There Is No Difference in Safety and Efficacy Mechanical Thrombectomy alone or Mechanical Thrombectomy with Tirofiban for Patients Undergoing Treatment of Large Vessel Occlusion and Underlying Intracranial Atherosclerosis

Introduction: Mechanical thrombectomy (MT) is the current standard of care treatment for patients presenting with severe symptoms due to large vessel occlusion (LVO); approximately 30% of patients with LVO however present with mild symptoms (NIHSS < 6). The safety and efficacy of MT in this group has not yet been established. The purpose of this study is to evaluate the safety of MT in patients presenting with mild symptoms due to LVO in a large multicenter registry. Methods: STAR registry combined the prospectively maintained databases of 11 thrombectomy-capable stroke centers in the US, Europe and Asia. Patients who underwent MT were included in these analyses. Baseline features, risk factors, location of occlusion, time from symptom onset, tPA receipt, procedural complication rates, symptomatic hemorrhage, and long-term functional outcome were compared between patients with mild symptoms (NIHSS < 6) to those with severe symptoms (NIHSS ≥ 6). Results: Total of 2,114 patients were included in this analysis. Of those, 162 patients presented with NIHSS ≥ 6. Baseline features and outcomes are summarized in table 1. There was no difference in age, or sex, tPA receipt, number of attempts, rate of successful revascularization, symptomatic hemorrhage, or length of hospital stay. Median ASPECTS score was 9 in the mild Vs 8 in the severe symptom group (p=< 0.001), there was a higher percentage of patients in the mild symptom group with hypertension, hyperlipidemia, and LVO in the posterior circulation. Conversely there were more patients with atrial fibrillation in the severe symptom group. Excellent outcome (mRS 0-2 at 90 days) was achieved in 69.8% patients in the mild group compared to 38.3% in the severe group, p=<0.001) Conclusion: In patients with minor symptoms due to large vessel occlusion, mechanical thrombectomy appears to be safe with low complication rates. Approximately seventy percent of patients achieved excellent functional recovery. Table 1:

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Comparison of Risk Factors, Safety, and Efficacy Outcomes of Mechanical Thrombectomy in Posterior vs. Anterior Circulation Large Vessel Occlusion

Frontiers in Neurology ◽

10.3389/fneur.2021.687134 ◽

2021 ◽

Vol 12 ◽

Author(s):

Joshua Mbroh ◽

Khouloud Poli ◽

Johannes Tünnerhoff ◽

Alexandra Gomez-Exposito ◽

Yi Wang ◽

...

Keyword(s):

Functional Outcome ◽

Mechanical Thrombectomy ◽

Meta Analysis ◽

Posterior Circulation ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Safety And Efficacy ◽

Favorable Functional Outcome

Background and Purpose: It is believed that stroke occurring due to posterior circulation large vessel occlusion (PCLVO) and that occurring due to anterior circulation large vessel occlusion (ACLVO) differ in terms of their pathophysiology and the outcome of their acute management in relation to endovascular mechanical thrombectomy (MT). Limited sample size and few randomized controlled trials (RCTs) with respect to PCLVO make the safety and efficacy of MT, which has been confirmed in ACLVO, difficult to assess in the posterior circulation. We therefore conducted a meta-analysis to study to which extent MT in PCLVO differs from ACLVO.Materials and Methods: We searched the databases PubMed, Cochrane, and EMBASE for studies published between 2010 and January 2021, with information on risk factors, safety, and efficacy outcomes of MT in PCLVO vs. ACLVO and conducted a systematic review and meta-analysis; we compared baseline characteristics, reperfusion treatment profiles [including rates of intravenous thrombolysis (IVT) and onset-to-IVT and onset-to-groin puncture times], recanalization success [Thrombolysis In Cerebral Infarction scale (TICI) 2b/3], symptomatic intracranial hemorrhage (sICH), and favorable functional outcome [modified Rankin Score (mRS) 0–2] and mortality at 90 days.Results: Sixteen studies with MT PCLVO (1,172 patients) and ACLVO (7,726 patients) were obtained from the search. The pooled estimates showed higher baseline National Institutes of Health Stroke Scale (NIHSS) score (SMD 0.32, 95% CI 0.15–0.48) in the PCLVO group. PCLVO patients received less often IVT (OR 0.65, 95% CI 0.53–0.79). Onset-to-IVT time (SMD 0.86, 95% CI 0.45–1.26) and onset-to-groin puncture time (SMD 0.59, 95% CI 0.33–0.85) were longer in the PCLVO group. The likelihood of obtaining successful recanalization and favorable functional outcome at 90 days was comparable between the two groups. PCLVO was, however, associated with less sICH (OR 0.56, 95% CI 0.37–0.85) but higher mortality (OR 1.92, 95% CI 1.46–2.53).Conclusions: This meta-analysis indicates that MT in PCLVO may be comparably efficient in obtaining successful recanalization and 90 day favorable functional outcome just as in ACLVO. Less sICH in MT-treated PCLVO patients might be the result of the lower IVT rate in this group. Higher baseline NIHSS and longer onset-to-IVT and onset-to-groin puncture times may have contributed to a higher 90 day mortality in PCLVO patients.

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Abnormal neurological pupil index is associated with malignant cerebral edema after mechanical thrombectomy in large vessel occlusion patients

Neurological Sciences ◽

10.1007/s10072-021-05218-x ◽

2021 ◽

Author(s):

Ehsan Dowlati ◽

Kwadwo Sarpong ◽

Stanley Kamande ◽

Austin H. Carroll ◽

Jerome Murray ◽

...

Keyword(s):

Cerebral Edema ◽

Mechanical Thrombectomy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Neurological Pupil Index

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Which Glucose Parameter Best Predicts Poor Outcome after Mechanical Thrombectomy for Acute Large Vessel Occlusion Stroke?

Internal Medicine Journal ◽

10.1111/imj.15259 ◽

2021 ◽

Author(s):

Xiandong Li ◽

Chao Li ◽

Mingchao Shi ◽

Yang Qu ◽

Longwen Huo ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Poor Outcome

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Mechanical Thrombectomy Improves Outcome for Large Vessel Occlusion Stroke after Cardiac Surgery

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2021.105851 ◽

2021 ◽

Vol 30 (8) ◽

pp. 105851

Author(s):

D. Andrew Wilkinson ◽

Sravanthi Koduri ◽

Sharath Kumar Anand ◽

Badih J. Daou ◽

Vikram Sood ◽

...

Keyword(s):

Cardiac Surgery ◽

Mechanical Thrombectomy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion

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Acute and Chronic Kidney Dysfunction and Outcome After Stroke Thrombectomy

Translational Stroke Research ◽

10.1007/s12975-020-00881-2 ◽

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.

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