P.194 In search of real-world neuroprotection in mechanical thrombectomy
                        for ischemic stroke

Background: The promise of neuroprotection for stroke remains elusive. Common medications in endovascular stroke thrombectomy have putative neuroprotective mechanisms in basic science literature. We evaluated our stroke registry for evidence that these medications have any impact on clinically meaningful outcome. Methods: A retrospective stroke thrombectomy database was evaluated for clinical and angiographic outcomes of patients receiving IV or IA tPA, Heparin, or Verapamil during procedure. Univariate analysis evaluated associations with periprocedure hemorrhage, recanalization, and functional outcomes. Results: 284 patients underwent mechanical thrombectomy over 2.75 years. For periprocedural hemorrhage, IV tPA (OR 0.457, CI 0.261-0.811, p=0.008) and Heparin (1.897, CI 1.112-3.205, p=0.019) had significant relationships. No medication had impact on favorable recanalization (TICI 2b/3). Heparin had a negative impact on 90day mRS 0-2 (OR 0.563, CI 0.348-0.901, p=0.023). Favorable recanalization remains associated with favorable outcomes at 90days (OR 2.066, CI 1.063-4.069, p=0.0361). Conclusions: While the adjunctive use of 3 commonly used periprocedural medications have a logical role in the mechanical thrombectomy eg IA tPA for clot lysis, they do not have clinical benefit that represents neuroprotection. Multivariate analysis may show more effect. A role for intraarterial neuroprotective agents exists given only 45% of patients in this series achieved functional independence.

Download Full-text

Abstract 1122‐000084: Does Intravenous Thrombolysis Promote Delayed Reperfusion After Incomplete Mechanical Thrombectomy?

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000084 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Adnan Mujanovic ◽

Christoph Kammer ◽

Christoph C Kurmann ◽

Lorenz Grunder ◽

Morin Beyeler ◽

...

Keyword(s):

Perfusion Imaging ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Functional Independence ◽

Considerable Proportion ◽

Time Interval ◽

Start Time ◽

Vessel Occlusion ◽

Stroke Registry

Introduction : The value of intravenous thrombolysis (IVT) in patients eligible for mechanical thrombectomy (MT) remains unclear. We hypothesized that pre‐treatment with and/or ongoing IVT may facilitate reperfusion of distal vessel occlusion after incomplete MT. We evaluated this potential association using follow‐up perfusion imaging. Methods : Retrospective observational analysis of our institution`s stroke registry included patients with incomplete reperfusion after MT, admitted between February 1, 2015 and December 8, 2020. Delayed reperfusion (DR) was defined as the absence of a persistent perfusion deficit on contrast‐enhanced perfusion imaging ⁓24h±12h after the intervention. The association between baseline parameters and the occurrence of DR was evaluated using a logistic regression analyses. To account for possible time‐dependent associations of IVT with DR, additional stratification sets were made based on different time windows between IVT start time and final angiography runs. Results : Among the 378 included patients (median age 73.5, 50.8% female), DR occurred in 226 (59.8%). Atrial fibrillation (aOR 2.53 [95% CI 1.34 ‐ 4.90]), eTICI score (aOR 3.79 [95% CI 2.71 ‐ 5.48] per TICI grade increase), and intervention‐to‐follow‐up time (aOR 1.08 [95% CI 1.04 ‐ 1.13] per hour delay) were associated with DR. Dichotomized IVT strata showed no association with DR (aOR 0.75 [95% CI 0.42 ‐ 1.33]), whereas shorter intervals between IVT start and end of the procedure showed a borderline significant association with DR (OR 2.24 [95% CI 0.98 ‐ 5.43, and OR 2.07 [95% 1.06 – 4.31], for 80 and 100 minutes respectively). Patients with DR had higher rates of functional independence (modified Rankin scale 0–2 at 90 days, DR: 63.3% vs PPD: 38.8%; p<0.01) and longer survival time (at 3 years, DR: 69.2% vs PPD: 45.8%; p = 0.001). Conclusions : There is weak evidence that IVT may favor DR after incomplete MT if the time interval between IVT administration and end of the procedure is short. In general, perfusion follow‐up imaging may constitute a suitable surrogate parameter for evaluating medical rescue strategies after incomplete MT, because a considerable proportion of patients do not experience DR, and there seems to be a close correlation with clinical outcomes.

Download Full-text

Successful mechanical thrombectomy in acute ischemic stroke: revascularization grade and functional independence

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-018436 ◽

2022 ◽

pp. neurintsurg-2021-018436

Author(s):

Sherief Ghozy ◽

Salah Eddine Oussama Kacimi ◽

Ahmed Y Azzam ◽

Ramadan Abdelmoez Farahat ◽

Abdelaziz Abdelaal ◽

...

Keyword(s):

Systematic Review ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Meta Analysis ◽

Functional Independence ◽

Complete Revascularization ◽

Modified Rankin Scale ◽

Technical Success ◽

Endovascular Thrombectomy ◽

Quantitative Synthesis

Most studies define the technical success of endovascular thrombectomy (EVT) as a Thrombolysis in Cerebral Infarction (TICI) revascularization grade of 2b or higher. However, growing evidence suggests that TICI 3 is the best angiographic predictor of improved functional outcomes. To assess the association between successful TICI revascularization grades and functional independence at 90 days, we performed a systematic review and network meta-analysis of thrombectomy studies that reported TICI scores and functional outcomes, measured by the modified Rankin Scale, using the semi-automated AutoLit software platform. Forty studies with 8691 patients were included in the quantitative synthesis. Across TICI, modified TICI (mTICI), and expanded TICI (eTICI), the highest rate of good functional outcomes was observed in patients with TICI 3 recanalization, followed by those with TICI 2c and TICI 2b recanalization, respectively. Rates of good functional outcomes were similar among patients with either TICI 2c or TICI 3 grades. On further sensitivity analysis of the eTICI scale, the rates of good functional outcomes were equivalent between eTICI 2b50 and eTICI 2b67 (OR 0.81, 95% CI 0.52 to 1.25). We conclude that near complete or complete revascularization (TICI 2c/3) is associated with higher rates of functional outcomes after EVT.

Download Full-text

Prestroke selective serotonin reuptake inhibitor use and functional outcomes after ischaemic stroke

Stroke and Vascular Neurology ◽

10.1136/svn-2017-000119 ◽

2018 ◽

Vol 3 (1) ◽

pp. 9-16 ◽

Cited By ~ 7

Author(s):

Mark R Etherton ◽

Khawja A Siddiqui ◽

Lee H Schwamm

Keyword(s):

Length Of Stay ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Serotonin Reuptake ◽

Functional Outcomes ◽

Selective Serotonin Reuptake Inhibitors ◽

Negative Impact ◽

Univariate Analysis ◽

Stroke Recovery ◽

Selective Serotonin

BackgroundSelective serotonin reuptake inhibitors (SSRIs) have been implicated in contributing to recovery after acute ischaemic stroke. In particular, poststroke initiation of an SSRI has been demonstrated to improve motor recovery. The role of prestroke SSRI use on functional outcomes and stroke recovery is less clear. We aimed to examine the effect of prestroke SSRI use on metrics of hospitalisation and functional recovery.MethodsWe included 4968 consecutive patients from January 2006 to June 2015 in our local Get With The Guidelines-Stroke registry in whom a preadmission drug list could be extracted from an administrative research data registry. Univariate and multivariate analyses were performed to identify predictors of functional outcomes.ResultsOn univariate analysis, among 4698 ischaemic strokes (740 SSRI users and 3948 non-users), SSRI use before acute ischaemic stroke did not impact the National Institutes of Health Stroke Scale (NIHSS) admission score, length of stay or rate of symptomatic haemorrhage. Patients using SSRIs prior to their stroke were more likely to present with weakness (57% vs 47.3%; P<0.001) and have hospitalisations complicated by pneumonia (7.6% vs 5.7%; P<0.001). Moreover, prestroke SSRI use was associated with a negative impact on ambulatory status at discharge and discharge to home. On multivariate regression analysis, SSRI use was associated with lower likelihood of discharge to home (adjusted OR 0.79, 95% CI 0.62 to 0.997, P<0.05).ConclusionsSSRI use preceding an acute ischaemic stroke is associated with lower rates of discharge to home despite no significant increase in length of stay or NIHSS score.

Download Full-text

Cerebral venous outflow profiles are associated with the first pass effect in endovascular thrombectomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-018078 ◽

2021 ◽

pp. neurintsurg-2021-018078

Author(s):

Noel van Horn ◽

Jeremy J Heit ◽

Reza Kabiri ◽

Marius M Mader ◽

Soren Christensen ◽

...

Keyword(s):

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Univariate Analysis ◽

Multivariable Logistic Regression Analysis ◽

Venous Outflow ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Cortical Vein ◽

Number Of Patients ◽

First Pass

BackgroundRecent studies found that favorable venous outflow (VO) profiles are associated with higher reperfusion rates after mechanical thrombectomy (MT) in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Fewer retrieval attempts and first-pass revascularization during MT lead to better functional outcomes.ObjectiveTo examine the hypothesis that favorable VO profiles assessed on baseline CT angiography (CTA) images correlate with successful vessel reperfusion after the first retrieval attempt and fewer retrieval attempts.MethodsA multicenter retrospective cohort study of patients with AIS-LVO treated by MT. Baseline CTA was used to determine the cortical vein opacification score (COVES). Favorable VO was defined as COVES ≥3. Primary outcomes were successful with excellent vessel reperfusion status, defined as Thrombolysis in Cerebral Infarction (TICI) 2b/3 and 2c/3 after first retrieval attempt.Results617 patients were included in this study, of whom 205 (33.2%) had first pass reperfusion. In univariate analysis, ordinal COVES (p=0.011) values were significantly higher in patients with first pass than in those with non-first pass reperfusion, while the number of patients exhibiting favorable pial arterial collaterals using the Maas scale on CTA did not differ (p=0.243). In multivariable logistic regression analysis, higher COVES were independently associated with TICI 2b/3 (OR=1.25, 95% CI 1.1 to 1.42; p=0.001) and TICI 2c/3 (OR=1.2, 95% CI 1.04 to 1.36; p=0.011) reperfusion after one retrieval attempt, controlling for penumbra volume and time from symptom onset to vessel reperfusion.ConclusionsFavorable VO, classified as higher COVES, is independently associated with successful and excellent first pass reperfusion in patients with AIS-LVO treated by endovascular thrombectomy.

Download Full-text

Mechanical thrombectomy with second-generation devices for acute cerebral middle artery M2 segment occlusion: A meta-analysis

Interventional Neuroradiology ◽

10.1177/1591019919886405 ◽

2019 ◽

Vol 26 (2) ◽

pp. 187-194 ◽

Cited By ~ 1

Author(s):

Guangshuo Li ◽

Rui Huang ◽

Weishuai Li ◽

Xiaotian Zhang ◽

Guorong Bi

Keyword(s):

Ischemic Stroke ◽

Functional Outcomes ◽

Second Generation ◽

Mechanical Thrombectomy ◽

Meta Analysis ◽

Mortality Rates ◽

Functional Independence ◽

Intracerebral Hematoma ◽

Modified Rankin Scale ◽

Significant Difference

Background The benefit of mechanical thrombectomy for an acute ischemic stroke involving M2 segment occlusion is not clear, especially when performed with second-generation thrombectomy devices. Method We reviewed the literature to investigate clinical outcomes and the rates of recanalization, symptomatic intracerebral hematoma, and mortality in mechanical thrombectomy performed using second-generation thrombectomy devices. We compared the outcomes between patients treated for M2 and M1 occlusions. Results Seven studies involving 805 patients with M2 thrombectomy were included in this meta-analysis. The functional independence rate 90 days after thrombectomy (modified Rankin Scale 0–2) was 59.3% (OR 1.81, 95% CI 1.74–1.88). The recanalization rate (thrombolysis in cerebral infarction 0–2) was 84.16% (OR 2.32, 95% CI 2.08–2.29). The symptomatic intracerebral hematoma rate was 4.9% (OR 1.05, 95% CI 1.03–1.09). The mortality was 7.7% (OR 1.08, 95% CI 1.03–1.13). The outcomes were better in patients with M2 occlusion than in those with M1 occlusion. In a subgroup analysis, we found that among patients with hypertension, mechanical thrombectomy achieved better functional outcomes and recanalization in M2 occlusion than M1 occlusion. Conclusion Mechanical thrombectomy performed with second-generation thrombectomy devices for M2 occlusion can provide a good functional outcome as well as satisfying recanalization. Moreover, there was no significant difference in the symptomatic intracerebral hematoma and mortality rates, suggesting this procedure is as safe in M2 occlusion as in M1 occlusion.

Download Full-text

More Retrieval Attempts are Associated with Poorer Functional Outcome After Unsuccessful Thrombectomy

Clinical Neuroradiology ◽

10.1007/s00062-021-01054-w ◽

2021 ◽

Author(s):

F. Flottmann ◽

N. van Horn ◽

M. E. Maros ◽

H. Leischner ◽

M. Bechstein ◽

...

Keyword(s):

Propensity Score ◽

Clinical Outcome ◽

Propensity Score Matching ◽

Mechanical Thrombectomy ◽

Harmful Effect ◽

Functional Independence ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Stroke Registry ◽

The Impact

Abstract Purpose In mechanical thrombectomy, it has been hypothesized that multiple retrieval attempts might the improve reperfusion rate but not the clinical outcome. In order to assess a potential harmful effect of a mechanical thrombectomy on patient outcome, the number of retrieval attempts was analyzed. Only patients with a thrombolysis in cerebral infarction (TICI) score of 0 were reviewed to exclude the impact of eventual successful reperfusion on the mechanical hazardousness of repeated retrievals. Methods In this study 6635 patients who underwent endovascular thrombectomy (EVT) for acute large vessel occlusion (LVO) from the prospectively administered multicenter German Stroke Registry were screened. Insufficient reperfusion was defined as no reperfusion (TICI score of 0), whereas a primary outcome was defined as functional independence (modified Rankin scale [mRS] 0–2 at day 90). Propensity score matching and multivariable logistic regressions were then performed to adjust for confounders. Results A total of 377 patients (7.8%) had a final TICI score of 0 and were included in the study. After propensity score matching functional independence was found to be significantly more frequent in patients who underwent ≤ 2 retrieval attempts (14%), compared to patients with > 2 retrieval attempts (3.9%, OR 0.29, 95% CI 0.07–0.73, p = 0.009). After adjusting for age, sex, admission NIHSS score, and location of occlusion, more than two retrieval attempts remained significantly associated with lower odds of functional independence at 90 days (OR 0.2, 95% CI 0.07–0.52, p = 0.002). Conclusion In patients with failure of reperfusion, more than two retrieval attempts were associated with a worse clinical outcome, therefore indicating a possible harmful effect of multiple retrieval attempts.

Download Full-text

Revascularization and functional outcomes after mechanical thrombectomy: an update to key metrics

Journal of Neurosurgery ◽

10.3171/2019.6.jns183649 ◽

2020 ◽

Vol 133 (5) ◽

pp. 1411-1416

Author(s):

Nikolaos Mouchtouris ◽

Fadi Al Saiegh ◽

Evan Fitchett ◽

Carrie E. Andrews ◽

Michael J. Lang ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Mass Effect ◽

Functional Independence ◽

Inpatient Mortality ◽

Nihss Score ◽

Effective Option ◽

Device Technology

OBJECTIVEThe advent of mechanical thrombectomy (MT) has become an effective option for the treatment of acute ischemic stroke in addition to tissue plasminogen activator (tPA). With recent advances in device technology, MT has significantly altered the hospital course and functional outcomes of stroke patients. The authors’ goal was to establish the most up-to-date reperfusion and functional outcomes with the evolution of MT technology.METHODSThe authors conducted a retrospective study of 403 patients who underwent MT for ischemic stroke at their institution from 2010 to 2017. They collected data on patient comorbidities, National Institutes of Health Stroke Scale (NIHSS) score on arrival, tPA administration, revascularization outcomes, and functional outcomes on discharge.RESULTSIn 403 patients, the mean NIHSS score on presentation was 15.8 ± 6.6, with 195 (48.0%) of patients receiving tPA prior to MT. Successful reperfusion (thrombolysis in cerebral infarction score 2B or 3) was achieved in 84.4%. Hemorrhagic conversion with significant mass effect was noted in 9.9% of patients. The median lengths of ICU and hospital stay were 3.0 and 7.0 days, respectively. Functional independence (modified Rankin Scale score 0–2) was noted in 125 (31.0%) patients, while inpatient mortality occurred in 43 (10.7%) patients.CONCLUSIONSAs MT has established acute ischemic stroke as a neurosurgical disease, there is a pressing need to understand the hospital course, hospital- and procedure-related complications, and outcomes for this new patient population. The authors provide a detailed account of key metrics for MT with the latest device technology and identify the predictors of unfavorable outcomes and inpatient mortality.

Download Full-text

Predictors of malignant brain edema after mechanical thrombectomy for acute ischemic stroke

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014650 ◽

2019 ◽

Vol 11 (10) ◽

pp. 994-998 ◽

Cited By ~ 8

Author(s):

Xianjun Huang ◽

Qian Yang ◽

Xiaolei Shi ◽

Xiangjun Xu ◽

Liang Ge ◽

...

Keyword(s):

Ischemic Stroke ◽

Brain Edema ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Functional Independence ◽

Large Vessel Occlusion ◽

Midline Shift ◽

Anterior Circulation ◽

Vessel Occlusion

BackgroundMalignant brain edema (MBE) is a devastating complication in ischemic stroke. Data on MBE in patients who have had mechanical thrombectomy (MT) are relatively scarce.ObjectiveTo investigate the incidence, predictors, and clinical outcomes of MBE in patients after MT.MethodsWe included 130 consecutive patients after MT caused by anterior circulation large vessel occlusion stroke, treated with MT. MBE was defined as a midline shift of ≥5 mm on the follow-up imaging within 72 hours after MT. Characteristics of patients at admission and details of treatment were collected. The 90-day modified Rankin scale score was used as a measure of functional outcomes.ResultsOf the 130 patients (age, 68.6±10.9 years; male, 50%), 35 (26.9%) patients developed MBE. The patients with MBE had a lower rate of functional independence (OR=7.831; 95% CI 1.731 to 35.427; p=0.008) and significantly higher mortality at 90 days (OR=7.958; 95% CI 2.274 to 27.848; p=0.001) than patients without MBE. In 104 (80%) patients with successful recanalization (modified Thrombolysis in Cerebral Infarction score of 2b–3), 24 (23.1%) patients exhibited MBE. After adjustment for confounding, ICA occlusion (OR=3.746; 95% CI 1.169 to 12.006; p=0.026) and worse collateral score (grade 1 vs grade 0: OR=0.727; 95% CI 0.192 to 2.753; p=0.638; grade 2 vs grade 0: OR=0.130; 95% CI 0.021 to 0.819; p=0.030) were significantly associated with the development of MBE, despite successful recanalization.ConclusionsMBE after MT is not uncommon and was related to poor functional outcomes. Localization of a vessel occlusion and collateral status may play a role in the development of MBE.

Download Full-text

Intra-arterial neuroprotective therapy as an adjunct to endovascular intervention in acute ischemic stroke: A review of the literature and future directions

Interventional Neuroradiology ◽

10.1177/1591019920925677 ◽

2020 ◽

Vol 26 (4) ◽

pp. 405-415 ◽

Cited By ~ 3

Author(s):

Thomas W Link ◽

Alejandro Santillan ◽

Athos Patsalides

Keyword(s):

Clinical Trials ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Systemic Exposure ◽

Functional Independence ◽

Neuroprotective Agents ◽

Cold Saline ◽

Guide Catheter ◽

Neuroprotective Therapy

Mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion has been shown to significantly improve outcomes. However, despite efficient rates of recanalization (60–90%), the rates of functional independence remain suboptimal (14–58%), most likely due to pathways of cell death in the brain that have already committed despite successful reperfusion. Pharmacologic neuroprotection provides a potential means of preventing this inevitable damage through targeting excitotoxicity, reactive oxygen species, cellular apoptosis, and inflammation. Numerous clinical trials using various neuroprotective agents have failed, but the majority of these trials did not include endovascular reperfusion, and thus the drugs were not reaching the therapeutic target. Intra-arterial delivery of neuroprotective agents via the guide catheter already in place for mechanical thrombectomy could provide a way to deliver high doses directly to the affected territory while limiting systemic exposure. Agents that have shown promise via the intra-arterial route in preclinical as well as some clinical models include magnesium sulfate, verapamil, cold saline, stem cells, and various combined approaches. Targeted hypothermia, achieved with intra-carotid infusion of cold saline, may provide an effective means of achieving hypothermia of the ischemic tissue while avoiding the systemic effects that have limited its use previously. Combination therapy of targeted hypothermia and a cocktail of drugs that provide anti-excitotoxic, anti-oxidant, anti-apopototic, and anti-inflammatory effects may provide an ideal approach that deserves further study in clinical trials.

Download Full-text

Added Value of Rescue Devices in Intra-Arterial Thrombectomy: When Should We Apply Them?

Frontiers in Neurology ◽

10.3389/fneur.2021.689606 ◽

2021 ◽

Vol 12 ◽

Author(s):

Cheng-Fu Ni ◽

Sho-Jen Cheng ◽

Cheng-Yu Chen ◽

Tu-Hsueh Yeh ◽

Kevin Li-Chun Hsieh

Keyword(s):

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Rescue Therapy ◽

Functional Independence ◽

Posterior Circulation ◽

First Line ◽

Anterior Circulation ◽

First Line Therapy ◽

Line Therapy ◽

Reperfusion Rate

Introduction: Recent trials have demonstrated the superior efficacy of mechanical thrombectomy over other medical treatments for acute ischemic stroke; however, not every large vessel occlusion (LVO) can be recanalized using a single thrombectomy device. Rescue devices were proved to increase the reperfusion rate, but the efficacy is unclear.Objective: In this retrospective study, we evaluated the efficacy of rescue therapy in different locations of LVO.Methods: We analyzed the outcomes of mechanical thrombectomy from a prospective registry of consecutive 82 patients in Taipei Medical University Hospital. The reperfusion rate and the functional outcome were compared in patients who received first-line therapy only and patients who need rescue therapy.Results: An 84.1% reperfusion rate was achieved in our cohort. We applied first-line stent retriever (SR) treatment in 6 patients, among which 4 (66.6%) achieved successful reperfusion. We applied a direct-aspiration first-pass technique (ADAPT) as the first-line treatment in 76 patients, among which 46 (60.5%) achieved successful reperfusion. Successful reperfusion could not be achieved in 30 cases (39.5%); therefore, we applied a second-line rescue SR for 28 patients, and reperfusion was established in 18 (64.3%) of them. These results revealed that the LVO in anterior circulation has a higher chance to respond to SR rescue therapy than posterior circulation lesions (68 vs. 33.3%, P < 0.001). Patients who received only first-line therapy exhibited significantly better functional outcomes than those who were also treated with rescue SR therapy (41.2 vs. 16.7%, P = 0.001). In addition, patients with LVO in the anterior circulation were found to have a higher probability of achieving functional independence than patients with posterior circulation lesions (10.7 vs. 0.0%, P < 0.001). The adjusted multivariate analysis revealed that successful reperfusion and treatment type (first-line or rescue therapy) were significantly related to a modified Rankin Scale (mRS) score at 90 days.Conclusion: This study reveals that rescue SR therapy improves the reperfusion rate. Patients who require rescue SR therapy have a lower likelihood of functional independence. LVO in the anterior circulation responds better to rescue SR therapy and results in better functional outcomes than posterior circulation lesions.

Download Full-text