scholarly journals An older thrombus delays reperfusion after mechanical thrombectomy for ischemic stroke

2021 ◽  
Author(s):  
Takaya Kitano ◽  
Yumiko Hori ◽  
Shuhei Okazaki ◽  
Yuki Shimada ◽  
Takanori Iwamoto ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcomes ◽  
Endovascular Procedures ◽  
Mechanical Thrombectomy ◽  
Patient Characteristics ◽  
Reperfusion Therapy ◽  
Neutrophil Extracellular Trap ◽  
Time Analysis ◽  
Restricted Mean Survival Time ◽  
Quality And Outcomes

Background: Thrombosis is a dynamic process, and a thrombus undergoes physical and biochemical changes that may alter its response to reperfusion therapy. This study assessed whether thrombus age influenced reperfusion quality and outcomes after mechanical thrombectomy for cerebral embolism. Methods: We retrospectively evaluated 185 stroke patients and thrombi that were collected during mechanical thrombectomy at three stroke centers. Thrombi were pathologically classified as fresh or older based on their granulocytes’ nuclear morphology and organization. Thrombus components were quantified, and the extent of NETosis (the process of neutrophil extracellular trap formation) was assessed using the density of citrullinated histone H3-positive cells. Baseline patient characteristics, thrombus features, endovascular procedures, and functional outcomes were compared according to thrombus age. Results: Fresh thrombi were acquired from 43 patients, and older thrombi were acquired from 142 patients. Older thrombi had a lower erythrocyte content (P<0.001) and higher extent of NETosis (P=0.006). Restricted mean survival time analysis revealed that older thrombi were associated with longer puncture-to-reperfusion times (difference: 15.6 minutes longer for older thrombi, P=0.002). This association remained significant even after adjustment for erythrocyte content and the extent of NETosis (adjusted difference: 10.8 min, 95% CI: 0.6–21.1 min, P=0.039). Compared with fresh thrombi, older thrombi required more device passes before reperfusion (P<0.001) and were associated with poorer functional outcomes (adjusted common OR: 0.49, 95% CI: 0.24–0.99). Conclusions: An older thrombus delays reperfusion after mechanical thrombectomy for ischemic stroke. Adding therapies targeting thrombus maturation may improve the efficacy of mechanical thrombectomy.

Abstract WP46: Patient Characteristics, Quality and Outcomes After Endovascular Therapy for In-Hospital Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Feras Akbik ◽  
Haolin Xu ◽  
Ying Xian ◽  
Shreyansh Shah ◽  
Eric E Smith ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Therapy ◽  
Functional Outcomes ◽  
Patient Characteristics ◽  
National Registry ◽  
Arterial Puncture ◽  
Process Measures ◽  
Logistic Regression Models ◽  
Quality And Outcomes ◽  
Community Onset

Introduction: A significant number of acute ischemic strokes occur while patients are hospitalized for other reasons. No national data have been reported on endovascular therapy (EVT) for in-hospital onset stroke. Here we compare the patient characteristics, process measures of quality, and outcomes for in-hospital onset vs. community-onset of strokes in a large US national registry. Methods: We performed a retrospective cohort study of Get With The Guidelines-Stroke (GTWG-Stroke) from January 2008 to June 2018 from 2,333 participating sites that included 2,428,178 patients with acute ischemic stroke. Among 67,493 in-hospital onset strokes, 2494 (3.7%) underwent EVT. We examined the association between key patient characteristics (in-hospital onset, demographics, comorbidities, treatment with EVT) and functional outcomes using multivariable logistic regression models. Results: The rate of EVT increased from 2.5% in 2008 to 6.4% in 2018 (p<0.001), with a significant and sustained increase in EVT after the second quarter of 2015 (p<0.0001). Compared with patients with community-onset strokes, patients with in-hospital onset stroke had longer times to cranial imaging and arterial puncture but similar median NIHSS (16 (9 - 21) vs. 16 (10 - 21) Std Diff 1.9). Patients with in-hospital onset stroke were less likely to undergo EVT within 120 mins of symptom recognition, have symptomatic intracranial hemorrhage, or ambulate independently at discharge. They were more likely to die or be discharged to hospice. Conclusions: Though use of EVT in GWTG-Stroke for in-hospital stroke remains low, it more than doubled in the past decade. Compared with community onset stroke, these patients have longer intervals to CT and arterial puncture, with associated worse functional outcomes. While there may be important differences in baseline patient characteristics between the groups, efforts must still be made to shorten time to reperfusion for in-hospital strokes.

Safety and efficacy of mechanical thrombectomy in acute ischemic stroke of anticoagulated patients

2018 ◽  
Vol 10 (12) ◽  
pp. e29-e29 ◽  
Author(s):  
Vincent L’Allinec ◽  
Marielle Ernst ◽  
Mathieu Sevin-Allouet ◽  
Nathalie Testard ◽  
Béatrice Delasalle-Guyomarch ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Mechanical Thrombectomy ◽  
Univariate Analysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Reperfusion Therapy ◽  
Safety And Efficacy ◽  
Risk Of Death ◽  
Anticoagulated Patients

BackgroundAnticoagulated patients (APs) are currently excluded from acute ischemic stroke reperfusion therapy with intravenous recombinant tissue plasminogen activator (IV-rtPA); however, these patients could benefit from mechanical thrombectomy (MT). Evidence for MT in this condition remains scarce. The aim of this study was to analyze the safety and efficacy of MT in APs.MethodsWe analyzed three patient groups from two prospective registries: APs with MT (AP-MT group), non-anticoagulated patients treated with MT (NAP-MT group), and non-anticoagulated patients treated with IV-rtPA and MT (NAP-IVTMT group). Univariate and multivariate logistic regression were used to evaluate treatment efficacy with modified Rankin Scale (mRS) ≤2 and safety (radiologic intracranial hemorrhage (rICH), symptomatic intracranial hemorrhage (sICH) and death rate at 3 months) between groups.Results333 patients were included in the study, with 44 (12%) in the AP-MT group, 105 (31%) in the NAP-MT group, and 188 (57%) in the NAP-IVTMT group. Univariate analysis showed that the AP-MT group was older (P<0.001), more often had atrial fibrillation (P<0001), and had a higher ASPECTS (P<0.006 and P<0.002) compared with the NAP-MT group and NAP-IVTMT groups, respectively. Multivariate analysis showed that the AP-MT group had a lower risk of rICH (OR 2.77, 95% CI 1.01 to 7.61, P=0.05) but a higher risk of death at 3 months (OR 0.26, 95% CI 0.09 to 0.76, P=0.01) compared with the NAP-IVTMT group. No difference was found between the AP-MT and NAP-MT groups.ConclusionsWith regard to intracranial bleeding and functional outcome at 3 months, MT in APs seems as safe and efficient as in NAPs. However, there is a higher risk of death at 3 months in the AP-MT group compared with the NAP-IVTMT group.

Association between acute ischemic stroke etiology and macroscopic aspect of retrieved clots: is a clot’s color a warning light for underlying pathologies?

2019 ◽  
Vol 11 (12) ◽  
pp. 1197-1200 ◽  
Author(s):  
Alessandro Sgreccia ◽  
Zoé Duchmann ◽  
Jean Philippe Desilles ◽  
Bertrand Lapergue ◽  
Julien Labreuche ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Infective Endocarditis ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Patient Characteristics ◽  
Study Groups ◽  
Double Blind ◽  
Stroke Etiology

BackgroundFew case reports have considered the chromatic aspect of retrieved clots and the possible association with their underlying etiology.ObjectiveThe aim of our study was to analyze the frequency of the TOAST ischemic stroke typical (atrial fibrillation, dissection, atheroma) and atypical (infective endocarditis, cancer-related, valve-related thrombi) etiologies depending on the chromatic aspect of retrieved clots.MethodsA total of 255 anonymized and standardized clot photos of consecutive patients treated by mechanical thrombectomy for acute ischemic stroke were included. A double-blind evaluation was performed by two senior interventional neuroradiologists, who classified the visual aspects of the clots into two main patterns: red/black or white. Main patient characteristics, distribution of underlying stroke etiologies, and outcomes were compared between the two study groups.ResultsThe inter-reader agreement for clot colors was excellent (k=0.78). Two hundred and thirty-three patients were classified as having red/black clots and 22 as having white clots. A statistically significant association (p=0.001) between atypical etiologies and white clots was observed.ConclusionsWhite clots were significantly associated with atypical etiologies in this cohort,in particular, with infectious endocarditis.

scholarly journals Reperfusion Therapy Frequency and Outcomes in Mild Ischemic Stroke in the United States

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3241-3249 ◽  
Author(s):  
Hamidreza Saber ◽  
Kasra Khatibi ◽  
Viktor Szeder ◽  
Satoshi Tateshima ◽  
Geoffrey P. Colby ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Odds Ratio ◽  
Mechanical Thrombectomy ◽  
Reperfusion Therapy ◽  
Interquartile Range ◽  
Nihss Score ◽  
Discharge Disposition ◽  
Younger Age

Background and Purpose: More than half of patients with acute ischemic stroke have minor neurological deficits; however, the frequency and outcomes of reperfusion therapy in regular practice has not been well-delineated. Methods: Analysis of US National Inpatient Sample of hospitalizations with acute ischemic stroke and mild deficits (National Institutes of Health Stroke Scale [NIHSS] score 0–5) from October 1, 2016, to December 31, 2017. Patient- and hospital-level characteristics associated with use and outcome of reperfusion therapies were analyzed. Primary outcomes included excellent discharge disposition (discharge to home without assistance); poor discharge disposition (discharge to facility or death); in-hospital mortality; and radiological intracranial hemorrhage. Results: Among 179 710 acute ischemic stroke admissions with recorded NIHSS during the 15-month study period, 103 765 (57.7%) had mild strokes (47.3% women; median age, 69 [interquartile range, 59–79] years; median NIHSS score of 2 [interquartile range, 1–4]). Considering reperfusion therapies among strokes with documented NIHSS, mild deficit hospitalizations accounted for 40.0% of IVT and 10.7% of mechanical thrombectomy procedures. Characteristics associated with IVT and with mechanical thrombectomy utilization were younger age, absence of diabetes, higher NIHSS score, larger/teaching hospital status, and Western US region. Excellent discharge outcome occurred in 48.2% of all mild strokes, and in multivariable analysis, was associated with younger age, male sex, White race, lower NIHSS score, absence of diabetes, heart failure, and kidney disease, and IVT use. IVT was associated with increased likelihood of excellent outcome (odds ratio, 1.90 [95% CI, 1.71–2.13], P <0.001) despite an increased risk of intracranial hemorrhage (odds ratio, 1.41 [95% CI, 1.09–1.83], P <0.001). Conclusions: In national US practice, more than one-half of acute ischemic stroke hospitalizations had mild deficits, accounting for 4 of every 10 IVT and 1 of every 10 mechanical thrombectomy treatments, and IVT use was associated with increased discharge to home despite increased intracranial hemorrhage.

Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit

2018 ◽  
Vol 42 (5) ◽  
pp. 274-282
Author(s):  
L. Viña Soria ◽  
L. Martín Iglesias ◽  
L. López Amor ◽  
I. Astola Hidalgo ◽  
R. Rodríguez García ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Stroke Patients

scholarly journals The Impact of Age on Mortality and Disability in Patients With Ischemic Stroke Who Underwent Cerebral Reperfusion Therapy: A Brazilian Cohort Study

2021 ◽  
Vol 13 ◽  
Author(s):  
Natália Eduarda Furlan ◽  
Gustavo José Luvizutto ◽  
Pedro Tadao Hamamoto Filho ◽  
Silméia Garcia Zanati Bazan ◽  
Gabriel Pinheiro Modolo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Hospital Discharge ◽  
Functional Disability ◽  
Mechanical Thrombectomy ◽  
Reperfusion Therapy ◽  
Secondary Outcome ◽  
Stroke Treatment ◽  
Cerebral Reperfusion ◽  
The Impact

Introduction: The main driver for increased stroke prevalence is the aging of the population; however, the best evidenced-based strategies for stroke treatment and prevention are not always followed for older patients. Therefore, the aim was studying the association of age with clinical outcomes (mortality and functional disability) in stroke patients who underwent cerebral reperfusion therapy at hospital discharge and 90 days after ictus.Methods: This was a retrospective (stroke databank analysis) cohort study of participants who had been diagnosed with ischemic stroke and undergone intravenous cerebral reperfusion therapy or mechanical thrombectomy. The variable of interest was patient age, which was categorized into four groups: (1) up to 59 years; (2) 60 to 69 years; (3) 70 to 79 years old; and (4) above 79 years. The primary outcome was mortality at hospital discharge and 90 days after stroke, and the secondary outcome was functional capacity at hospital discharge and 90 days after stroke.Results: A total of 281 patients was included in the study (235 treated by thrombolysis alone, and 46 treated with mechanical thrombectomy). The mean age of the total sample was 67 ± 13.1 years. The oldest patients had the most unfavorable outcomes, except for mortality rate, at hospital discharge (mRS &gt; 2; OR: 1.028; 95% CI 1.005 to 1.051; p = 0.017; mRS &gt; 3; OR: 1.043, 95% CI 1.018 to 1.069; p = 0.001) and 90 days after stroke (mRS &gt; 2; OR: 1.028; 95% CI 1.005 to 1.051; p = 0.017; mRS &gt; 3; OR: 1.043, 95% CI 1.018 to 1.069; p = 0.001).Conclusion: Cerebral reperfusion was a viable treatment for ischemic stroke in both elderly and very elderly patients, as it did not increase mortality. However, it was observed that older individuals had worse functional outcomes at hospital discharge and 90 days after stroke.

Differential effect of mechanical thrombectomy and intravenous thrombolysis in atrial fibrillation associated stroke

2020 ◽  
pp. neurintsurg-2020-016720
Author(s):  
Feras Akbik ◽  
Ali Alawieh ◽  
C Michael Cawley ◽  
Brian M Howard ◽  
Frank C Tong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Intracranial Hemorrhage ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Anterior Circulation ◽  
Increased Risk ◽  
First Pass

BackgroundAtrial fibrillation (AF) associated ischemic stroke has worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Limited data exist about the effect of AF on procedural and clinical outcomes after mechanical thrombectomy (MT).ObjectiveTo determine whether recanalization efficacy, procedural speed, and clinical outcomes differ in AF associated stroke treated with MT.MethodsWe performed a retrospective cohort study of the Stroke Thrombectomy and Aneurysm Registry (STAR) from January 2015 to December 2018 and identified 4169 patients who underwent MT for an anterior circulation stroke, 1517 (36.4 %) of whom had comorbid AF. Prospectively defined baseline characteristics, procedural outcomes, and clinical outcomes were reported and compared.ResultsAF predicted faster procedural times, fewer passes, and higher rates of first pass success on multivariate analysis (p<0.01). AF had no effect on intracranial hemorrhage (aOR 0.69, 95% CI 0.43 to 1.12) or 90-day functional outcomes (aOR 1.17, 95% CI 0.91 to 1.50) after MT, although patients with AF were less likely to receive IVT (46% vs 54%, p<0.0001).ConclusionsIn patients treated with MT, comorbid AF is associated with faster procedural time, fewer passes, and increased rates of first pass success without increased risk of intracranial hemorrhage or worse functional outcomes. These results are in contrast to the increased hemorrhage rates and worse functional outcomes observed in AF associated stroke treated with supportive care and or IVT. These data suggest that MT negates the AF penalty in ischemic stroke.

scholarly journals Association between low-density cholesterol change and outcomes in acute ischemic stroke patients who underwent reperfusion therapy

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ting Cui ◽  
Changyi Wang ◽  
Qiange Zhu ◽  
Anmo Wang ◽  
Xuening Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Reperfusion Therapy ◽  
Low Density ◽  
Poor Functional Outcome ◽  
Lower Tertile

Abstract Background Low-density lipoprotein cholesterol (LDL-C) can increase cardiovascular risk. However, the association between LDL-C change and functional outcomes in acute ischemic stroke (AIS) patients who underwent reperfusion therapy remains unclear. Methods Patients who received reperfusion therapy were consecutively enrolled. LDL-C measurement was conducted at the emergency department immediately after admission and during hospitalization. The change of LDL-C level (ΔLDL-C) was calculated by subtracting the lowest LDL-C among all measurements during hospitalization from the admission LDL-C. Poor functional outcome was defined as modified Rankin Scale (mRS) > 2 at 90 days. Results A total of 432 patients were enrolled (mean age 69.2 ± 13.5 years, 54.6 % males). The mean LDL-C level at admission was 2.55 ± 0.93 mmol/L. The median ΔLDL-C level was 0.43 mmol/L (IQR 0.08–0.94 mmol/L). A total of 263 (60.9 %) patients had poor functional outcomes at 90 days. There was no significant association between admission LDL-C level and functional outcome (OR 0.99, 95 % CI 0.77–1.27, p = 0.904). ΔLDL-C level was positively associated with poor functional outcome (OR 1.80, 95 % CI 1,12-2.91, p = 0.016). When patients were divided into tertiles according to ΔLDL-C, those in the upper tertile (T3, 0.80–3.98 mmol/L) were positively associated with poor functional outcomes compared to patients in the lower tertile (T1, -0.91-0.13 mmol/L) (OR 2.56, 95 % CI 1.22–5.36, p = 0.013). The risk of poor functional outcome increased significantly with ΔLDL-C tertile (P-trend = 0.010). Conclusions In AIS patients who underwent reperfusion therapy, the decrease in LDL-C level during hospitalization was significantly associated with poor functional outcomes at 90 days.

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