A Retrospective Study of Clinical Outcomes After Endovascular Treatment in Acute Ischemic Stroke Patients with Complete Anterior Circulation Infarction in the Absence of Multimodal Computed Tomography

2017 ◽  
Vol 108 ◽  
pp. 460-464
Author(s):  
Chenghua Xu ◽  
Anyang Tao ◽  
Zhimin Wang ◽  
Yi Zhang ◽  
Xiaoxiao Tao ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Retrospective Study ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Stroke Patients ◽  
Anterior Circulation

scholarly journals Outcome of endovascular treatment within and beyond 6 h without perfusion software

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhen Jing ◽  
Hao Li ◽  
Shengming Huang ◽  
Min Guan ◽  
Yongxin Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
General Anesthesia ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Symptom Onset ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Group A ◽  
Group B

AbstractEndovascular treatment (EVT) has been accepted as the standard of care for patients with acute ischemic stroke. The aim of the present study was to compare clinical outcomes of patients who received EVT within and beyond 6 h from symptom onset to groin puncture without perfusion software in Guangdong district, China. Between March 2017 and May 2018, acute ischemic stroke patients who received EVT from 6 comprehensive stroke centers, were enrolled into the registry study. In this subgroup study, we included all patients who had acute proximal large vessel occlusion in the anterior circulation. The demographic, clinical and neuroimaging data were collected from each center. A total of 192 patients were included in this subgroup study. They were divided into two groups: group A (n = 125), within 6 h; group B (n = 67), 6–24 h from symptom onset to groin puncture. There were no substantial differences between these two groups in terms of 90 days favorable outcome (modified Rankin scale [mRS] ≤ 2, P = 0.051) and mortality (P = 0.083), and the risk of symptomatic intracranial hemorrhage at 24 h (P = 0.425). The NIHSS (median 16, IQR12-20, group A; median 12, IQR8-18, group B; P = 0.009) and ASPECTS (median 10, IQR8-10, group A; median 9, IQR8-10, group B; P = 0.034) at baseline were higher in group A. The anesthesia method (general anesthesia, 21.3%, group A vs. 1.5% group B, P = 0.001) were also statistically different between the two groups. The NIHSS and ASPECTS were higher, and general anesthesia was also more widely used in group A. Clinical outcomes were not significantly different within 6 h versus 6–24 h from symptom onset to groin puncture in this real world study.

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.

Abstract WP372: Hydration Status and Clinical Outcomes in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mona N Bahouth ◽  
Rebecca Gottesman
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Blood Urea Nitrogen ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Hydration Status ◽  
Creatinine Ratio ◽  
Stroke Patients ◽  
Anterior Circulation

Introduction: Impaired hydration measured by elevated blood urea nitrogen (BUN) to creatinine ratio has been associated with worsened outcome after acute ischemic stroke. Whether hydration status is relevant for patients with acute ischemic stroke treated with mechanical thrombectomy remains unknown. Materials and Methods: We conducted a retrospective review of consecutive acute ischemic stroke patients who underwent endovascular procedures for anterior circulation large artery occlusion at Johns Hopkins Comprehensive Stroke Centers between 2012 and 2017. A volume contracted state (VCS), was determined based on surrogate lab markers and defined as blood urea nitrogen (BUN) to creatinine ratio greater than 15. Endpoints were achievement of successful revascularization (TICI 2b or 3), early re-occlusion, and short term clinical outcomes including development of early neurological worsening and functional outcome at 3 months. Results: Of the 158 patients who underwent an endovascular procedure, 102 patients had a final diagnosis of anterior circulation large vessel occlusion and met the inclusion criteria for analysis. Volume contracted state was present in 62/102 (61%) of patients. Successful revascularization was achieved in 75/102 (74%) of the cohort. There was no relationship between VCS and successful revascularization, but there was a 1.13 increased adjusted odds (95% CI 1.01, 1.27) of re-occlusion within 24 hours for every point higher BUN/creatinine ratio in the subset of patients who underwent radiological testing for pre-procedure planning (n=57). There was no relationship between VCS and clinical outcomes including early neurological worsening and 3 month outcome. Conclusions: Patients with VCS and large vessel anterior circulation stroke may have a higher odds of early re-occlusion after mechanical thrombectomy than their non-VCS counterparts, but no differences in successful revascularization nor clinical outcomes were present in this cohort. These results may suggest an opportunity for the exploration of pre-procedure hydration to improve outcomes.

Abstract TP18: Endovascular Treatment in the Elderly with Acute Ischemic Stroke - Is it Safe in Clinical Practice?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Thabele M Leslie-Mazwi ◽  
Syed F Ali ◽  
Sanjeeva R Onteddu ◽  
Adewumi D Amole ◽  
Mehmet S Akdol ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Univariate Analysis ◽  
The Elderly ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Younger Patients

Introduction: An overwhelming benefit from endovascular treatment (EVT) of acute ischemic stroke (AIS) has been shown in recent trials, making it the new evidence-based standard of care for ischemic stroke due to anterior circulation large vessel occlusion. We sought to determine usage, safety and efficacy of EVT in patients ≥80 years of age. Methods: Using GWTG stroke registry data from MGH and UAMS, we analyzed 7,505 consecutive stroke admissions from 01/2009 - 06/2016. Univariate analysis was carried out to compare AIS patients < 80 vs. those ≥ 80yr. Results: Of the total 7,505 AIS patients, 3,722 presented within 12 hr of last known well and of these 334 (334/3722, 9%) underwent EVT. The majority of AIS patients undergoing EVT were younger than 80yr of age (264/334, 79%). Of the patients who underwent EVT, younger patients were more often male, Caucasian, and had stroke risk factors of atrial fibrillation, CAD, hypertension and smokers. The two groups were similar in NIHSS, initial clinical presentation, modified pre-stroke Rankin scale of ≤ 3, and initiation of tPA as a drip and ship or stroke center front-door administration. Higher rates of pneumonia were observed in younger patients while rates of sICH were similar. Younger patients were more often discharged to home/inpatient rehabilitation facility. On univariate analysis, in-hospital mortality was significantly higher in patients ≥ 80yr [Unadj. OR 2.50 (1.24, 5.03), p=0.01], however the strength of the association attenuated substantially after adjusting for significant covariates [Adj. OR 2.34 (0.99, 5.47), p=0.05] (Table). Conclusion: Elderly stroke patients are largely excluded from clinical trials and data are limited on the effectiveness of EVT in this cohort. Our results showed that rate of sICH and adjusted in-hospital mortality was not statistically different between those < 80yr vs. ≥ 80yr. Further studies are needed to explore the functional outcome of the elderly stroke patients undergoing EVT.

scholarly journals Prospective Endovascular Treatment in Acute Ischemic Stroke Evaluating Non-Contrast Head CT versus CT Perfusion (PLEASE No CTP)

2019 ◽  
Vol 8 (2-6) ◽  
pp. 116-122
Author(s):  
Ameer E. Hassan ◽  
Hafsah Shamim ◽  
Haralabos Zacharatos ◽  
Saqib A. Chaudhry ◽  
Christina Sanchez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Ct Perfusion ◽  
Treatment Decision ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Contrast Ct

Background: Studies have shown a lack of agreement of computed tomography perfusion (CTP) in the selection of acute ischemic stroke (AIS) patients for endovascular treatment. Purpose: To demonstrate whether non-contrast computed tomography (CT) within 8 h of symptom onset is comparable to CTP imaging. Methods: Prospective study of consecutive anterior circulation AIS patients with a National Institute of Health Stroke Scale (NIHSS) score > 7 presenting within 8 h of symptom onset with endovascular treatment. All patients had non-contrast CT, CT angiography, and CTP. The neuro-interventionalist was blinded to the results of the CTP and based the treatment decision using the Alberta Stroke Program Early CT score (ASPECTS). Baseline demographics, co-morbidities, and baseline NIHSS scores were collected. Outcomes were modified Rankin scale (mRS) score at discharge and in-hospital mortality. Good outcomes were defined as a mRS score of 0–2. Results: 283 AIS patients were screened for the trial, and 119 were enrolled. The remaining patients were excluded for: posterior circulation stroke, no CTP performed, could not obtain consent, and NIHSS score < 7. Mean ­NIHSS score at admission was 16.8 ± 3, and mean ASPECTS was 8.4 ± 1.4. There was no statistically significant correlation with CTP penumbra and good outcomes: 50 versus 47.8% with no penumbra present (p = 0.85). In patients without evidence of CTP penumbra, there was 22.5% mortality compared to 22.1% mortality in patients with a CTP penumbra. If ASPECTS ≥7, 64.6% had good outcome versus 13.3% if ASPECTS < 7 (p < 0.001). Patients with an ASPECTS ≥7 had 10% mortality versus 51.4% in patients with an ASPECTS < 7 (p < 0.001). Conclusions: CTP penumbra did not identify patients who would benefit from endovascular treatment when patients were selected with non-contrast CT ASPECTS ≥7. There is no correlation of CTP penumbra with good outcomes or mortality. Larger prospective trials are warranted to justify the use of CTP within 6 h of symptom onset.

scholarly journals Serum Iron for Prognosis of Acute Ischemic Stroke by Endovascular Treatment

2020 ◽  
Author(s):  
Mingli Liu ◽  
Zhongfei Hao ◽  
Ruiyan Li ◽  
Jinquan Cai ◽  
Yongli Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Retrospective Study ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Receiver Operating Characteristic ◽  
Clinical Outcomes ◽  
Serum Iron ◽  
Operating Characteristic ◽  
Iron Level ◽  
Serum Iron Level

Abstract Background Iron, as an import micronutrient, is related to many diseases in a human body. Although the function of iron in acute ischemic stroke is yet debatable, there are few reports from clinical data on serum iron for the prognosis of acute ischemic stroke by endovascular treatment. The current retrospective study aimed to investigate the correlation between serum iron and acute ischemic stroke prognosis by endovascular treatment.Methods This study was carried out retrospectively and 84 patients participated from March 2016 to April 2019 who suffered acute ischemic stroke and were treated by endovascular treatment at this stroke center. The laboratory test and clinical data were assessed for the prognosis of acute ischemic stroke by endovascular treatment. An independent relationship was analyzed through binary logistic analysis and receiver operating characteristic curves for the accuracy of the test.Results This retrospective study was carried out at Harbin Medical University’s Second Affiliated Hospital, and enrolled 84 patients from March 2018 to September 2019, including 32 patients in whom the outcomes were clinically favorable and 52 patients with unfavorable clinical outcomes. The groin puncture to recanalization time significantly varied between patients with favorable as well as unfavorable clinical outcomes (45.0 min vs 72.5 min, p = 0.001), serum iron (10.87 μmol/L vs 4.07 μmol/L, p < 0.001) and thrombin time (13.40 s vs 14.25 s, p = 0.034) from univariable analysis. Serum iron (p < 0.001; adjusted OR [95% CI]:70.765 [9.904 - 505.636]) was associated independently with acute ischemic stroke prognosis by endovascular treatment, and receiver operating characteristic showed area under the curve of 0.926 (p < 0.001, 95% CI: 0.872 - 0.979).Conclusions The outcomes of this study reveal that serum iron level was associated independently with acute ischemic stroke prognosis, and high serum iron level could predict favorable clinical outcomes with a significantly accurate ability. Thus, serum iron could be a marker for acute ischemic stroke prognosis through endovascular treatment.

Abstract W P8: "Double Trouble": Endovascular Treatment of Tandem Arterial Occlusions in Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Mikayel Grigoryan ◽  
Diogo Haussen ◽  
Andrey Lima ◽  
Jonathan Grossberg ◽  
Shannon Doppelheuer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
Imaging Data ◽  
Stroke Patients ◽  
Symptomatic Intracerebral Hemorrhage

Background: Tandem extracranial/intracranial arterial occlusions in acute stroke present treatment challenges both due to suboptimal response to systemic intravenous thrombolysis as well as complex endovascular approach. We report our experience in treating this cohort of acute stroke patients with the analysis of angiographic and clinical outcomes Materials and Methods: We retrospectively reviewed clinical and imaging data of all consecutive acute stroke patients with proximal intracranial arterial occlusion and additional extracranial occlusion/critical stenosis, treated with endovascular techniques between February 2011 and February 2014 at two hospitals. We analyzed patients’ demographics, clinical presentation, treatment strategies, time to recanalization, imaging and clinical outcomes. Results: A total of 66 patients were included. The mean NIHSS on presentation was 19. Extracranial carotid with concomitant intracranial anterior circulation occlusions were present in 95% of the patients (63/66), while 5% (3/66) had tandem vertebrobasilar occlusions. 41% of the patients (27/66) received intravenous rt-PA. With regards to endovascular treatment, in 70% of the cases (46/66), extracranial lesion was treated with a stent placement. Stentrievers were used in 50% (33/66) of the patients for intracranial thrombectomy. Thrombolysis in Cerebral Infarction (TICI) >= 2B reperfusion was achieved in 77% of all the patients (51/66) and in 97% (32/33) of the stentriever patients. Good clinical outcome at 90 days (mRS<=2) was seen in 42% of the patients. Symptomatic intracerebral hemorrhage (PH-2)occurred in 9% (6/66) of the patients. Conclusions: Endovascular treatment of tandem arterial occlusions in acute ischemic stroke is relatively safe, feasible, and may yield excellent angiographic and good clinical outcomes.

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