scholarly journals Acute and Chronic Kidney Dysfunction and Outcome After Stroke Thrombectomy

2021 ◽  
Author(s):  
Simon Fandler-Höfler ◽  
Balazs Odler ◽  
Markus Kneihsl ◽  
Gerit Wünsch ◽  
Melanie Haidegger ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Mechanical Thrombectomy ◽  
Multivariable Analysis ◽  
Unfavorable Outcome ◽  
Large Vessel ◽  
Study Cohort ◽  
Large Vessel Occlusion ◽  
Kidney Dysfunction ◽  
Vessel Occlusion ◽  
The Impact

AbstractData on the impact of kidney dysfunction on outcome in patients with stroke due to large vessel occlusion are scarce. The few available studies are limited by only considering single kidney parameters measured at one time point. We thus investigated the influence of both chronic kidney disease (CKD) and acute kidney injury (AKI) on outcome after mechanical thrombectomy. We included consecutive patients with anterior circulation large vessel occlusion stroke receiving mechanical thrombectomy at our center over an 8-year period. We extracted clinical data from a prospective registry and investigated kidney serum parameters at admission, the following day and throughout hospital stay. CKD and AKI were defined according to established nephrological criteria. Unfavorable outcome was defined as scores of 3–6 on the modified Rankin Scale 3 months post-stroke. Among 465 patients, 31.8% had an impaired estimated glomerular filtration rate (eGFR) at admission (< 60 ml/min/1.73 m2). Impaired admission eGFR was related to unfavorable outcome in univariable analysis (p = 0.003), but not after multivariable adjustment (p = 0.96). Patients frequently met AKI criteria at admission (24.5%), which was associated with unfavorable outcome in a multivariable model (OR 3.03, 95% CI 1.73–5.30, p < 0.001). Moreover, patients who developed AKI during hospital stay also had a worse outcome (p = 0.002 in multivariable analysis). While CKD was not associated with 3-month outcome, we identified AKI either at admission or throughout the hospital stay as an independent predictor of unfavorable prognosis in this study cohort. This finding warrants further investigation of kidney–brain crosstalk in the setting of acute stroke.

scholarly journals Heart Failure Is Not Associated with a Poor Outcome after Mechanical Thrombectomy in Large Vessel Occlusion of Cerebral Arteries

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Marlena Schnieder ◽  
Anneki von Glasenapp ◽  
Amelie Hesse ◽  
Marios N. Psychogios ◽  
Mathias Bähr ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mechanical Thrombectomy ◽  
Left Ventricular ◽  
Large Vessel ◽  
Left Ventricular Ejection ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Significant Difference ◽  
Patients With Heart Failure ◽  
The Impact

The impact of heart failure on outcome in stroke patients is not fully understood. There is evidence for an increased mortality and morbidity, but it remains uncertain whether thrombectomy in patients with large vessel occlusion (LVO) in the anterior circulation is less effective in patients with heart failure compared to patients without. Retrospectively, we analyzed echocardiographic data of all patients in our stroke database, who underwent mechanical thrombectomy (n=668) for the presence of heart failure. Furthermore, we collected baseline characteristics and neurological and neuroradiological parameters. In the analysis, 373 of the 668 patients of our stroke database underwent echocardiography. Of these 373 patients, 90 patients (24%) suffered from heart failure with reduced left ventricular ejection fraction measured by echocardiography according to the current guidelines. After adjustment for age, the Alberta stroke program early CT score (ASPECTS), and time from symptom onset to recanalization, the analysis revealed that thrombectomy in patients with heart failure and LVO is not associated with less favorable outcome measured by the modified Rankin Scale after 90 days (3 (0-6) vs. 3 (1-5); p=0.380). Moreover, we could not find a significant difference in mortality compared to patients without heart failure (11.0% vs. 7.4%; p=0.313).

Abstract P11: Clinical Utility of Aspects in Late Window Stroke Thrombectomy Patients: Insights From Star

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Guilherme B Porto ◽  
Zachary Hubbard ◽  
Sami Al Kasab ◽  
Eyad Almallouhi ◽  
Robert Starke ◽  
...  
Keyword(s):  
Ct Scan ◽  
Symptom Onset ◽  
Mechanical Thrombectomy ◽  
Multivariable Analysis ◽  
Star Collaboration ◽  
Outcome Data ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy

Introduction: Recent trials have proven safety and efficacy of mechanical thrombectomy for patients presenting with emergent large vessel occlusion beyond 6 hours of symptom onset. While evidence supports using baseline CT scan to evaluate the candidacy for mechanical thrombectomy for patients presenting in the early window, late window trials have used advanced imaging such as CT and MR perfusion. We aim to assess outcomes of MT stratified by admission Alberta Stroke Program Early CT Score (ASPECTS). Methods: We used data from the prospectively maintained registries of 28 stroke centers in the Stroke Thrombectomy and Aneurysm (STAR) collaboration. Demographics, comorbidities, LVO site, ASPECTS, MT technique, radiographic and clinical outcome data were collected. Patients with M1 or ICA occlusion were included in these analyses. Multivariable analysis was performed using a generalized linear model with logit link to assess for variables associated with favorable outcomes. Results: 3356 patients in the STAR database were reviewed and 347 (10.3%) of those underwent MT in the late window (table). Median age was 69, 189 (54.5%) were female, and 181 (52.2%) were white. 295 patients ASPECTS ≥6. In this group, 200 (68.8%) had M1 occlusion, and the remaining had ICA occlusion. Aspiration thrombectomy was used in 139 (47.1%) of patients. Successful reperfusion was achieved (mTICI≥2b) in 264 (76.1%). sICH was observed in 15 (5.1%). Excellent functional outcome (mRS 0-2) was observed in 124 (42%) patients. ASPECTS score was independently associated with favorable outcomes (aOR 1.2, 95% CI 1.1-1.4, P=0.006). Conclusion: Excellent outcomes are observed in patients with good ASPECT score presenting in the late window irrespective of perfusion criteria. Admission CT scan could be used to triage patients presenting with emergent large vessel occlusion beyond 6 hours of symptom onset.

Risk Factors for Distal Clot Migration during Mechanical Thrombectomy of Anterior Circulation Large Vessel Occlusion

2020 ◽  
Vol 49 (2) ◽  
pp. 185-191 ◽  
Author(s):  
Mahmoud H. Mohammaden ◽  
Christopher J. Stapleton ◽  
Denise Brunozzi ◽  
Eman M. Khedr ◽  
Peter Theiss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Thrombectomy ◽  
Multivariable Analysis ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Intravenous Tissue Plasminogen Activator ◽  
Multivariable Analyses ◽  
Iv Tpa

Introduction: Distal clot migration (DCM) is a known complication of mechanical thrombectomy (MT), but neither risk factors for DCM nor ways of how it might affect clinical outcomes have been extensively studied to date. Methods: To identify risk factors for and outcomes in the setting of DCM, the records of all patients with acute ischemic stroke due to anterior circulation large vessel occlusion (LVO) treated with MT at a single center between May 2016 and June 2018 were retrospectively reviewed. Uni- and multivariable analyses were performed to evaluate predictors of DCM and good functional outcome (90-day modified Rankin Scale; mRS 0–2). Results: A total of 65 patients were included, DCM was identified in 22 patients (33.8%). Patients with DCM had significantly higher pre-procedural intravenous tissue plasminogen activator (IV-tPA) administration (81.8 vs. 53.5%, p = 0.03), stentrievers thrombectomy (95.5 vs. 62.8%, p = 0.006), and longer median puncture to recanalization time (44 [34–97] vs. 30 [20–56] min, p = 0.028) as compared to group with non-DCM. Also, they had lower rates of Thrombolysis in Cerebral Infarction (TICI) 2b/3 recanalization (p = 0.002), higher median National Institutes of Health Stroke Scale (NIHSS) scores at discharge (p = 0.01), and lower rates of 90-day mRS (0–2; 18.2 vs. 48.8%; p = 0.016). On subgroup analysis, patients with middle cerebral artery occlusions who underwent MT with stentrievers <40 mm in length had a higher risk of DCM (p = 0.026). On multivariable analysis, IV-tPA administration (OR; 5.019, 95% CI [1.319–19.102], p = 0.018) and stentrievers thrombectomy (OR; 10.031, 95% CI [1.090–92.344]; p = 0.04) remained significant predictors of DCM. Baseline NIHSS score (OR; 0.872, 95% CI [0.788–0.965], p = 0.008) and DCM (OR; 0.250, 95% CI [0.075–0.866], p = 0.03) were independent predictors of 90-day mRS 0–2. Conclusion: In patients undergoing MT for anterior circulation LVO, DCM is associated with lower rates of TICI 2b/3 recanalization and worse functional outcomes at 90 days. IV-tPA administration and MT with short stentrievers are independent predictors of DCM development.

scholarly journals Impact of onset-to-groin puncture time within three hours on functional outcomes in mechanical thrombectomy for acute large-vessel occlusion

2017 ◽  
Vol 24 (2) ◽  
pp. 162-167 ◽  
Author(s):  
Takahiro Ota ◽  
Yasuhiro Nishiyama ◽  
Satoshi Koizumi ◽  
Tomonari Saito ◽  
Masayuki Ueda ◽  
...  
Keyword(s):  
Scale Score ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Multivariable Logistic Regression Analysis ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
The Impact

Introduction Endovascular treatment for acute ischemic stroke with acute large-vessel occlusion (ALVO) has established benefits, and rapid treatment is vital for mechanical thrombectomy in ALVO. Time from onset of stroke to groin puncture (OTP) is a practical and useful clinical marker, and OTP should be shortened to obtain the maximum benefit of thrombectomy. Objective The aim of the present study was to assess the impact of early treatment of anterior circulation stroke within three hours after symptom onset and to evaluate the role of OTP in determining outcomes after endovascular therapy. Methods Consecutive patients with acute stroke due to major artery (internal carotid or middle cerebral arteries) occlusion who underwent endovascular recanalization between March 2014 and January 2017 were retrospectively evaluated. Patients were stratified by OTP into three categories: 0–≤3 h, >3–≤6 h, and >6 h. The primary outcome measure was a 90-day modified Rankin scale score of 0–2 (good outcome). Results Data were analyzed from 100 patients (mean age, 76.6 years; mean National Institutes of Health Stroke Scale score, 17). Groin puncture occurred within 0–≤3 h in 51 patients, >3–≤6 h in 28, and >6 h in 21. Median OTP in each group was 126 min (range, 57–168 min), 238 min (range, 186–360 min) and 728 min (range, 365–1492 min), respectively. On multivariable logistic regression analysis, category of OTP represented an independent predictor of patient outcome (adjusted odds ratio, 0.48; 95% confidence interval, 0.25–0.93; p = 0.029). Conclusions OTP is a prehospital and in-hospital workflow-based indicator. In this single-center study, OTP was found to independently affect functional outcomes after endovascular stroke treatment.

scholarly journals Blood pressure levels post mechanical thrombectomy and outcomes in non-recanalized large vessel occlusion patients

2018 ◽  
Vol 10 (10) ◽  
pp. 925-931 ◽  
Author(s):  
Nitin Goyal ◽  
Georgios Tsivgoulis ◽  
Abhi Pandhi ◽  
Kira Dillard ◽  
Diana Alsbrook ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Mechanical Thrombectomy ◽  
Brain Perfusion ◽  
Functional Independence ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Lower Maximum ◽  
Multivariable Analyses ◽  
The Impact

ObjectivePermissive hypertension may benefit patients with non-recanalized large vessel occlusion (nrLVO) post mechanical thrombectomy (MT) by maintaining brain perfusion. Data evaluating the impact of post-MT blood pressure (BP) levels on outcomes in nrLVO patients are scarce. We investigated the association of the post-MT BP course with safety and efficacy outcomes in nrLVO.MethodsHourly systolic BP (SBP) and diastolic BP (DBP) values were prospectively recorded for 24 hours following MT in consecutive nrLVO patients. Maximum, minimum, and mean BP levels were documented. Three-month functional independence (FI) was defined as modified Rankin Scale (mRS) scores of 0–2.ResultsA total of 88 nrLVO patients were evaluated post MT. Patients with FI had lower maximum SBP (160±19 mmHg vs 179±23 mmHg; P=0.001) and higher minimum SBP levels (119±12 mmHg vs 108±25 mmHg; P=0.008). Maximum SBP (183±20 mmHg vs 169±23 mmHg; P=0.008) and DBP levels (105±20 mmHg vs 89±18 mmHg; P=0.001) were higher in patients who died at 3 months while minimum SBP values were lower (102±28 mmHg vs 115±16 mmHg; P=0.007). On multivariable analyses, both maximum SBP (OR per 10 mmHg increase: 0.55, 95% CI 0.39 to 0.79; P=0.001) and minimum SBP (OR per 10 mmHg increase: 1.64, 95% CI 1.04 to 2.60; P=0.033) levels were independently associated with the odds of FI. Maximum DBP (OR per 10 mmHg increase: 1.61; 95% CI 1.10 to 2.36; P=0.014) and minimum SBP (OR per 10 mmHg increase: 0.65, 95% CI 0.47 to 0.90; P=0.009) values were independent predictors of 3-month mortality.ConclusionsOur study demonstrates that wide BP excursions from the mean during the first 24 hours post MT are associated with worse outcomes in patients with nrLVO.

Endovascular treatment for large vessel occlusion stroke in patients with ventricular assist devices

2019 ◽  
Vol 11 (12) ◽  
pp. 1205-1209 ◽  
Author(s):  
Yoshinori Kadono ◽  
Hajime Nakamura ◽  
Shunsuke Saito ◽  
Takeo Nishida ◽  
Masatoshi Takagaki ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Large Vessel ◽  
Ventricular Assist Devices ◽  
Study Cohort ◽  
Cardiac Transplant ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Ventricular Assist

BackgroundEmbolic stroke with large vessel occlusion (LVO) is a major adverse event during ventricular assist device (VAD) support. In this study we aimed to clarify the efficacy of, and problems associated with, endovascular treatment (EVT) of LVO in patients with VAD support.MethodsWe retrospectively reviewed EVT for LVO in patients with VAD support between 2006 and 2017 at our institute and evaluated baseline characteristics, treatment variables, outcomes, and complications.ResultsThe study cohort comprised 12 consecutive patients (age 35.4±20.4 years), with 15 LVO events involving 20 arterial occlusions, who had undergone EVT. The median Alberta Stroke Program Early CT score was 10 and good collaterals were observed in 10 of 17 occluded middle cerebral artery areas. No study patients had received intravenous thrombolysis therapy. EVT was performed on 18 of the 20 occluded arteries and mechanical thrombectomy on 13 vessels. The successful reperfusion (modified Thrombolysis in Cerebral Infarction grade ≥2 b) rate was 67% in all EVTs and 85% with mechanical thrombectomy. Histological analysis showed fibrin-rich thrombi in four of five samples. Seven of 12 patients (58%) maintained their neurological function (modified Rankin Scale score ≤2 or equal to pre-stroke score) at 90 days. Periprocedural complications comprised two symptomatic intracranial hemorrhages and the 90-day mortality rate was 13%. Seven of 10 cardiac transplant candidates (70%) returned to the waiting list and three of them received transplants.ConclusionsEndovascular therapy for acute LVO stroke is feasible even in patients with VAD support.

Abstract TMP4: Impact of Bridging Therapy With Intravenous Thrombolysis Prior to Mechanical Thrombectomy in Patients With Large Vessel Occlusion- Insights From the STAR Registry

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sami Al Kasab ◽  
Eyad Almallouhi ◽  
Ali Alawieh ◽  
Christine A Holmstedt ◽  
Reda M Chalhub ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Mechanical Thrombectomy ◽  
Group Versus ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Bridging Therapy ◽  
Vessel Occlusion ◽  
Procedural Time ◽  
The Impact

Introduction: Clinical trials have proven the safety and efficacy of mechanical thrombectomy (MT) with intravenous alteplase (tPA) compared to tPA alone in patients presenting with large vessel occlusion (LVO). The impact of tPA prior to MT on procedural metrics, successful revascularization, symptomatic hemorrhage and long-term functional outcome has not been established from large scale real-world studies. In this study we evaluate the impact of tPA prior to MT on procedural times, immediate and long-term outcomes. Methods: The STAR registry combined prospectively maintained databases of 11 thrombectomy-capable stroke centers in the US, Europe and Asia. Patients who received mechanical thrombectomy with or without intravenous tPA prior to MT were included in these analyses. Baseline characteristics, procedural time, successful revascularization (TICI ≥ 2B), symptomatic intracranial hemorrhage (PH2), and long-term functional outcomes were compared between the two groups. Results: Total of 1869 patients were included in this analysis. Of those, 907 received tPA prior to MT. Baseline features and outcomes are summarized in table 1. There were more white patients in the non-tPA group, and more patients in this group had atrial fibrillation and hyperlipidemia; otherwise there were no differences in baseline features between the two groups. Median NIHSS on admission was 16 in both groups, median ASPECTS was 9 in the tPA group versus 8 in the non-tPA group, p=0.208. Patients in the tPA group had higher rate of successful revascularization, lower number of revascularizations attempts and were more likely to achieve excellent long-term functional outcome. There was no difference in procedural time, rate of symptomatic hemorrhage or length of hospital stay. Conclusion: Bridging therapy with intravenous tPA prior to mechanical thrombectomy may facilitate MT and yield to better long-term functional outcome.

Abstract TMP67: Impact of Pre-Hospital Stroke Alerts and Parallel Process on Door-to-Puncture Times in Large Vessel Occlusion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Brijesh P Mehta ◽  
Raul G Nogueira ◽  
Mayank Goyal ◽  
Bijoy K Menon ◽  
Eric E Smith ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Large Vessel ◽  
Neurological Deficits ◽  
Time Of Arrival ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Time To Treatment ◽  
Early Activation ◽  
The Impact

Background: Endovascular mechanical thrombectomy is now the standard of care for acute strokes with large vessel occlusion (LVO). Time to reperfusion is a significant predictor of favorable outcomes in strokes caused by LVO. Pre-hospital notification by Emergency Medical Services (EMS) and parallel in-hospital processes may reduce time to treatment. Methods: A single center stroke redesign initiative was launched with implementation of: 1) EMS pre-hospital stroke alerts comprised of last known well (LKW) time, neurological deficits, estimated time of arrival; 2) immediate notification of NeuroInterventionalist (NI) if presence of severe deficits (e.g., gaze preference, aphasia, hemiplegia); 3) early activation (i.e., pre-imaging) of cath lab team based on clinical judgement of NI. Results: A retrospective analysis was performed on 164 consecutive stroke patients transported by EMS who underwent mechanical thrombectomy for LVO from August 2014 to July 2016. The median NIHSS score was 17. Pre-hospital EMS stroke alerts were called in 80% (n=132) of treated patients. Among patients with EMS alerts, the NI was notified prior to imaging in 64% (n=80) of cases and the cath lab team was mobilized in parallel for 33 patients. The median door-to-puncture times for patients with EMS alerts + cath lab activation pre-imaging vs EMS alerts + cath lab activation post-imaging vs no EMS alerts were: 66, 79, and 100 minutes, respectively (p<0.05). The impact of field notification was even more pronounced after hours: median door-to-puncture time 76 minutes with EMS alerts (n=70) compared to 111 minutes without EMS alerts (n=21). For patients treated with bridging therapy (IV tPA + IA thrombectomy), the picture-to-puncture interval was notably shorter among patients with EMS alerts, 62 vs 80 minutes (p<0.05). Conclusion: We demonstrate a stroke system of care aimed to reduce time to treatment in patients with LVO. In the new era of mechanical thrombectomy, this is the first study to show feasibility and efficacy of pre-hospital EMS stroke alerts triggering early activation of the cath lab team in patients with possible LVO. Development of regional stroke protocols aligning EMS with efficient in-hospital processes are now a top priority.

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