CTP-Based Tissue Outcome: Promising Tool to Prove the Beneficial Effect of Mechanical Recanalization in Acute Ischemic Stroke

Though obesity is generally associated with the development of cardiovascular disease (CVD) risk factors, previous reports have also reported that obesity has a beneficial effect on CVD outcomes. We aimed to verify the existing obesity paradox through binary logistic regression (BLR) and clarify the paradox via association rule mining (ARM). Patients with acute ischemic stroke (AIS) were assessed for their 3-month functional outcome using the modified Rankin Scale (mRS) score. Predictors for poor outcome (mRS 3–6) were analyzed through BLR, and ARM was performed to find out which combination of risk factors was concurrently associated with good outcomes using maximal support, confidence, and lift values. Among 2580 patients with AIS, being obese (OR [odds ratio], 0.78; 95% CI, 0.62–0.99) had beneficial effects on the outcome at 3 months in BLR analysis. In addition, the ARM algorithm showed obese patients with good outcomes were also associated with an age less than 55 years and mild stroke severity. While BLR analysis showed a beneficial effect of obesity on stroke outcome, in ARM analysis, obese patients had a relatively good combination of risk factor profiles compared to normal BMI patients. These results may partially explain the obesity paradox phenomenon in AIS patients.

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Preventing vessel perforations in endovascular thrombectomy: feasibility and safety of passing the clot with a microcatheter without microwire: the wireless microcatheter technique

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014267 ◽

2018 ◽

Vol 11 (7) ◽

pp. 653-658 ◽

Cited By ~ 7

Author(s):

Annika Keulers ◽

Omid Nikoubashman ◽

Anastasios Mpotsaris ◽

Scott D Wilson ◽

Martin Wiesmann

Keyword(s):

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Acute Ischemic Stroke ◽

Complication Rates ◽

Anterior Circulation ◽

Contrast Extravasation ◽

Endovascular Thrombectomy ◽

Mechanical Recanalization ◽

Video Recordings ◽

Interventional Ct

BackgroundTo place a stent retriever for thrombectomy in acute ischemic stroke, the clot has to be passed first. A microwire is usually used for this maneuver. As an alternative, a wireless microcatheter can be used to pass the clot.ObjectiveTo analyze the feasibility and complication rates of passing the clot using either a microwire or a wireless microcatheter.MethodsA retrospective non-randomized analysis of 110 consecutive patients with acute ischemic stroke in the anterior circulation was performed, in whom video recordings of mechanical thrombectomies were available. In total, 203 attempts at mechanical recanalization were performed.ResultsSuccessful recanalization (TICI 2b–3) was achieved in 97.3% of patients. In 71.8% of attempts the clot was successfully passed using a wireless microcatheter only. When a microwire was used initially, clot passage was successful in 95.3% of attempts. Complication rates for angiographically detectable subarachnoid hemorrhage were 6.1% when a microwire was used to pass the clot compared with 0% when a wireless microcatheter was used (p<0.001). Complication rates for angiographically occult circumscribed subarachnoid contrast extravasation observed on post-interventional CT scans were 18.2% when a microwire was used to pass the clot and 4.5% when a wireless microcatheter was used (p<0.001).ConclusionsIn most cases of mechanical recanalization the clot can be passed with a wireless microcatheter instead of a microwire. In our study this method significantly reduced the risk for vessel perforation and subarachnoid hemorrhage. We therefore recommend the use of this technique whenever possible.

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Mechanical Recanalization With Flow Restoration in Acute Ischemic Stroke

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2012.11.013 ◽

2013 ◽

Vol 6 (4) ◽

pp. 386-391 ◽

Cited By ~ 14

Author(s):

Christian Roth ◽

Wolfgang Reith ◽

Silke Walter ◽

Stefanie Behnke ◽

Michael Kettner ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Recanalization ◽

Flow Restoration

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Successful Utilization of Mechanical Thrombectomy in a Presentation of Pediatric Acute Ischemic Stroke

Case Reports in Pediatrics ◽

10.1155/2018/5378247 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Esther S. Kim ◽

Erica K. Mason ◽

Andrew Koons ◽

Shawn M. Quinn ◽

Robert L. Williams

Keyword(s):

Emergency Department ◽

Interventional Radiology ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Pediatric Population ◽

Acute Onset ◽

Mechanical Recanalization ◽

Clot Removal

Guidelines regarding the management of acute ischemic stroke (AIS) in the pediatric population using mechanical recanalization procedures are lacking. We present a case of a 14-year-old male diagnosed in the Emergency Department with an acute onset stroke who underwent successful mechanical clot removal by interventional radiology.

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Evidence for a Beneficial Effect of Oral N-acetylcysteine on Functional Outcomes and Inflammatory Biomarkers in Patients with Acute Ischemic Stroke

Neuropsychiatric Disease and Treatment ◽

10.2147/ndt.s241497 ◽

2020 ◽

Vol Volume 16 ◽

pp. 1265-1278

Author(s):

Maryam Sabetghadam ◽

Mehrdokht Mazdeh ◽

Parnaz Abolfathi ◽

Younes Mohammadi ◽

Maryam Mehrpooya

Keyword(s):

Ischemic Stroke ◽

Beneficial Effect ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Inflammatory Biomarkers

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Faculty Opinions recommendation of Worse endovascular mechanical recanalization results for patients with in-hospital onset acute ischemic stroke.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733885970.793551199 ◽

2018 ◽

Author(s):

David Liebeskind

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Recanalization

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Extended preclinical investigation of lactate for neuroprotection after ischemic stroke

Clinical and Translational Neuroscience ◽

10.1177/2514183x20904571 ◽

2020 ◽

Vol 4 (1) ◽

pp. 2514183X2090457 ◽

Cited By ~ 1

Author(s):

Lara Buscemi ◽

Camille Blochet ◽

Melanie Price ◽

Pierre J Magistretti ◽

Hongxia Lei ◽

...

Keyword(s):

Ischemic Stroke ◽

Beneficial Effect ◽

Acute Ischemic Stroke ◽

Ischemia Reperfusion ◽

Combined Treatment ◽

Recombinant Tissue Plasminogen Activator ◽

Lesion Size ◽

Positive Influence ◽

Artery Occlusion

Lactate has been shown to have beneficial effect both in experimental ischemia–reperfusion models and in human acute brain injury patients. To further investigate lactate’s neuroprotective action in experimental in vivo ischemic stroke models prior to its use in clinics, we tested (1) the outcome of lactate administration on permanent ischemia and (2) its compatibility with the only currently approved drug for the treatment of acute ischemic stroke, recombinant tissue plasminogen activator (rtPA), after ischemia–reperfusion. We intravenously injected mice with 1 µmol/g sodium l-lactate 1 h or 3 h after permanent middle cerebral artery occlusion (MCAO) and looked at its effect 24 h later. We show a beneficial effect of lactate when administered 1 h after ischemia onset, reducing the lesion size and improving neurological outcome. The weaker effect observed at 3 h could be due to differences in the metabolic profiles related to damage progression. Next, we administered 0.9 mg/kg of intravenous (iv) rtPA, followed by intracerebroventricular injection of 2 µL of 100 mmol/L sodium l-lactate to treat mice subjected to 35-min transient MCAO and compared the outcome (lesion size and behavior) of the combined treatment with that of single treatments. The administration of lactate after rtPA has positive influence on the functional outcome and attenuates the deleterious effects of rtPA, although not as strongly as lactate administered alone. The present work gives a lead for patient selection in future clinical studies of treatment with inexpensive and commonly available lactate in acute ischemic stroke, namely patients not treated with rtPA but mechanical thrombectomy alone or patients without recanalization therapy.

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