Angiographic Outcome of Endovascular Stroke Therapy Correlated with MR Findings, Infarct Growth, and Clinical Outcome in the DEFUSE 2 Trial

Introduction: Few reports have compared the commonly used technical approaches of stentriever, suction thrombectomy, and combined technique, particularly with emphasis on thrombus volume, fragmentation, distal embolization, and clinical outcome. Methods: Medical records and radiographic images of patients undergoing endovascular stroke therapy at our institution between 2014 and 2015 were reviewed for the following data points: Patient age, sex, NIH stroke scale (NIHSS) at presentation, number of passes, presence of distal embolization on angiography, TICI score, and Modified Rankin Scale (MRS) at discharge. When available, photographic images of the retrieved thrombus were analyzed for number of fragments and size of the largest fragment. Parameters were compared for the three thrombectomy techniques of suction (ADAPT technique), stentriever, and the combined approach. Results: Of 63 patients receiving endovascular stroke therapy, 47 (75%) underwent mechanical thrombectomy: Stentriever 17 (36%), Suction 18 (38%), and combined 12 (26%). Average age and presenting NIH stroke scales were similar in the groups. A single pass thrombectomy was more common in the suction group (72%) than in the stentriever (29%) and combined groups (8%). There were more thrombus fragments in the stentriever (2.3) and combined groups (3.4) than in the suction group (1.4), correlating to more frequent distal embolization (suction 22%, stentriever 70%, combined 50%). The retrieved thrombus was largest in the suction group (12.9 mm; stentriever 6.6 mm; combined 10.4 mm). Overall outcome at discharge was better in the suction group (61% MRS 0-2) than in the stentriever (35%) and combined groups (17%). Conclusions: In our patient sample suction thrombectomy outperformed the stentriever and combined techniques in the categories of achieved reperfusion grade, single pass, retrieved thrombus size, number of fragments, distal embolization and clinical outcome. While stent retriever and suction thrombetomy were used as primary approaches, the combined technique was commonly utilized as a rescue attempt once the primary approach had failed, constituting a potential limitation of the analysis in this category.

Download Full-text

O-001 Pre-treatment CTA ASPECTS as a predictor of clinical outcome in endovascular stroke therapy (EVT): results from the penumbra START trial

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2012-010455a.1 ◽

2012 ◽

Vol 4 (Suppl 1) ◽

pp. A1.1-A1 ◽

Cited By ~ 1

Author(s):

D Frei ◽

A Yoo ◽

D Heck ◽

F Hellinger ◽

V McCollom ◽

...

Keyword(s):

Clinical Outcome ◽

Stroke Therapy ◽

Pre Treatment ◽

Start Trial ◽

Endovascular Stroke Therapy

Download Full-text

Abstract TMP7: Endovascular Stroke Therapy Abrogates Sex-Related Differences in Recanalization in Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tmp7 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sunil A Sheth ◽

Steven Warach ◽

Jan Gralla ◽

Reza Jahan ◽

Mayank Goyal ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Functional Independence ◽

Stent Retriever ◽

Stroke Therapy ◽

Procedural Time ◽

History Of ◽

Sex Disparities ◽

The Impact ◽

Endovascular Stroke Therapy

Background: Ischemic stroke affects women differently than men. Prior studies evaluating recanalization treatment with IV tpA showed that while women are more likely to achieve recanalization, there are strong sex disparities with respect to clinical outcome. We evaluated the effect of endovascular stroke therapy (ET) on recanalization and outcomes in women versus men. Methods: In the combined databases of the SWIFT, STAR, and SWIFT-PRIME trials, we identified patients treated with the Solitaire stent retriever to determine the effects of sex on recanalization and clinical outcome. Results: Among 389 patients treated with ET, mean age was 67±13, 55% were female, and median National Institutes of Health Stroke Scale (NIHSS) score was 17 [8-28]. There were no differences between females vs. males in presentation NIHSS (17 vs. 17, p=0.21), occlusion location (69% vs. 64% M1, p=0.62), or ASPECTS score (9 vs. 8, p=0.24). Rates of successful TICI 2b/3 recanalization were nearly identical (87% vs. 83%, p=0.374). There were no differences in onset to recanalization time (OTR) (277 vs. 306, p=0.46), procedural time (44 vs. 48 minutes, p=0.23), number of stent-retriever passes (1.7 vs. 1.8, p=0.17), rate of PH2 hemorrhage (1.9% vs. 1.1%, p=0.70), or functional independence at 90 days (53% vs. 56%, p=0.54). In ordinal multivariate analysis, collateral grade (OR 1.4, p=0.007) but not sex, age, or history of atrial fibrillation predicted improved TICI recanalization. In logistic (Figure) and ordinal regression analysis, the impact of delayed OTR was no different between men and women (1% versus 1.2% likelihood of worsened mRS outcome per 5 minute delay, p=0.27). Conclusions: In our prospective multicenter randomized cohort of nearly 400 patients undergoing ET, presentation and treatment characteristics of women were similar to men. Women were equally likely to achieve successful recanalization and good clinical outcomes.

Download Full-text

Abstract WP57: Perfusion Angiography Improves Clinical Outcomes Prediction in Endovascular Stroke Therapy

Stroke ◽

10.1161/str.48.suppl_1.wp57 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sunil A Sheth ◽

Julius Weng ◽

Priscilla McElhinney ◽

Benjamin Quachtran ◽

David S Liebeskind ◽

...

Keyword(s):

Clinical Outcome ◽

Predictive Power ◽

Important Determinant ◽

Treatment Success ◽

Regions Of Interest ◽

Modified Rankin Scale ◽

Stroke Therapy ◽

Post Intervention ◽

Quantitative Changes ◽

Endovascular Stroke Therapy

Background: Successful reperfusion is a key determinant of outcome in endovascular stroke therapy (ET). However, present methods of grading treatment success using the Thrombolysis in Cerebral Infarction (TICI) scale fail to measure quantitative changes in cerebral blood flow and volume (CBF and CBV) and as such, may not fully represent treatment effect. Methods: From our prospectively maintained institutional registry, we identified patients treated with ET between February 2014 and May 2016. CBF and CBV maps were calculated automatically for both AP and Lateral projections and regions of interest (ROIs) were drawn by two experienced neuroimagers over the middle cerebral artery territories. Delta CBF and CBV scores were determined by subtracting pre- from post-intervention maps and averaging over the ROIs. Non-linear regression was used to calculate correlations against clinical outcome (modified Rankin scale at discharge). Results: Among 104 patients treated with ET, average age was 70, 50% were female, and median presentation NIHSS was 16 (IQR 10-19). Target occlusion location was ICA in 14%, M1 in 67%, and M2 in 18%. TICI scores ranged from 0 (4%), 1 (13%), 2a (2%), 2b (22%), 3 (58%). Relative increases in CBF and CBV ranged from 0.4-17% (CBF) and 0.3-14% (CBV). Delta CBF and CBV maps correlated well with angiographic TICI (CBF p<0.05, CBV p<0.05). TICI alone did not correlate significantly with outcome (r=0.24, p=0.14). However, including delta CBF and CBV with TICI resulted in a stronger correlation (r=0.37, p<0.05) against outcome. Conclusions: TICI is an important determinant of outcome in EST. The incorporation of perfusion angiography measurements (CBF and CBV) improves the predictive power of angiography for clinical outcome.

Download Full-text