P 78. The prognostic value of motor-evoked potentials in motor recovery and functional outcome after stroke – a systematic review of the literature

Objective. The primary aim of this study was to compare the predictive value of motor evoked potentials (MEPs) and early clinical assessment with regard to long-term hand motor recovery in patients with profound hemiplegia after stroke. Methods. The sample was an inception cohort of 39 stroke patients with an acute, ischemic, supratentorial stroke and an initial upper-extremity paralysis admitted to an academic hospital. Hand motor function recovery was defined at 26 weeks poststroke as a Fugl–Meyer Motor Assessment (FMA) hand score >3 points. The following prognostic factors were compared at week 1 and week 3 poststroke: motor functions as assessed by the FMA upper-extremity and lower-extremity subscores, and the presence of an MEP in the abductor digiti minimi and biceps brachii muscle. Results. Both the presence of an abductor digiti minimi–MEP and any motor recovery in the FMA upper-extremity subscore showed a positive predictive value of 1.00 at weeks 1 and 3. The FMA lower-extremity subscore showed the best negative predictive value (0.90; 95% CI 0.78-1.00 at week 1 and 0.95; 95% CI 0.87-1.00 at week 3). Conclusions. In stroke patients with an initial paralysis of the upper extremity the presence or absence of an MEP has similar predictive value compared with early clinical assessment with regard to long-term hand motor recovery.

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Debunking the Myth: Neuromodulation Promotes Post-Stroke Motor Recovery in The Absence of Motor Evoked Potentials

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2019.10.031 ◽

2019 ◽

Vol 100 (12) ◽

pp. e173

Author(s):

Lumy Sawaki ◽

Philip Westgate ◽

Larry Goldstein ◽

Elizabeth Powell

Keyword(s):

Evoked Potentials ◽

Motor Evoked Potentials ◽

Motor Recovery ◽

Post Stroke

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Rescue carotid puncture for ischemic stroke treated by endovascular therapy: a multicentric analysis and systematic review

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016725 ◽

2020 ◽

pp. neurintsurg-2020-016725

Author(s):

Julien Allard ◽

Sam Ghazanfari ◽

Mehdi Mahmoudi ◽

Julien Labreuche ◽

Simon Escalard ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Elderly Patients ◽

Functional Outcome ◽

Endovascular Therapy ◽

Older Patients ◽

Intravenous Thrombolysis ◽

Review Of The Literature ◽

Femoral Access ◽

Life Threatening

BackgroundEndovascular therapy (EVT) for acute ischemic stroke (AIS) can be challenging in older patients with supra-aortic tortuosity. Rescue carotid puncture (RCP) can be an alternative in case of supra-aortic catheterization failure by femoral access, but data regarding RCP are scarce. We sought to investigate the feasibility, effectiveness and safety of RCP for AIS treated by EVT.MethodsPatients treated by EVT with RCP were included from January 2012 to December 2019 in the Endovascular Treatment in Ischemic Stroke (ETIS) multicentric registry. Main outcomes included reperfusion rates (≥TICI2B), 3 month functional outcome (modified Rankin Scale) and 3 month mortality. We also performed an additional systematic review of the literature according to the PRISMA checklist to summarize previous studies on RCP.Results25 patients treated by EVT with RCP were included from the ETIS registry. RCP mainly concerned elderly patients (median age 85 years, range 73–92) with supra-aortic tortuosity (n=16 (64%)). Intravenous thrombolysis (IVT) was used for nine patients (36%). Successful reperfusion was achieved in 64%, 87.5% of patients were dependent at 3 months, and 3 month mortality was 45.8%. The systematic review yielded comparable results. In pooled individual data, there was a shift toward better functional outcome in patients with successful reperfusion (median (IQR) 4 (2–6) vs 6 (4–6), p=0.011).ConclusionRCP mainly concerned elderly patients admitted for AIS with anterior LVO with supra-aortic tortuosity. The procedure seemed feasible, notably for patients treated with IVT, and led to significant reperfusion rates at the end of procedure, but with pronounced unfavorable outcomes at 3 months. RCP should be performed under general anesthesia to avoid life-threatening complications and ensure airways safety. Finally, RCP led to low rates of closure complications, emphasizing that this concern should not withhold RCP, if indicated.

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