving 282 847 patients for the study. EXPOSURE Ischemic stroke and laboratory-confirmed COVID-19. MAIN OUTCOMES AND MEASURES Monthly counts of discharges among patients with IS in 2020. Demographic characteristics and outcomes, including in-hospital death, among patients with IS who were discharged in 2019 (control group) were compared with those of patients with IS with or without comorbid COVID-19 (COVID-19 and non-COVID-19 groups, respectively) who were discharged between April and December 2020. RESULTS Of the 282 847 patients included in the study, 165 912 (50.7% male; 63.4% White; 26.3% aged ≥80 years) were allocated to the control group; 111 418 of 116 935 patients (95.3%; 51.9% male; 62.8% White; 24.6% aged ≥80 years) were allocated to the non-COVID-19 group and 5517 of 116 935 patients (4.7%; 58.0% male; 42.5% White; 21.3% aged ≥80 years) to the COVID-19 group. A mean (SD) of 13 846 (553) discharges per month among patients with IS was reported in 2019. Discharges began decreasing in February 2020, reaching a low of 10 846 patients in April 2020 before returning to a prepandemic level of 13 639 patients by July 2020. A mean (SD) of 13 492 (554) discharges per month was recorded for the remainder of 2020. Black and Hispanic patients accounted for 21.4% and 7.0% of IS discharges in 2019, respectively, but accounted for 27.5% and 16.0% of those discharged with IS and comorbid COVID-19 in 2020. Compared with patients in the control and non-COVID-19 groups, those in the COVID-19 group were less likely to smoke (16.0% vs 17.2% vs 6.4%, respectively) and to have hypertension (73.0% vs 73.1% vs 68.2%) or dyslipidemia (61.2% vs 63.2% vs 56.6%) but were more likely to have diabetes (39.8% vs 40.5% vs 53.0%), obesity (16.2% vs 18.4% vs 24.5%), acute coronary syndrome (8.0% vs 9.2% vs 15.8%), or pulmonary embolus (1.9% vs 2.4% vs 6.8%) and to require intubation (11.3% vs 12.3% vs 37.6%). After adjusting for baseline factors, patients with IS and COVID-19 were more likely to die in the hospital than were patients with IS in 2019 (adjusted odds ratio, 5.17; 95% CI, 4.83-5.53; National Institutes of Health Stroke Scale adjusted odds ratio, 3.57; 95% CI, 3.15-4.05). CONCLUSIONS AND RELEVANCE In this cohort study, after the emergence of COVID-19, hospital discharges of patients with IS decreased in the US but returned to prepandemic levels by July 2020. Among patients with IS between April and December 2020, comorbid COVID-19 was relatively common, particularly among Black and Hispanic populations, and morbidity was high.
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Affiliation(s)
| | - John P. Ney
- Department of Neurology, Boston University, Boston, Massachusetts
| | | | | | | | - Shadi Yaghi
- Department of Neurology, New York University, New York
| | - Mohammad Anadani
- Department of Neurology, Washington University in St Louis, St Louis, Missouri
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