Clinical and radiological outcomes of acute ischemic stroke patients without angiographic occlusion on digital subtraction angiogram. A pooled analysis of case series

2008 ◽  
Vol 50 (11) ◽  
pp. 963-968 ◽  
Author(s):  
Qaisar A. Shah ◽  
Muhammad Zeeshan Memon ◽  
Gabriela Vazquez ◽  
M. Fareed K. Suri ◽  
Haitham M. Hussein ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Case Series ◽  
Pooled Analysis ◽  
Digital Subtraction ◽  
Stroke Patients ◽  
Digital Subtraction Angiogram

Abstract TP13: Procedural Time (Groin Puncture to Recanalization) Significantly Predicts Outcomes in Endovascular Treatment: A Pooled Analysis of SWIFT, STAR and SWIFT PRIME Trials

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Jeffrey L Saver ◽  
Mayank Goyal ◽  
David S Liebeskind ◽  
Reza Jahan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Pooled Analysis ◽  
Favorable Outcome ◽  
Stroke Patients ◽  
Nihss Score ◽  
Post Procedure ◽  
Procedural Time

Background: Recent single center studies have suggested that “procedural time” independent of “time to procedure” can affect outcomes of acute ischemic stroke patients undergoing endovascular treatment (ET). We performed a pooled analysis from three ET trials to determine the effect of procedural time on angiographic and clinical outcomes. Objective: To determine the relationship between procedural time and clinical outcomes among acute ischemic stroke patients undergoing successful recanalization with ET. Methods: We analyzed data from SWIFT, STAR and SWIFT PRIME trials. Baseline demographic and clinical characteristics, NIHSS score on admission, intracranial hemorrhage rates and mRS at 3 months post procedure were analyzed. TICI scale was used to grade post procedure angiographic recanalization. Procedural time was defined by the time interval between groin puncture and recanalization. We estimated the procedural time after which favorable clinical outcome was unlikely even after recanalization (futile) after age and NIHSS score adjustment. Results: We analyzed 301 patients who underwent ET and had near complete or complete recanalization (TICI 2b or 3). The procedural time (±SD) was significantly shorter in patients who achieved a favorable outcome (mRS 0-2) compared with those who did not achieve favorable outcome (44±25 vs 51±33 minutes, p=0.04). Table 1. In the multivariate analysis (including all baseline characteristics with a p value <0.05 as independent variables), shorter procedural time was a significant predictor of lower odds of unfavorable outcome (OR 0.49, 95% CI 0.28, 0.85, p=0.012). The rates of favorable outcomes were significantly higher when the procedural time was <60 minutes compared with ≥60 minutes (62% vs 45%, p=0.020). Conclusion: Procedural time in patients undergoing mechanical thrombectomy for acute ischemic stroke is an important determinant of favorable outcomes in those with near complete or complete recanalization.

scholarly journals Intravenous thrombolysis in acute ischemic stroke patients with negative CT perfusion: a case series

2014 ◽  
Vol 3 (7) ◽  
pp. 204798161454321
Author(s):  
Ratnesh Mehra ◽  
Chiu Yuen To ◽  
Omar Qahwash ◽  
Boyd Richards ◽  
Richard D Fessler
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion ◽  
Case Series ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Tissue Type ◽  
Stroke Patients ◽  
Radiographic Findings ◽  
Type Plasminogen Activator

Background Computed tomography perfusion (CTP) is a commonly used modality of neurophysiologic imaging to aid the selection of acute ischemic stroke patients for neuroendovascular intervention by identifying the presence of penumbra versus infarcted brain tissue. However many patients present with evidence of cerebral ischemia with normal CTP, and in that case, should intravenous thrombolytics be given? Purpose To demonstrate if tissue-type plasminogen activator (tPA)-eligible stroke patients without perfusion defects demonstrated on CTP would benefit from administration of intravenous thrombolytics. Material and Methods We retrospectively identified patients presenting with acute ischemic symptoms who received intravenous tPA (IV-tPA) from January to June 2012 without a perfusion defect on CTP. Clinical and radiographic findings including the NIHSS at presentation, 24 h, and at discharge, symptomatic and asymptomatic hemorrhagic transformation, and the modified Rankin score at 30 days were collected. A reduction of NIHSS of greater than 4 points or resolution of symptoms was considered significant. Results Seventeen patients were identified with a mean NIHSS of 8.2 prior to administration of intravenous thrombolytics, 3.5 after 24 h, and 2.5 at discharge. Among them, 13 patients had significant improvement of NIHSS with a mean reduction of 6.15 points at 24 h. One patient initially improved but had delayed hemorrhagic transformation and died. Two patients had improvement in NIHSS but were not significant and two patients had increased in NIHSS at 24 h, although one eventually improved at discharge. There was no asymptomatic hemorrhagic transformation. Mean mRS at 3 months is 1.76. Conclusion The failure to identify a perfusion deficit by CTP should not be used as a contraindication for intravenous thrombolytics. Criteria for administration of intravenous thrombolytics should still be based on time from symptom onset as previously published by NINDS.

Abstract 22: Late Functional Improvement in Acute Ischemic Stroke Patients: Pooled Analysis of Three Multicenter Clinical Trials

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Sher Afghan ◽  
Ahmed A Malik ◽  
Omar Saeed ◽  
Nazli A Janjua
Keyword(s):  
Clinical Trials ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Pooled Analysis ◽  
Functional Improvement ◽  
Stroke Patients ◽  
Multicenter Clinical Trials

Abstract 132: Acute Kidney Injury in Acute Ischemic Stroke Patients: Pooled Analysis of ALIAS I and II and IMS III Trials

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Hunain Aslam ◽  
Werdah Zafar ◽  
Wei Huang ◽  
Iryna Lobanova ◽  
Farhan Siddiq ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Stroke ◽  
Serum Creatinine ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Kidney Injury ◽  
Pooled Analysis ◽  
Stroke Patients ◽  
Volume Depletion ◽  
Ct Angiogram

Background: Acute ischemic stroke patients are at risk of acute kidney injury (AKI) due to volume depletion, contrast exposure and pre-existing co-morbid diseases. We determined the incidence and identified predictors associated with AKI in acute ischemic stroke patients. Methods: Data from the Albumin in Acute Ischemic Stroke trial (ALIAS) - I and II and Interventional Management of Stroke (IMS) - III clinical trials were pooled and analyzed in which acute ischemic stroke patients were randomized into either IV albumin, placebo, endovascular or IV thrombolytic treatment groups. Serum creatinine levels from baseline and within day 5 or discharge along with the demographic and comorbidity information was collected. AKI classification was used to ascertain severity of renal dysfunction and based on increase in serum creatinine levels from baseline, stage 1 ≥ 0.3 mg/dl (≥ 26.4umol/L) or (>1.5 to 2-fold), stage 2 (>2 to 3-fold) and stage 3 (>3-fold) were identified. We analyzed the relationship between AKI and mortality at 3 months post randomization. Results: A total of 1931 acute ischemic stroke patients (mean age 66± 13 (SD) years; 1024 were men) were analyzed. Any increase in serum creatinine was seen in 691 (35.8%, 95% CI 30%-40%) and AKI was seen in 68 (3.5%, 95% CI 3%-4%) of 1931 patients. Severity of AKI was grade I, II, III in 2.1 %, 0.4%, and 0.1% patients, respectively. The risk of AKI was not higher between those who either underwent CT angiography (2% compared with 4.2%, RR 0.5, 95% CI 0.3-0.8, p=0.02) or endovascular treatment (1.9% compared with 4.1%, RR 0.4, 95% CI 0.2-0.8, p=0.0096). Patients with preexisting hypertension (4.3% compared to 1.5%, RR 2.8, 95% CI 1.3-5.7, p=0.006) and preexisting renal disease (9.1% compared to 3.0%, RR 3.1, 95% CI 1.8-5.3, p=0.006) had higher risk of AKI. Mortality at 3 months was significantly higher among patients with AKI (27% compared with 15%, RR 1.8, 95% CI 1.2-2.7, p=0.0083). Conclusions: The incidence of AKI in acute ischemic stroke patients was low and was not higher in patients who underwent CT angiogram or those who received endovascular treatment. Occurrence of AKI increased mortality at 3 months among acute ischemic stroke patients.

Readministration of intravenous alteplase in acute ischemic stroke patients: case series and systematic review

2015 ◽  
Vol 33 (2) ◽  
pp. 307.e1-307.e4 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Ahmed A. Malik ◽  
Melissa Freese ◽  
Michelle J. Thompson ◽  
Asif A. Khan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Case Series ◽  
Stroke Patients ◽  
Intravenous Alteplase

scholarly journals Cortical Venous Changes on Susceptibility-Weighted Imaging Predict the Cerebral Collateral Circulation as Confirmed by Digital Subtraction Angiography

2021 ◽  
Vol 12 ◽  
Author(s):  
Yun-Hao Zhan ◽  
Yang-Kun Chen ◽  
Run-Xiong Li ◽  
Gen-Pei Luo ◽  
Zhi-Qiang Wu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Collateral Circulation ◽  
Artery Occlusion ◽  
Susceptibility Weighted Imaging ◽  
Large Artery ◽  
Digital Subtraction ◽  
Stroke Patients ◽  
Severe Stenosis ◽  
Anterior Circulation

Objective: Asymmetrical cortical vein sign (ACVS) shown on susceptibility-weighted imaging (SWI) can reflect regional hypoperfusion. We investigated if ACVS could predict the cerebral collateral circulation (CC) as assessed by digital subtraction angiography (DSA) in acute ischemic stroke patients with ipsilateral severe stenosis/occlusion of the anterior circulation.Methods: Clinical data and imaging data of 62 acute ischemic stroke patients with ipsilateral severe stenosis or occlusion of the anterior circulation confirmed by DSA were collected retrospectively. Participants underwent magnetic resonance imaging, including an SWI sequence. ACVS was defined as more and/or larger venous signals in the cerebral cortex of one side of SWI than that in the contralateral side. ACVS was measured using the Alberta Stroke Program Early Computed Tomography score based on SWI. The grading of the cerebral CC was judged using DSA.Results: Of the 62 patients, 30 patients (48.4%) had moderate-to-severe ACVS. According to DSA assessment, 19 patients (30.6%) had a good CC (grade 3–4), and 43 (69.4%) patients had a poor-to-moderate CC (grade 0–2). Among the 30 patients with moderate-to-severe ACVS, only three (10%) patients had a good CC, and 27 (90%) patients had a poor-to-moderate CC; among the 32 patients with none or mild ACVS, 16 (50%) of them had a good CC, and the other 50% had a moderate-to-severe CC. We constructed two logistic regression models with ACVS grading and none or mild ACVS entered into the models, respectively, together with age and large-artery occlusion. In model 1, no ACVS (compared with severe ACVS; OR = 40.329, 95%CI = 2.817–577.422, P = 0.006), mild ACVS (compared with severe ACVS; OR = 17.186, 1.735–170.224, 0.015) and large-artery occlusion (OR = 45.645, 4.603–452.592, 0.001) correlated with a good CC. In model 2, none or mild ACVS (OR = 36.848, 95%CI = 5.516–246.171, P &lt; 0.001) was significantly associated with a good CC as judged by DSA, adjusted by age and large-artery occlusion.Conclusions: Cortical venous changes in SWI may be a useful indicator for the cerebral CC as confirmed by DSA.

Use of intravenous cangrelor and stenting in acute ischemic stroke interventions: a new single center analysis and pooled-analysis of current studies

2021 ◽  
pp. 159101992110144
Author(s):  
Alexandra R Paul ◽  
Pouya Entezami ◽  
Devin Holden ◽  
Nicholas Field ◽  
John Dalfino ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Case Series ◽  
Platelet Inhibition ◽  
Pooled Analysis ◽  
Thromboembolic Complication ◽  
Symptomatic Intracranial Hemorrhage ◽  
Neurointerventional Procedures ◽  
The Ideal

Introduction Emergent stenting of both extra- and intracranial occlusions during acute ischemic stroke procedures is complicated by the need for immediate platelet inhibition to prevent thromboembolic complications. IV cangrelor is a relatively new antiplatelet that was initially approved for coronary interventions. Five prior case series have been published evaluating the results of IV cangrelor in neurointerventional procedures. We sought to combine the data from all prior studies and analyze only ischemic stroke interventions. Methods A prospectively maintained database was reviewed to identify all cases of IV cangrelor administration during acute ischemic stroke intervention. Nine additional patients were identified who have not been previously published. In addition, a literature search was performed to identify five prior publications of cangrelor in neurointervention. The data from these was combined with our institution in a pooled-analysis. Results Overall, 129 patients who received IV cangrelor during an acute ischemic stroke intervention were identified. The asymptomatic intracranial hemorrhage rate was 12.6%(11/87). The symptomatic intracranial hemorrhage rate was 6.2% (8/129). The rate of retroperitoneal hematoma and gastrointestinal bleeding were also low (1.5% and 0.8%, 2/129 and 1/129). There was one case of intraprocedural thromboembolic complication (0.8%) and no cases of intraprocedural in-stent thrombosis(0%). Conclusions IV cangrelor during acute ischemic stroke intervention appears to be safe, with a symptomatic intracranial hemorrhage rate of 6.2%. More research is needed to determine the ideal dosing regimen.

scholarly journals Alternative Transcarotid Approach for Endovascular Treatment of Acute Ischemic Stroke Patients: A Case Series

2019 ◽  
Vol 14 (2) ◽  
pp. 131-136 ◽  
Author(s):  
Hanna Styczen ◽  
Daniel Behme ◽  
Amelie Carolina Hesse ◽  
Marios Nikos Psychogios
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Case Series ◽  
Stroke Patients
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